The Making Of A Super-Hospital

The Making of

a Super-Hospital

Nick Fairham,head of Bristol studio, recounts how modern design technology and construction techniques enabled the early delivery of a state of the art healthcare facility in Wales.

Grange University Hospital In a year most of us can’t wait to forget, on a fabulous site in the Welsh countryside north of Newport, a cutting-edge specialist critical care centre opened four months ahead of schedule - and under budget. Despite the challenges presented by the Covid pandemic, incredible treatment and care continues to be delivered daily with the facility’s built-in flexibility key to its response.

As one of a handful of people involved in the design and construction of the Grange University Hospital, from the beginning to end of its 13 year journey to completion, I wanted to reflect on what we, our partners and client have learned along the way, and how these findings can fundamentally change the approach to designing and delivering future hospital construction projects.

Firstly, timeframes: a decade or more for the design, development and delivery of a major critical care hospital was to be expected when we started. Naturally, the planning, approval and procurement processes are complex. But it is now acknowledged that streamlining and prioritising the approval process, in particular, can save years of time and millions of pounds. It means suppliers can plan workloads, agree design approaches and maintain greater continuity of people and expertise - not to mention the cost savings – a year’s delay on a £300m project could lose £12m to inflation. That’s a shortfall that has to be recovered – so you have to start taking things out. Therefore establishing efficient and timely processes from the outset is critical.

Flexibility in healthcare design is fundamental to ensure a hospital can evolve to meet advances in treatment and care, adapt to a population’s changing healthcare needs and enable continuous improvement and system transformation. Flexibility to adapt to changes in design, technology and construction over the course of a decade is also hugely important. Take energy supply for example; at the start of this project, biomass boilers were the sustainable solution of choice. By the time the hospital was being built, combined heat and power was the way forward and installing biomass would have been practically prehistoric. At the other end of the scale, light fittings were switched to more energy efficient LEDs which had become commercially viable during the lifetime of the project.

An expert client and efficient supplier framework greatly contribute to reduced timescales and keeping budgets on track. The Aneurin Bevan University Health Board and the NHS have significantly invested in skills and are expert customers buying expert suppliers.

The framework is fundamental to that expertise, ensuring teams of architects and designers, project managers, construction engineers and contractors work together from the outset. It meant the contractor could share experience

of building hospitals across the UK, rather than each stage happening in isolation with a contractor engaged too late to inform designs. Conversations and knowledge sharing took place much earlier. Laing O’Rourke’s expertise in offsite manufacture and Modern Methods of Construction (MMC) for example, helped inform and develop our design. Large windows that flood patient bedrooms with natural light, proven to have a positive impact on wellbeing and recovery, were made even larger than our original design, following their suggestion to reduce the weight of the wall components to allow better transportation and more efficient logistics on site.

At the outset of this project MMC was in its formative stages. Every element was effectively a prototype. The contractor brought a great deal of learning from the delivery of two other major hospitals at Alder Hey and Dumfries and Galloway and this informed a lot of decisions. From reducing material waste and construction traffic on site, to the procedure for loading and unloading lorries, offsite manufacturing of large component parts of the hospital allowed for unprecedented levels of efficiency and precision.

Lastly, this project substantiated a fact we have always known: the importance of involving people. As well as bringing contractors and suppliers together from the outset and delivering sufficient corporate memory to stay the course of the project, engaging staff and clinicians early is also crucial. The decision to design storage into every pod of single patient rooms rather than at the ends of long corridors was informed by nursing staff who pointed out crucial time lost to gathering medication, equipment and supplies.

Helping teams to prepare for transition was also vital. The Grange University Hospital is at the centre of a fully transformed healthcare system, so as well as working in a new building, teams had to adjust to new operational procedures and models of care. We created a website to make the space available virtually in advance so that staff could undertake training and familiarisation long before they moved in.

It’s been a privilege to see this project through from start to finish and a valuable learning experience to inform the design of the best healthcare facilities we can possibly create; efficiently, collaboratively, effectively.