Future thinking

In the construction of University College Hospital Grafton Way Building, a technologically pioneering cancer hospital, much more rested on the project team’s shoulders than delivering on time and on budget, explains AECOM director Sam Danquah.

The way the success of huge construction programmes is measured is changing and nowhere is this more evident than the delivery of University College London Hospitals’ (UCLH’s) new Grafton Way Building.

While the construction industry project professional’s mantra of ‘quality, on time and on budget’ is still central to our work, achieving sustainable, optimised outcomes is now more critical than ever. And when the project will deliver one of only two proton beam therapy (PBT) centres in the UK to treat complex cancers and blood disorders, the stakes don’t get much higher.

Creating a landmark

The centrepiece of the £380m building is a state‑of‑the‑art PBT centre. It will treat 650 people with cancer and benign tumours each year. One of Europe’s largest dedicated haemato‑oncology hospitals, the building also includes eight operating theatres, a surgical recovery area, a surgical ward, an imaging centre, a 10‑bed critical care unit and three floors of in‑patient haematology wards.

The outcomes set at the beginning of the project were to support the national NHS PBT service, with the advanced treatment meaning patients don’t need to travel abroad for treatment – relieving patients and families of the stress of travel and offering better financial value for the NHS. The facility would enable pioneering research, attracting world‑class specialist clinicians, researchers and staff. It contributes to UCLH’s strategic vision to become a world‑class centre for the treatment of cancer and other conditions, clinical and technical research, and teaching.

UCLH employed AECOM as NEC project manager, risk manager, programmer and infrastructure advisor to administer the construction contract, provide governance and manage in‑house project consultants. Our project management approach was largely waterfall, with project controls and governance embedded at day one and constantly communicated, ensuring effective change management and escalation processes to deliver consistent time, cost and quality reporting and benefits realisation. We started work on the project in September 2015, and completion was done in stages, with the first patients being treated in the PBT unit in December 2021, and HRH The Prince of Wales officially opening the building in March 2022.

Going underground

Project scope meant that the 34,600sqm building would need to be constructed in a constrained site within the Bloomsbury conservation area, close to two Grade II‑listed UCL buildings and just metres away from London Underground lines. To respect protected views and surrounding heritage, five of the 13 floors would be constructed in a 28m‑deep basement to house the PBT facility.

The actual site was once a cinema and I clearly remember standing on the site once it had been demolished and thinking about how we would excavate something the size of the Royal Albert Hall below. It is at times like this, as a project professional, that you put faith in the process and remind yourself how important it is to invest in getting systems and plans right up‑front, but also to engage and collaborate – and importantly following it through, with the drive and passion to make it work.

The building was designed by Scott Tallon Walker Architects in association with Edward Williams Architects and constructed by Bouygues UK. This complex project involved more than 3,000 people in its construction, which included the removal of 80,000 cubic metres of earth from the site.

No going back

Cyclotron (c) David Parry

The day the 90‑tonne cyclotron, which delivers the PBT, was delivered was a landmark for the project. Weighing the same as seven London buses, it was craned and manoeuvred into place with a surgeon’s precision. But the delivery was an example of just how complex this project was. This technology simply wouldn’t work unless the groundwork had been done to ensure it could be tested and commissioned – which takes months – while construction on the building above ground was continuing. The extremely sensitive equipment works at ‑269˚C, so the installation of resilient temporary services such as an electrical supply was of vital importance. There was no going back once the cyclotron was in situ.

Following the installation of the PBT equipment, above‑ground construction consisted of a seven‑level concrete‑framed structure that formed the L‑shaped ‘perimeter’ building as well as the lighter steel‑framed courtyard building.

Getting started

We started with a ‘conditions for success’ workshop to set and agree project KPIs, behaviours, protocols and deliverables with a common aim, rather than a series of individual outputs. It was hugely important to embed a team culture from the outset. Of particular importance was the use of clear language and a transparent process, given the diversity of the project team. Contractors and suppliers were from Turkey, Germany, France, Ireland and America, while we had UCLH representatives and multiple stakeholders who were not construction professionals, yet were highly experienced in their fields.

One of the biggest challenges was ensuring the one‑team approach on a project where more than 3,000 people were working on it at its peak. We needed to ensure the roles and responsibilities matrix was adhered to and reviewed as needed.

