Leeds Teaching Hospitals NHS Trust describes the construction of new Centre for Laboratory Medicine at St James’s Hospital – the building was completed by BAM in July 2023, and is expected to be fully operational this summer (2024) – as ‘a significant milestone in regional healthcare’. This is because the 450-500 staff that will move into the £35 m, threestorey building over coming months will be undertaking pathology work not only for the Leeds Teaching Hospitals NHS Trust, but also regionally for the Mid Yorkshire Teaching NHS Trust and Calderdale and Huddersfield NHS Foundation Trust.
In a press release issued on 26 September, the day the building was officially opened, the Trust said ‘this pioneering regional partnership, forged in collaboration with the West Yorkshire Association of Acute Trusts (WYAAT)’, would ‘drive innovation in testing and diagnostics’, while with its ‘advanced technology and state-of-the-art equipment’, the new laboratory building would aim to deliver faster results for patients, ‘irrespective of their geographical location’. Simultaneously, the Trust said, consolidating these ‘essential pathology services’ within a single facility would ‘streamline access to routine and direct testing, while fostering improved staff working environments’ and ‘facilitating seamless continuity and transfer of patient care across the region’.
To find out more, I visited Leeds and met Emma Storey, Project manager for the new building at the Leeds Teaching Hospitals NHS Trust, and a senior member of the ‘Building the Leeds Way’ Programme team. She started in her current project management role in 2020 because – as she put it – she wanted ‘to make a difference to the quality and environment of the buildings from which we provide care’ – and has spearheaded the project from the Trust side. The Centre will be a highly automated facility – both in terms of the equipment used to transport samples to the intended scientist or lab technician for testing once inside, and then, once the samples reach the destination bench or tabletop, to undertake the testing and analysis of samples arriving from healthcare facilities across West Yorkshire. As a highly serviced facility, the building’s design required some meticulously planned and complex mechanical and electrical engineering. To tell me more about these aspects, Emma Storey and I were joined at our meeting by Alison Ryan and Andy Munro, respectively Deputy Healthcare lead, and Associate electrical engineer, at multidisciplinary engineering business, Mott MacDonald, which acted as technical advisor on the scheme.
Potential locations sought
Gathered in the new building’s first floor boardroom, with views onto the nearby Gledhow Wing, we began by discussing the background to its construction, and the key clinical and patient benefits it will bring once staff transfer to it over the next few months. Emma Storey explained by way of context: “The Trust began looking into potential sites for a new regional pathology facility in around 2018. To date, our pathology services have been split between various buildings dispersed across both the St James’s site and the city’s other major acute hospital – Leeds General Infirmary. Undertaking pathology at two sites, and at a number of other healthcare facilities in and around Leeds and across West Yorkshire, can lengthen the time it takes for clinicians to receive results. There can be duplication of services, some test samples may initially not reach the right destination, and communication lines can get blurred – none of which make for optimal efficiency. Equally, some of the buildings that our Pathology staff currently work in – such as the LGI’s Old Medical School – are ageing and in poor condition, and thus are neither conducive to high-quality pathology, nor a comfortable place to work in.”
She continued: “As a key clinical service, we have had the ambition to centralise many of our pathology services into a single, new, purpose-designed building for some time. The anticipated benefits – particularly in terms of faster testing and quicker dissemination of results, and thus more rapid diagnosis and treatment, which can significantly affect outcomes with diseases such as cancer and heart disease – are very much those that Lord Carter highlighted in his 2006 and 2008 reports published under the title Independent Review of NHS Pathology Services in England.” In those, Lord Carter set out a strong case for regional consolidation of pathology services, ‘to improve quality, patient safety and efficiency’. He re-stated the case, and the anticipated benefits, in his 2016 report, Operational Productivity and Performance in English NHS Acute Hospitals: Unwarranted Variations, which led NHS Improvement to ask NHS Trusts to draw up business plans to consolidate services ‘to improve productivity’
A ‘flagship’ project
Emma Storey explained that the scheme to build the new Centre for Laboratory Medicine is also a ‘flagship project’ within the Leeds Teaching Hospitals’ high-profile ‘Building the Leeds Way’ Programme. Returning to the new pathology building, she said: “The Centre for Laboratory Medicine will bring many of the Trust’s pathology services into a single, modern, and efficient facility, and once the Old Medical School at the LGI is vacated, it will be repurposed as part of plans to use surplus estate there to develop an ‘innovation village’.” (Expected to deliver up to 4,000 new jobs, over 500 new homes, and almost £13 bn in net present value.)
