Harnessing a standard ‘kit of parts’ approach pays off

In May last year the Government announced that five more hospitals would be built in England, in addition to the 40 new projects announced in 2019 as part of its New Hospital Programme (NHP), making it the largest hospital building programme in a generation. This ambitious proposal requires innovative thinking and a strategic approach when it comes to how we design and build new hospitals. While cost and time efficiencies are high on the agenda for the NHP, so is the journey to reaching Net Zero Carbon, particularly for the NHS, which has pledged to be carbon neutral by 2040.1

At least 14 buildings in the NHP will be built using standardised components and Modern Methods of Construction (MMC), with the aim of completing the projects 25% faster.2 However, despite MMC having been positioned as the key to transforming construction, it is still relatively underutilised. The Government’s commitment to using MMC within the NHP therefore has the potential to shape the future of not only the entire healthcare system, but the construction industry too.

Championing MMC for decades

At NG Bailey we have been championing MMC for decades, making it a key part of our approach for projects across the business. Our application of this approach, and our specialised offsite manufacturing facility in Bradford, the largest of its kind in the UK, allows us to deliver projects in a significantly safer, better, greener, and more efficient way than if we used traditional construction methods. It’s an approach we have used many times in healthcare settings, particularly in our 20-year partnership with Integrated Health Projects (IHP), the joint venture between VINCI Building and Sir Robert McAlpine, where we have gained a reputation for delivering high-quality engineering solutions for complex healthcare facilities. This is largely due to our ‘offsite first’ approach, which not only maximises efficiency by delivering fully assembled components to site, but also enables the hospitals we work on to remain fully operational throughout the build.

Challenges of hospital construction

Healthcare construction has always presented a unique set of challenges, and these have only been exacerbated in the wake of the COVID-19 pandemic, with the number of people on waiting lists for hospital treatment up from 2.5 million in 2010 to over 7 million in 2023.2 This is why it is vital that hospital repairs and developments are delivered efficiently, safely, and without complication, to ensure that the public can continue to access essential medical care. MMC can be a vital tool in ensuring that this happens, with offsite manufacturing delivering savings of between 10 and 50% on construction time, meaning projects are delivered more quickly.3

Careful construction planning and logistics are also essential to ensuring minimal disruption to live healthcare facilities. To ensure the safety of patients and hospital staff, construction teams must be rigorously trained and adhere to precise protocols, such as securely isolating dangerous working areas, and diligently decontaminating materials. Then, of course, there’s the inherent challenge of working with older structures. From replacing outdated materials such as RAAC, and incorporating asbestos surveys into project timelines when carrying out refurbishment projects, to ensuring that risk assessments have been completed when integrating new systems into existing buildings, there are many complex facets to consider. This requires close collaboration with hospital staff and the Estates team, and carefully planning routes of access and localised shutdowns to connect MEP systems, all while ensuring that the hospital remains operational.

For these reasons, Estates teams need to carefully consider who they partner with when undertaking refurbishments or new builds. Healthcare facility projects are complex by their very nature, so it’s of the utmost importance that those leading on the developments have experience working in these environments and can deliver the work in the safest, most efficient way possible using the most up-to-date techniques.

Expertise in healthcare: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust

At NG Bailey we have a long track record working on complex healthcare facilities. For nearly two decades we have worked in partnership with IHP on projects across England, most recently delivering nine projects together at Chesterfield Royal Hospital over a 10-year period. Our most recent project at Chesterfield Royal Hospital was the development of a new state-of-the-art Urgent and Emergency Care unit, as well as an extension and refurbishment of the Paediatric Assessment Unit. We used MMC throughout the development, with internal service modules and the pipe spools manufactured at our offsite facility. Our use of MMC allowed us to speed up the manufacture and installation of equipment, reducing the impact of the works on the wider hospital estate.

This successful delivery meant that when the Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust sought a partner for its Bassetlaw Hospital Emergency Care Village, NG Bailey and IHP were the perfect fit. We began work for the Doncaster and Bassetlaw Hospital Trust at its site in Worksop in October last year, with the project due to be completed this summer. We are delivering all mechanical, electrical and public health installations on site, which includes the new Emergency Care Village, as well as the refurbishment of existing clinical accommodation to create a new Children’s Assessment Unit (CAU) and new Assessment and Treatment Centre (ATC) at Bassetlaw Hospital.