As a modern construction project, the digital aspect of delivery was key. We ensured there was a robust employer’s information requirements (EIR) document. The early adoption of a digital approach ensured the resilience of the team and project processes when COVID‑19 impacted the project, with our project management plan including online risk management/registers and interdependency trackers. It meant delivery was consistent and we were able to manage risks. We could review expectations and deliverables within the context of the pandemic and the supply issues that would inevitably arise. Through the development of a mitigation plan, the team was able to achieve buy‑in from all stakeholders and the delivery team for a revised plan.

Our early work also included ensuring that the project’s sustainability and environmental performance was a primary focus. The final project achieved a BREEAM Excellent, which in the context of the high energy needs of the building, because of equipment to administer treatment such as the cyclotron and high‑tech imaging, demonstrated what can be achieved when sustainability is factored in from the start.

Exceptionally diverse stakeholders

Early stakeholder mapping was undertaken, alongside a stakeholder responsibilities matrix to ensure the right information was sent to the right people at the right time. An unusually high level of reporting had to be maintained, with tailored content ranging from the UCLH Trust Project Board and NHS England through to the UK Nuclear Authority and the Anti‑Terrorism Unit.

Internal and external project stakeholders were exceptionally diverse: NHS England, Public Health England, patient reference groups, clinicians, the PBT equipment provider, residents, local businesses, the London Borough of Camden, the Environment Agency, UK Power Networks, the Metropolitan Police Anti‑Terrorism Unit, the UK Nuclear Authority, Transport for London, Thames Water and international PBT centres.

We worked in close collaboration with UCLH’s communications team, which was essential to ensure all stakeholder communication provided accurate and timely information.

On site we worked with Bouygues UK (the main contractor), UCLH stakeholders and clinicians together with UCLH’s supervisor team, comprising specialist consultants in architecture, MEP, structures and radiation shielding. Our regular face‑to‑face meetings helped us dissect and agree ways forward for complex matters and maintain effective progress. Meetings were recorded, with notes displayed on screen to ensure clear, concise communication, and post‑meeting notes swiftly issued.

Regular meetings were held between project principals from the trust, the contractor and our project management team to ensure emerging issues were identified early and escalated for swift resolution. A group was formed including the PBT equipment supplier to ensure seamless collaboration to minimise impacts on its delivery, installation and commissioning. Quarterly resident meetings were held to provide progress information.

Global headwinds

In ordinary times, the scale and complexity of the project would be immense. But our project management team also faced the external challenges of delivering through the pandemic, as well as the UK’s departure from the EU and the associated impacts these would have on labour and supplies. This was a nationally important project and, reflecting that significance, we placed relationships, attitudes and management of dependencies at the core of the project. This meant physically being on site, alongside key trust and contractor partners. However, it will come as no surprise to learn that, as the COVID‑19 pandemic hit the UK, this strategy was put to the test.

The Prime Minister announced the first UK‑wide lockdown on 23 March 2020, and as a project team, we needed to quickly recalibrate. The design element of the project was complete, so our on‑site presence was mainly to work with Bouygues UK on problem‑solving issues as they came up. We moved to online meetings and the construction team was given key worker status and able to continue. By May 2020 we had a clear plan to get suppliers to prioritise our project, which involved the client (UCLH) leveraging its connections so that we could get manufacturing and production slots, particularly for the specific medical components.

This was a prestigious project that would deliver remarkable outcomes for patients. It was hugely rewarding to work on. The technical complexity and innovative thinking required to work through it pushed our project management skills and systems further than they have ever been pushed, presenting challenges we never knew existed. So, while it was of course important that the project be delivered within the agreed funding and timeframes, the real measurement of the project’s success is that, despite the complexity and challenges, the facility is now changing outcomes for patients.

5 top tips for complex construction projects

It may not be original, but it is truly vital for success. The full delivery team embraced the NEC spirit of mutual trust and cooperation – a one‑team approach.
Early engagement and tailored communication. Deliver the relevant information to the right people, especially bringing in specialist stakeholders, such as fire safety, early. If everyone is ahead of the game in terms of what’s happening with the design and on site, problems can be identified and mitigated earlier.
Conflict management. Less experienced colleagues learnt the importance of identifying and efficiently managing conflict, learning moderating skills and facilitating dialogue to ensure optimal outcomes.
Technical expertise. Good building design and construction doesn’t just involve built environment professionals. In this case we sought experts in areas such as radiation and healthcare.
Project processes. Clear and effective processes from the outset are critical for key activities, such as design submissions review, change control and defects close‑out, to enhance decision‑making and ensure a rigorous audit trail.