CONSTRUCTION
Learning from hospitals built during the pandemic
Asha Devi, a director at Arup, explores what the construction and healthcare sectors can learn from hospitals built during the COVID-19 pandemic, citing the NHS Exeter Nightingale hospital – the only such facility still in use by the NHS today. In recent years, it has been repurposed as a Community Diagnostic Centre, an elective care surgical centre, and an Outpatient Department facility.
The need for new hospitals is more urgent than ever, with demand for hospital treatment continuing to significantly outstrip capacity. The latest government figures show that over 6.48 million people are waiting for treatment following the backlog caused by COVID-19. This means that we must be prepared to build hospitals as efficiently as possible so that we ensure their long-term success. They must be built with flexibility in mind, and be able to meet the long-term needs of both the NHS and local communities. Learning from the hospitals that were built during the COVID-19 pandemic will be the only way to rise to this ambitious challenge. The NHS Exeter Nightingale hospital is a particularly useful example to learn from, particularly given that it is the only such hospital which is still being used by the NHS today, and has thus proven its versatility. BAM Construction, and the design
team (which included built environment consultancy, Arup, providing a range of specialities), repurposed a disused retail store into an effective medical facility able to cope with an influx of COVID-19 patients in under 60 days. Two years on, now working with Nevada Construction, the building has been repurposed once again into a Community Diagnostic Centre (CDC), elective care surgical centre, and rheumatology and ophthalmology departments. The diverse range of departments within the facility were carefully selected to match the specific waiting list backlogs in the local area.
Delivering time-pressured projects Both the original Exeter Nightingale and the repurposed CDC were built under extreme time pressure, which will likely be the case for similar projects going forward. The initial 116-bed hospital was designed and built in just 57 days, while the second saw just a six-month turnaround from inception to welcoming its first patients. Supply chain constraints also impacted both projects, with the original Nightingale
Both the original Exeter Nightingale and the repurposed CDC were built ‘under extreme time pressure’.
team also having to work with COVID-19 social distancing and biosecurity measures in place. This complex brief required Modern Methods of Construction. Supply chain engagement and factory visits at the beginning of the project enabled the design team to identify the most effective solutions. For example, the reconfigured Exeter Nightingale Hospital used modular construction to expedite the delivery of a new orthopaedic department, comprised of two operating theatres, a recovery ward, and a clinical store.
Steel podium While the operating theatres were being built in a controlled environment off site, the area was prepared with a steel podium and adequate drainage to overcome the challenges caused by the sloping topography. This allowed the modular theatres to be simply lifted into place, with 450 m2
of fully furnished clinical space
installed in just 48 hours, the M&E services having already been tested in the factory. Once the modules were installed on site,
the services were reconnected at the module boundaries, allowing for a swift commissioning process. The construction coincided with a period of particular pressure on material supply chains. The designers responded to this constraint by presenting multiple options for each part of the construction, allowing the contractor to procure whichever option was most readily available. When reconfiguring the large multi-bed wards to form cellular consultation spaces, timber became the material of choice, because it was adaptable on site and in plentiful supply. Close collaboration between fire engineers and acousticians enabled this material to meet the technical demands of a hospital environment.
Fire safety considerations From a fire safety perspective, the existing portal frame structure needed careful assessment. Detailed calculations were performed to predict the largest fire that could occur, based on the fuel load within the Nightingale. This exercise showed that
October 2023 Health Estate Journal 43
NHS Exeter Nightingale hospital photos courtesy of Tim Pestridge
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