Hospital Construction

The Concrete Centre

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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

3 Building better futures

4 Hospital design

7 Concrete benefits

8 Concrete solutions

10 Concrete proof: A selection of projects

11 Cost model study

14 Case studies

15 References

Building hospitals for the future Building better futures

Hospital buildings need to be facilities that help medical staff in the efficient delivery of quality healthcare and provide a positive environment for A major government initiative is underway to provide 100 new hospital
speedy patient recovery. Good building design can provide more efficient facilities and a better environment for both staff and patients. buildings. To meet this ambitious target and also ensure best value, the plan is
This publication examines the role that
being funded by a mixture of public, private and local NHS trust capital, with
Concrete construction presents great opportunities for the project team to meet the needs of the client by helping to improve the function, value and procurement under the Private Public Partnership, often involving ProCure21, concrete can play in the current hospital
whole life performance of the facility. By checking that the design and construction process gives timely consideration to the benefits discussed in this PFI and DBFO. These initiatives aim to promote better capital procurement development programme to provide effective,
publication, decision makers in the procurement process can ensure that extra value is added to the building, often at little or no additional cost. and improve the service to patients through a partnering programme between
the NHS and the private sector. Construction partnerships will often design high quality healthcare to meet the nation’s
the facilities and be financially involved with their operation and maintenance. growing and changing needs. It aims to inform
Whole life value The aim is to help secure high-quality designs and earlier access to new
Whole life costs and value are especially important in hospitals, both for concrete can provide a sustainable solution, which makes use of its fabric energy facilities, and ensure best value, both from initial and whole life decision makers in the procurement process
Local Authorities/Trusts and PFI consortia. The whole life value of a hospital storage capacity to moderate energy demands in cooling and heating the cost perspectives. about areas where concrete construction can
is determined by the capital cost, cost in use and value in use. The ratio of building. This solution is applicable for functions that need to be housed within
these three (capital cost: cost in use: value in use) is often given a 1:5:200 ratio a hospital estate which require air conditioning because of the sensitivity of Recent research has confirmed that good design creates the best environment
help improve the function, value and whole
for buildings [1], but the cost in use can be even less and the value in service functions within the space and/or the heat generated through equipment and for patients, staff and visitors, which promotes effective services and speedier life cost of the facility.
improved if concrete is chosen. Since these relate to the ‘5’ and ‘200’, concrete lighting. However there are other areas that can utilise the benefits of thermal recovery, resulting in more efficient use of resources. The design, construction
can bring significant advantages to a project. The principle extends to hospitals, mass to reduce the probability of air conditioning being installed in the future, and operation of new facilities is now formally assessed using a variety of
where the 200 relates to the value of healthcare provided. which will mean using less energy during the lifetime of the building and measures – not just financial – encouraging more considered and holistic
avoiding overheating. design and construction processes and better value solutions.
Concrete construction can reduce energy requirements during the operation
of buildings. It is widely acknowledged that the climate is changing [2]. As Concrete’s range of other inherent benefits, including fire resistance, high levels The new buildings will have to satisfy a range of complex and often conflicting
temperatures increase, there will be a greater need to control internal building of sound insulation, and robust finishes means that hospitals made of concrete needs, including the flexibility to accommodate not only changes in demand,
temperatures. By taking advantage of concrete’s high thermal mass properties [3], also tend to have lower maintenance costs. healthcare procedures, IT and working methods but also issues such as
cross-infection and MRSA, daylighting, natural ventilation and sustainability.

