An integrated decision support model for the sustainable refurbishment of hospitals and healthcare facilities: Developing a prototype

The National Health Service (NHS) is recognised as the largest public sector institution in Europe. This presents significant challenges in regards to operation and maintenance of the diverse built estate, and the ever-evolving clinical models of care. The economic downturn, and strict policy of austerity in the UK, presents limitations and challenges in capital investment. The majority of healthcare facilities which will be used throughout the 21st century, have already been built. This demands that solutions be found in the areas of asset maintenance and refurbishment. These challenges are complicated further, by the institutional and statutory requirements of the NHS to meet demanding sustainability targets. This in turn, is underpinned by exacting assessment methodologies and rating systems, and critically, an institutional 'duty' to pursue and evidence that 'value for money' has been achieved as far as reasonably practicable. The existing estate management tools were assessed by a process of triangulation, and the relevant decisionmakers and stakeholders from both the NHS and the Design Teams and Constructors were identified. The original contribution demonstrates the development of a novel decision . . . (continues)