HEJ reports on the ongoing £485 m scheme to redevelop and replace key buildings at Brighton’s historic Royal Sussex County Hospital – one of the largest Treasury-funded NHS projects in recent years.
One of the largest Treasury-funded NHS projects in recent years is now well under way at Brighton’s Royal Sussex County Hospital. The ‘3Ts’ project (Teaching, Trauma, and Tertiary Care) is being undertaken in three stages to minimise disruption, and will see all the buildings on the front half of the historic hospital site replaced by two new buildings. HEJ editor, Jonathan Baillie, spoke to director of the ‘3Ts’ project at the Brighton and Sussex University Hospitals NHS Trust, Duane Passman, to find out more.
The new 11-storey Stage 1 building at the Royal Sussex County Hospital will incorporate new diagnostic and treatment facilities, an expanded critical care unit, increased facilities for the Emergency Floor, and inpatient beds and teaching and meeting facilities, plus a new main entrance and spacious reception area. The separate, but linked Stage 2 building will include a well-equipped and much expanded Cancer Centre and accessible roof gardens. The £485 m development’s third and final phase will see a new purpose-designed delivery and service area for this busy hospital created.
As I walked through parts of the existing buildings to reach the ‘3Ts’ project offices where I was to meet with Duane Passman, I was immediately struck by how circuitous and multi-level the journey for patients, staff, and visitors, travelling from one part of the existing complex to another must be. Making all the key clinical and treatment areas more accessible is indeed one of the key goals of this major redevelopment scheme.
Before we discussed progress to date, Duane Passman put the scheme into context with a little of the hospital’s history. He explained: “The first building constructed, in the mid-1820s, was the Barry Building. The hospital was originally established as a sea-bathing infirmary. Ironically, just as it opened, sea-bathing went out of favour. The various benefactors therefore decided instead to make the new healthcare facility the Sussex County Hospital. It opened in 1828 with just 40 beds.”
Designed by famous architect
He continued: “The original hospital was completed 20 years before Florence Nightingale started nursing, so none of the Nightingale principles are embodied in the Barry Building, parts of which are no longer fit for purpose. I believe the Barry – at the hospital’s heart, and one of its most distinctive buildings – is now the NHS’s oldest building in England still providing acute care.”
Duane Passman explained that the Barry Building’s architect was Charles Barry, who gained fame in the 1840s designing London’s Palace of Westminster. He said: “The Barry Building, in particular, has been added to numerous times, and very little of the original remains. Initially the Sussex County Hospital and Sea Bathing Infirmary was effectively run by a Committee, who set up the hospital and funded it. The site, and the area around it, were pretty much open land. However, the adjacent St Mary’s Hall, a girls’ school, was already open.” In fact, following a wholesale re-location of staff from the Trust’s ‘old’ headquarters in 2012-2013, St Mary’s Hall, which was renovated in 2014, now serves as the organisation’s headquarters.
Long-standing plans for change
Duane Passman went on to touch on some of the other milestones in the hospital’s development, explaining: “The hospital’s evolution stretches right back to 1828, when the Barry Building opened; it has been added ever since. In fact in 1928, ironically a century after it opened, the Hospital Board of Governors said they felt it needed replacement – it only took us a further 80 years to get to that point! Come the 1960s,” he continued, “and the 14-storey Thomas Kemp Tower, a classic 1960s tower and podium, was constructed.” The ‘tower’ contains the hospital’s A&E Department, surgery facilities, intensive care, most of the operating theatres, the delivery suite, and Special Care Baby Unit, and six floors of wards.
“Meanwhile in today’s Barry Building,” Duane Passman explained, “is the main imaging department, and 200 medicine and care of the elderly beds. The Barry Building is a four-storey building, with the first and second floors housing wards. Many of the rooms and wards are simply too old, outdated, and cramped, for modern healthcare provision.”
