INFRASTRUCTURE
Designing mechanical and electrical interfaces
that allow for switchover with minimal downtime ensure service continuity throughout any building work.
The impact of construction on hospital operations extends beyond traffic and logistics. For new developments on existing hospital sites, the design of the new building itself must consider how its delivery and eventual operation will affect adjacent clinical areas, patients flows and visitor egress
Waste collection, pharmacy deliveries and emergency
transfers are all equally reliant on unobstructed access. These routes and internal delivery networks have often evolved and adapted over years, or decades, across a changing estate, and any disruption to this finely tuned system can have a cascading negative impact on patient care and staff efficiency. That is why engagement with the Trust’s facilities and operations teams must begin at the same time as discussions with clinical stakeholders and other user groups. The membership and terms of reference of these operational stakeholder groups should be defined early in the project, whilst the project schedule should build in adequate consultation and assurance periods with the relevant operational stakeholder groups. As the design gains momentum, and the new project or building begins to take shape, the input from operational teams is vital to ensure that the hospital’s core functions remain uninterrupted, and that risks are identified for mitigation plans to be put in place.
Parallel pressures: Delivering BAU projects during major construction Whilst large-scale developments often dominate stakeholder attention due to their higher transformational potential and capital spend, NHS Trusts, as a part of business-as-usual operations, continue to deliver a wide range of smaller capital projects in parallel. Individual projects, typically valued below £5 m, are often delivered as part of an annual programme of works. These could include ward refurbishments, service upgrades and essential maintenance works, many of which are driven by the need to address backlog maintenance or meet NHS Net Zero targets. These projects do not pause during major construction
works or new developments taking place elsewhere on the hospital campus. In fact, the seamless delivery of business-as-usual (BAU) capital projects often becomes more urgent, and clinical teams must adapt to temporary constraints and evolving service needs. The coexistence
176 Health Estate Journal October 2025
of major and minor projects within the same operational environment requires careful sequencing, coordination, and communication. Without this, the risk of delays, cost overruns, and service disruption increases significantly, with a higher likelihood of the schemes not achieving their objectives.
The equipment challenge: Logistics of high-impact installations Projects involving the replacement of large-scale medical equipment such as MRI scanners, CT machines or linear accelerators present their own logistical challenges. These installations typically require road closures, large cranes for equipment movement, and precision scheduling, all of which are complex enough as individual projects – without the added pressures introduced by a neighbouring construction site in the case of hospitals that have major new developments on site. In many cases, temporary trailer-mounted mobile imaging facilities must be provided to maintain continuity of care. These trailers, often housing CT or MRI units, require additional space within already constrained hospital sites and place further pressure on access routes and utilities. Another potential challenge arises when a tower
crane required for new construction is located near existing MRI suites. The electromagnetic interference from crane operations can disrupt imaging equipment. In such cases, additional shielding and mitigation measures must be embedded in the Construction Environmental Management Plan (CEMP) and agreed with the Trust’s medical physics team. Once construction is complete and the crane is dismantled, MRI systems must be recalibrated to ensure diagnostic accuracy. The impact of cranes on air ambulance service routes, and their exclusion zones on blue light routes, must also be given significant consideration as applicable. Conversely, tower cranes can also present opportunities. When traditional delivery routes are
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