Why Cork Needs More Than a Generalist Architect for Its Next Hospital

The strange thing about building inside a live hospital is how quickly the extraordinary becomes normal.

At University Hospital Limerick, the site for a new acute ward was an enclosed courtyard between the emergency department and the paediatric department. There was no ordinary construction access. The hospital street still had to function, patients still had to move through the building, and the clinical departments on either side could not simply close while we got on with the job.

The answer involved prefabricated light-gauge steel panels being lifted by crane over the live hospital and lowered into the courtyard. Watching a building arrive through the air is memorable. Watching it happen while the hospital beneath it carries on treating people is something else entirely.

That project began as a fast-delivery, 16-bedroom acute care unit with an extremely tight programme and limited budget. It subsequently moved through further phases of additional accommodation. The design work was only one part of the challenge. Logistics, risk, structure, clinical continuity and very quick coordination across every discipline were just as important. Probably more important on certain mornings. The full project account is here.

This is why I get uneasy when healthcare work is discussed as though it were simply another commercial project with a few more sinks.

It isn’t.

Recent reporting on Cork’s planned elective hospital at St Stephen’s Hospital in Glanmire says the HSE is continuing detailed design work, with a planning application targeted for the second half of 2026. Patient and staff movement, campus access and road infrastructure are already part of the conversation. None of that is surprising. A hospital may look like a building on a planning drawing, but operationally it is closer to a small town that never sleeps. The current position was reported by the Irish Examiner in June 2026.

So, what is actually different about designing a hospital versus an office?

Well… nearly everything that matters.

The Brief Is Not Just a List of Rooms

A commercial brief might tell you how many people need desks, how many meeting rooms are required and what sort of reception the client has in mind. There will be technical constraints, of course, but you can usually move a chair, change a partition or reconsider a cupboard without setting off a chain reaction through six other disciplines.

In clinical building design, a room is not merely a room.

It is an activity, a patient pathway, a staffing pattern, an infection-control environment and a collection of equipment, services and clearances that all have to work together. Where is the clinical hand-wash basin? Can a member of staff reach it without crossing the clean zone? Does the bed turn properly through the doorway? Can equipment be brought in, maintained and eventually replaced? Where does the mobile hoist go when it is not in use? What happens when two beds and an emergency team meet in the corridor?

You wouldn’t think a corridor width mattered this much. It does.

The tolerances are different too. In an office, a socket that ends up 150 millimetres from where somebody expected it is irritating. In a clinical room, the wrong outlet position can interfere with equipment, cleaning, patient handling or staff access. A late equipment change can affect power, data, medical gases, structure, ventilation and fitted furniture all at once.

That is why healthcare teams use systems such as the Activity Database, or ADB, and dRofus. They are not glamorous tools. Nobody puts a room-data sheet on the cover of an architecture magazine. But they allow the clinical brief, room requirements and equipment information to stay connected to the design.

We use both because memory, scattered spreadsheets and good intentions are not a reliable way to coordinate a hospital. dRofus, for example, is designed to track space, room and equipment requirements from planning through delivery. That single source of information becomes very useful when the question changes from “Where should the scanner go?” to “Who approved moving it, and what else did that decision affect?” That is precisely the sort of coordination the platform is built to handle.

And those questions do change. Regularly.

A “Simple” Hospital Extension Rarely Stays Simple

Clonakilty Community Hospital is a good example.

Read quickly, the brief might sound straightforward: improve the existing accommodation and provide 20 new en-suite single bedrooms. But the actual need was driven by several connected requirements — reducing occupancy in existing eight-bed wards, adding day rooms for those wards and providing the new bedrooms with the necessary supporting clinical spaces.

That led to two different extensions rather than one blunt addition. A smaller pavilion introduced five day rooms into an existing courtyard. A larger extension created the bedrooms, further day rooms and ancillary accommodation around another courtyard, bringing in daylight, views and usable outdoor space.

The word homely came up repeatedly in the design thinking. That can sound soft beside all the technical language of healthcare, but it is not a decorative extra. If someone is living in a community hospital, daylight, colour, a window seat and a visible connection to the outdoors affect daily life. The building still has to satisfy the clinical brief. It just should not make every resident feel as though they are permanently inside a piece of medical equipment. HBM’s Clonakilty Community Hospital project explains the brief and response in more detail.

Here’s where healthcare projects sometimes go sideways: a team sees the room schedule, prices the floor area and assumes the difficult thinking can happen later.

Later is expensive.

By the time the clinical users are properly consulted, the structural grid may be fixed. By the time the equipment is confirmed, the service routes may be full. By the time infection prevention and control reviews the layout, the tender drawings may already be out. Then everybody gathers around a drawing and tries to recover flexibility that disappeared six months earlier.

Ask anyone who has project-managed a live hospital extension and they will tell you the same thing: the cheapest decision is usually the one made properly and early.

Not the quickest decision. The properly tested one.

Keeping a Hospital Open Changes the job.

Look, I’ll be honest: working in a live healthcare environment can test everybody’s patience.

Construction wants access. Clinical operations need quiet. Infection control needs dust, air movement and routes managed. Estates staff need critical services protected. The contractor may need an isolation, but the department cannot lose power. Deliveries have to come in, waste has to go out and emergency routes must remain emergency routes — not convenient places to leave plasterboard for ten minutes.

It is a little like renovating the kitchen while the family still expects three meals a day from it, except the family is operating around the clock and some of the appliances are keeping people alive.

