Académique Documents
Professionnel Documents
Culture Documents
Ref: TCC/03/44
ISBN: 978-1-904818-65-6
First published 2008
©The Concrete Centre 2008
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2 Hospital Construction Hospital Construction 3
Contents
2 Building hospitals for the future
4 Hospital design
7 Concrete benefits
8 Concrete solutions
14 Case studies
15 References
Cover images:
Front: Great Western Hospital, Swindon. Inset top: Coventry Acute Hospital, Coventry. Inset bottom: CT scanners benefit from concrete’s good vibration performance.
Back cover: St James Hospital Oncology Wing, Leeds. Courtesy of Faber Maunsell.
4 Hospital Construction Hospital Construction 5
Hospital design
There are a wide range of design considerations to meet, with many of these affected by the choice and use of building materials. The design issues
presented here are limited to those affected by choice of building material.
Concrete benefits
Table 1: Benefits offered by concrete frames
Concrete solutions
Well-designed and effectively managed hospital buildings help support the Currently, flat slab construction, typically on grids of 7.2m to 8.4m on a
work of frontline staff and provide an appropriate environment for patient 1.2m module, is the preferred choice for many hospitals because of its
recovery thus improving efficiency. The choice and design of a building’s frame speed, vibration performance and ability to best facilitate the installation of
and cladding can have a surprisingly large influence on the performance of the services and partition walls. Increasingly, the flat slabs are post-tensioned
final building. to reduce slab thickness and provide potential for longer spans of up to
12m if necessary. Longer spans can be provided but are rarely needed as the
Today’s concrete frames are ideally suited to support the requirements of arguable benefit of fewer columns is more than outweighed by either having
modern hospital buildings. By playing an important background role in the the disadvantage of downstand beams which interrupt servicing, or having
operation and performance of the building, concrete frames can help reduce increased floor thickness which increases the height of the building.
running costs and maintenance.
Some alternatives to flat slab construction and their advantages are described
Concrete is regularly used for new construction alongside existing working below:
buildings. Construction, forming methods and deliveries can all be adapted • Prestressing of concrete beams and floor units provides fast,
to suit congested areas and precast or self-compacting concrete can be used light and economical solutions.
where construction noise is an issue. • Ribbed in-situ slabs on wide shallow beams are lighter than flat
slabs and even better for vibration. However this has to be offset against
Concrete frames are available in a wide range of structural types to suit all being less versatile and taking longer to construct.
needs and can be constructed in precast or in-situ concrete, or a combination • Hybrid concrete construction combines the best qualities of precast
of the two, known as hybrid concrete construction. concrete (high quality finishes, off-site manufacture) with those of in-situ
construction (flexibility for late changes, mouldability, robustness, two-
way spanning, local manufacture).
Figure 1: Some concrete frame design solutions
Flat slab construction with Ribbed in-situ slabs on wide shallow beams Hybrid concrete construction
optional post tensioning
Reconstructed stone cladding at the Royal Alexandra Children's Hospital, Brighton. Courtesy of Trent Concrete.
designed to these tighter criteria to permit future space planning flexibility. The building envelope
When considering penetrations through slabs for services, the needs of the Precast concrete cladding can be designed with a wide range of finishes,
services engineer must be co-ordinated with those of the structural engineer, from brick to reconstructed stone. Panels are secure, highly durable, low
who should incorporate them into the structural design. Working with the design maintenance and long life. They can have glazing fitted in the factory and be
team, the client will need to decide how much flexibility it is reasonable to build designed for installation without scaffolding. Recently, some new hospitals
in. For future flexibility, soft spots are generally designed in; polystyrene knock out have been criticised for problems caused by excessive heat or cold. Using
slots, cast-in lightweight blocks or cast-in markers are all commonly used. These, concrete cladding to control solar gain and thermal loss can help avoid this.
together with the design drawings, aid those making future modifications.
Flat slabs supported on columns These slabs are lighter than flat slabs, Combines the best qualities of precast Panels can be large and self-supporting between columns if desired,
without any beams. but are not as versatile. concrete with those of in-situ construction.
