EQUIPMENT INSTALLATION
Choices made early in design, whether informed by accurate data or shaped by outdated assumptions, will continue to influence building performance, clinical flow, and running costs long after construction has been completed.
the consequences are visible, costly, and operationally disruptive. When they go right, they are largely invisible, absorbed into a smooth handover and a facility that performs as intended from the first day of operation, with minimal need for adjustment during the early phases of clinical use. Achieving this positive outcome requires disciplined
Lifecycle future proofing For every major equipment item, the project team should identify and formally document the replacement route – meaning the physical pathway through which a future system will need to travel from the delivery point to its final installed location. Careful analysis of this route often reveals that access openings require resizing, corridor structures require reinforcement, or roof access points need to be introduced to accommodate future crane lifts. These considerations are not theoretical. They directly influence the long-term usability and adaptability of clinical spaces and can prevent significant operational disruption when equipment reaches the end of its life.
A deliberate approach to services capacity uplift should also be applied. In practice, this means designing the facility with structural, electrical, and cooling capacity that goes beyond current requirements, allowing it to seamlessly support the higher demands of future technologies as they emerge.
Colm Gaughan
Colm is a highly skilled construction professional with 20 years of experience in the UK and internationally across multiple sectors. Throughout his career, he has gained expertise in a wide range of roles, including building surveyor, party wall surveyor, land and measured building surveyor, principal contractor, and client side project manager. Colm has delivered projects with multiple stakeholders and is recognised for his clear communication style, enabling him to resolve issues methodically and maintain positive working relationships.
The project manager’s role The primary driver of better outcomes is effective project management. It is the project manager who controls the sequencing of design activities, manages interfaces between consultants, ensures that clinical stakeholders are engaged at the right times, and maintains the discipline needed to verify that critical information has been captured and acted upon. This includes raising the question of equipment technical data at the very first design team meeting, challenging structural load assumptions that rely on outdated precedent and confirming that cooling calculations are based on actual manufacturer data rather than informal rules of thumb.
It also requires project managers to have direct and
honest conversations with clients when the temptation to defer equipment decisions in the interests of maintaining a sense of programme momentum creates downstream risks that are not fully recognised. Clients who understand the genuine cost, programme, and operational implications of deferring equipment planning decisions are far more likely to invest the time and resources needed to address these issues at an early stage. The commissioning and activation phase demands the
same level of attention. A commissioning plan should be developed in parallel with the construction programme, with clear milestones, defined responsibilities, and robust contingency measures established well in advance of practical completion. This structured approach strengthens project readiness and supports a smoother transition to operational use.
Clinical equipment installations are among the most
technically demanding and risk intensive components of healthcare capital delivery. When they go wrong,
146 Health Estate Journal October 2026
and proactive project management that treats equipment planning as a core responsibility rather than an optional supporting task. It requires integration of equipment considerations into the design process from the earliest stages and a consistent level of rigour to ensure that known requirements are acted upon promptly and unknown requirements are actively identified and resolved. This approach creates a stronger foundation for both construction delivery and operational readiness.
A significant opportunity NHS Trusts, integrated care boards, and their advisers should embed explicit equipment planning standards within their project governance frameworks. These standards should define the minimum level of technical assurance that must be reached at each RIBA stage gateway and hold project teams accountable for delivering that assurance. Procurement frameworks should also be reviewed to ensure that early engagement with equipment suppliers is required, and that the cost of obtaining robust technical information is reflected within project budgets rather than treated as an optional allowance. The wider NHS capital investment programme presents a significant opportunity to adopt these practices at scale. The investment required is modest when compared with the cost of the problems it prevents, and the case for implementing these improvements is strong and well supported by evidence.
Bibliography n NHS England (2014) Health Building Note 00 01: General
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n NHS England (2001) Health Building Note 6: Designing facilities for diagnostic imaging and interventional radiology. London: NHS England.
https://www.england.nhs.uk/ publication/designing-facilities-for-diagnostic-imaging-hbn-6/
n Royal Institute of British Architects (2020) RIBA Plan of Work 2020. London: RIBA.
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n NHS England (2024) Delivering productivity through the NHS estate. London: NHS England, 8 October. https://www.
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n Medicines and Healthcare products Regulatory Agency (2021) Managing medical devices: guidance for healthcare and social services organisations. London: MHRA, January. https://www.
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