Healthcare is not the only sector that has seen activity affected by the pandemic, construction activity has been impacted too. We take a look at what hospital construction projects were already underway, what new funding has been announced and how priorities have changed since the start of the pandemic. 

During the Covid-19 pandemic, construction firms have encountered similar challenges to other sectors employing key workers; staff shortages which have been exacerbated by the closure of borders and the lower number of workers from overseas arriving in the country, social distancing and vaccination requirements for those working on site and a series of imposed restrictions including periods of shutdown and capped activity.

But there are some good news; the NSW government recently announced the state’s construction industry would return to full capacity from late November as vaccination coverage continues to grow. It is easing all capacity limits on construction sites (which had been at 50%, then 75%) but is retaining the ‘four square metre’ density rule. Activity in Victoria, however, remains restricted at the time of writing.

Progress during the pandemic has actually been better than expected, probably helped along by additional funds being made available. Not only have most construction work finished on time; some projects have even been fast tracked. For example, it was recently announced that the $341.2 million Concord Hospital redevelopment in New South Wales was to be delivered ahead of schedule to provide dedicated care for patients with Covid-19. Other projects that were fast tracked or got an early start included the Macksville Hospital Development, the Mudgee Hospital Redevelopment and the $750 million Royal Prince Alfred Hospital Redevelopment.

In fact, during 2020, Health Infrastructure NSW delivered its largest ever health capital spend, with $2bn worth of infrastructure projects delivered, including the completion of 20 projects, many of which were in the health sector. Key projects included the Westmead Health Precinct Central Acute Services Building, the tallest health building in Australia, and the expansion of the John Hunter Hospital Emergency Department, which started earlier than planned to help with the Covid-19 effort.

In Victoria, construction is underway on a $1.5 billion project to deliver a new Footscray Hospital – the largest ever health infrastructure investment in the State – which is expected to open in 2025.

New development

A good number of new projects have been announced. NSW Health Infrastructure, for example, has a pipeline of $10.7 billion worth of projects over four years to 2023-24 across 110 projects. A project at Sutherland Hospital to upgrade its operating theatre complex and MRI scanning facilities, and to build a new central sterilisation services department, was recently started.

Earlier this year, it was announced that stage 2 of the $1 billion Nepean Hospital Redevelopment would be brought forward by two years. The project will expand and upgrade the hospital substantially, and is significant for the region as it will mean a wider range of health services can be offered much closer to the Penrith and Nepean Blue Mountains communities.

In Victoria, the government has committed $320 million to fund the upgrade of vital health infrastructure, including a new $200 million Metropolitan Health Infrastructure Fund (MHIF), which will fund over 50 construction, remodelling and vital upgrade projects as well as equipment and technology at Melbourne’s busiest hospitals and community health services, including Austin Health.

It also opened a fifth round of the $120 million Regional Health Infrastructure Fund (RHIF) earlier in the year. The $22.9m Wangaratta Hospital project (under RHIF) is on track for completion in November next year, and will deliver a bigger and better hospital for the community, reducing the need for patients to travel to Melbourne.

Looking more long-term, Infrastructure Victoria issued an updated 30-year Infrastructure Strategy back in September, to reflect the unprecedented levels of investment to meet the challenges of the Covid-19 pandemic and to ensure the state is prepared for the future needs of its population. Two of the main areas of focus in the strategy are to manage urban change and to develop regional Victoria.

In Western Australia, the first stage of the redevelopment of $300m Subiaco Hospital Redevelopment, which includes refurbishment works to its Sterilising Services Department, has just been announced and is expected to be completed in May 2023. Last month, the government announced additional funding of $400m to expand hospital capacity, to include both bedspaces and staff. The investment is said to be one of the biggest ever in Western Australia’s health system and will create more than 500 bedspaces across various hospitals, and support the addition of more than 400 nurses.

