healthcare construction how to build an emergency … · 18 health estate journal june 2020...

18 Health Estate Journal June 2020

HEALTHCARE CONSTRUCTION

How to build an emergencyhospital in two weeksHow do you build a 650-bed hospital in two weeks? Garry Bowker, Regional director of Integrated Health

Projects (IHP) and VINCI Construction UK, tells the ‘behind-the-scenes’ story of the NHS Nightingale

Hospital North West in Manchester.

IHP (the VINCI Construction UK & SirRobert McAlpine joint-venture) hasextensive healthcare experience andcapacity in the north-west of Englanddelivering ProCure framework projects outof the VINCI Construction UK offices inWidnes. On 27 March this year IHP wasadvised by the Department of Health &Social Care and NHS England/NHSImprovement (NHSE/NHSI) that the new Manchester Nightingale hospitalemergency facility was to be deliveredunder ProCure22, and Alan Kondys, IHPFramework Director, offered our servicesfor immediate mobilisation. The NHSNightingale Hospital North Westexperience began for me at 11 am onSaturday, 28 March, when we were giventhe green light by NHSE/I to by deliver the project, and we were ‘all systems go’.

An unprecedented experienceWhat followed was like nothing else I haveever been involved with, in all my years ofhealthcare construction and supportservices. We needed to address threepriorities – sorting out key experts, lining upour supply chain, and organising a team tomanage the design and installation of theworks. The weekend became a blur ofphone calls, organising colleagues andpartners to put together the right team.Straight after getting the ‘go ahead’

from Alan Kondys, my first call was to Ged Couser, Architect Principal for BDP inManchester. I knew that BDP was alreadyworking on the NHS Nightingale HospitalLondon at the ExCeL conference andexhibition centre, and had worked withhim and his team before. Even better, likeme, he is a Manchester man through andthrough, and I knew that he would not just be professional, but also passionate.After speaking to Ged Couser, I next calledup Paul Aulton, Regional director at NGBailey, to ask him to lead on the M&Edelivery. The next step was to think about the

flooring. Even before there was a plandrawn up by BDP, we knew that around14,000 square metres of vinyl flooringneeded to be laid. That meant a very frankconversation with Horizon, our flooring

contractor. How fast could it getmaterials, and how quickly could it finish?This conversation is a good example ofwhat followed, because as politely as I could, I said: ‘Thanks, but can you do it in a third of that time please?’

Releasing the right people for the jobAs this was a VINCI-led IHP project, I worked with our Regional managingdirector, John Roberts, to release the right people for the job – even if it meantpulling them away from existing work. I also called upon the combined strengthof the IHP JV, and requested two people I knew within the Sir Robert McAlpineteam to play key roles: Paul Jackson assenior Design manager, and CarolineMulholland as Clinical Liaison manager.Meanwhile, still on the Sunday, othermembers of our team were walking thesite, accompanied by the Army.“Garry Bowker, from IHP, called me at

about 11 am on the Saturday,” explainsGed Couser, a healthcare specialist. “Heoutlined what NHSE/I had requested, and asked me to get myself down to theManchester Central site on the Sunday,which is exactly what I did.”When he arrived there, Ged Couser

met representatives from the Army,Manchester University NHS FoundationTrust, Andy Kelly, FM director at theManchester Central convention complex,

and Martyn Frackleton, Project principalat Mott MacDonald. The idea was to walkaround the space and assess how wewere to deliver what was required.“We were taken around the site by

Major Matt Fry of the Royal Engineers andhis colleagues, who had been on site for a few days,” Ged Couser explains. “Theyhad already sized up what was going towork and what wasn’t, checked thelogistics and done a basic layout, and

Garry Bowker, Regional director ofIntegrated Health Projects (IHP) andVINCI Construction UK: “Right at thebeginning we did not know the full scaleof the task we faced.”

Across the whole team, there was ‘a shared desired outcome, a sense of purpose,and real clarity about roles and responsibilities’.


