A modular solution to one of the NHS’s biggest problems

In the realm of architectural and construction innovation for healthcare, the NHS is grappling with a formidable challenge: the prolonged backlog for a spectrum of vital medical services and the physical space in which to provide for additional capacity.

This issue is fuelled by a variety of factors, including an ageing population, rising demand for healthcare services in general, and strain on existing infrastructure, all of which have profound repercussions for patient wellbeing and the healthcare ecosystem.

Lindsay Dransfield discusses how modular facilities are proving to be an exceptionally versatile solution for the NHS, both for stopgap requirements and longer-term planning of buildings and spaces.

The benefits of modular facilities

There’s nothing new about the fact that the NHS has long had a capacity and waiting list issue, and the pandemic really couldn’t have come at a worse time, with its legacy of backlog. Whilst the government may have promised new hospital builds and facilities, these are long-term strategic assets, whenever they might arrive; they don’t solve the problem in the here and now. Whilst this is a clinical issue first and foremost, it’s also one about buildings, physical structures, and real estate - the gamut of healthcare estates decision-makers up and down the country.

Modular off-site construction provides a range of advantages that can address some of these challenges effectively. Modular facilities can be assembled swiftly, due to their prefabricated nature, minimising disruption to existing facilities and augmenting patient and staff environments.

Unlike conventional construction, which can take years, modular buildings are ready for use in a matter of months, quickly addressing the need for additional medical capacity where there is a strain on existing infrastructure. They also offer versatility and speed in adapting to emerging needs, providing a degree of future-proofing and long-term relevance and value.

This was the case for Skåne University Hospital (SUS) in Malmö, Sweden’s third largest and one of two national centres for cardio-thoracic surgery, which is undergoing a major, seven to ten year construction programme. During the build, an urgent need arose for increased capacity for performing high-risk orthopaedic procedures, and the hospital’s management wanted an interim solution that would be quick to implement, while being robust enough to fill the gap until the new building was complete. The entire project was completed within just 10 months from start to finish and, while commissioned as an interim facility, the complex is designed to serve the hospital for a period of up to 10 years.

In terms of value to the public purse, modular facilities represent remarkably cost-effective solutions to very specific capacity problems. The streamlined manufacturing process and shorter construction timelines for a start. We all know the NHS is under financial constraints and budgets simply aren’t available for large scale healthcare infrastructure overhauls, including the fact that buildings undergoing renovation or construction will be out of action for long periods of time with all the knock-on issues this implies. Resultant cost savings can quickly be redirected towards other pressing elements of the clinical pathway in addressing capacity and patient outcomes.

Regarding cost control, there is one other final, but I think especially important, point. Estates managers - in fact, all budget-holders in the public realm - need as much control over their budgets as possible. It’s often a challenging balancing act for them, as new pressures come in on what is meant to be a plannable year. However, because of the standardisation of components designed into modular solutions, there is budgetary predictability and dependability. It really is possible to get certainty with modular, right down to the last penny. What’s more, the fact that parts are in stock all of the time, means that deployment times really can be properly relied upon, guaranteeing timely and efficient implementation.

It goes without saying that continuity of service and facilities in any hospital is crucial, and one of the attractions of modular is the ease with which modular facilities can seamlessly be integrated within an existing footprint.

In the same way, hybrid solutions, combining modular facilities with standard units, such as vehicle-borne mobile theatres or with existing fixed buildings, can help to expand the hospital’s capacity seamlessly, flexibly, and quickly. This was the case at Kettering General Hospital during the pandemic, which commissioned a modular ward to provide a COVID-free zone. This stand-alone ward facility was completed within a period of just five weeks, despite the restrictions imposed by the lockdown protocol that was in place at the time, reinforcing the nimble and rapid solution that modular is.

Then, there are Community Diagnostic Centres (CDCs). The aim of CDCs is to deliver additional diagnostic capacity in England by providing quicker and more convenient access for patients and reducing pressure on hospitals. The Richards' Report from 2020 emphasised the urgent need to transform diagnostic services in response to rising demand, proposing creating new diagnostic facilities outside main hospitals, using locations like high streets and retail spaces for quicker and more convenient access to tests. The report advocated for Community Diagnostic Hubs to revolutionise UK diagnostics.

Fitting within Integrated Care Systems (ICS), which tend to cover large geographical areas, typically a population of more than 1 million, CDCs offer a flexible and economic solution. These can be strategically placed across the ICS to offer a range of diagnostic services. The benefits can be huge, from tailored design and ultra-rapid deployment to the advantages of increased availability of appointments, freeing up main hospital space, improved infection control, whilst, at the same, bringing services closer to patients.

Modular facilities can also be tailored to specific healthcare needs, providing an opportunity to design spaces that optimise patient flow and enhance efficiency. Whether it's additional treatment rooms, diagnostic centres, or outpatient clinics, modular structures can be easily customised to meet the evolving demands of NHS hospitals and health facilities. Modular assets can also be easily digitised for efficient building management, displayable on an easy-to-use, all-on-one-page dashboard, from HVAC to utilities.

Looking at the construction and assembly of modular facilities, this also brings with it its own environmental and sustainability considerations, with each building solution incorporating eco-friendly materials and energy-efficient systems, aligning with the NHS's commitment to sustainability simultaneously providing efficient and accessible services. Modular facilities also incorporate composite materials to meet fire compliance standards.

Any old modular won’t do

It is important for NHS estate managers to know how they want to benefit from the modular concept before they commit to it. For example, modular buildings are not just static, but can be repurposed to meet new needs, be it more beds or surgical facilities. NHS trusts implementing modular buildings need to seek advice from modular constructors, in order to understand what they need and then how to make modular solutions effective in the healthcare environment.

Because healthcare is such a highly regulated sector, it’s important that modular suppliers understand the implications, and yet, incorporating these regulations into modular structures can be complex and requires meticulous planning and coordination with relevant health authorities to ensure compliance.

Modular structures need be flexible enough to accommodate different clinical settings, equipment, and technologies. Achieving this adaptability, while maintaining a standardised approach across different modules, can present its own challenges: it’s not a generic solution to a generic problem.

Standardisation of construction methods, materials, and finishes is important to guarantee that every module meets the same high standards. As with any building project, but more so in healthcare, is the importance of ensuring consistent quality across all module installations, requiring meticulous construction planning and assembly, and an intimate understanding of the complexity of delivering critical services. Integrating modular structures with existing systems, such as electrical, and plumbing, demands precise planning and coordination and, again, an understanding of and familiarisation with NHS environments.

While modular facilities offer potential cost savings compared to traditional construction, they still require significant upfront investment. Balancing the initial costs with long-term savings is important. Fixing modular build costs makes this easier, which is why rental schemes and other ways to offset the upfront investment are attractive.

Considerations for successful implementation

The patient experience should lie at the heart of good design process. Modular facilities that are comfortable, conducive to patient needs, and efficient in delivering care is what NHS estates managers are striving for. Involving clinicians and patients in the design phase can provide valuable insights to create patient-centred spaces. Meanwhile, the ability to expand or reconfigure the facility as demands evolve ensures its longevity and cost-effectiveness.

In conclusion

The integration of modular facilities holds the potential to reduce waiting times significantly, without disruption or delay, all whilst improving patient experiences and at genuine value for an already overstretched public purse. Pressed NHS management and estates professionals need solutions that are quick to deploy, effective in delivery, responsible to budgets, and versatile enough to cope with changing needs. For their sake, and the patients they serve, modular facilities must be higher on the agenda.