Will this hospital still work as a hospital in twenty years?

The 0 to 10 scale

• 0–2, fundamental failure: would not meet minimum standards anywhere, or breaks a mandatory minimum that only structural change can fix.
• 3–4, below standard: significant deficiencies that workarounds cannot make up for.
• 5–6, minimum and workable: meets minimums, often through a documented fallback.
• 7–8, good practice: meets international good practice, verifiable against a named clause.
• 9–10, best in class: ready for the 2040s, with headroom designed in.

A design is judged on what it shows, not what it promises. A provision mentioned only in a brief earns no credit. A 7 or more needs the evidence on a drawing, schedule or specification; a 9 or more needs it confirmed by the responsible discipline. Every score carries a note explaining why it stops where it does.

Why three stages

A design at 55 that reaches 82 after correction is a good building with a documentation problem. A design at 55 that stops at 68 because the site has run out of room is a different conversation, and one to have before the piling rig arrives.

What the bands mean

• Future ready, 80 and above: still a competitive, compliant, workable hospital at the end of the horizon.
• Future capable with targeted upgrades, 65 to 79: sound fundamentals; a defined, affordable upgrade set gets it there.
• Foundation in place, material gaps, 50 to 64: it will function, but its gaps bring recurring cost or a significant retrofit.
• Not future ready, below 50: deficiencies that are structural, expensive to reverse, or both.

The safety floor in full

The four safety-critical dimensions are D2, D3, D4 and D12. If any scores below 5, the band label is held at "Foundation in place" and the reason is printed beside the score. A hospital cannot be called future-ready while it cannot isolate a patient, ventilate a theatre, keep power to a ventilator or contain a fire. The number itself is never changed, only what it may be called.

Hospital L, structure complete

• The first score is held down by six absent documents: no ventilation schedule, fire strategy, single-line electrical diagram, room schedule naming isolation rooms, metering schedule or commissioning plan.
• Most of the 17.6-point climb to Post-Correction is paperwork. If those documents exist in subcontractor packages, re-run the assessment before pricing any correction.
• One fault is different: no dedicated goods or service lift in the main tower, so food, linen, waste, pharmacy and sterile supplies share the bed lifts. In a finished structure that cannot be cured.

Hospital M, schematic stage

• No generator room, no medical gas manifold shown, isolation rooms that cannot hold a pressure difference, and a sterile services department about half the size its theatres need.
• Two lifts, both labelled for fire and bed use, carry everything. On a fire alarm the firefighting lift is recalled, so the hospital loses its lifts at the worst moment.
• At schematic stage almost every fix is still a drawing decision, which is why it climbs 36.5 points after correction.
• The site sets the limit: theatres fixed at the top floor, a tight plot with one expansion face, contested roof space and soft ground.

Both score badly on ventilation, for opposite reasons. Hospital L's rooms could work once a schedule exists; Hospital M's cannot work as drawn. Same dimension, entirely different remedy.