Are hospitals the next to close? The urgent call to address RAAC, structural problems and fire compliance.

Hospitals, with their complex structures and multiple functions, require expertise to ensure safety and compliance. Vital infrastructure for community health, it is imperative that they be structurally sound and meet regulations.

So why does DB3 Group receive so many enquiries for hospitals with structural problems and fire compliance issues – and, importantly, what can we do about it? DB3’s Senior Associate, Matt Jones, gives us the details…

“As part of a multi-disciplinary group serving a plethora of significant sectors, I can’t help but notice a recent marked increase in enquiries from hospitals grappling with structural challenges and fire compliance issues. From the removal of reinforced aerated autoclaved concrete (RAAC) roofs to breaches in fire compartments, it’s clear that there are pressing concerns within the industry. Unlike schools, hospitals cannot be closed at short notice, and so they limp on with significant risks known to the Trust, the Local Authority, and the Government. Remedial works are sold to the public as investment in the NHS, but the reality is clinical upgrades are not what is driving spending.

RAAC, once a favoured building material, has been known in the industry for many years to be beyond its lifespan, but only recently has it revealed its Achilles’ heel to the general public – structural vulnerability over time when exposed to moisture or temperature fluctuations. Numerous news articles had already sounded the alarm about the “critical risk” and “ticking time bomb” of RAAC well before the school crisis unfolded. These concerns were initially raised in 2018/2019, and they came to a head with the September 2022 ‘Safety Briefing Notice’ from the Office of Government Property, which explicitly stated that “RAAC is now life-expired and liable to collapse.”

Meanwhile, the prevalent use of structural wood wool roofs, composed of a mixture of wood fibres and cement, can be equally questionable due to their sometimes combustible nature and structural degradation. Recently DB3 have observed systems in place which have had their BBA certificate withdrawn, and we have been provided fire consultant advice that if not adequately protected, the roof could inadvertently facilitate the rapid spread of fire.

Regrettably, the construction of hospitals in the past was primarily driven by the need for speed and affordability, particularly in times of crisis like post-war periods. The priority was to swiftly establish facilities to accommodate a surge in patients, often working within tight budgets. Consequently, the emphasis was on expediency rather than longevity.

The use of new materials and construction methods, often the MMC of the time, typically lacked comprehensive testing and long-term studies. Insufficient investment in hospital infrastructure compounds the problem, as limited funding often prevents timely remedial measures, allowing issues to persist for years or even decades.

At times, due to the severity of the problems, a new hospital might be the optimal solution, and many of the governments dubious ’40 new hospitals by 2030’ fall into this category However, capital expenditure and land availability pose significant obstacles to this approach. Assuming remedial works are pursued, it raises the question: what challenges are involved in addressing these issues?

Interestingly, when it comes to hospital refurbishments, the design and construction aspects, while significant, are often one of the least challenging parts of the equation. The real hurdle is maintaining operations during renovations. Hospitals must continue providing essential services while works are underway. Strategic approaches like phasing and decanting ensure patient safety and comfort, with architects like DB3 Group playing a crucial role.

Phasing, or dividing construction into stages, is a key strategy; allowing hospitals to maintain operations while renovating. This minimises disruptions, prioritises crucial areas, and safeguards patient care, although the program will be extended as a result. On the other hand, decanting can be considered – offering a solution to relocate patients and staff to alternative areas or temporary facilities, ensuring safety and uninterrupted care during construction. Decanting allows the construction team to work efficiently without disruptions, streamlining the renovation process. Finding a suitable space to decant to is often the biggest challenge.

One intriguing strategy for enhancing construction project capacity lies in modular construction. In projects we are actively involved in, a new permanent modular block is built to expand capacity, with renovation works carefully planned around the modular construction timeline to ensure that the additional space seamlessly integrates into operation.

Another option is a more temporary approach, like the remarkable Nightingale hospitals built during the pandemic, showcasing the potential of off-site manufactured components, rapidly creating functional wards within weeks. However, it’s crucial to consider the unique needs of different hospital departments, such as emergency care or those relying on cutting-edge equipment; these cannot always be easily replicated in temporary locations.

Undoubtedly, these endeavours introduce additional time and expenses to the project. Moreover, as time progresses, key personnel, priorities, politics, or objectives may undergo shifts. The solution to these problems is not a simple one. It will require a multi-faceted approach involving a long term government plan and investment, regulatory oversight, and industry-wide collaboration.

Ultimately, the goal is to create a safe and patient-centric hospital infrastructure. This requires sustained effort and a re-evaluation of design and construction choices. As the healthcare infrastructure faces these complex challenges, it’s essential we continue to delve into these issues, find solutions, and ensure the safety and resilience of our hospitals. In an era where innovation and safety go hand in hand, it’s time to re-evaluate the choices we make in hospital design and construction.”



Date Published: 20 September 2023
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