Building for better health
The pandemic put an immense strain on hospitals around the world as unprecedented numbers of people were admitted for life-saving treatment. With clinical staff at risk of infection, there was intense focus on measures to limit in-hospital transmission and protect those on the frontline caring for patients.
It was a reminder, if one was needed, of the critical importance of stopping the spread of infections, like MRSA, in hospitals. This is something the healthcare sector team at construction company Laing O’Rourke is aware of and factors into the design and delivery of all new hospitals it is building. Dumfries & Galloway Royal Infirmary, which Laing O’Rourke completed in 2017, is a good example of what can be achieved.
Now a construction partner of choice for NHS health boards and trusts all over the UK, Laing O’Rourke has completed 16 major new hospitals across the nations in the last decade, as well as delivering primary care schemes and hospital refurbishments –12 of which have been for NHS Scotland (for six different health boards).
Laing O’Rourke’s experience of digitally designing and constructing NHS hospitals has improved both the quality of the finished product and the speed at which the projects are delivered. Using its industry-leading knowledge of modern methods of construction, and with components manufactured at its own UK factories, its healthcare team believes it can now deliver a 600-bed critical care hospital in less than two years.
Holyrood spoke with Rory Pollock, Laing O’Rourke’s healthcare sector specialist, and Andy Thomson, one of the company’s most experienced healthcare project directors to discuss the organisation’s work in healthcare over the last decade, and examine why Dumfries & Galloway Royal Infirmary has been such a success. Thomson, responsible for the delivery of healthcare facilities including Alder Hey Children’s Hospital and the completion of the Royal Liverpool University Hospital, also played a pivotal role at Dumfries & Galloway. He describes the multi-faceted success of the Dumfries & Galloway Royal Infirmary construction, pointing to the speed of construction, the importance of stakeholder engagement and the next to zero in-hospital infections.Thomson says: “Dumfries and Galloway is one of the biggest healthcare projects we’ve done in Scotland, at almost 60,000 square metres. We built it in 134 weeks, which is swift and certainly less than most hospitals of that size take. There were a few factors that made this possible.
“A key factor was early and close collaboration with the client – the health board management team, clinical staff and patient groups. A hospital is a complex, hi-tech building, and it helps when clinical staff, and the end users of the building, know exactly what they want and how they want it delivered.
“Then in terms of the build, we place huge store in what we call digital prototyping or digital modelling. There is no way we could have put the building together and met the quality and time requirements of the health board without building it virtually first. This, combined with modern methods of construction and off-site manufacturing, enabled us to meet all of the client’s expectations. It has been in operation now for about five years, and we still get really good feedback about it from the client.
“One of the biggest clinical benefits it has delivered is that their hospital-acquired infection rate plummeted to almost zero from the moment they moved into the new hospital, which is a obviously a massive positive for the NHS. This is largely down to the fact the hospital has 100 per cent single occupancy rooms.”
Pollock adds: “In terms of infection rates, single occupancy rooms perform well. We also understand how patient isolation benefits recovery. At Dumfries & Galloway, design features including setting the windows of each patient room at a height to provide views over the surrounding countryside helps combat isolation and aids recovery. It’s become known as the garden hospital.
“Ultimately, we listen to our clients’ clinical objectives, draw on our experience of delivering facilities across the NHS estate and provide advice to optimise design.”
‘‘It is not just patients that are seeing tangible benefits from the new hospital. Clinicians are benefiting from new technology and better IT systems,” says Thomson. “Going from something built in the 70s to something built in 2017 is chalk and cheese from a technology point of view. Healthcare technology changes every six months, particularly what is called ‘big ticket’ or cat-F equipment; MRIs, CT scanners, and X-ray kits and modern hospitals have to be designed to flex for emerging technologies.
“The ability to put in the very latest kit means you need a facility that has the supporting infrastructure to let you operate and service it appropriately.
“From an IT perspective, Dumfries & Galloway had a complete change in how they delivered, for example, crash calls. Rather than a pager that may not go off all around the hospital, we provided a completely different way of delivering crash calls. It was 100 per cent effective and reliable, they utilise what I call a ‘digital backbone’, effectively a very heavily meshed Wi-Fi system, that runs almost everything. This includes all the medical records, crash calls, and RFID [radio frequency identification].”
Another key part of Laing O’Rourke’s hospital projects is the social value they generate for local communities. Thomson explains the lasting impact their projects have on local people and local businesses: “It is fundamentally important to us to engage the local community and to create opportunities for employment, training and education. We work with local small businesses and schools and colleges to do this – we want and need to attract more people into our industry.
“It provides fascinating careers and a good future for people.
“One of the first things we did on Dumfries & Galloway was to find out what small businesses were in and around the area and explore if they could be part of our supply chain for the new hospital. While many businesses were perfectly equipped to join the supply chain, a number did not have experience of working on such a major healthcare project, and in that instance we supported them – for example providing upskilling in digital capability.
“We created 40 apprenticeships throughout Dumfries, in mechanical, electrical, plumbing and construction. We had a link in with the local college, particularly the BTEC level three construction technician courses. 75 per cent of placements were working on the hospital.
“Two-thirds of our workforce was from the local area. In our experience, this is a real benefit – building something for your own community is hugely motivating.”
Pollock adds: “Some of our employees ended up working within the health board. After we’d left, they realised their skills were transferable. Many avenues tend to pop up.”
There is excitement about designing and constructing Scotland’s future hospitals, explains Pollock: “If the government can deliver its ambition to spend £10bn in the next ten years to upgrade, renew, or refurbish existing facilities, we are going to see a transformation in how care is provided. With our experience, we can help maximise the benefits of this major public investment. For example, we can help develop pathfinder projects to create net zero carbon assets. I know there is an ambition within NHS Scotland to build a net zero carbon hospital.
“That’s where it gets interesting, the future technologies and experience that the industry can bring now, in terms of how efficiently a building can operate, and on non-fossil fuel energy sources, is quite exciting.”
As Thomson is speaking, design images of another major Scottish project sit behind his shoulder. He is currently in the final throes of completing the multi-billion pound transformation of Edinburgh’s St James Quarter. Expressing his delight as the city centre, retail-led project nears its conclusion, he says: “It is a fantastic project, particularly from a technical and civil engineering point of view. Like our hospital builds, digital engineering played a huge role in making sure we had a clear course of action before construction began. It is complex working slap bang in the middle of historic Edinburgh, with as many stakeholders as you can imagine. Everybody is interested in it.
“[After the pandemic] I think everybody was on tenterhooks last June when the galleria opened, worried if people would return to the shops, or if they would they stick to online. So seeing customers, visitors and tourists enjoy the retail, leisure and restaurant facilities is hugely rewarding. We’re particularly proud of being involved in this. The Everyman Cinema and almost all of the shops are now open, and the W Hotel is being fitted out.
“These are the last big changes that we are doing before we fully complete the project and hand it over to the client and the public.”
This article is sponsored by Laing O'Rourke. This article appears in Holyrood’s Annual Review 2021/22.