Choosing the Right Site or Building
The first and most consequential decision in any healthcare facility project is the choice of site or building. This decision shapes every aspect of what follows — the planning route, the compliance strategy, the construction programme, and ultimately the clinical environment that is delivered.
Healthcare clients come to NVDC at different starting points. Some have already identified a site or building; others are at an early feasibility stage weighing their options. The three main routes are a new-build on a cleared or undeveloped site, a shell fit-out within an existing commercial development, and the adaptive reuse of an existing standalone building. Each has a different cost profile, programme, and set of constraints.
Key questions to establish at the outset- Is the site or building capable of accommodating the clinical brief — in terms of floor area, floor-to-ceiling heights, structural capacity, and drainage?
- What is the planning position, and what consents will be required?
- Can the building services be installed or upgraded to the standards required for clinical use?
- Are there any constraints — listed building status, conservation area designation, or party wall obligations — that will affect the design or programme?
NVDC's experience across completed healthcare projects means we understand the constraints that matter most and can advise clients on site selection before heads of terms are agreed.
"NVDC are the premier small hospital designer in the country. They have a keen eye for the regulations, embrace innovation and are great at getting everything over the line."Dr Vivek Sivarajan · Elanic Private Hospital, Glasgow
a) The Project Brief
A thorough project brief is the foundation of every successful healthcare design. For a hospital or clinical facility, the brief must go beyond describing the number of rooms required — it must set out the clinical workflows that the building needs to support, the patient demographics it will serve, the procedures that will be carried out, and the operational model that will govern how the facility runs day to day.
NVDC works closely with the client and their clinical team at the outset to develop a brief that captures all of these requirements. For clients who are setting up a healthcare facility for the first time, we support the brief development process — translating clinical needs into architectural requirements, identifying what is achievable within the available budget and site, and establishing a realistic programme before design work begins.
The brief also establishes the schedule of accommodation — the definitive list of rooms and spaces the building must contain, with the area, adjacency, and performance requirements of each. This document underpins the entire design process and is the benchmark against which every design decision is tested.
b) Compliance
Healthcare facilities are subject to two distinct but related compliance frameworks: Health Technical Memoranda (HTMs) and Building Regulations. It is important to understand the difference between them.
i) Health Technical Memoranda (HTMs)
HTMs are the technical guidance that governs the design and equipping of healthcare facilities. They are comprehensive — covering every aspect of the healthcare environment from space standards, lighting, colour contrast, and DDA compliance, through to infection control, ventilation, medical gases, electrical systems, water quality, and building finishes.
HTM standards apply to all healthcare facilities. They are the established framework within which all healthcare design must be delivered — compliance is therefore a design requirement from the very first stage, not something to be addressed later in the process.
Because of the breadth and complexity of the HTM framework, early involvement of the full design team — including mechanical and electrical engineers — is essential. NVDC coordinates this process from the outset, ensuring that HTM requirements are built into the design from day one and that there are no conflicts between clinical requirements, architectural proposals, and engineering systems.
ii) Building Regulations
Building Regulations are separate from and additional to the HTM framework. They are the statutory minimum standards that all buildings must meet, administered by the local authority building standards department. For healthcare facilities, Building Regulations are considerably more onerous than for most other building types.
A building warrant from the local authority is required for all healthcare facility projects. The warrant application must demonstrate compliance with the relevant Building Regulations across all applicable areas, and the building standards officer will carry out inspections during construction.
It is important to note that Building Regulations set the statutory minimum. In many areas, HTM standards will exceed Building Regulations requirements, and it is the HTM standard that the design must achieve. Where there is any conflict between the two, the more demanding standard applies.
c) The Design Team
A healthcare facility project requires a multidisciplinary design team with experience in clinical environments. The composition of the team will vary depending on the scale and complexity of the project, but for a hospital or surgical facility the team will typically include the following specialists.
NVDC acts as lead consultant and design team coordinator on all our healthcare projects, managing the interfaces between disciplines and ensuring that the clinical requirements of the brief are maintained throughout the design and construction process.
Architect
Overall design in full compliance with HTM standards, planning applications, building warrant submissions, coordination of the design team, and technical support during construction.
M&E Engineer
Ventilation, medical gases, electrical systems, lighting, and water services — all compliant with the relevant HTM standards.
Structural Engineer
Assessing structural capacity and designing new structural elements and any modifications required to the existing building fabric.
Cost Consultant / QS
Project cost forecasting, tender documentation, managing the tender process, contract administration, and cost control during construction.
d) Design Development
The feasibility and concept design stage establishes whether the project is viable — and if so, what form it should take. For healthcare projects, this stage is particularly important because the decisions made at concept level have a disproportionate impact on the clinical effectiveness of the finished building.
NVDC's feasibility process covers the planning position, the capacity of the site or building to accommodate the clinical brief, the ventilation and services strategy, the structural requirements, and the programme. The output is a written summary of what is achievable, the key constraints, and a recommended approach — together with a concept design that demonstrates how the clinical brief can be accommodated.
Clinical flow mapping is central to the concept design process. Before any room is positioned, NVDC charts the patient admission routes, staff circulation, clinical workflows, and waste removal paths that the building must support.
ii) Detail DesignThe detail design stage develops the concept into a fully coordinated set of drawings and specifications from which the building can be built. Room data sheets — detailed schedules setting out the finishes, services, and equipment requirements of every room — are produced at this stage and used throughout construction to verify that rooms are fitted out in accordance with the clinical brief.
Healthcare facility projects typically require a number of statutory consents depending on the nature and location of the project.
The Build Process
a) Contractor Appointment & Tender Process
The appointment of the right contractor is critical on a healthcare project. The clinical environment imposes demands on the construction process — the coordination of specialist subcontractors for medical gas, ventilation, and electrical systems, and the phasing of works where an existing facility must remain operational during construction.
Each member of the design team contributes to the tender package: NVDC produces the architectural tender drawings and specification; the M&E consultant the M&E drawings and specification; the structural engineer the structural drawings and specification. The cost consultant manages the procurement process — advising on contractor selection, assessing tender returns, and making a recommendation before any appointment is made.
b) Construction Stage
NVDC provides technical support throughout the construction stage — attending site regularly, checking that works are being carried out in accordance with the approved design and technical drawings, resolving contractor queries and unforeseen site condition matters, and reviewing and approving contractor submissions.
The commissioning and validation of building services — particularly ventilation systems — is a critical stage. Before the facility can open, the mechanical and electrical systems must be commissioned, tested, and validated to demonstrate that they meet the required HTM standards. NVDC coordinates the handover process and ensures that all relevant documentation is in place before practical completion is certified.