Critical path to success

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A new critical care hospital in south Wales has been designed by BDP for optimum efficiency to attract the best staff, while achieving an accelerated programme to meet the challenge of Covid. Adrian Hitchcock takes Jack Wooler through the project

A new 450 bed specialist and critical care hospital has been constructed in South Wales by global interdisciplinary design practice BDP to sit naturally among the sweeping hills of the valley it resides in, and to bring functional benefits to its patients, workers, and project team.

Secured under the Welsh Government’s Designed for Life Strategy, which sets a long term framework for improving National Health Services, Grange University Hospital is intended to provide care only for the most critically ill patients and those requiring the most complex care.

Users will spend time in this facility only for the duration of the critical intervention necessary – being moved as quickly as possible back to their local general hospital, and eventually home. This means the NHS is able to deploy its most highly skilled clinicians – and the most serviced and engineered facilities in the area – into one location, creating a “centre of excellence.”

Procurement
Through a short form, competitive bid, BDP and contractor Laing O’Rourke were appointed to take the outline business case forward. With the NHS board having complex needs and strict deadlines, a ‘modern methods of construction’ (MMC) strategy was developed to meet the client’s strict timelines, and BDP were challenged with providing sufficiently detailed models for the builder to achieve the pace required.

The team designed three distinct zones built around a central spine, on the axis of the listed Grange House and its adjacent walled garden. Each of these zones have been designed and built as separate volumes, allowing them to be constructed simultaneously, enabling the installation of services to be as smooth as possible, and even giving the construction team the ability to complete the project six months early to help tackle the pandemic.

Blending with the landscape
“Just like a country house,” says Adrian Hitchcock, director at BDP, “when arriving at the hospital from its main access route, the building slowly reveals itself; it’s quite low key for what is such a large development.”

The access road rises through a deep cut in the landscape to the new hospital, constructed on a man-made plateau along one side of the escarpment. This site offers views across the valley to the west and to the Monmouth hills to the east.

Once belonging to Grange House, with its historic stained glass windows and a walled garden, the estate provides a mature landscape, “giving it very much a country park feel,” says Hitchcock.

BDP worked with the health board, planning authority and local residents to choose what was a “perfect spot” in order to maximise the far reaching views, while simultaneously allowing the building to remain discreet from its immediate residential neighbourhood.

The architect’s brief included the need to make the most of the prospect towards the east, to the valley. The building’s spine was therefore placed along the north-south axis, following the ridgeline and same axis of the house and its walled garden – the latter being brought into the landscape scheme as a place for staff to gain some respite between shifts.

The team also utilised the sloping topography by dropping all the services of the building, including an energy centre, logistics and servicing, to a lower floor level than the hospital’s main zones.

The landscape parkland extends right up to the base of the building on the western side – where the wards look across the landscape to distant views across the valley. On the eastern side the site has been cut to accommodate the logistics and primary energy plant. This is tucked away behind the treeline, so is “not evident in distant views into the site,” says the architect.

Circulation
Heading inside, the architect explains the “very simple” circulation routes, with visitors always traversing north-south along the ground floor axis. Moving from the entrance, the design leads visitors to the ward accommodation – avoiding the diagnostic and treatment patient flows – via the visitor lifts which exit into inpatient visitor lounges, from where they can be escorted to their relatives.

According to the architect, this routing was decided early on: “There are very critically ill patients who will likely journey backwards and forwards from the inpatient zone to the diagnostic and treatment zone several times a day for various interventions, and we wanted to avoid that crossflow between visitors and inpatient movement.”

As such, the hospital streets on the upper levels – where the inpatient wards and the diagnostic and treatment zones are located – are exclusively for bed and trolley traffic. “That’s really good from both a privacy and a dignity point of view,” says Hitchcock. It also simplifies things for staff; “You haven’t got the complication of visitors looking for destinations in what is a clinical zone.”

Separating functions
Unlike more common hospital typologies, where differing zones are split vertically in a tower and podium solution, the building’s three separated zones, inpatient care, diagnostics, and treatment, have been stacked ward on top of ward, all leading from different parts of the central axis.

“In this configuration,” explains Adrian, “there’s an interdependency from the outset between the design of the different zones, their superstructures, and the engineering and services work behind them.” He adds: “While atypical, building each section of a zone side by side is a simpler solution.”

He explains further construction benefits of repeatable stacked templates; the engineering and services can be “straightforward all the way up.”

Separate construction teams can work alongside each other in a “quasi-independent way,” with teams on one section not reliant on the other.

This also allowed for greater design flexibility, with differing superstructures on each zone providing dedicated structural arrangements, grids, services and distributions. All of these were built with column grids spaced far enough out for them to change over time with the changing modalities of specialist medical equipment.

“Having these separated zones – without the added pressures of mixing differing building services – allows the spaces the opportunity to flex over time,” he says.

Interior layout
When it came to the layout, the architects naturally began with NHS guidelines, which set baseline standards for elements such as space and ergonomics. However, Adrian tells me that as part of recent moves under its “Designed for Life Framework,” the NHS intends to capitalise on supply chain expertise and learning, which allowed them more design freedom.

