Supporting NHS Left Shift: Designing Flexible, Multi-use Clinical Spaces

Designing Around the Patient Journey

There is a real risk that care closer to home becomes little more than a redistribution exercise – moving activity out of hospitals without genuinely improving how patients move through the system. Scattered clinics, disconnected hubs and standalone facilities may shift services geographically, but they can easily recreate the same inefficiencies in new locations. Effective community infrastructure must do more than decentralise care. It must bring services together in a way that makes clinical and operational sense. Adjacency between urgent treatment, GP provision and diagnostics is what makes the patient journey work. If a patient can consult, receive imaging and complete blood tests in a single visit within one integrated setting, the system saves time, reduces duplication and improves experience and outcomes. If those services are spread across separate buildings or disconnected estates, the inefficiencies simply reappear elsewhere.

The redevelopment brought up during the discussion illustrates this principle clearly. The estate in question was originally built as wartime wards: long corridors, limited ventilation and layouts that proved impossible to segregate safely during COVID.  Earlier proposals had suggested building a completely new hospital over the old one which would’ve been a five-year programme with significant disruption and no obvious solution for maintaining continuity of care. Instead, the team took a different approach. They condensed the required functions into a smaller, purpose-designed footprint on part of the existing site, allowing services to continue operating throughout construction.

The new arrangement places a UTC and GP practice side by side, each with its own entrance and triage flow but designed to flex together. Out of hours, the UTC could expand into GP space. During quieter periods, that footprint could contract again. Directly connected to this cluster sat a Community Diagnostic Centre – MRI, CT, X-ray and ultrasound – creating a compact and intuitive pathway that reduced unnecessary movement across the campus. The building was reshaped to reflect the clinical journey, rather than the historical logic of the estate. The result is a smaller building that simply works harder, is flexible enough to respond to demand and designed to support better care.

Making Every Square Metre Work Harder

One of the strongest themes from the discussion was the need to stop designing rooms around specialties and start designing them around what they are capable of doing. Across much of the NHS estate, space is effectively “owned.” Departments are allocated rooms on a permanent basis, even if those rooms are only used for part of the week. Over time, this creates an inflated footprint, higher capital costs and buildings that look busy on paper but are underused in reality. The alternative is not radical architecture; it is thoughtful standardisation. By designing repeatable clinical rooms to consistent sizes and specifications, spaces become adaptable. It can support different services at different times without structural change. The room is no longer defined by the plaque on the door, but by what it is equipped to do.  As Banfield noted during the discussion, “Take the name off the door, look at the space and how you use that space.”

That simple shift in mindset has significant implications. A room used five days per week by different services is fundamentally more valuable than one used twice weekly by a single provider. Flexibility in this context is not an abstract design aspiration but a utilisation strategy.  When rooms are designed around capability rather than ownership, utilisation improves, costs are better controlled and flexibility becomes embedded rather than bolted on.

Starting with Clinical Process

Another recurring theme throughout the discussion was the order in which projects begin. Too often, schemes start with room schedules, compliance checklists and spatial templates. The drawings take shape before anyone has fully unpacked how services actually operate. The result is technically compliant space that doesn’t always reflect the realities of clinical practice. Dickson and Banfield argued for turning that sequence around. Before a single line is drawn, there needs to be a clear understanding of how patients move through care, how clinicians work, what equipment is required, where storage sits and what infection control truly demands. Design should follow that conversation, not lead it.  Banfield was clear on this point, “Don’t tell me what you want, tell me what you need.” This is an important distinction, clinicians may ask for particular room because that is what they have always had, but when you unpack the workflow, the requirement often looks different. Getting this right demands early collaboration between clinical teams and those responsible for delivering the estate. It also requires openness on both sides, which historically has not always been easy, but without that early, honest engagement, flexibility risks becoming cosmetic – rooms that look adaptable on plan but don’t quite work in practice.

Intelligent Zoning

Flexibility does not mean building every room to the highest possible clinical standard. In fact, doing so is one of the fastest ways for a project to become unaffordable. If every space is ventilated to treatment‑room levels and equipped for complex procedures, both capital costs and long‑term M&E burdens rise sharply for very little gain.

A more intelligent approach is to zone the building: place higher‑spec, higher‑acuity rooms where they are genuinely needed, and position lower‑intensity consultation or assessment rooms around them. This creates a layout where specialist clusters sit alongside more general spaces without compromising safety, adaptability or patient flow. As Dickson and Banfield stressed, flexibility isn’t about preparing every space for the most extreme scenario “just in case.” It’s about understanding the foreseeable range of activity and designing in a way that uses infrastructure wisely. Intelligent zoning gives teams the adaptability they need while keeping the estate economical to build, run and maintain.

A Stronger Value Proposition

At a time when capital is tight, the financial argument for flexible community infrastructure is hard to ignore. Smaller, smarter buildings do not just support better clinical flow, they make better use of every pound spent. When facilities are designed around clusters of activity rather than over-specifying every room, mechanical and electrical costs stay under control. When rooms are used consistently throughout the week, operational efficiency improves, and when spaces are designed to adapt, expensive refurbishments become less frequent and less disruptive. Over the lifetime of a building, those gains add up.

With large-scale hospital programmes under increasing scrutiny for cost and pace, flexible community hubs present a different proposition. They are smaller, more repeatable and easier to scale across systems, and most importantly, they allow investment to be distributed in a way that responds to real demand rather than concentrating risk in a handful of mega-projects.

A Practical Checklist for NHS Trusts

For organisations looking to turn the left shift into built reality, the conversation highlighted a clear set of actions:

• Start with the patient journey: Map clinical pathways in detail before design begins. Understand how patients move, where delays occur and what services truly need to sit side by side.
• Design rooms around capability: Avoid permanently allocating space to single specialties. Standardise room sizes and specifications so spaces can flex between services as demand changes.
• Cluster Complementary services: Co-locate urgent treatment, primary care and diagnostics where possible. Adjacency reduces duplication, shortens journeys and improves flow.
• Zone infrastructure intelligently: Do not over-specify every room. Identify where higher acuity requirements genuinely sit and concentrate mechanical and electrical intensity there.
• Test utilisation assumptions: Model how space will be used across the week. A room used five days per week by multiple services delivers significantly greater value than one used part-time by a single team.
• Bring clinicians and delivery partners together early: Challenge assumptions before scope is fixed. Collaboration at the front end prevents costly redesign later.
• Plan for adaptability from day one: Assume services, technology and demand will evolve. Design spaces that can accommodate change without major structural intervention.
• Link estate strategy to financial reality: Smaller, repeatable, high-utilisation hubs are more scalable across systems than single, large capital projects.