December 15, 2014
Emir Tursic

Manchester Proton Beam Therapy Centre has been my first assignment in the London office. It will be the first Proton Treatment Center in the UK, located at the Christie Hospital Campus, one of the largest European cancer treatment centers of its kind. Proton Beam Therapy (PBT) is a type of radiotherapy that uses a high energy beam of protons rather than the more traditional high energy X-rays to deliver a dose of radiotherapy for patients with cancer. It is used to treat very rare cancers and can be a more effective form of therapy because it directs the all-important radiation treatment to precisely where it is needed with minimal damage to surrounding tissue. The treatment is therefore particularly suitable to pediatric patients with complex childhood cancers.

HKS has designed a number of Proton Treatment Centers in the United States and worldwide. Currently HKS has three Proton Beam Therapy Centers in design and one under construction. I was fortunate to have had the opportunity to work on a Proton Beam Facility at the King Fahad Medical City in Saudi Arabia with the Detroit office. Although I was already familiar with this peculiar building type, working on a similar facility in the London office gave me a unique opportunity to learn more about healthcare project delivery in the United Kingdom.

All public healthcare projects in the UK, which represents about 80% of total healthcare work, are procured through one of two delivery methods regulated by the government. The Private Financing Initiative (PFI) method requires mandatory public funding and in concept is similar to the Public Private Partnership (PPP) delivery in the US. This delivery method is open to all contractors from the European Union and requires a multi-stage design-build competition that spans over several months. The successful bidder is selected based on the overall construction cost and the quality of design. In addition, a hypothetical design is often developed by a separate architect hired directly by the healthcare provider that is used as a cost model for funding and financing purposes.

The second, and somewhat less bureaucratic delivery method is called ProCure21+, where the project is awarded to one of six pre-qualified general contractors. The award is based strictly on the qualifications of the project team, as the construction unit cost and hourly rates are already pre-agreed during the pre-selection process. In both instances, the healthcare providers enter into a design build agreement with the general contractor who becomes the primary contract holder responsible for the project design and delivery. In the PFI delivery method, the general contractor also remains the facility operator for a period of 30 years. This delivery method prolongs the contractor’s responsibility for the facility maintenance and performance beyond project completion and makes them an invested partner.

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Manchester PBT Centre was procured using the ProCure 21 delivery method. Due to the extensive proton therapy experience, HKS was a front contestant and an obvious choice for many general contractors, and ultimately Christie NHS Trust. HKS was contracted by InterServe Construction, an international general contractor with presence in 40 different countries. InterServe Construction also retained the structural, mechanical and electrical consultants under a separate contract. I found this very interesting and beneficial in many ways as it reduces the architect's overall responsibility and liability in comparison to the United States where the architect is contractually responsible for all design consultants. As a result of the project team organization and contractual relationships, the design meetings are facilitated by the Contractor and attended by the construction team, the design team, cost consultants and the owner's representative called "Trust". The team works in a very collaborative fashion without tension between the builders and the design team, something commonly experienced on the US projects.

However, this does not mean that the demands on the design team are any less. The check and balances and cost control appear to be micromanaged on a weekly basis for the duration of the project, requiring additional management time. Although the project has been under design for two years now, the design team continues to design and coordinate with two different equipment vendors that are still taking part in a competitive bid process. Since the design of proton beam facilities is heavily driven by the equipment requirements that are specific to each vendor, this is essentially requiring two different designs and Revit models to be developed concurrently until the final equipment vendor is selected just three months before the end of the Construction Documents phase. While the hourly fee warrants fair compensation for the design team efforts, it does not reduce the design challenge or the amount of redundant work.

The healthcare design firms in the UK often have to make a choice between working directly for a healthcare provider to develop a hypothetical design and prove the feasibility of a project that never gets built or to work under a general contractor in a design build scenario and deliver designs that are actually executed. The only other alternative is to pursue the remaining 20% of privately funded healthcare work where the competition is higher and the volume of work significantly smaller. Our London office has been very successful in maintaining good relationships with general contractors and marketing our worldwide resources and expertise in healthcare design. Therefore, our London office is experienced in both delivery methods described above. While Manchester PBT Centre was awarded as a ProCure 21+ project, the Liverpool Hospital currently in design is an example of a PFI delivery method. The London office is currently pursuing another major PFI healthcare project which is in the last stage of the design competition.

Lesson Learned:

  • The healthcare delivery systems practiced in UK appear to get traction in other parts of the world including Australia and US, and could potentially become a precedent and a delivery model for new healthcare trends. In that case, HKS would be in a great position to have the experience and expertise of our London office to implement the new delivery system faster than our competitors.

I would like to thank Paul Sawyers, the Director of Healthcare in our London office, for taking the time to share his knowledge of the complex delivery system with me. I decided to make the most of it by sharing it with the rest of the firm. I have enjoyed being a part of the London healthcare team and having the opportunity to broaden my international healthcare experience.

Posted in Health