Nurse call | mobile communications | software and device integration

Ascom.com/[email protected]

0121 353 6151

Use it wearing glovesNitrile (0.05mm) and vinyl (0.035mm)

Disinfectant readyUse it 24/7Hot swappable battery

At one point there were in in the region of 20 people spaced out around whatamounted to a test bed bay.

estimated the likely bed capacity. Thisgave the rest of us a great starting point.”

A ‘helicopter overview’That starting point was very much ahelicopter overview. So, one of the nexttasks (because so many things werealready running in parallel) was bringingall of the designers and specialiststogether to refine that initial plan. At thispoint, everyone involved was also stillpulling their own teams together. Thiswas made easier because each person ororganisation contacted did not hesitate.This says an awful lot for the culture ofP22 and the construction industry,because no one knew what would berequired, or indeed if they might have tostay away in isolation. As Ged Couserputs it: “It’s not the kind of project whereyou can just click your fingers and pointat people. We needed volunteers whounderstood the urgency and wereprepared to drop what they were doing.”BDP had a team of around 10 people on

the project, focusing on the architectureof the hospital. This began with three onsite with Ged Couser, and five working athome, and then another two on sitetowards the end of the project. Workingalongside the architects was the BDPM&E design team of 10 people, led byPrincipal, Building Services Engineering,Rob Ferry. This dovetailed with the otherteams; Mott MacDonald started off withfour people and this moved to eight, whileNG Bailey began with 11, with the numberrising to over 120 technicians by the endof week two. Overseeing this was our IHP team, largely based on site, andsupported by others working from home.At peak we had around 1,000 peopleworking around the clock.

Positive from the start Right at the beginning we did not knowthe full scale of the task we faced. On theMonday, 30 March, when the initial teamgathered on site, the reality was spelledout by Major Matt Fry. Paul Aulton of NGBailey takes up the story: “All of ourpreconceptions were stripped bare by thebriefing by the Army. It was made clearthat whilst things looked like a mess now–my words, not theirs – we wouldsucceed in opening this hospital.”He added: “It was clear that this was

going to be like no other project, let aloneany hospital we had worked on before. As an emergency hospital, it was going to be a totally different proposition.”John Fowler, VINCI Construction and

IHP Contracts manager, recalls: "That jointbriefing set the tone to focus the mindsetof everybody on the project. My role was to ensure that we all stuck to thatmindset, and we did. The team focus was

on solutions, speed, and delivery, and tokeep on thinking differently to get the job over the line on time. One of the keymessages was; ‘Forget all you know aboutnormal healthcare construction – this isabout constant problem-solving.’”

Split into working groupsFollowing the briefing, we split intoworking groups, each focused on aspecialisation. In these workshops, whichprobably lasted a few hours, concernswere graded and narrowed down so weidentified the big-ticket items, or ‘biglevers’, as Major Matt Fry called them.Among many key issues two are worthfocusing on: the overall design, and thebed bays. Building on the initial foundation from

the Army, it was important for the designteam to really understand the constraintsand potential of the Manchester Centralconvention complex. That meant working

June 2020 Health Estate Journal 19

very closely with the site FM team, as well as the NHS Trust, and it also meantchallenging and testing the brief, so thateveryone was sure they were working inthe same direction to deliver what wasrequired. “One of the scary things was that while

we were doing what we needed to interms of refining the brief and developingdrawings, construction had alreadybegun,” explains Ged Couser. “We wereon a tight timescale, and some elementsof the build could not wait. While we wereworking on designs with NG Bailey,Archus, and the clinical teams, the IHPteam, led by John Fowler, IHP Contractsmanager, was preparing to lay flooringthroughout the convention centre beforea line had been drawn on the grid.”

‘Almost like reverse engineering’The problem for the designers was thatthey could not work as normal. Just like allof us, they needed to adjust. It was almostlike reverse engineering. It was not designand build, but instead more like ‘build andverify by design’. John Fowler and I knewthe flooring had to go down, so byMonday we had the material deliveredand work had started. “Meanwhile we had not agreed the bed

bay set-up, let alone the overall layout,”says Ged Couser. “This was critical tomoving the build forward. Flooring wasone thing, but we needed to agree theexact proportions of the bed bay to knowthe capacity and overall floor plan.” It was thus good to know that NG

Bailey team was ahead of the game. Itsteam had already been working on theHarrogate Nightingale hospital, and knewthe likely requirements for bedheadtrunking, sockets, switches, and wiring.“We opened up our off-site factory onSunday, and had begun to collate thematerials we anticipated might be neededbased on what we had learned fromHarrogate,” explains Paul Aulton. “Thatexperience, and the fact we had alreadybeen working with BDP, gave us an edge.”

