A healthcare first on so many levels

The new Proton Beam Therapy (PBT) centre at The Christie NHS Foundation Trust in Manchester is not only the first to be built in the UK, it is also the first PBT centre in the world to achieve a BREEAM Excellent rating. It has also won multiple awards for its design (around the equipment it houses and the patient experience) by architect firm HKS.

One of the most complex and precise projects in the history of the NHS, it was delivered on budget and completed ahead of programme by main contractor Interserve who, due to the lack of previous UK PBT examples, travelled more than 20,000 miles around the world to visit 10 such centres and equipment vendors to learn best practice.

The Kawneer systems which feature on its five storeys are the manufacturer’s traditional stick-frame AA 100 zone-drained curtain walling, which has 50mm sightlines, and thermally-advanced AA 720 top-hung casement windows which feature a BRE Green Guide ‘A’ rated frame.

Christie’s was selected by the Department of Health as one of two providers of the service, together with University College London Hospitals NHS Foundation Trust. Although procured at the same time, Christie’s chose to deliver the construction phase through the Procure 21 framework and Interserve were appointed as its preferred construction partner at an early stage.

Minimal disruption

Funded by a £250m Government investment in conjunction with the second PBT centre, the Manchester site will treat annually up to 750 patients with complex cancers who would previously have had to go abroad for treatment, to typically Switzerland and America. Given this treatment can last several months, this was very disruptive to patients’ lives, and those of their families, and hugely expensive to the NHS.

Conventional radiotherapy uses lower-energy photon radiation to destroy cancerous cells but surrounding tissue can also be damaged. In higher-energy proton therapy, the beam stops once it hits the cancerous cells, resulting in less damage to surrounding tissue – particularly important for children.

However, the particle accelerator used to deliver the Proton Beams is as energy-hungry as its sounds and requires a significant amount of power to generate the high-energy beam. This demanded a dedicated electricity sub-station which provides the same amount of power needed to run the nearby Trafford Industrial Park.
The power generated results in similar levels of waste heat but reclaiming this has made a significant contribution to the BREEAM rating.

Future-proof design

Modelled using 3D technology and BIM, which is believed to have created theoretical savings of around £1.95m through early clash detection, the 15,000m2 building features three 360° rotating gantry rooms as well as a research room, CT and MRI imaging facilities, patient reception and public space, and planning and support accommodation.

It is designed to be future-proofed – the research room can be equipped with a treatment gantry, the structure to support the equipment
that delivers the treatment, if required.

Its list of technical features is almost as extraordinary as PBT itself. To contain the radiation, the concrete walls are up to 6m thick. The building incorporates 20,000m³ of concrete and 1700 tonnes of reinforcement, including steel bars up to 100mm diameter. Through this, 10km of services pipework has been threaded. The concrete itself weighed 48,000 tonnes, the same as two aircraft carriers, with the biggest single pour in a day being 648m³, the same as 105 concrete wagons.

All of this was conducted in a suburban residential area, on a restricted site, and adjoining live hospital buildings at the UK’s busiest cancer hospital creating immunosuppressed patients.

Patient experience

HKS said: “From the outset, the design approach was to focus on patient experience. Various measures were applied to create a warm and inviting space, aimed to reduce fear and anxiety. Natural daylighting and landscaping were given high priority, as well as a sense of community amongst the building’s users. The waiting spaces were positioned on external walls and courtyards, and the main waiting area designed as a winter garden, integrating light, vegetation and social interactivity.

“Given the shallow bedrock and water table, the large three-storey concrete structure of the treatment block was placed at grade and is situated in a dominant position near the hospital main entrance. This provided an opportunity to announce the facility’s importance to passers-by, so signage, feature lighting and quality cladding materials were used to showcase the building.”

Life-changing treatment

Lead Radiographer Hazel Pennington added: “Who would have thought as a student radiographer that 25 years later I would be discussing the logistics of the crane size needed to get a 90-tonne cyclotron into place and how we needed part of the external wall removing on the first floor to get the MRI scanner into place as it was too large for the corridors? I now know what a crane oversailing license is and that a joggle joint ensures each concrete element locks together securely to prevent radiation leakage at stop ends. I spent many an hour with architects, engineers, the construction team and designers.

“But one of our five-year-old proton patients on his first visit said the centre was the ‘best place ever’ and he couldn’t wait to come back next week to show his mum!”

Jason Dawson, Director of capital, estates and facilities at the Christie NHS Foundation Trust, said: “We are delighted to be able to offer this life-changing treatment to patients. The delivery of this facility has been one of the most complex and precise projects within the NHS.”

Manchester’s new PBT centre won Best Procure project in the BBH Building Better Healthcare awards, Building of the Year by Greater Manchester Chamber of Commerce, and North West Building Project of the Year in the Constructing Excellence awards delivered with the BRE.