High quality for low cost was the brief for a £125m PFI hospital. For Kvaerner’s facilities management team, that meant planning 30 years of operation before a brick was laid.
Three years before the first brick was laid, the team at Kvaerner Facilities Services was already hard at work on the design for the Queen Elizabeth Hospital in Woolwich, South-east London. It will be responsible for running the £125m private finance initiative hospital, 24 hours a day 365 days a year, when it opens in spring 2001.

The hospital is the sixth to be constructed under the PFI but the first to be let as a design, build and operate project in the UK. The FM team’s design input will be critical to its success.

Early involvement was essential if the facility is to be operated within budget. The hospital will be leased to the NHS trust over a 30-year period with an option for a 30-year extension. During that time, the team will be responsible for preventive maintenance, the repair and replacement of all building services, the fabric and all hospital equipment, and the maintenance of grounds, roads and communications systems.

The facilities services team was part of a much larger group assembled by Kvaerner in its 1998 winning bid for the PFI contract. The hospital will be run by Meridian Hospital, a joint venture company owned by Kvaerner Investments and private equity company Innisfree Partners. It is being designed and built by Kvaerner Construction.

The mechanical and electrical services are being installed by Kvaerner Construction’s sister company, Kvaerner Rashleigh Weatherfoil, and the hospital will be run by another Kvaerner operation, Kvaerner Facilities Services. George Trew Dunn Partnership, the architect, was also employed by Kvaerner: the construction arm of the company retained the architect and Allott & Lomax, the structural engineer, while the services arm employed consultant Capita Greatorex.

The hospital is part of Greenwich Health Care’s rationalisation scheme that will combine the services of two smaller hospitals on one site. The scheme will involve the redevelopment of a 10 ha site, formerly a 1960s military hospital.

The design team put together a budget for the proposal, including “up-front” costs for building the hospital and an estimate of costs for running and maintaining it.

The financial equation involved capital expenditure on the fabric, plant and equipment, maintenance costs and interest repayments to funding bodies.

The trust specified how the hospital should operate and the services it should include in the form of an output specification. It provided a “room data sheet” telling the designers what each room was to be provided with in terms of services and equipment, but left it open to the consortia to decide how they were to meet these requirements. “The trust was looking for the highest standard of hospital for the minimum cost,” says Paul Rogers, a director of Kvaerner Facilities Services.

Life-cycle analysis was an important part of the design process. “Our early involvement was important to see if investing more capital up front on plant and fabric could extend a product’s life-time sufficiently to make it a worthwhile investment,” Rogers explains. To prepare the company’s bid for the PFI contract, the facilities team approached a number of manufacturers.

The enquiries were developed through brainstorming sessions between Kvaerner Rashleigh Weatherfoil’s project management personnel, Kvaerner’s Facilities Services and the consulting engineers.

The idea was to pool information on “previous experience of different systems,” says Rogers, “particularly for the building management and security systems”.

From the replies, quotations and presentations from the preferred bidders, the facilities team selected two suppliers. The process involved assessing the proposals on buildability, capital cost, running cost, expected life span of the product and a commitment from the supplier for long-term support. Life-cycle information was taken from the BRE and “the company’s own database of construction worldwide,” says Rogers.

The number of suppliers was whittled down to one after the consulting engineers had developed the design. “Working with the engineers, we came up with long-term innovative warranties and maintenance packages,” says Rogers. “These were not always with the lowest-priced package but involved establishing a long-term partnership with a supplier rather than just a one-off sale.”

Eight months before the contract was due to be signed, detail design began. “Once the contract is signed, the price the trust will pay is cast in stone,” says Rogers, “so we are always looking to make savings”.

The successful supplier is expected to assist in the finalisation of the design to achieve these savings. Autronica, for example, was chosen to install the fire alarm system. The company proposed using a self-testing system that would save time, money and manpower and result in savings for the operator.

The system also includes a text display unit in wards so staff know the nature of the emergency and whether to evacuate patients. The same criteria were used to select the emergency lighting systems which are also self-testing.

It was not just the electrical suppliers that proposed innovative solutions: for the ventilation plant, York’s stainless steel air-handling units have been installed.

The units are supplied in sections to make them easy to maintain and, if necessary, to allow single sections to be replaced.

The wall covering in the mental health unit was another area investigated. The facilities team must repair any damaged decoration. A new type of plaster was chosen for the walls that, unlike conventional plaster, does not crumble on impact; instead, it dents so that the defect can be remedied with filler, rather than by replastering the entire wall.

The transfer of 56 maintenance staff and managers to run the hospital is now under way. They will be transferred from other hospitals in the region under a TUPE agreement and start work on 1 August, although many of them are already familiar with the scheme.

The senior management has already worked with the design team offering advice. “We haven’t always incorporated what they’ve wanted into the design,” says Rogers, “but we have always listened to them.”

The maintenance team, too, is busy familiarising itself with the systems. It has been watching them being commissioned and has been involved in assessing how easy it will be to get at them.

It has been hard work. “We’ve had to instil a new type of culture,” says Rogers.

Construction started in summer 1998 and will include a new medical block with 560 beds and an outpatient facility. An existing clinical block has been demolished and is being rebuilt to include operating theatres and an accident and emergency unit. A pathology and mortuary block and a stores and records block will also be constructed on the site of a previous building where stores were kept, along with a new acute mental health unit.

For the facilities team, the arrival of the first patient in spring next year will be the acid test. It might have taken three years to finalise the design, but the proof of the pudding will be in the 30 years the hospital has to run.

Choosing products to last for 30 years

To assess the market rate, at least five suppliers were asked to quote. Their prices were then compared with Kvaerner’s database at the local office. For the pipework system, for example, a Friatherm system has been installed throughout the hospital. It is a PVC system selected on the basis of:
  • cost
  • corrosion resistance
  • ease of installation
  • 50-year life expectancy
  • low maintenance
  • track record in use at other hospitals
  • 10-year defects liability
  • ease of modification and repair: being plastic the pipe can be joined using solvent-based connectors. Some copper-based systems, for example, require solder to connect and an open flame to provide the heat.