Engineers, Assemble

Civil and structural engineering director, John Roycrofttakes a pragmatic look at modern methods of construction in hospital design, sharing his view on how intelligent engineering and material choices can enable quicker, more efficient building.

Offsite manufacturing has been around for a very long time. The master of engineering, Isambard Kingdom Brunel, designed a prefabricated timber field hospital to treat injured soldiers in the Crimean war. He responded to a plea from Florence Nightingale to improve the environment for injured British soldiers at the Turkish Barracks with a design that enabled modern sanitation, ventilation, drainage and even rudimentary temperature control. It was built in Britain in five months then shipped and erected at Renkioi in the Dardenelles. It cared for 300 wounded, rising to more than 1,000 by the end of the year.

The best ideas are those that are recycled, often generations later. As the healthcare sector continues to battle admirably through a global pandemic, speed of delivery and efficient, flexible hospital designs are very much in need: re-enter off site construction.

Modern methods of construction like this could prove crucial in new hospital design, providing predictability and accuracy. They have the potential to improve product quality and increase productivity, enabling speedier build schedules and leaner budgets. But for projects to truly unlock the benefits of modern methods of construction, a shift in engineers’ approach to design is pivotal and an assembly mindset is key.

I’m continually impressed by the benefits of precast concrete, prefabricated steel or even engineered timber post and beam structures, especially in complex designs. For example, when we use precast concrete we know the sort of quality we’ll get on the finish because the approach is so consistent. So offsite construction means we are improving quality as well as mitigating the impact of the weather and reducing the risk around forming concrete on site that is so dependent on workmanship. This is why offsite manufacturing is so compelling and it’s exactly why we should be embracing it.

As a result, we are developing structural concepts with at least 90% offsite, modular or standardised component construction methods, ensuring a culture of component assembly rather than on site construction. We are even exploring how to reuse components from older, disused buildings in our designs. As we move towards a circular economy, and with the ability to use building information modelling to record materials, if a building becomes obsolete, we should be dismantling and reusing rather than demolishing. Delivering a progressive approach is about bringing different disciplines and approaches together to create something unique that’s assembled from readily available standard components.

Renkioi Hospital – an early prefabricated timber construction (Isambard Kingdom Brunel)

The benefits of MMC are abundant and while we practise these philosophies across all sectors, we know we are uniquely placed to play a lead role in the delivery of new hospitals. The government is actively promoting modern construction approaches and standardised components across the NHS, with one MP advocating for its use so that hospitals can be more adaptable to keep up with rapid advances in medicine. Indeed, the most fundamental benefit of MMC is flexibility and the parallel options developed at feasibility stage give clients real choice. Most hospitals we are involved with are working towards an outline business case, with NHS trusts looking at scheme designs as they try to secure funding. This includes projects in Epsom, Watford and Leicester. We will bring new ideas and our experience of using MMC to these projects to help deliver new, modern hospitals on a national scale, faster, more cost effectively and with less impact on the environment.

Brunel recognised the urgency of the Renkioi prefabricated hospital and devoted his time and passion to create a place where many lives were saved. Using the benefit of modern technology and expert clinical insight, we are following in his footsteps; harnessing our knowledge and interdisciplinary thinking to swiftly deliver robust healthcare facilities for those most in need.

Epsom and St Helier Hospital – Early concept sketch of the 'cocoon'