Cundall: putting patients and staff first by building WELL

Cundall’s healthcare sector leader Stephen Maddocks talks to Construction Global about the challenge of delivering sustainable designs for healthcare facilities that will meet future needs

Cundall is among the UK’s leading engineering consultants working in healthcare today. Recognising that building design is a key component of any such facility, Cundall’s approach is to put people first. Its mission is to recognise and support the needs of patients, staff and visitors with a design in tune to the wider issues beyond the actual building; to ensure that design is flexible, adaptable and future-proofed.

Founded in 1976, Cundall’s core disciplines in civil structures, building services and sustainability are in demand in the UK and overseas. Cundall is experienced in working directly for NHS Trusts, Private Healthcare Organisations and PFI (Private Finance Initiative) projects, both as technical advisors and consortia members on projects such as the soon to open Tessa Jowell Health Centre in Dulwich, UK and the Royal Children’s Hospital in Melbourne, Australia.

Collaboration 

Stephen Maddocks is Building Services Partner at Cundall and leader of the firm’s healthcare sector. With more than 30 years’ experience in the building services industry, he has worked extensively as a project director in charge of multi-disciplinary engineering teams and actively champions the collaboration and integration required between building teams, “It's something we instil in our teams from day one,” confirms Maddocks, who explains that Cundall uses Yama internally to keep its nearly 1000 staff united in their approach. 

“It's always about talking and making sure we're all on the same page. We make sure our teams communicate across a rigid framework, for example, a RIBA plan of work, and consistently engage. How projects come to market is one of the challenges we face; we’re chasing so many frameworks and some are more beneficial than others in terms of the projects that get the green light. We aim to keep up our market intelligence through our relationships with the main contractors.” With the UK healthcare framework NHS Procure 2020 coming back out to the market it’s vital for Maddocks and his team to collaborate and be aware of all the potential routes to market.

Innovation

Maddocks marvels at the innovation in technology he’s witnessed across the industry during his long career. “It’s changed massively. We take on around 25 graduates to our training programme each year, and they're coming out of university doing parametric modelling, generative design, using Trello boards… it’s quite mind blowing. As a business, we're committed to embedding digital technologies, paperless offices, etc. We've got the digital processes to deliver project information in a more cohesive way. For example, we’re using VR (virtual reality) to offer our clients 3D walkthroughs and we’re also looking at AR (augmented reality).”

Eschewing the flat graphic interface of traditional acoustics computer modelling, the Cundall team has combined the Oculus Rift virtual reality headset with a gaming engine and high-quality audio to take clients and project design team members on an immersive audio and visual tour of a building - before it is built. Cundall’s Virtual Acoustic Reality (VAR) system uses audio prediction modelling to mimic the environment. “Our lighting teams can also replicate the daylight in a space,” adds Maddocks. “We can prove the benefits of a chosen design using climate-based daylight modelling.”

Maddocks highlights that Cundall is also embracing the concept of the digital twin. “When we finish our design and hand over our Revit models to the contractor, that level of information from design to build can then be passed on to the client as a digital twin to help them operate the building - vital for the future-proofing of healthcare projects.”

Maintaining a healthy balance

The synergies across the many sectors Cundall operates in – from education and industrial to residential and healthcare – allow for new techniques to be shared. “Some of the work we’re doing with pumping technologies in high rise residential can be transferred to hospitals,” explains Maddocks. “Healthcare can also learn from the resilience technology required in the construction of data centres. Because one of the problems we’re going to have on the net zero carbon journey [Cundall aims to be carbon positive by 2025] is the huge backlog of maintenance issues across healthcare sites that still have oil or steam powered boilers. Creating resilient low carbon strategies that still meet the process requirements of a hospital will be a major challenge over the next ten years.”

