Operating on the Heart of the Hospital

Read More

We are delighted to introduce Professor Phil Begg who recalls his experience of the Royal Orthopaedic Hospital Birmingham modular Operating Theatre and Ward facility. The complex consists of 4 Laminar Flow Operating Theatres and a 20-bed ward, all delivered using industry-leading modular construction techniques and was handed over to the Trust on December 14th 2020.

With over 40 years of experience in the NHS, a Clinician, Clinical Researcher and Academic, and as the Director of Strategy and Delivery for one of the most established hospitals in Britain, I think you can safely say that I’ve committed myself to a life of learning.

This last year, the curve may have been steeper than most; the only difference as I write this today, is there has seldom been a time when our health and well-being has been the top of everyone’s agenda – ironically, if you work in the NHS, there is never a time when it isn’t.

Now I’m remarkably fortunate, the very place where I work is a Grade 2 Listed Building, steeped in history; once owned by the Cadbury family, this fabulous 11-acre site has successfully brought together a number of Orthopaedic Hospitals which have been in existence for a staggering 203 years.

With that history, naturally comes the design and architectural challenges of facilities which, let’s just be polite and say, were very much ‘created for their time’, grown organically and spun-up-as-and-when they were needed from 1907 to 1990. Fast-forward to today and when we were faced with the necessity of creating a new facility at the ROH, that design legacy cocktail presented some very real obstacles.

Pretty close to the top of the list, is the way the Operating Theatres are built, which is essentially in clusters of three and each cluster run by a shared plant and machinery; so, if anything breaks, you instantly lose all of them. Being a small but very productive Hospital that focuses just on Orthopaedics, the productivity and financial impact of losing three Theatres is significant, to say the least – but equally not an isolated issue.

The new facility was planned to be set at the very centre of the Hospital where it had the potential to cause the greatest level of disruption. Someone (it may have been me) coined the phrase that we were essentially performing heart surgery on our own building. Adding to its uniquely awkward position, you have the Theatre complex on the right-hand side, the Ward Blocks straight ahead and to the left, the Residency and Out-Patient Department, all surrounding the very area we needed to replace.

All we had to do was get permission, remove over a thousand tonnes of earth, ferry huge lorries and five hundred tonne cranes, in-and-out of a small kidney-shaped car park and then build four new operating theatres and a twenty-bed ward at the heart of a working hospital – Oh and without causing any disruption.

As a consequence, it wasn’t long before the option of traditional construction was eliminated. Along with a shopping list of logistical challenges, it became abundantly clear that route could also take anywhere up to two years and the costs were simply implausible.

Now, whatever your experience of modular buildings, I can tell you they are not the same animal they once were. In fact, if you’re lucky like we were and meet a group of people who genuinely put the patient’s recovery at the centre of their designs, then you are essentially presented with a blank canvas to create a quality, leading-edge (and indeed a more versatile) facility than any traditional build.

When we met the team at ModuleCo, we already knew they had a healthy track record and history for providing premium healthcare facilities and modular buildings to the NHS but what set them apart was their level of credible confidence in approaching a project of this complexity.

There was, however, also the issue of money…not only is the NHS under exceptional pressure this year, with Capital Expenditure being squeezed from all angles, this was not going to be an easy ask, but together with the team at ModuleCo Healthcare, we agreed a two-phase approach where we could effectively lease the facilities by leveraging revenue generated by the Hospital over a 10-year period.

And it was genuinely that simple, we had ‘zero’ capital expenditure on ‘day one’ and a clear path forward to build two state-of-the-art Operating Theatres, Anaesthetic Rooms, a six-bed Recovery Unit and half of a 20-bed Ward attached to our existing Theatre block.

Together as a team, Phase One of the project was delivered on time, including two premium Theatres, twelve beds on the first floor (two-four bedded bays) and four single rooms and with little-to-no-disruption to the Hospital at all, which to this very moment, I still view as a remarkable accomplishment by everyone involved.

Within a matter of weeks, Phase One was so successful that we initiated the launch of Phase Two, so as of 14th December, we have four brand new, state-of-the-art Theatres, a twenty-bed Ward with eight rooms (in two blocks of four) and the remaining twelve are single rooms with their own en suite bathrooms. The facilities are such high quality, they promise to revolutionise our patient experience, bringing me nicely to where this all began.

I fundamentally believe that both health professionals and patients share a common desire and that is faster and successful recoveries. For that to be a possibility, it is essential the stage is set correctly and this is where I believe the Royal Orthopaedic Hospital is the most extraordinary organisation I’ve ever worked for.

From the front-line care-workers to the Chief Executive, you won’t witness any project or initiative embraced, unless we all understand the impact it has on patient care, and with our most recent work, we’ve taken that quality to a different level. Every last aspect of our new facility is designed to support a quicker and successful recovery and I would defy anyone to walk inside and identify them as modular buildings.

The Operating Theatres are so exceptional, we have surgeons quite literally queuing up to use them – The recovery rooms include noise reducing features, regulated temperature, and no sign of the vibrating floors associated with typical modular buildings. Between us, we have created the optimum conditions for the recovery of the patients in our care. That’s something to be proud of but equally, as far as I’m concerned, it’s also just the beginning.

What we have achieved together as team is a genuine sense of accomplishment through authentic collaboration and a blueprint for future projects. Today, when ModuleCo sit in on our project meetings, there are times we agree on all points and days that we don’t, that’s what great partnerships are made of but this much is also true – we are both unrelenting in our commitment to quality patient care and the evidence now sits at the very centre of the ROH for everyone to see.

If this facility was like performing surgery at the very heart of our building, then it is perhaps very fitting that its creation was born from the well-being of our patients, alive at the very heart of its endeavours.


We are proud to announce that this combined ModuleCo, ModuleCo Healthcare and The Royal Orthopaedic Hospital Operating Theatre and Ward project was awarded ‘Off-Site Project of the Year 2020’ at the annual Building Awards. This project also featured as part of our recent Manufactured for Life campaign.


About the Author

Professor Phil Begg is the Executive Director of Strategy and Transformation for The Royal Orthopaedic Hospital Birmingham NHS Foundation Trust. He has over 40-years of experience working in the NHS and is an Honorary Professor in Life and Health Sciences at Aston University. Phil played a critical role in delivering the combined Operating Theatre and Ward complex and kindly authored this article on behalf of ModuleCo.