APRIL 2026 | £8 healthcaredm.co.uk healthcare design & management First Voluntary Surgical Hospital How British and Ukrainian expertise is reshaping rehabilitation Designing for decarbonisation Are we doing enough towards net zero buildings? Improving medical gas systems Practical steps for NHS Trusts and healthcare providers Also in this issue: Transforming care, research and housing in East London The Whitechapel Healthcare and Research Campus
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healthcaredm.co.uk 3 Publishers Stable Publishing Limited SBC House, Restmor Way Wallington, Surrey SM6 7AH, England. t. 020 8288 1080 f. 020 8288 1099 e. sales@healthcaredm.co.uk healthcaredm.co.uk Editor Helen Adkins Production Nicola Cann Design Gemma England Media Sales Manager Terry Stafford Head of Sales Julian Walter Managing Director Toby Filby Whitechapel Healthcare and Research Campus The publishers do not necessarily agree with views expressed by contributors and cannot accept responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication. healthcare design & management Few developments capture the complexity and urgency of the UK’s healthcare challenges quite like the proposed Whitechapel Healthcare and Research Campus. At £750m, the scheme is ambitious in scale, but its real significance lies in what it represents – a shift in how we think about the role of hospitals, research and the city itself. At its core, the project is a response to the mounting pressures facing The Royal London Hospital, one of the capital’s busiest teaching hospitals. Like many NHS facilities, it is grappling with ageing infrastructure, rising demand and constrained space. Expanding on a traditional footprint is no longer viable in dense urban centres such as Whitechapel. Instead, this scheme proposes something more fundamental in the form of redistribution, integration and reinvention. By relocating outpatient and research functions into a purpose built facility, the campus aims to release capacity for acute care where it is most needed. This is not simply an estate upgrade, but a rebalancing of how healthcare is delivered. Crucially, it acknowledges that the future of clinical excellence is increasingly tied to proximity, between disciplines, between sectors and between ideas. The co-location of NHS services with life sciences companies, from diagnostics to AI and robotics, signals a deliberate move towards a more collaborative model of innovation. What also sets Whitechapel apart is its insistence that healthcare infrastructure cannot be considered in isolation. The integration of housing, particularly affordable and key worker homes, reflects a growing recognition that workforce challenges are inseparable from the wider urban context. Staff cannot sustain the NHS if they cannot afford to live near it. In that sense, housing here is not an add on, but essential infrastructure. The emphasis on public realm further reinforces this point. Opening up routes such as Walden Street and introducing green space within a dense part of East London reframes the hospital not as an inward looking institution but as part of the civic fabric. This is a subtle but important cultural shift. Hospitals are no longer just places of treatment, but are anchors for community, wellbeing and economic activity. Of course, ambition at this scale invites scrutiny. The success of such a model will depend on delivery, governance and the ability to balance commercial interests with public good. Questions will inevitably be asked about affordability, access and whether the benefits of investment are felt by existing communities as much as by incoming businesses. Even so, the direction of travel is clear. The NHS estate cannot stand still. Across the country, similar pressures are forcing trusts to rethink how space is used, how services are configured and how partnerships are formed. Whitechapel offers a glimpse of one possible future, one in which healthcare, research, housing and public life are no longer siloed but interdependent. Helen Adkins Editor Helen.Adkins@stable-media.co.uk Editor’s letter April 2026 A blueprint for the NHS estate of the future
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IN THIS ISSUE... April 2026 7 News A round-up of all the news from across the sector. 14 First Voluntary Surgical Hospital, Ukraine Hal Jones, managing director at Floyd Slaski Architects, outlines how an Anglo-Ukrainian collaboration is helping to expand rehabilitation care for wounded soldiers in Ukraine. 19 Designing for low-temperature heat in net zero buildings As healthcare estates accelerate towards electrification and heat pump-led systems, Harry Davis, founder and managing director at Eden Energy Partners, argues that unless buildings are designed from the outset for low-temperature heat, the performance gap will be designed in from day one. 23 Whitechapel’s £750m life sciences vision A new healthcare and research campus for East London aims to relieve pressure on The Royal London Hospital, deliver affordable homes for key workers, and embed life sciences innovation at the heart of East London. We examine how. 28 Decarbonising medical gas systems NHS Trusts and healthcare providers face increasing pressure to cut carbon emissions while maintaining safe and reliable clinical infrastructure. Andy Tudor of BeaconMedaes outlines practical steps to improve the efficiency, sustainability and resilience of medical gas systems. 31 Washrooms, and why smarter fittings matter As healthcare providers navigate rising costs and stricter safety requirements, Anil Madan, Armitage Shanks, explains how smarter water fittings are emerging as a crucial tool in improving efficiency, hygiene and long-term sustainability. 14 19
