The NHS is under unprecedented pressure. Record waiting lists, ageing buildings and rising patient demand mean hospitals must expand and modernise at speed – often while remaining fully operational. This convergence of urgency and complexity underscores why preconstruction has never been more critical. Modernising hospitals isn't simply a matter of creating more space; it's about doing so safely, efficiently and without disrupting the care patients rely on every hour of the day.
The preconstruction phase is crucial in achieving this balance. It brings together detailed scheduling and cost planning with a focus on how construction activity can safely coexist with hospital operations. Close partnership with healthcare teams ensures that works are planned to ensure emergency access is available and any potential disruption is minimised.
By engaging early and building trusted relationships, construction teams can deliver essential improvements efficiently and safely, supporting the continuity of care while modernising the facilities that make it possible.
The rising demand for healthcare infrastructure
The need to modernise the UK's healthcare estate has never been greater. The total estimated cost to eradicate backlog maintenance in the NHS estate climbed to £15.9bn in the 2024/25 financial year, according to the latest Estates Returns Information Collection. Decades of underinvestment, combined with record patient demand, have left many hospitals struggling with outdated buildings not designed for the realities of today's clinical pressures and mounting maintenance backlogs.
The Government's New Hospital Programme (NHP) represents a pivotal opportunity to update the NHS estate, with over £1bn allocated for critical maintenance. While its ‘Hospital 2.0' model aims to streamline delivery and create adaptable, digitally enabled spaces, the wider challenge across the NHS remains the significant backlog of vital repair and upgrade works.
This is where effective preconstruction planning becomes critical. For organisations delivering backlog maintenance, early collaboration with contractors experienced in live healthcare environments ensures issues are identified upfront, disruptions to clinical services are minimised and solutions are shaped around how hospitals actually operate day to day.
By applying rigorous planning and a deep understanding of clinical settings, backlog projects can deliver immediate, tangible improvements for staff and patients - helping to strengthen the estate now, while broader programmes like the NHP continue to take shape.
The realities of live-site construction
Delivering construction projects in live hospital environments also requires a level of precision and collaboration unlike any other sector. Every decision must account for clinical operations: A&E traffic, theatre schedules, patient privacy, emergency vehicle access, infection control and unpredictable peaks in activity mean there is no margin for error.
Seddon's £5m redevelopment at Colchester Hospital demonstrates this in practice. With the site's delivery and loading entrance shared with A&E, the team had to co-ordinate around emergency arrivals, meaning preconstruction planning had to anticipate and co-ordinate around real-time patient arrivals. By working closely with clinical staff, planning was conducted during quieter periods and the project remained agile to accommodate last-minute changes. This approach successfully delivered a 400-square-metre extension to the Emergency Department's Critical Care Unit and a new two-storey entrance, all without disrupting patient care. The result is a modern, efficient space that enhances the hospital's capacity and strengthens its ability to deliver life-saving services around the clock.
Solutions for successful projects
Delivering complex projects on live hospital sites demands more than technical expertise – it requires meticulous planning and strategic foresight. The preconstruction phase is where success is built, bringing together logistics planning, stakeholder engagement and phased delivery strategies that allow construction and clinical operations to work in harmony.
Early collaboration with hospital management and clinical teams is critical. Their insight shapes everything from access routes and infection prevention measures to scheduling work around shift patterns or quieter periods of patient activity. Flexible logistics plans, developed hand-in-hand with those on the front line, ensure that essential services remain uninterrupted while progress continues behind the scenes. By embedding communication and adaptability into preconstruction, contractors can not only deliver projects safely and efficiently but also strengthen trust, turning challenging live environments into opportunities to enhance both infrastructure and patient experience.
Building for the future of healthcare
As the NHS faces growing demand and an evolving landscape of care, the importance of preconstruction has never been clearer. It is the stage where vision meets practicality, where complex clinical needs, safety considerations and operational pressures are translated into deliverable plans.
By investing time in early collaboration, fostering strong relationships with healthcare teams and drawing on real-world experience of live hospital environments, contractors can create facilities that are not only efficient to build but also enduringly fit for purpose. Modernising the healthcare estate is about more than expanding capacity – it's about building environments that support staff and strengthen the resilience of our health service for generations to come.