The next major phase of development was the construction of the multi-storey car park and the Sussex Kidney Unit. Duane Passman said: “We were the region’s first hospital outside London to undertake hospital-based dialysis. The Millennium Wing, adjacent to the multistorey car park and renal unit, was then completed in the late 1990s, while above the A&E Department on level 5, adjacent to the Thomas Kemp Tower, is the Pathology Unit. The site’s sloping topography means there is a six-floor differential between front and back.”
One of the most well-known facilities at the Royal Sussex County Hospital site is the Royal Alexandra Children’s Hospital (winner of over 70 international design awards). Designed by BDP, also the architect on the ‘3Ts’ scheme, the ‘Alex’ was built by Kajima Partnerships, and completed in 2007. The £36 m building incorporates 100 inpatient and day case beds, 15 outpatient consulting rooms, three operating theatres, diagnostic and treatment facilities, a paediatric intensive care unit, an oncology day centre, a dedicated paediatric A&E Department, children’s outdoor play areas, and parents’ accommodation. The striking eight-storey building’s internal and external design – it is often referred to as ‘The Ark’ – were strongly informed by young patients’ views; for example nearly all the patient rooms enjoy sea views.
Bringing things up to date
Having spent the beginning of our discussion looking back, Duane Passman brought things up-to-date: “At about the time the new children’s hospital was completed, there was considerable discussion about redeveloping the front part of the site. When Duncan Selbie (now Public Health England CEO) arrived as Trust CEO in 2007/ 2008 from the DH, things started moving on apace.”
The first major consideration, however, was ‘a simple but critical’ one – how to find a way of building new facilities, because the site is so densely developed. Duane Passman elaborated: “The only thing we could think of was to look at the site’s lowest rise buildings – which are two and three-storey.” These, he explained, were the ‘old Trust headquarters’, the Estates Department and Occupational Health Building, the Latilla Building (Outpatients), the Stephen Ralli Building (mainly administrative facilities), the Nuclear Medicine facility, and part of the 1880s built Jubilee Building (incorporating Infectious Disease, Oncology, and HIV beds). “These, we determined, were probably going to be the easiest buildings to get out of the way.
Major decant process
“However, “he added. “when you add it all up, what we have decanted from this area is the equivalent of seven floors of the Thomas Kemp Tower. We are now nearing completion of the decant phase, having also had new modular facilities built to house some of the departments displaced. In front of the Barry Building’s east wing, for example, we have erected a six-storey temporary modular building, accommodating the Nuclear Medicine, Radiopharmacy, and the Physiotherapy and Rheumatology Outpatients’ Department. We have also had a threestorey modular ward block extension built behind Pathology to accommodate patients from the Jubilee Block. The Trust HQ, meanwhile, moved out into St Mary’s three years ago, as did Estates and Occupational Health. Laing O’Rourke is the prime contractor on this major redevelopment scheme, while the modular building supplier is Portakabin.”
Stage 1 building
Once the buildings we had just discussed have been demolished, the new ‘Stage 1’ clinical building will be constructed – some four times the size of the children’s hospital, with two storeys below ground and 11 above. There will also be a new helideck on the top of the Thomas Kemp Tower.
The Stage 1 Building will replace the wards and departments in the Barry Building, and accommodate a new and expanded Neurosciences Centre, plus facilities to support the Major Trauma Centre. The lower floors will focus on outpatient and support services, including ENT, audiology, non-invasive cardiology, nuclear medicine, fractures, and rheumatology, while also provided will be new car parking, bed and furniture storage areas, and security. A new energy centre will also be provided. Level 5 of the building will connect directly to the hospital’s Emergency Department, allowing it to greatly expand its floor area, and providing easy horizontal transfer to it. The new build will incorporate ambulatory care, neuroscience and polytrauma theatres, an interventional radiology suite and acute imaging, while floors 7-11 will house medical, neurology, stroke and brain injury, elderly care, and critical care wards, an inpatient therapeutic garden, relatives’ overnight rooms, a simulation suite, management offices, and teaching facilities.
