The building is only half the problem: lessons from RAAC remediation in a live hospital

Most construction programmes start with a site that can be handed over. In a hospital, the space a contractor needs may still be a ward, a clinic or an office supporting an essential service. That changes almost every conversation about time, access and risk.

At Airedale General Hospital in West Yorkshire, the challenge of reinforced autoclaved aerated concrete (RAAC) is well known. RAAC was first identified at the hospital in late 2019, following a national safety alert. Subsequent assessments found that approximately 83% of the hospital estate was built using RAAC, making it one of the country’s most extensively affected hospital sites.

The trust has a wide programme of structural works to keep the hospital operating while plans for a replacement hospital progress through the government’s New Hospital Programme.

The ongoing remediation includes structural interventions and a rolling programme of ward works, which require clinical services to be temporarily relocated. Robertson is the lead contractor on the ward remediation programme, working alongside AGH Solutions, the Airedale NHS Foundation Trust’s wholly-owned subsidiary. Specialist structural engineering expertise is provided by Curtins.

But the reality of delivery is more complicated than the visible engineering work.

My involvement is on the project delivery and programme assurance side, including the accommodation and service reprovision work that makes construction possible. Structural specialists determine the technical interventions, and clinical teams determine what is safe and workable for patients. My responsibility is to help bring those requirements together in a sequence that people can actually deliver.

When people outside healthcare ask about RAAC, they usually want to talk about the concrete. One of the first questions on a live hospital site is often more practical: where does the service go while the work is carried out?

That question has changed the way I think about project readiness. On paper, a service move can look straightforward: identify an alternative space, agree a date, move the team, release the area. In practice, the destination must work as a service, not just as an empty room.

Is there enough suitable accommodation? Do staff have access to the systems and equipment they use? Are telephony, records, storage and patient-facing arrangements covered? Who is briefing the receiving team, and who has agreed that the move will not create a problem elsewhere? A room can be physically available without being operationally ready.

I have learned to treat those details as part of the project, not as matters to tidy up after the programme has been agreed. They can decide whether a move happens at all. And because one decant can release space for another, a small unresolved issue at the start can affect several later activities.

Airedale’s public explanation of its estates programme describes an approach familiar to anyone who has worked in a hospital: one ward is temporarily moved so another can be taken out of use for structural work. That means construction sequencing and operational sequencing are inseparable.

For a project manager, the temptation is to focus on when a contractor can start. I now put equal weight on what needs to be true before the space can be released. Clinical capacity, alternative accommodation, IT arrangements, workforce implications and the readiness of the next receiving area are all real dependencies. A clinical service cannot simply be treated as float in a construction programme.

The same applies to return moves. Practical completion is a major milestone, but it is not the whole story. There may be cleaning, commissioning, operational checks, communication and a carefully managed move back before the next area becomes available. A programme that stops at handover has missed part of the delivery chain.

Another lesson has been about the quality of challenge. When a programme changes, it is easy to ask a contractor to finish earlier.

The more useful questions are specific. Which activities genuinely drive completion? What can be done in parallel? Is the proposed sequence realistic in a live clinical environment? Would longer working hours help, or would they simply introduce new safety, access or operational constraints?

Those questions matter because acceleration has to be demonstrable. There is no value in showing a recovered date if the route to achieving it is not credible. Equally, programme scrutiny should not become the client designing the contractor’s methodology. The contractor and the technical advisers must own their professional responsibilities; my role is to test the evidence, make the dependencies visible and help decision-makers understand the options.

I have become more comfortable with the idea that a carefully tested programme may still be the right programme even when its completion date is not the one everyone hoped for. The important distinction is whether the date has been genuinely challenged or merely accepted.

Working in a hospital also makes stakeholder engagement very tangible. A clinical team may agree with the need for structural works and still be concerned about the effect of moving on patient flow, staff routines or service quality. That is not resistance to the project. It is information the project needs.

I try to approach those conversations as a two-way exercise. The service knows what cannot be compromised. Estates and technical colleagues understand the building. Contractors know the constraints of the work. Programme teams are responsible for connecting those perspectives without pretending the trade-offs have disappeared.

Good communication is equally practical. People need to know what is changing, why it is changing, when it is likely to happen and who will confirm the final arrangements. A broad programme update is helpful, but it is not a substitute for a named contact and a clear plan for those who have to move.

There is much reporting around a programme of this scale, and rightly so.

Yet I have found the most useful assurance often comes down to a few honest questions. What is agreed? What remains an assumption? Which decision is needed, from whom, and by when? What happens to the next activity if that decision is delayed?

That is where governance becomes meaningful. It gives the right people a clear basis for making choices, rather than presenting confidence that has not yet been earned.

Sometimes the best contribution a project manager can make is to distinguish between a date that is planned, a date that is achievable and a date that has actually been authorised.

The biggest change in my own practice is that I no longer see decants, stakeholder conversations and operational readiness as supporting activities around the construction programme. They are part of the delivery strategy itself.

That does not diminish the structural engineering challenge. Without specialist judgement and well-executed works, the programme cannot succeed. But the engineering solution has to be delivered inside an organisation that cannot stop caring for people while the work takes place.

There are lessons here for schools, transport, utilities and any other sector working on ageing assets that must remain in use. Start with the service, not just the site. Test the interfaces, not just individual packages. Challenge the programme with evidence. Keep professional responsibilities clear. And do not call a space ready because it looks empty on a drawing.

RAAC is the reason much of this work is necessary. What it has taught me about delivery is broader: a construction programme is only as credible as the operational plan that allows it to happen.

Dr David Baiyeshea MCIOB is a chartered construction project manager involved in capital project delivery, service reprovision and programme assurance at Airedale NHS Foundation Trust.