Healthcare construction has always been demanding, but as healthcare facilities grapple with ageing infrastructure and urgent rebuilds, new Building Safety Act requirements are adding significant time to project timelines.
Working within live clinical environments and managing competing operational priorities leaves little margin for financial error. Yet cost overruns remain stubbornly common, driven by the complex, multi-stakeholder nature of the work and a rapidly changing regulatory landscape. Below are the five most common sources of cost loss in healthcare build projects – and how to avoid them:
ONE: Failing to extend planning horizons
The most significant change affecting healthcare construction today is the Building Safety Act, which classifies any building over 18 metres as a high-risk building and subjects it to a multi-stage gateway approval process. Since virtually all major acute hospital facilities are five storeys or more, the overwhelming majority of significant healthcare projects now fall within scope of these regulations. The gateway process, and Gateway 3 in particular, which has yet to be tested for a new build hospital, has the potential to add considerably more time to projects.
The cost implications can also be severe. Projects may reach physical completion, with wards fitted out and equipment purchased and delivered, yet remain unable to become operational while awaiting Gateway 3 approval. Extended pre-construction periods may inflate professional fees, but this investment pre-construction can offset the risks of achieving signoff, which in turn could add additional costs.
The solution is to extend usual planning horizons. If a facility needs to be delivered in two years, design needs to begin now. This represents a significant cultural shift away from the traditional approach of establishing the clinical model and then engaging the project team. The design process should ideally run in conjunction with clinical planning, rather than following it, to ensure all stakeholder requirements are embedded in both the design and operational planning phases at the earliest possible stage.
Cash flows should ideally be modelled across two to three years
TWO: Treating Gateway 3 as an afterthought
Of the 158 Gateway 3 applications submitted last year, 55 took more than three months to receive a decision, against an intended eight-week target. No new-build high-risk buildings that have gone through Gateway 2 have yet applied for Gateway 3, meaning the sector is heading into uncharted territory at precisely the moment when the pipeline of major hospital builds is growing, with the onset of the first wave of schemes to be delivered through the New Hospital Programme (NHP).
A central requirement of Gateway 3 is the maintenance of the "golden thread", a comprehensive, accurate and up-to-date electronic record of the building that demonstrates compliance with Building Regulations throughout the project lifecycle. Organisations that treat this as a documentation exercise to be completed at the end of a project, rather than a continuous process maintained from day one, will face delays and additional costs at the submission stage.
Planning for Gateway 3 from the outset, and ensuring that safety information is created, maintained and shared electronically throughout the project, is the best solution.
THREE: Failing to account for
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