The Evolving Role of Standardisation in Healthcare Environments: Insights from the Future HealthSpaces Round Table

At a time when the health system is under acute pressure to deliver more for less, the role of standardisation in healthcare infrastructure has never been more contested — or more consequential. The recent Future HealthSpaces round table convened a diverse cross-section of NHS Trusts, designers, manufacturers, contractors, and policy influencers to explore the evolving opportunities and limitations of standardisation as a lever for system-wide improvement.

The discussion was incisive, pragmatic, and — at moments — fiercely candid. While the benefits of standardisation were acknowledged across the board, it became clear that its implementation must be balanced against the imperative to maintain human-centric design, safeguard clinical functionality, and retain flexibility for site-specific nuance.

This summary outlines five critical insights emerging from the session:

1. Wellbeing Is Not a Standardisable Metric

Perhaps the most profound point of consensus was that patient and staff wellbeing cannot — and should not — be subject to rigid standardisation. As a contributor noted, “wellbeing isn’t standardised” — a reminder that while efficiencies in design and construction are essential, the lived experience of the built environment must remain a primary consideration.

Examples such as the removal of the “starry night” ceiling feature at Great Ormond Street Hospital (GOSH), sacrificed due to the adoption of a standardised 600x600 ceiling system under value engineering constraints, underscored the tangible trade-offs between cost containment and therapeutic value. Standardisation, when applied indiscriminately, risks eroding the very qualities that make healthcare environments humane, responsive, and dignified.

2. There Is an Urgent Need for Enforceable, Performance-Based Specifications

Several participants highlighted the inadequacy of current specification frameworks, with calls for more rigorously enforced, performance-based standards that better reflect contemporary clinical needs and construction realities. HBNs and HTMs were frequently cited as outdated or insufficiently precise.

The experience of Russell James — who led an initiative to consolidate 752 door variants into just eight on a major healthcare project — served as a powerful case study in the cost, maintenance, and procurement benefits that intelligent standardisation can deliver. Yet the ability to implement such reforms systemically will depend on greater alignment between clients, specifiers, and manufacturers — and a willingness to police non-compliant substitution.

3. Value Engineering Has Become a Misnomer for Risk Management

Throughout the discussion, it became evident that the term “value engineering” has drifted far from its original intent. Rather than delivering genuine value through optimisation, it is now frequently deployed as a euphemism for reactive cost-cutting — often at the expense of long-term functionality, user experience, and clinical adaptability.

A couple contractors and consultants pointed to a range of projects that began with robust design intent but were progressively diluted due to inflation, shifting capital timelines, or programme uncertainty. In many cases, cost plans were not adhered to or revisited with sufficient rigour, leading to reactive decisions that undermined original objectives. True value, it was argued, can only be protected through earlier alignment on scope, clearer cost forecasting, and protected budgets that reflect the realities of healthcare construction cycles.

4. A Systems-Based Approach to Standardisation Is Needed

The idea that standardisation must begin with the “chassis” — the base infrastructure of the hospital — and build upward in logical, tiered layers, emerged as a unifying theme. Borrowing from the automotive sector, speakers proposed a structured hierarchy: standardising departments and suites first, then rooms, then fittings and components.

This systems-based model allows for repeatable efficiencies in back-of-house and clinical support areas, while preserving flexibility in high-touch patient zones where therapeutic outcomes and experience vary by specialty. Such an approach also supports better interoperability between systems, particularly where Modern Methods of Construction (MMC) and platform-based design are involved.

However, the success of such a model depends on early, multidisciplinary collaboration — particularly between clinical stakeholders and design teams. As a clinical contributor observed, clinical teams often lack familiarity with estates strategy, while estates teams may not fully grasp the clinical implications of spatial decisions. The earlier these worlds converge, the fewer compromises are made downstream.

5. Standardisation Must Not Preclude Idiosyncrasy

Finally, a critical insight emerged around the need to preserve space for local context, clinical variation, and cultural nuance. Whether in relation to seclusion spaces in mental health units, bariatric care, or paediatric environments, the group agreed that a degree of idiosyncrasy is not only acceptable — it is essential.

As discussions around the “80/20 rule” illustrated, the future of standardisation in healthcare lies not in wholesale uniformity, but in strategic consistency. Eighty percent of the design — the core — can and should be standardised to streamline procurement, construction, and maintenance. The remaining 20 percent must remain open — to accommodate emerging technologies, local needs, patient voices, and the evolving nature of clinical practice.

Conclusion: Towards a New Standard for Standardisation

What emerged from the Future HealthSpaces round table was not a rejection of standardisation, but a desire to do it differently — more intelligently, more collaboratively, and with a deeper sensitivity to the complex interplay between cost, care, and context.

The next phase must focus on developing practical toolkits, robust specifications, and shared protocols that elevate consistency without compromising humanity. The NHP, in partnership with industry, has a unique opportunity to lead this transition — not by enforcing rigid templates, but by enabling a smarter standard: one that delivers system value, local adaptability, and long-term resilience.

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