Modern Methods of Construction in healthcare in a time of crisis
by Gareth Banks
Regional Director, Architecture
Covid-19 the ultimate disrupter. The wide-ranging impact of Covid-19 has undermined many of the accepted orthodoxies that have underpinned British society over the last decade.
The world has changed. We must use the unique circumstances that we have found ourselves in as a force for positive change and grasp the opportunities that present themselves.
Many Government initiatives have attempted to improve efficiency in the construction sector, with the “Transforming Construction Industrial Strategy Challenge Fund” just the latest. Along with the “Construction Sector Deal”, born from the Construction Leadership Council’s 2016 Farmer Review, the fund attempted to reconcile the fact that whilst construction outputs underpin the nation’s social, economic, and environmental future wellbeing, the industry productivity is comparatively low and its long-term value suspect. The Covid-19 crisis is one more threat such as climate change, skills shortages, and an ageing population on one hand which with the (now clear) need for huge infrastructure spending plans in the NHS, in its current form the industry does not have the capability or capacity to deliver.
Covid-19 has forced the NHS to move rapidly and explore ways to meet this unprecedented challenge, including the building of military style field hospitals in converted conference facilities, diverting staff from non-critical care and even repurposing the manufacturing base- solutions unthinkable just 2 weeks ago. The construction sector has demonstrated that it can react quickly to meet the challenge and in the process hinted at how it might be possible to organise itself in a different way for the benefit for clients and its workforce. The ‘traditional’ way of doing things is coming to an end.
A new way of working
Architects like AHR have a pivotal role to play in the transformation process. Challenge Fund director Sam Stacey, agrees stating that architects are central to the process to balance the technical demands of new technology with the wider needs of society. 
Architects are well practiced at working creatively within statutory regulations and standards, in this context, the additional constraints offered by a more manufacturing orientated approach to construction simply provide another set of rules to be respected. The benefits of deliverability, cost-efficiency, and good co-ordination therefore allow architects to concentrate on adding value, rather than negotiating the balance between quality and cost.
Modern Methods of Construction
Modern methods of construction (MMC) is one of the industry’s most talked about topics. MMC encompasses a range of disciplines that seek to improve upon the traditional building process. These include modular, in which units are constructed entirely off-site before assembly onsite, and hybrid techniques that combine prefabricated structures built offsite with traditional on-site construction techniques. But MMC has had a hard time overcoming its associations with the poor quality, ‘pre-fab’ stock built in the 1950s and 60s so perception is key to re-establishing and maintaining support for the continued development of modular and offsite projects. This places architects at the forefront of not only designing high quality and cost-effective modular buildings, but also dispelling the myths that surround the concept by integrating new technology and positioning it as a viable and innovative solution for a wide range of the issues facing the construction industry.
With an off-site approach to construction, elements can be designed and constructed through a manufacturing assembly line – this improves efficiency, scalability and speed of delivery. ModuleCo Healthcare, for instance, claims to be able to deliver a single ward in 16 weeks, with individual operating theatres available in just 10. Having part of the construction process completed in factory-controlled conditions also negates extraneous factors that can impede project progress. Bad weather will cease to be a critical factor in programming and operating in tightly controlled conditions also creates an environment where a high-quality of workmanship can be guaranteed, resulting in a higher-quality building, and brings with it additional significant health and safety benefits. Building in a modular discipline can provide benefits that have the potential to totally transform the way in which we look at Healthcare development, allowing the industry to work smarter to achieve the ambitious targets which will arise from the current crisis.
Covid 19 is a tragic but not unique event. Winter flu has disrupted acute services for several years now. There is no doubt that the capacity of the acute system must be much more responsive in future to save not only the lives of those directly affected by a deadly virus, but those who’s scheduled treatments are delayed as facilities and personnel are re-deployed. Great strides have been taken in standardising room types and improving flexibility across similar functional components. The implementation of plug-in units builds on this and adds a level of portability previously unheard of in the health sector. In the context of rapidly shifting health challenges, developments can be constructed in an area of high demand (seasonal or unplanned) and remain there until the need has abated at which point they can be moved to another area to fulfil a similar purpose, thereby significantly reducing the level of redundancy required in the system and allowing the rapid deployment of additional units should the situation arise.
MMC also offers some real advantages in meeting long term sustainability targets. Working on these elements in factory-controlled conditions also allows for ‘in-situ’ recycling, while the increased quality of the assets themselves mean superior standards of thermal insulation can be achieved. These elements boost the sustainability credentials of modular builds and their clients. The inherent mobility of the units can further compound these savings as once designs are finalised, there is the option for manufacturers to develop on-site factories to limit the size of the supply chain required to bring pre-assembled units from production to the intended site. This in turn has a sizeable impact on the carbon footprint of the build and the man-power required to bring a project to fruition.
The role of the architect
The architect has three key roles to play if MMC is to succeed:
Ensuring every scheme is designed to the highest standards
Whether that’s to the Health Technical Memoranda, or a bespoke specification provided by a Health provider. As Architects, we must lead the way in driving innovation in this field, encouraging schemes that provide the benefits typically associated with this approach, while delivering attractive, site-specific design solutions. This must include the findings of “wellness” studies as they relate to creating environments which:
- Improves air quality by reducing VOCs (volatile organic compounds), controlling microbes and mould, managing construction pollution and reducing the use of toxic materials;
- Improves the quality of lighting through better visual lighting design, better electric light glare control, better solar glare control
- Improved surface design and daylight modelling
- Provides more comfortable environments through lower external (and internal) noise intrusion, better sound reducing surfaces and individual thermal control.
Creating a strong sense of place in developments
Whether they be schools, hospitals or housing, developments can only be achieved through effective stakeholder communication and the implementation of other technologies, such as BIM (Building Information Modelling), early in the design process. The architects’ creativity, when combined with the utility of a BIM model provides a resource for data-rich visualisation before delivery, giving the vital insights required on the materials and dimensions required for a build, early in the construction process. This is crucial in a modular context, as it allows for greater confidence to be fostered among stakeholders, for whom a modular approach may be unfamiliar. There is greater certainty around what the delivered elements will be, how they will look, the standard to which they will perform, and the way they will integrate within the existing estate. As decision makers become increasingly aware of modular solutions this high level of insight is important in building confidence in the approach and its suitability.
Leveraging the relationship between manufacturers and the supply chain to the benefit of all parties
Our final role is perhaps the most radical. At AHR we have a strong legacy of harnessing the potential of MMC to deliver new school places across the country. This is well illustrated by the Salford Schools project where, working with Laing O’Rourke we used BIM data to prototype and test components before being used to inform the machinery that drove the off-site manufacturing process. With much of the work front-loaded in the off-site manufacturing process, the construction time for the project was rapid, resulting in a 750-place, watertight high school erected in just 16 weeks. Aligning both the architect and manufacturer’s approach through the intelligent application of technology facilitates a manufacturing process that maximises efficiencies, allowing both sides of the process to push the boundaries of design which in turn creates more desirable and affordable clinical environments.
The very best architects have always sought to exploit and express the opportunities that new construction methodologies have generated, from Le Corbusier to Richard Rogers and Zaha Hadid. The hospitals of the future cannot and should not rely on hand crafted solutions. The hospitals of the future will need to be efficiently planned and manufactured, be visually stimulating and spiritually nourishing. This will need architects to engage fully with the manufacturers and establish a new language that is authentic and human.
- Streamlined design set to tackle rising construction demand- RIBA Journal, 12 November 2019, Matt Thompson
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