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 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.
Functionality: space
Work environment
The look and feel of a hospital is known to affect patient and staff well-being and
hence healthcare performance. Uplifting architecture in public areas, involving the
use of efficient exposed soffits, columns and walls can all add to the character and
ambience of a building. This avoids having to develop an artificial architectural
veneer that adds to first costs, maintenance, and refurbishment.
Concrete is inert with no harmful off-gassing, and its structural form is commonly
associated with enhanced natural ventilation and daylighting. It provides robust,
damage-resistant surfaces for walls, partitions, columns, soffits and cladding that
are easily sealed for cleaning where required.
Aesthetics, ease of cleaning and a healthy atmosphere all lead to enhanced user
satisfaction of concrete hospitals.
Acoustics
It has been shown that patient comfort is an important factor in recovery. Concrete’s
mass and damping qualities are able to be used to achieve the required acoustic
performance, which provides a restful and productive environment that is isolated
from the noise and vibrations resulting from normal hospital routines. In concrete
buildings, floor and ceiling finishes are rarely dictated by acoustic requirements; these
are delivered by the performance of the concrete slab and walls.
Vibration
Vibration control is especially important in areas such as operating theatres
and night wards and is an important factor in the design and specification
of building frames. Concrete can easily be designed for the most complete
control of vibration over whole areas, often without the need for significantly
thicker floor slabs, giving great flexibility for change in use.
An independent study [4] into the vibration performance of different
structural forms has provided insight into the additional mass and stiffness
required for various structural materials to upgrade a basic ‘office‘ structure to
meet the higher criteria of hospitals. The study showed that concrete solutions
can meet vibration criteria with only small increases in mass and depth and hence
cost, compared with other solutions. They also help the design team to avoid the
risks, often associated with other materials, of having to seek modifications to NHS
vibration criteria to avoid the cost penalties of providing this extra mass and stiffness.
The benefits of using concrete:
• Reduces initial and running costs
• Speeds construction
• Minimises vibration
• Accommodates future changes
• Facilitates partition wall sealing
Hospital Construction 5
Functionality: uses Build quality: performance
Flexibility and adaptability Whole life costs can be reduced by using concrete as it provides long life cladding,
Healthcare methods, provision of IT, patient expectations, and standards of durable walls and columns with direct finishes and can easily accommodate
environment and equipment are all changing rapidly; so flexibility of use of services under flat soffits. Cladding can be designed to last the full design life of
new buildings is a major design requirement. For instance, less invasive surgery the building, with only periodic inspection of the external seals.
is likely to continue to change the required proportions of theatre, recovery
and ward space. The use of concrete construction automatically ensures many By using exposed soffits, suspended ceilings and air conditioning may be reduced
of the qualities that aid flexibility. or avoided, lowering maintenance and refurbishment costs.
For services and future stairs or lifts, holes in both normal and post-tensioned
slabs can easily be designed-in and either formed during construction or cut out
later as required. For vibration, larger areas can be designed to meet stringent
Build quality: Build quality:
criteria for operating theatres at little extra cost, permitting future flexibility.
engineering services construction
Early consideration of these benefits during design can optimise flexibility
The choice of material and design of a building’s frame and cladding can have a Sustainability is an issue acquiring ever growing importance and is increasingly
at little or no extra expense.
surprisingly influential role on the services, which are generally the most critical being embedded into building regulations and client demands. Concrete
element in construction cost and time. has much to offer those who aim for sustainable construction as it has the
Partition walls
potential to reduce both the initial impacts and impacts in use by:
Hospitals require literally miles of partition walls and their construction
Concrete flat slabs are ideal for highly serviced areas in hospitals, such as operating • Reducing the need for air conditioning through fabric energy storage and
is a major factor in cost, time and the consequent disruption to other
theatres and intensive care units. They allow complete freedom to prefabricate, the use of daylighting and natural ventilation. Concrete has an excellent
construction procedures. Sealing walls at the soffits of the floor above is
install and maintain services without having to thread ducts under or through track record in passively cooled buildings.
particularly important. The use of flat slabs simplifies this, reducing partition
intrusive downstand beams. Openings in the slab for service risers can be simply • Reducing the need for heating through airtight construction.
costs by up to four per cent of the frame cost even before considering additional
accommodated during design; they can be formed during casting or cut later to suit. • Reducing maintenance by providing durable walls, columns and cladding.
programme savings.
For the longest spans, wide shallow beam solutions provide large areas uninterrupted
by secondary beams and the freedom to route ducts under the shallow main beams.
Ancillary buildings
The use of techniques such as tunnel form and precast wall and floor panels
For the less heavily serviced areas, designers are encouraged to use concrete’s
introduces further mass production methods into concrete construction. Both
thermal mass properties to reduce air conditioning. This in turn reduces capital,
are fast, economic, highly-mechanised and increasingly popular. For repetitive
refurbishment and running costs.
room layouts, such as staff residences, they are ideal because of excellent
sound and fire properties and low maintenance, durable finishes.
Concrete is also ideal for car parks due to its robustness, corrosion resistance,
low maintenance and long life. It is a popular choice with users, with modern Sustainable aspects of concrete construction:
design taking advantage of concrete’s clear span capabilities to provide easy
• U K manufactured reinforcing steel is made from 100 percent recycled scrap. • T he raw materials for concrete are abundant in the UK, and their use does not
access/parking and bright clean soffits that help security and boost user
• Cement manufacture now uses waste-derived fuels (such as scrap tyres), thereby compromise availability to future generations.
confidence.
saving fossil fuels, reducing CO2 and relieving pressure on landfill facilities. • The energy and carbon dioxide emissions embodied in a concrete frame
• By-products of other industries such as ground granulated blast furnace slag (ggbs) are slightly less than those in a steel frame. More importantly, however, the
and fly ash, which would otherwise go to landfill, can be incorporated into both embodied energy in any frame is only a fraction (typically one tenth) of the
cement and concrete to reduce the environmental impact. energy used and CO2 emitted during a building’s operation. By using the
• Aggregates are usually extracted locally, and ready-mixed concrete is typically excellent thermal mass properties of concrete it is possible to make significant
made no more than 15 miles from any project. This reduces the environmental whole life savings in energy, carbon dioxide emissions and operating costs.
impacts associated with transportation. • On demolition of a building, both the concrete and its reinforcement can be recycled.
• Unlike some materials, extraction and manufacture arising from concrete • Concrete buildings are adaptable, durable and have many inherent qualities
generally occur in the UK, rather than being ‘hidden’ abroad. (sound, fire and vibration performance), which give long life sustainable buildings.
• Caters for easy services installation
• Enhances sustainability
• Promotes a good work environment
• Resists spread of fire and sound
• Improves air quality
6 Hospital Construction Hospital Construction 7

