Exploring how offsite construction methods can provide permanent healthcareinfrastructure that is flexible to changes in demand
Offsite construction methods have helped to provide emergency and temporary accommodation for the NHS throughout the COVID-19 pandemic.
Creating much-needed additional space to enable patient isolation, and ensuring super-fast delivery of vaccination and testing sites across the UK; modular and mobile solutions have increasingly been the go-to for NHS organisations.
But, according to industry leaders, so-called Modern Methods of Construction (MMC) also have a part to play in delivering permanent facilities needed for the future, including the 48 new and improved hospitals promised under the Government’s New Hospital Programme, announced last year.
Alan Davidson, healthcare director at Darwin Group, said: “The growth in the marketplace of offsite solutions has largely been due to the high[1]quality, fast-track delivery that has been achieved and the realisation at NHSE/I and trust board level that this is a great value-for-money route to meeting the Build Back Better agenda.
“This has been widely acknowledged by the Department of Health and is clearly demonstrated by the evolution of the procurement strategies and the framework options available for NHS organisations to use for new infrastructure.”
Delivering at speed
Speaking at the 2022 healthcare buildings forum, held last month in the Cotswolds, Andy King, technical director of the Modular and Portable Building Association (MPBA) and group technical and environmental director at Wernick Group, said the term MMC was inaccurate as modular facilities have been around since the late 1930s.
“The last two years have shown that MMC can provide temporary and emergency space, but what we want to do moving forwards is provide quality, permanent facilities at speed,” he added.
Offsite construction methods are attractive to NHS trusts as they dramatically reduce delivery time, with many facilities operational in a matter of weeks, compared to years for traditionally-developed projects. They also reduce onsite disruption, associated health and safety risks, and can be cheaper to deliver.
“If you have a faster programme then you can reduce costs,” said King.
“Not from the building products used, as they are the same, but if you can build something faster then you are reducing time-dependent factors like site kit and hoardings.”
The MMC approach also enables greater flexibility and standardisation, with modules acting like building blocks which can be pieced together to create bespoke solutions.
King explained: “Over the last few years the MPBA has been working on the NHS Repeatable Rooms project and has come up with standard models and sizes for particular areas, such as four-bed bays, single rooms, and theatres.
Mix and match
“Standard modules are between 3m[1]3.5m wide; but over recent years we have created new models and we now offer 3m, 3.2m, 3.6m, 3.8m, and 4.2m[1]wide modules which you can mix and match and this means you’ve got building blocks to start from.”
And modular solutions no longer need to be temporary.
Increasingly, trusts are using the approach to create buildings that will have an anticipated lifespan of over 50 years.
Davidson explains: “It is very much about changing the perception across the healthcare industry.
“Our next-generation modular builds have a design life of more than 60 years and have been used in other industries as permanent solutions, given the critical importance of whole[1]life cost and the requirement for sustainable buildings.
“Since the start of the pandemic, we have seen NHS trusts looking to adopt what they thought would be a temporary solution as a permanent facility moving forwards.
“Volumetric modular construction offers many long-term efficiencies, including the ability to restructure the internal aspects for future growth or change of use.”
King adds: “We worked with Queen Alexandra Hospital in Portsmouth on a temporary ward block. The trust then decided to make it permanent and, as it had already chosen a modular solution, the plans were adapted.
“The £8.2m scheme took just 22 weeks to deliver and we were able to mock up a demo model in the factory grounds so staff could visit the site to see how it would look.
“This is another great benefit of the offsite approach.”
Another project Wernick Buildings worked on at the George Eliot Hospital in Nuneaten involved a two[1]storey ward block and operating theatre being delivered over three phases, the first of which took just 14 weeks from inception.
But King said that to properly embrace MMC moving forwards, the current procurement model needs to be adapted.
Start at the beginning
“A well-procured modular building can be delivered in half the time of a traditional build, but we need to look closely at the point when we choose the modular contractor,” he added. “Traditionally, this has been at RIBA stage 3 or 4, but that’s too late.
“That is expected to change, though, and RIBA is reissuing its plan of works to take note of the role of MMC advisors at the very beginning of a project.”
Also speaking at the forum, organised by hdm publisher’s sister company, Stable Events, was Paul Sheldon, consultant healthcare planner at Archus, who championed the use of offsite construction solutions for their flexibility, particularly in light of the fast[1]changing demands on health services.
“We have been talking about the potential of standardisation for years, but for some reason we do not do it,” he said. “With standard modular solutions nurses can walk into a room they have never been in before and they are instantly familiar with it.
“No-one wants long thin rooms or L shapes, so modules become a kit of parts, not a cookie-cutter approach.
“It’s standardising the use of a room, not taking away architectural flair, but instead providing the clinical make-up that architects can put their design flair around.
Best value
“Standardisation creates consistent infrastructure, reduces clinical risks, is easily maintained, and is adaptable and flexible.
“Within MMC, we can standardise components and activity zones, room planning principles, rooms sizes and ratios, clusters of rooms, departments, planning grids, and circulation spaces.
“Ultimately, it’s best-practice design that provides value.”
Davidson adds: “All the current evidence would suggest that MMC and manufactured solutions offer an ideal answer to the future demands for the modern healthcare estate.
“However, there will always be a place for both solutions.
“Offsite and traditionally designed and built solutions should be selected to best match the client requirement and the site in question. In a small number of cases an offsite solution may not be suitable.
“However, given the carbon savings during manufacture, the sustainability aspects of MMC, and speed of design, development, and construction; it is no surprise that public sector procurement is focusing on offsite solutions to meet the demand for new healthcare construction works.”
