Walsall Manor Hospital Urgent
& Emergency Care Centre

The Trust gained funding for the project following a surge in admissions and their existing environment impeding the quality of care that was being administered. Built in the early 1960s, the existing estate created major limitations for the Trust. The original Emergency Department was designed for c.60,000 attendances per year, however with over 90,000 attendances currently, the ability to be flexible and manage pathways is near impossible.

Within the new centre, facilities include the following:

• A new Urgent Treatment Centre (UTC)
• A Paediatric Assessment Unit (PAU)
• A new Acute Medical Unit (AMU)
• A Medical Ambulatory Unit (MAU)
• Same Day Emergency Care (SDEC)

The enabling works for this project were significant. An intensive period of civil works, logistical planning and diversions took place prior to starting on the new build in order to release the site.

Keeping adjacencies and routes live throughout was imperative so that the Trust could conduct business as usual. The enabling programme was like a Rubics Cube of carefully coordinated activity.

We relocated the staff car park and the visitors’ entrance, working with the Trust to secure the critical ambulance route.

As is synonymous with the Black Country, surveys returned various mine-shaft issues, including a 30m deep mineshaft in the corner of the site, which the foundations were designed around, as well as a 3m void 27m below the ground. This was filled with 60 tonnes of grout, and elsewhere on the site required a further 40 tonnes.

Another key challenge involved complex service diversions for the decontamination showers. We had to solve the drainage issue of the decontamination liquid getting into the normal foul drainage system. We provided the solution by designing a system that allows the hospital to flush the legionella out, and avoids water sitting in the pipe for too long. Our design included installing a sensor that allows the drainage to be diverted to a tank rather than draining into the water course.

As often the case with the process of funding streams, by the time Tilbury Douglas was appointed to deliver this project, the original design for the New Urgent & Emergency Care Centre was already outdated and unfit for the longer term needs of the Trust.

Advances in way that patients are managed in emergency and acute care and clinical standards had altered the needs for the centre, for example the RCPCH 70 standards, the Five Year Forward View, new radiology standards and best practice from across the globe.

A critical clinical planning exercise was needed. Clinical planning was led by industry expert, Suzanne MacCormick, an experienced clinical planner that we partnered with and we knew could bring a lot of value to the process.

The design options were reviewed with the key stakeholder groups, concentrating on clinical adjacencies and flows. We explored how standardisation and repeatable rooms could bring flexibility and efficiency into both the construction and operation of the facility. We produced mock ups and tested room sizes with clinical teams, looking at nursing positions, bedhead services heights, and how patient observation could be maximised. We worked through the patient pathways and streaming model to create a tangible a design that translated the clinical model.

We looked closely at how clinical procedures, and different patient pathways intertwined; for example, developing the EPRR pathway to provide a wet decontamination facility that could be connected to RAT, and working through the mental health pathways and how we could support this need throughout the facility.

One of the most game-changing strategies for the new design was the transformation strategy for both the front and back door of the hospital. The strategy focused on admission avoidance models, streaming away from Emergency Care wherever possible and discharging patients early from hospital. The back door ensures that emergency care does not become a bottleneck for patients whose next step is elsewhere.

Tilbury Douglas Engineering put together a high level plan detailing how we could make the services strategy highly efficient to work with the design, while using minimal space. Engaging with the supply chain early, we outlined potential methods and design ideas to meet the requirements of the project.

In terms of services, in the early stages two new High Voltage supplies were required on an already congested site, alongside new gas mains and new water mains. We also had to ensure that the site was linked to new fibreoptics so that the new building can talk to the rest of the estate.

In parallel, the design team began the digital journey via the production of BIM models enabling co-ordination and clash detection and developing the MEP and structural strategies to be co-ordinated with the clinical design such as riser positions and structural zones.

The team worked closely to establish the required structures and protocols to keep the project on track in terms of information flow and key decisions. This included the production of a stakeholder engagement plan with organogram, and a meeting matrix, which provided governance and allowed meetings to be planned to ensure the right questions were asked to the right people at the right time.

We ran the 1:50 process via virtual meetings and had to work very closely with the Trust and be very flexible in our approach in order to get clinicians availability, as well as the wider stakeholder teams including IPC, FM and Estates.

We managed the design development process by linking our IRS directly to the procurement and construction programmes to make sure that information was issued on time at the right level of co-ordination and detail.

We communicated the developing design using 3D visuals and with the help of BDP, the team produced a series of QR codes that enabled the design to be viewed on a mobile phone or tablet, we used these techniques with the clinical teams and patient groups. With the Estates and technical teams we held sessions where we did fly throughs of the BIM model focusing on plant maintenance and MEP coordination.