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Opportunities for flexible design are limited

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NHS figures show that one in 10 people admitted to hospital for treatment suffer 'adverse events' which end up prolonging their stay - costing the NHS and extra £1bn a year.

To prevent healthcare associated infection (HAI), architects and engineers are being pressed to improve on current NHS standards for hospital design, taking on board the latest evidence-based principles.

This means more single rooms are appearing in hospitals and the space between beds on the ward is increasing. The size of operating theatres is also likely to change, as new surgery techniques require the involvement of more people and equipment.

Atkins health director Ian Tempest advises NHS Scotland on these issues.

'Until now the bed spacing standard was 2.7m, but the recommendation is now 3.6m.

This can increase the capital cost of a project by up to 5%, ' he says.

The way round this is to reconfigure the hospital's working regime. 'We look at the number of beds, patients and theatres and examine alternative models - perhaps six theatres would be required for a 10-hour working day, but only four if the hospital worked a 15 hour day, ' says Tempest.

But despite these efforts, designers believe that the changing pace of healthcare means that many new hospital schemes are obsolete before construction starts.

Health sector management consultant Andy Black believes that if hospitals are designed according to the 'form follows function' principle, 'you're building in obsolescence'.

Most hospital designs make use of flat slab concrete construction with moveable partitions, to allow for flexibility. Design floor loads are boosted where possible, to accept heavier plant in the future.

Engineers also design hospital buildings to accommodate extra wings or floors.

But catering for flexibility comes at a cost and affects the competitiveness of bids. Building in extra services, risers or redundant floor area creates unusable space.

'We're designing buildings for 60 years but creating spaces which may not be suitable in five years time. The difficulty is that no one knows what the likely needs are going to be, and no one can give direct guidance - how do you design in flexibility in a brief?' asks Arup healthcare director Phil Nedin.

There is also a lack of consistency across different healthcare trusts so if advisers change, so does the design.

'And we have to second guess what will go, ' says Nedin.

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