New main entrance
The Stage 1 building will also incorporate the hospital’s new main entrance, with a spacious reception and retail outlets, while Level 6 will house large public spaces, including a café, ‘The Sanctuary’ multi-faith space, the PALS service, and a link to the Stage 2 building’s roof gardens. The building’s design makes the maximum use of natural light and open spaces. Duane Passman elaborated: “At ground floor level, you will be able to walk in through the new main entrance, right through to the back of the hospital, and get a lift up to the tower. This will improve access, while on Level 5 you will be able to get between the new building and the Emergency Department, and on Level 6, through the Tower Block to the site’s north side. There will be a new underground car park for patients and visitors, with overall access to the hospital greatly improved.”
Improved cancer treatment facilities
Next to be built, with construction due to start in summer 2020, will be the ‘Stage 2’ building, housing the new and expanded Sussex Cancer Centre, with more space for chemotherapy. and more linear accelerators. Patients will no longer need to be taken outside on being transferred between inpatient areas and treatment facilities. The considerably larger Cancer Centre will significantly increase the number of patients who can be treated at the hospital, reducing the need for them to travel elsewhere. The Stage 2 building will also house additional research and training facilities. Duane Passman said: “The building will have its own entrance on Eastern Road, an ambulance drop-off and collection point, and direct access to the new underground car park, plus rooftop gardens. Stage 1 is due to complete in 2020, Stage 2 in 2023, and Stage 3 – demolishing the existing Cancer Centre on the east of the site and setting up a goods distribution centre in its place – in 2024. That will mark the project’s end.”
The Barry Building will be demolished in 2020, prior to the start of Stage 2. Duane Passman said: “In fact English Heritage was considering listing it, although only part of the original structure is still intact. I argued, however, that not only is it one of the architect’s early buildings, and not terribly interesting, but that it has also been changed very dramatically over the years, and lost much of its original sense of proportion. I also pointed out that many of the additions had been designed by other architects. English Heritage also looked at the windows, and realised that a number had been replaced just a decade or so previously by UPVC. At that point they took on board my arguments that the original building had been added to so much that it was unrecognisable, and agreed it wasn’t worthy of listing.”
The planning application for the ‘3T’s’ redevelopment was submitted in September 2011, and approved in late January 2012, with the Trust’s Section 106 signed in late March 2012. Duane Passman said: “We initiated the decant process in 2012; we had to get a separate planning application to undertake the 18-month refurbishment of St Mary’s Hall (staff moved into the former girls’ school in June 2013). It was a difficult project for Kier, as quite a lot of the building was in poor repair. Other decant projects have then been ongoing while we secured the final approval, which we received just before Christmas 2015.”
The approvals process was ‘extremely difficult’, Duane Passman acknowledged: “We were asking for public money – £485 million from the DH – and had to jump through many hoops to get it. My team and the project team, here – 15 of us in all – took about 6-7 months to write the full business case; from submission it then took just over a year to approval. I can’t begin to describe how big a document the full business case is.”
A ‘very substantial’ scheme
I asked about local people’s views on what is – by any measure – a substantial scheme. Duane Passman replied: “There were a substantial number of views expressed, which is not surprising, given that we are bordered by residential areas. There were pockets of resistance, mainly about the impact of constructing such a big development, and what that would mean for residents. We addressed this in our planning application. By the time it is all completed it will all be one large building – the Cancer Centre on the western side, and the new general acute clinical and neurosciences building on the east.
“There were people who were genuinely worried about the construction work’s impact, and I completely understand that, and another group who said: ‘You shouldn’t be building it here anyway. Why don’t you build it outside Brighton?’ While I acknowledged their argument, the question would have been ‘Where?’ Around the whole of Brighton, you have the South Downs National Park. The only other potential site was where the Brighton & Hove Football Stadium now is, next to the University.”