In Queensland, a new $265m Satellite Hospitals Program (SHP) is in planning. It will involve building seven new satellite hospitals to meet the healthcare needs of rapidly growing communities across South East Queensland. The seven new satellite hospitals will be built in the north and south of Brisbane, Bribie Island and across various communities, and will deliver a wide range of services including community health,  chemotherapy, urgent care for minor injury and outpatient services. Earlier in the year, this year, the Queensland government also announced funding of $163.7m for the creation of additional 351 beds across the state’s hospital network.

Hospital design challenges

The planning phase for hospital building projects usually starts with a clinical services plan, based on need. Following a consultation exercise, this then evolves into a master plan, and is outlined in a project brief and the business case. Starting with the concept, the design process that follows moves through stages from schematic design and into more detailed designs.

Key considerations during the planning and design phases include how core services will operate, as well as how these services will work alongside surrounding or ancillary services. Any functional requirements of the building, what utilities or services need to be accessible from where, and how staff and patients will use the hospital space, as well as how they will get to and from the hospital, also need to be considered.

New hospitals will need to serve the surrounding population for many years, so looking further into the future is necessary. How is the hospital likely to be used in the future? Will there be enough space to accommodate the local population in 30 years’ time, and will it suit the age and attendance profile? Thankfully, modelling tools are becoming ever more advanced, and it is now possible to create scenarios to predict the effect of a new build on the economy and the population over time.

As a result of Covid-19 we have seen some of the longer term trends accelerate, and this needs to be included in design – the future may arrive sooner than initially expected. Climate change is gaining more attention and is being prioritised higher than before, and there is pressure to reduce timelines for addressing the issue. Therefore, a stronger focus on energy efficiency, sustainability, recycling and minimising waste, reducing water use and using renewable energy sources is needed.

The changing climate has also brought a need to design for greater resistance to extreme weather events, such as fires, flooding and storms, and in combination with the arrival of Covid-19 has brought to the forefront a need for resilience in the unexpected events in general.

Hospitals are busy places, and something else that needs addressing is the potential disruption to essential services to the community during the construction phase. For that reason, hospital projects are often delivered in stages. Unfortunately hospital projects, even when staged and carefully planned, can be both large and complex, and delays or disruption to works are not uncommon. It is advisable to plan for the implementation of temporary healthcare infrastructure, to help bridge the gap in the case of such an event occurring.

Ensuring service continuity during the build

Flexible healthcare solutions, such as modular or mobile facilities, can be used both on a short-term basis, from periods of weeks or months, or more long term, ensuring the delivery of essential services can continue without a hitch during a major construction project taking several years.

A modular hospital extension

Modular has many advantages over traditional builds – not least the speed at which they can be built. In Queensland, there are several modular or mobile operating theatre facilities in place, and it was recently announced that the new Centre for National Resilience quarantine facility in Brisbane would be constructed as a modular build.

And in Western Australia, the government has just announced plans to expand Osborne Park hospital, Rockingham General Hospital and two other sites using modular construction to create additional capacity including a provision for 120 new beds.

The healthcare construction sector looks to be experiencing a bit of a boom at the moment, which may continue for years to come if the growing pipelines are anything to go by. Covid-19 has forced us to consider various ‘what if’ scenarios and review contingency plans. It has also brought a realisation that more capacity – and flexible capacity at that – is needed to be able to cope with events such as a pandemic.

Victoria’s 30-year infrastructure strategy contains some useful insight into the potential future needs that will be essential to incorporate into plans. In a healthcare context, they include addressing the energy transition to meet future net zero emission targets, including the use of zero emission vehicles, and considering water usage. It also points out the importance of embracing technology and innovations in healthcare, including the expansion of telehealth, and accommodating these.

We need to plan for population growth overall, but also accelerated growth in certain areas. The plan also talks about expanding the use of climate scenarios and modelling tools, and expanding information sharing capabilities as well as embedding resilience in the system to be able to respond to any national emergencies or unexpected events.