In what was nothing short of an extraordinary feat of engineering, collaboration, innovation and sheer determination, the creation of the Nightingale NW presented enormous challenges on every level.
In this very special webinar that took place live at our #DPU Manchester 2021 exhibition, we spoke with some of the team involved in delivering the project and consider what learnings could be taken forward to a variety of sectors in the future.
Meet the panel
Emma Lepley – Architect Associate, BDP Design team lead for the hospital
Major Matt Fry – Civil Engineer, Royal Engineers
Paul Jackson – IHP P22 framework Manager
John Fowler – Contract Manager Building Division, North – Vinci Construction UK
Shaun Hinds – Chief Executive, Manchester Central
Neil Grice – Associate Director, Archus
Setting the scene: a global pandemic
Back in March 2020, the world was in a state of panic. The COVID-19 pandemic tightened its grip, and extreme measures were needed to cope with the constantly changing situation. With the UK’s first lockdown put into place on 23rd March and hospitals already unable to cope with the volume of patients, plans were put in place to build emergency surge hospitals around the UK.
The first Nightingale Hospital opened at the Excel Centre in London on 3rd April. Still, work was already starting around the UK on a series of other hospitals to cope with the unprecedented demand. The scale of the challenge was intimidating: how to plan, source, test, and deliver a fully functioning hospital in just 14 days amid a national lockdown.
The right team for the job
Ensuring that the right team was in place to deliver the project on track and brief was essential. BDP had already been involved in the London Nightingale project, so it was logical to continue with the NW project and join Archus, IHP and Motts. Once the site was selected, the Manchester Central team were on board, and the Trust established to manage the project was on hand throughout.
The British Army Royal Engineers played a vital role in the project management and delivery of the hospital. Trained in the field and used to constantly shifting parameters and unstable conditions, the Army approach cut through the noise and got straight to the absolute essentials. They played an invaluable role in establishing the schedules and communication frameworks that enabled the project to be delivered.
While our panel represented several of the organisations involved in the project, they were quick to point out that many more people were involved. It was only as a result of the combined efforts of every member of the cross-functional, cross-organisation team that the project was completed.
Having an existing framework under the NHS P22 procurement scheme meant that some of the pre-selection processes were dramatically simplified. It was a case of appointing pre-approved partners rather than going through a tendering process for project management and goods procurement. Having that framework in place significantly sped up the process and made the project's timeline more achievable, even though it was still an enormous challenge.
Choosing the site
Choosing the right location for the Nightingale was a challenge, and several different sites were in the mix. In addition, the area needed to fit several precise criteria, spanning access, infrastructure, accessibility and logistics.
A Grade II listed building that has been used in many different ways since its original construction in 1880, Manchester Central started life as a railway station and was renovated in 1982 to become the G-Mex exhibition centre. It has hosted countless events and conventions in its lifetime and has been meticulously cared for throughout. Offering a central location and ready-installed utilities, it offered a promising option as the required emergency medical facility.
There were a lot of considerations necessary in choosing the site, and it was a case of balancing the risks, as there wasn’t time for a “perfect” solution,” explained Shaun Hinds of Manchester Central.
“There were other sites in contention but the location and infrastructure made it the best option.”
Paul Jackson praised the impeccable maintenance of the building as well, saying: “The fact that regular checks had been made was a real advantage. Everything was spot on, which isn’t always the case with listed buildings, which made everything much easier.”
The stark reality of the situation meant that on-site provision had to be made for medical treatment and staff facilities and storage of bodies. The politics and logistical complexities made it a tough decision, but there was no time to waste once the site had been chosen.
Working to strict time constraints with military precision
Under usual circumstances, it would take months or even years to build a hospital. But, unfortunately, the bureaucracy and planning regulations alone can stretch into years, so attempting to deliver this project within two weeks was always going to be a considerable challenge.
“All the usual RIBA framework stages of a project had to happen at once,” explained Emma Lepley. “While taking strategic briefing decisions, we were also doing detailed design, M&E queries and development, with all the elements constantly changing, as well as liaising with building and planning control. Given the short time scale, we often had to work with what was available; logistically, we couldn’t necessarily pick and choose the perfect solution.”
As mentioned, the procurement and partner appointment process was expedited thanks to the NHS P22 framework, but the project’s day-to-day running needed an unprecedented pace. This was a project on which every minute genuinely made a difference, and concurrent workstreams had to be managed 24/7 to stand a chance of delivering all the different elements on time.
Represented by Major Matt Fry, the British Army Royal Engineers played a pivotal role in keeping the project on track, and it was, according to Emma Lepley and the rest of the panel, “a master class in communication and project management.”
Looking through the chaos
“We are trained in chaos,” said Major Fry. “We are used to working in volatile, rapidly changing conditions where at any given minute, the whole project can change. We are therefore used to cutting through to the critical factors with the biggest implications. We also knew this could change at any minute, so we had to remain mindful that we didn’t want it all to become redundant if the parameters changed. It was about building resilience and redundancy into the plan at every step.”
