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News archive - September 2016

Getting under the skin of hospital refurbishment

Getting under the skin of hospital refurbishment

With a growing need to modernise an ageing NHS estate, and increasingly-constrained capital resources, refurbishment projects continue to prove popular. Overcladding of occupied buildings presents some of the most-challenging construction problems. However, the recent revamp of the Bristol Royal Infirmary (BRI) shows how hospital buildings can be overclad and windows replaced with minimal disruption to services, while at the same time improving environment efficiency.

Like many hospitals of its generation, the Bristol Royal Infirmary had been subject to ongoing internal refurbishment and upgrade while retaining its original facade.

Over time, the facade’s concrete elements had deteriorated necessitating remedial structural works to make the building safe.

University Hospitals Bristol NHS Foundation Trust also recognised that the external appearance of the Bristol Royal Infirmary did not reflect the quality of care provided within.

“When I understood just what we had to do to the facade to make it safe long-term, in terms of windows and efficiencies of the building, it became apparent that for relatively little additional cost we could start improving the appearance,” said Deborah Lee, chief operating officer and trust deputy chief executive.

When the appearance of the building was discussed with patients and visitors they told her it gave the impression that the hospital was dirty.

To address both deficiencies, the trust held an international design competition. The winning design, entitled ‘Veil’, was entered by Spanish architects, Nieto Sobejano Architectos, which subsequently worked closely on design development with CODA Architects, the local architectural practice responsible for redevelopment projects on the BRI precinct.

Robert Woolley, chief executive at University Hospitals Bristol NHS Foundation Trust, said: “We believe that Nieto Sobejano’s design strongly met the original aims of the commission, namely to create a landmark building for Bristol that is welcoming and non-threatening, enhances the streetscape and public realm and reflects, through excellence in design, our reputation for excellence in clinical services.”

The new facade had to meet the architect’s aesthetic intent as well as the technical requirements of the project.

Andy Headdon, strategic development programme director at the trust, said of the existing building: “At the moment, the concrete has some problems. We are tidying it up and making sure it is safe. The new system will protect the structure underneath so it will not deteriorate and there will be better natural ventilation in the hospital when the windows are open.”

In addition, overcladding will extend the useful life of the building and provide a thermally-efficient building envelope while substantially reducing heating energy consumption, operational carbon emissions, and internally improving patient comfort levels.

Following a two-stage procurement process, overcladding specialist, d+b facades, was appointed for detailed design and installation of the new polyester powder-coated insulated aluminium rainscreen, high-performance windows, and a free-standing overclad screen in front of the building interfacing back to the main facade.

The project was technically challenging, not only because the existing facade comprised an irregular array of projecting concrete nibs; but the building was occupied throughout, requiring sophisticated project delivery in order to minimise disruption to patients, clinical services, and other building users. Non-uniformity of the facade precluded modular design, instead requiring bespoke solutions installed floor by floor with the projecting nibs being encased. Integrated within the rainscreen are vertical full-height LED lighting strips with phased operation.

The 500 tilt-and-turn windows presented further challenges as the architectural design demanded that the white façade should appear to have no distinguishing windows.

d+b facades’ innovative solution was to apply film to the windows to preserve the consistent appearance, but minimise opacity when viewed from inside.

Replacement windows were installed from the outside before removing the existing windows from within in order to minimise disruption.

The new façade is designed to surpass current building standards and protect the original building’s fabric, futureproofing and extending the life of building for generations to come, and exemplifying sustainable regeneration.

Furthermore, appearances DO matter and improved aesthetics can translate into tangible financial benefit for NHS trusts.

Trusts are businesses with patients generating revenue. If transforming a hospital increased patient numbers by less than 0.1%, the refurbishment cost would pay for itself.

A prize-winning makeover

Another example of this innovative approach is the recladding of the East Wing at St Thomas’ Hospital, which won the Design for Conversion or Infill category at the 2016 European Healthcare Design Awards, held recently in London.

The revamp project - managed by Essentia, Guy’s and St Thomas’ estates, facilities, capital development and IT directorate - was also highly commended in the Health Service Journal (HSJ) Value in Healthcare Awards.

The solution has encased the 13-storey tower in a glazed façade, weatherproofing it and improving energy efficiency.

A key benefit is the addition of two new lifts for critically-ill patients who need to be transferred from A&E to the intensive care units and inpatient wards in East Wing.

The interior of the building now also includes two airy and light glass atria, which contain eye-catching artwork to improve the hospital environment for patients, visitors and staff.

The challenge of the East Wing project was to carry out the work without disruption to clinical services, which include two intensive care units and 200 inpatient beds.

Steve McGuire, director of Essentia, said: “East Wing is home to some of the most-important clinical services at St Thomas’, caring for some of our sickest patients.

“The rationale for the project was simple - the building was leaking, it wasn’t energy efficient, and the lifts to take patients from A&E to intensive care and wards were not fit for purpose, so a complete overhaul was needed.”

The East Wing project was managed by Essentia and delivered by a team including lead building contractor, ISG; architect, Hopkins Architects; engineering consultants, Arup, and project managers, Mace.



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