Engineering better design for healthcare

COVID-19 has thrown all aspects of our healthcare system into stark relief. From staff shortages and overwork to a lack of appropriate equipment available to combat the virus, every detail is under the socio-political microscope.

One such area facing particular scrutiny is healthcare construction and design, with questions rightly raised about infrastructural capacity to handle the current and future pandemics.

When it came into office in December 2019, this government made a manifesto commitment to the construction of 40 new hospitals. So far it’s only delivered six, and most of these are still works in progress. Given the current pressures faced by hospitals and facilities across the UK, this is nowhere near fast enough.

It’s time the construction industry stepped up. As an industry we play a vital role in delivering these buildings and we urgently need to scrutinise our methods and processes to increase efficiency. Fundamentally, we need to explore solutions which will help us build at pace, creating safe, modern and relevant spaces in which medical professionals can work effectively.

In tough times like these, it’s not constructive to dwell on the negatives. We need to find as many positives as we can and, as a structural and civil engineering firm, with many years’ experience working on healthcare projects, we’ve taken the time during lockdown to consider how we could help deliver safe and robust buildings with greater efficiency.

Immediate Action

For a rapid-response solution to the challenges we face, offsite construction is an obvious answer. It’s always had the capability to mobilise quickly to provide high-quality temporary and permanent accommodation, upscaling seamlessly to increase output.

Importantly, the partial pre-design of the structures makes it simpler to check structural loads in relation to the site, and the lightweight nature of components often means simple, more cost effective foundation designs.

Furthermore, the benefits of offsite technology are not just limited to structure. Utilising pre-designed mechanical and electrical components, or even precast foundations, can significantly enhance and speed-up the build. This also reduces the number of people required on site and minimises disruption to existing services, particularly important if extending an existing structure and/ or working in a busy live healthcare environment.

Setting the Standard

Another important efficiency-booster, which goes hand in hand with offsite construction, is standardisation. For example, there are many advantages to using pre-rendered ward and theatre block layouts, which generally require a standard configuration and have predefined space requirements.

This process saves essential time and money, through streamlining design input, realising efficiencies through volume  manufacture of standardised components and waste reduction from utilising standard material sizes.

ProCure 22, the Department of Health and Social Care’s Construction Procurement framework, for the development and delivery of NHS capital schemes, aspires to this scenario.

So far it has been moderately successful in delivering a more consistent, streamlined and less complex procurement journey. Testament to its effectiveness, it has provided more than 850 publicly funded NHS projects (valued around £6bn) over the past 15 years.

Particularly, it has explicitly recognised and endorse the use of standardised components, leading to improved cost efficiencies and savings of up to 30% on projects where ProCure 22 has been followed.

However, there’s still much to learn. Best practice to achieving this standardised, procurement landscape can be taken from the development of the standard layouts and output specifications carried out by ESFA and the education capital programme.

They worked with the offsite sector through round table discussions, design workshops, dedicated offsite frameworks and collaborative lessons learnt sessions. Through this they managed to deliver the aspirations of the schools whilst embracing a host of design and manufacturing efficiencies, bringing cost, time and quality improvements across the programme.

Digital First Approach

Wider BIM adoption, also has the potential to significantly improve how healthcare facilities are built, by helping to deliver a more precise, joined-up and collaborative approach to construction.

The architectural community has seen an enthusiastic uptake of the system, yet engineers have been a little more sluggish. They will need to follow suit if they want to be involved earlier in the design journey. This will help to establish that all important ‘Golden Thread’ of information which the construction industry needs to achieve, particularly with changes to building regulations imminent.

Equally, digital design will also bring us that one step closer to the above-mentioned, all-important standardisation, which will be essential for building safely and at pace.

Engineering Excellent Design

Looking beyond systems and approaches to the human factor, I feel engineers are hugely under-utilised in the design process, particularly in the construction of healthcare facilities. This is a great shame as our professional input could significantly improve the final design model.

Engineers can positively impact and contribute to the design of a building. We offer a unique perspective on material and structural performance, especially assisting in the delivery of future-proofed buildings. This aspect is essential for expansion or repurposing of the facility at a later date, which is more often the norm than the exception.

We need to be more disciplined, setting ourselves tougher timescales and committing to meeting them. The above solutions will no doubt help, however we also need to push for a collective drive behind them to ensure they are adopted. There’s a massive opportunity here to transform the way we design and build our healthcare facilities. It will require us, as an industry, to make a significant investment in new technology, skills and expertise. However, the benefits to our business, and wider society, will far outweigh the effort.

Equally, it might also help governments to deliver on their ambitious targets for infrastructural projects!

Rachel Davis, Marketing & Business Development Director, Perega