Unprecedented times require unprecedented action, and a new form of modular architecture is rising to the challenge. The creation of the first Nightingale Hospital at the Excel Centre in a record breaking nine days is just the first in a series of projects designed to increase intensive care capacity at short notice. 

Offsite construction has been a hot topic recently as the industry deals with the housing crisis and the pressure to create sustainable housing. Build and fit out can be completed to much higher standards than traditional construction methods and, in a situation such as the Coronavirus crisis, provide fast response times. No wonder the Harrogate Convention Centre, Westpoint Arena in Exeter and the NEC in Birmingham are undergoing conversion into temporary field hospitals.

Simple, repeatable and modular
 

So what makes an exhibition centre the ideal location for these temporary critical care centres? First, the pre-existing built environment means less has to be constructed and procured, leading to modular solutions that are simple and repeatable across similar sites. 

Existing MEP infrastructure and large flat spaces were quick and easy to adapt to purpose. This efficient use of existing assets was critical to delivering the project rapidly and that blueprint can be used to ensure that other Nightingale Hospitals can maximise the efficient use of their existing build elements.

Utilities challenge
 

In order to deliver the first 500 bed phase of the ExCel build, developers were faced with the challenge of getting electricity and services to every ward and bed. Again the temporary infrastructure available was repurposed to feed three metres of dado trunking at each bed head.

The new medical gas installation requires two ring mains to feed each bed head. A challenge that was met by running services through a basement car park and then distributed via a service corridor.

Lessons learned
 

The lessons learned from the ExCel conversion are already being used as the Harrogate Convention Centre undergoes conversion to accommodate critical care beds for Leeds Teaching Hospitals NHS Trust. 

Eight halls will be converted by teams working a 24/7 shift pattern with support from the Army and the medical profession. As James Hepburn, BDP's building engineering services principal on the ExCel project explains, it's the clinical flow that is critical to determining the circulation strategy for the Nightingale Hospital projects.

The conversion in Harrogate is being handled by BAM construction, who built temporary hospitals during both world wars. The work is being undertaken in partnership with BDP and will maximise the learning from the ExCel project.

Quick decisions
 

As Hepburn points out, to effectively deliver a project of this scale at speed requires quick decision making that allows construction and design to progress in parallel. Delivering a large volume of fully equipped beds in such a tight timeframe depended on rapid construction and flexible solutions. For fit out to start immediately, procurement channels also had to be taken into account.

What made the project such a success was the development of a highly collaborative working style to deliver simple and innovative solutions for increased capacity. In Italy, shipping containers have been repurposed as intensive care pods. Berlin's Brandenburg Airport is awaiting repurposing as a temporary superhospital and flat-pack start-up Jupe has created a stand-alone intensive care unit.

Nightingale Hospitals operational
 

In what was described as another Herculean effort, the NEC in Birmingham is now a fully operational 500 bed hospital with the capacity to be increased by another 1,000 beds if necessary. In Bristol, 300 ICU beds fully equipped with ventilators will be made available at the University of the West of England.

With their unprecedented scale and timeframe, the Nightingale Hospitals have seen architects and contractors developing solutions on the fly; solutions that are now rolling out across the country in a rapid response to protect the capacity of the NHS. The BDP team has put together a construction manual that has teams in Australia and Canada interested in similar projects.