Intensive care

No one can accuse the National health Service of being extravagant with money. Walk into any casualty department in the country and you won't feel as if you are in the presence of an organisation that overspends.

But when Totty Construction tendered for an extension to Fairfield Hospital in Bury, which included an intensive care unit, an accident and emergency department and adult acute beds, it slashed more than £1.5m off Bury NHS Trust's original budget of £8.5m, proving that this time the NHS had allocated too much cash. And all because Totty was given time to think about it.

"The scheme was competitively tendered, but we had eight weeks to do the tender, which is a longish period for a job of this size," says Mike Parkinson, operations director of the Yorkshire-based contractor. The contract was design and build, which Parkinson says also contributed considerably to the success of the project.

"Design and build allows the contractor to bring something to the party," says Parkinson. "We can deliver buildability, product knowledge and specification information. The cost of materials fluctuates and we've got our finger on that. Consultants are not as driven by cost as contractors, so we bring that commercial element to the specification."

"Once we were awarded the contract," explains Parkinson, "we set up a design review, and did a value engineering exercise on every component with the client and the client's agent MPM Capita, giving ourselves a target each month. We liased with the heads of each medical department and determined which elements were crucial to the project and which may have been over specified." Using this exercise meant Totty was able to drive the cost of the building down to £89.24 per square foot, 22% below NHS average standard costs.

Design and build allows the contractor to bring something to the party

Being given time to look in depth at the specification for the hospital, meant Totty and its team of key subcontractors was able to come up with considerable savings. One example was the building management system. Originally the same system that was in the existing part of the hospital was specified in the extension. Totty and the mechanical and electrical engineer NG Bailey, decided to use a different product which still integrated with the hospital's other system, but which saved £100,000. Some of this was fed back into the project, and the finishes were upgraded to give the hospital a more relaxed atmosphere. The rest of it the client took as savings. "It's a case of looking in detail at what's in the specification and seeing what benefits can be had from other approaches," says Parkinson.

As well as cosmetic enhancements, the savings Totty generated were ploughed back into new facilities for the hospital, including a seven-room digital X-ray department.

Totty saved another £100,000 by choosing timber for the floor that housed the services, explains Parkinson. "The existing hospital had a concrete floor with a steel frame to hold it up, where there were only services and we couldn't see the value in it. Using timber instead saved a lot of money."

As well as cut backs on cost, Totty also shaved 29 weeks off the original programme. "The original tender period was 104 weeks. From experience we knew we could do the job in 85 weeks. We ended up beating that by another 10 weeks," adds Parkinson.

The original tender period was 104 weeks. From experience we knew we could do the job in 85 weeks. We ended up beating that by another 10 weeks

Working next to a live hospital helped Totty plan its time more effectively and contributed to the speedy completion of the project, as did a good relationship with the client. "We had a lot of restricted interfaces with live theatres and so on," says Parkinson. "We had to keep tight control on the programme and plan it carefully. A close relationship with the hospital meant going into certain areas quicker than we expected."

Phasing the handover also meant the job was done quicker, and helped Totty control quality, says Parkinson. "We split the extension into sections, agreeing with the hospital which areas were the most critical. The accident and emergency department for example, was identified as being crucial, so we targeted it early and locked off other sections leading into it. It was ready 20 weeks before the final handover date, which was of considerable benefit to the hospital. We snagged each item as we went along, from the plaster upwards, and then snagged each section as it was completed. This meant we weren't trying to catch up with a big list of snags at the end."

Using a design and build contract contributed to the speed of the project, as well as the cost, says Parkinson. "Because we did the design as well, we were able to influence the speed of it. We had regular design meetings to push things along and we produced a design and development document with cut off dates to keep the design moving."

Focusing on building up a relationship with the client has also been an important factor, says Parkinson. "We spent time in the early stages of the project making sure that the personalities on our side and the client's gelled. By coming up with good ideas and cost savings at the outset we established a rapport with the client."