Open-access content 23rd February 2009
Modern construction sites can never make for tranquil surroundings but in developing Barts and The London NHS Trust into Europe's biggest hospital, contractors Skanska must stay sensitive to the needs of all those within earshot
23 February 2009
The £1 billion PFI project to redevelop two of the UK's oldest hospitals sounds like a major headache for contractors Skanska. Not only has the company had to build two massive extensions while both hospitals are fully-operational but it has committed itself to zero disturbance and an exacting waste reduction programme. And that's before you start looking at the problems of unearthing an ancient landmark, 740 corpses and assorted body parts.
The project for the Barts and The London NHS Trust is currently Britain's largest hospital development. The Royal London Hospital in the capital's East End was originally a in 1740 as an infirmary for the sick and poor - specifically among the merchant seamen and factory workers. By 2012 it will be the largest hospital in Europe with a cluster of new buildings - including a 17-storey tower - all clad in various shades of blue glass panelling. Down the road in the Smithfield area of central London, the hospital at St Bartholomew's (Barts) is also going through a major redevelopment which will transform the hospital into a cancer and cardiac centre of excellence as well as providing other specialist services. Combined, the two hospital extensions will provide almost 1,250 new beds.
From the outset, Skanska's workforce was essentially required to swap its boots for slippers. Rule number one was that noise and inconvenience had to be kept to an absolute minimum. At some points during the laying of the new foundations, the company was piling concrete into the ground just a few metres away from the Royal London Hospital's basement operating theatres while both the main construction sites were situated a few metres away from children's wards.
To buffer general construction noise, giant acoustic screens made from aluminium and foam panels were brought over from Germany. The result was a reduction in noise levels of around 25 decibels, James Macmillan, environmental manager at Skanska Barts and The London, says. "They're built on a scaffold structure that can be taken down and used again so they're great from a sustainability point of view as well," he adds. When it came to keeping the Royal London's surgeons happy, Macmillan says all piling was scheduled around the hospital's timetable and low-vibration rigs used in areas adjacent to existing walls. But if the low vibration rigs were so effective, why weren't they used all the time? "They're slow and don't go down to the same depth," Macmillan explains. "It's horses for courses."
To keep the hospital free of site dust, Skanska brought in a highly-sensitive particulate monitor. On the downside, the monitor was so sensitive that the alarm was being triggered constantly. "We used the monitor's website to tell us whether the alarm was because of generally high levels over London or directly from our project," Macmillan explains. "The majority of the time it has been external."
In between responding to dust alerts, alternating piling rigs and liaising with the hospital and the local community, Skanska had to deal with the small matters of the 700-plus bodies excavated from a burial ground at the rear of the Royal London together with a piece of the original London wall and various limbs. "Barts and the Royal London were two of the first hospitals to develop surgery techniques," Macmillan explains. "So amputations were not uncommon." Despite much local interest, work was again slowed down while the Museum of London's archaeology team investigated the site over three months at the start of the project in 2006.
To overcome all these obstacles, the project was planned meticulously from the outset. "From the very start, six years prior to financial close, there was dialogue at every stage of the process," Macmillan recalls. The trick, he says, was to build different scenarios into the planning. "You have to factor in variations and once construction starts, you have to stick to the programme," he continues. "Not being on programme in a PFI project will cost us a vast amount of money."
Another important part of Skanska's toolkit is the development of 3D computer modelling. Although 3D software is often used on large construction projects to ensure any 'clashes' between design and function are ironed out, Skanska has been developing the concept in a number of new directions. The company has also won the contract to maintain the hard FM and waste services once the development has been completed and the company has been using its 3D modelling to harness the expertise of the FM team. "In terms of FM, our aim is to maximise efficiency right through the 42 years of the PFI project," Macmillan explains. "The modelling enables the team to walk around a building before it's actually built to make sure they can operate and maintain it in the safest and most efficient way."
The early introduction of the FM team also enables them to advise on the best type of plant and equipment for the hospitals' needs. "It's up to our FM and financial teams to work closely with the construction side and make sure that these decisions are reflected in the costs," Macmillan says. "If they don't communicate, there's a likelihood that corners may be cut. Quality is really important in a long-term project like this."
In the long term, Macmillan says 3D modelling will also make general FM maintenance quicker and easier. "One of the things we are working on at the moment is how we label our 3D layouts so the FM team know not only when equipment needs maintenance but also where to location without having to sift through piles of drawings," he explains. Overall, Skanska's sustainability programme for the Barts and The London project has had the dual benefit of improving waste management and reducing costs. Instead of paying for all waste to be taken away in one lot, materials are divided into eight different types of container and disposed of individually.
"That way we are certain that all the waste is being disposed of properly and at the same time, the company has made savings of almost £7,000 a month," Macmillan says. 3D modelling has also played a part in reducing the amount of surplus material. "From the model, we know exactly how much material we have on site," he continues. "Traditionally, a quantity surveyor would measure that but now we can do it with the click of a button."
Savings have also been made by reducing the amount of packaging used along the project's supply chain. "Most companies are working to the theme of 'reduce, reuse and recycle' but we have one before that which is 'eliminate'," says Macmillan. "For this reason, no packaging is allowed on the site. Full stop." Various methods have been used to rise to this challenge. Some of the M&E is brought onto site pre-constructed. Suppliers, like piping company PSI and lighting specialist Whitecroft, are contracted to deliver all their supplies in reusable containers.
"This has been the first time any Skanska project has tried this approach and our supply partners are already seeing the potential," Macmillan says. "Whitecroft has told us that they have already made a £10,000 saving. It's a glimpse of construction's future." Expecting suppliers to completely rethink their packaging policy is a big ask but Macmillan says Skanska has the clout to make it happen. "It requires a change in mindset but it does help to get things moving if you're a big name and you're working on a £1 billion project," he adds with a grin. Skanska's softly-softly strategy is clearly working. The project is on schedule, on budget and there have been no significant complaints from their client. The project's attention to protecting the hospitals and the wider environment is admirable but there is one major disappointment. For all its eco-friendly intentions, there is very little in the way of green innovation.
Other projects undertaken by Skanska have included progressive energy solutions such as geothermal cooling, combined heat and power and wind turbines. There is nothing like this at the Barts and The London project however. Nor is there any sign of more sustainable M&E such as rainwater harvesting or passive air circulation. Macmillan says that physical and medical constraints of the sites have ruled out many green options. "When the hospital was designed eight years ago, the main the main focus was on keeping out MRSA," he explains.
This is disappointing and when the Barts and The London project reaches its completion dates, in 2016 and 2012 respectively, the new hospitals may seem rather out of step with the times. However, the assurance from Macmillan that the Skanska team is committed to ensuring best practice in sustainable M&E performance under NHS regulations makes this thought a slightly less bitter pill to swallow.
Camilla Berens is a freelance journalist
The Barts and The Royal London project is run by Capital Hospitals, a consortium jointly owned by Skanska (37.5 per cent), Innisfree (37.5 per cent) and John Laing (25 per cent). Skanska is undertaking the design and construction of the two sites.
The PFI contract runs over 42 years and the service providers are:
Hard FM and waste services: Skanska UK
Soft FM: Carillion
Technology services/medical equipment: Siemens Medical Solutions
Sterile services: Synergy Healthcare
Management and co-ordination services: Health Care Projects
James Macmillan, environmental manager at Skanska Barts and The Royal London, will be speaking about the project on the second day of the BIFM conference, taking place from 31 March-1 April at Keble College, Oxford.
Visit www.bifmconference.com for information