Global learnings for the UK’s acute facilities reset

Kirstie Irwin, Principal at BVN Architecture, shares some of the challenges and solutions to healthcare infrastructure from other world systems, specifically Australia, that might bring inspiration and learning to the NHS.

The NHS is both a treasured national institution and one of the most complex healthcare systems in the world. It has delivered care ‘free at the point of need’ for more than 75 years, embodying a model of universal access that has inspired health systems globally. Yet today, the NHS is under acute pressure. An ageing estate, rising demand, workforce challenges and constrained capital budgets are driving the need for fundamental change.

The New Hospital Programme (NHP) and the NHS Long Term Plan set out a clear ambition: to reshape healthcare facilities so that they are more resilient, sustainable and responsive to evolving models of care. The stakes are high: the hospitals designed and delivered in the coming decade will serve generations.

But the UK is not alone in facing this challenge. Around the world, healthcare systems have grappled with similar pressures and have developed new ways of briefing, designing and delivering infrastructure.

Australia in particular offers useful parallels: a publicly funded system, a mix of ageing assets and new builds, and a reform agenda focused on integration, efficiency and patient-centred design. Over the last decade, BVN has designed and delivered more than a dozen major hospitals across Australia, many commissioned during a period of systemic change not unlike that being experienced in the UK at present.

The NHS is standing at a pivotal moment. The health sector faces major systemic change and amid all the upheaval the transition to a new governance model has begun.

The health system isn’t just reshaping policy, however. It’s redefining how infrastructure is envisioned, briefed and delivered. As alliances form between Trusts and contractors to accelerate capital delivery across the NHS, the design industry must stay alert and agile.

For too long, hospitals have been forced to stick plasters on plasters when it comes to their facilities, (excuse the pun), rather than receiving the true investment they deserve. This is unsustainable, both for the NHS and for the patients and staff who rely on these environments every day. One of the failings of the design community in all sectors has been not getting close enough to the facilities teams, who, against all odds, in the world of healthcare somehow keep hospitals operational – even when faced with obstacles as stark as RAAC. It’s time to shift from patching to properly building for the future.

This is where Australia’s healthcare infrastructure rollout offers some valuable parallels. With more than 50 major hospitals designed and delivered in the last 15 years – spanning new builds, refurbishments and expansions – it has been useful to reflect on how development and procurement models have evolved, learning lessons along the way that have enabled major hospitals to be handed over in less than five years. These things offer some strategic navigation to the UK’s evolving system and programme of work.

One of the most instructive characteristics of Australia’s hospital development model is its naturally iterative and collaborative nature. The Australasian Health Facility Guidelines (AusHFGs) provide a flexible framework that balances standardisation with adaptability, enabling designs to evolve with clinical, social and technological needs. While the guidelines are used diligently, they ensure efficiencies without rigid constraints.

The AusHFGs embody a component-based approach to standardising hospital design, enabling facilities to be planned and delivered at scale with consistency, safety and efficiency. This framework was itself informed by the UK’s original Health Building Notes (HBNs), highlighting how ideas can travel and evolve across health systems. Now, as the UK develops its Hospital 2.0 guidelines, a similar opportunity emerges: while these standards will inevitably go through an initial period of adjustment as early schemes test and refine them, they can also build on lessons already embedded in the AusHFGs. Given that Australia’s healthcare system is itself rooted in the NHS, there is value in knowledge sharing to accelerate learning – ensuring both countries benefit from shared experience in designing hospitals that can meet future demands at scale.

Australian projects often embrace early collaboration, notably through processes like Very Early Contractor Involvement (VECI). These bring together client, clinician, designer and contractor from the outset, allowing risk-sharing, design optimisation and co-authored living briefs. Traditional procurement pathways in the UK often separate these parties, resulting in design intent often lost in translation, programmes stretched and cost certainty slipping.

The new Critical Services Building at Canberra Hospital marked a first for Australia when it opened in 2024, as an all-electric hospital powered entirely by renewable energy, cutting around 1,886 tonnes of carbon emissions each year – the equivalent of removing 780 cars from the road. More than a clinical facility, the design integrates outdoor terraces, family-focused spaces and locally curated artworks to create an environment of connection and healing. By combining low-carbon operations with community-centred design, the project set a benchmark for sustainable healthcare in Australia. Another important outcome emerged from early collaboration. Working with the contractor and client, the design team identified opportunities beyond the initial brief – including the creation of new ‘in between’ spaces such as a welcoming hall that allowed for improved campus connections. These interventions, not originally specified, are examples of how integrated teams can unlock hidden opportunities in projects.

Hospital in New South Wales was designed for a fast-growing regional population. The project demonstrates the importance of balancing efficiency with human scale. Standardised modules and layouts support operational performance, but equally the design integrates generous public spaces, landscaped courtyards and views to the surrounding area. The lesson here is that hospitals must function as both highly efficient machines for care and welcoming civic places that anchor communities.

The Prince of Wales Hospital Redevelopment in Randwick, Sydney illustrates the complexities of working within constrained urban campuses. The project sought to integrate acute care with research and education, while also connecting to neighbouring facilities and transport networks. The UK’s growing focus on translational research, coupled with the increased adoption of precinct approaches to healthcare, provides a timely opportunity to rethink how we integrate care, research and education. The government’s Life Sciences Vision is closely aligned with the NHS Long Term Plan announced earlier this summer, highlighting the need for closer partnerships between the health system and academia. While many UK hospitals have higher education connections, physical proximity is often limited and deeper integration can be challenging. Long term campus planning and master planning in advance of and around the Prince of Wales project ensured investment didn’t constrain future possibilities

Systemic inefficiency and bureaucratic inertia have cost the NHS dearly, both in budget and outcomes. The NHS’s reorganisation signals a potential pivot toward simplicity and accountability, and a rare opportunity to rethink how healthcare spaces are required to function.

Australian hospital developments, with their flexible frameworks, integrated delivery processes and campus-scale planning, present a compelling reference point. At stake is more than buildings: it is how those buildings serve communities over generations.

As the NHS embarks on reinventing its acute infrastructure with the New Hospital Programme’s latest and most promising iteration, preserving that long-view perspective – through collaborative, future-facing design – will be essential.

For the NHS, adopting these lessons could mean embedding sustainability from the outset, not as an add-on, but as a core design driver. Co-authoring briefs not only with clinicians, patients and estates teams, but also contractors and specialists, creating living documents that evolve through delivery. Investing in health precincts, where hospitals are part of integrated networks of care, research, education and community facilities. Designing for adaptability, ensuring today’s assets remain relevant in a future shaped by demographic change, digital health and new models of care.

The NHS is rightly described as one of the UK’s most important social achievements. For those who grew up with it, or have experienced its care, the opportunity to contribute to its renewal carries personal as well as professional weight. Designing and delivering the next generation of hospitals is not simply an architectural task, it is a societal responsibility.

If there is one overarching lesson from Australia, it is that the process matters as much as the product. Hospitals designed through collaboration, shaped by diverse voices and built with a clear long-term vision, are better placed to serve patients, staff and communities alike. The NHS deserves facilities that are not only clinically efficient, but also humane, sustainable and resilient. Achieving that will require fresh thinking, integrated delivery and a willingness to learn from global experience.

This article includes excerpts from an original piece written by Kirstie Irwin, Principal at BVN Architecture, originally published in HEFMA Pulse Magazine, Sept/October 2025 issue.