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This paper aims to identify costs related to dementia care provision and explore how purpose-built environment investments can help control these costs and improve quality of life and clinical outcomes.

This research adopts a multi-method approach where the findings of a literature review drove the analysis of data obtained from the 115 pilot projects funded by the Department of Health England’s National Dementia Capital Investment Programme.

Under the UK Government’s new productivity challenge, it is fundamental to identify actions that provide value for money to prioritise policy and practice. This paper identifies healthcare spaces (e.g. bathroom) where the impact of the built environment on healthcare costs are most evident and building elements (e.g. lighting) to which these costs can be directly associated. The paper advocates the development of evidence and decision support tools capable of: linking built environment interventions to the healthcare costs; and helping the healthcare and social care sectors to develop effective and efficient capital investment strategies.

Further work needs to develop more systematic ways of rationalising proactive and timely built environment interventions capable of mitigating dementia (and older people) care cost escalation.

This research takes an innovative view on capital investment for care environments and suggests that appropriate built environment interventions can have a profound impact on costs associated with dementia care provision.

Health and social care facilities are usually complex buildings that require continuous effort to provide resilient and sustainable responses to changes in demographics, technologies, diseases and models of care. Despite resilience and sustainability concepts being frequently used by practitioners and researchers, ambiguities in their definitions often result in a lack of operational solutions to record, monitor and improve the resilience and sustainability of health and social care facilities. Although the importance and complexity of the issues are widely acknowledged, there is little strategic guidance as to how they should be achieved. The purpose of this paper is to assess the suitability of developing a roadmap for improving the resilience and sustainability of UK health and social care facilities, and to identify the layers and processes needed to construct such a roadmap.

A qualitative approach was adopted, starting with a literature review of different types of roadmaps and their suitability to support the desired improvement objectives. Layers and processes were thus developed using the key issues identified in three recent research streams, and the roadmap was structured.

The major findings have been captured within a three-layer, four-step process generic roadmap for improving the resilience and sustainability of health and social care facilities that can be used to monitor performance, plans future actions and implement response to change.

This paper targets decision makers, especially estate managers, but the proposed layers and processes can be modified for other stakeholders.

This paper suggests an original approach for the development of a roadmap for resilience and sustainability of health and social care facilities, and specifically of how to structure layers and processes, envisioning a more integrated development of service provision and infrastructure asset management.

Lord Carter’s (2015) “Review of Operational Productivity in NHS providers” stated that to improve National Health Service (NHS) England’s efficiency, operational productivity should be targeted in four main areas, one being estates management. NHS England’s estate includes a variety of buildings some of which are considered no longer fit-for-purpose, thus creating risk to patients and staff. These built assets require continuous maintenance, adding pressures to NHS England’s precarious financial situation. The purpose of this paper is to identify positive strategies and major constraints to achieving sustainable management of backlog maintenance (BM) across the NHS assets, and thus suggest balanced actions.

The research adopts a qualitative approach and combines: literature review of current BM methodologies; interviews with estates and facilities directors from seven NHS trusts on BM strategies; and a NHS trust detailed case study.

The major finding is that sustainable management of BM is achievable if there is a consistent, pro-active and long-term strategic approach where critical levels of BM are prioritised. Additional issues (i.e. appropriate methodology, performance metrics and links with clinical service delivery strategies) also need to be considered.

This study is relevant to the management of the NHS estate including development and adoption of sustainable strategies.

This paper offers original insights to the factors influencing healthcare estates’ BM at a time when the UK policy agenda is targeting infrastructure operational efficiency and organisations are seeking more comprehensive methodologies.

This study aims to explore the challenges associated with the integration of resilience and sustainability, and propose a workable solution that ensures resilient and sustainable buildings. Recent research outcomes suggest that the number of natural hazards, both environmental and geophysical, will increase due to the effect of global warming. Various approaches have been investigated to reduce environmental degradation and to improve the physical resilience to natural hazards. However, most of these approaches are fragmented and when combined with cultural barriers, they often result into less-efficient assessment tools.

The primary source of information used to develop this paper has been research publications, policy papers, reports and tool guidelines. A set of questions were developed to guide the review which was complemented with information distilled from the HFA 2005-2015 to develop an integration process to evaluate 10 international sustainability appraisal tools.

The major finding of this research is that, from a technical point of view, resilience and sustainability could be integrated. However, it requires a long and thorough process with a multidisciplinary stakeholder team including technical, strategic, social and political parties. A combination of incentives and policies would support this process and help people work towards the integration. The Japanese model demonstrates a successful case in engaging stakeholders in the process which led to the development of a comprehensive appraisal tool, CASBEE®, where resilience and sustainability are integrated.

Although data have been sought through literature review (i.e. secondary data), the research is expected to have significant impact, as it provides a clear theoretical foundation and methods for those wishing to integrate resilience within current sustainability appraisal tools or develop new tools.

This paper provides original concepts that are required to reduce fragmentation in the way resilience and sustainability are addressed. It sets up a new research agenda which has the potential to have a strong impact due the fact that sustainability and resilience are getting higher on the political priority scale.

This paper provides findings of an original idea to reduce fragmentation in the way resilience and sustainability are addressed. It sets up a new research agenda which has the potential to have a strong impact due the fact that sustainability and resilience are getting higher on the political priority scale.