Introduction
The healthcare estate directly contributes to the delivery of high quality healthcare for patients and it is a key enabler to change in the health system with its contribution largely undervalued and untapped (Naylor, 2017). Unfortunately, for senior management in public healthcare organisations the often vast and valuable facility portfolio presents significant challenges for decisions surrounding the long term planning of future options for the estate (i.e. new-build, modernisation, refurbishment or disposal). These decisions need to relate to the changing demand for care, driven by the aging population, epidemiology issues (change in disease pattern) and the potential impact of new technologies that have been taking place over the last forty years and that will continue with increasing impact in the coming decades. Today hospitals are structures whose design and configuration reflects the practice of healthcare and patient requirements often from a bygone era (McKee and Healy, 2000). Therefore, they are neither efficient nor functional when it comes to efficiently addressing the demands of the service now and in the future. At the same time there is an increasingly austere financial climate in many developed countries that results in cuts to public expenditure which in turn has affected budgets within the healthcare sector (Nunes et al., 2015, Stuckler et al., 2011). An increasing need has arisen to adapt the estate to reflect both current and future demands in order to avoid affecting adversely the quality of health offered to patients and its economic viability (Naylor, 2017).
