09 Nightingale Hospital London
For creating a COVID-19 emergency care center in just nine days
First it was Italy, then Spain. In European hot spots, the novel coronavirus overwhelmed healthcare workers and hospitals in March. Aware of the potential death and chaos in the United Kingdom, a team from the National Health Service (NHS) took just nine days to transform the ExCeL exhibit hall in London, England into a massive emergency medical facility dedicated to treating COVID-19 patients.
The NHS Nightingale Hospital opened with 500 beds on 3 April, with space to scale up to 4,000 beds as needed. Its 80 wards covered 87,328 square meters (104,443 square yards), the equivalent of roughly 12 football pitches.
“The medical intelligence wasn’t clear enough to tell us how the disease would develop,” says Capt. Stuart Silvester, Royal Army Medical Corps, London. “The main risk was that the London health trusts could be overwhelmed with COVID patients, and the rest of the country was slightly behind the curve in terms of disease projection. So the extra COVID beds would ease pressure on the already creaking NHS trusts.”
The project provided a template for other hospitals treating COVID-19 patients in the United Kingdom. And it helped lay the groundwork for other teams around the world rushing to transform spaces—stadiums in Brazil and China, vacant land in the Gaza Strip, a Navy ship in the United States—into field hospitals. Nightingale’s project and design team, including BDP, developed an instruction manual that captured the London facility’s lessons learned. Emergency teams in Canada and Australia were among those that reached out, according to the BBC.
“We shared all the information that we could. We shared all our risks,” Silvester says. “We also sent some of our key NHS leads to go look at the systems that have been built so they could deliver talks on how we built our model.”
The Nightingale hospital ultimately treated only 54 patients in its six weeks of operation, as the spread of COVID-19 cooled in London. But by preparing for the worst, project leaders helped diminish the city’s collective anxiety and demonstrated how pandemic response could combine speed and innovation.
To open the hospital as quickly as possible, the team secured financial and technical support from myriad stakeholders. ExCeL’s owner, Abu Dhabi National Exhibitions Co., donated the space to NHS (which would cost as much as £3 million a month to rent on the open market). The team also brought in soldiers from the Royal Anglian Regiment and Royal Gurkha Rifles to help.
“Military medicine is full of evidence of innovation delivered at speed,” says Silvester. “There is generally a base plan for systems and patient flows, modularity, networked infrastructure and integration of utilities.”
The team put those skills to work, making sure patients on ventilators would also have access to medical gases, for example. Meeting this specialized need required a bespoke medical gas compressor built for ExCeL’s layout—and that required getting the order in as soon as possible.
“While the world was in a pandemic shutdown, every piece of medical equipment was vital to each patient,” Silvester says. “And we were waiting for our share of the medical equipment, as well.” As the team converted exhibition stalls into critical care units, it prevented major delays by identifying and managing risks throughout planning and delivery—which happened for different pieces of the project in tandem.
“It’s called red teaming, where we did mission analysis on everything the NHS wanted to implement, ensuring the correct steps were analyzed and taken, so that all the right systems would work in conjunction with the areas we were working in,” Silvester says.
Managing the contractors, soldiers and NHS staff as one integrated team helped avoid disagreements and delays. “We were bringing companies together that have never worked together before, and sometimes they’re in competition in the construction industry,” he says. “But we did it, conflict-free.”