The NHS is facing record pressures, with waiting times and performance statistics continuing to paint a bleak picture. According to the latest figures, there are more than seven million people on a hospital waiting list in England, which equates to one in eight of the nation’s entire population. Delays and backlogs caused by the pandemic are undoubtedly a major factor, along with the continuing treatment of a substantial number of seasonal illnesses.
It would be all too easy to point to COVID-19 as the root cause of the problems within the NHS. However, a closer look reveals a far more complex picture, with a range of issues contributing to the current situation. One of these is the lack of much-needed new facilities, and the poor condition of existing buildings. As anyone who follows developments in public health in the UK will know, insufficient staffing levels are one of the primary causes of higher waiting times, but lack of building space and outdated facilities are also contributing heavily to the bottlenecks within the NHS. Very simply, reducing waiting times requires both an increase in staffing levels, and improvements to the physical estate. No More Sticking Plasters: Repairing and Transforming the NHS Estate – a report from NHS Providers published in March this year, states that ‘Deteriorating NHS infrastructure and estates risk patient safety and quality of care’. The report goes on to add that, ‘the operational ask of the NHS cannot be delivered without adequate capital investment’.
Finding ways to deliver more with less
However, with no promise of adequate capital investment on the horizon, the NHS must find ways to deliver more with less. It’s clear that an innovative and cost-effective approach to developing new infrastructure and improving the existing estate is required. Modular, offsite construction offers a faster, more cost-effective way to deliver high-quality, new NHS buildings, by maximising efficiencies at every level. For over 60 years, Algeco has been supplying high-quality modular buildings to customers across a variety of sectors – including the healthcare sector. We work under various NHS modular frameworks and solutions, and our buildings are are compliant with HTMs, HBNs, SHTMs, WHTMs, and HAI-SCRIBE standards.
Lean manufacturing and DfMA
Lean manufacturing and Design for Manufacturing and Assembly (DfMA) are central to our approach, and we have invested heavily in both, along with an extensive R&D programme
DfMA focuses on reducing time to market and total production costs by prioritising the ease of manufacturing parts and simplifying assembly. By taking a DfMA-led approach, and adopting the principles of lean manufacturing, such as process optimisation and waste reduction, our offsite construction methods offer a faster way to deliver high-quality new buildings. Our methodology involves the design and fabrication of building components or ‘modules’ taking place offsite in a factory setting, prior to them being transported to the construction site for assembly
An optimised supply chain
Aside from DfMA, offsite construction in itself offers numerous benefits over traditional building methods, and there are many reasons why it represents the way forward for the NHS. Principally, offsite can deliver permanent healthcare buildings in up to half the time that it takes for an onsite build, while the fact that most work is done away from the hospital minimises disruption to care.
By completing many of the construction stages offsite, the supply chain can be optimised, disruption minimised, and the overall build time reduced by up to 50%. Offsite construction also results in a higher quality end-product, better overall performance of the finished building, and better value for money, due to tighter cost control. Compliance with Building Regulations is also easier to manage, because elements such as fire ratings can be verified and quality checked before the modules arrive on site, mitigating the need to commission a third-party fire consultant
This level of factory completeness is measured by Pre-Manufactured Value (PMV), and for healthcare buildings, up to 85% PMV can be achieved. That means that the majority of the building work is already complete by the time modules arrive on site, with the remaining 15% consisting of finishing and commissioning.
Standardised modular designs
Algeco was part of the industry-wide Seismic Consortium which developed a standardised platform for building modules, with the aim of further simplifying the design and manufacturing process. Designed in line with the Government’s Construction 2025 targets, the Seismic platform was developed to drive a major shift towards a more productive, better quality, and lower carbon, construction industry. Ultimately, its purpose is to deliver high-quality buildings that can be mass-produced and delivered within shorter timescales.
The platform, which has now been added to the Construction Platform Rulebook, facilitates the design, procurement, manufacture, and assembly, of buildings using standardised and interoperable components and assemblies.
