Flexibility is an important value driver for hospital infrastructure in a highly unpredictable health care environment. We illustrate this by way of a case study based on the development of a major UK teaching hospital over the past 80 years. We then lay out some principles for the articulation of the value of flexibility to enable the designer to make an economic case for a flexible infrastructure. Finally, we argue that hospital procurement under Public Private Partnership (PPP), in particular under the UK Private Finance Initiative (PFI), can be an inhibitor to the design and development of flexible infrastructure. To realize the value of flexible infrastructure systems, the PFI parties need to create a genuine long-term partnership. The private parties have to stay engaged during the lifetime of the infrastructure to help adapt it to developing circumstances and thereby minimize value risks, maximize opportunities if and when they arise, and allow the public sector to reap as much social benefit from the infrastructure as possible.
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