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The Making of a Super-Hospital

The 13 year journey to design and deliver The Grange University Hospital, Gwent

Nick FairhamBy Nick Fairham

After a year most of us can’t wait to forget, on a fabulous site in the Welsh countryside, north of Newport, a state-of-the-art specialist critical care centre opened four months ahead of schedule and under budget. As has been well documented in the media, hospitals up and down the country, including The Grange University Hospital, have been faced with significant challenges as the Covid pandemic has worsened this winter. However, despite these, incredible treatment and care is being delivered hour after hour with the facility’s built-in flexibility key to its response.

As one of a handful of people involved in the design and construction of The Grange University Hospital from beginning to end of its 13 year journey to completion, I wanted to reflect on what we, our partners and our client have learned along the way and how this learning is fundamentally changing future hospital construction projects.

Firstly, time frames: a decade or more for the design, development and delivery of a major critical care hospital was to be expected when we started this work. Naturally, the planning, development, approval and procurement processes are complex. But it is now recognised that streamlining and prioritising the approval process, in particular, can save years and millions. It means suppliers can plan workloads, agree design approaches and maintain greater continuity of people and expertise, not to mention the cost savings – a year’s delay on a £300 million project could mean £12 million lost to inflation. That’s a shortfall that has to be recovered – you have to start taking things out. So, paving the way for efficient and timely processes at the outset is critical.

Flexibility in healthcare design is fundamental, ensuring a hospital can evolve with advances in treatment and care, adapting to a population’s changing healthcare needs and enabling continuous improvement and system transformation. Flexibility to adapt to design, technology and construction changes over the course of a decade is also hugely important. Take energy supply for example. At the start of this project, biomass boilers were the sustainable solution of choice. By the time the hospital was being built, combined heat and power was the way forward and installing biomass would have been practically prehistoric. At the other end of the scale, light fittings were switched to far more energy efficient LEDs, which had become commercially viable during the lifetime of the project.

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Working for an expert client and as part of a supplier framework are two aspects that contribute greatly to success in terms of reduced timescales and keeping budgets on track. The Aneurin Bevan University Health Board and the NHS more broadly have significantly invested in skills so that they are expert customers buying expert suppliers.

The framework is fundamental to that expertise, ensuring teams of architects and designers, project managers, construction engineers and contractors are working together from the outset. It allowed for expert contractors Laing O’Rourke, to bring their experience of building hospitals across the UK into the project, rather than each stage happening in isolation with a contractor being brought in too late to inform designs. Conversations and knowledge sharing took place much earlier. Their expertise in off-site manufacture and Modern Methods of Construction (MMC) for example, helped inform and develop our design. So, the large windows that flood patient bedrooms with natural light - proven to have a positive impact on wellbeing and recovery – were made even larger than our original designs following the contractor’s suggestion to reduce the weight of the wall components, allowing better transportation and more efficient logistics on site.

At the outset of this project MMC was in its formative stages. Every element was effectively a prototype. But Laing O’Rourke brought a great deal of learning from the delivery of two other major hospitals at Alder Hey and Dumfries & Galloway. From reducing material waste and construction traffic on site right down to the order in which to load and unload lorries, off site manufacturing of large component parts of the hospital allowed for unprecedented levels of efficiency and precision.

Lastly, this project strengthened something we have always known: the importance of involving people. As well as bringing contractors and suppliers together right at the outset, delivering sufficient ‘corporate memory’ to stay the course of the project, bringing in staff and clinicians early is also crucial. The decision to design in storage at every pod of six single patient rooms, rather than at the ends of long corridors, was informed by nursing staff who pointed out crucial time lost to gathering medication, equipment and supplies.

Helping teams to prepare for transition was also vital. The Grange University Hospital is at the centre of a fully transformed healthcare system so, as well as working in a new building, teams were working with new operational procedures and models of care. We created a website to make the space available virtually in advance, allowing staff to carry out training and familiarisation long before they moved in.

It’s been a privilege to see this one through from start to finish and now to watch its life as a hospital unfold - which let’s face it, is the closest any of us ideally wants to get to a specialist critical care centre, no matter how good it is.