The team at Birmingham’s Royal Orthopaedic Hospital was charged with creating a £15m state-of-the-art specialist treatment centre. So what made them choose modular construction – and was the operation a success?

“It was just like the cavalry charging over the hill,” says John Simmons, contractor Medicor’s project manager, describing the massive convoys that brought modular construction units to Birmingham’s Royal Orthopaedic Hospital.

In a meticulous operation that lasted over three weekends, 48 modules up to 15 m long, 5 m wide and weighing 28 t were brought on to site on transporters and craned into position for a new three-storey treatment centre (see “Logistical challenge”, page 18).

The decision to go modular was based on a number of factors. Andy Mitchell, the trust’s project director who was involved in the deliberations, recalls: “It became evident at an early stage that the programme was unachievable with traditional build.

“The Royal Orthopaedic is a specialist acute trust located on a small and complex site. Logistically, traditional build was considered as impacting too heavily on the organisation’s ability to continue delivering a service.”

Mitchell says the trust was also concerned about whole-life costs. “Modular buildings demonstrate improved operating and running costs because they perform better than traditional or concrete-framed buildings. Higher levels of thermal and acoustic insulation and airtightness can be achieved. These improvements and the prediction of lower running costs were particularly attractive to the trust.”

Medicor proposed modular construction when interviewed by the trust as part of the ProCure21 selection process. Although off-site manufacture was deemed the most appropriate method, the trust did take some convincing that it was the best solution.

Simmons explains: “One of the older wards at the hospital is prefabricated and it looks just like an old-style school building. The trust was terrified that was what they would be getting.”

Medicor director Mark Giltsoff continues: “So we took members of the trust to see completed schemes carried out by Cadolto (a modular building manufacturer based in Nuremberg) in North Yorkshire and Germany. We included the chief executive, project director, facilities and estates people, and the clinical team. It was all about winning over hearts and minds – so they knew what to expect and couldn’t say afterwards: ‘That’s not what we wanted’.”

we took members of the trust – chief executive, project director, the clinical team – to see schemes in germany. it was all about winning hearts and minds

Mark Giltsoff, Medicor director

Giltsoff says Cadolto was chosen as a partner based on three principal factors. It offered a more flexible approach on the size of the modules than some of the British manufacturers approached. It had a good track record stretching back over 50 years. And perhaps more importantly, Cadolto was prepared to guarantee the structure of the modules for the 60-year design life insisted on by the trust.

Once everyone was happy, it took a further 12 weeks to finalise the design of the modules and agree the level of fixtures and fittings within each unit.

Giltsoff comments: “The hardest bit was getting the design finalised and agreed. However, once that had happened, the rest was remarkably quick. One of the things we learned on the project was that certainty of design was paramount. You have got to have all details finalised and signed off before manufacturing can start.”

Simmons adds: “We learned from this building. It wasn’t as finished as it could have been. Some that we saw in Germany, you literally only had to move the beds in. Modularisation of a building has to be part of the overall design process. You need to design in such a manner that it comes almost fully finished.”

Simmons estimates that the modules were less than 60% fitted-out when they arrived on site. “They came virtually as first fix with a degree of second fix, for example, the bathrooms and showers were fully finished.”

He suggests: “Perhaps, we looked at it from too traditional a point-of-view. We should have started with a rectangular, blank piece of paper and said: ‘What is the maximum size of module? What is the most effective module size?’ If we had settled those issues, we could have said: ‘Let’s design our room arrangements around the modules’.”

Simmons reckons this procedure would have lessened some of the minor headaches such as positioning of the joints in the trunking system that runs around the walls. The trunking is used to carry an array of electrical services, communication systems and medical gases from bed to bed.

There are some complexities compared with timber frames, but once you sort those out, this is simpler

John Simmons, Project Manager

The procedure would also have removed any temptation late in the process for people to think about moving a wall here, a door there, or relocating electrical sockets. Simmons explains: “The key is getting people to understand that what is on the drawings is what is going to be built, so the approvals process can be quite painful.”

Whatever minor pains that might have been suffered, the end result convinced the ROH that modular construction was the right way to go for another new building containing two operating theatres and a 15-bed recovery unit. Medicor was asked to add the theatre complex in January and the lessons learned on the other building came in handy.