Concrete benefits
Table 1: Benefits offered by concrete frames

Feature Initial cost Cost in-use

Fire resistance No extra cost for fire protection
No separate trades for fire protection
Construction programme savings
Services installation and adaptability Clear zone for simple services distribution
Maximum off-site fabrication of services
Higher quality of services installation
Reduced risk of errors
Shorter installation programmes
Increased design flexibility
Partition sealing Simplest with flat soffits and hence
cost and time savings
Less maintenance
Potential for lower insurance premiums
Re-usability and less downtime after a fire
Reduced maintenance downtime
Easier equipment change-out
Greater future adaptability for:
- building refurbishment
- new layouts
Fewer sound transmission problems
Reduced heat losses

Other design considerations Durability Lower finishes costs

Lower maintenance and repair costs
Lower maintenance costs
Construction programme savings Lower repair and replacement costs
Acoustics Additional finishes minimised/eliminated Lower maintenance costs
Air tightness Speed and programme Reduced project financing Lower repair and replacement costs
Part L of the Building Regulations requires precompletion pressure testing of The use of concrete is highly compatible with fast programme construction
Thermal mass Lower initial services plant costs Reduced energy consumption
the external skin of buildings. A building failing these tests has to undergo due to quick mobilisation at the start of the project and the use of modern
a time consuming joints and interfaces inspection process, resealing where methods of construction, including sophisticated formwork systems, post- Suspended ceilings reduced/eliminated Lower maintenance costs
necessary. tensioning and precast elements. With previous methods of construction, Shorter installation programmes Lower repair and replacement costs
concrete frames were erected on a floor-to-floor cycle of two to three weeks. Increased design flexibility
With concrete, the flat soffits enable the partitions between rooms to be With modern methods it is common to achieve this in one week.
sealed easily. Hospitals require additional sealing to prevent airborne cross
contamination between compartments. Large panel external cladding reduces Concrete frames normally require no disruptive fire protection after erection
the number of external joints, so cuts air loss and saves energy. and can be made sufficiently watertight for early installation of M&E services
(the longest phase of construction in hospitals) and other following trades.
Fire resistance
Concrete is inherently fire resistant and, unlike some materials, normally The use of concrete flat slab floors provides flush soffits that simplify service
requires no added fire protection. This avoids the delays and disruptions of provision. This encourages the swift installation of prefabricated services,
following trades caused by site applied protection or repair on site of damaged where major savings in cost and time come from factory-tested assemblies
off-site applied protection. Concrete’s fire protection is provided at no extra and fewer joints on site. Prefabricated bathroom pods can also be installed and
cost and does not need continuing maintenance or reapplication after set flush by recessing them into the floor slab.
refurbishment or retrofit.
Cost
The inherent fire resistance results in concrete often performing in excess The use of concrete in hospital buildings can reduce the costs associated
of design requirements for occupant safety. This benefits the building ‘owner’ with both initial outlay costs and costs in-use. For further information on the
as repairs and the period before re-use following a fire are minimised. economic benefits of using concrete for hospital projects see the independent
cost model study summarised on pages 11-13.