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healthcaredm.co.uk 7 NEWS Electiva Healthcare to open new flagship hospital in London Electiva Healthcare has announced plans to open a new hospital in South West London in summer 2026. The purpose-built facility on the banks of the River Thames will be the company’s flagship site, featuring two surgical theatres and ten private patient suites. The hospital will offer services including corrective, aesthetic, orthopaedic and gynaecology treatments. It aims to create approximately 300 jobs and generate annual revenues exceeding £50 million. The building has been designed with multiple access options, including road, river and helicopter transfer, to support patient and staff transport. Brian Welsh, CEO of Electiva Healthcare, described the development as a significant expansion for the group: ‘This is a huge opportunity for us to build something new, something different and something special, and to treat our consumers with the very best that we can possibly offer.’ Electiva Healthcare Group operates a network of hospitals and specialist services, including sites in Manchester and Glasgow, along with medical consumables manufacturing through Swift Surgical. The new London hospital forms part of Electiva’s ongoing expansion plans, with further acquisitions and developments anticipated across the UK and internationally. ■ Proposals for a new building to expand diagnostic services at Newmarket Community Hospital have been submitted for planning approval. The development will house endoscopy and paediatric audiology facilities alongside the recently completed Community Diagnostic Centre. Planning submitted for endoscopy and paediatric audiology building at Newmarket Community Hospital Designed by Medical Architecture for West Suffolk NHS Foundation Trust, the two-storey building is intended to provide a patient-focused environment that prioritises privacy and dignity. Individual patient pods will be used for preparation and recovery, allowing flexibility for varying admission numbers and separation by gender. The internal layout is organised around an efficient circulation loop, with waiting and movement areas positioned to maximise daylight and views. The design aims to create a calm atmosphere, with clear navigation from entrance to clinical spaces to support patients who may feel anxious. The building features a prominent public-facing elevation with a canopy guiding visitors to the entrance, incorporating colourful features that continue inside. The design facilitates modern construction methods and allows for future reconfiguration of internal spaces through a regular window grid and coordinated structural layout. West Suffolk NHS Foundation Trust representatives emphasised the project’s alignment with regional and national strategies to enhance diagnostic capacity and patient access to care closer to home. Medical Architecture has noted ongoing progress in collaboration with contractor Morgan Sindall to advance the project. ■
8 healthcaredm.co.uk NEWS Cancer centre to bring advanced care to the North of England and Scotland A new state-of-the-art cancer centre is under construction in Leeds, promising to deliver cutting-edge oncology, haematology and research services to the North of England and Scotland. The 36,000 sq ft facility, located at Thorpe Park, will become the largest centre in the UK network of GenesisCare, an independent cancer care provider. The centre will introduce adaptive radiotherapy technologies, including both MRI and CT guided radiotherapy, allowing highly personalised treatment tailored to each patient’s needs. This development will provide easier access to advanced cancer care for those who previously had to travel to GenesisCare’s sites in Oxford or London. Preparatory works on the building, a former office space, have already been completed, with major construction now underway. The project includes extensive internal refurbishment, structural and façade alterations, and the installation of specialist treatment facilities such as two concrete bunkers for Linac treatment, along with MRI, CT and X-ray scan-ners. Additionally, the centre will feature an elevated external garden on the first floor for patients receiving Systemic Anti-Cancer Therapy, as well as landscaped areas and essential plant and service rooms. HBC Construction Limited (HBC), formerly Henry Boot Construction, is leading the construction work following a successful tender process earlier this year. The company has a strong background in healthcare projects, having recently completed a significant extension to Weston Park Hospital’s radiology department. Lee Powell, managing director of HBC, said: ‘We’re proud to be delivering this pioneering centre in Leeds. Working closely with GenesisCare has enabled us to develop an accelerated programme to ensure timely delivery and installation of specialist equipment. ‘It’s incredibly rewarding to be contributing to the enhancement of cancer services across the North of England and Scotland, providing patients with access to the latest treatments closer to home.’ Justin Hely, CEO at GenesisCare, added: ‘We remain committed to delivering world-class cancer care throughout the UK. Progress at the Leeds centre is excellent, and we’re on track to open by the end of the year, bringing vital diagnostic and treatment services to the region without delay.’ The centre is expected to open in December 2026, marking a major step forward in cancer care for the North of England and Scotland. HBC continues to expand its presence across Yorkshire, with recent projects in Wakefield, York and Rotherham. ■ A new £25 million Community Diagnostic Centre at Upton Hospital, Slough, has officially opened. Delivered by offsite construction specialists Western, the 2,800m² facility Western completes £25 million CDC at Upton Hospital was completed within 52 weeks using advanced off-site manufacturing and BIM 3D modelling. Modules were pre-assembled off-site and made watertight within five days of installation, reducing disruption and risk in the live healthcare environment. Western provided a full turnkey design and build service, including internal fit-out, car parking and EV charging infrastructure. The centre operates seven days a week, 12 hours a day, offering up to 150,000 additional diagnostic tests annually. Services include MRI, CT and ultrasound scanning, respiratory and cardiology testing. The facility supports earlier diagnosis of conditions such as cancer and heart disease while easing pressure on Wexham Park Hospital and local GP practices. Conveniently located within a 10-minute walk of Slough railway station and near bus routes, the centre was designed with accessibility in mind. Rory McGuigan, managing director of Western, highlighted the project as an example of how modern construction methods can deliver high-quality healthcare infrastructure quickly and sustainably. ■