Single-storey extension to A&E building

The new build Bassetlaw Emergency Care Village will be a single-storey extension to the existing A&E building, which includes a main public entrance, as well as a secondary access route for ambulances. The refurbishment of the existing clinical accommodation will create an assessment and treatment centre ward and a children’s assessment unit.

The new Children’s Assessment Unit will be located in close proximity to the hospital’s new 24/7 A&E department, so the finished developments will minimise the likelihood of patients being redirected to Doncaster Royal Infirmary, ensuring that patients can be seen more quickly, and helping to improve health outcomes.

Keeping costs low, and work efficient, sustainable, and safe, is vital in this development, which is why we are tackling these challenges head-on by collaboratively agreeing to a set of standardised components. This involves standardising solutions so they can be manufactured off site and slotted together in situ, meaning less people are needed during the installations, and in turn minimising the risk of contaminants and reducing labour hours on site.

Historically, designs are progressed from concept through to the spatial coordination stage based upon traditional installation techniques. This means that key architectural design decisions are sometimes made against outdated engineering principles, which ultimately increases both the time needed on site and the costs for the client. By working collaboratively with the hospitals to agree on a standardised ‘kit of parts’, we can ensure that everything we produce is not only compliant, but also delivers the best value for the project, saving time and cost on lengthy re-designs.

In Bassetlaw, we are using our tried and tested ‘one-size-fits-all’ approach by prefabricating many of the materials we are using at our specialist offsite manufacturing facility in Bradford. This includes the pipework spools connecting the hot water to the existing hospital, the valve sets serving heating radiant panels in the clinical spaces, and DWS pipework IPS modules in the ward and clinical areas. This ‘offsite first’ approach allows us to speed up the manufacture and installation of equipment, helping us to keep to a tight delivery schedule, and ensuring that the new and refurbished areas of the site will be operational by summer.

Collaborative construction

Working on live hospital sites presents complex challenges, which is why collaboration is one of the most important aspects of successful delivery. This is especially true during M&E installations, where we’re installing vital functions, such as heating and electricity. In the Bassetlaw Emergency Care Village new build, we are delivering an all-electric design, which involves providing new air source heat pumps (ASHPs) on the outer roof of the first floor’s plant deck, as well as installing new air-handling units on the inner roof of the new first floor plantroom. The NHS uses large quantities of heat and hot water each year to provide safe and effective healthcare. ASHPs are sustainable and affordable solutions to heating and cooling, with the capacity to reduce the associated costs, as well as the carbon emissions, of the building by over 30%.4

Once the ASHPs and air-handling units are installed, we will then install the MEP services for the Emergency Care Village, connecting existing site-wide infrastructure to the building. This includes medical gases, heating from the mains, security and IT systems, as well as fire alarms and building management system controls. Similarly, in the new Children’s Assessment Unit and Assessment and Treatment Centre we are adding a new internal plantroom above the existing Endoscopy Department, which will house the new heating, cooling, and ventilation plant.

Looking forwards

There is no doubt that MMC will continue to play a significant role in the future of healthcare construction. MMC and offsite manufacturing offer considerable benefits — from creating a safer working environment, to reducing the emissions of the entire facility, both during construction and operationally.

Complexity and urgency can make undertaking healthcare projects a daunting task. However, by working with organisations such as Integrated Health Projects — the joint venture between VINCI Building and Sir Robert McAlpine, and taking advantage of MMC, combined with careful planning, attention to detail, and collaborative client relationships, it is possible to successfully deliver schemes that will create a more sustainable, more resilient, NHS for generations to come.

References

1 Delivering a ‘Net Zero’ National Health Service. NHS England, October 2020 http://tinyurl.com/3ewewwh5

2 Lowe T. Building, Rebooting the New Hospital Programme: Is this the solution to the NHS backlog? Building online 16 June 2023. http://tinyurl.com/2mkxu9mw

3 Modern Methods of Construction: Benefits and Challenges. Procure Partnerships Framework, 12 September 2022. http://tinyurl.com/nh6rumy4

4 Makosinski J. NHS leads the way in adopting heat pump technology. Building Better Healthcare 19 April 2023. http://tinyurl.com/3surbsjy