University College London Hospital is the latest PFI project to open its doors to the public, promising – as they all do – to get the best value from the private sector. So Building sent in an expert to assess just how well the fabric of this £422m building will withstand daily wear and tear over the 35-year PFI contract. Here he tells Thomas Lane what he found – plus, on page 58, a fresh approach to whole-life costing

Peter Caplehorn is an architect with a no-nonsense approach to assessing how well products and materials stand up to use in completed PFI projects. Instead of relying on the maker’s claims about its products and the data produced by whole-life cost models, he checks out building performance for himself. As the technical director of Scott Brownrigg, he spends his days trekking around factories and grilling those running them. He then visits completed projects to see how well its components have lasted. Only when he is satisfied that he understands how a product performs will he specify it on his own projects.

Caplehorn’s experience of PFI projects in recent years has taught him to be cautious. “The aspirations of projects in terms of their quality and ability to meet the needs of end user have been difficult to fulfil,” he says. “There’s such a long period between financial close and construction starting that keeping the principles alive, let alone the detail, is difficult. This was particularly bad in the early days as people were so focused on getting the job they forgot was the job was about.” All of which goes some way to explaining why Building asked Caplehorn to cast a critical eye over University College London Hospital, a £422m teaching hospital on the junction of Tottenham Court Road and Euston Road. We chose this particular PFI project for several reasons. First, it is brand new, having opened on 14 June this year and as such it should represent the latest thinking on whole-life costing. Moreover, its architect, Llewelyn Davies, was also responsible for the Cumberland Infirmary in Carlisle, which was criticised for its poor build quality. And as for design quality, this hospital has already come in for some stick – CABE has said it was at least a decade out of date.

Also present on the tour of the building was Roger Dolan and several members of his team. He is the general manager of UMU, a special purpose vehicle set up to operate the hospital during the 35-year life of the PFI deal, and he is here to answer Caplehorn’s probing questions and defend the project team’s decisions. UMU is a joint venture between contractor Balfour Beatty and project management and services specialist Amec, which constructed the building under a design-and-build contract. The facilities management is handled by Interserve.

1. Atrium

Visitors and staff enter the building through large revolving drum doors and pass into a lofty atrium extending up to the roof of a four-storey podium block. This is next to a 16-storey tower block – people can circulate between the two blocks via the atrium at ground level and by link bridges above. The atrium is intended to give visitors a good impression of the hospital – it has polished plaster panels set into the walls, a sleek-looking reception desk with backlit yellow glass and terrazzo flooring.

Caplehorn seems satisfied by the revolving drum doors. “These are alright, although the question is how long will they stand up to the traffic.” He is less happy about the entrance matting inside the drum of the door, which has already started to fray at the edges. “The matting is not proportionate to the quality of the rest of the scheme,” he says. “The terrazzo will be slippery when wet. Those mats won’t take all the water off peoples shoes.” Dolan concedes the frayed mats are an “ongoing issue”.

A scissor lift will be employed to clean the tall atrium walls and ceiling. This intrigues Caplehorn. “I would like to see the machine that does that – they will have to get it up the ramp outside, then do a tight turn and get it through those entrance doors.”

2. General flooring

One of the most important elements in a hospital is its floor surfaces, which get a constant beating and need constant cleaning. The atrium’s terrazzo flooring should last the 35-year term according to Dolan, but Caplehorn is more interested in the linoleum flooring used throughout the bulk of the building. Dolan says: “We went for Marloleum [the trade name for a specific linoleum] because it’s hardwearing, easy to maintain and is environment-friendly. We think it will last the contract term but there are provisions in the lifecycle assessment for replacement.”

Caplehorn is unhappy about the shiny finish on the floor. “A glossy floor is a clean floor but its also slippery,” he says. Dolan responds that his team had made a “huge assessment” of cleaning products and methodology. “The flooring is easy and cost-effective to maintain and there are no issues of slip,” he adds.

Caplehorn asks him what would happen “if you get someone running down the corridor and there’s some water on the floor?” “Interserve do not use water for cleaning,” is Dolan’s response. Caplehorn then points out spillages are inevitable but Dolan says water on the floor shouldn’t make any difference.

3. Lifts

The lifts are central to the efficient functioning of a 16-storey hospital. If these break down the whole building could grind to

a halt. Dolan says a lot of attention was paid to this issue during the design stage because UMU gets paid a fee for ensuring the floors are available at all times. “We had a very in-depth logistics plan at the beginning to make sure the logistics would be okay,” says Dolan, adding that UMU went to the USA for this expertise.

“Even with some lift failures and planned maintenance we should still be able to stick within the logistics plan. The challenge is making these assumptions come true.”

“These lifts appear quite chunky and seem quite fast between floors. It also feels pretty smooth, “ says Caplehorn. “They’ve done all the right things with the logistics plan – the Americans must be the experts when it comes to lift strategy. The only thing that concerns me is door protection on the lifts – there is just the plain, stainless steel edge.”

