Rushed to hospital

BOB ANDERSON likes NUMBERS. In a brief conversation in his site hut, he manages to fit in 872 beds and 4500 rooms in a 31 ha site where seven million man-hours are worked by 220 subcontractors installing 54 km of internal partitioning, 160 km of pipework … and so on. Each of his statistics – of which the above is a small assortment – is delivered in his slow, considered manner.

Anderson is project director of the Edinburgh Royal Joint Venture, the contractor assembled o design and construct the New Royal Infirmary of Edinburgh and University of Edinburgh Medical School. At £180m, the hospital is the largest privately financed healthcare project in the UK, and Anderson has spent the past six years ensuring that it is completed on time and to budget – hence his obsession with figures. "The challenge was to design and construct the largest teaching hospital in the UK," he explains.

Dressed sedately in a dark suit, his dark hair dusted with grey, Anderson has more of the air of an insurance clerk than a construction manager. When he speaks, the trace of an Edinburgh burr reveals that he is, in fact, a local boy – born just down the road in the existing Edinburgh Royal Infirmary. So there's more than a little pride of place at work here. "This was a massive project for any neighbourhood – from day one we aimed to build a project that everyone would be proud of," he says.

To add a little spice to Anderson's task, the building's client, Consort Healthcare, has reinforced a tight construction programme with the threat of a huge penalty for late completion. However, given the scheme's progress, it is a clause that is less likely to be invoked by the day. From his site hut, Anderson can see the white-clad, slab-like walls of the huge complex as it nears completion.

Three main elements make up the hospital. A three-storey ward block, 350 m long, forms an arc to the east of the complex. "This is about half the length of Edinburgh's Princes Street," he says, putting the scale of the project in a local context. Tucked behind its curved form is the rectangular diagnostic unit. This includes the high-intensity treatment areas and laboratories. Finally, to the east of this is another rectangular block containing the 24 operating theatres and their support services.

Although not part of the main hospital, the University of Edinburgh's medical school has found a new home in a purpose-built block to the east of the main hospital buildings.

The many faces of Balfour Beatty
The hospital has been designed and constructed by ERJV for Consort Healthcare – the PFI concession company made up of Balfour Beatty, Royal Bank of Scotland and AWG. Balfour Beatty and Royal Bank of Scotland are the concession's main stakeholders.

It is hard to find a part of this project that Balfour Beatty is not involved in. As well as being part of PFI concession Consort Healthcare, the project is managed by Balfour Beatty Capital Projects on behalf of the shareholders. Haden Building Management, part of the Balfour Beatty group, will run the hospital. What is more, the complex is being constructed by ERJV, a consortium that includes Balfour Beatty and Haden Young (also part of the Balfour group). Even some of the subcontractors fall under the group's umbrella, including Andover Controls and Balfour Kilpatrick. "Although they are all part of the same group, there are firm lines drawn between the different parties," says Andrew Smith, project manager at Consort.

As one of Balfour Beatty's senior managers, Bob Anderson has been involved in this project from the early concept design. "Our role [at ERJV] is to manage the design and construction and marry the two," explains Anderson.

He started work on the project in 1996 with a small team of four people including a planning manager, a cost expert and a designer. The first bid was submitted to Lothian NHS Trust by Consort in June 1996. By October that year, the consortium reached preferred bidder status. In this time period, contractor ERJV prepared 44 drafts of its bid. "We've spent a lot of time reiterating the design to make it affordable," Anderson says.

To develop the design, the contractor worked with Keppie Architects, M&E engineers Hulley & Kirkwood and structural engineers Blyth & Blyth Associates. Anderson describes the process of developing a layout for the three floors of rooms as "like assembling three jigsaws one on top of the other". Continuing with the jigsaw analogy, he says that the problem is: "If you change one piece, the whole lot is thrown out, because the service risers pass through all three floors."

To ensure the hospital would function efficiently and the design was appropriate, the NHS trust allocated 500 staff to monitor the scheme. Every room has a data sheet stating its minimum dimensions, the equipment it will contain and its service requirements; it also includes plans of the walls, floor and ceiling to show the location of the services. "The trust said what they wanted in an area, then it was up to the architects to lay it out," explains Anderson.