healthcaredm.co.uk 9 NEWS GRAHAM has completed and handed over the main phase of works for a new clinical building at Birmingham Children’s Hospital, marking a key milestone in the transformation of the Loveday Street site. Awarded through NHS England’s ProCure23 framework, a strategic partnership with Crown Commercial Service, the three storey facility was formally handed over to the Trust in December and is set to open later this year. The building is expected to significantly improve surgical capacity and provide advanced clinical technologies, supporting care for children and young people from across the region and beyond. The facility includes a state of the art intraoperative MRI machine, operating theatres and recovery facilities, alongside critical electrical and plant infrastructure. Funded entirely through charitable donations, the suite will allow surgeons to access real time imaging during procedures, improving surgical precision and reducing the need for repeat operations. Additional theatre capacity is also expected to help reduce waiting times and improve patient flow. A ground water heat plant integrated within the building will support the hospital’s transition to more sustainable energy use across the wider site. The project presented significant technical challenges due to the building’s location within a tightly constrained area surrounded by live clinical environments, including active theatres directly adjacent and below. Even minor noise or vibration had the potential to disrupt critical hospital activity, requiring continuous monitoring and careful control throughout construction. Close collaboration with the Trust’s estate’s team ensured constant communication and co ordinated decision making to maintain uninterrupted clinical operations. A further phase of works, to be delivered by Birmingham Women’s and Children’s NHS Foundation Trust, will include new decarbonisation plant rooms, as well as the fit out and refurbishment of the Emergency Department and the creation of a new main entrance, supported by the hospital’s charity. ■ New clinical building for Birmingham Children’s Hospital Planning permission has been granted for a new Maggie’s cancer Planning granted for cancer support centre at Maidstone Hospital support centre to be built in the grounds of Maidstone Hospital, part of Maidstone and Tunbridge Wells NHS Trust. The centre will offer free practical and emotional support tailored for people at all stages of cancer, as well as their family and friends. It is expected to open by 2028. Located close to the Kent Oncology Centre, it will provide patients and families with community, guidance and support. Dame Laura Lee DBE, chief executive of Maggie’s, said the new centre marked an important milestone in expanding support across Kent and brought the charity closer to its goal of 60 centres across the UK. Designed by Assemble, the building will include a kitchen area, rooms for one-to-one support and larger spaces for groups and exercise classes. The design draws on the culture, landscape, geology and heritage of Kent, with natural and local materials used to create a familiar and atmospheric space. The garden, designed by landscape architects J&L Gibbons, forms an integral part of the centre, reflecting Maggie’s focus on the health benefits of contact with nature. Architect Anthony Engi-Meacock said securing planning permission was a significant step and that the design aimed to create uplifting spaces to support patients and staff. The centre is expected to support around 20,000 visits annually and assist the 11,000 people diagnosed with cancer in Kent each year. Fundraising is in the early stages of a £7 million campaign. Maggie’s aims to have 60 centres nationwide and is working towards supporting millions of visits in the coming decades. ■
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healthcaredm.co.uk 11 NEWS Hereford Community Diagnostic Centre completed PROJECT DETAILS • Location: Hereford, Herefordshire • Value: £18 million • Client: Wye Valley NHS Trust • Architect and Lead Consultant: Architype • Healthcare Architect: Medical Architecture • Contractor: Speller Metcalfe • Services Engineer: Arup • Structure and Civil Engineer: Innovare • Landscape: Environmental Dimension Partnership Construction has finished on the Hereford Community Diagnostic Centre (CDC), developed for Wye Valley NHS Trust to increase local diagnostic capacity and improve patient access to imaging and testing services. The £18 million facility, designed by Architype and Medical Architecture, and built by Speller Metcalfe through the NHS ProCure23 framework, provides a range of diagnostic services including blood testing, X-ray, CT and MRI. Located near a retail park, the centre operates 12 hours daily to offer an alternative to hospitalbased diagnostics, easing pressure on Hereford County Hospital. The building’s design focuses on patient experience and operational efficiency. A double-height entrance hall serves as a central wayfinding landmark, reducing reliance on signage with a clear layout enhanced by distinctive colours and icons. The interior incorporates universal design principles to support accessibility for diverse users, including those with visual impairments and non-English speakers. Clinical spaces balance specialist and flexible areas to optimise costeffectiveness while supporting staff ergonomics and patient dignity. Consultation rooms and staff welfare areas are located on the first floor with views and natural light to promote wellbeing. Externally, the centre features black standing-seam metal cladding with timber detailing at the entrance, reflecting the local