Fires, flooding and snow are usually the driver for military aid in the UK but the Covid-19 pandemic triggered one of the largest national military responses – the building of the temporary Nightingale hospitals. Claire Smith reports.
Clinical staff have been described as being on the front line of the UK’s response to Covid-19 but standing alongside them were many thousands of military personnel too.
As well as offering support in clinical roles, this military aid also brought much needed civil engineering skills that were a key factor in ensuring the NHS was not overwhelmed.
“Eight months ago no one had ever heard of Covid-19 and we certainly didn’t have a contingency plan for it,” says Lieutenant General Tyrone Urch, Commander Home Command and Standing Joint Commander.
The purpose of Standing Joint Command (SJC), based in Aldershot, is to co-ordinate defence’s contribution to UK resilience operations in support of other government departments, in this case Covid-19.
“What we did have was a contingency plan for a flu pandemic and a good proportion of that plan turned out to be what we needed to do in response to Covid-19,” said Lt Gen Urch.
SJC received its first order from the government to support the Covid-19 response on 28 February – what is known as an Activation Order.
Following that order, Lt Gen Urch said that 20,000 soldiers – mostly from the British Army – were stood up for the task, which was named Operation Rescript.
On a normal working day, he said that SJC has a permanently established headquarters in Aldershot with about 30 men and women from the Royal Navy, British Army and the Royal Airforce.
“Our job is resilience operations for the UK government,” he noted. “We don’t do anything for ourselves or by ourselves – all of our work is for a specific government department.”
In the summer, Lt Gen Urch said that SJC typically gets called in to deal with wildfires and in winter it might be required to assist with flooding or snow clearance. Often it works for Defra or the Environment Agency.
“We have three regiments with permanent notice to move around the country – two in the south and one in the north – ready to deploy for the government and deal with whatever it might need,” he said.
“On 28 February, I had no idea what 20,000 troops would be needed to do and, in truth, we haven’t needed anything near 20,000 as there have not been mass deployments of soldiers.”
At that point, SJC’s work began in support of the NHS and the Department of Health and Social Care in order to deliver the Nightingale temporary facilities.
“We have a process called MACA – military aid to the civil authorities – and if the government wants our help it must meet a number of criteria set out under MACA in order for us to deploy troops,” said Lt Gen Urch.
“It has to be within the interest of the nation, there has to be a cost capture – we don’t do it for free – and plan to hand over to civilian organisation in due course as we don’t do it forever.”
The first MACA request was for the Nightingale Hospital at Excel in London. “We sat down with the NHS and asked them what they wanted,” noted Lt Gen Urch. “They said they didn’t know and asked what we could do.”
Lt Gen Urch drew on his experience of planning and deploying troops to South Sudan, where he said the model used there was like a milking parlour stool.
The seat is command and control – essentially the leadership – and the three legs are engineers, clinicians and medical staff and general duties staff. “Using that model, we could meet whatever the NHS needed,” he said.
In 72 hours, his troops had built 4,000 beds by working round the clock in three shifts. The NHS also called on SJC to build the wards, deliver the oxygen and plumb in toilets.
Within 10 days the London Nightingale was built through the efforts of SJC, the NHS and civilian contractors.
According to Lt Gen Urch, military support was key because few contractors were able to work at the start of the Covid-19 pandemic in the UK, as they could not get tested and did not have safe methods of working.
As time went by, contractors came online and were available to support the work to build the later Nightingale Hospitals – eventually there were 11 in total around the country – and the need for SJC to support the work waned.
“The NHS learned the lessons and were able to manage the work themselves,” said Lt Gen Urch, who added that the next challenge was to help the government meet the target of 100,000 coronavirus tests a day by the end of April.
Over the Easter weekend, a team from SJC came up with the concept of mobile testing units. They designed, built and commissioned 96 teams to operate the units within three weeks for mobile testing in the community.
Lt Gen Urch said he had been heartened at how society had accepted the military role in the Covid-19 response, which he said was the first national resilience operation that has been done on this scale.
He describes work on Operation Rescript as a success so far with the NHS not being overwhelmed but said there were still 4,000 troops deployed on the mission around the UK and that was not expected to reduce soon, as the need for testing continues.
