INFRASTRUCTURE Building design should
emphasise creating safe, therapeutic and efficient
environments that cater to the diverse needs of both patients and staff.
Tom Howells
Tom Howells is a director and National Healthcare lead at Pulse Consult, where he drives delivery across healthcare capital programmes and critical infrastructure schemes. With cross-sector experience spanning healthcare education, manufacturing and residential, Tom brings strategic insight and operational rigour to healthcare environments. He has led multimillion- pound projects for Trusts and Integrated Care Boards across the UK, specialising in stakeholder engagement, live environment delivery and whole-estate resilience planning. Tom is professionally trained in project management and has been instrumental in Pulse achieving ISO 9001/14001 and Investors in People Gold. Now focused solely
on healthcare, Tom has recently transitioned from his role as director overseeing Pulse’s East Midlands hub - delivering over £2.5 m in turnover and managing a 20+ strong team. He is passionate about designing fit-for-purpose healthcare infrastructure that supports NHS staff and improves patient outcomes.
Just as importantly, they bring sector-specific
knowledge. They know where projects go wrong, and how to avoid those pitfalls. From regulatory permits to innovative design solutions, their input can help Trusts balance risk, cost and care priorities more effectively. Their expertise ensures that works in live environments strengthen, rather than compromise, the long-term resilience of healthcare facilities.
Governance, compliance and value Design governance in healthcare is often misunderstood as red tape, when, in reality, it’s one of the most powerful tools for protecting both patient safety and programme budgets. Without firm control over scope, standards and change, projects can quickly spiral, either through avoidable costs or through designs that fail to support care delivery. Strong governance is therefore not an administrative burden, but a critical foundation for resilient estate planning. Critically, value must be measured through outcomes, not just cost per square metre. A facility that’s cheap to build but inefficient to operate, or clinically unfit, doesn’t offer true value. The focus should always be on how space performs – for staff, patients and future demand. Compliance plays a huge role here. Health Technical
Memoranda (HTMs) and Health Building Notes (HBNs) should not be seen as guidelines to interpret – they are non-negotiable standards that define what good looks like in the NHS. They cover every aspect of healthcare design and engineering, from ventilation and water safety to room sizes and clinical flows. Adhering to these from the outset reduces the risk of costly redesigns, delays and safety breaches. Robust governance frameworks should be in place to manage design evolution and mitigate scope change. This includes clear roles and responsibilities at each RIBA stage, appropriate reporting structures and formal change control processes to manage adjustments. Ensuring decisions are evidence-based and clinically informed keeps projects aligned with core objectives. In doing so, governance frameworks safeguard both the immediate functionality of facilities and their capacity to serve future generations, a cornerstone of resilience. Ultimately, good governance ensures the NHS gets
what it actually needs – not just what’s affordable or deliverable in the short term.
162 Health Estate Journal October 2025
At its heart, infrastructure isn’t about buildings – it’s about people. The clinicians pulling back-to-back shifts. The porters navigating corridors at 3am. The patients relying on a clean, safe and welcoming space during some of the most vulnerable moments of their lives. The physical environment plays a central role in both care quality and staff wellbeing. Intuitive, well-designed spaces don’t just streamline clinical delivery, they make staff feel supported, respected and safe. That can have a direct impact on retention, morale and patient outcomes. By involving clinicians in the design process, we can create environments that reflect how care is actually delivered. Their insight ensures layouts are logical, workflows are intuitive, and patient safety is prioritised at every touchpoint. Involving staff directly in planning ensures that resilience is built into every corridor, ward and workspace – not as an abstract concept, but as a lived reality.
Sustainability also can’t be left behind. NHS
infrastructure must support Net Zero goals as well as operational performance. From insulation and materials to energy systems and renewables, sustainable design isn’t just a climate necessity, it’s an economic one. Smarter buildings cost less to run and are better equipped to adapt to future needs.
Infrastructure as a strategic enabler NHS infrastructure is not background; it’s the foundation on which every clinical decision is made. Every diagnosis, treatment and recovery depends on a safe, functional and supportive environment. By treating infrastructure as a strategic enabler – not just a capital cost – we can embed resilience into the health service from the ground up. That means planning smarter. Engaging stakeholders
earlier. Designing for long-term performance rather than short-term gain, and, most of all, building with purpose. This isn’t just about bricks and budgets, it’s about building environments that enable life-saving care, support hard-working staff and stand up to future pressures. From climate resilience to digital readiness, today’s decisions shape tomorrow’s outcomes. The Spending Review offers a rare window of opportunity. Let’s use it to shape healthcare environments that are safer, smarter and ready for whatever the future brings – not just for the system, but for every person who depends on it.
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