Nine-day wonder – the nascency of Nightingale Hospital amid COVID-19

IOM3 Content Cafe
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13 May 2020
Masked doctor

Fangcang shelter hospitals were established in China early in the COVID-19 outbreak, the UK take is the NHS Nightingale Hospital. Katherine Williams explores the story behind its creation.

With NHS Nightingale Hospitals now in operation around the UK, it was exciting to hear the story behind the first one set up at London’s Excel Centre in an Institution of Civil Engineers (ICE) webinar at the end of April.

‘This building has a very simple function,’ stated Major Gary Jackson, ‘it is not a hospital.’ Shocking words, but totally accurate. The Excel Centre is an exhibition venue and was chosen because of location, size and services. Its role is to be ‘simply good enough’ in a time of national emergency.

As COVID-19 worked through Europe, James Hepburn, Principal and Chartered Engineer at the Building Design Partnership (BDP), saw the situation in Spain and Italy and realised that London would face a bed shortage if swathes of the population needed intensive care support. For the NHS Nightingale London project, he led a BDP team of architects and engineers working collaboratively with project stakeholders, other consultants, specialists, contractors and the army to deliver designs.

Day 0 – the team has access to Excel and by lunchtime has presented a plan for bed numbers and layouts. Next come workshops to develop workstreams. Initially, no one is sure how utilities can be delivered from the floor boxes – water, electricity and a waste pipe – to bedheads. Inevitably, inspiration strikes. The Excel teams are used to working with the shell schemes normally employed for exhibition stands. These polymer layouts are a good size for housing beds, simple to clean and quick to build though a little flimsy.

Day 1 – The shell schemes are being built but need some reinforcement in the form of wood panels – these are inserted on day 4. Utilities are put in and the vinyl floor laid. ‘You were only on site if you needed to be there,’ notes Hepburn.

Day 2 – The ventilation system becomes the focus of attention. There is little time to make significant interventions, but the system is vital  for infection control. The team decides to use full fresh air mode and directs the air flow from reception areas through into the hall housing the wards. Pressure controls can stop potentially contaminated air flowing back into staff preparation areas. By the end of the day, says Hepburn, ‘it felt like we had made significant progress.’

Day 3-4 - Concrete is poured to hold oxygen tanks for air supply. There is concern over curing, but all goes well.

Day 5 – The military team creates a walkable site model so NHS staff can walk through a patient journey from admission to release. This allows the build and user teams to identify issues and anyunder-utilised space.

Day 7 - Ian Watkins, Project Director, Mott MacDonald Ltd, focuses on the external factors, considering traffic management for the build work and ambulance flow. Materials are delivered to an offsite location and a designated fleet delivers to the site – controlling who is there and when. Fire safety is considered, the Metropolitan Police Force advises on security and a dedicated clinical waste hub is set up at the site’s perimeter.

Outbuildings to house staff accommodation, showers, lockers and the largest ambulance station in London, are procured on short-term leases from the open market.

Day 8 - Access to the site is arranged, with patient transfer by ambulance only. Staff have a dedicated shuttle bus from a large car park.

Day 9 – The teams have a fully functioning ward and have learnt key lessons – procurement, communication and the authority to make a decision on the spot are key in delivering a project at this scale in a short timeframe. It seems that the Nightingale Hospitals will not be needed at scale in the UK outbreak, but the knowledge gained will benefit construction teams in the future.

The Engineering Nightingales webinar was produced by ICE London for the Institution of Civil Engineers ‘Lunch and Learn’ series.