The inherent benefits of concrete, coming at no extra cost, further underline

concrete’s economic advantages. These features, which are split into initial
cost and cost in-use, are tabulated on page 7 (Table 1).
8 Hospital Construction Hospital Construction 9

Concrete solutions
Well-designed and effectively managed hospital buildings help support the
work of frontline staff and provide an appropriate environment for patient
recovery thus improving efficiency. The choice and design of a building’s frame
and cladding can have a surprisingly large influence on the performance of the
final building.
Today’s concrete frames are ideally suited to support the requirements of
modern hospital buildings. By playing an important background role in the
operation and performance of the building, concrete frames can help reduce
running costs and maintenance.
Concrete is regularly used for new construction alongside existing working
buildings. Construction, forming methods and deliveries can all be adapted
to suit congested areas and precast or self-compacting concrete can be used
where construction noise is an issue.
Concrete frames are available in a wide range of structural types to suit all
needs and can be constructed in precast or in-situ concrete, or a combination
of the two, known as hybrid concrete construction.
Figure 1: Some concrete frame design solutions
Currently, flat slab construction, typically on grids of 7.2m to 8.4m on a
1.2m module, is the preferred choice for many hospitals because of its
speed, vibration performance and ability to best facilitate the installation of
services and partition walls. Increasingly, the flat slabs are post-tensioned
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
arguable benefit of fewer columns is more than outweighed by either having
the disadvantage of downstand beams which interrupt servicing, or having
increased floor thickness which increases the height of the building.
Some alternatives to flat slab construction and their advantages are described
below:
• Prestressing of concrete beams and floor units provides fast,
light and economical solutions.
• 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
being less versatile and taking longer to construct.
• Hybrid concrete construction combines the best qualities of precast
concrete (high quality finishes, off-site manufacture) with those of in-situ
construction (flexibility for late changes, mouldability, robustness, two-
way spanning, local manufacture).

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.

Flat slabs supported on columns These slabs are lighter than flat slabs, Combines the best qualities of precast
without any beams. but are not as versatile. concrete with those of in-situ construction.
For each hospital the most effective solution can be determined only after
considering all design, construction and use parameters. The benefits of using
concrete discussed in this publication provide a useful guide for designers
when comparing construction types. For the structural engineer, assistance is
available from the design tool, Concept which is available from The Concrete
Centre (see page 15).
designed to these tighter criteria to permit future space planning flexibility.
When considering penetrations through slabs for services, the needs of the
services engineer must be co-ordinated with those of the structural engineer,
who should incorporate them into the structural design. Working with the design
team, the client will need to decide how much flexibility it is reasonable to build
in. For future flexibility, soft spots are generally designed in; polystyrene knock out
slots, cast-in lightweight blocks or cast-in markers are all commonly used. These,
together with the design drawings, aid those making future modifications.
In reinforced concrete, holes near columns can be situated at the faces of the
columns, rather than being restricted to the corners of columns so as not to clash
with beams. This avoids the need to offset pipe work back to column faces or use
oversized clad columns to hide pipe work on column corners.
Off-site manufactured bathroom pods are commonly used. To incorporate these
with the required falls, pods may be set on the slab with a traditional screed used
elsewhere. However, it is common to omit the thick screed and at most have a
thin bed levelling screed. To obtain the falls into the wet area, the slab is locally
cast with a recess of 30mm to 50mm into which the pod is placed.
The building envelope
Precast concrete cladding can be designed with a wide range of finishes,
from brick to reconstructed stone. Panels are secure, highly durable, low
maintenance and long life. They can have glazing fitted in the factory and be
designed for installation without scaffolding. Recently, some new hospitals
have been criticised for problems caused by excessive heat or cold. Using
concrete cladding to control solar gain and thermal loss can help avoid this.
Panels can be large and self-supporting between columns if desired,
thereby simplifying the frame and maximising air tightness. Sandwich
panels (factory insulation between two concrete skins) provide significant
extra thermal mass due to their solid inner wall and have a durable inner
face, suitable for direct decoration.
With most cladding systems, hospitals will have to allow for the major cost
of recladding – and loss of use of the facilities during this work – within their
design life. However, concrete panels can be designed to require only periodic
inspection of the external seals, with any replacement of seals being carried
out without scaffolding or closure of the building.

