This paper stems from the development of research currently undertaken at the Bartlett, University College London and Loughborough University School of Civil and Building Engineering, Open Scenario Planning for Healthcare Infrastructure (OPHI). The study has investigated the concepts, tools and techniques that enable innovation and support the financial planning of built infrastructure. The aim is to improve decisionmaking for healthcare pathways across locations and settings through development of a framework for the rationalisation of existing property and buildings. Evidence and analysis is drawn from case studies of Accident & Emergency/Trauma, Urgent Care and service re-organisation within six English Foundation Trust Hospitals, examining their strategic estates planning approach. The study sets out a process to determine scenarios of a shifting pattern of patientcentered requirements and clinical priorities by testing strategic options for clinical effectiveness rather than functional arrangements. The ideas and direction of the research were also supported by case studies from elsewhere in Europe. Most notably, at the Inselspital (Island Hospital) in Switzerland, the Canton of Bern has set out a 2025 to 2060 strategy for an 'Open Development Framework'. Organised through principles of Open Building this directs the future development of the hospital as a set of high-level objectives driven by clinical priorities incorporating planning and design innovation through the mapping of two divergent operational scenarios. The paper sets out the findings of the study with the Trusts in England that respond to these emerging radical solutions and the appropriateness of their introduction within the context of UK service reorganisation for patient-centred, integrated care overcoming organisational commissioning boundaries. Findings suggest the emergence of new, clinically-led business units, supported by mobile multi-disciplinary teams on and off-site, for the planning of admission avoidance, referral patterns and long term care of chronic conditions. This work is informing an outcome for a Strategic Scenario Planning Framework to enable decisions based on explicit values of stakeholders, together with the specific competencie