The new hospital will have 872 beds – 200 less than the health trust occupies at the moment – so the building had to be designed for efficient operation. The key to the contractor's solution is what Anderson describes as "aggregations of specialities". This means that all departments – including operating theatres, intensive care units, laboratories and wards – are assembled into self-contained groups for each specialism. For example, orthopaedics is one group, liver/renal is another and cardiovascular another.

"We produced schematics to show whose accommodation needed to be linked," he says.

All aspects of the contractor's design had to be submitted to Consort for approval by the concession's own team of consultants. "The design was assessed for capital cost, maintenance cost, replacement cost and energy efficiency," says Mike Ross, contracts director at Balfour Beatty Capital Projects.

As well as using consultants to check the scheme, Consort also involved Haden Building Management – the contractor that will run the hospital when it opens. "It was vital that the facilities management contractor was involved from the earliest stage," says Ross. The team value-engineered and undertook life-cycle studies on the suitability of different types of doors ceilings and floor coverings. "There is no point in putting something down if it will last forever but will need constant maintenance throughout its life," says Consort's Smith.

Particular attention was given to assessing the hospital's M&E services. "When you are looking at the capital costs for a hospital, M&E only accounts for 40%, whereas the cost of the building itself is around 60% of the total," says Ross. However, during operation this figure changes dramatically. "Then, M&E takes about 60% of the maintenance costs, whereas the building is only 40%," he continues. The selection of equipment is all the more critical given that there are enormous penalties if a room is taken out of commission during occupation.

Forging ahead
On 21 August 1998 the construction contract was signed. The joint-venture group to build the hospital was formed from Balfour Beatty Construction, Haden Young and Morrison Construction. Although each company has a different stake in the project, "they all share the risk", according to Anderson. As project director, E E it was Anderson who had to help the separate teams mesh. "We called ourselves ERJV to focus on the design and build of this project," he explains. Anderson laughingly says he "started the brainwashing" by getting the ERJV logo put on all the site helmets.

The building was to be assembled using "proven construction techniques" for programme predictability and longevity. "The client didn't want a fancy building; it wanted a building that would work as a hospital," says Anderson.

However, using proven techniques was not without its problems. Under the initial construction programme it would have taken too long before the hospital was occupied and generating revenue. "We had to cut construction time to make the job affordable," admits Anderson.

Preparation and prefabrication
The maximum construction programme was set at four-and-a-half years. To ensure construction could begin immediately, some of the enabling works were carried out before the contract was signed. "When we were certain that the job would go ahead, we diverted two burns that flowed across the site, moved a couple of sewers and relocated a footpath," recalls Anderson.

The prefabrication of some components also helped speed up construction. Modular toilet pods were used in all the ward areas. These are pre-plumbed units, fully finished, and include a toilet, sink and shower. "The real benefit of these were that they were prefinished before they came to site," says Anderson. Bed-head trunking was also supplied in a modular form with all wiring and pipework preinstalled. And pipework for some of the main service runs was supplied in prefabricated modules to cut down on installation time on site.

Each of the hospital's main buildings was allocated a dedicated project manager. However, when it came to finding suitable subcontractors, the project's size meant many of the packages were too large for a single firm. "We ended up using subbies from two or three different ones," says Anderson.

Another challenge faced by Anderson and his construction team was that the hospital had to 0be occupied in two separate phases – so part of the building is already in use as a hospital while the remainder is still currently under construction. The division between the two phases follows an approximate east-west axis through the centre of the complex. The part of the hospital to the north is already complete and was handed over in October 2001. The remainder will be handed over as the second phase in December 2002.

The phased handover meant the design of the services had to be thought through carefully and the system installed so that all the services would function even though many installations were incomplete. Phasing the work also had a knock-on effect on the construction programme, with many rooms constructed ahead of programme to form a buffer zone adjacent to occupied areas. Smoke and fire alarms were activated in the buffer zones to protect patients.

The completed complex will be leased to Lothian NHS Trust for 25 years, with the contract starting on 13 December this year. After 25 years, the NHS trust has to choose between one of five options to decide the fate of the hospital. Options include the chance to walk away from the scheme or, if the trust is feeling flush, the opportunity to purchase the building from Consort for £1. Whatever the option, the building must be in "an ongoing condition" according to Consort, which means the hospital cannot deteriorate towards the end of the contract.

Back in his site hut, Anderson is still talking of the project in numbers. "We've used 78,000 tea bags on this project so far," he laughs.