Back on the key drivers for consolidating the region’s pathology services, she said: “By consolidating services and scaling up activity at one central facility, and linking certain specialities, we will be able to share expertise across the services, and create a regional pathology Centre of Excellence.”
Having discussed the broader rationale for the new building, I asked the Trust Project manager for some examples of the types of pathology it would bring together. “Currently,” she said, “we have Specialist Laboratory Medicine and Transplant Immunology services at St. James’s, while at LGI we have Clinical Immunology, Blood Sciences, and Microbiology, among others. We want to bring all these together; some will benefit from greater automation, and others from sharing of knowledge across services. In all, we expect to transfer over 450-550 staff, but some of our Pathology services – such as those that won’t benefit as greatly from co-location, or are located in newer buildings, like Cellular Pathology and Genomics – will stay in situ on the St James’s site.”
Original funding request
Emma Storey explained that the initial funding request for the new pathology facility had been submitted to the Sustainability and Transformation Partnership in 2018. She elaborated: “We received some funding then, which kick-started preparation of the Outline Business Case. We then received OBC approval in 2020/2021, and Full Business Case approval in early 2022. Following the completion of a complex set of enabling works, completed separately, BAM commenced construction of the new 6,000 m2 facility in March 2022, and completed the traditional steel-framed building – to a very high standard – in July 2023.”
Andy Munro explained that right at the project’s outset in 2018, as technical advisor, Mott MacDonald’s team created a Basis of Design document for the new building, and submitted it to the main contractor, BAM. He said: “BAM then brought in its various sub-contractors, with Silcock Leedham as mechanical and electrical engineering consultants, Arup as structural engineer, and ADP as the architect, plus Mott MacDonald as technical advisor for both MEPH and Civil and Structural Engineering.”
The new pathology facility has been built on the site of former doctors’ flats and an unused university building, close to the Gledhow Wing, on the north of the St James’s site. Emma Storey explained: “We undertook a comprehensive options appraisal, looking at potential locations here at St James’s, at the LGI, and at other potential sites. This site was available, is on Trust land, and has excellent access to all main routes – a key consideration, as well as being co-located with key clinical services and specialist staff.”
The pathology laboratory building will incorporate a high degree of automation, in line with the Leeds Teaching Hospitals NHS Trust and its two counterparts’ goal of significantly improving the efficiency and speed with which laboratory testing and analysis can be undertaken.
Emma Storey explained: “Leeds Teaching Hospitals NHS Trust has just signed a new ‘end-to-end’ managed services contract with Siemens Healthineers for elements including equipment, consumables, maintenance, and management of third-party subcontractors, and will simultaneously be installing a new Clinisys laboratory information management system (or ‘LIMS’), WinPath Enterprise, which will operate region-wide. The Centre will thus be equipped with the latest in technology and equipment linking us with the whole region. The shared system will simplify and speed up the transfer of samples and results, and support shared analysis by scientists of results, through the shared system between organisations. This will improve the resilience of the service, and support training and development of staff, through the shared access to samples and results. The equipment on the ground floor – for example for transporting samples for blood sciences to the correct analyser – will also be fully automated, which should greatly enhance speed and efficiency.”
Facilities floor by floor
Emma Storey explained that the building’s ground floor will house a central specimen reception that will receive all the specimens from across the St. James’s site, and those arriving from throughout the region, as well as accommodation for blood sciences and microbiology services. Following our meeting, we had a look around the building, where equipment will be installed in the coming months, and then commissioned and validated. The tour of the facility reinforced the impression of the size and scale of the building, with its open plan design – so that scientists and other personnel working there will not only have ample space, but can easily interact. The open plan configuration also affords considerable flexibility should personnel wish to move, or re-locate benching, in the future. Emma Storey added: “This flexibility will also be an advantage when we want to move equipment in or out, or expand services, as well – we hope – as encouraging valuable sharing of expertise and knowledge between staff.”
