Standardised design creates a thriving NHS

Across the UK, the NHS is struggling with budget constraints, ageing infrastructure, and maintenance backlogs, compounded by rising patient demand and staff shortages. This situation is fraught with peril — particularly in underserved and rural areas. How can we, as architects, help keep the NHS not only functioning but thriving in such locations? The answer lies in a deep understanding of what can be standardised and how best to work with stakeholders to reduce costs and time, ensuring high-quality designs delivered on time to those in need.

These new facilities must be conceived as hubs that include primary care, midwifery, mental health, diagnostics, rehab, and elderly step-down services to reduce pressure on hospitals. With such varied demands, architects should design them as standardised, template-based designs scaled and adapted to local needs. They should be presented as networked, tiered facilities that relieve acute hospitals, streamline patient pathways, and enable preventive care.

NHS’ Project Wings is gearing up to develop new private finance models gleaning insights from public-private models from a Public Private Partnership (PPP) and NHS Local Improvement Finance Trust programme (LIFT) to execute vibrant community hub projects with primary care, remote monitoring, future-ready telehealth services, midwifery, district nursing, mental health, addiction support, light diagnostics, rehab, and perhaps even elderly step-down care and social care.

A new era for care

In 2025, the government announced the launch of its Neighbourhood Health Centres programme, a key part of a new 10-Year Health Plan, which aims to move care out of hospitals and into community settings. The 2025 autumn budget suggested plans to deliver 250 neighbourhood health centres, and set targets to deliver 100 of these across England by 2030 to tackle the root causes of ill health and reduce dependence on acute hospitals. The initiative aims to address health inequalities by integrating social care, mental health support, and other localised services.

Rural areas are in need of this type of diverse support if they are to continue supporting generations to come, and must prioritise people with long-term conditions, older adults, babies, and children. Rural and facilities in underserved areas must offer dignity and belonging to patients, and help to attract and retain staff. They are not simply smaller hospitals; when shaped around local needs, these facilities can deliver significant clinical and social impact. With flexible planning and experience led design, they can become hubs for hybrid care. Integrating design, technology, and community engagement will be essential to creating a strong blueprint for the UK’s next generation of Neighbourhood Health Centres.

Translating healthcare design expertise into the Neighbourhood Health Centres initiative represents a shift from fragmented service delivery to a model where care is shaped around people, place, and community. The ambition is to improve routine care for everyone, strengthen proactive support for people with complex needs, and create credible alternatives to hospital-based care.

Navigating the crisis

The NHS is crumbling, physically, with some of its facilities. It was starved of capital in the 2010s, with £37bn in underinvestment, meaning the country did not build enough new hospitals to keep up with demand today.

The Neighbourhood Health Framework is positioned as a complement to the New Hospital Programme (NHP), established in 2020. Both programmes are tasked 
with identifying ways to improve the efficiency 
and quality of health facility construction, whether large-scale acute hospitals or smaller projects, through a centralised approach. Both Royal Liverpool University Hospital (RLUH) and Midland Metropolitan University Hospital (MMUH) are part of the New Hospital Programme, which our practice has been directly involved with.

Neighbourhood health is central to the government’s aim of shifting care from hospitals to communities and from treatment to prevention. Rural and underserved areas require new care models that improve connectivity and access, supported by scalable infrastructure, repeatable layouts, and transferable design logic. NHS strategy is moving between centralised acute hospitals and community focused hubs to widen access, infrastructure essential nationwide, particularly in rural and underserved regions.

The Neighbourhood Health Centres Initiative is an efficient, cost-effective way to provide our NHS with the future-proofed buildings it needs. A standardised approach, whether for large or small projects, aims to systematise design to ensure value for money and support delivery. Historically, NHS hospitals have been built individually by trusts and funded by public finances, with projects often over budget and delayed. We need a credible approach with a focus on standardising plans with future flexibility, as well as a more accurate delivery timeline.

A standardised design considers the whole project, from the outside and the inside, and can have a net-positive impact on its staff, patients, and the environment. It can support client trust and partnerships and deliver credibility. Having a model that can be replicated with slight tweaks, and a scalable framework with transferable approaches is invaluable, with specific design details ranging from adaptability and flexibility to materials and access to nature and natural light.

Designing for impact: standardisation as a tool for excellence

All projects have budget constraints and keeping this at the forefront of mind in design is crucial. Learning how to balance aesthetics with budgets is a critical part of the design process. Community health centres need to be about bringing care closer to home, with comprehensive facilities where patient safety and the personal level of care are major factors, alongside design components such as construction, layout, and interior details.

Design thinking is critical, and with it comes a range of tools that directly support the neighbourhood health agenda, from human-centred insights to inform neighbourhood models and reflect what communities value to an understanding of the user experience of navigating services. Architects’ design experience includes considerations for user experience, operational modelling spans variable estates, and understands clinical services strategies.

Our work as designers also includes systems mapping to help Integrated Care Boards and local authorities understand patient pathways; prototyping and developing new models of care and new physical environments before scaling; and place-based design, including understanding location, orientation, and building context, and their impact within the community.

One specific design element from our work that felt radical at the time but could actually be the ‘silver bullet’ for a modern rural health hub is thinking about the grid. Applying a single structural grid to align parking, outpatients, theatres, diagnostics, and wards has proved effective at Midland Metropolitan University Hospital and can be scaled for other, more remote centres.

Despite MMUH’s large scale and acute services, including a children’s emergency department, 13 operating theatres, a midwife-led birthing unit, and a regional sickle cell centre, the design aims to be a community hub. Its structure can be scaled down for rural areas. The hospital uses a standardised 7.8 x 7.8m structural grid, allowing for easy adaptation of spaces to future needs. The grid is a stacked shape, with car parking, outpatients, and emergency/diagnostics arranged in a very efficient manner. Such stacking and massing of different rooms and types ensured accuracy and successful construction. The grid approach lends itself to design for manufacture and assembly (DfMA) and modern methods of construction (MMC), making it ideal for rural locations.

