Reframing Modern Methods of Construction for NHS Trusts

Understanding What MMC Can Do

One of the biggest barriers to adoption is the perception that MMC means committing to a single construction solution, such as volumetric modular buildings. In reality, MMC encompasses a spectrum of approaches, from volumetric modules and panelised systems to prefabricated structural elements and pre-assembled mechanical and electrical services. The key difference lies in how projects are designed.

Traditional construction approaches typically begin with a bespoke design, which is then interpreted by contractors during construction. By contrast, MMC-led projects start by designing with manufacture, assembly and standardisation in mind, allowing multiple delivery routes to remain open throughout procurement. As James explains, projects designed with MMC principles can still be delivered using traditional construction methods if required. However, the reverse is rarely true. Once a building has been designed purely around traditional construction, many opportunities for off-site manufacturing or componentisations become difficult or impossible to implement later in the process.  Designing with MMC in mind therefore preserves flexibility while unlocking the potential benefits of industrialised construction. This shift is also reinforced by wider government policy. The Construction Playbook explicitly links greater use of offsite manufacturing with improved quality, safer delivery and lower greenhouse gas emissions, while also advocating demand aggregation and standardisation to improve onsite efficiency across public sector programmes, including hospitals. The message is becoming clear: MMC is no longer being framed as an alternative route, but increasingly as a more disciplined and resilient way to deliver public infrastructure.

Moving from Bespoke Design to System Thinking

Healthcare estates projects are frequently approached as unique, one-off exercises. Each facility begins with a blank sheet of paper, even though many functional requirements remain largely unchanged. Yet hospitals contain many elements that are fundamentally repeatable.

Patient bedrooms, bathrooms, circulation spaces and clinical layouts are governed by strict standards around safety, infection control, accessibility and daylighting. These requirements rarely change significantly from one project to the next. MMC encourages a shift toward system thinking, where certain building elements become standardised components rather than repeatedly redesigned features. Instead of starting the design from scratch every time, projects can evolve through the refinement of established components, similar to how industries such as automotive and aerospace develop new products. As James argued, “a car manufacturer does not redesign every component for each new model; it refines existing systems and improves them over time.”

This approach is increasingly being formalised through pattern book and “kit of parts” strategies. As James noted, the aim is not to standardise everything, but to be deliberate about what should be fixed and what should remain flexible. Certain elements can be treated as repeatable components, providing clarity and consistency across projects, while other aspects, including how a building responds to its site, context and patient experience, remain open to design. In many ways, this thinking already exists within healthcare design. As James pointed out, “we already accept that a door is a repeatable component within a building, it’s a known, standardised element that doesn’t constrain design.” The shift now is one of scale: applying that same logic to larger components and patterns, from clinical rooms to building systems, in order to improve efficiency and coordination.

This approach does not eliminate architectural design and creativity. Instead, it allows design effort to focus where it adds the greatest value: clinical flow, patient experience and site integration. By separating standardised components from site-specific design, healthcare organisations can deliver buildings that are both efficient and responsive to local needs. This is particularly relevant in the current healthcare policy context. The New Hospital Programme and its Hospital 2.0 principles further reinforce the role of MMC, standardisation and design for manufacture and assembly as a route to accelerating delivery while improving consistency and efficiency. That message should matter not only to major national programmes, but also to Trusts delivering smaller or medium-scale projects within live estates.

Why Traditional Design Processes Must Change

Adopting MMC effectively requires more than selecting different construction techniques. It also requires a shift in how projects are planned and developed. Traditional design processes, including the widely used RIBA stages, were developed around conventional construction sequencing. These frameworks often allow critical design decisions to remain flexible until relatively late in the process. MMC, by contrast, depends on earlier design certainty. Key elements such as structural grids, service zones and interface tolerances often need to be agreed earlier in order to enable off-site manufacturing and coordinated assembly. While this can initially feel restrictive to organisations accustomed to keeping options open throughout design development, the benefits are significant.

This shift is already being reinforced by changes in both regulation and industry practice. The introduction of the Building Safety Regulator under the Building Safety Act 2022 has fundamentally reshaped how higher-risk buildings are designed and approved in England following the Grenfell Tower fire. Through a staged gateway process, design must now be far more developed, coordinated and evidenced before construction can begin, effectively enforcing a “design then build” approach and limiting the ability to carry unresolved decisions into the construction phase. By resolving complexity earlier, projects can move forward with greater programme certainty, fewer redesign cycles and reduced construction risk. Industry guidance on design for manufacture and assembly DFMA suggests that where these principles are embedded early, projects can achieve significant efficiency gains, with reported programme reductions of 20–60% and substantial reductions in on-site labour requirements. In effect, MMC shifts effort forward in the project timeline, allowing problems to be solved in design rather than on site.

Improving Safety and Control on Live Hospital Sites

One of the most compelling benefits of MMC in healthcare lies in its ability to reduce disruption and risk within live clinical environments. Hospital construction sites are uniquely complex. Work often takes place adjacent to operational wards, emergency departments and diagnostic services where safety, noise control and infection prevention are critical considerations. MMC can significantly reduce these risks by moving much of the construction activity away from the hospital site entirely.

When building components are manufactured and pre-assembled in controlled factory environments, the work carried out on-site shifts from traditional construction to installation and assembly. This change in activity has important implications:

• Fewer personnel on site, reducing congestion and safety risks
• Higher levels of supervision, as installation teams are typically specialist crews
• Reduced variability, as factory-controlled processes ensure consistent quality
• Shorter construction periods, limiting disruption to clinical operations

In some cases, building elements can even be fully assembled and tested in a factory environment before being delivered to site for installation. According to James, this level of pre-assembly can allow buildings to be installed in a matter of weeks rather than months, with site activity limited to lifting operations, structural connections and final commissioning. For NHS Trusts managing projects within operational hospitals, this reduction in on-site activity can significantly improve site safety, logistics and operational continuity.

However, it is also important to note that in a live hospital, site safety is not only about workforce injuries; it is also about patient safety, infection prevention and control, and operational resilience. NHS infection-control guidance sets a high bar for managing dust, debris and airflow pathways during construction or refurbishment. Measures such as critical barriers, negative pressure, HEPA filtration, controlled waste containment and staged clinical cleaning are essential, but they also become more complex and more failure prone as the volume of on-site cutting, wet trades and trade overlap increases. In that context, one of MMC’s most underappreciated benefits is risk compression: fewer worker-hours, fewer interfaces, fewer hotspots and fewer unknowns in the live environment. This matters because it aligns directly with the everyday reality of NHS estates teams: constrained sites, critical adjacencies, patient and ambulance routes, infection prevention requirements and the reputational risk that comes with disruption to live services. For many Trusts, the strongest case for MMC is not simply that it can be faster, but that it can reduce the operational burden of building safely in places where disruption carries much greater consequences.