4. Wall protection

This is normally fixed at dado and skirting height to stop the walls getting bashed by trolleys. “We looked at the traffic and points of impact. We know the dimensions of the trolleys so you can work out where the impacts are likely to occur and put in suitable protection,” says Terry Shaw, UMU’s design liaison manager. “The wall protection is okayish – it doesn’t strike me as particularly robust,” says Caplehorn. “Wall protection can be either sacrificial or robust. It strikes me that this is sacrificial – it can take everyday knocks but if it gets a big bang you have to throw it away.”

5. Doors

Hospital doors get hammered with trolleys bashing into them, and because hospitals can have hundreds of doors they are a big-ticket item. “I am concerned the doors don’t have enough protection,” says Caplehorn. He says the leading edge protection is good but the lack of protection on the rear edge could be a problem, and the architraves are not protected either. “Some studies show if the doors have too much protection these can get ripped off the hinges, so some degree of damage is acceptable,” chips in Shaw.

6. Roof

The roof also satisfies Caplehorn. It is an “upside-down” roof – the insulation is placed over an impermeable membrane made by Permaquik, which is capped with paving slabs. The advantage of this arrangement is the slabs protect the membrane. Dolan says this type of roof was selected as it had been tried and tested on other Balfour Beatty–Amec PFIs. “It will do the term – there would have to be something pretty weird for it not to,” says Caplehorn.

7. Wards

An important consideration for the whole-life costings of hospitals is how easily these can be reconfigured if clinical needs change – as indeed they have. Since financial close, beds have to have electric motors so the nurses do not have to move them manually and every ward has to have a handwash station to tackle the MRSA superbug. “We have had to provide a flexible design in case of future changes,” says Dolan. “It’s all studwork partitions so we can take it down and clear the whole floorplate easily.”

8. Cladding

Austrian firm Bug-Alu-Technic made the cladding. Bert McCabe, a director of Llewelyn Davies, says getting this specified was quite an achievement. “The exterior is the easiest thing to rip out of the project so you end up using brick and punched windows. That would have been disastrous on the Euston Road and we had to fight hard to get what we wanted.” He adds the cladding was not expensive, given its environment. McCabe’s efforts are appreciated by Caplehorn, who thinks it looks sleek and elegant. “Its good quality and engineered to do a job – none of it looks skimped,” he says. He is more cautious about the fins on the facade, as there is nothing to prevent maintenance cradles from bashing into these.

9. Wet areas

The walk-in shower rooms have central drains set into non-slip vinyl flooring. Caplehorn is concerned about the joints between the linoleum in the corridors and the vinyl in the shower room. “The vinyl will shrink and put the joint under pressure,” he warns. He is also concerned the vinyl could shrink and pull away from the drain outlet set into the floor. “We spent a lot of time on the drain joint,” says Shaw. Caplehorn says this will need carefully watching.

10. Plant rooms

The plant in a hospital never gets a break, and this one is fully air-conditioned to deal with traffic pollution. The plant rooms are one area where the team deviated from its plan to improve whole-life costs. “We envisaged having individual humidifier units next to the air-handling units,” says Dolan. “It was recognised a centralised steam unit would be easier to maintain than lots of individual ones. It also freed up space in the plant room.”

Dolan explains that 80% of the pipe runs in the plant rooms were prefabricated to minimise construction risk. Caplehorn is impressed. “The plant rooms are pretty well nailed down – I couldn’t see any obvious areas for improvement,” he beams. The space freed up by the centralised steam unit could also pay lifecycle-costing dividends as it means that if the trust needs extra plant over the life of the hospital there is plenty of space for it.

Energy needs can make up a big chunk of the lifetime costs of a hospital. UMU had to agree energy targets with the NHS Trust. “If we don’t meet the energy targets we are obliged to pay the hospital the difference,” says Dolan. He adds these targets get tougher each year, obliging UMU to find new ways of saving energy. This is to compensate for the plant becoming less efficient over time. An allowance has been made to replace the plant during the 35-year contract.

11. The verdict

So what is Peter’s verdict on the hospital? “I’d give it 8.5 out of 10,” he says. “They have kept the project on track and have achieved some pretty good goals. I put this down to the close relationship with the client, which is pretty hands-on, plus the FM guys have been involved too. I don’t believe all PFIs are like that – it’s amazing how many projects there are where they’re nowhere to be seen. That’s a lesson to everyone in the sector.”

University College London Hospital key points

  • The hospital has moved on the industry’s approach to whole-life costs, which was poor in the early days of PFI
  • Project success was based on team collaboration from inception to completion
  • Top marks for the roof, plant rooms and cladding
  • Question marks over cleaning, door protection and wet rooms