Standardised structural grids are key in anticipating the inevitable future service reconfigurations required to meet changing demographics and policy, emerging technologies, and future service expansion. Standard room design creates more agile facilities where clinical spaces can become multi-functional, accommodating a wider range of services to maximise their utilisation. Healthcare buildings are expensive to build and as designers we must ensure that every square metre provides better value for money through higher productivity, accommodating the broadest range of occupants and services possible. Well-considered design of these new facilities will balance a standardised building system alongside a thoughtful use of local materials and details, to ensure that the building is of its place and encourage a feeling of community ownership. The rural Health Centre needs to link back to acute care as a mini hospital — the first point of call.

The benefits of biophilic design

There is also immense benefit to consider biophilic design, including views to the outside, and landscaping. An example of this would be a transparent ETFE roof, like that at MMUH, to bring sunlight deep into the core of the facility. These design choices create a calm, light-filled space for patients, staff, and visitors.

Working from the outside inwards, a detailing of interior components, including paint colour, materials, fabrics, and finishes, can also have an enormous impact on the long-term success of the initiative. Another component to integrate into the framework is virtual care or telehealth.

Of course, in health facilities, we must avoid live plants and running water for infection control, and choose materials that can withstand cleaning and clinical use. However, there is potential to pursue daylight, views, and biophilic strategies by embracing the surrounding landscape in the design. We should design projects at a human scale, blending nature with built spaces more organically and cohesively, and including access to courtyard gardens and external areas. For rural projects, there is so much more opportunity to soften the design, with natural materials such as wood with coatings or sealants and different laminates for a more domestic feel.

There are ways to design and live up to what needs to be done, and to balance the practicalities of working in healthcare and around infection control standards. Materials inside can be more natural, making the healthcare facility feel more domestic and comfortable, like a home.

There are innovations in materials and products that should be adopted, with higher-end finishes for look and feel, yet remain durable for healthcare environments, rather than the typical hospital plastic upholstery. Manufacturers are developing softer, more domestic products for health uses that reduce the clinical aesthetic.

Creating visual identities

Interior design strategies can also enhance wayfinding, helping to define public spaces and guide users through facilities by creating visual identities to describe spatial hierarchies. Where building zones and public areas are identified using colours and material finishes, the need for directional signage and visual clutter is reduced, creating a less institutional and consequently more welcoming atmosphere. This approach becomes particularly useful where zones may be occupied by different services on different days of the week.

Proper use of colours can promote a variety of benefits, from healing and reducing stress to improved wayfinding and navigation, from careful colour choices and dementia-friendly designs for patients living with dementia, to places for children where colour can foster fun, less frightening environments, as well as calming, restorative atmospheres for patient rooms and waiting rooms.

Recently designed patient rooms incorporate high-quality, adjustable detailing that allows control and comfort. For lighting control, patients can adjust room settings such as privacy curtains and both natural and artificial lighting. There is a way to balance privacy and dignity with corridor design and nurse access.

Culturally responsive design is essential, whether in rural Scotland or an English town, and global best practice can raise standards. Middle Eastern health projects, often influenced by hospitality design, offer useful cues. At King’s College Hospital in Jeddah, interiors use warm tones inspired by traditional wooden shading screens and sea foam accents. These refined approaches to the interiors can inform future rural healthcare interiors.

Restoring access and belonging in underserved areas

The new Neighbourhood Health Centres need to be first and foremost community centres. Although their locations will vary — from high streets to more spacious plots with parking — I believe many should be brought back to high streets for a more communal feel. As neighbourhood hubs, they should include GPs, but, depending on the needs of the locale, some should also include offerings such as a baby crèche, a nutritionist, a pharmacy, a physio, preventive health services, and even a library. On top of this, modern technology and the digitisation of health should be supported. They should be flexible spaces, with areas for health practitioners to perform virtual calls and assessments.

In rural areas, we typically have GP services very much just for nurse practitioners and GPs. Decades ago, they were more likely to be the family doctors you grew up with. How do we maintain that connectivity while also supporting the government’s desire to reestablish Neighbourhood Health Centres that are thriving 30 years from now?

Well-designed community spaces can help to provide a more patient-focused environment which encourages those individuals who might otherwise be less inclined to visit a healthcare facility to engage with the system. These are often more vulnerable or isolated members of the community who might visit a library or cafe space, where healthcare staff can informally offer social prescribing, group therapies and identify those who would most benefit from community services. Careful planning and design of welcoming public spaces and complimentary community facilities can help to support a more preventative model and a truly integrated system.

The design of these Centres must also create a fantastic working environment for staff, where they feel valued and motivated to Deliver high-quality care. This is especially important in rural areas where Community teams often work in isolation. Well-designed offices, training spaces and welfare facilities can bring individuals, and disciplines together reducing isolation. Careful acoustic treatments and booths for confidential conversations in high quality open-plan offices with good views and natural daylighting can help to encourage a feeling of combined purpose and encourage interaction between clinical teams — and will be vital to foster a more integrated approach to community healthcare.

Neighbourhood health is ultimately about shifting power closer to communities. Many of the best ideas will come from residents, frontline teams, and local partners. Design expertise helps create the conditions in which those ideas can surface, be tested, and be embedded in the system. Architects’ experience in healthcare design will help articulate how these centres can become catalysts for neighbourhood transformation rather than just new premises. They are not simply buildings, but platforms for integrated working, reflecting local identity and community ownership, strengthening trust and engagement, and user-centred design.