A mock-up of the bed bayTo agree the bed bay we needed a mock-up, which was a critical stage of thedesign process. The beds were a standardsize, and we knew approximately thedimensions needed by the nursing team.What we also needed was a partition fitfor purpose. Feedback from the LondonExCeL Nightingale Hospital was that thesystem used there was not ideal – so weopted for a temporary hygiene systemthat the VINCI team had used before.Samples of product arrived on Monday,and on Tuesday NG Bailey brought the kitfabricated in its factory and the mock-upbed bay was assembled. “At one point we had in the region of 20 people spacedout around what amounted to a test bedbay,” says Ged Couser. “The overall

configuration was checked to allow for ITservices at every bed, with provision ofhandwash facilities and nurse spacetalked through. It was live beta testing ofa full-scale working model, and it worked.”

A process of adjustmentThis meant that the design, procurement,and construction could move forward. Itwas an example of how the drawing stageneeded to adjust; whereas on a normalproject designs might be created, andmock-ups provided over months, thishappened in hours. However, flexibilitythrough the project remainedfundamental. What we came to know as ‘the new

normal’ at the Manchester Nightingalegained momentum. Decisions began toflow. This was due to a clear hierarchy,but not one that was rooted in any notion

of one leader. Ernst & Young workedalongside the NHS; its requirements werechecked, and then conducted down a‘funnel’ by Mott MacDonald and Archus tothe IHP design and delivery team. It wasan organic system that allowed individualspecialists to focus on solutions. “While commercial concerns, contract

paperwork, and pricing, were not thedriver on this job, we still needed to trackwhat was going on,” explains MartynFrackelton, Project principal, MottMacDonald. “Yes, we needed to crack on– see a problem, develop an answer, testit, build it – but we needed a paper trailtoo. Timesheets, materials, and orders, allhad to be auditable. That’s part of our jobas project managers, as well as being theinterface with the client team.” The lighttouch from the project management teamgave the authority and flexibility to deliverthe solutions needed. It meant that JohnFowler could rapidly organise the supplychain, and team members from NG Bailey,BDP, and other suppliers, could liaiseseamlessly with IHP.

Go-between, translator, and fixer“Clinical liaison means you are the go-between, the translator almost, and thefixer joining up the thinking of the clinicalteams and contractors,” says CarolineMulholland, Clinical Liaison manager at SirRobert McAlpine. “I’ve been involved inhealthcare contracting for 30 years, butthis was unique – indeed special. My job isto ensure that the NHS teams make theirconcerns heard and understood. In this



Around 14,000 m2 of vinyl flooring needed to be laid, requiring a very frankconversation with the flooring contractor as to how fast could it get materials,and finish the installation.

Integrated Health ProjectsIntegrated Health Projects is a joint venture between VINCI Construction UK and Sir Robert McAlpine that operates under the ProCure22 Framework. The Department of Health & Social Care and NHSE/I approached IHP and otherProCure22 providers in late March to discuss the likelihood of field hospitalsbeing delivered. The IHP team in the North West put its name forward for thework proposed at the Manchester Central convention complex.

NHSE/INHSE/I commissioned NHSNightingale North West viaManchester University NHSFoundation Trust, as the client whichruns the hospital. The Client projectmanagers were Mott MacDonald,alongside Archus. Integrated HealthProjects was the principal contractor,with BDP as architect and M&Edesigner. IHP engaged NG Bailey asM&E installer, and other suppliers fromthe experienced IHP supply chain.