In reinforced concrete, holes near columns can be situated at the faces of the thereby simplifying the frame and maximising air tightness. Sandwich
columns, rather than being restricted to the corners of columns so as not to clash panels (factory insulation between two concrete skins) provide significant
with beams. This avoids the need to offset pipe work back to column faces or use extra thermal mass due to their solid inner wall and have a durable inner
oversized clad columns to hide pipe work on column corners. face, suitable for direct decoration.
For each hospital the most effective solution can be determined only after
considering all design, construction and use parameters. The benefits of using Off-site manufactured bathroom pods are commonly used. To incorporate these With most cladding systems, hospitals will have to allow for the major cost
concrete discussed in this publication provide a useful guide for designers with the required falls, pods may be set on the slab with a traditional screed used of recladding – and loss of use of the facilities during this work – within their
when comparing construction types. For the structural engineer, assistance is elsewhere. However, it is common to omit the thick screed and at most have a design life. However, concrete panels can be designed to require only periodic
available from the design tool, Concept which is available from The Concrete thin bed levelling screed. To obtain the falls into the wet area, the slab is locally inspection of the external seals, with any replacement of seals being carried
Centre (see page 15). cast with a recess of 30mm to 50mm into which the pod is placed. out without scaffolding or closure of the building.
Design loadings will be agreed between client, architect and structural In line with Government policies, various hospital design guides [5] promote Precast concrete cladding panels provide opportunities for rapid construction,
engineer early in the design process. Allowances for larger point loads for important, non-financial aspects to consider. These include: just-in-time delivery and minimal waste, with low construction risk.
ceiling-hung equipment and heavy-weight blockwork partitions are often Again, for best economy, the cladding should be considered early in
required. Vibration criteria for operating theatres and night wards will • Air quality (optimisation of natural ventilation) conjunction with the specialist concrete supplier. This will ensure best value by
often dictate structural design. The client may choose to have larger areas • Daylighting (improving natural light penetration and minimising solar gain) optimising repeat mould use and fixing/interface details with the frame.
• Integration of passive cooling and sustainable construction into design
Post-tensioned construction is a fast and economic solution. • Aesthetics
10 Hospital Construction Hospital Construction 11
Today, concrete frames are both economic and fast to build. With additional acoustic, fire, security, The precise location, size and design of the buildings were based on the design team’s judgement of current design practice and market requirements
sustainability and whole life cost benefits, concrete is hard to beat for a hospital project. These Page 11 - Cost model study in terms of performance and cost, in conjunction with appropriate DoH and NHS guidelines and current regulations.
three case studies, together with the outcomes of an independent, in depth, research cost model Six structural options were fully priced, for
study, serve to clearly verify the benefits that concrete frames can provide in the building of a typical local general hospital and a district
a hospital. general hospital by an independent team
District general hospital (DGH)
A design for a DGH providing 480 beds, surgical facilities and support facilities, The building was proposed as a four storey development, to limit the
Cost model study - overview Page14 - Case studies with a gross internal floor area of approximately 40,000m2 was prepared. overall plan size and, therefore, travel distances through the hospital. Ward
An independent cost study for hospitals was carried out by a team comprising Nightingale Associates, • St James Hospital, Leeds accommodation was provided at 1st-3rd floor levels, operating theatres and
Arup, Davis Langdon and Costain [6]. Six structural options in concrete and steel were fully priced, with - new oncology wing The building was planned on an orthogonal basis with a series of ‘L-shaped’ associated critical care facilities were located at 1st floor level and outpatient
the costings based on detailed plans and structural solutions both for a typical local general hospital
• Queen Alexandra Hospital, Portsmouth templates configured from a central hospital spine or street. This central and other facilities were provided at ground floor. The design also allowed
and a district general hospital. Figures 2 and 3 (see pages 11 and 12) show the ground floor plans of the
- hospital redevelopment street formed the basis for all communication within the building for patients, for a degree of flexibility, with the ability to move the boundaries of each
hospitals used in the study.
visitors, staff and often goods. This central street also provided the main department within the wider footprint. Expansion, space permitting, was also
The cost breakdown is shown in Tables 2 and 3 (see page 13).
fire route for escape and fire fighting purposes as defined within the Health possible from either end of the building.