Phasing and decanting therefore become part of the architecture. Temporary partitions, clean and dirty routes, fire escape arrangements, noise restrictions, shutdown windows and commissioning sequences cannot be left as somebody else’s site problem.

On a normal fit-out, a missed detail might mean opening a day late.

In a hospital, it can mean a clinical room cannot be used, a department cannot move or a carefully planned shutdown has to be abandoned. The cost is not confined to the contractor’s programme. It lands on staff, patients and the wider hospital service.

Anyway. That corridor…

It is very easy to make a circulation route look efficient on a drawing. It is harder to make it work when a bed, a meal trolley, a mobile imaging unit, staff and anxious relatives all need it at once. Hospital design in Ireland requires architects to listen to the people who actually operate these buildings, including the porter who knows where movement always jams and the nurse who spots a line-of-sight problem before anyone else does.

Clinical staff do not always describe their needs in architectural language. They should not have to. Our job is to turn how care is delivered into a building that supports it.

Planning Permission Is Only One Kind of Planning

Healthcare estates bring their own planning realities.

The statutory planning process matters, particularly where a hospital campus meets housing, protected structures, traffic constraints or limited road access. Cork has no shortage of difficult sites. But there is another layer of planning happening inside the boundary: ambulance movement, service access, pedestrian safety, future expansion, construction compounds and the question nobody wants to discover too late – where does the next phase go?

A building can obtain planning permission and still be extremely difficult to deliver.

That is why our approach at Healy Butler Moffat is design-led, but never design-only. Planning strategy, construction detail, logistics and future adaptability are considered from the beginning. They are not items to be tidied up once everybody has fallen in love with a concept image.

We are currently designing the new regional headquarters for the National Ambulance Service. That is healthcare architecture too, though of a different sort: an operational building where readiness, movement, resilience and support functions matter every hour of the day. The architecture has to serve the operation, not make the operation negotiate with it.

Why Experience Protects the Budget

People sometimes assume that choosing an experienced healthcare architecture firm in Cork is primarily about reducing clinical risk. It is, but that is only part of the value.

Experience protects the budget because the team knows where coordination usually fails. It protects the programme because clinical engagement starts before late changes become a redesign. It protects procurement because the drawings, room data and equipment requirements tell the same story. And it protects the client from a design that technically reaches completion but arrives with a long list of operational compromises.

Healthcare is one of the largest and most demanding parts of our work at Healy Butler Moffat. We have been designing from Cork since the original Butler Moffat practice was established in 2005, and our partners and senior staff remain directly involved in projects. That matters. The person discussing the brief at the beginning should still understand the decisions when the job reaches the site.

We are also an RIAI-registered practice, registration number 05028. That is worth explaining because it is more than a logo at the bottom of a webpage. Under Section 18 of Ireland’s Building Control Act 2007, “architect” is a protected title, and the RIAI maintains the statutory Register of Architects. Registration means a person has demonstrated the education, training, experience and competence required to practise. The RIAI sets out the legal position clearly here.

There is a reason procurement teams check it. On a clinical project, competence is not an optional reassurance.

What People Actually Ask Us About Healthcare Architecture in Cork

How early should a healthcare architect be appointed?

Earlier than most clients initially expect.

Ideally, the healthcare architect should be involved while the brief, site strategy, clinical pathways and budget are still being tested. If the architect arrives after the room schedule and major operational decisions have been fixed, much of the opportunity to prevent problems has already gone.

Can a general commercial architect design a healthcare building?

Legally and technically, a registered architect may take on many building types. The more useful question is whether the practice understands clinical workflow, infection control, healthcare equipment, HSE processes, room-data coordination and construction besides live services.

Healthcare is an unforgiving place to learn those lessons for the first time.

What are ADB and dRofus used for?

They help organise and control the detailed clinical brief.

In plain language, they record what happens in each space, what the room needs and what equipment and services belong there. They also help the client and design team track changes. On a large clinical project, that can mean thousands of individual requirements. A marked-up spreadsheet will only carry you so far.

Does hospital design have to be cold and institutional?

No. Nor should it be.

Clinical safety and durability come first, but daylight, acoustics, views, colour, intuitive wayfinding and access to outdoor space all matter. Clonakilty Community Hospital is a good example of a clinical brief being met without losing the sense that residents are living there, not merely occupying beds.

Can a hospital extension be built while the hospital stays open?

Often it has to be.

The work requires careful phasing, infection-control measures, protected routes, controlled shutdowns and constant coordination with hospital management and clinical teams. The design and construction programme must be shaped around the live service from the outset.

Trying to solve operational continuity after the contractor arrives is asking for trouble.

What should we look for in a healthcare architecture firm in Cork?

Look beyond a general project portfolio. Ask who will actually lead the job. Ask for experience of live clinical environments, HSE projects, equipment coordination, ADB or dRofus, phased construction and healthcare commissioning.

Then ask about the awkward project. The answer will tell you more than the polished case study.

Is specialist healthcare experience more expensive?

The appointment fee is only one line in a much larger budget.

Late rehospital open changesipment allowances, disrupted services, unusable rooms and delayed opening cost far more than getting the right expertise involved early. A low fee is not good value if the project spends construction trying to recover decisions that should have been settled during design.

We work from Farnham House on MacCurtain Street, but the real work of healthcare architecture in Cork happens in conversations with clinical users, estates teams, planners, engineers, contractors and the people trying to keep a service running while a building changes around them.

Hospitals have very little patience for assumptions. Even less for shortcuts.