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In the complex landscape of healthcare facility design, the NHS Health Building Note (HBN) design guidance programme stands as a cornerstone for creating environments that serve patients and practitioners alike. These technical documents represent more than mere specifications—they embody a philosophy that places clinical effectiveness, patient experience, and operational efficiency at the centre of healthcare infrastructure.
As a result, the HBNs address a fundamental challenge in healthcare design: to create spaces that balance the technical and operational requirements of modern medicine with the human needs of those who use them.
Murphy Philipps has been privileged to contribute to the development of this essential body of knowledge, and through this involvement, we have developed a historical perspective of the NHS design guidance programme.
The roots of today's HBNs trace back to the early 1960s, when the NHS first formalised hospital design guidance. In the post-war period, the focus was primarily on standardisation and efficiency, reflecting the modernist architectural principles of the time. Early guidance documents emphasised functional layouts with clear departmental segregation, standardised room sizes, and modular construction methods—a response to the urgent need to expand healthcare infrastructure during a period of significant population growth. As a result, these early iterations of HBNs, strongly reflected the hospital-centric model of healthcare delivery prevalent at the time.
By the 1990s, the guidance began shifting toward a more patient-centred approach. This period saw the incorporation of evidence about the impact of the built environment on healing and wellbeing. This included the incorporation of natural daylight, views of nature and patient privacy and dignity as essential elements of healthcare design. This shift coincided with the growing influence of the patient voice in healthcare policy and reflected broader societal trends toward consumer-focused services.
Recent decades have witnessed perhaps the most dramatic transformation in HBN guidance. The shift toward integrated care models, ambulatory services, and digital healthcare has fundamentally changed how facilities are conceived. Modern guidance acknowledges that healthcare increasingly happens outside traditional hospital settings and emphasises flexibility, adaptability, and technological infrastructure. The rise of evidence-based design has further strengthened the scientific foundation of these documents, moving them beyond expert opinion to incorporate rigorous research findings.
The collaborative nature of the HBN development process deserves special recognition. By bringing together architects, clinicians, engineers, and patients, the NHS has created guidance that reflects diverse perspectives and addresses multifaceted needs. This collaborative ethos ensures that technical requirements don't overshadow human experience, and that aesthetic considerations don't compromise functionality. More recently, The COVID-19 pandemic has highlighted the importance of providing resilient healthcare infrastructure. This has been accompanied by an increased focus on infection prevention and control in healthcare facility design.
In this era of rapid technological advancement and evolving models of care, the HBN guidance programme faces the challenge of remaining relevant. The shift toward more ambulatory care, with digital solutions supporting integrated services, demands flexible spaces that can adapt to changing needs. It is therefore critical that guidance strikes a delicate balance—providing clear direction while allowing for innovation.
The NHS Health Building Note guidance programme continues to play a vital role in shaping healthcare infrastructure that meets the needs of both patients and staff. As healthcare challenges grow in complexity, the importance of evidence-based, forward-thinking design cannot be overstated. Murphy Philipps remains committed to contributing to this evolving body of work, ensuring that NHS facilities remain safe, sustainable, and adaptable for generations to come.
