The government’s high-profile plan to deliver 40 new hospitals by 2030 depends on radically transforming the way building engineering projects are procured and delivered, according to the Minister leading the programme.
Lord Markham CBE told a webinar hosted by the Building Engineering Services Association (BESA) that the £20bn plan would only succeed if building services supply chains adopted greater product and design standardisation, and fully embraced modern methods of construction (MMC).
The Portfolio Minister for the New Hospital Programme (Hospital 2.0) told BESA chief executive David Frise, who chaired the webinar on behalf of the industry umbrella body Actuate UK, that efficiency and productivity improvements across the whole supply chain were critical.
“We need standardised designs using MMC to improve efficiency and standardised components to manufacture at scale and get the speed we need,” said Lord Markham. “These are not just buildings – they will need to be showcases for what the hospital of the future will look like.”
He added that MEP (mechanical, electrical, and plumbing) would be crucial “for making sure these are fantastic places for patients” and that the expertise of specialist contractors would be vital. He said that improving ventilation was a top priority – not just to mitigate the risk of infections, but also to speed up patient recovery and so reduce waiting times.
Lord Markham urged the industry to adopt a ‘Nightingale Style’ approach – referring to the collaborative spirit that delivered healthcare facilities at speed during the pandemic – and to “challenge current methods”.
He said the government had learned a lot from previous efforts to improve the procurement of schools and prisons – and the success of Hospital 2.0 could lead to decades of work to upgrade every hospital in the country.
However, he acknowledged that the government was “often the biggest barrier to progress” and was responsible for an “unwieldy planning process” that would also have to be addressed. “We need the industry to invest and scale up to meet this challenge,” he said. “So, we need you to have confidence in the programme.”
Lord Markham said the fact that there were “27,000 different door types” in UK hospitals was one example of why standardisation was so desperately needed. The Hospital 2.0 programme is working to reduce that number to around 700.
Morag Stuart, the project’s chief programme officer, was also a guest on the BESA webinar and said the building services sector needed to see that it was “a clear part of this journey otherwise we won’t be able to deliver at the scale we need”.
She said manufacturing and production-based design was crucial to this platform approach. “We are looking at what level of investment will be needed to support the supply chain. The mechanism will be via frameworks for the main works, but we will need a wide range of contractors including new entrants into the market to cope with the scale of what we are doing.”
The issue of ongoing maintenance would be a central part of the planning with Stuart citing the example of an operating theatre that was currently out of action because it was “waiting for a replacement light bulb from Finland”.
“We plan to be ground-breaking to move from a typical construction programme to a manufacturing approach with a key role for standardisation. We will be very explicit about the standards that must be adhered to in all our hospitals,” said Stuart, who hoped that as many of the standardised components as possible could be manufactured in the UK.
Frise raised the issues of lack of industry capacity and problems with late payment that often made it hard for contractors to invest for the long-term. Stuart said the programme’s payment policy was not fully agreed but “the direction of travel” was not to hold retentions.
“We recognise that smaller firms have found it hard to work with government in the past so we are looking at how we can vary our routes to market…and improve engagement.”
The speakers also said they would take a “pragmatic” approach to delivering net zero in the NHS estate and wanted to work closely with the industry to make it achievable including ways for making better use of innovative materials and onsite processes including 3D printing.
“A hospital is a huge consumer of energy not least because you are looking at six air changes per hour across the whole facility so there’s a lot of work going into how we do that better,” said Stuart.
Lord Markham said the programme team had resisted a lot of political pressure to “go go go and start building” because they wanted to take their time and get the design right first.
“This is a transformation programme, and we are determined to make it work,” said Stuart. “We need to do things differently, so please challenge us – we desperately need to get this right.”