The new acute critical care centre at Good Hope Hospital for Heart of England NHS Trust was designed from inception to completion by Highbury Design who led the design team, initially on behalf of the Trust, and then under the constructor using NHS Procure 21. The scheme located adjacent to the existing A&E required reprovision of the ambulance access to the site, main dining room, medical records department, as well as a first floor bridge link. The four storey building on a confined site has a roof plant room with clinical decisions unit on the ground floor, ITU and HDU departments on the first floor with 18no pendant treatment bays, with CCU and coronary care on the second floor, and an elderly ward on the top. The scheme was designed to achieve BREEAM excellence, with a budget of £16million.