Design loadings will be agreed between client, architect and structural
engineer early in the design process. Allowances for larger point loads for
ceiling-hung equipment and heavy-weight blockwork partitions are often
required. Vibration criteria for operating theatres and night wards will
often dictate structural design. The client may choose to have larger areas
Post-tensioned construction is a fast and economic solution.
In line with Government policies, various hospital design guides [5] promote
important, non-financial aspects to consider. These include:
• Air quality (optimisation of natural ventilation)
• Daylighting (improving natural light penetration and minimising solar gain)
• Integration of passive cooling and sustainable construction into design
• Aesthetics
Precast concrete cladding panels provide opportunities for rapid construction,
just-in-time delivery and minimal waste, with low construction risk.
Again, for best economy, the cladding should be considered early in
conjunction with the specialist concrete supplier. This will ensure best value by
optimising repeat mould use and fixing/interface details with the frame.
10 Hospital Construction Hospital Construction 11

Concrete proof Cost model study - brief

A selection of projects including a cost model study Independent designs were prepared for a typical 500 bed district general hospital and a typical 100 bed local general hospital, based on various
different ward templates and bed mixes as commonly found in contemporary hospital design, to enable a comparison of the total building costs when
different structural solutions are chosen.

Today, concrete frames are both economic and fast to build. With additional acoustic, fire, security,
sustainability and whole life cost benefits, concrete is hard to beat for a hospital project. These
three case studies, together with the outcomes of an independent, in depth, research cost model
study, serve to clearly verify the benefits that concrete frames can provide in the building of
a hospital.
Cost model study - overview
An independent cost study for hospitals was carried out by a team comprising Nightingale Associates,
Arup, Davis Langdon and Costain [6]. Six structural options in concrete and steel were fully priced, with
the costings based on detailed plans and structural solutions both for a typical local general hospital
and a district general hospital. Figures 2 and 3 (see pages 11 and 12) show the ground floor plans of the
hospitals used in the study.
The cost breakdown is shown in Tables 2 and 3 (see page 13).
Cost model study - the value benefits of concrete
On a total project basis, concrete solutions produced savings of between 0.9 and 7.1 per cent in overall
construction costs in comparison with alternative solutions (see Figures 4 and 5).
Page 11 - Cost model study
Six structural options were fully priced, for
a typical local general hospital and a district
general hospital by an independent team
Page14 - Case studies
• St James Hospital, Leeds
- new oncology wing
• Queen Alexandra Hospital, Portsmouth
- hospital redevelopment
The precise location, size and design of the buildings were based on the design team’s judgement of current design practice and market requirements
in terms of performance and cost, in conjunction with appropriate DoH and NHS guidelines and current regulations.
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
with a gross internal floor area of approximately 40,000m2 was prepared. overall plan size and, therefore, travel distances through the hospital. Ward
accommodation was provided at 1st-3rd floor levels, operating theatres and
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
templates configured from a central hospital spine or street. This central and other facilities were provided at ground floor. The design also allowed
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
visitors, staff and often goods. This central street also provided the main department within the wider footprint. Expansion, space permitting, was also
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
the study, as, although hospital design is sometimes more varied, this typology Indicative sketches for the ground floor layout of the DGH, showing the
still forms the basis of many hospital layouts, in particular the use of the building form and column layout, are shown in Figure 2.
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).

