2012 recipients

Steve Wolstenholme

The design of health buildings in a time of austerity

As a piece of practice-based research, the outcome of this research aims to be a published practical and relevant design guidance, drawn from the past experience of the practice Stanhope Wilkinson Associates (SWA).

Following a brief period of apparent national affluence, ready availability of private finance, and high - sometimes over-reaching - political aspirations for the creation of new health buildings, the NHS is once again faced with stringent capital constraints.

The former financial extravagance of PFI procurement was coupled with comparable ambition within the NHS Estates' design guidance of the same period; this was an era when 'consumerism' entered Estates' vocabulary and enjoyed the allocation of specific funding; and when single-room inpatient accommodation was increasingly advocated.

But in the aftermath, much of the NHS built estate remains as it ever was; an accumulation of over a century's-worth of disparate buildings, needing to be adjusted, adapted and modestly extended, with the most limited of capital resources, to try to accommodate the shifts and turns of evolving health policies, technologies and medical practice.

The proposed research aims to demonstrate, through real-world examples taken from experience in practice, how appropriate and necessary economies can be achieved.
The approach will be to select examples of buildings from SWA's extensive past experience and archives, as well as similar examples drawn more widely; to group them by health building categories (diagnostic imaging, theatres, wards, outpatients) and to analyse them spatially and graphically.

The intention will be to illustrate comparative layouts, circulation, clinical equipment and above all, space standards; in order to directly compare actual cost-effective and space-efficient real-world design solutions, against the more abstract and idealised standards promoted through Health Building Notes and other design guidance.


Steve Wolstenholme is a partner at Stanhope Wilkinson Associates (SWA).

Much of his professional life has focussed on the design and construction of health buildings, initially with the Oxford Regional Health Authority (ORHA) and subsequently in private practice. He joined SWA in 1993. Over this period around 60% of the practice's experience has been in the field of health buildings. Most of these projects have been in the context of active hospitals and many have involved the adaptation and extension of existing buildings. 

Steve has also conducted design research and contributed to design guidance, commissioned by NHS Estates in Leeds, and comprising:

  • Co-authoring Health Building Note (HBN) 6, Facilities for Diagnostic Imaging
  • Contributing technical design guidance to HBN 13, Sterile Services

Top of page