industrial context while creating a distinctive identity. The building is designed for future adaptability, allowing reconfiguration or expansion to accommodate additional services. Sustainability is embedded through Passivhaus principles, focusing on energy efficiency and occupant comfort. The design employs a fabric-first approach with airtight construction, thermally efficient materials, and a glazing strategy that maximises daylight while controlling heat gain. The building aligns with NHS Net Zero Carbon standards and achieved a BREEAM Excellent rating of 74.1%. Use of prefabricated timber framing and precast concrete floors minimised embodied carbon and construction waste. Wye Valley NHS Trust Chairman Russell Hardy said the centre was a significant step in bringing healthcare closer to local communities, with positive feedback from patients and staff. Architype and Medical Architecture praised the collaborative process with the NHS and contractor Speller Metcalfe, who highlighted the centre’s immediate impact on service delivery. The centre forms part of a national NHS programme to expand communitybased diagnostic services and reduce hospital demand. ■
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healthcaredm.co.uk 13 NEWS The built environment’s leading healthcare event returns to The Belfry in July 2026. Bringing the sector together to rethink the healthcare estate. Here’s what to expect Rising demand, ageing infrastructure and a growing shift toward community-based care are placing increasing pressure on the NHS to move beyond its traditional hospital-centric model. At hbf 2026, we will tackle this challenge through our theme Healthcare without walls: Rethinking the estate. Our programme will explore how the healthcare estate must adapt to support a more sustainable, flexible and future-ready system – one that delivers care closer to home, makes better use of existing assets, and responds to the changing needs of patients and communities. Bringing together leaders from across the sector, we will examine practical strategies, innovative design approaches and forward-thinking investment models that can help reshape the healthcare estate for the years ahead. Key topics will include: • Designing environments that enable effective and accessible communitybased healthcare • Addressing the challenges of ageing infrastructure: When to retrofit and when to replace • Unlocking funding and investment to support long-term transformation • Creating estates that prioritise prevention and population health, not just treatment • Maximising the value of underused or underperforming estate assets WHAT’S ON OFFER Delegates benefit from thoughtprovoking seminars and pre-arranged one-to-one meetings, providing valuable opportunities to discover new solutions and build meaningful connections. Complimentary project delegate places are offered to senior decisionmakers involved in the delivery and management of healthcare estates and facilities, including those from NHS and private providers, as well as experts in construction, design and consultancy. For suppliers, the forum offers limited competition and a highly effective platform to build relationships and generate new business.. Additionally, we will provide one to two nights’ accommodation, as well as all meals and refreshments, a drinks reception and a gala dinner, plus a networking golf day on the legendary Brabazon course on 8 July. ■ For more information about the event, or to register for your place, visit hb-forum.co.uk or email georgie.smith@stable-events.co.uk (speaker and project delegates) or Leslie.dehoog@stable-events.co.uk (supplier delegates) Call for speakers! Got something to share? We’re finalising our speaker line-up and would be pleased to receive a proposal from you. Contact Georgie Smith on Georgie.smith@stable-events.co.uk or 0208 288 1080. healthcare buildings forum 2026 9-10 July 2026 The Belfry Sutton Coldfield PREVIEW
14 healthcaredm.co.uk PROJECT First Voluntary Surgical Hospital Hal Jones, managing director at Floyd Slaski Architects, outlines how an Anglo-Ukrainian collaboration is helping to expands rehabilitation care and build hope for wounded soldiers As Ukraine enters its fourth year of full-scale war, the country’s healthcare system continues to shoulder extraordinary pressure. Nowhere is this more visible than at the First Voluntary Surgical Hospital (FVSH) in Ivano-Frankivsk; a facility born in the earliest days of the invasion and sustained entirely through charitable effort and volunteer clinicians. Since opening on 7 March 2022, FVSH has provided more than 1,200 military personnel with reconstructive surgery, alongside the physical, psychological and social rehabilitation required to restore dignity and independence to those injured on the frontline. Operating from a small 14-bed reconstructive orthopaedic surgery centre, the hospital works free of charge and maintains an ethos that ‘we try to treat not only injuries, but the person as a whole.’ But as the volume and complexity of injuries have grown, so too has the need for a purpose-built rehabilitation environment – one capable of tripling patient throughput and enabling FVSH to secure long-term state funding. That ambition is now being realised through a pro bono collaboration between Floyd Slaski Architects, the UK-based international healthcare design specialists, and Archus, international healthcare strategy consultants. Together, they have produced a comprehensive feasibility study, clinical brief and schedule of accommodation that define a new 40bed rehabilitation hospital to sit alongside the existing surgical unit. This partnership demonstrates how expert international cooperation can meaningfully strengthen healthcare resilience in wartime. A HOSPITAL BORN OF URGENCY AND OVERWHELMING DEMAND FVSH’s facility and surgical team is capable of performing two to three complex reconstructive operations per day, yet the facility’s limited recovery and rehabilitation footprint restricts activity to only 250 procedures per year, a throughput far below demand. Referrals arrive continuously from frontline stabilisation points, regional hospitals and military units across the country. Archus’ clinical brief identifies this unmet need starkly, with the hospital
