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A typical exhibition-stand shell structure was adapted to accommodate beds in the London Nightingale Hospital at the ExCel Centre

Building London’s Nightingale Hospital

Image credit: Getty Images

When more intensive care beds were urgently needed to meet the horrific results of Covid-19 unfolding, with wartime speed and ingenuity the first of the UK’s new Nightingale hospitals was installed at London’s ExCel exhibition centre.

Before the coronavirus crisis hit, across England there were only 5,900 critical care beds available in hospitals. While that’s enough to serve a population of 55 million people in normal times, as the virus began to spread across the world it quickly became clear that more would be needed to handle the expected large numbers of people requiring intensive care. So how could capacity quickly be scaled up?

Enter London’s ExCel Centre. Normally host to everything from trade shows to comic-book conventions, the government and NHS got to work transforming the event space into the first of a number of new hospitals around the country – a process that went from planning to a Skype ribbon-cutting with Prince Charles in less than two weeks.

The initial scoping of the building took place on 21 March, when a team from building services consultancy The Richard Stephens Partnership (RSP) visited the site, followed the next day by a team of engineers and architects from design practice BDP. “Nobody knew what to expect,” says BDP principal James Hepburn. “Ten days later we had a 500-bed specialist healthcare facility.”

The newly dubbed NHS Nightingale Hospital began receiving its first patients on 7 April – and was constructed with the intention of scaling-up to 4,000 beds.

Conveniently, BDP had already thought about the problem. A previous discussion with Matthew Shaw, the CEO of Great Ormond Street Hospital, about the shortfall in intensive care beds had led the company to put together a “high-level” paper based on its experience master-planning a number of major hospitals, including Birmingham’s Queen Elizabeth Hospital. It was a proposal for converting exhibition and convention centres into healthcare facilities if required in a crisis.

“When the scale of the shortfall across London became evident, the ExCel Centre was the obvious choice,” says Hepburn. Not only is the centre large enough to accommodate thousands of patients, but it already had good transport connections, outside space for generators and gas storage, and is surrounded by accommodation for staff to stay in.

It is the core design that really makes NHS Nightingale work.

“The key to the ExCel project is the clarity of the conceptual thinking and the rigorous approach to procurement and construction, which have enabled the project to be built safely at speed,” says Hepburn.

The new hospital resembles a production line. At one end of the building, patients arrive in ambulances from other London hospitals, where they are taken to an admissions area. Then there is the enormous patient area: back-to-back beds, each stocked out with a ventilator and other medical equipment. The 4,000 beds have been divided for management purposes into 80 wards, though functionally they all share the same space. At the other end of the building is a recovery area and a discharge area.

Also tucked away inside the ExCel site is a morgue, as well as a canteen area for up to 16,000 staff who could end up working on the site. BDP illustrates this simply and clearly on its website, with an IKEA instructions-style infographic showing how the Nightingale is configured.

“Where possible we made the most of the ExCel Centre’s infrastructure and temporary systems, designed around what could be sourced and implemented within the very short amount of time available,” says Hepburn. One example of this is how beds were laid out similarly to a trade show – with the same type of temporary walls being used to create separated areas. The ExCel’s existing electrical system, usually used to power LCD screens and lights on exhibition stands, was used to power each bed too, with a dado power-strip added to the wall at the head of each bed. This means that ventilators and other medical equipment can be powered just like in a normal hospital.

Behind the scenes, though, electrical supply was much trickier, as engineers needed to add a critical component that the ExCel lacked but which is essential in a hospital: an uninterruptible power supply. A low-voltage standby generator was also required, because, unlike a conventional hospital, the ExCel lacked the ability to isolate power supplies, which are used in hospitals to keep equipment running even if there are ground faults.

Similarly, RSP brought its experience to the table: it had led the conversion of 19 positive pressure isolation rooms to negative pressure rooms at the Royal Free Hospital, for use fighting Covid-19. This came in useful when designing the highly controlled ‘don and doff’ area where staff change into and out of their personal protective equipment (PPE), such as masks. If airflow is not carefully managed here, it could risk spreading the virus among the people we’re relying on to care for us.

The biggest challenge was perhaps not the engineering, but the time pressure. “To deliver this volume of equipped beds within such a short timeframe required all teams to make immediate decisions to allow construction to progress in parallel with design,” says Hepburn. In other words, the long procurement period that would usually take place on a project of this size had to take place in hours, rather than weeks.

But this didn’t mean that the designers couldn’t be careful. Somehow they had to come up with a design that was both fast and flexible. “Decisions had to be made quickly to allow construction to progress [and] design proposals had to be sufficiently flexible to accommodate the developing design of specialist systems such as the medical gases,” says Hepburn.

Ultimately, despite these challenges, it appears that the heroic construction of NHS Nightingale has been a huge success, and one that is being replicated across the country in other conference centres and temporary venues. So much so that BDP has been approached by teams working on other sites to share knowledge and best practice.

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