Sample transportation – to and within the facility
While samples from other hospitals will mainly arrive by courier, those dispatched from other buildings on the St James’s University Hospital site will arrive via a new pneumatic tube system. This was engineered to connect to the hospital’s existing system, and is so efficient that samples sent from the other side of the campus arrive ‘within minutes’. Once at the sample reception, pathology specimens will then enter a sample transport ‘track’ system which will take them to the right bench or workstation
Scientists and others working within the new building, and clinicians sending in samples for testing, will benefit considerably from the new Clinisys laboratory information management system, of which Emma Storey said: “Its installation will mean that a clinician will be able send a specimen here, and, after testing, the results will be viewable at any linked healthcare facility. All the participating Trusts will move over to use the same Clinisys LIMS.”
Moving on to the first floor, and in addition to the boardroom, this level will accommodate more specialist services, such as Specialist Laboratory Medicine. The Trust already provides such testing and analysis services or healthcare facilities in the region, and – in some cases – nationally. These, Emma Storey explained, include neonatal screening. She said: “This first floor will also house Transplant and Cellular Immunology Laboratories – which are particularly important because they support the Trust’s, and some of the region’s, transplant services. This will be the first time such a diverse range of pathology services in West Yorkshire have been brought together.”
I asked how the new facility had been funded. Emma Storey explained: “We obtained the funding via a combination of money from the original STP Wave 4 Bid, Trust contribution, and other external sources.”
A noticeable aspect when entering the building is how light and airy it is, with full height glazing in many areas. This is especially noticeable in the canteen and boardroom. There is also a series of lightwells, including a large central lightwell, running the building’s full height. When we toured the building, Emma Storey showed me a number of the laboratories – all have a clean, clinical finish, and ample light. She said: “The design stipulated that that all the lab spaces should have internal or external windows.” A number also incorporate a daylight-sensitive, digitally controlled DALI lighting system, which dims or raises light levels depending on the ambient light, but can also be manually controlled. Several laboratories also incorporate safety cabinets, into which staff can place their (gloved) hands when working on samples which emit potentially harmful substances. Any ‘emissions’ are then contained inside the cabinet and removed to atmosphere via a dedicated extract system
Staff wellbeing
One would expect high levels of staff safety and security in such a building, but Emma Storey and Andy Munro were equally keen to stress how much thought had gone into making the new Centre a comfortable, appealing place to work. Emma Storey said: “We are on track to achieve a WELL Gold and a BREEAM Excellent; the design was very much focused on both staff wellbeing and sustainability.” She added: “You can’t fail to notice how light, airy, and spacious the building is, and the high standard of fit and finish – in contrast to some of the outdated buildings in which a number of our Pathology staff currently work.”
This focus on comfort and wellbeing was immediately apparent when we viewed some of the ‘consolidated flexible workspace’ on the first floor. Here, enclosed glazed work ‘pods’ are interspersed around the open plan layout. These can either be used for meetings of, say, 2-3 people, or by individual staff requiring privacy. A number incorporate both a louvred roof and dedicated mechanical ventilation. Users can thus choose whether to ventilate the pod space by opening the louvres or – where they want more privacy and quiet – can close the louvres and activate the ventilation system. Another thoughtful touch is decorated internal acoustic baffles, which not only partition the space, but also absorb excess sound.
Emma Storey explained that with the building complete, the equipment will be installed over coming months, and then validated, before services transfer over. She said: “The aim is to have the building fully operational by this summer, but we will be transferring services over in a phased way, with those services not as reliant on the managed services contact, or automated equipment, first.”
External plantroom
Having discussed the staff floors, I asked about the sizeable rooftop plant enclosure. Andy Munro explained: “The external rooftop plant room, located well away from the clinical spaces in adjoining buildings, takes up about a quarter of the roof, and houses three Mitsubishi Q-Ton air to water heat pumps operating on an N+1 arrangement, with baffles around the enclosure to allow air in. These provide domestic hot and cold water, and serve two 1500 litre storage tanks.
The first floor also incorporates a large plant space with four separate air-handling units directly below the roof plant, with risers for the mechanical services. The air-handling units provide fresh air, environmental control, and extract ventilation. Areas such as the workspace and meeting spaces, changing rooms and toilets, plant areas, and sub-station rooms, all have their own dedicated airhandling or mechanical heat recovery ventilation unit. Mechanical ventilation to the specialist laboratory equipment such as the mass spectrometers and chemical cabinets is via dedicated polypropylene extract fans. On the lower ground floor are mechanical services entry points and water storage tanks.
