Raymond Millar, construction director at offsite specialist The McAvoy Group, looks at how a new ambulatory care facility was delivered in Northumbria in less than a year – an unprecedented programme for the scale and complexity of the project
Northumbria Healthcare Trust had established a clinical need for a purpose-designed ambulatory care facility to help decompress a very busy emergency department and ensure patients are seen quickly by the most appropriate healthcare professional. Ambulatory care provides urgent same day medical care without the need for patients to stay overnight in hospital.
The trust wanted the new building to replicate the existing hospital and recognised that additional accommodation would be needed to meet the future care needs of the local community. The solution from The McAvoy Group was to construct a three-storey wing offsite that would precisely match the design of the original facilities, internally and externally.
The ambulatory care unit would occupy the middle floor to provide level access to both the main hospital entrance and the A&E department. This would achieve the most efficient patient flows. The ground and second floors would be fitted out as a future phase.
The building had to be fully compliant with all relevant HTM and HBN requirements and to have no difference in feel, appearance and quality to the existing facilities. It would be seamlessly linked to the existing hospital on three levels.
The new unit had to be fully operational by summer 2019, just 11 months after start on site.
Developing the design
The new building had to follow the architectural principles of the existing hospital. This has a bold, striking and simplistic design, and is finished in the trust’s corporate colours of blue and white.
Award-winning healthcare architect P+HS had worked with both the trust and The McAvoy Group previously and was brought into the team to develop the schedule of accommodation with the users and the design to suit offsite construction.
James Almond, director of P+HS Architects, said: “This construction project is unprecedented in terms of the scale and complexity, delivered in such a short timescale. We estimate it would have taken around 18 months on site to build this traditionally. With an innovative offsite solution and a completely focused client, design and delivery team, it was operational nine months earlier and well ahead of the busy winter period. This speed of construction was a critical benefit to the trust in terms of significantly less on-site disruption to patient care, reduced waiting times, and a faster return on investment.
“The trust made good strategic decisions and forward planning was reflected in the design to futureproof the facilities to meet changing local needs.”
The facility was designed collaboratively and inclusively in conjunction with stakeholders via a clinical user group and led by P+HS Architects. This group was made up of around 25 healthcare professionals including clinicians, nurses, and facilities and estates managers, who met on a weekly basis to develop and sign off the design.
The stakeholder group was very engaged in the building requirements, creating a precise brief and setting out the clinical needs.
Flexibility for future growth had to be designed into the project from the outset. The facilities are constructed around a central corridor to which a further wing can be added at a later date if required, mirroring the recent construction.
The internal space was also designed to accommodate changing needs. The roof was structured to allow a light well to be constructed in the future to bring light deep into the upper floor of the building, creating greater flexibility in the range of options for this space. This would allow more external wall area and natural light for an additional ward if required.
The plant room was sized to accommodate two further air handling units for when the two other floors of the new wing are fitted out in the next phase, meeting the future demands of the building.
Digital construction technology
VR and 3D modelling were used via QR codes to assist the user group in assessing the building design and layout. This also helped to inform other stakeholders about how the proposed spaces would be used on completion. Nurses could ‘walk through’ the building for familiarisation. This digital solution gave the client full awareness of the space and how the different specialisms would interact.
The user group was able to experience the facilities, check adjacencies and select colour schemes in a virtual environment as part of the detailed design phase. One person wearing a headset would ‘drive’ the VR with others in the group looking on. This allowed colour options for floors, walls, architraves and handrails to be agreed as a group, for example, and very efficiently.
Rob Sanderson, deputy director of capital projects at the trust, said: “Having a virtual reality model of our proposed new facilities was invaluable. It allowed us to demonstrate the clinical environment to our staff and stakeholders, equipping them with all the information they needed while the project was under construction adjacent to the main hospital.”
BIM was valuable throughout the design process to help coordinate the architectural design, structural design and complex building services. This facilitated clash detection to maximise offsite production and reduce construction work as much as possible on this fully operational hospital site.
The construction challenges
A significant challenge was to tie the new wing into the main hospital streets at each level for a seamless transition and efficient patient flows. The floors had to be level throughout the wing and into the existing hospital on three levels. However, the modular structure has different ceiling heights to the in-situ constructed hospital – approximately 3.9m versus 5m.
McAvoy responded to this challenge by developing and engineering floor cassettes, which integrated with the modular structure to provide a truly seamless extension without the need for any ramps and steps. Mechanical ventilation, heating and cooling systems were installed in the ceiling voids in the McAvoy factory. This is believed to be an industry first in the healthcare sector.
In order to replicate the appearance of the existing hospital, the new wing has a faceted external façade to create curved ends to the wing. This was achieved by stacking modules containing the en suite bathrooms and cladding with an advanced render system to achieve the curved appearance. The rainscreen system was tied back to the modular structure to reflect the aesthetic of the main hospital.
From briefing meeting to building envelope in just 10 months
The £15m contract encompassed the offsite manufacture of the structure for the 6,500m2 three-storey wing. It also included the fitting out of the first floor to accommodate one of the UK’s first purpose-designed ambulatory care units.
The building was craned into position as 294 steel-framed modules in a highly complex operation that was completed just 10 months after the initial meeting with the trust.
A relaxed patient environment
The dedicated, 2,025m2 facility for ambulatory care provides medical, surgical and gynaecology care in a relaxed and comfortable environment. It also accommodates a fracture clinic. This allows around 100-120 patients to be treated the same day across four specialisms, without the need for hospital admissions – seven days a week and from 8am to 10pm. This is helping to decongest the emergency department, allowing patients to be seen by the most appropriate clinician earlier and offering an enhanced service for the local community.
Enhancing services for the local community
Rob Sanderson, deputy director of capital projects at the trust, said: “This was a highly complex and ambitious scheme which was delivered to a very tight timescale and to the trust’s stringent quality standards. It has taken a real team effort to get to this stage in such a short time. The new facilities for ambulatory care will bring enormous benefits for providing alternative pathways for patients needing urgent care.
“Everyone worked on this project in a completely collaborative and focused way to define and build the new wing in a highly ambitious timeframe. I believe what we have achieved collectively – in terms of complexity and timescale – is unprecedented in the healthcare sector and we hope the partnership will continue on other projects.
“The new wing looks exactly the same as the existing building, internally and externally and there has been absolutely no compromise on the quality of finish and the standard of the clinical facilities. The clinical teams had full involvement from the inception of the project, so the layout, clinical adjacencies and patient flows work really well. We are impressed with the quality offsite can achieve and you would never know this was a modular building. No departments in the hospital were adversely affected by the construction process and the finished building is performing well. We are all very proud of the new facility and this application of offsite construction has certainly exceeded our expectations.”
Dr Eliot Sykes, clinical director for surgery and elective care, added: “The building was clinically designed and led and there was fantastic collaboration and engagement across the clinical, estates, design and construction teams. This strong working relationship at every level was key to the success of the project.
“The new ambulatory care unit has already made a very real difference to our patients. It will significantly enhance our ability to manage peaks in demand while still providing dedicated ambulatory care.
“Offsite construction and the McAvoy approach has been brilliant in terms of build quality and the pace of construction. We were amazed at the rapid progress from our first meeting to commissioning, and for a building of this scale. Most importantly, feedback from patients has been extremely positive.”