However, working in the field is a very different proposition to working within the healthcare and constructions sectors, let alone considering the uncertain backdrop of the pandemic. Working with people more accustomed to protracted timelines and highly detailed planning, Major Fry said he was incredibly impressed at how fast the people on the ground were able to adapt and take charge.
“Within two weeks, people who had looked lost on day one had stepped up, outside their comfort zone, and become confident making these huge decisions on the spot. They had never attempted anything like this before, and it was an amazing thing to witness and be a part of.”
With no time for delay, decisions needed to be made fast and be stuck to, and the weight of pressure was immense.
“Under pressure, people tend to fall back on what they know and dive into the details of their specialisms,” he explained. “But there wasn’t time for that. We had to cut across the detail and find out what was critical. Every decision we made was a balance of risk, and it’s an uncomfortable place to be operating.”
“We needed to work out what the biggest levers were,” added John Fowler. “Every element was time-critical, and there was just no time for anything that wasn’t 100% essential.”
Communication was vital
Getting access to the key decision-makers on every side of the equation was imperative. Clinicians, architects, engineers and supply chain — every area needed to be on hand and primed for rapid and clear decisions.
“From a design management point of view, having immediate access to key decision-makers was vital,” said Paul Jackson.
“The Army mentality helped with that, and I’ve never seen anything like it. We had regular Q&A sessions at 11 am and 3 pm every day right from day one, and we had to submit exact questions and sub-questions in advance. Having that rolling system of decisions and approvals kept everything on track, and I hope we can take some learnings forward from that process.”
Emma Lepley agreed but said, “The pressure of those decisions being made so quickly was incredibly intense. I want to think there’s a happy medium for less pressured situations, but having to work through all the different permutations of an issue to put forward the right questions made it so much faster to get the decisions made.”
On top of the complexity of various cross-functional decisions, the workforce was also split geographically, with a hybrid situation of on-site and home working. The schedule was 24 hours a day for the build, so having robust communication frameworks in place to ensure nothing got missed was vital.
“It was a case of using anything you could to communicate as quickly as possible,” said Emma Lepley.
“Sketches, informal meetings, photos of drawings, on and offsite meetings, Skype calls, physical mock-ups, texting, WhatsApp, detailed drawings, morning briefings in the auditorium, Revit modelling, site-based queries, Facetiming – we improvised every minute of every day to get the job done.”
Hitting the ground at a sprint
When the team first assembled, it was clear there was no time to stand on ceremony. Right from day one, the pace of the project was phenomenal, with as many learnings rolled forward from the London project as possible. Considering the ongoing pandemic, national lockdown and risk to health on site, the stakes could not have been higher.
The first steps were quickly establishing essentials; goods in and out, clean and dirty areas, fire safety, power and utility points, how staff and patients would access and move through the building, what changing rooms, toilets, catering, and maintenance areas would be required. Next, the flooring was ordered, and mock-ups were started for the individual patient bays with oxygen, power, and accessibility requirements.
By day two, the flooring was being laid, partitioning plans, mock-ups and floor plans were available and being tweaked. Fire safety plans continued to evolve, and materials were being ordered to create the patient bays and wash areas. Meanwhile, the complex legislation required to gain approvals was being rapidly expedited, and the situation was changing by the minute.
By day four, plans were being drawn up for the reception area, pharmacy, showers, graphics and wayfinding signage. The procurement of materials continued punishingly fast, with logistics a key factor throughout, especially given the city centre location.
“We used the existing frameworks where we could to make as much use as possible of what’s already there,” explained Emma Lepley. “It was so important to consider every aspect, like the movement and flow of people, how do logistics work within a tight city-centre site with ambulances, fire engines and so on. We constructed new outbuildings and temporary structures in the car park and had to physically test the space available to make sure it all worked, such as ambulance turning circles and so on.”
Complex technical and logistical challenges were met head-on
In any construction project, there are complexities, but given the context of this project, things were about to get very tricky indeed.
Firstly, the organisational team set up to run the “business” of the Nightingale needed establishing. This required a fully functioning structure; ordinarily, it would take weeks or months to secure the right team, incorporating CEO, finance, business leads, HR, administrative staff and so on to create a fully functioning Trust. On this occasion, it was achieved in just two weeks, which is extraordinary. The managerial challenge of running a hospital is immense so getting a qualified team in place quickly to make sure everything was set up correctly was vital but incredibly difficult to achieve.
On site, the challenges continued. From establishing visibility levels from windows to ensure patient privacy to implementing rigorous fire safety procedures, no detail could be overlooked – for example, even the temporary foam used to obscure the windows had to be compliant with the restrictions for a listed building and could not damage the glass beneath. Yet everything had to be identified, solved and checked in record time.