Figure 2: DGH ground floor layout.

Case studies
Many good case studies of concrete hospitals exist. The two chosen are very recent examples and
Departments include emergency centre; rehabilitation/renal unit; outpatients department; imaging;
demonstrate the versatility of concrete and the advantages resulting from its use. Other case studies can administration/records; pharmacy; mortuary; pathology; dining and kitchens; stores and linen.
be found at The Concrete Centre website - visit www.concretecentre.com/casestudies.

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

and the cost of construction

A

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

Partnering, Design-Build-Finance-Operate (DBFO) and modern methods of construction in concrete are

M
all highly compatible with the above approaches as they encourage integration, rather than the traditional
N
separation, of the design and construction processes. This minimises construction risk, with its consequences
of higher tender prices, extra programme allowances and potential over-runs.

Departments include Emergency Centre,

Rehabilitation/Renal Unit, Outpatients Department,
Imaging, Admin/Records, Pharmacy, Mortuary,
Pathology, Dining and Kitchens, Stores and Linen

DGH Ground Floor Layout

12 Hospital Construction Hospital Construction 13

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

£/m² £/m² £/m² £/m² £/m² £/m²

Substructure 64 65 60 64 64 61
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Frame and upper floors 140 153 156 180 179 246

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

Internal planning 95 95 100 110 109 102

C Outpatient/support accommodation
OUTPATIENT / SUPPORT ACCOMODATION
M&E, lifts and builder’s work 666 666 666 678 678 666
OUTPATIENTS
Service/vertical circulation core
SERVICE / VERTICAL CIRCULATION CORE
Preliminaries 297 297 297 281 306 318
D

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

£/m² £/m² £/m² £/m² £/m² £/m²

COURTYARD COURTYARD PHARMACY K
Substructure 71 74 71 71 71 71
L Frame and upper floors 129 138 141 137 156 232
MINOR INJURIES
PRIMARY CARE CENTRE Roof finishes and internal finishes 399 400 401 402 402 402
ADMIN CLERICAL RECORDS
M
External cladding 177 179 188 187 195 179
N
Internal planning 92 92 95 102 101 96

O
M&E, lifts and builder’s work 566 566 566 575 575 566
ENTRANCE

Preliminaries 227 227 215 203 193 203

MAIN ENTRANCE P
Contingency, overheads and profit 214 216 217 218 221 228
Total £1,875 £1,892 £1,894 £1,895 £1,914 £1,977