Claire Smith is editor of New Civil Engineer
Case study: Building Birmingham’s Nightingale
Images of Italy’s hospitals struggling to cope with the peak in Covid-19 infections led the UK to add capacity to avoid the NHS beaming swamped. In major cities throughout the country the drive for more beds resulted in facilities more commonly used for conferences and sporting events converted in a matter of days.
The adaptation was no simple task and the British Army was asked to support the NHS by tasking Military Assessment Teams (MATs) made up of infrastructure experts from 170 (Infrastructure Support) Engineer Group. These teams conducted technical assessments of proposed sites and coordinated work to deliver the Nightingale Hospitals within a short time scale.
Civil engineer Major Angela Laycock led the work on Birmingham’s Nightingale Hospital that saw the National Exhibition Centre repurposed in just eight days, building on experience gained from converting London’s Excel Centre.
“Initially the MAT was requested to attend a site scoping visit with the NHS regional director on Tuesday 23 March,” said Major Laycock. “This visit with key NEC Group technical event management personnel enabled the NHS to look at the size and the scale of the venue and what facilities were available.
“The bed space analysis required a bit of engineering judgement. We knew that the ideal intensive care unit (ICU) bed space would have 16m2, whereas high dependency beds with medical gases would require 13m2 and low dependency ward beds 10m2. However, we didn’t know which type of bed was needed nor what other space was required for corridors, stores, other medical equipment, etcetera.”
The scale of the hospital would place a huge electrical load on the existing infrastructure and early identification of constraints was vital to ensure that the number of bed spaces was not over-predicted.
Detailed site visits took place on 25 March and just two days after that the NHS Clinical Team and military liaison officers (LOs) from the Royal College of Defence Medicine (RCDM) invited the original MAT leader to the Queen Elizabeth Hospital Birmingham, to develop the concept design.
“The weekend was spent drawing up designs for each of the halls,” said Major Laycock.
“The clinical staff explained what additional equipment was required such as wash stations, sluices, macerators and storage areas and these were located around the halls and beds, which were laid out along the rows of underfloor ducting.
“Another site visit was hastily organised which allowed the infection control lead and head of nursing to see the site and agree the plan for locations of facilities.
“The halls were of different sizes but most either accommodated 125 or 250 beds, this was like the modular tented camp designs that the British Army use on operations. The scalable and modular camps are 125, 250 and 500 person camps that just need to be fitted into the space available.
“This idea of having scalable wards of around 25 beds per ward was used to design one of the smaller halls and the requirement could then just be scaled up into the larger halls.”
Interserve was appointed as the main contractor on 30 March and medical gas installers Air Products and Midlands Medical Services were already on site to start the detailed design of the medical gas system, which would be a critical path activity.
“Over the next few days a KPMG project management team and mechanical and electrical services from Hoare Lea took on the project management and detailed design tasks allowing the military LOs to pass on any lessons identified from the Excel build and to also feedback best practices to the other Nightingale Hospital designs which were emerging in Harrogate, Manchester, Bristol and Exeter,” adds Laycock.
Construction on site – with social distancing in place – started on 2 April with people working round the clock. According to Major Laycock, by 6 April the exhibition halls were almost unrecognisable.
“The vinyl flooring had been laid, partitions were in and stores, ablutions, nursing stations and other additional facilities were being added,” she said.
“The scalable modular design had proven to be a success since every row was almost identical making the parts easy to prefabricate and install.
“The military assisted with a section of Royal Engineer heating and plumbing tradesmen and around 60 Royal Gurkha Signals soldiers providing support to the logistics hub by unloading and moving the hospital equipment.
“Additional military personnel were supporting the NHS with military planning officers helping work strand leads; medical officers supporting training and staffing; logisticians aiding the receipt and accounting of equipment; and Engineering and Logistic Staff Corps personnel providing advice in their areas of expertise of engineering and procurement.
“With everyone working together, by the afternoon on 9 April it was starting to look like a hospital and the goal of a 10 April completion date was looking possible.”
The early hours of 10 April saw the electrical and mechanical members of the infrastructure team test the power outage and black start capability should there be a power cut across the site.
All were successful, clearing the way for the final “go live” checks for the new hospital. The build was completed on 10 April – just eight days after construction started.
While the UK appears to be past the peak of Covid-19 infections – and the Birmingham Nightingale Hospital only called into light action – it is likely that the facilities will remain in place ready should there be a second peak to the pandemic.