Technical Manual (HTM) 05. This basic typology was considered appropriate for
Cost model study - the value benefits of concrete
the study, as, although hospital design is sometimes more varied, this typology Indicative sketches for the ground floor layout of the DGH, showing the
On a total project basis, concrete solutions produced savings of between 0.9 and 7.1 per cent in overall
still forms the basis of many hospital layouts, in particular the use of the building form and column layout, are shown in Figure 2.
construction costs in comparison with alternative solutions (see Figures 4 and 5).
hospital street concept.
In addition to the post-tensioned slab on concrete columns proving to be the most economic solution,
the main advantages of using concrete were identified as the extra value benefits that a concrete frame
provides at no extra cost; these are presented in Table 1 (page 7).
Hospital procurement 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 29
The specialist frame contractors should be involved early in the procurement process to allow the design D
to reflect the economies of their preferred form of construction, balanced against whole project value. This
E Courtyard Courtyard Courtyard
will depend on the contractor’s previous experience, the availability of equipment and the opportunity to
F
tailor design details to the construction method.
G
Core 01 Core 02
For instance, many specialists have their own prestressing firm (or preferred partner), allowing them to H
provide fast and cost effective prestressed frames. Others may have their own stock of special formwork,
I
giving them an edge in another form of concrete construction. Alternatively, precast elements that can be
J Courtyard Courtyard Courtyard A
swiftly erected may offer critical advantages. This needs early involvement of the precaster to obtain the A
best programme and economies through repetition of components and hence mould use. K
Cost breakdown
Local general hospital (LGH) A key driver in the development of the building footprint and the configuration Figure 4: Cost breakdown – district general hospital Figure 5: Cost breakdown – local general hospital
A design for a LGH providing 96 beds and support facilities, with a gross internal of the floor plate was the provision of inpatient accommodation. Traditionally this
floor area of approximately 10,000m2 was prepared. was provided by large ‘multi-bed’ bays, originally the “Nightingale Wards”, moving M&E, lifts and builder’s work 31% Internal planning 5% M&E, lifts and builder’s work 30%
towards two, four or six bed bays in more modern hospitals. These spaces were External cladding 10% Substructure 4%
As with the DGH, the building was planned on an orthogonal basis with a series of supplemented by the provision of a number of side rooms for patients with specific Frame and
‘L-shaped’ templates configured from a central hospital corridor or street. The basic nursing needs. However, consideration was also given to the provision of a larger Internal
Roof finishes upper floors 8%
planning 5%
principles for the development of the LGH followed those of the DGH, with the key proportion of single rooms, to reflect the need for flexibility in use, a higher degree of and internal
finishes 18% Preliminaries 11%
differences being that of scale and the fact that there were more spaces requiring emphasis on patient dignity and the increased requirements for isolation and better Substructure 3% External
cladding 10%
special consideration. infection control. For this reason, the development of the footprint had
to be able to support the provision of 100 percent single bedrooms or a 50 Frame and
The building was proposed as a two storey development, with plant enclosures percent provision of single bedrooms and multi-bed bays. upper floors 8%
Contingency and Contingency and
at 2nd floor/roof level. Ward accommodation was provided at 1st floor level, Roof finishes
overheads and overheads and
and internal
and outpatient and other facilities were provided at ground floor. There was also An indicative sketch of the ground floor layout of the LGH, showing the building profit 11% profit 11%
finishes 21%
Preliminaries 14%
provision for further expansion of ward space at first floor level. form and column layout, is shown in Figure 3.
