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Prefabrication is remedy our health service needs
Construction News; 12 December 2002

The National Health Service has a 3.2 billion construction programme planned. But as much as a quarter of this could be wasted by a construction industry struggling with skills shortages and traditional methods, and a client attached to lowest-price contracts and design changes. Mark Smulian reports

The only way to get value for money on NHS projects is through a dramatic shift to off-site construction.

But off-site construction usually means higher initial costs and a fixed design from the start, unfamiliar concepts for the notoriously staid NHS.

Others say prefabrication means boring design and removes local discretion over what each hospital offers.

So how can construction's reformers convince an industry and a client traditionally resistant to change that prefabrication is the way forward? These were the issues under discussion when the NHS's huge construction programme was the debated at a recent conference on off-site construction organised by Manufacturing The Future, held at the Birmingham Motorcycle museum.

One of the key speakers at the conference was John McDonough, chief executive of PFI giant Carillion. Mr McDonough told the conference that, apart from conservatism of contractors, architects and clients, there were few limits to what the NHS might achieve through prefabrication, in particular as part of long-term partnering arrangements. All that stood between it becoming mainstream or remaining peripheral, he claimed, was how the industry sold it to clients.

But he warned the industry would not be able to do this convincingly until it was able to prove the benefits of prefabrication through measurement.

'As an industry we need to get to grips with benchmarking and measurement so that we can monitor our progress and see precisely how well we are doing in terms of delivering value, ' he said. 'As far as Carillion is concerned, measurement is a priority because, unless we monitor and measure overall progress, there will always be an element of faith in making the business case, when it ought to be based on facts.'

Dennis Benson, chair of Chorley and South Ribble Primary Care Trust, who described himself as 'part of the small team of madmen involved in reforming the NHS', called for a 'significant cultural change in construction procurement, which for too long has focused on lowest cost and not on best value.'

He continued: 'The NHS knows about health care but has not always been a good client. There has been a warlike approach in contracts. We have not always given clear briefs and we have made late design changes.'

He stressed that constant design changes had not always led to better buildings and that standardisation could allow the NHS to spread best design practice. 'We want buildings that uplift and improve confidence.

Poorly designed buildings give patients the impression their needs are not important, ' he said.

Using prefabrication more widely would wean the NHS off its habit of large and late design changes.

The problem was put into perspective by Peter Woolliscroft, head of construction services for NHS Estates.

He said research last year showed cost overruns amounted to 25 per cent. That was 'a lot of money to waste' out of a 3.2 billion construction programme, he pointed out.

Mr Woolliscroft contrasted this with the fast food industry's ability to get new outlets built and functioning in days using standardised units.

Both the European Union and the National Audit Office now accepted that health construction contracts need not be based on the lowest initial price, he said.

'The private sector has changed from seeking lowest cost to seeking best value,' said Mr Woolliscroft, who urged NHS managers to look at costs over a project's lifetime. He took issue with those who criticise design standards of prefabricated health buildings.

'Some say modular hospitals will be poor quality massed produced and lacking in local discretion, ' he said.

'That is not the case. It is about having the right environment every time a hospital is built. We can say 'this is the best layout for a room and every hospital should use it'.

How it is deployed is where local initiative comes in and external appearance will always be the province of the architect.'

As Mr McDonough told delegates, making prefabrication work means having an integrated team that has agreed from the start on what it is trying to do. That includes construction workers.

He pointed out that most studies suggest on-site productivity is only around 50 per cent because of difficulties in managing different trades, shifting workforces and weather disruption, even when skilled labour can be found.

The industry's perennial skills shortage affects its ability to deliver the large public sector construction programmes now under way. By moving as much construction work as possible from sites to factories the industry can use static workforces, invest in training, and offer better - indoor - working conditions.

This clearly overcomes several of the usual obstacles to recruitment for conventional construction work.

'Growing demand and a shrinking capacity in our skills base, means our problems will get worse unless we get smarter and better at what we do, ' warned Mr McDonough.

Gary Connolly, technical solutions director of Carillion's mechanical and electrical subsidiary Crown House Engineering, explained: 'As big jobs come along, where are the skilled people? With factory fabrication, workers can be multiskilled. We have a 53,000 sq ft factory at Wolverhampton where 80 employees are trained in Japanese manufacturing methods.'

Once prefabrication takes hold 'everyone involved will need some kind of factory,' he predicted.

Jim Pettigrew, project manager of Inventures, the project management arm of NHS Estates, went even further, urging the service to use volumetric modular buildings. These, he explained, are made fully fitted out in 'slices', which can then be fitted together on site.

'The freedom of design and application that can be achieved means that they can provide new or extended healthcare facilities with a bespoke appearance, ' he said.

The greatest hurdle for off-site construction is manufacturers' capacity, Mr Pettigrew admitted, though European manufacturers will be ready to step into the breach if UK ones are overloaded.

The industry has for years been after the Holy Grail of safe, high-quality, environmentally friendly and profitable work, delivered by a skilled and stable workforce.

The supporters of off-site construction think they have cracked this problem - so long as manufacturers can meet demand and clients overcome unfavourable images of 'prefabs'.

Pre-fab benefits

Safety: Static factory workforce makes it easier to invest in training, control health and safety and mechanise processes.

Innovation: Suppliers, designers and customers together as a truly integrated team. New materials and techniques can be tested before going on site.

Quality: Once designs are established, they can be repeated time and again with zero defects. The stable workforce helps to deliver continuous improvement.

Time: Off-site manufacturing can offer greater certainty on delivery times. Its processes become fewer and easier to accomplish.

Sustainability: It is easier to manage waste in a factory than a site. Local supplier bases minimise the distances over which materials are transported.

Cost: A stable supply chain, and certainty of delivery and quality, help to create more reliable and better margins. These benefits can be shared with clients and partners.

Great Western Hospital

Last month Carillion handed over the 486-bed Great Western Hospital in Swindon after three years - two years quicker than would have been needed under traditional construction, the company claimed.

Off-site construction played a key part in the project. The hospital's exterior was manufactured as pre-cast concrete panels, including the windows.

Single-skin room partitions were designed and manufactured off-site and then delivered cut to correct size. Mechanical and electrical plant modules were manufactured and delivered on 'skids' that slotted in as working units. After more than 1.5 million man hours worked there were no reportable accidents and the company says the project was snag-free.

The Building Research Establishment has named the Great Western as the UK's most sustainable building. Waste was reduced by half, and carbon dioxide emissions both during construction and over the life of the hospital have been cut by more than 30 per cent.

Carillion employed as many local people as possible by creating an on-site job centre, although on-site manpower levels were drastically reduced, compared with a traditional project.