Published: 10/04/2003, Volume II3, No. 5850 Page 37 38
A new generation of modular buildings is finding its way into hospital development, saving time and money. Seamus Ward reports
In February, deputy prime minister John Prescott announced plans to help alleviate the housing crisis in the south east of England by building 200,000 new homes. Many will be prefabricated, a technique that dates back to the early 1900s when kit or modular homes became popular. Since then, it has developed an image problem but Mr Prescott insists modern methods have improved quality beyond compare - and at least some NHS hospitals would agree.
'Modular' is becoming one of the buzzwords of NHS construction projects. It is being used to increase capacity (either temporarily or permanently) to tackle waiting lists and as part of larger developments providing accommodation for operating theatres, bedrooms, bathrooms and laboratories.
Portakabin, for example, has built a 56-bed ward and a twostorey office building for King's College Hospital, London, using its modular system.
Modular construction has been used in the new Edinburgh Royal Infirmary, as well as in developments in Calderdale, Bradford and Romford. It is even being proposed as a solution to trusts' car parking problems.
Modular units are built in sections in a factory. They normally have steel supports and each is usually finished (including partitions and decoration) before they leave for the building site. Once there, it is simply a case of bolting the sections together and connecting utilities.
Raymond Ketland, a consultant to medical services provider Draeger Medical, which sells the modules, says that in traditional construction 10,000 square metres takes 20 months to build.
It takes less than a year using a modular system.
Time is not the only benefit, he says. 'There are insufficient quality tradesmen to produce anything like the numbers of operating theatres, for example, that are needed over the next five or six years. In construction, you get a 12-month defect period; in Halifax, we built a modular pathology unit that was signed off with no defects after 12 months of people working in it.
That is unheard of.'
Private finance initiative constructors are keen to incorporate the method into their building process. They hope that the greater build quality and standardisation will reduce longterm maintenance costs, while the shorter construction time will reduce building costs and mean they are paid quicker.
E'There are lots of benefits in using modular units for operating theatres and parts of hospitals where you have important and expensive medical equipment, ' says Steve Rickwood, head of PFI at consultants Cyril Sweett.
'They will be accurately built and any extra expense caused by the transportation costs will be more than offset by the short timescale for construction.'
He adds that modular buildings could be used as part of the health service's green agenda - a building that is no longer required could be dismantled into its sections and transported to another site.
Catalyst Healthcare provided Calderdale Royal Hospital with a pathology module built in Germany and transported to the site in seven large sections.
Mike Davis, Catalyst's chief executive, says it is looking at using modular buildings on the Central Manchester Hospitals trust project, where it is preferred bidder.
'As part of the redevelopment, there needs to be a new mental health unit built in the shortest possible time to release land on which to build. We will be looking at modular construction for the mental health unit because of the time it would save.'
Gerry Galligan, Bovis Lend Lease design manager working on the Central Manchester project, says the mental health unit will cover 8,000 square metres and modular units are an option to speed up the building process.
'At Calderdale, we built a unit over two floors using modular construction. The only onsite work we had to do was to prepare the foundations and fix it together and it was ready three to four weeks after the modules arrived on site.'
Modular construction does have its drawbacks. Some experts say the units are inflexible and can only be used for small buildings and sections of hospital buildings for which they are currently being used.
'We see using modular construction in a number of different ways, including modular bedrooms and bathrooms. It can be used for part of hospitals, rather than complete hospitals, ' says Mr Davis.
Mr Galligan adds: 'Everything has to be transported by road and even with a wide load there are limitations to what you can bring. In the Central Manchester mental health project, the residential rooms are small so you stand a better chance of making it work. It doesn't lend itself to large, open-plan areas, not that it cannot be done but that is an areas where my industry needs to mature.'
Bill Headley, project director at Newcastle upon Tyne Hospitals trust, agrees. 'I can see benefits where you have standardised units that could be put in as part of a whole but I do not think the concept of modular building for a whole hospital works.'
He adds that trusts do not tend to act together as a corporate body with bigger buying clout when it comes to procuring buildings but standard modules for bathrooms and bedrooms, for example, could help achieve this.
'If you consider how many four-bed bays or single bedrooms we have, I think the modular concept could be used to standardise these units across the whole country.' l Whipps Cross Hospital: the need for speed Speed and minimal disruption were the reasons why modular construction was chosen for the new emergency medical centre at Whipps Cross Hospital in east London, according to Reg Hollis, the hospital's head of building and engineering services.
The single-storey extension to the accident and emergency department - manufactured by Portakabin subsidiary Yorkon, in York - will have 30 beds in a mix of six-bed, four-bed and single en suite rooms, together with blood, gas and ultrasound units, dirty and clean utility rooms, offices and assisted showers.
The£2.5m centre, which is under construction, aims to cut trolley waits by providing assessment beds for patients in the first 24 hours after admission. Mr Hollis says the unit will help achieve government targets.
'The modular approach will help us to cut the build time by half. It is also essential for the A&E department to remain fully operational throughout the construction period, despite the building's location adjoining the major treatment area and between the pedestrian and ambulance bluelight entrances.'
Royal Surrey County Hospital: short-term solution The new short-stay surgical ward at the Royal Surrey County Hospital, Guildford, is not what it seems. It was previously used to house soldiers at the army apprentices' college in Harrogate, while their quarters were under construction.
The new modular ward was supplied by Foremans-RBS Ltd on an 18-month lease to the hospital but not before it carried out a major refurbishment programme.
'Modular buildings were chosen as we needed the accommodation very quickly and for shortterm rental, ' says Richard Wood, capital planning manager at Royal Surrey.
The ward will provide accommodation while refurbishment takes place at nearby Farnham Road Hospital. The single-storey building includes four four-bed wards and three single wards all with en suite facilities, a day room, ward office, nurses' staff base, patient/staff rest rooms, a waiting area and a link corridor to the main theatre block.
Vanguard Healthcare: touring theatre Vanguard Healthcare not only brings temporary modular and mobile theatres to hospitals but it also can provide the nursing staff.
The company spent three months from last November at Southmead Hospital in Bristol, helping treat an extra 383 patients as daycase patients who would otherwise have been treated as inpatients. Patients included those in orthopaedics, general surgery, urology, gynaecology and ear nose and throat. Vanguard has six theatres and two wards currently in use in a mixture of modular and mobile units and will expand its modular theatre offering by taking delivery of three more before the end of the summer.
Jane Hopes, North Bristol trust's assistant director of policy and planning, says the 'visiting hospital' was a cost effective way to reduce waiting lists while permanent theatres were built.