healthcaredm.co.uk 15 PROJECT ‘regularly operating at 100% capacity and above,’ and with staff struggling to find space for incoming patients. The priority is therefore clear – to expand capacity rapidly while embedding an integrated, modern model of care that combines surgery, physiotherapy, mental health support and long-term community reintegration. The proposed facility increases total capacity from 14 to 54 beds, surpassing the crucial 50-bed threshold required to unlock sustainable funding through the National Health Service of Ukraine. This would raise annual patient numbers from 250 to around 750, dramatically expanding access to free care for wounded soldiers. DESIGNING FOR WHOLE-PERSON RECOVERY Floyd Slaski Architects (FSA) approached the commission with a strong sense of purpose, offering their feasibility and concept design expertise to support FVSH’s holistic ethos. Drawing on extensive experience in complex healthcare environments, they shaped their brief around that ethos, ensuring the design supports the hospital’s mission to treat each person, not just their injuries. The design intent, developed through detailed plans, site analyses and early visualisation, is structured around a continuous therapeutic circulation axis that connects patient bedrooms, clinical spaces and rehabilitation facilities into a coherent and legible whole. The building adopts a human-scale massing strategy, with stepped rooflines and articulated volumes that respond sensitively to the surrounding residential context while maintaining a calm and dignified presence. Strong relationships between indoor and outdoor spaces are prioritised throughout, with generous access to daylight, landscaped therapeutic gardens and an outdoor gym supporting physical and psychological recovery. Mental health provision is fully integrated within the scheme through a dedicated four-bed ward with its own entrance and garden, ensuring privacy, safety and dignity. The design supports holistic, personcentred care through the inclusion of kitchen and laundry spaces, as well as environments that welcome family involvement and enable overnight stays. Future adaptability is embedded within the proposal, allowing facilities such as hydrotherapy to be incorporated in later phases as funding and need evolve. The resulting building is calm, dignified and rigorous in its clinical logic. The warm, vertical façade elements, generous glazing and carefully modelled roofscape present a facility that is both contemporary and deeply humane. A CLINICAL MODEL INFORMED BY INTERNATIONAL BEST PRACTICE While Floyd Slaski shaped the architecture, Archus produced a robust clinical brief and schedule of accommodation, drawing on international healthcare guidelines and local Ukrainian standards. The key features listed below are taken directly from the original clinical brief, which defines the functional requirements for the new rehabilitation model: • Two 18-bed rehabilitation wards, each equipped for intensive 21-day recovery pathways supported by physiotherapy, occupational therapy and psychological care. >>
16 healthcaredm.co.uk PROJECT • Each ward can be further sub-divided into 9-bed clusters, allowing future flexibility such as gender separation. • A dedicated mental health unit with four single rooms, recognising that many patients present with PTSD, depression or trauma-related conditions. • A 120 m² gymnasium, doubling as a reinforced shelter, ensuring continuity of rehabilitation even under air-raid conditions. • Outdoor therapy spaces, including gardens and exercise zones. • Conference and training spaces, enabling FVSH to continue hosting international collaborations, knowledge exchange and volunteer missions. • An outpatients’ consultation unit at ground floor level, recognising that this facility will change and adapt with population needs in a post-war scenario. Archus’ schedule of accommodation defines a 2,578 m² Gross Internal Area, including support spaces, and plant and circulation, ensuring operational efficiency and compliance with funding requirements. In a letter to Floyd Slaski Architects, FVSH’s head, Stanislav Onyshchuk, emphasised the hospital’s desire to develop a facility that would ‘serve
healthcaredm.co.uk 17 PROJECT Project Type: 40-bed rehabilitation hospital extension Location: Ivano-Frankivsk, Ukraine Proposed development: • New 40-bed rehabilitation building • Total combined capacity: 54 beds • Designed to exceed 50-bed threshold for National Health Service of Ukraine funding • Estimated 2,578 m² Gross Internal Area • Capacity increase from 250 to approx. 750 patients per year Architect: Floyd Slaski Architects (pro bono feasibility and concept design) Healthcare strategy and clinical brief: Archus (pro bono) Funding model: • Charitable funding (current operations) • Targeting long-term state funding via National Health Service of Ukraine PROJECT SNAPSHOT: FIRST VOLUNTARY SURGICAL HOSPITAL (FVSH) wounded defenders of Ukraine on charitable terms, now and for many years to come’. He added that FVSH sees the new building as a ‘vivid example’ of international cooperation, expressing enormous gratitude. For both UK organisations, the project represents a rare opportunity to use expertise for immediate humanitarian impact. Floyd Slaski leveraged its healthcare design heritage, rooted in UK NHS standards and honed across complex international settings, to produce a solution that is elegant yet eminently buildable. Archus contributed rigorous operational planning, ensuring the building will support sustainable staffing, throughput and funding. LOOKING BEYOND THE WAR While the short-term priority is clear, meeting the urgent rehabilitation needs of injured soldiers, the project is designed to evolve. Archus highlights several longterm opportunities, including: • Outpatient consultation services to support the broader local community after the war • Virtual wards using repurposed military communication technology • Broader veteran and family support programmes In this sense, the proposed hospital is not merely an expansion project, but a cornerstone in the rebuilding of Ukraine’s post-war healthcare landscape. At a time when rebuilding lives is as critical as defending territory, the partnership between FVSH, Floyd Slaski Architects and Archus demonstrates the profound impact that skilled, compassionate professional collaboration can achieve. Where resources are scarce but determination is abundant, thoughtful healthcare design becomes more than an architectural exercise. It becomes a lifeline. This new rehabilitation centre, forged through empathy and expertise, stands as a testament to what can be achieved when international healthcare communities unite behind a cause that transcends borders. ■