Budget allocation is a regular challenge for construction in the healthcare sector, Maddocks laments. “Healthcare has always been a political pawn. Money is allocated for capital budgets, but then the operational team tends not to get their budget lifted to meet changing requirements. So they will inherit a brand-new building, but not have the money to fund the resource, either in skills, or equipment, or staff numbers, to look after it. We need a mindset change among the healthcare estate to boost resourcing and look at recruitment to get more leaders and apprentices into our schemes to better maintain them.”

Sustainability

Australia is at the forefront of driving sustainability practices in construction, as Maddocks explains. “They’re aiming to offset the country’s coal usage and so have been focused on carbon neutral buildings.” Opened in 2011, Cundall acted as a technical advisor to the government on the BREEAM Outstanding Royal Children's Hospital in Melbourne, based on the hospital’s need for a family-centred care model that put children and their parents at the centre of the facility.

“We’ve learned from that experience on projects like the Willmott Dixon Community Healthcare Campus in Hertfordshire,” says Maddocks. “We used copper handrails to minimise the spread of MRSA; and installed low energy lighting and mechanical ventilation.” This award-winning project showcased what could be done in a small environment; something that Maddocks and his team are keen to see transposed to bigger projects. Cundall’s healthcare team have carried this through on projects like the Banbridge Health and Care Centre in Northern Ireland. The four-storey multi-purpose centre – which provides physical and mental daycare services, ICT and primary care facilities, GP services, dental labs, OT and physiotherapy – was designed to achieve a BREEAM excellent rating and, among an array of accolades, was named RIBA National Award winner in 2016

2020

“We're working with South London Health partnerships on the soon to be completed Tessa Jowell Health Centre, in Dulwich,” reveals Maddocks.” We won that project five years ago but it’s been more than a decade in the making. We’ve taken learnings from previous projects to deliver a BREEAM excellent building with features including night time ventilation and automatically controlled blinds and windows with daylight sensing systems. It’s vital for communities to have a facility that brings together a range of primary care services in one building that’s operational for 18 hours each day.”

“Willmott Dixon came on board as the main contractor and we monitored their work to ensure we could find solutions together to meet the challenges. This is where frameworks can improve healthcare construction. We worked much closer with a major contractor here than we would under the traditional procurement process, to examine the impact on the civil, structural, and the MEP. We brainstorm ideas early on to deliver the best value for the client by working to the old adage: ‘Design it twice, build it once.’” Maddocks adds that, on projects like these, Cundall is keen to revisit 12 months after delivery to collate energy data and carry out a post-occupancy evaluation that can inform maintenance, other live builds and future designs. 

Cundall is also involved in the Ulster Hospital Project, just outside Belfast in Northern Ireland. “We’ve been working on a budget of £200mn,” says Maddocks. “The first phase integrated ward blocks which were handed over in 2016. We’ve delivered 300 beds and are due to hand over the acute care block this summer. It’s a huge investment in our health economy with five operating theatres, radio, MRI, catering and support accommodation across 600,000 square feet.

Elsewhere, Cundall has worked on the Hong Kong Children’s Hospital which has been shortlisted for the Quality Building Award 2020 (to be presented in June), themed around ‘Transforming Communities - Build with Heart and Care’. The first hospital in Hong Kong to achieve a Platinum rating in BEAM Plus Provisional Assessment, Cundall is part of the design and build project team appointed to provide sustainability and BEAM consultancy services, introducing technologies to maximise environmental performance and improve patients’ experience.

Building WELL

Maddocks explains that Cundall’s commercial clients are starting to understand the necessity of working to the WELL Building Standard and it’s a big part of his strategy to expand that awareness to healthcare facilities. The WELL Building Standard is a performance-based system for measuring, certifying, and monitoring features of the built environment that impact human health and wellbeing, through air, water, nourishment, light, fitness, comfort and mind. “As global practitioners, Cundall has Europe’s only gold WELL Building Standard, so we’re aiming to push that forward to make sure that everybody – staff, patients and visitors – are treated well across a healthcare facility.”

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