Demolition progressing well
Duane Passman explained that demolition of some of the existing buildings, such as the ‘old’ Trust headquarters, and the ‘extension to Building 545’ (the audiology and ENT building), had already taken place, while in the week I met with him, work was about to be completed on the internal asbestos strip of the Estates and Occupational Health building. He added: “By late January 2017, the contractors will be ready to start digging a very large hole.”
While the demolition work had been ongoing, another ‘massive project’ had been progressing elsewhere on the site to divert heating and electrical services to and from the Barry Building to existing facilities on the northern part of the estate to ensure uninterrupted clinical activity while demolition progressed ‘in the middle’. “Laing O’Rourke is overseeing and managing that project very quietly and with minimal disruption, despite it being a phenomenally complicated job,” Duane Passman explained. “Crown House is the building services contractor, while the overall ‘3Ts’ project is being expertly managed by our project manager and cost adviser, Turner & Townsend, working with the internal Trust team.”
Challenges on a ‘live’ site
I asked about the biggest challenges of undertaking the project on a ‘live’ site. He said: It’s principally the obvious one – keeping the hospital operational while we undertake such a major redevelopment.”
Access to busy hospital sites during major construction projects can be challenging, and I asked Duane Passman about this. He said: “We will have only one entrance for site traffic, off Eastern Road, entailing a good deal of planning. Our construction environmental management plan, which explains how construction traffic will be managed and mitigated, is still being finalised with Laing O’Rourke and Brighton and Hove City Council, with whose planning and transport departments we have developed excellent working relationships. I have found them really engaged, prepared to listen and, once the scheme go-ahead was given, incredibly helpful.”
Controversy over the Barry
I wondered about the degree of controversy about the demolition of the Barry Building. Duane Passman said: “There has been some opposition; there are loads of local conservation societies, and there were about 20 objections to the planning application, but for a scheme this size that is not many. In the main, everyone has been willing to listen, to have a proper dialogue, and to treat each other with respect.”
Overall, I think the finished buildings, which have been beautifully designed by BDP, will be first class. I know BDP was chosen for the practice’s understanding of the site, and for its extremely successful design of the Royal Alexandra Children’s Hospital. The architects came up with some interesting design concepts, but were willing to listen and have that dialogue. During the design process we changed the building’s form, shape, and elevation 30 or more times to get to final plans which met both clinical and local planning requirements. The buildings will mainly be clad with concrete panels, with much of the panel structure pre-fabricated by Laing O’Rourke off site and transported here on large lorries.
Traffic flow analysis
“We will have six tower cranes on site, but have conducted a really big analysis which showed, monthly, what type of construction traffic there would be, so we could agree the most appropriate routes. Equally, we will be able to tell local residents well in advance what is going on. Deliveries will have to be carefully scheduled – for instance none will be able to arrive either very early in the morning or late at night.”
Looking forward to the scheme’s completion, Duane Passman said: “One of the biggest benefits will be much improved clinical adjacencies. For example, currently, if you have had a stroke, and are brought into the emergency department, you will be stabilised there. Stroke patients should, however, generally be moved to a stroke ward within an hour. To undertake the journey from the ED to the stroke wards in the Barry Building currently is a considerable journey. With the existing hospital layout, the journey can take 15-20 minutes. In winter it is shocking, because you have to walk across the exposed service road, and if it’s wet the rain may be coming in sideways
A transformational difference
“In the new hospital, a stroke patient will literally come into ED, the porter will turn left with them into the new building, put them in a lift, and take them to the stroke ward on Level 10. The new layout, adjacencies, and buildings, will make a transformational difference to the way services are provided. We will also be up to 65 per cent single beds, with 361 beds in all; a net increase of about 100. The helideck, on the top of the Thomas Kemp Tower, will be completed in 2018, and emergency patients will then be able to be taken straight down via a lift into the relevant area for treatment. The scheme as a whole is an excellent one. I think the new buildings will make such a difference, offering an improved experience for thousands of patients and staff every year.”
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