Table 2: Elemental breakdown for different structural solutions – district general hospital
Figure 3: LGH ground floor layout
Departments include primary care centre; therapies; outpatients department; minor injuries department; Post-tensioned In-situ and Steel and
imaging; administration/records; pharmacy; mortuary; pathology; dining and kitchens; stores and linen. Element Flat slab Composite Slimdek*
flat slab Hollowcore Hollowcore
A Roof finishes and internal finishes 390 391 391 389 388 387
(Non clincal)
(Non clincal)
External cladding 208 210 221 232 223 211
MORTUARY
B
Clincial support
Clincial Support
PATH
THERAPIES
Inter-departmental circulation
INTER DEPARTMENTAL CIRCULATION Contingency, overheads and profit 236 238 241 247 247 253
E
COURTYARD COURTYARD Catering/Dining
Catering / Dining Total £2,096 £2,115 £2,132 £2,181 £2,194 £2,244
F
Pharmacy
Pharmacy
G
Primary care workers
Primary Care Workers
Table 3: Elemental breakdown for different structural solutions – local general hospital
H
Minor injuries
Minor Injuries
PHYSIO DINING
Therapies
Therapies
CATERING STORES /
I Post-tensioned In-situ and Steel and
LINEN Element Flat slab Composite Slimdek*
flat slab Hollowcore Hollowcore
J
O
M&E, lifts and builder’s work 566 566 566 575 575 566
ENTRANCE
References
To download or access many of these publications, visit www.concretecentre.com/publications
1. Evans R, Haryott R, Haste N, Jones A, The Long-term Cost of Owning and Using Buildings, Royal Academy of Engineering, 1998
2. Climate Change and the Indoor Environment: Impacts and Adaption, TM36, Chartered Institute of Building Services (CIBSE), 2005
3. Thermal Mass: A concrete solution for the changing climate, The Concrete Centre, 2005
4. Hospital Floor Vibration Study. Comparison of Hospital Floor Structures with respect to NHS Vibration Criteria, Study commissioned by The Concrete Centre, 2004
5. NEAT evaluation toolkit (NHS Estates); Better health buildings (Centre for Healthcare Design); and Design evaluation toolkit (Department of Health).
Online at www.efm.ic.nhs.uk - phone the Helpdesk on 0113 254 7010 for a password
6. Cost Model Study - Hospital Buildings, The Concrete Centre, 2008
• SpeCC registration scheme for specialist concrete frame contractors – visit www.SpeCC.co.uk
• Structural Precast Association (SPA) – www.structural-precast-association.org.uk
• Concept design software – visit www.concretecentre.com/concept
Case study: St James Hospital, Case study: Queen Alexandra
Leeds, New Oncology Wing Hospital, Portsmouth, Listed below are other publications in this series. To download or order free hard copies of any of these publications visit www.concretecentre.com/publications.
Concrete Framed Buildings
Project description
redevelopment At the start of each project, a decision is made about the form and material for the
structural frame. This publication sets out to help the designer come to an informed
The new oncology wing at St James Hospital in Leeds is a PFI project creating one of decision, giving likely structural options for a concrete frame, with useful points to
Europe’s largest cancer treatment centres. The 66,500m2 building is built on 12 levels Project description note written by engineers for engineers. The publication also discusses issues facing
and contains 12 linear accelerator treatment rooms housing15 MV and 25 MV high The redevelopment of the existing Queen Alexandra Hospital is a PFI contract tasked designers and provides background information on sustainability, innovations in
energy equipment. Also contained within the Centre of Excellence are simulators, PET with providing additional beds, operating theatres, car parking and other healthcare concrete and best practice.