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healthcaredm.co.uk 19 DECARBONISATION Are we doing enough to design for lowtemperature heat in net zero buildings? As healthcare estates accelerate towards electrification and heat pump-led systems, Harry Davis, founder and managing director at Eden Energy Partners, argues that unless buildings are designed from the outset for low-temperature heat, the performance gap will be designed in from day one In its report to Parliament in June 2025, the UK’s Climate Change Committee underscores how buildings and heating decarbonisation are crucial to meeting carbon budgets and net zero commitments. It highlights the scale of transition required in the heat sector and the urgency for effective delivery, beyond just technology adoption. And for the healthcare estate – from acute hospitals to community clinics – this challenge is heightened by 24/7 operation, infection control requirements and strict comfort thresholds for vulnerable patients. That transition, however, needs to lean on new ways of delivery, not just technology. As the industry accelerates towards electric, heat pump-led buildings, many designs still rely on legacy assumptions about heat distribution. In healthcare settings, those assumptions can have significant operational and financial consequences. On paper, the journey towards net zero buildings looks clear. Across many sectors, gas boilers are being replaced with air and ground source heat pumps, electric networks are expanding, and policy is steadily tightening around operational carbon. Within the NHS and wider private healthcare sector, decarbonisation strategies are now embedded in long-term estate plans, with many Trusts committing to ambitious net zero timelines. But there still exists a growing disconnect between the heat sources we are specifying and the buildings we are designing to receive that heat. If buildings are not designed from the outset to operate efficiently at lower flow temperatures, the performance gap is effectively designed in, regardless of how low-carbon the heat source may be. In hospitals, for instance, this can translate into higher running costs and increased strain on already stretched facilities teams. Heat pumps are fundamentally different from the fossil fuel systems they replace. They work best when delivering heat at lower flow temperatures, typically in the 35-50°C range rather than the 70–80°C that traditional boiler-led systems operate at. Yet many building designs still assume high-temperature heat distribution as the default. This is particularly challenging in healthcare refurbishments, where legacy distribution systems were originally sized around high-temperature boilers, and clinical risk assessments understandably favour a ‘tried and tested’ approach. LOW-TEMPERATURE HEAT IS NOW A DESIGN PARAMETER For decades, the make-up of heat distribution meant that systems would still deliver comfort because high temperatures masked inefficiencies. That landscape has shifted, however, because when a building is served by a heat pump, system efficiency – and therefore running cost and carbon performance – is highly sensitive to return water temperatures. The lower the temperature the system can operate at while maintaining comfort, the higher the seasonal coefficient of performance (SCOP) and the lower the electricity demand. The Renewable Energy Consumer >> Decarbonisation strategies are now embedded in long-term NHS estate plans, with many Trusts committing to ambitious net zero timelines
20 healthcaredm.co.uk Code (RECC) backs this up, finding in tests that ‘significant performance gap between the design SCOPs and the insitu efficiencies remains for both ASHPs and GSHPs (air and ground source heat pumps)’. For healthcare providers operating complex, multi-building sites, even small deviations in SCOP can equate to substantial annual cost and carbon impacts. In essence, this means heat distribution directly affects operational carbon, and flow temperature has become a core design parameter. If the building cannot comfortably be heated at low temperatures, the design team might be forced into compromise by raising system temperatures, which reduces efficiency and increases plant size (and cost). The outcomes then fail to align with net zero guidance. Raising temperatures to address localised comfort complaints – such as in wards with high glazing ratios – can quickly erode the anticipated benefits of electrification. The ability of a building to operate at low flow temperatures is largely determined long before the detailed services design is finalised. By RIBA Stage 2, many of the most important decisions affecting future system temperatures have already been made. This makes early-stage coordination between estates teams, infection control leads and design consultants even more critical. For example, emitter type and area become critical because low-temperature systems need larger heat transfer surfaces to deliver the same level of comfort. Underfloor heating, oversized radiators, trench heaters or active chilled beams can all be effective, but they require physical space, careful integration and early coordination with the architectural design. When emitter strategy is deferred on the assumption that it can be resolved later by the mechanical and engineering