It uses a small number of repeatable base designs, which enable all modular manufacturers to work to the same specification when creating the basic building components. This delivers significant efficiencies. It also aligns with the creative talent of UK architects, because it allows bespoke elements to be incorporated into the design at later stages, while still facilitating the repeatability of large elements.
Addressing the needs of the health sector
To us, the benefits of standardised offsite construction from a manufacturing point of view are clear – but why does this matter to the health sector? Quite simply, offsite construction has the potential to address the urgent needs of the UK’s health sector, by revolutionising the way that much-needed wards, hospitals, and primary care facilities, are built.
Ultimately, standardisation will mean that an architect can design a new A&E wing, or an entire hospital, to a clearly defined industry standard design. The design can then be tailored to meet individual hospital needs later on in the process, leading to significant economies of scale. In addition, an architectural practice can offer it as a repeatable design across the Trust, delivering important efficiencies in the process. At the same time, because of the platform-based approach, they are creating a costeffective, efficient solution for tackling the pressing estate shortages in the health sector. Project teams will be able to drive cost efficiencies within the NHS, and build wards and A&E departments in a fraction of the time that it takes for a traditional build, with minimal disruption to the rest of the hospital. Increasing capacity is one way that the NHS can focus on delivering great patient care and tackle waiting times.
The Seismic platform approach
The Seismic platform approach (see https://www.seismicgroup.co/whyseismic) has revolutionised the way we work. For instance, previously, the bottleneck in the modular industry was making the steel frame, yet with Seismic we have been able to more than quadruple throughput. That has made a huge difference for NHS providers looking for efficiencies in their construction delivery programme. In fact, the standardised Seismic approach is 75% faster, and achieves a 47% improvement in value, compared with traditional construction techniques.
In sustainability terms, Seismic offers up to a 70% reduction in operational and embodied carbon. This is achieved through factors including design efficiency, materials selection, and manufacturing effectiveness, culminating in reduced wastage. Let us now look at some healthcare construction projects where the benefits of offsite build have been strongly in evidence.
Pinderfields Hospital, Wakefield
Offsite methods were utilised in the design and construction of the new two-storey Clinical Support Unit (Opthalmology) at Pinderfields Hospital in Wakefield. The permanent offsite-manufactured building, housing an advanced eye clinic and state-ofthe-art office space, was constructed using a steel-framed modular building system, which allowed large elements of the build to be completed off site. A rapid construction schedule minimised disruption to the hospital environment, and meant that service-users were able to access the new Ophthalmology Unit at the earliest opportunity. The environmentally-friendly design includes increased levels of insulation, low-energy lighting, energy-efficient heating systems, and water-saving technology.
New facilities at King’s College Hospital, London
Offsite methods were also used to deliver a highly complex £15 m project for King’s College Hospital in London. A new five-storey building, consisting of operating theatres and wards, was added to a live hospital site. Our offsite team delivered a hybrid structure to the lower ground and ground floors, with a further four storeys of modular structure above, including solar shading to two elevations.
Remediation of existing buildings
While we can see that the benefits of permanent offsite builds provide a way forward for replacement and expansion of healthcare buildings, often it is a temporary decant solution that is required to house patients and staff while remediation work is carried out on existing buildings.
The replacement of reinforced autoclaved aerated concrete (RAAC) planks at a number of hospital is one such good example. RAAC has a structure similar to honeycomb, which allows water to penetrate it, causing serious deterioration over time. The RAAC planking features mainly within roof structures, and many of the buildings – including healthcare facilities – that were constructed using RAAC between the 1960s and the 1980s are now in need of urgent replacement. The Department of Health & Social Care provided £110 m of ring-fenced cash to address the immediate RAAC issues in 2021-22, and has committed to providing another £575 m to Trusts during the current Spending Review period, which runs to the end of the 2024- 2025 financial year
Clearly, large-scale improvements to roof structures have the potential to cause significant disruption to both patients and staff, potentially increasing local waiting lists even further. Modular buildings for hire can alleviate this problem, by allowing hospitals to ‘decant’ patients to temporary hire facilities while work is being carried out. This is a quick and straightforward solution which doesn’t require capital expenditure. The temporary facilities are fully equipped, comfortable, and to patients and visitors, completely indistinguishable from a permanent build.