Heating and cooling
Heating and cooling are provided by three four-pipe (simultaneous heating and cooling) Mitsubishi Integra NECS-Q-B1614 heat pumps that provide low temperature hot water and chilled water to air-handling units, heater batteries, chilled beams, and radiators. These work in an N+1 arrangement. DX heat pumps serve the IT Hub / server, freezer, and cold rooms.
Andy Munro continued: “As technical advisor to the Trust, Mott MacDonald was involved early on – in 2019 – in producing a Basis of Design document. We also liaised closely with the Trust’s Estates team to identify infrastructure connection points into the existing estate, and incorporated these into the Basis of Design along with other environmental conditions – such as lighting levels and airflows, and the building’s proposed use. This enabled BAM to produce a design to meet the client’s requirements in conjunction with its M&E consultant, Silcock Leedham. BAM both built the new Centre and undertook the MEP installation for it. Our role included reviewing the design documentation from BAM and its specialists, and making some recommendations to give the Trust assurance that the design would meet its requirements.”
Andy Munro has been with Mott MacDonald for 15 years, and has worked on the pathology building scheme from its inception. He said: “One of the most important aspects of the project was the building’s resilience. Being on a healthcare estate, and given the services it will provide, we needed to ensure there was no downtime.” To do this, Mott MacDonald’s M&E Basis of Design document included the proposal to bring across two independent high voltage supplies to the new building. These are diversely routed, and both rated at 100% with allowance for spare capacity, and are connected into the Gledhow Wing’s main switch panel. Andy Munro explained: “The main hospital electrical infrastructure here is an HV ring, with high voltage standby generation. The HV supplies connect into high voltage transformers in two substations on the lower ground floor of the new lab building, which then convert to LV. They supply main switchboards ‘A’ and ‘B’, and operate in N+1 configuration. Both the ground and first floor are provided with two sub-section panels to supply final circuit distribution boards at floor level. Supplying each floor with two switch panels to split the load across the floor plate reduces the risk of a full floor being affected should a problem occur, or maintenance be required.”
Dual supplies, diversely routed, are provided to each sub-section panel, complete with automatic transfer switches, so that in the event of one cable being damaged, the changeover will ensure continuous operation from the second. Within the main switch panels are busbar couplers that allow the incoming ‘A’ stream to switch over and provide power to the internal dual supplies up the main switch panels on each floor. These panels then distribute to local final circuit distribution boards around each floor – serving the specialist labs and departments. There are also dedicated supplies to the mechanical services.
Fibre optic supplies
“Information technology-wise,” Andy Munro continued, “the building incorporates dual incoming fibre optic connections, diversely routed, and taken from alternative existing core rooms to ensure resilience to the ICT infrastructure. High count copper cable for voice communications come into IT cabinets on the lower ground floor, distributed to local hubs on each floor, and then out to final connection points. Category 6 cabling provides future-proofing for high data flows, which will give the Trust the flexibility to introduce new equipment as and when needed. For lighting, we used the CIBSE LG2 Healthcare Lighting Guide with LED lighting installed throughout, and extensive uplighting – so that we don’t have dark ceilings. A large lightwell runs through the first floor to the roof to provide natural daylight into the central open plan area. We have also fitted high bay-mounted LED lighting there – with the lights on mechanical winches, so that they can be lowered for maintenance.”
He added: “The laboratory areas feature lighting that provides the correct colour temperature and rendering for scientists and other laboratory staff viewing samples and tissue. Resiliencewise, there is a connection to the lower ground floor LV switch panel to allow a standby generator to be brought in to provide power independently of the main hospital infrastructure. This would, however, only be needed in the event of a major incident.” Daylight linking, manual, presence, and absence detection control, are used for lighting, with scene setting control employed in the large open plan laboratory area
All luminaires are LED type, with a minimum 50,000 hour lifetime, 4000 K colour temperature, and Simmtronic DALI dimmable drivers
Andy Munro explained that throughout the building varying air change rates apply – from 10 litres/ second/person in offices, to 10 air changes / hour in CL2 laboratories, and 6 air changes / hour in WCs. Emma Storey explained that benching, specialist furniture, and many of the other fixtures and fittings, are being supplied by Labflex. Of the safety cabinets in laboratory areas, she added: “These will be fitted in certain locations depending on the work likely to be undertaken there. The dedicated flues and other extract infrastructure for them are already in situ, but the cabinets will be installed by a specialist contractor.”