As a result, while the hospital contains 15 wards (with some specifically for critical care, cardiology and paediatrics) their 32 beds include 24 single ensuite rooms and just two four-bedded bays. There are 470 inpatient rooms in total in the hospital, plus 11 operating theatres and an intensive care department that consists of individual rooms separated by glass screens, enabling nurses to monitor two patients simultaneously.

The architects’ expertise bore fruit in the creation of a repeatable single ensuite bedroom – developed through some of BDP’s previous healthcare schemes, but adapted for the Grange University Hospital. “The latitude we had for this project was to develop this repeatable design by testing the NHS’ space standards and the equipment necessary for each room – and optimising the engineering and space allocations for both patient and staff benefit for the higher dependency patients,” explains Hitchcock.

Where previous Designed for Life projects have adopted the arrangement of ‘bathrooms between bedrooms,’ this would have added travel distance for nursing staff; the architects here therefore set out to shorten that distance allowing staff increased time with their patients.

“We organised patient rooms in clusters around the nursing care in a very direct way,” says Hitchcock, “with blocks of eight single bedrooms around the team that will be supporting those eight patients.”

Heavy usage
As with the layout, many of the internal finishes were dictated by NHS guidelines, which focus largely on cleaning, maintenance, and longevity – due to the heavy usage they must endure, and the significant lifecycle costs of the NHS estate. Adrian tells ADF that, as opposed to being hamstrung by these guidelines, BPD in fact spent “a long time” working with various suppliers and manufacturers to improve on the health board’s minimum standards.

The architects’ ambition was to not just specify materials that could “simply accommodate” the high footfall moving through the building, but to ensure that each element would “look as good over time as they did on the day they were installed.”

“We attached a lot of importance to that concept, because the environment you experience in a healthcare facility – whether consciously or not – can really affect the way you feel,” says Adrian. “If it’s poorly maintained and the materials are not delivering as they should, then that can affect one’s perception of the care they are likely to receive.”

Modern methods
One of the “big challenges” introduced in designing these spaces was reportedly brought to the practice by Laing O’Rourke was their MMC strategy, with both the Health Board and the construction team keen to use pre-assembled components wherever possible.

This led to a strategy of ‘Product-Led Design,’ with a detailed understanding of the potential and constraints of the manufacturing process to inform the development of design. For example, while essentially only three different types of precast facade panels have been utilised, different aluminium window configurations set within the standardised openings produced more “interesting and lively facades” than would have been possible under a more “cookie-cutter” approach.”

To enact this, the practice’s use of BIM provided a system whereby panel geometry could be transferred seamlessly to the manufacturing team from architectural design models. The teams embraced paperless methods here, reviewing panel geometry and data in 3D and communicating using BIMCollab.

The MMC elements that were eventually included within this strategy were wide-ranging, including reconstituted stone, insulation and load bearing inner skin sandwich panels incorporating pre-installed windows, precast concrete columns, precast concrete sheer walls, hollow core prestressed plans, precast stairs, bathroom pods and vertical services riser modules.

The team also used virtual reality “extensively” for interior design reviews, progress reporting and briefing on the client’s monitoring team, as well as for a virtual tour website created for hospital staff orientation – which also proved useful for the construction team.

According to Laing O’Rourke, these methods combined provided a “measurable improvement in productivity overall,” saving 42 weeks or 23% of the programme as compared with a traditional build, as well as the reduction of health and safety and waste issues.

With the vastly increased need for rehabilitation demanded by Covid, this system even allowed the construction team to bring the Grange’s completion forward by some six months. Besides the speed of the MMC used, this was also made possible by focusing on completing the inpatient care zone (the area most needed in the area through the pandemic), as representing a different entity from the other zones, and one which didn’t rely on the others.

Making a difference
Looking back on the success of the project, Hitchcock attributes much of it to MMC, the in-depth modelling process behind it, and the benefits brought to the construction team.

Despite this, he warns that achieving success with MMC against the complex needs of NHS facilities is not as easy as “cutting and pasting,” and that there were many aspects of realising the project’s ambitions, particularly in financial terms, that proved a significant challenge.

“There is always a huge amount of scrutiny as to how money is spent, where capital is released, and in all areas of the design. It can be tough sometimes – but it’s worth it to be a part of such important projects and their contributions to society,” he says.

After working in the healthcare sector for over 30 years, and for a practice celebrating its 60th birthday this year, Adrian knows more than most “the crucial part of the fabric of our society” healthcare provides, and believes that through design in this sector, architects are able to “make a real difference to the critical points in people’s lives.”

While he says it can be “frustrating” enduring the slow fruition of such large scale projects, he tells me there is “real joy in the degree of engagement with the building’s users and the benefits design is able to bring to them.”

“Ultimately, healthcare is a large part of our civic fabric in the UK, and at the heart of a lot of communities,” he concludes. “They are hugely important to us as a collective, and the pandemic has heightened that appreciation.”

Project FactFile

  • Construction cost: £350m
  • Floor area: 55,000 m²
  • Client: Aneurin Bevan University Health Board
  • Architect: BDP
  • Contractor: Laing O’Rourke
  • Engineering team: Aecom and WSP
  • Ceilings: Rockfon
  • Vinyl: Polyflor
  • Dry lining supplies: British Gypsum
  • Windows & curtain walling: Kawneer
  • Prefabricated steel beams: Peikko