Royal Liverpool University Hospital

A year ago this week, Laing O’Rourke proudly handed over the keys for the new Royal Liverpool University Hospital to Liverpool University Hospitals NHS Foundation Trust (LUHFT), allowing staff, patients, and services to mark the start of a new chapter for healthcare in the city.

Paul Fitzpatrick, Director of Estates and Facilities at Liverpool University Hospitals NHS Foundation Trust at the time of handover said:

"The response from staff, patients and visitors to the new environment has been overwhelmingly positive and is a real tribute to the collaborative approach by our construction partners."

A year into its operation, we take a focused look at how our healthcare team delivered a project which came with very considerable challenges from the outset.

Construction first began at the end of 2013, with Carillion appointed to deliver the project and the ongoing facilities management for the hospital. However, when Carillion entered liquidation in 2018, almost a year after construction was originally due to finish, the project was left facing an existential crisis.

Later that year in October, the Trust appointed Laing O’Rourke to recommence the 96,000m2 project, after it had lain dormant for over nine months.

Laing O’Rourke’s Project Director, Andy Thomson, explained how important the assembled teams’ experience was in ensuring that the project’s issues were sufficiently investigated and understood from the beginning to allow a construction methodology and project programme to be formulated to safely re-start the construction process.

Despite the advanced state of construction and fit out of the hospital, the extent of the issues left by Carillion could not have been anticipated given that the project was reportedly so near to completion. Subsequent to recommencing, substantial issues were discovered with the structure, façade, fire integrity and MEP systems within the hospital, necessitating a comprehensive remedial and re-sequencing exercise involving all stakeholders to ensure a viable construction programme could be put into operation.

With the extent of remediation sufficiently understood and the majority of the local suppliers and works contractors re-engaged, the Laing O’Rourke team worked in close collaboration with project manager, Gleeds, architects NBBJ and HKS, structural engineers Arup, MEP engineers Hoare Lea and consulting firm Aecom to form a world-leading team of healthcare experts to complete the project for the people of Liverpool.

Covid-19

The emergence of Covid-19 in the UK affected the project around 18 months into the contract, which by that point was part-way through the structural remediation works with construction proceeding at pace. The pandemic presented the construction team with considerable health implications and logistical challenges to maintain focus, particularly since the hospital had been given ‘critical project' status to continue construction. The pandemic also had an immediate and substantial impact on the ongoing function of the NHS in their ability to deliver care in the existing hospital which was adjacent to the new scheme.

Andy noted how the project team immediately adapted to the challenging situation, as the company navigated the needs of the hospital and the safety of project staff and the wider community.

“When a crisis hits, people have a tremendous capacity to collaborate and innovate to find new ways to continue to make progress and still comply with very unfamiliar new rules. Our 900 strong team was no exception, quickly adapting and getting stuck into navigating the issues we were faced with.

“That meant implementing new procedures for all tasks and getting used to a completely different way of working. As well as constant enforcement of two-metre distancing rules, we had heat cameras to monitor body temperatures, staggered breaks throughout the day to limit numbers through the welfare areas, separate day and night shifts, perspex screening to limit interaction, whole site PCR testing and face mask & hand washing enforcement, which had all been completely alien only weeks previously.”

Due to the pressure the NHS was under in the adjacent existing hospital, a month into the pandemic, the Laing O’Rourke team was asked if it could provide any additional bed spaces within the new hospital site to help with the rapidly evolving emergency, despite the area still being in full construction mode. The need for added healthcare facilities for Covid patients to help the NHS outweighed any other considerations and soon the team was also prioritising the delivery of a step-down unit for Covid patients within the new hospital site, which was achieved in record time.

Seventy-six single bedrooms and twenty-four assessment rooms were subsequently created within the live construction site, all segregated to allow the clinicians to move between the existing hospital and new unit through a tunnel link, which underwent a corresponding accelerated completion. The temporary unit, consisting of single-bedded rooms and associated support areas, was a major boost to the city’s health and social care response to Covid-19, and one of the only ‘nightingale’ units which was utilised in the UK throughout the pandemic.

Solutions

Laing O’Rourke’s solution to the challenges involved in delivering the new Royal included a combination of engineering complexity and relationship-building. The company had to ensure that the hospital team was satisfied with the quality of the work while also meeting tight deadlines and controlling costs. The team also had to work closely with the professional teams to ensure that the new hospital met the requirements of the original design brief. This was layered with the needs of the people of Liverpool, who were understandably frustrated with the delays caused by Carillion’s collapse.