We had already touched on the speed with which samples will arrive from other parts of the St James’s site – via a dedicated pneumatic tube system which connects a number of other buildings to the new facility. Andy Munro elaborated: “For the new Aerocom pneumatic tube system we had to engineer in eight lines of sufficient diameter to transport the sample pods via an underground service duct provided as part of enabling package engineered by DSSR. The lines runs through the duct from one side of the Gledhow Wing, and then under the car park opposite the new pathology building and the access road just outside into this building.” Emma Storey said: “The main challenge with bringing in such pipes is getting them around corners. Aerocom has recently upgraded the whole of our pneumatic tube system; the original system was another supplier’s. Wherever you are, samples will arrive in minutes to start being processed. Fast turnaround times are essential in pathology. Urgent results might – for example – be required within an hour.”
Sustainability elements
Turning to the ‘green aspects’ of the new building, Emma Storey said: “There is a significant Trust drive towards Net Zero, so it was important that the building have a low carbon footprint.” Alison Ryan said: We have three Mitsubishi air source heat pumps within the rooftop plant enclosure. With the drive towards carbon Net Zero and low carbon electric, air source heat pumps are seen as a key technology.”
Emma Storey said: “Much of the building is ‘smart’. For example, especially in the automation areas, the lighting is on daylight sensors, so won’t activate if not required. Parameters including temperature, humidity, CO2, and other lab gases, are monitored and maintained at the right levels via an advanced Building Management System from Trend Controls, installed by Westminster Controls. This BEMS will quickly identify any excess gas levels or leakages.” Among the lab gases that will be used are anaerobic mixed gas, Nitrogen, CO2, Helium, Argon, and compressed air; wherever there is a gas, there are sensors.
The patient benefits
Having discussed the key M&E aspects, I asked Emma Storey to reiterate some of the biggest benefits consolidating the region’s Pathology services on a single site would bring to patients. She said: “First and foremost, we should receive samples much faster, instead of them potentially reaching the wrong location and having to be transferred. In turn, we will be able to achieve faster resulting. Our new equipment will process samples faster, and we will then be able to put the results onto a single laboratory information management system – so they can be viewed by all the clinicians who need to see them straight away, rather than potentially being delayed, for instance in the post.”
The Centre for Laboratory Medicine had an official opening on 26 September last year, where attendees included the Trust’s Chair, Dame Linda Pollard, its CEO, Phil Wood, West Yorkshire Mayor, Tracy Brabin, and Minister of State at the Department of Health and Social Care, Will Quince.
“Involving staff in the building’s design and planning was one of our priorities from the outset,” Emma Storey explained. “Pathology laboratory staff have helped drive the design, participating in all the Design meetings, and have been involved in all the major design decisions. We have also liaised extensively with the Trust’s Estates team – a prime stakeholder, which has provided some invaluable advice and guidance.”
Andy Munro added: “One of the Estates team’s key roles has been to ensure that the M&E services within the new pathology facility don’t impact on the infrastructure of the existing hospital. The team is also fully aware of the equipment which will be going into the building, so they can maintain it efficiently following handover.” The Trust’s Estates team will be responsible for the general upkeep and maintenance of the new laboratory building, while Siemens Healthineers’ managed services contract will see it maintain and service specialist automated equipment
‘24/7 operation’ for some parts of the building
“Parts of the Centre for Laboratory Medicine, such as the ground floor automation area, will operate ‘24/7’, and – in addition to its fully programmable access control system – the building will be well lit externally and monitored via CCTV,” Andy Munro explained. This is an Axis IP CCTV system that harnesses a Synectics front-end video management system platform which allows for a PSN 4 Enterprise Class storage device, along with Synergy camera licences for all cameras. ‘Fast-acting’ IG541 inert gas fire suppression systems are installed within the HV, LV, switchrooms, and ICT rooms, as a key fire safety measure.
Emma Storey added, as our discussions closed: “The new pathology building will also play a significant part in training students at the University of Leeds keen to work in the field. Hopefully the fantastic working environment, and the level of automation, will make the Centre a place pathology professionals will really want to come and work in. The build quality is exemplary – a credit to BAM, its supply chain, and sub-contractors, while the excellent working relationships between all parties throughout have played a big part in the building being completed in rapid time to such a high standard. I am really looking forward to Pathology staff moving in, and to the difference the new working environment and technology will make to the speed, efficiency, and quality of Pathology services across the region. The biggest beneficiaries – quite rightly – should be the patients that we and the region’s other acute Trusts serve.”