INFRASTRUCTURE
unavailable, cranes already on site for major developments may be used to lift major equipment into place in the existing site depending on constraints and reach. This requires close coordination between the project managers for both the equipment replacement projects and the redevelopment project, the principal contractor for the larger scheme, and the various internal Trust teams to align lifting plans with equipment replacement schedules. 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. From the earliest stages, the design team, led by a
project manager with experience in delivery of healthcare projects and an understanding of the effects that each decision regarding the new building may have on the existing estate, must collaborate closely with Trust stakeholders to evaluate the impact of design choices on BAU operations. Key considerations include: n Noise, vibration and air quality mitigation: Selecting construction methods and materials that limit disruption to adjacent wards, particularly those housing vulnerable patients and sensitive medical equipment, and ensure appropriate monitoring and escalation methods are deployed.
n Service continuity: Designing mechanical and electrical interfaces that allow for switchover with minimal downtime, ensuring that critical systems remain operational throughout the build.
n Wayfinding and security: Maintaining clear and safe pedestrian flows for patients, staff and visitors during phased construction, while ensuring that security protocols are upheld.
These considerations are not just technical – they are deeply operational. They require a mindset that prioritises the lived experience of hospital users throughout the construction period of the new development.
Waste management: Planning for the future Another critical but often overlooked aspect is waste management. Major projects can disrupt existing waste collection routes and storage areas for the live hospital operations teams. Once new facilities are operational, the volume of waste generated also often increases, whilst the space allocated for waste handling may decrease. To address this, project managers must work with design teams, facilities managers and equipment suppliers to develop bespoke and holistic site solutions. These may include waste compactors designed for narrow spaces, or the installation of resilient bins on lightweight mezzanine structures where ground-level space is limited. Hospital sites located in residential areas must also consider the impact that the current logistics related to waste management have on the neighbours and ensure the solutions related to the new development look to mitigate these concerns as far as possible.
It is vital that teams working on major projects should demonstrate their understanding of working in live hospital environments.
Construction work, both of smaller capital projects and
large-scale developments on site can disrupt established fire egress routes, posing risks to safe evacuation and breaching regulatory standards. To safeguard patients, staff and visitors, the fire safety management master plan must be updated during building works. Following completion of any new development, the plan should also be reassessed and revised to reflect new layouts, occupancy changes and fire safety systems, including any egress routes interfaced from new to existing buildings, ensuring ongoing compliance, resilience and protection.
Finding site space for projects Ongoing capital projects delivered as part of internal capital programmes are a necessity to sustain the operational NHS estate and address backlog maintenance. Even when a contractor begins a minor project on a congested and constrained hospital site, they still require space for equipment and material storage, welfare facilities and waste skips. On high density and constrained sites, it is worth
exploring options for the principal contractor delivering the main scheme to share welfare and storage facilities with the Trust’s incumbent contractors undertaking smaller projects.
A coordinated construction logistics plan, aimed at coordinating the requirements of all contractors and suppliers involved across the different projects should be considered as part of the overall project implementation strategy. To overcome all described obstacles and bottlenecks will not be possible without deep and sustained engagement with all stakeholders. From the outset, the success of major projects on existing hospital sites depends not just on the appointed project team’s construction expertise but on a concentrated effort by the entire team to obtain a granular understanding of how the live hospital works, hour by hour, day by day. Project teams for major projects should also demonstrate
their understanding of working in live hospital environments during the procurement phase for professional services and principal contractor roles. We find that regular coordination meetings with clinical
personnel, estates managers and facilities teams offer a forum to quickly and collaboratively share any queries and concerns. By walking the site, observing routines and listening to concerns, we can anticipate and respond to challenges early. This ‘business-as-usual-first’ mindset helps build trust between the project team and the wider stakeholder group, enabling swifter decision-making and reducing the risk of costly project delays. We have often worked with Trusts to ensure works
Sujiv Fonseka
Sujiv Fonseka is an RICS Chartered and NEC4 ECC accredited project manager with over 15 years’ experience in strategically and practically managing construction projects and large-scale real estate programmes, workplace strategy, and facilities services across a diverse international portfolio. Sujiv has delivered healthcare, commercial, residential, and life sciences projects in the UK, Europe and Asia. Sujiv has a strong
understanding of NHS protocols and procedures, having been a part of the Estates Capital Delivery team for a large NHS Trust in the Midlands, delivering sensitive and complex capital projects in a live hospital environment during the pandemic. Sujiv is now a part of the healthcare project management team at Turner & Townsend covering London and the South East, and leading the delivery of large-scale healthcare development schemes across the region.
October 2025 Health Estate Journal 177
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