Steve McSorley, Director, Perega¹ kindly shares his insight with Hospital Hub…
Reports² on the crumbling state of NHS hospitals have shone a light on an almost £14bn maintenance backlog, £2.7bn of which is a “high risk” to safety. The recent announcement about delays³ of up to nine years in building 18 new hospitals only intensifies the urgency of addressing these structural challenges.
Refurbishment is no longer a choice for buildings nearing the end of their usable lives, it’s essential to ensure continuity of care. The UK’s engineering community is at the forefront of this challenge, bringing expertise and innovative solutions to bridge the gap between now and the delivery of new facilities. This article explores how structural engineers are meeting these urgent demands head-on.
Navigating a live environment
Hospital refurbishment projects are inherently complex, primarily because they take place in live environments where structural work must be carried out while minimising disruption to patient care. This often involves phased refurbishments, with contractors taking over small sections of an area at a time, screening them off and allowing investigations and works to proceed incrementally. This process, while necessary, is time-consuming, costly and fraught with risks.
One of the biggest challenges is simply understanding what you’re working with. Many UK hospital buildings were constructed or altered between Victorian times and 1970s, meaning original structural records are often incomplete, outdated, or entirely missing. Establishing the structure’s material composition and integrity often requires invasive physical investigations, such as removing ceilings, cutting into walls, or exposing beams, all while avoiding essential services elements like wiring, pipework and ductwork. In some cases, this process is further complicated by the presence of asbestos, which demands specialist handling to ensure safety.
Additionally, older buildings were designed to outdated fire safety standards and protection. Measures considered adequate in the 1960s, for example, may no longer comply with modern regulations, requiring upgrades to ensure both compliance and safety.
Expect the unexpected
Even with thorough investigations, one constant in hospital refurbishments is the unexpected. Older buildings often conceal hidden issues such as unrecorded alterations, deteriorated materials or critical systems routed through seemingly unrelated areas. For example, a live cable or pipe serving an entirely different department might run through the ceiling of an area where work is scheduled, creating a risk of service disruption.
Risk workshops at the outset of a project are invaluable to managing these uncertainties. These bring together all stakeholders to compile a risk register, assess potential issues agree ownership and agree on mitigation strategies. Regularly revisiting and updating this register throughout the project ensures that risks are managed proactively rather than reactively.
However, no amount of planning can eliminate all risks. The reality of working in live hospital environments means that unforeseen events happen and a quick reaction is needed to mitigate potential delays and cost increases. Effective communication with hospital leadership fellow consultants and site teams and flexibility in planning and approach are key to navigating these challenges.
Working as a unit
Credit: martha-dominguez-de-gouveia-nMyM7fxpokE-unsplash
Refurbishment projects in healthcare settings are not just technical challenges, they’re also human ones. Success depends on collaboration between a multidisciplinary team, including structural, mechanical and electrical engineers, architects, fire safety consultants, hospital staff and more. Each discipline brings its own perspective, and open and honest communication is critical.
In my experience, the most effective teams are those that embrace ‘creative friction’, challenging one another constructively to develop the best possible solutions. This requires a culture where team members feel empowered to speak up if something doesn’t seem right even if it isn’t strictly their area of expertise. Mistakes happen, but when teams work dynamically and supportively, they can anticipate and mitigate problems before they escalate. In healthcare projects, where lives are at stake, this collaborative ethos is critical.
No time to lose
While funding constraints often force estate teams to focus on firefighting the most critical issues, early intervention on structural problems is vital to stop escalating costs and risks in their tracks. Just as with maintaining a home or car, addressing minor defects early can avert major failures.
The challenges facing NHS hospitals are immense, but they are not insurmountable. By leveraging the expertise of the UK’s engineering community, embracing early intervention and fostering a collaborative, solutions-driven culture, we can ensure that hospitals continue to operate safely and effectively. This work is far from easy, but these are not just professional concerns, they are moral imperatives. Together, we can build a stronger foundation for the future of healthcare.
1 – https://perega.co.uk/
2 – https://www.theguardian.com/uk-news/2024/dec/30/england-rundown-hospitals-are-outright-dangerous-say-nhs-chiefs
3 – https://www.gov.uk/government/publications/new-hospital-programme-review-outcome/new-hospital-programme-plan-for-implementation