team (M&E), the result is often compact radiators sized around higher flow temperatures, which undermines heat pump efficiency from the outset. It must also consider cleaning regimes, infection prevention and control (IPC) guidance and safe surface temperatures, adding another layer of complexity that reinforces the need for early decisions. Glazing ratios and overall façade performance also play a major role. High perimeter heat losses drive up peak heating loads, which in turn push system designers towards higher flow temperatures simply to maintain comfort near the façade during cold weather. Ceiling heights and service zone allowances are another enabling factor. These dimensions influence whether larger emitters, deeper floor build-ups for underfloor heating or alternative lowtemperature distribution strategies can be accommodated without compromising the architectural intent. Tight zones and minimal build-ups tend to limit options and make higher temperature systems more likely by default. Finally, zoning and spatial layout matter more than is often recognised. Deep-plan areas with high internal gains behave very differently from cellular spaces dominated by perimeter losses. System design temperatures should respond to that diversity, allowing different parts of the building to operate in different ways. That is only realistic, however, if these variations are understood and planned for early in the design process. THE DANGER OF ‘NET ZERO READY’ IN THEORY ONLY We are starting to see a pattern in performance evaluations, with buildings designed with heat pumps that technically meet compliance targets, but only achieve their modelled performance under narrow operating conditions. In use, facilities teams raise flow temperatures to deal with cold complaints at the perimeter, slow heat-up times or control instability. The heat pump still runs, but at a lower coefficient of performance (COP). Electricity consumption rises, carbon intensity increases during peak grid periods, and We are starting to see a pattern in performance evaluations, with buildings designed with heat pumps that technically meet compliance targets, but only achieve their modelled performance under narrow operating conditions OH4-wrapped pipes – an energy-saving technology designed for water-based heating and cooling systems that uses ‘magnetically programmed’ technology to restructure water molecules, reducing fuel usage and carbon emissions DECARBONISATION
healthcaredm.co.uk 21 DECARBONISATION 1. What is our target peak system flow temperature and has it been defined early enough? 2. Is the building genuinely designed to operate at 35–50°C or are we relying on legacy high-temperature assumptions? 3. Has the façade design been tested against perimeter heat loss and patient comfort requirements? 4. Are emitters properly sized for lowtemperature operation, or will they force higher flow temperatures in winter? 5. Have we allowed sufficient space for larger emitters, underfloor heating or alternative low-temperature strategies in services-dense clinical areas? 6. Does the zoning strategy reflect the different thermal behaviours of wards, theatres, diagnostic suites and admin spaces? 7. Have return water temperatures been modelled under realistic 24/7 healthcare operating conditions? 8. Is the system robust at part load, and will it remain efficient when occupancy patterns change? 9. Are facilities teams equipped and trained to manage seasonal optimisation and avoid unnecessary temperature increases? 10. If patient comfort complaints arise, can they be resolved without simply raising flow temperatures and undermining efficiency? Ten questions healthcare estates directors could consider about low-temperature heat the operational performance gap widens. On paper, the building is all-electric and therefore ‘low carbon’. In reality, it is working much harder than necessary to deliver the same comfort. True net zero readiness is not just about swapping the heat source. It is about ensuring the building can maintain comfort at the lowest practical system temperatures from day one. HEAT TRANSFER EFFICIENCY MATTERS AS MUCH AS HEAT GENERATION There is an understandable focus on the carbon intensity of heat generation, but we talk far less about the efficiency of heat transfer within the building. Yet improving heat transfer can deliver carbon savings just as significant as selecting a marginally more efficient heat pump. Architects and specifiers influence this more than they might think. The choice to prioritise floor build-ups that can accommodate underfloor heating, to allow wall space for larger radiators, or to design façades that reduce perimeter loads, are all decisions that support low-temperature operation. If low-temperature heat is treated as a core performance objective from concept stage, the design conversation changes. Some practical questions worth raising at RIBA Stage 2 include: • What is our target system flow temperature at peak design conditions? • How does the façade strategy affect perimeter heat loads? • What emitter strategies are we assuming? • Are plant space and riser routes sized for higher flow rates? • How will different space types be zoned and controlled? In doing so, the team can test whether the architectural concept is aligned with low-temperature operation, rather than assuming it can be engineered in later. By technical design, RIBA Stage 4, the focus shifts from principle to proof. Useful questions at this stage include: • How will facilities teams be supported to manage and optimise the system in a live clinical environment? • What are the calculated return water temperatures under typical and peak loads? • Are emitters sized based on realistic room temperatures and occupancy patterns? • How robust is the system to partload operation? • Is there a clear strategy for commissioning and seasonal optimisation? • What happens if occupants override setpoints or change usage patterns? DESIGNING OUT THE PERFORMANCE GAP The industry has made huge progress in reducing fabric heat demand and adopting low-carbon technologies. But if we continue to design buildings around legacy assumptions about heat distribution, we will undermine those gains. The performance gap is often discussed in terms of construction quality or controls. This is important, but so too are the design decisions that quietly determine whether a building can ever operate efficiently at low temperatures. The conversation around net zero design seems to be changing, which is a good thing, and we are now having more discussions with architects and specifiers not just about the generation of heat, but also about how effectively we can deliver it. ■ www.edenenergypartners.co.uk The ability of a building to operate at low flow temperatures is largely determined long before the detailed services design is finalised