Departments include Primary Care Centre,

Therapies, Outpatients Department, Minor
Injuries Department, Imaging, Admin/Records,
Pharmacy, Mortuary, Pathology, Dining and
Kitchens, Stores & Linen
* Slimdek is a registered trademark of Corus UK Ltd.
Ground floor departmental plan
14 Hospital Construction
Case study: St James Hospital,
Leeds, New Oncology Wing
Project description
The new oncology wing at St James Hospital in Leeds is a PFI project creating one of
Europe’s largest cancer treatment centres. The 66,500m2 building is built on 12 levels
and contains 12 linear accelerator treatment rooms housing15 MV and 25 MV high
energy equipment. Also contained within the Centre of Excellence are simulators, PET
Scanners, nuclear medicine and shielded accommodation. In addition to the hospital
accommodation the site has a 7,000 space concrete car park.
Construction
Concrete flat slabs were adopted for the building frame providing a structural solution
which enabled construction speed to be maximized through repetitive layouts whilst
facilitating the installation of building services. The concrete frame provided good
vibration performance, adaptability and flexibility, inherent fire resistance, durability,
low maintenance and a robust design solution. (The PFI concession contract is
30 years).
Initial design considerations included the use of reinforced concrete ribbed slabs with
wide flat beams. However, consideration of follow-on trades such as fire separation
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
accommodation and 8.1m x 7.2m in the ward accommodation. The slab thickness
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.
Concrete is used for the 12 linear accelerators (Linac) treatment rooms in the
basement. They required significant radiation shielding properties and thick concrete
sections provided the solution generally. Some walls of the Linac chambers are formed
with heavyweight concrete using magnetite aggregate imported from Sweden. The
density of these sections is 3,900kg/m3. Local areas of the deep concrete roof sections
contain multiple steel plates, each 50mm thick, up to a total thickness of 350mm to
provide the required radiation resistance.
What concrete brought to the project
Concrete’s excellent vibration and inherent fire resistance performance made it
the natural choice for the construction of the hospital housing sensitive medical
equipment. The repetitive layout of the building made it ideal for maximizing the
benefits of adopting standard construction components such as formwork and
cladding support systems. Risk management and availability of normal and heavy
weight concrete made concrete the natural choice to successfully contain radiation
leakage from the Linac chambers.
Main contractor: Bovis Lend Lease
Frame contractor: Heyrod Construction
Architect: Anshen + Allen
Structural and services engineers: Faber Maunsell Limited
Case study: Queen Alexandra
Hospital, Portsmouth,
redevelopment
Project description
The redevelopment of the existing Queen Alexandra Hospital is a PFI contract tasked
with providing additional beds, operating theatres, car parking and other healthcare
services. The new build extension totals 76,000m2, making the entire hospital a 1200
bed acute general hospital. The PFI contract is for a period of 33 years.
Construction
The eight-storey building utilises post-tensioned slabs which were originally
selected for economy, speed of construction and future flexibility. This form of
construction can be designed to conform to the stringent vibration criteria of
a hospital building. Further to this, the use of post-tensioned concrete meant
that the frame could economically span long distances plus it provided the full
range of inherent benefits of concrete, including fire resistance, flexibility of
layout and speed of programme.
Concrete was well suited to this project. It simplified the design and installation of
the considerable amount of mechanical and electrical (M&E) services required and
the miles of partitioning, which needed to be airtight. Concrete also provided a high
level of acoustic performance with minimum additional finishes. Concrete’s mass and
damping qualities met the required level of HTM 2045 acoustic performance and
contributed to a better patient environment which is isolated from invasive noise and
vibration.
The Linac chambers also benefitted from concrete’s proven mass qualities, in order to
ensure that radiation could safely be used within.
What concrete brought to the project
The use of post-tensioned concrete at this hospital extension ensured that the many
inherent benefits of concrete were fully utilised, whilst also ensuring that the material
was used economically and sustainably.
Client: Carillion plc
Architect: Building Design Partnership
Structural engineer: Buro Happold
Hospital Construction 15
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
Recommended reading and further information
• 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
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
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
decision, giving likely structural options for a concrete frame, with useful points to
note written by engineers for engineers. The publication also discusses issues facing
designers and provides background information on sustainability, innovations in
concrete and best practice.
■ Publication date: 2006
■ Ref: TCC/03/024
Crosswall Construction
Crosswall is a modern and effective method of construction which uses precast,
cellular concrete components to achieve structurally robust, fast, economical medium
and high-rise buildings. This publication explains the benefits of using crosswall
construction and includes case studies of projects which have benefited from its
effectiveness.
■ Publication date: 2007
■ Ref: TCC/03/26
Post-tensioned Concrete Floors
Post-tensioning concrete increases the many benefits associated with a concrete
framed building. The purpose of this publication is to widen the understanding of
post-tensioned floor construction and show the considerable benefits which include
minimum storey heights, rapid construction, economy, maximum design flexibility,
minimum number of columns, optimum clear spans, joint-free, crack-free construction
and controlled deflections.
■ Publication date: 2008
■ Ref: TCC/03/33
High Performance Buildings using Tunnel Form Construction
Tunnel form is a formwork system that allows the contractor to cast walls and slabs in
one operation on a daily cycle. It combines the speed, quality and accuracy of offsite
produced ready-mix concrete and formwork with the flexibility and economy of cast
in-situ construction. This publication describes how this construction method works
and the benefits it can offer as well as highlighting projects where tunnel form has
been used.
■ Publication date: 2004
■ Ref: TCC/04/02