A client keen to ‘crack on’, unorthodox funding and a hybrid modular offsite system are combining to deliver a hospital build remarkably quickly
Project: Ward extension, NNUH
Phase one project value: £10m
Main contractor: MTX
Contract type: Design and build
Piling subcontractor: G M Piling
M&E consultant: DSSR
Structural engineer: Rossi Long
Architect: IBI Group
Project start: September 2019
Project end: April 2020
Swift construction delivery can come in a range of guises, but an extension to a hospital in Norwich is demonstrating what can really be achieved from a standing start. The Norfolk and Norwich University Hospital (NNUH) has so far proved itself an exemplar when it comes to rapid decision making and pace of build.
“The hospital is too small,” says the client’s construction manager Steve McIntosh. “We’ve got a whole programme to increase in-patient capacity and this is a main plank of that in providing a three-storey block ASAP.”
McIntosh rattles off a startling timeline with evident satisfaction. “The first enquiry [for a contractor] we made was in March last year, we were in contract in August, we got planning and started work in September and we will have patients in it within 12 months of that first enquiry, which is extraordinarily rapid.”
Scope of works
There will be a 32-bed acute unit on the ground floor, which will be used for short-stay emergency treatment that NNUH construction manager Steve McIntosh describes as “busy, really stressful” work for medical staff. The first floor will become a 33-bed “stroke unit” with patients being relocated to it from an existing ward, thereby increasing capacity.
A third story is being built in phase one and will it receive a £3-4m fitout in the second phase, once NNUH decides what it will be used as. A fourth-floor plant room – also under way – completes the structure, meaning it will be vertically aligned with the existing adjoining buildings
“The first enquiries were for a single storey [building],” says McIntosh. “Pretty quickly we realised it would be mad to not only do just one [floor] but even two, given that all those [existing] blocks are the same size, we’d have to build three.
“We wouldn’t do one and put the plant room on the top and stymie ourselves for the future.”
“We only really had the design appointment in July,” says main contractor MTX project director Adam Robertson. “Until then we had some conceptual layouts – it was one floor, then it was two floors,” he says, drawing attention to the fact the shape was not yet fixed. “The design period was effectively a month. Within that we added lifts and staircases – that was a challenging period.”
Bespoke design
He is keen to point out that this is anything but a shrink-wrapped solution from a catalogue. “This isn’t an MTX off-the-shelf design that they must have for expediency and the programme, this is a bespoke solution.” he says.
“[We said] ‘you can have something in eight months and you get to tell us what you want’. We followed the same structural footprint [as the existing buildings]. To replicate those intricacies, the central core on the ground floor is completely different to the core on the first floor.”
He says this is simply down to the fact that individual medical teams operating on different floors have differing requirements. “To transport the load right the way throughout the facility and offer two unique core designs is a challenge.”
But how does this all compare to a contemporary project? “More usually this is a two-year job to get to site and a 12-month build,” says McIntosh. “This is a three-year job. It’s been really driven by [NNUH chief operating officer] Chris Cobb whose demeanour hasn’t changed throughout – it’s just ‘crack on, crack on, get on. You need the chief exec to sign a contract? There it is, there you go'.”
BIM, but not Level 2
In design and delivery terms, the scheme is benefiting from a fully co-ordinated 3D model, but it is not strictly speaking Level 2 BIM.
“You add in the COBie data and you’ve got a Level 2 scheme, but only if [the client] has the desire to use that is it truly BIM Level 2,” says MTX project director Adam Robertson. “We find a lot of estates departments for NHS trusts simply don’t have Revit – their record systems don’t require a BIM Level 2 project yet.”
He explains that this speed has in part been down to effective chivvying of large numbers of stakeholders who have had to play a part alongside their day jobs. It is also the result of a good relationship with the local council.
“Myself and [Chris] went along to the council meeting and our community understands the issues associated with a hospital. Almost what we’re doing is copy and pasting an existing block; architecturally we’re repeating the bricks, shape and roofline,” says McIntosh.
Modular hybrid
While the block will match the rest of the hospital, it is certainly not down to it being constructed in a similar fashion. “It’s a brick slip [facade] but it’s a cut brick,” says Robertson. He says these were matched against ones from the existing structures so the new build will be sympathetic with the adjacent building, with new and old connected via corridors.
“While it’s an offsite solution, it’s not what you would see in a modular or relocatable solution”
Adam Robertson, MTX
“Part of the brief was this has to look … and feel part [of the existing wards],” says McIntosh. “We know it’s a modular building but it’s going to look and feel like it was traditionally built. I’ve had to work hard to stop people in the hospital from calling it ‘the modular building’.”
Robertson says it is not something that should be considered as a standard offsite construction scheme.
“Because of the brick slip, the curtain wall details and the concrete floors, while it’s an offsite solution, it’s not what you would see in a modular or relocatable solution,” he says, adding that using concrete means the new wards will conform to the necessary vibration and acoustic requirements.
McIntosh agrees. “I’ve seen modular buildings in hospitals and as soon as you walk in [to a non-concrete floor] you know it’s different and straight away it feels a bit cheap and nasty,” he says.
Hybrid though it is, the job is still following offsite build principles and sequencing, with the 95mm-deep concrete floors for each module precast, rather than poured on site. This called for careful design and planning when it came to the size of the modules and employing precast has added to the crane capacity required for lifting them in over a scheduled three-week period.
“If you go too big, you can’t get a crane big enough to install them,” Robertson says. “We had a 22-tonne limit from the start of the design.”
Lifting these in is a 500-tonne capacity unit fitted with a super jib that allows it to effectively operate to nearer 700 tonnes. This is needed given the maximum reach for this job is 40 metres.
Following module installation is a six- to eight-week fitout period, after which the ward will be ready for handover and its first patients, currently scheduled for the first week in April. Nonetheless, the project team will be keeping an eye on the weather in the wake of Storm Ciara and, at the time of writing, the forthcoming Storm Dennis. If there's one thing that can hit a module-lifting schedule it's gusty weather, as CN found out, with the first attempt at a site visit in late January rescheduled to early February after the crane was winded off.
Unusual funding
Another reason the project is benefiting from a substantially compressed timeline is an unorthodox funding mechanism.
“We’re a PFI hospital, so our scope for making improvements and changes is somewhat constricted because of the nature of that contract and that’s just a fact of life,” says McIntosh.
“It’s got to be some kind of record”
Steve McIntosh, NNUH
“What we’ve done here, with the cooperation of our PFI partners, is build an extension and rent it, and that’s something else that’s allowed us to go so quickly. I’m not aware of that being done before on such a complex build.”
This has seen funding secured from a separate party to the existing PFI deal. “It’s sort of a mini-PFI on top of an existing [one],” says Robertson.
With the rental agreement, planning approval and contract signature with MTX all happening in August, the board and its pieces were set for a flying start into the eight-month delivery programme of the 4,000 square metre total floor-space job.
“It’s got to be some kind of record,” says McIntosh. “I’ve got to emphasise that my first enquiry was only last spring – well under a year ago. To get a design, a contract, planning and all of those things fall into place in such short time is quite remarkable.”