Scanners, nuclear medicine and shielded accommodation. In addition to the hospital
services. The new build extension totals 76,000m2, making the entire hospital a 1200 ■ Publication date: 2006
accommodation the site has a 7,000 space concrete car park.
bed acute general hospital. The PFI contract is for a period of 33 years. ■ Ref: TCC/03/024
Construction
Concrete flat slabs were adopted for the building frame providing a structural solution Construction
which enabled construction speed to be maximized through repetitive layouts whilst The eight-storey building utilises post-tensioned slabs which were originally Crosswall Construction
facilitating the installation of building services. The concrete frame provided good selected for economy, speed of construction and future flexibility. This form of Crosswall is a modern and effective method of construction which uses precast,
vibration performance, adaptability and flexibility, inherent fire resistance, durability, construction can be designed to conform to the stringent vibration criteria of cellular concrete components to achieve structurally robust, fast, economical medium
low maintenance and a robust design solution. (The PFI concession contract is a hospital building. Further to this, the use of post-tensioned concrete meant and high-rise buildings. This publication explains the benefits of using crosswall
30 years). construction and includes case studies of projects which have benefited from its
that the frame could economically span long distances plus it provided the full
range of inherent benefits of concrete, including fire resistance, flexibility of effectiveness.
Initial design considerations included the use of reinforced concrete ribbed slabs with ■ Publication date: 2007
wide flat beams. However, consideration of follow-on trades such as fire separation layout and speed of programme.
■ Ref: TCC/03/26
and partition head fixings steered the team away from this original concept on the
grounds of programme and cost. The structural grids are 8.1m x 8.1m in the research Concrete was well suited to this project. It simplified the design and installation of
accommodation and 8.1m x 7.2m in the ward accommodation. The slab thickness
the considerable amount of mechanical and electrical (M&E) services required and
is 350mm deep including provision for shower recesses. A thin cementitious based
screed was applied to the entire floor plate before laying the sheet floor finishes. the miles of partitioning, which needed to be airtight. Concrete also provided a high Post-tensioned Concrete Floors
level of acoustic performance with minimum additional finishes. Concrete’s mass and Post-tensioning concrete increases the many benefits associated with a concrete
Concrete is used for the 12 linear accelerators (Linac) treatment rooms in the damping qualities met the required level of HTM 2045 acoustic performance and framed building. The purpose of this publication is to widen the understanding of
basement. They required significant radiation shielding properties and thick concrete contributed to a better patient environment which is isolated from invasive noise and post-tensioned floor construction and show the considerable benefits which include
sections provided the solution generally. Some walls of the Linac chambers are formed vibration. minimum storey heights, rapid construction, economy, maximum design flexibility,
with heavyweight concrete using magnetite aggregate imported from Sweden. The minimum number of columns, optimum clear spans, joint-free, crack-free construction
density of these sections is 3,900kg/m3. Local areas of the deep concrete roof sections
The Linac chambers also benefitted from concrete’s proven mass qualities, in order to and controlled deflections.
contain multiple steel plates, each 50mm thick, up to a total thickness of 350mm to
ensure that radiation could safely be used within. ■ Publication date: 2008
provide the required radiation resistance.
■ Ref: TCC/03/33
What concrete brought to the project What concrete brought to the project
Concrete’s excellent vibration and inherent fire resistance performance made it The use of post-tensioned concrete at this hospital extension ensured that the many
the natural choice for the construction of the hospital housing sensitive medical inherent benefits of concrete were fully utilised, whilst also ensuring that the material High Performance Buildings using Tunnel Form Construction
equipment. The repetitive layout of the building made it ideal for maximizing the was used economically and sustainably. Tunnel form is a formwork system that allows the contractor to cast walls and slabs in
benefits of adopting standard construction components such as formwork and one operation on a daily cycle. It combines the speed, quality and accuracy of offsite
cladding support systems. Risk management and availability of normal and heavy produced ready-mix concrete and formwork with the flexibility and economy of cast
Client: Carillion plc
weight concrete made concrete the natural choice to successfully contain radiation
Architect: Building Design Partnership in-situ construction. This publication describes how this construction method works
leakage from the Linac chambers.
Structural engineer: Buro Happold and the benefits it can offer as well as highlighting projects where tunnel form has
been used.
Main contractor: Bovis Lend Lease
Frame contractor: Heyrod Construction ■ Publication date: 2004
Architect: Anshen + Allen ■ Ref: TCC/04/02
Structural and services engineers: Faber Maunsell Limited