HOSPITAL CONSTRUCTION
Increasing shift to MMC requires different mindset
Regina Kennedy, Healthcare Strategy and Planning director at ETL – the multidisciplinary consultancy formed in 2014 which is wholly owned by Guy’s and St Thomas’ NHS Foundation Trust (GSTT) in London – argues that the presumption in government circles toward greater use of Modern Methods of Construction (MMC) in healthcare building projects calls for a distinctly different mindset and approach.
The New Hospital Programme (NHP) is challenging our industry to lead a revolution in the way that hospitals are designed and built. How can we foresee the future performance of something entirely new? For one, we can set performance criteria, requirements, and priorities. It takes well-informed planning. Healthcare planning is most often a second or third career for that very reason: it requires many years of training and practical experience. If the way in which our clinical and functional briefs are translated into design solutions is changing, we will need to work a bit differently, but our objective remains the same – a hospital that works, for patients, families, and staff. The ultimate objective is a hospital that will remain high-functioning well into the future.
Presumption towards MMC Government policy in the UK, and indeed influential documents such as The Cabinet Office’s Construction Playbook, published in December 2020, call for wide-scale adoption of Modern Methods of Construction (MMC) – the term MMC covers a lot of ground, but generally refers to offsite manufacturing of components, systems, and modules. The immediate stated goal,1
as set out in, for instance, the
Gardiner & Theobald and NHS Property Services Primary Care/Community Health Premises Schedule of Standards and Minimum Design Requirements document published in January 2021, is for each project to achieve a minimum of 65% premanufactured elements, as part of the project’s Modern Methods of Construction (MMC) strategy. The targeted 80% standard repeatable rooms will help enable MMC and future design automation. This move away from bespoke, unique rooms toward modularisation requires a new mindset. If, on the one hand, there is a hope that
we shall save time and money by investing in MMC strategies, on the other it’s our duty to safeguard the quality, safety, and long-term operational benefits of each project’s chosen MMC strategy. Long-
Figure 1: Six key areas to consider when rating Modern Methods of Construction for sustainability.
term operational suitability will need to be described through healthcare planning requirements.
Healthcare planners’ understanding How much do healthcare planners need to understand about MMC? Enough at least to ensure that designers and builders respond correctly to requirements around flexibility, adaptability, obsolescence planning, resilience, and a need for agile response to changing clinical, technological, and population health environments. However, just saying that is not enough; we need to be clear and specific throughout.
The MMC supply chain Building the New Hospital Programme’s 40 new facilities is an opportunity to encourage investment in the supply chain in components and modules suited to the construction of hospitals. In healthcare, to rationalise the
investment, building typologies are designed based on being suited to a certain type of use, or a range of uses. For instance, the requirements of layout, equipping, adaptability, infection control, air-handling, and maintenance access in an operating theatre department are far more exacting than those in an Outpatients’ Department. There are some
truly excellent tried and tested MMC systems – for operating theatres2
– mainly
‘imported’ from European suppliers – that tend to require high upfront capital investment, and could not be justified in an Outpatients’ Department. The reverse is just as true; it would be short-sighted to adopt a low-tech MMC solution in theatres. How much of the hospital MMC supply chain needs to be specialised in healthcare? Some of these MMC elements may not be unique to hospitals, but generic commercial build does not make for hospitals that work. Façade systems need not be exclusively intended for hospitals, but key areas of the fit-out – such as imaging, radiotherapy, interventional and procedure areas, as well as support services such as aseptic suites, pathology labs, and decontamination and sterilisation services – are highly specialist.
Operational efficiency and lifecycle costs Operational costs are a key element of lifecycle hospitals costs: in fact roughly 75%, excluding utilities. To enable more accurate contextualised assessments, more transparency is needed around lifecycle costs in healthcare. The NHS is uniquely positioned to collate and analyse data and disseminate this information. Suffice to say that limiting
February 2022 Health Estate Journal 63
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