The National Health Service (NHS) is recognised as the largest public sector institution in Europe. This presents significant challenges in regards to operation and maintenance of the diverse built estate, and the ever-evolving clinical models of care. The economic downturn, and strict policy of austerity in the UK, presents limitations and challenges in capital investment. The majority of healthcare facilities which will be used throughout the 21st century, have already been built. This demands that solutions be found in the areas of asset maintenance and refurbishment. These challenges are complicated further, by the institutional and statutory requirements of the NHS to meet demanding sustainability targets. This in turn, is underpinned by exacting assessment methodologies and rating systems, and critically, an institutional ‘duty’ to pursue and evidence that ‘Value for Money’ has been achieved as far as reasonably practicable. The existing estate management tools were assessed by a process of triangulation, and the relevant decisionmakers and stakeholders from both the NHS and the Design Teams and Constructors were identified. The original contribution demonstrates the development of a novel decision support prototype which facilitates and improves the current decision making process. The prototype allows the integrated team to consider, evaluate, and agree, best-fit options in a measured, recordable, and replicable manner. Key to this process, is the ability to compare and rank often competing criteria, and to test the nonfinancial, and financial preferences by means of sensitivity analysis techniques. The research and the developed working prototype, were then tested and validated against an expert panel, on a broad scope of issues, ranging from Graphical User Interface aesthetics and usability, to functionality and applicability to the current standard business case process. The results of the testing and validation excercises were overwhelmingly positive.

Environmental policymaking is a difficult issue for governments. It is desirable to have the decisions based on the results of quantitative and analytical studies. On the other hand, by their very nature, many such decisions have political aspects, whose subtleties are difficult to be captured by quantitative approaches alone. It is left to the political establishments to decide how best to allocate the efforts to improve environmental conditions. In this respect, evaluating the countries by generating environmental indices and the subsequent ranking of the countries with respect to those indices is a common practice. Perhaps the best known environmental sustainability index, the Environmental Performance Index-2008 (EPI-2008), is a composite index that comprises 6 core policy categories and 25 indicators. While recognizing the qualitative aspects of such decision making, in order to support and guide the policymaking process, we develop analytical tools to assist the process. We carefully delineate our models to be limited only to the provable quantitative properties of the available objective data. However, such data are processed into more meaningful statements concerning the available options. Specifically, using EPI-2008, meaningful mathematical models that shed further light onto the country sustainability measures are developed.

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