Clinical staff are the experts in how healthcare buildings could run better. Capturing their perspective is the key to avoiding a two-tier healthcare estate, says Wayne Ashton, a former paramedic and head of healthcare planning at Ridge.
The government’s reset of the New Hospital Programme means that the final wave of projects will not be completed until 2046. Many trusts had postponed investment in expectation of a new building. Now they need a plan B to keep departments and services functioning in the medium term. Without a clear strategy, there is a risk of creating a two-tier healthcare estate, where some patients and staff benefit from modern facilities while others continue to rely on ageing buildings that were never designed for today’s models of care.
My healthcare planning team at Ridge are working with a number of trusts, helping them to manage legacy facilities while modernising care. Having worked as a paramedic, I have seen first-hand how clinical teams adapt their practice to work around the limitations of outdated buildings. My colleagues include a former nurse and a project manager within a hospital trust and the ambulance service – so we know how important it is to engage with frontline staff, and understand their operational challenges and day-to-day pressures.
Clinical staff are experts in healthcare delivery. They understand where delays occur, where patient journeys break down, what works well and what creates inefficiencies.”
Wayne Ashton
Project Manager, Partner and Healthcare Planning Lead
Too often, organisations start with the floorplan rather than the patient pathway. That skips a key thinking stage, and it risks reproducing current constraints and limitations in a new layout, or creating a solution that won’t meet changing clinical practices or needs. A clinical design brief gives everyone a clear, shared, evidence-based understanding of what the design needs to achieve.
There’s no need for a lengthy exercise if you’re converting a store room into a clinical area. But if you need to relocate or expand an intensive care unit or an emergency department, it’s an opportunity to really think about how your space is working, and to sense-check how best to enhance it for patients and staff.
Start with the people, not the space
Clinical staff are experts in healthcare delivery. They understand where delays occur, where patient journeys break down, what works well and what creates inefficiencies. The role of the healthcare planner is to capture that expertise and translate it into clear requirements for the design team.
We engage with department leads and clinical staff in their language. The focus is on what they do, where they go, their challenges and frustrations, what the future might look like. Sometimes we shadow them for a day. If it’s an operating theatre, we want to know where the pre-op takes place, how long patients are in theatre, where the anaesthetics and gases are located.
The insights gained during these conversations and observations are often more valuable than information contained within drawings or schedules. They help identify opportunities to improve patient experience, staff workflows and operational efficiency before design solutions are developed.
How evidence-based decisions support good governance
A well-developed clinical brief is a governance tool as well as a design tool. It demonstrates that stakeholder engagement has been undertaken, options have been assessed and decisions are based on evidence rather than assumptions. Under the NHS business case framework, the brief aligns with the Strategic Outline Case stage – the upfront work to establish the rationale for a project, the context for change, and the options for achieving it.
Once we understand the clinical brief, we work with the project team to make sure it can be delivered within the space and funding available. We share best practice from other projects, and make sure that the solution follows NHS guidance and is compliant and safe. In some cases, we might construct a mock-up. On a recent MRI scanner refurbishment in Oldham we marked out the entry area on the floor and brought in a trolley, so the staff could make sure if it was large enough to bring a ventilated patient down for a scan.
Where there are hard limits on space, it may be necessary to agree a derogation from standards. The briefing phase can provide justification, by demonstrating that the proposed solution has been tested and is clinically functional.
Get ahead on operational readiness
As the design progresses, there will inevitably be compromises. We make sure that the brief is updated along the way, as it can become an invaluable reference for the operational readiness team as they seek to get the building up and running as soon as possible after completion. They can use the information it captures from clinical staff to maintain continuity, and to devise policies and procedures for running the building efficiently. Getting the brief right means facilities will function better, go live more quickly and offer better value for money.
Hospital buildings exist to support the delivery of care, not the other way around. The most successful projects are not defined by the quality of the architecture alone, but by whether they enable staff to work efficiently and patients to receive care safely, in the best possible environment. Rather than seeing the brief as a tick-box exercise, we think of it as a catalyst for improvement. That’s important on any project, but especially so when you need a plan B.
Let's talk
Wayne Ashton is a partner at Ridge and leads our healthcare planning team. Contact him at wayneashton@ridge.co.uk.
Find out more about our work in healthcare, operational readiness and PFI/PPP advisory.
Wayne and colleagues will be at Stand G6 at the Healthcare Estates 2026, Manchester Central, from October 13 to 14 2026.
