Features: September 30th, 2011

The NHS reforms will bring radical changes to the way health and care services are delivered across the country. Andy Stuart sketches out the way change will effect the built environment. He highlights the impact this will have on architects, facility managers, local authorities and contractors, as well as others concerned with the built environment.

Although the NHS Future Forum has presented its findings, and confirmed how the reforms are going to be delivered, there is still much confusion as to how they will affect the way in which health and care facilities are built, managed and maintained.

For an essential public body as old and as large as the NHS, reform is inevitable. Whilst this doesn’t mean such reforms are ever uniformly palatable, they are a fact of life and crucial if the NHS is to prosper – especially given the present economic climate.

The UK Government’s Health and Social Care Bill stands to be just as divisive as any other preceding set of reforms, and the NHS Future Forum’s recommendations seem to have engendered even greater discord in the debate. However, it appears inevitable that the amended reforms, which will now incorporate more than 16 of the Future Forum’s recommendations, will come into effect and change the face of the NHS for decades to come.

For anyone involved in building and maintaining health and care facilities, both in the private and public sector, these reforms are going to have far-reaching consequences. In conjunction with this, the sector is faced with the constant need to respond to changing patient demands and social pressure. Built environment professionals need to understand these issues if they are to implement cutting edge health and care environments. While the health sector is being affected by a range of factors, there are three key areas that the built environment needs to focus on.

Impact of Policy Reforms on Design and Construction

In a recent interview, health secretary Andrew Lansley claimed that the NHS could be facing a potential funding gap of £20 billion by 2015 with expenditure reaching £130 billion by this point#. This is despite the Government providing an additional £11.5 billion in funding. There are many reasons why NHS costs are going to rise so dramatically over the next few years, including an aging population and the corresponding increase in chronic diseases, as well as better informed patients demanding new and more expensive treatments.

To curb spiralling costs, the NHS has to make tough choices as to how resources are allocated. With cuts to front-line services, treatments and staff considered a last resort, the easier option is to cancel or postpone new facilities, and reduce the money spent on refurbishment and maintenance. However, the need for new sites remains, and it will be up to those responsible for securing these construction projects to demonstrate the value they deliver. And while the NHS has always had to face up to the problems of demand being greater than the resources available, the situation isn’t getting any easier. This is going to be a key consideration for the way in which the built environment interacts with the health sector.

Competing for care

Increasing the level of competition between different facilities, both private and public was at the heart of the healthcare reforms originally proposed by the Government. The idea was that it would result in a greater quality of care, since facilities would be forced to maintain high standards in order to attract patients. In the amendments to the reforms based on the Future Forum’s recommendations however, the competition aspect of the bill is scaled back.

Monitor, the public body originally responsible for overseeing competition in the health and care sector, will now also be responsible for promoting collaboration and integration. Encouraging competition is still recognised as a ‘tool for supporting choice, promoting integration and improving quality’#, as Steve Fields, chairman of the Future Health Forum confirmed recently. Although he argued that it should never be used ‘as an end in itself’.

Clearly, competition is becoming a bigger part of the NHS, and is something that the built environment is going to need to play a larger role in as free-market ideas gain more prominence across the health sector. This pressure is only going to get larger as patients increasingly turn to providers of private care. While patients will be judging private and public providers on waiting times and available treatments, the quality of the facilities they are visiting will also play an important part in their final decision.

On top of this, it is a simple matter of cost. In order to compete effectively, both now and in the future, sites need to deliver value for money. It is the built environment that is going to be the key facilitator in delivering cost effective and attractive facilities to help providers compete in the healthcare market.

Keeping up with the trends

In addition to the Government’s NHS reforms, the built environment sector needs to adapt to meet the challenges presented by growing social and economic trends. There are so many factors at work, it is virtually impossible to list them all, but even by skimming the surface, it is clear that the way in which health and care facilities are built and managed is going to have to change.

For example, Private Finance Initiatives, the scheme through which health trusts can outsource the cost of building and maintaining care facilities, are a constant expense for many NHS Trusts. Attempts to renegotiate monthly repayments will become more common as the NHS looks for ways to improve available resources. At the same time, there may be an increase in the number of PFI projects. New health care facilities are always going to be required, but given that the NHS won’t have the necessary resources for the foreseeable future, PFIs will offer the only viable alternative.

Contractors and architects will therefore need to reassess how the change in the NHS’ relationships with PFIs will be affected. In addition, the way in which facilities are built and maintained must adapt in response to changing health demands from the public. For example, with hospital-borne diseases like MRSA constantly in the media, the need to update existing facilities and equipment to reduce the risk of infection is paramount. And with the standards of care that patients expect from their NHS trust always under scrutiny, care providers must ensure that the facilities they provide are modern and efficient.

The built environment will therefore continue to be an integral part of the way in which care is delivered in the UK, and the health and care sector will be increasingly reliant on its ability to adapt and support it in ensuring that patient needs continue to be met.


The NHS reforms result in a state of flux within the health and care sector. Although the NHS Future Forum has presented its findings, and confirmed how the reforms are going to be delivered, there is still much confusion as to how they will affect the way in which health and care facilities are built, managed and maintained.
From architects and facility managers to local authorities and contractors, everyone involved in the health and care built environment is going to have to readdress how they serve the needs of the NHS and private sector health and care providers. Together, they must ensure that the sector remains healthy and profitable, and be able to guarantee that patient care maintains a high standard.
The process of writing the amended Health and Social Care Bill into law will take some time. Even with additional amends being introduced, the built environment clearly needs to scrutinise the changes and make adequate provisions for adapting to the changing landscape.

The changes set to sweep the health and care industry are going to be far reaching, and for those involved in the built environment, it is vital to understand exactly how the reforms affect them.

About Future Health & Care Expo

Organised by UBM Built Environment, Future Health & Care Expo is the must-attend free exhibition and conference for anyone involved in building and maintaining health and care facilities. Spread over two whole days, the show will include over 100 of the leading companies in the health and care construction and maintenance sector, including Balfour Beatty Healthcare, BAM, Graham Construction and Facilities Management, Anshen + Allen and MedicX. The show will bring together stakeholders and industry leaders in this rapidly developing sector, providing a wealth of networking opportunities and allowing attendees to keep up-to-date with new industry innovation. The parallel conference will feature keynote speeches delivered by senior industry figures, as well as a modular conference programme delivering in-depth discussions on a range of topics. Future Health & Care Expo will take place 3-4 October 2011 at the Business Design Centre, London; for more information please visit: www.futurehealthexpo.com. UBM Built Environment is part of UBM plc (www.ubm.com).