The NHS recovery plan led to a renewed focus on healthcare facilities and buildings. As elective care resumed, we witnessed an increase in demand for ultra clean operating theatres to help shorten waiting lists. In turn this created a need to address energy consumption and re-engineering major plant and systems to save energy. Healthcare projects usually involve complicated redesign and reconfiguration of old buildings and facilities to host new and innovative services, not invented at the time the buildings were constructed. In addition, according to the King’s Fund, “the cost of tackling the problem of poor NHS buildings and equipment has more than doubled from £4 billion in 2011/12 to over £10 billion in 2021/22.” 

Your Problem – Our Design Solution 

Paul Cairns (Associate) explains some of the typical healthcare Mechanical, Electrical and Plumbing (MEP) design challenges he and his team regularly overcome.

“We have worked on a number of projects where the Estates Department or Trust have insufficient as-fitted information to enable the specific redesign to take place. This is especially common with hospitals that have older building portfolios.

To help resolve this we undertake surveys to determine the existing services information. Where energy use patterns are required for the suitable sizing of services, we provide temporary metering that establishes gas and electrical usage to derive heating, hot water and electrical base loads.”

Fast turnaround / budget projects

“Another situation common to healthcare projects is the need to spend the budget by a prompt deadline. This was significant post the pandemic, when budgets not used during lockdown had to be spent, and there was additional funding available to tackle the backlogs. This was also the case when NHS hospitals needed to refurbish existing operating theatres to bring them up to ultra clean standards.

On a recent project we had to meet a Trust’s ambitious programme. To tackle this, out-of-hours surveys were undertaken to validate the as-fitted drawings. In addition, we engaged a specialist manufacturer to gain a better understanding of delivery times and costs as material lead times were uncertain allowing us to produce the MEP design, within programme, meeting the Trust’s timeframes and managing the various stakeholders’ expectations.”

Retrofit of ventilation

“Increasing levels of ventilation to ensure a hospital is compliant with the changes to HTM-03-01 is another common issue for us. Typically, higher ventilation rates require larger ductwork, however, this is often difficult because of the spatial restrictions of existing risers which means they cannot be routed sensibly through the building.

Whilst working on another recent project, we identified alternative Air Handling Unit (AHU) plant locations allowing our team to coordinate ductwork down the external elevation of the building to enter the ceiling void of the relevant floor and distribute the air to the required space.

“Ductwork was supported from the existing façade and treated to ensure the solution was as sympathetic as possible to the architectural finishes. This required collaborative management of the different stakeholders including the Trust, the Structural Engineer, and the local Planning Authority.”

Effective validation reduces the risk of problems from the start

Our specialist validation team de-risk building services issues at the early stage of a project by assessing exactly what plant and systems can be reused and where budget can be saved. This stage has a focus on preventable compliance and Health and Safety issues, as NHS Trusts combine and grow. This has become especially important as hospitals and their associated building services systems integrate. Whether it is a refurbishment or extension, we survey the MEP systems to evaluate the condition of the equipment, with a view to providing advice on what can be reused or repurposed.

Graham Watt, Operations Manager explains:

“During the last two years we have been extremely proud to have worked on the development of the Evelina London Children’s Hospital, one of the world’s leading hospitals for paediatric care.

We were engaged by the project team to carry out the validation of the MEP services for the phase 2 expansion programme before the extension and upgrades were deemed possible. As part of the surveys our team identified whether the existing systems had capacity for integration with the future systems, which served 100 new beds, 20 additional critical care beds, new operating theatres and interventional rooms, specialist imaging facilities and space for families and staff.”

Commissioning from Design through to Completion

Planning the commissioning phase from the beginning of the project is essential; it mitigates future challenges, especially during the design stage and it alleviates risk at the end of the project.

In recent times we have experienced the introduction of increasingly ambitious project deadlines and as Independent Commissioning Managers part of our role is to plan and protect the crucial commissioning period to achieve these challenging handover dates.

David Cocksedge, Director explains:

“Based on experience, the most challenging healthcare projects involve the commissioning activities associated with operating suites and theatres. This is due to their complexity and the requirement for all the different systems to interact seamlessly. Full planning and compliant commissioning negate potential operational issues, ensuring a smooth and successful handover. This includes Hepa filter operation, correct ventilation flow rates and air balancing, setting of pressure relief dampers and compliant pressure cascades through to Building Management System control.”

With medical advancement and innovation comes new “never been done before” projects. A good example of this is our award-winning work as the Independent Commissioning Managers for the Christie NHS Foundation Trust Proton Beam Therapy Centre in Manchester. This was the first proton beam therapy centre built in the UK and arguably one of the most technically challenging projects, overcoming significant environmental issues and lifecycle costings.

Neil Burdess, Associate Head of Commissioning explains:

“The associated building services systems were designed to match the new technology. The project utilised Level 2 BIM throughout the design process and the facility was successfully designed around the equipment. Four gantries house the machinery that administer the high energy beam. Each machine is served by deionised chilled water and dedicated supply and extract systems to form activated air.  Deionised water circuits were implemented to stop the water becoming radioactive. Stainless steel pipework was utilised to reduce radiological activation, as the iron in the water would become activated, increasing the decommissioning costs.

Energy efficient systems were incorporated, such as LED lighting, self-check emergency lighting, self-check fire and smoke dampers, floor by floor sub metering to monitor energy usage, low NOx boilers, and Combined Heat and Power (CHP) units.

“Heat pumps provide Reduced Temperature Hot Water (RTHW) to the domestic hot water cylinders, and the automatic Kemper system reduces the domestic systems manual draw off regime and monitors return loop temperatures. In addition, and for resilience there are N+1 pipework routes into the gantry areas in case of failure and to facilitate quick and easy change over.”

The Proton Beam Therapy Centre has been an enormous success, treating patients who have some of the most complex forms of cancer, whilst reducing the potential long-term effects of conventional radiotherapy.

Every one of our Healthcare clients and their stakeholders are important to us. Due to the nature of complex healthcare schemes, we know these projects have more stakeholders than other sectors. Patient groups, consultants and clinicians, estate management, Trust boards and equipment manufacturers all need to be consulted and involved. Whether we are designing or commissioning a new healthcare facility, we engage with our stakeholders to make the important decisions that will not only get a project completed but fully operational and problem free. 

The experience of experience

At Banyards we get it right first time, knowing how to design and commission building services, whilst complying to the strict NHS guidelines and industry regulations. Our commissioning teams validate, manage, and verify from the design stage all the way through to the handover and beyond.

Whether working for the NHS or the private sector, our combined experience has enabled us to successfully deliver hundreds of healthcare projects benefiting millions of patients.