Healthcare Specialists Axis has over 37 years of experience and expertise working across all sectors and has earned a serious reputation as a market leader in healthcare solutions with the company’s end-to-end abilities to: • Innovate & Design • Manufacture & Test • Supply & Install • Service & Maintain Axis is an active member and contributor to the Architects for Health network and also has the coveted award of a place on the ProCure23 Recommended Suppliers List enabling the company to continue contributing to new build, refurbishment & maintenance projects within NHS properties, across the UK. Transforming Healthcare Delivery Axis manufactures the innovative Flo-Motion® manual sliding door system, developed specifically for the healthcare sector. The Flo-Motion® door system was first conceived, designed and developed in-house by Axis, while working with architects BDP and main contractor Laing O’Rourke on the new, state-of-the-art, Alder Hey Children’s Hospital in Liverpool, which opened in 2015. The doors have extruded aluminium profiles, a self-supporting goalpost frame and use re-circulating ball guides on a low resistance linear track with an ingenious damper, which absorbs the energy of the heavy doors for fingertip control. The operation force of 10N is astounding for doors of this size and weight. The Flo-Motion® range, which now includes single, bi-parting and telescopic doors, was an instant success with David Houghton, the Project Manager for Alder Hey Children’s Hospital, stating: “The extra-large, easy opening, glazed sliding doors have transformed the way single rooms work to deliver healthcare.” Multi-Award-Winning Awards for Axis and their Flo-Motion® door range also followed, including: • Laing O’Rourke Award for Innovation • IHEEM Product Innovation Award • BBH Best Internal Building Product Award • European Healthcare Design Award EPD Verification for ‘Top 10’ Doors In 2024, the Top 10 most specified doors in the Axis Flo-Motion® range all received the Environmental Product Declaration, from the Building Research Establishment (BRE). “We’re very proud of the sustainable benefits of our doors, which help specifiers too, with the increasing responsibilities they have, for delivering buildings more sustainably.” Explore Flo-Motion Doors Online Architects, specifiers and main contractors can explore Axis Entrance Systems and their Flo-Motion range online, on the BIM Object and the NBS Source platforms, as well as the company’s own website: www.axisentrances.com World Class Partners Perfectly complementing their Flo-Motion® range of manual sliding doors, Axis is proud to also have UK distributor partnerships with both Doorson and Manusa – two world class innovators and manufacturers of advanced automatic sliding doors and access systems. See the Doors in Action Visit the Axis team and see the latest product developments and innovations in healthcare doors at Healthcare Estates Exhibition 2025, at Manchester Central, in October – you’ll find Axis on STAND F20. More and more architects, specifiers and main contractors on healthcare projects are reaping the benefits and outcomes of working with Axis Entrance Systems and their world class range of: “Making an Entrance” • Manual Swing & Sliding Doors • Automatic Swing & Sliding Doors • Hermetically Sealed Doors E: sales@axisentrances.com www.axisentrances.com For enquiries & more information: T: 01604 212500 Axis MD, Rob Brunero
healthcaredm.co.uk 23 PROJECT The Whitechapel Healthcare and Research Campus A £750m healthcare and research campus in Whitechapel aims to relieve pressure on The Royal London Hospital, deliver affordable homes for key workers and embed life sciences innovation at the heart of East London. We look at what to expect A major new healthcare and research campus in Whitechapel is poised to reshape the future of clinical provision, life sciences innovation and key worker living in East London. Submitted for planning in January 2026, the £750m, 1 million sq. ft scheme forms part of the newly announced Barts Life Sciences Cluster and is projected to add £1bn annually to the UK economy while creating 1,325 jobs. Led by global real estate investment manager BGO in partnership with Barts Health NHS Trust, the proposals bring together an extensive consultant team including PLP Architecture, dMFK, DSDHA and BD Landscape Architects, alongside Avison Young, Sweco, AKT II, DP9 and GIA. Together, they set out a new model for co-locating NHS services, research, housing and public realm within a dense urban life sciences quarter. At its heart, the Whitechapel Healthcare and Research Campus seeks to relieve mounting pressure on The Royal London Hospital, one of the capital’s busiest and most overstretched teaching hospitals, while delivering affordable homes, green space and community facilities in an area facing acute health and socio-economic challenges. ADDRESSING PRESSURE ON THE NHS Healthcare in London is under sustained strain, with ageing infrastructure, growing demand and workforce shortages combining to test capacity. The proposed campus is designed to respond directly to these pressures. Central to the scheme is a new 64,427m² clinical and research building designed by PLP Architecture. The facility will accommodate modern outpatient and clinical research functions, freeing up >>
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