It was agreed that the site needed atleast one vacuum insulated evaporator(VIE) unit.

instance they always got what theyneeded, but in a different manner to usual,because all the contractors were focusedon the field hospital concept.”Someone like Caroline Mulholland is

key on a project such as this, because herexperience means she understands theclinical drivers and questions to ask. “I worked closely with the clinical team,BDP, and NG Bailey to make sure nothingwas missed,” she explains. “It was easy tofocus on bed bays, and to overlook issueslike patient flow, infection control, andissues like donning and doffing – wherethe clinicians change in and out of PPE.”

Visualising the ‘points of detail’To visualise the points of detail, the layoutwas marked out on the floor with tape. Itmight have looked like basic stuff fromthe design team, but it worked. The aimwas to create three zones – Red forCOVID-19 infection – where staff wear fullPPE; the Amber zone as the ‘breakoutarea’ for all staff, with the requirementhere for minimal PPE and scrubs, and theGreen zone for all support services – thedelivery of all supplies, food, materials,and medicines, where no PPE is required.The challenge is how to have each zoneoperating, and for nothing to come intocontact with the Red zone. For example,movements in and out of the Red zonemust be able to occur without crossingthe Green and Amber areas. The fourthzone was the 100-bed mortuary. All thesefactors were covered through true andrapid collaboration.John Fowler, IHP Contracts manager,

says: “The discussions needed to work outthese solutions were much easier on thisscheme, because we were all not just inthe same location, but able to see and

says: “It was not unusual for us to cometogether as a small group, identify achallenge, and then someone wouldliterally sketch out an answer with penand paper. We’d then agree it and make it happen.”

Need for a VIEBy Tuesday evening it had been agreedthat the site needed at least one vacuuminsulated evaporator (VIE) unit – in effecta giant thermos flask which almost allhospitals have located outside theirbuildings. BOC can then re-supply easily.For us that meant assessing the loadingbay to the rear of the convention centre.“The service yard was ideal, but very close to the Hilton, live rail lines, andabove the arches of the car park,” explainsPaul Aulton. “Bear in mind also that thebuilding is grade II listed. The space wassurveyed by a structural engineer. Then,overnight, a concrete base had appeared,so we could set up the 12 m high tank andthen set about working out how to pipethe oxygen into the field hospital andaround the wards.”The NG Bailey team set about

constructing a pipe framework offsite inits factory, while the design team andbuilders formed four access holes throughthe external fabric of the building – afterappropriate consultation with the localplanning authority. “Oxygen was just one of the ‘external’ issues that if we gotwrong would limit the operationalcapability of the hospital,” explains MartynFrackelton. It was a reminder that wecould build something, but it all needed to be connected to run the facility. Thatmeant we needed to check that what we did was not going to impact uponmovements of patients, supplies, and staff

speak to each other instantly. It’s unusualfor specialists to be working inconjunction with contractors and theclient in such a hands-on way. It allowedus to focus on the issue and deal with it.”“In many ways,” adds Ged Couser, “it

felt like a series of scenes from Apollo 13.We knew had a problem – only certainmaterials to work with and limited time –so, we just got on with it.” Paul Aulton

June 2020 Health Estate Journal 21

in and out of the building. It also meantthat we needed to allow for teams fromthe ambulance and fire services and theirneeds.” The oxygen cylinders, air-handlingunits, and generators, all eat into valuableoperational space outside of the hospital.So, the closer we came to completion, the more important those details andconversations with the client became.

Pace of delivery heated upJohn Fowler explains: “From the middle ofthe first week the pace of delivery heatedup. Flooring contractors across the NorthWest worked together to complete the14,000 m2 of flooring to be finished insidethe first week. As they completed, thepartition teams followed. Site closures inManchester meant we could access labourmore readily than normal, and 3,500metres were erected within days, withover 50 men in two shifts working 24/7. In fact, by the middle of the first week, thewhole site was working 24 hours a day.” Pressure was now on – literally – the

NG Bailey team to complete the oxygenframework.“Our big concern was a lack of available

specialist pipework and then, once we had it, we were nervous about finding thequalified technicians to finish the work,”says Paul Aulton. “Understandably, thedemand for this material and expertisewas high right across the NHS, but oursuppliers came through.”

