Medical and Healthcare Fit-Out

The services decide the plan. The finishes only decorate it.

Every room in a medical premises is defined by what has to reach it. Ventilation to the standard the room's use calls for. Hot and cold water that will not sit and stagnate in a dead leg behind a hand-wash basin. Electrical capacity and resilience for equipment that cannot lose power mid-procedure. Sometimes medical gases. Where those runs can go, and what the existing building can carry, is what decides how many usable rooms a floor plate holds.

That is why the survey happens before the design. On a conversion of a former office or retail unit it is usually the survey that determines the room count, not the layout. On a refurbishment of a clinic that is already running lists, the ceiling void and the riser are where the risks are hiding, and finding them at week four of a programme is what turns a fixed price into a variation. A clinic laid out first and serviced afterwards produces rooms that look right on a drawing and cannot be commissioned.

Four, and only two of them are law.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are what the Care Quality Commission registers and inspects against in England. They place duties on the registered provider about the premises and equipment used, and regulation 15 is the one that reaches the building itself.

The Health Building Notes, published by NHS England, are the design guidance: what a room type is for, what has to fit in it and how people move through it. The Health Technical Memoranda, from the same publisher, are the engineering: HTM 03-01 for specialised ventilation, HTM 04-01 for safe water, HTM 06-01 for electrical services and HTM 02-01 for medical gas pipeline systems. They are written for NHS estates and they are the reference private clinics are measured against too, because there is no separate private standard.

IRR17, the Ionising Radiations Regulations 2017, covers radiation protection for staff and the public: the risk assessment, controlled areas, local rules and signage. For the building that means shielding to your adviser's specification, a controlled area that is physically marked out, and warning signs at the door.

IR(ME)R, the Ionising Radiation (Medical Exposure) Regulations 2017, is the fourth and it is the one most often misapplied. It governs the exposure of patients to ionising radiation in medical and dental settings, and the Care Quality Commission enforces it in England. It does not apply to veterinary practice, where radiography sits under IRR17 alone. If a supplier quotes IR(ME)R for a veterinary imaging room, they have brought the wrong document.

Three routes into the same building, and the constraints differ more than the finished rooms do.

Clinic design starts from the patient journey and the clinical adjacencies: where patients arrive and wait, where they are seen, where a procedure happens, where clean and dirty utility sit relative to it, and how staff move between those rooms without crossing a dirty route. Refurbishment applies that to premises that are already running lists, which is harder and is most of our work. Conversion of a unit that was never clinical adds services, drainage and sometimes structure to the list, and is the route most private clinics take into a new site.

The same discipline runs through a practice fit-out of a shell unit, a phased programme in a live clinic, a full practice refurbishment and, where the building does not exist yet, new build construction. The services element can be taken on its own as mechanical and electrical work. Room types have their own specialist room pages, dental and the other sectors we work in are described from the sectors page, and completed projects appear on our work pages as each client releases its material.