Perspectives on Health: How Will the Health Care Facilities of the Future be Funded?

With the death of the PFI funding model, there is currently great uncertainty within the health sector around which procurement methods will deliver the infrastructure of the next 20-30 years.

As architects, we are required to design functional and intelligent buildings that can flexibly deliver various types of health care.

But as health care delivery changes and the demands on new buildings increase, there needs to be some clarity about who and what is paying for them if they are to become more than just designs on a page.

Historically, PFI has been the go-to procurement method for delivering NHS buildings – with 120 hospitals to its name.

But the buildings delivered have been anything but flexible, with a prescriptive formula and lengthy procurement process often leaving the facilities obsolete by the time they are finished.

What is clear from senior figures in the health care industry is that flexibility is the key factor going forward – both for attracting early investment and for delivering a quality service to the end user.

The generally accepted result of that need for flexibility is that we will see an increase in adaptable buildings and therefore a rise in the number of mixed-use health schemes.

We are already seeing a blurring of lines around land-use across other sectors. For example, many hotels now offer branded residences, essentially operating as real estate developers. Stadiums offer hotels, conference facilities and office space, whilst retailers are increasingly introducing ‘other-use’ attractions that will increase footfall in a bid to combat the impact of online shopping.

The NHS must note these examples and take advantage of the opportunities presented by its own estate if it is to keep pace with the changing demands of its patients. Public/private partnerships (PPPs), for example – where part of a building may be leased out for use by private, third party companies – offer a chance to drive revenue streams in areas of its estate where capacity is not fulfilled.

There are constrictions of course – the size of the NHS alone makes it less adaptable to change than other sectors. But with the PFI programme dead in the water, NHS leaders need to think about being flexible, adaptable and doing more with less.

The shift does have its benefits. With the abolishment of PFI, NHS Trusts are free from the shackles of PFI’s painstaking specifications. This presents opportunities to produce more imaginative, adaptable buildings that can be future-proofed and will be instantly more attractive to private investors.

As designers, there is so much we can do to assist this transition. We at HKS have already been delving into health care design where non-essential back office functions are removed and centralised, leaving the core building to adopt a more flexible nature.

This streamlining and collaboration of building-use can and should result in a future of faster procurement, more realistic pricing and vision and, ultimately, a higher quality health facility.

Changing technology will further alter the demands on these buildings in future – but they will be built to adapt and meet these demands. By starting with a blank canvas, we place fewer restrictions on our health buildings and this should result in faster procurement and an ability to better and more-quickly adapt to modern technologies.

None of us can see into a crystal ball and predict exactly where procurement will go in the next few decades. But with the death of PFI, what we can be certain of is there are opportunities for designers to take advantage of this changing landscape and produce buildings that deliver a quality health care service for decades to come.

‘HKS: Perspectives on Health’ was the first in a series of events being held in 2019 to help celebrate HKS’ 80th anniversary.

The panel consisted of:

  • Rosemary Jago, Health Infrastructure Partner at Bevan Brittan
  • Chris Dunbar, Associate Director Infrastructure Advisory Group, KPMG
  • Peter Ward, Director of Health Care Real Estate Projects, Guy’s and St Thomas’ NHS Foundation Trust
  • Ben Martin, Principal & Head of Real Estate Consulting, HKS

If you are interested in attending the next event, please email [email protected].