Six lorries making a circuitAt one point NG Bailey had six lorriesmaking a circuit collecting pipework,delivering it to its factory, loading up afinished framework section and taking it to site, and then returning to the supplierto begin again. Then the six-metre framesof four pipes were installed.“In the second week we had a team

installing 30 metres of medical gas pipeevery 150 seconds,” says Paul Aulton. “Oncewe had a rhythm of repeatability, we weregood – by Thursday all the beds were done.”The pipework still needed brazing,

jointing, and testing at high pressure by a specialist team. The nature of the testmeant the main hall had to be clear of allworkers at a critical stage – but it alsoindicated that the finish line was in sight.However, as close as we were, it was notime to relax. In fact, we did the opposite.John Fowler set up a meeting of all thekey managers to critically assess all of thekey issues and robustly challenge whatmight go wrong, what needed checking,and what was outstanding. It was typicalof the mindset that the Army had instilledin the whole team. No one left that roomuntil we had finalised a plan to reachcompletion on schedule.

An achievement to be proud ofWe started on site on 30 March, and theNightingale NW Hospital was ready for

use on 13 April. At one point during thetwo weeks around 1,000 people wereworking on the project. It was an amazingachievement, and one that every memberof the team should be proud of. MartynFrackelton caught the mood: “Knowingwhat we had achieved – sitting in theauditorium at the official opening – it washumbling to be part of something sospecial.”The teamwork, culture, and

commitment is a lesson about what can beachieved. The solution drove the processand everything else followed, and thisfreed everyone up to deliver. Across thewhole team – NHSE/I, the Trust, MottMacDonald, IHP, BDP, NG Bailey, and the extended supply chain – there was a shared desired outcome, a sense ofpurpose, and real clarity about roles andresponsibilities.

Great client and stakeholder feedbackGed Couser says: “It’s easily the hardest,but also the most rewarding, project I’vebeen involved in. It is amazing what can be achieved so long as no one wants totake credit.”There was great feedback too from the

client and key stakeholders. The ChiefExecutive of NHS Nightingale HospitalNorth West, Michael McCourt, for instance,said: “Building this hospital in just a coupleof weeks has taken the determination andboundless energy of people from manyorganisations who have come together to ensure that our NHS has the necessarycapacity during the pandemic, in what is

an unprecedented response to anunprecedented crisis.” Tom Myers,Regional Delivery director NW, NHSEngland and NHS Improvement,meanwhile, said: “Just heard thateverything has been signed off andapproved for opening tomorrow.Absolutely great work guys, a great team effort, and thanks for the brilliant job you and your teams have done.” “Everyone involved in this fantastic

facility is a history-maker, and you willalways have our respect and admiration,”added Andy Burnham, Mayor of GreaterManchester.Alan Kondys, IHP Framework director,

said: “The seriousness of the COVID-19pandemic is putting pressure on the NHS,its clinicians, and key staff. IHP had nohesitation in responding to the call todeliver the Manchester surge facility, andwe are working collaboratively underProCure22, which is supporting thisinitiative nationwide.”VINCI Construction’s John Fowler

summed up: “NHSE/I and the Army setP22 and the construction industry a test in the shape of the Nightingale hospitals.Manchester is just one example whereboth P22 and the industry passed thattest. How? Because we setpreconceptions and egos to one side, andworked with a single, common purpose. In our discussions with the Army guys atthe opening event they stated howimpressed they were with IHP’s immediatestart, organisation, efficiency, speed, andsupply chain engagement. It was aprivilege to be a part of it.” hej



The key protagonistsn Garry Bowker – Project director, and IHP and VINCI Construction Regional director.n John Fowler – Contracts manager, VINCI Construction.n Caroline Mulholland, Clinical Liaison manager, Sir Robert McAlpine.n Ged Couser – Design lead. Architect principal and healthcare lead, BDP.n Martyn Frackelton – Project manager, Mott MacDonald, Project principal.n Paul Aulton – M&E provision, NG Bailey Northwest director of Engineering.

The beds were a standard size, and the team knew approximatelythe dimensions needed by the nursing team.

healthcare construction how to build an emergency … · 18 health estate journal june 2020...

Documents