Some challenges, such as how to get the oxygen tanks installed, were potentially on a project-threatening scale; if a solution could not be found, the site would not be suitable. The scale was such that temporary laws needed to be passed to ensure everything got through planning on time to keep the project on track. Patient bays had to be mocked up to provide enough space for intubated patients to be looked after, ensuring sufficient gaps between stations; the team even had to get an actual ambulance in to check that the turning circle was big enough. Nevertheless, completing the project on time (actually slightly ahead of schedule) was nothing short of miraculous and a huge testament to the unrelenting determination of the teams and organisations running it.
Having the right people on the project was of paramount importance, and the amount of teamwork and collaboration it took to realise the project fills the team with immense pride.
Supply chain success – and compromise
In any regular construction project, the materials sourced could take a great deal of deliberation. In this project, though, it was more a case of working with what was available. Having the P22 framework in place helped enormously, according to our panel, as it meant they were already working with pre-approved suppliers, so the procurement process was significantly sped up. But there were still significant issues around being able to source suitable materials and products quickly enough, so it became a case of working with what they could get at the time and making the best of it.
Major Fry attributes a massive amount of the project’s success to the Engineering Logistics Staff Corps, which created effective logistics systems during the war when railway networks were very separate. The links with rail companies such as Network Rail were therefore essential for this process.
“The collaboration was immense,” he said. “We reached out to the industry for support, and they stepped up to the plate. For example, Network Rail offered us storage facilities to use as a buffer so we could get close to a “just in time” model, and we absolutely could not have achieved this without the Logistics Corps’ help.”
“Availability was a real driver,” added John Fowler. “There was a lot of contingency planning, and it was very much a case of having to use what we could get hold of the fastest. We’d be contacting suppliers and manufacturers on an almost hourly basis seeing what materials we could get to the site quickly – we have a trusted supply chain, but you can’t knit without wool, so we had to work with what we could get.”
“It drove the design backwards, really,” said Emma Lepley. “We’d be told how many partitions or doors we could get, and we’d have to create the optimum design to get the best use out of them.”
Paul Jackson also commented on the sheer number of people and organisations involved. “There were so many people involved, and they can’t all be here today. For example, our contractors, NGBailey, played such an important role, working with us on the designs and how to use the elements we could get. The procurement framework sped things up there, so there was no time wasted at all quibbling over costs – we could press the button and go for it. Hats off to everyone involved; it really was amazing to have those supply chains and processes in place to fall back on.”
While the panel was unanimous in its hope that such a situation would never be required again, everyone agreed that there were some stand-out learnings that could be applied in other situations.
The clarity and structure of communication were highlighted, and Major Fry praised the modularity and adaptability of the designs, which meant that kits could be moved, built or repurposed extremely fast. “As a result of what we’ve worked on here, we are now looking at generative design for deployment in the field, based on the ideas of being able to plug in the known parameters like area, component parts and necessary elements, and it being able to produce a basic design plan to make reconnaissance much faster in future. That could potentially then be tweaked in the future even if the situation was different – it could give a lot of advantages.”
The procurement and supply chain processes were praised as a huge time saver, particularly in terms of costing and quoting for materials, and having the extended supply chain networks of trusted partner firms to rely on.
The variety of different media available and the options for remote working facilitated teamwork and speeded up timelines immensely, and enabled multiple workstreams to be managed concurrently for maximum efficiency. Being able to communicate things to people in a way they would understand was crucial; 3D visuals, physical mock-ups, size testing and so on, were all incredibly important, as well as rehearsal of various scenarios, known as the “rock drill,” as outlined by Major Fry, to walk people through each user’s perspective and experience to test suitability.
Having access to all the right people was another key learning; having people on site to be able to advise and consult on the key decisions was hugely beneficial and made the process much faster and meant decisions weren’t second-guessed after the fact. For example, having access to senior NHS clinicians, pharmacists and consultants to ensure that the final designs met the user needs – both staff and patient – was invaluable and underlines the importance of involving the user in design, as discussed in other webinars in this series.
Humbling and inspiring – the very best of human resilience
The stakes in this project were life or death, so the pressure was immense. As Emma Lepley recounted, in the beginning, there would be people in tears under the strain of the decisions they needed to make. Still, the panel all praised the resilience and incredible teamwork of everyone involved throughout the process. “I wouldn’t have been anywhere else,” she said, while other panellists said it was “truly humbling” to see the commitment and courage of everyone involved. “And no-one ever complained,” added Emma. “It was truly inspirational.”
“For me,” said Major Fry, “it was seeing absolute trust and camaraderie and sense of ownership of the problem across multiple sectors. Construction can be quite feudal, and all that was put to one side. Everyone worked almost instinctively, and I was humbled by the way the UK construction industry came together at that moment.”
“I was so proud of the way people rose to the occasion, from the events industry and every sector,” said Shaun Hinds. “People came back to volunteer as well; it was an incredible experience. But it will also be an amazing thing to look back on as Manchester Central archives its history. This will be an important part of that, just as it has been part of the fabric of this city for over 140 years.”
“Rome wasn’t built in a day – but we weren’t on that job!” John Fowler