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IN PRACTICE

How we designed and delivered NHS Nightingale Jersey

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NBBJ partner David Lewis tells Rob Wilson how the 180-bed Jersey Hospital Nightingale Wing, a 130 x 40m prefabricated building, was designed by NBBJ and delivered by contractor J3 less than a month after it was commissioned in light of Covid-19 

What were the key challenges of this emergency project?

Designing, building and commissioning a 180-bed hospital for a greenfield site on an island and having it operational in a month was quite an undertaking for the client and the project team. It represents a whole-team co-ordinated effort led by J3. In the event, all involved were able to respond to anticipated and unanticipated decision-making, react to site situations, and co-ordinate with a variety of people with different levels of expertise. 

All established ideas about designing healthcare environments needed to be rethought. This is a temporary hospital, and solutions needed to be developed from first principles – from patient services to fire strategy to co-ordination between the design and site teams and the client.

Can you describe the structure and reasons for this choice?

Immediately upon appointment, a rapid assessment of existing buildings and open sites was put in place. It became apparent very quickly that there were no existing building in Jersey that could deliver the particular Nightingale ward layout required by the client. A prefabricated new build on a greenfield site was the only option.

Because speed was imperative, opting for a prefabricated shell ensured the hospital could be quickly erected and demounted. The 40m-span spaceframe roof was assembled at ground level and hydraulics lifted the whole roof into position. The shell, manufactured in The Netherlands and delivered to Jersey via lorry and ferry, was erected in five days. To meet the deadlines, the building was ordered before the design had been finished. We knew the overall floor area needed – that was enough to place the order. We then had to have sufficient design work completed to stay ahead of the building delivery and erection.

Describe the procurement process.

Jersey’s government, the States Assembly, made the decision to procure a Nightingale Hospital and brought on board local contractor group J3 Limited.

How much did you try to use pre-existing modular or standardised systems? What were the key elements NBBJ designed?

Standardisation was key for this build, both for ease and efficiency of construction and also for easy navigation in use.

Once the modular shell was erected, a quick-fit partitioning and door system was used to segregate the internal spaces. As fire and acoustics were not an issue, these merely acted as visual and infection-control screening. The same supplier provided the many clinical hand-wash basins, which were a modular unit throughout.

Dji 0981

Dji 0981

How much preparation of the site and what foundations were needed?

The site was a green field prior to construction. Topsoil was removed (and stored for re-provision to the site following removal of the temporary hospital), and a hardcore sub-base was laid. The aluminium structural frame sits on metal plates at 5m centres. These bear directly onto the hardcore upfill and are held in place with steel spikes driven into the  fill. The modular building provided the floor structure, onto which the internal finish was laid. Tarmac was laid for the vehicular routes and access points.

Describe the reasons for the layout. Did you have guiding principles in the development of the structure or unique requirements for a coronavirus hospital that shaped what was needed?

The client had a very clear idea of the ward layout – 30 beds, 15 on each side. Long and narrow wards with uninterrupted views for staff. This layout does not require intensive staffing levels. We focused on creating a clear segregation of flows. The wards are arranged as 30-bedded units with a nurse base and medication facility at the centre of each providing good views to patients. Placing clean and dirty utilities at opposite ends of each ward provides ease of access and segregation of flows. The linear layout of two adjacent wards leading to four adjacent wards allowed for incremental use – the first 60 beds could be put into use without the need to open the entire 180-bed capacity.

Freedommedia nightingale 9093

Freedommedia nightingale 9093

Source: Freedom Media

Staff respite spaces are incredibly important during this stressful time. Facilities provided include a staff lounge with sea views, a space for pause and reflection, as well as staff changing facilities and a dedicated staff entrance into the hospital. There is space for changing into and out of PPE, with strategically placed PPE top-up facilities throughout the building.

Can you describe the key elements of the interior build – particularly in terms of partitions and the design of the bedheads?

Preserving dignity is important to patients, particularly at such a traumatic time and in such a large, open space. Folding screens and fixed ‘wing walls’ create a sense of privacy that it is hoped will help to put patients at ease and enable them to recover faster. Standardising bedheads for acute care, including oxygen provision but not invasive ventilation, was a good way to save time during construction and use.

How did you integrate services into the design?

The design created service zones, then dealt with on-site changes and queries. There was an experienced services team on the island. Below-ground drainage was fixed in the first couple of days. Main service spines were positioned over the bedheads to feed across the facility and to provide drops into the individual bed bays. An external services compound was created on the opposite corner of the patient entrance, which included medical gases, back-up generators, HV transformers and cold water tanks and boosters.

Freedommedia nightingale 9415 (1)

Freedommedia nightingale 9415 (1)

Source: Freedom Media

Given the pressures, did you look to minimise the embedded and operational carbon footprint?

The incredibly tight timescale of the project meant that there was little time to thoroughly investigate, design and build to exemplary carbon footprint levels. However, the following elements were incorporated:

  • In-situ concrete was used only where necessary, so that the site could be returned to its former green field state after the building has served its purpose
  • Split lighting and power distribution boards and meters were installed 
  • LED luminaires are used throughout 
  • Low storage-volume water heaters are installed to minimise distribution losses 
  • High-efficiency air source heat pumps provide heating and cooling for the main ventilation system 
  • Duct and pipe work services are fully insulated
  • Full commissioning and testing was carried out to deliver optimum fuel efficiency.

How did you minimise construction waste on the project? 

The entire prefabricated building arrived without packaging – it was delivered on pallets that were returned to the manufacturer. All elements of the building were prefabricated in the manufacturing plant and only required assembly on the site. 

Similarly, the partitioning system was delivered on pallets and during assembly required minimal panel cutting to fit room sizes. Off-cuts went for recycling. By using on-island suppliers as much as possible, J3 was able to have materials delivered without the packaging.

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008 in practice ajs 0620

How is the structure designed for disassembly and reuse or recycling?

The topsoil stripped from the site has been stored and will be returned to the site when the building has been removed. The prefabricated building (structure, walls, roof, floor) is modular and can very easily be dismantled and reassembled in many different configurations. The building is hired from the manufacturer and will be dismantled and returned when it is no longer needed. 

The internal partitioning system is made from click-together PVC panels and channels and all will be recycled to make crumb to feed back in to the PVC manufacturing industry. 

All equipment, wash basin assemblies, sanitaryware, storage assemblies and most of the plant (including oxygen generation plant) will be retained by the client and re-used in the current general hospital or stored for use in Jersey’s new hospital, which is currently at early design stage.

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