Streaming service for A&E Department
Another example is of our modular hire solution currently being used to tackle waiting times at the James Paget University Hospitals NHS Foundation Trust in Great Yarmouth. Although this project doesn’t involve RAAC, it illustrates just what can be achieved using modular healthcare buildings for hire. Envisaged as a GP streaming service, the layout consists of six of our building modules arranged in single storey format. They have been combined to create a series of consulting rooms, interconnected by waiting areas and corridors. Around 14,000 patients per year are now supported by the service, and receive appropriate treatment without having to wait to be seen by Emergency Department staff.
Our modular building for hire was delivered on time and on budget, within the required schedule of just 13 weeks. This approach could just as easily be used to provide continuity of patient care during an offsite build of a ward or entire hospital. We are currently taking a similar approach at a Northampton school, where our modular hire units are being used as teaching spaces until we hand over the permanent offsite build. In fact, we are seeing this approach achieve impressive results across the education sector, where offsite has effectively become the de facto choice for new developments. Offsite and modular construction are now routinely used to deliver any size of project – from individual classrooms through to entire schools. The same approach can be utilised within the NHS with great success, as the staff and patients at James Paget Hospital have already found.
Primary care – the cornerstone of the NHS
We can’t consider the healthcare sector without mentioning general practice – the cornerstone of the NHS, which helps around 50 million people in England every year. In 2022 alone, GPs carried out 370 million consultations. However, like all parts of the NHS, general practice is suffering from a lack of funding. Although by no means a ‘silver bullet’, offsite construction has the potential to mitigate some of the problems caused by budgetary constraints, by improving efficiency, and standardising the design of primary care facilities in line with the NHS strategic planning and predevelopment framework. Designers are already making use of standard layouts which are scalable and adaptable, and these could easily be translated to GP facilities.
Community diagnostic centres: a way forward
The Government is planning to open 40 new Community Diagnostic Centres across the country. The centres will lead to earlier diagnoses for patients through easier, faster, and more direct access to a range of diagnostic tests. It is hoped that many of these centres will embrace offsite construction as part of the build, in order to accelerate their completion. Rapid delivery of the Community Diagnostic Centres, through offsite construction methods, will lead to:
Fewer hospital visits, helping to reduce the risk of COVID-19 transmission.
A reduction in waiting times, as patients are diverted away from hospitals, freeing them up to treat urgent patients, while the Community Diagnostic Centres focus on tackling the backlog
A reduction in harmful emissions, as the buildings are designed to reduce carbon and can even be carbon-neutral
Real and lasting change
With a waiting list that was seven million strong at the time of writing, increasing capacity within the NHS is an operational imperative. We know that the picture is far from simple; solving the many problems faced by the NHS requires a multi-faceted, innovative, and patient-centred approach. However, as part of the consortium of partners that developed the Seismic platform, and one of the leading proponents of standardised, offsite construction, we know that it has a significant role to play in delivering permanent, new, and high-quality NHS facilities, as well as improvement programmes for existing buildings. All of this will help to alleviate pressure, improve conditions for staff, reduce waiting lists, and improve patient care – ultimately leading to better outcomes across the board
For those hospitals simply looking for temporary facilities, either while work is being carried out to improve older buildings, or as, for example, an A&E streaming service, modular hire offers a straightforward and cost-effective way forward. In many ways, as we saw with the education sector, permanent offsite builds and temporary modular hire work hand in hand, with the latter providing interim facilities while construction work is being carried out.
Indeed, if standardised offsite construction is embraced and used to its fullest potential, alongside a decant modular hire solution whilst the work is being done, it is capable of delivering real and lasting change within the NHS.
James Withey
James Withey is managing director at Algeco Offsite Solutions. He joined the business in 2021, and has over 15 years’ experience in senior leadership roles across the real estate, construction, and property services sectors, combined with a foundation in manufacturing.
He said: “Algeco has completed numerous projects in the healthcare sector, and has ambitions to deliver many more.”