On the extent of the issues identified when Laing O’Rourke first entered the project, Andy said:

“It became clear from the onset that the building would not pass any comprehensive compliance criteria tests which are essential in healthcare delivery completion. For example, Carillion identified nine structural issues in the reinforced concrete frame during construction and remediated six before it went into administration. As part of the new contract works, Arup was engaged to conduct a full structural review of the hospital, identifying 71 additional issues. As a result, an integral part of the works undertaken were the structural remediation, involving the complex placement of 500 tonnes of extra concrete and 200 tonnes of extra steel at discrete points within the structure to resolve these issues.”

Key to the structural intervention and remediation programme was the virtual modelling of the project and preparation of digital work packages to improve efficiency and ensure a safe installation methodology.

“Without firstly recreating the structure digitally, the highly complex structural remediation work could not have been constructed safely within an existing building at such pace and with such accuracy,” said Andy.

Despite the multiple challenges faced, Laing O’Rourke was able to deliver the hospital to the Trust within the timescales originally envisaged to bring the building to completion. The new facility is the largest hospital in the country to provide inpatients with 100% single en-suite bedrooms. It has 18 state-of-the-art operating theatres for inpatient and day-case surgery, 640 beds, including 40 critical care beds for patients in the intensive care and high dependency units. In addition, a large clinical research facility will place LUHFT as a national and international leader in clinical trials and studies. The hospital has already become a major asset for 750,000 people across Merseyside, providing high-quality care and support for generations to come.

Social Value

Laing O’Rourke placed a strong emphasis on social value and worked closely with the hospital and the community to create local jobs and apprenticeships and engage in many local initiatives.

With around 900 people on site at the peak of the construction project, there were immediate local employment opportunities. 60% of people who worked on the construction of the new Royal came from Merseyside, with the project employing 51 apprentices, providing valuable skills for sustainable careers. In addition to employment, there was a focus on continual development of the workforce, with more than 2,000 hours dedicated to upskilling and training throughout the project’s life span.

In terms of procurement, Laing O'Rourke made a concerted effort to source materials and services from local suppliers and was able to place 40% of procurement orders with suppliers within 50 miles of the construction site.

The company also looked to inspire the next generation, working closely with Everton in the Community (EITC). They provided a number of full day visits to the project from the community’s broad network of secondary schools; facilitated 30 activities, including lectures, career days, and visits to local schools and universities; all creating opportunities for learning and development for over 750 people. Even throughout Covid, the site provided virtual engagements and continued to deliver a number of pathways to construction programmes.

Laing O'Rourke recognised that building the hospital was not just about delivering a physical structure but also about creating social value for the community. As well as prioritising employment, apprenticeships, local procurement, and education activities, the project team took part in EITC’s 'home is where the heart is' campaign, delivering and installing white goods such as fridges and hobs, computer equipment for children, as well as putting together furniture for individuals who needed support during and after the effects of Covid-19.

Clatterbridge Cancer Centre

The new Royal was the 17th hospital delivered by Laing O’Rourke in the past decade and the third major hospital delivered within Merseyside, alongside Alder Hey Children’s Hospital in 2015, and in 2020 the completion of the Liverpool Clatterbridge Cancer Centre, next door to the new Royal.

In December 2022, the final level of the three-level link bridge was opened to fully connect the new Royal with Clatterbridge Cancer Centre, creating swift access to specialist treatment for patients at both sites.

Laing O’Rourke’s healthcare sector lead, Rory Pollock, who has been involved in a number of Laing O’Rourke’s past healthcare projects was instrumental in the delivery of the Clatterbridge Cancer Centre.

On the impact of the projects in the Liverpool area, Rory said:

“It has been humbling to see and hear the positive reactions of doctors, nurses and patients as they moved into the new hospital.

“The Trust, our project team, and suppliers all pulled together through challenging circumstances, including throughout the pressures of covid, to maintain a resilient focus on delivering an outstanding hospital. I watched with pride as a hospital building became a leading healthcare facility that will enable the NHS to care for thousands of people.”

Laing O’Rourke’s construction team handed over the keys to the Royal in July 2022 allowing the Trust to finalise plans for their phased move, with the first patients welcomed on 4 October of that same year.