MODERN METHODS OF CONSTRUCTION
The NRC – which HM Treasury gave a go-ahead for on 21 September – was the first project to be assessed under the P23 MMC tool, and to pass. In addition, its design is geared towards achieving Net Zero Carbon status, aligning seamlessly with the broader commitment of the Greener NHS pledge to become the pioneer in establishing a Net Zero National Health Service globally. Scott Tacchi added: “A 70-bed facility, the NRC harmoniously blends with the Stanford Hall Rehabilitation Estate’s natural surroundings, and exemplifies top-tier sustainability. Positioned within the Stanford Hall Rehabilitation Estate, it enjoys proximity to the new Defence Medical Rehabilitation Centre (DMRC), fostering shared facilities and access.” Key design features include: 1) Flexibility and functionality; 2) abundance of light and views; 3) nature-centric approach; 4) sustainability at its core; 5) contextual materials; 6) visual harmony.
in organising multiple small teams with ease – instantly see projects progress, and catch any tasks that may be falling behind before they delay the project, and share critical project information with external parties. This can be done through the use of dashboards and reports linked digitally across the whole team, which can vastly speed up delivery and assist with time and cost-critical decision making. Robotics, in the form of Buildots, HP Smart Print, and Hilti’s Jaibot (to name but a few), can also dramatically speed up on-site reporting, remove repetitive tasks, and improve health and safety practices. Undoubtedly, time on site equates
to cost. Site preliminaries can run as high at £10,000 per week on large hospital projects; a £300 m hospital which remains on site for 36 months can ultimately amount to costs of £1.6 m in preliminaries alone. Reducing time by even a third can yield savings equating to £500,000. The approach being taken to standardisation and MMC within the NHP programme, as outlined, can realistically expect significant time savings to be produced.
H2.0 standardisation The NHP’s Hospital 2.0 modelling, which brings the benefits of standardisation and industrialisation to the design and manufacture of new facilities, has built on the Platform 2.0 programme, and will create a set of standards governing layouts, critical dimensions, and standard workflows. This may come as a surprise, as Healthcare Technical Memoranda (HTMs) and Healthcare Building Notes (HBNs) have been about for years. Unfortunately, this is not the case: nearly every hospital
60 Health Estate Journal November 2023
has different grid spacing and floor-to- floor heights. There has, up until now, been no benchmark for standardisation. However, the benefits of standardisation are apparent: with standardisation comes repetition, and with repetition comes the ability to bulk purchase, which in turn comes with reduced cost. Furthermore, the standardisation approach has produced a ‘schedule of accommodation’ that looks to minimise waste and save double-digit percentage floor area within current hospital designs. With the new NHS Net Zero Carbon
targets now in place, an approach to standardisation and rationalisation of facades will be another priority, accounting for approximately 10% of the cost of a hospital. If a 10% cost-saving is achieved on this one item, that could ultimately account for a programme-wide saving of £1 bn.
Overlooking the value of MMC Despite the advent of these tools, the questions surrounding a project almost always come back to cost rather than asking what value can be gained by MMC practices like those outlined above. It cannot be denied that construction is still in a race to the bottom on pricing, and commercial managers pursue MMC not for its value in delivering quality and improving construction, but rather as a low-cost alternative to traditional methods. For this to be remedied, what is needed is a fundamental mindset shift that transforms attitudes within the industry away from its cost obsession and towards embracing the opportunities and benefits MMC can bring on a wider level, particularly in terms of productivity
improvement: after all, package price is only one dimension in a three-dimensional world. Assessing cost alone cannot quantify the benefits of MMC to quality, speed, and health and safety of projects industry-wide; neither can it quantify the environmental and social value benefits, as staff are no longer required to travel across the country to reach sites, reducing miles of unnecessary travel.
Investment into facilities We also have to address the cost that the construction industry will need to bear in readying itself for the delivery of the multi-billion NHP programme. This will include considerations such as investment into MMC manufacturing facilities for MEP module components, new facilities for two-dimensional composite panels and pre-wired walls, and design fees to complete the development of Hospital 2.0 components sets – allowing the development of manufacturing facilities to produce them, borrowing costs to fund the investment, which will only be recovered through Overhead and Profit training and recruitment considerations. All of this will need to be recovered before the MMC solutions start reducing the outturn costs of the schemes. It has been suggested in the past
that projects may benefit from running two cost plans; one traditional and one utilising MMC to compare and contrast. My response to this is that MMC is not a ‘bolt-on’ at RIBA stage 4. The true benefits of standardisation within all aspects of the design, such as with Platform-Design for Manufacture Assembly (P-DfMA) and digitisation, all need to be established at
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