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of our staff were responsibly self-isolating, we divided up the engineering work with Hulley & Kirkwood, who took on the mechanical engineering, allowing me to focus on the electrical design. Normally we would deliver the project at a

multidisciplinary level, but in fact having an immediate focus on a core discipline really paid off in terms of focus on the technical management, and having to undertake a lot of complicated design work in a very short space of time.

Generating capacity

Procurement of supplies was one of our first major challenges. As many of the Nightingale hospitals were being designed and constructed at the same time, the majority of standard sizes for elements such as medical gas pipework were unavailable. It wasn’t a matter of going out to the market and saying we need ‘x’; rather it was a case of going to the supply chain and asking ‘What have you got?’, and somehow slotting that into the delivery plan. We were out of our comfort zone in this instance: we had to take a product and make it work to the solution we had, and not compromise patient safety. For example, on the Saturday we had a vision of what the electrical load looked like for both low and high dependency beds. The provision of high dependency bed units meant we had to ensure that an uninterrupted power supply was in place. However, as the project was still only hours old, the architects couldn’t tell us how many beds there would be. When we enquired about getting the

uninterruptable power supply, we were told that all that was available was an 800 kVA supply, that could be configured into two 400 kVA units. At that point I had no idea if it would be enough or fit in with our model, but we made the decision to secure it. If we didn’t take this kit, it would be gone. Even at that stage we didn’t know where we were going to put it, or indeed how we would provide supporting infrastructure such as cooling. We secured the generators on the Sunday, but again we faced the challenge

The NHS Louisa Jordan Hospital, and the Scottish nurse (inset) who died in service during the First World War after whom the facility is named.

of having to put cabling through what would be clinical spaces, which required a lot of thinking in terms of whether it would impact services, and how it might be maintained over a number of months (including the impact on infection control). Each element had to be fully assessed and documented.

Those early procurement decisions – which included elements such as medical gas pipework, generators, and other plant – meant that circa £5 million was committed in the first 48 hours.

Doing things differently

As we moved into the detailed design, the early and strong collaboration with the clinicians and contractors paid dividends. Because everyone was on site, or at least accessible by phone, we were able to work differently, as evidenced by our lighting design. We knew that trying to procure thousands of light fittings and getting them installed would be a challenge. Given that patients could be in the hospital for several weeks, we were also mindful of the importance of lighting, especially as the main halls which would house most of the patients had no

daylight. With the time constraints, it was unrealistic to undertake a full lighting installation, particularly as the use of mobile construction platforms would hinder the delivery and installation of the bed bays at ground level.

Remembering who we were building for

So, what did we do? The answer came from myself, a clinician, and an architect, all lying on the floor and imagining how patients would experience the lighting that was already in situ – taking the project back to first principles, and remembering why and who we were building for. The light – mainly high-bay sodium downlights – was glary, gave retina burn if you looked at it for a long time, and was not suitable. Through speaking to the venue, we came up with the idea of using a theatrical film which is used in concerts to diffuse the light. It still wasn’t ideal, but at least we knew we had a solution that could be implemented if we could not design or source an alternative solution. We continued to review other options, and in conjunction with Forth Electrical Services (the

Left: Adapting the electrical infrastructure to the care model was essential, particularly for movement between patient and non- patient areas in terms of staff having to wear PPE when entering patient areas. Right: New Vacuum Insulated Evaporator plant.

50 Health Estate Journal September 2020

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