The design and signing-off procedures were tightened, resulting in the modules arriving with about 80% of the fit-out complete. The trust was also less worried about trying to hide all the joints between the modules. Some of the joints are detectable in the internal walls, but only just and only where the trim masking the joints sticks out a few millimetres from the perfectly flat wall surface. Ceiling tiles completely disguise where one module sits on top of another. It is almost the same with the floor joints – they are only discernible in the floor covering after you have spent time figuring out how big the modules are and how they are laid out.

Medicor’s project manager says: “With the theatres, the trust and Medicor had more confidence in the system. We used specific joint details that didn’t make it look like a prefab or an old school building. It’s the same as having an expansion joint in masonry construction.”

The previous lessons also helped streamline construction time and within seven weeks the building was almost complete. Whereas it had taken nearly three months preparing the way, with groundworks and diverting the plethora of services that cross the site taking the lion’s share of the time.

Simmons and Giltsoff’s experience at the ROH had made them strong advocates for modularisation. Simmons says: “For the previous seven years, I had been putting up timber-framed buildings for Travel Inns and the like. There are some complexities and difficulties compared with timber frames, but once you sort those out, this is even simpler.”

Giltsoff adds: “Here modular construction was just about cost neutral, but its impact on the trust was significant. It is much less disruptive and time was saved.

“I’m passionate about giving the client a good quality job. And the way the industry is at the moment over getting trades people, it is getting harder and harder to achieve that.”

A logistical challenge

  • For the diagnostic treatment centre, 48 modules were delivered to site during three weekends in November and December 2003.

  • Each module measured up to 15 m long by 5 m wide and weighed up to 28 t.

  • It took four days to transport the modules from Cadolto’s factory in Nuremberg, Germany, via ferry ports from Hull to Dover.

  • Frankley service station on the M5 motorway was used as a temporary staging point for the lorries, which were timed to arrive each Friday.

  • One half of the A38 dual carriageway, which runs past the ROH, was closed after the Friday night rush hour and used for overnight parking for the convoy.

  • Each Friday, two mobile cranes with capacities of 500 t and 250 t arrived on site and were rigged to lift the units into place.

  • Transporters were driven into the hospital in a pre-arranged sequence where the 250 t crane transferred the modules to a shuttle wagon, which then made the final 100 m journey to where the 500 t crane was waiting. The shuttle operation was necessary because the transporters, which were up to 22 m long, couldn’t turn into the narrow access road leading to the site. Space was also tight for the 500 t crane, which was located within centimetres of trees protected by a preservation order.

  • Under the directions of the transport crew, the 500 t crane placed a module within 75 mm of its intended position. Thereafter, specialists from Cadolto were responsible for ensuring the unit was lowered into position. Each weekend, one storey at a time was added.

  • Sundays were used to remove the cranes, reopen the A38, and return the staff car park to normal use.

  • Medicor reckons the entire erection sequence could have been compressed into about four days – with enough transporters and if the new building was far enough away not to impact on the day-to-day running of the hospital.

  • European allies: Sourcing the materials

    Although the modules were assembled in Germany, they represent the true international flavour of construction today. The hot-rolled sections for the modules’ steel frames were sourced in France.

    The concrete floor tiles came from Italy, whereas the ceiling tiles came from Armstrong in the UK. The mechanical and electrical installations were carried out in Nuremberg by UK contractors and the British firm that transported the modules had Dutch, French, German and Italian drivers.

    The plant rooms were manufactured in Germany and shipped to the UK for fitting out by British companies.

    Even the render coating that was used on the external elevations of the building came from Germany.

    The vitals: Birmingham

    Royal Orthopaedic Hospital, Birmingham
    about £15m
    September 2002 to autumn 2004
    Construction team
    Medicor, headed by Pearce Health as principal contractor
    Healthcare planner
    Consulting engineer
    Parsons Brinckerhoff
    Mason Richards Partnership
    Building services consultant
    MJN Colston
    Quantity surveyor
    Davis Langdon
    Modular units
    Off-site construction consultant