On a very hot, sunny day in early July, Health Estate Journal drove to John Radcliffe Hospital in Oxford to visit the site’s new six-storey Surgical Elective Centre (SEC), which has been designed and constructed by Modern Methods of Construction (MMC) specialist MTX for Oxford University Hospitals (OUH) NHS Foundation Trust.
Occupying a former car park, the 14,500m2 SEC was constructed using 365 bespoke, precisely designed steel structural modules, manufactured offsite and assembled at John Radcliffe Hospital between July and September 2025 over an eight-week period, effectively creating a weatherproof, ready-for-fit-out, six storey clinical building (including a sub-basement) in less than three months — an impressive feat. Indeed, the MTX team proudly point out that, a mere 10 months prior to our visit, there was nothing on the site at all.
The SEC is the latest project MTX has completed at John Radcliffe Hospital. Previous builds include the five-storey, 5,450m², 48-bed Oxford Critical Care (OCC) unit, comprised of 148 modules, which was completed in 2022.
On the day of our visit, the SEC — which is due to admit its first patients this autumn — was a hive of activity, as specialist teams worked to fit out the surgical floors and make the Centre ready for patients and staff, as well as continue construction on the raised three storey walkway that will link the SEC with the rest of the hospital. Donning hard hats, hi-vis vests, and safety boots, HEJ had the pleasure of a guided tour of the build courtesy of MTX’s project director Adam Robertson, and marketing manager Lizi Membery.
A surgical model for the 21st century
The John Radcliffe Hospital sits on a sloping site, and the land earmarked for the new Surgical Elective Centre was no different. MTX quickly realised that this offered an opportunity to create a sub-basement under the SEC; one that could be incorporated into the progressive surgical workflow model that MTX and OUH wanted to implement. Also of note is the height of the building: the six-storey SEC is nestled amongst a spread of older one, two, and three storey buildings, constructed when space was at far less of a premium than it is today.
The new SEC has been designed to expand surgical capacity in the Oxford region and, specifically, to reduce waiting times for elective surgery — which is to say, planned, non-emergency surgeries that have been scheduled in advance. Therefore, in creating a space that will offer cutting-edge, world-class surgical procedures, MTX and OUH also wanted to showcase an innovative surgical workflow — inspired by a number of fact finding visits by MTX and the Trust to hospitals in the United States — which combines an efficient approach that sets the standard for a surgical model fit for the 21st century while still keeping patient care and wellbeing at its core. The latter is, of course, key. As MTX puts it: ‘Clinical specialists have been involved in the design of the building from the outset to ensure the efficiency of the patient flow and an enhanced the patient experience in a calm and welcoming environment’.
Level One (the ground floor, such as it is, given the gradient of the site) boasts seven Operating Theatres that will primarily be used for vascular, spinal, neurology, maxillofacial, and other specialist surgeries. Across the hallway from these ORs are a row of generously-sized ‘medipods’ — all-in-one patient rooms that are integral to the surgical model being implemented at the SEC.
Under the ‘classic’ NHS model, where a patient comes to a hospital for a surgical procedure, their time before and after their operation would see them moving through a series of rooms. As Adam Robertson explains to us, historically, a patient would first find themselves in an admissions area, before then being moved to another room for their anaesthetic. From there, they would be taken to the OR, after which they would be taken to first stage recovery, then to second stage recovery — where they would awake from the anaesthesia — then be taken to a discharge lounge, before being sent home. While this may be how things have been done since the NHS was established almost 80 years ago (when the population of the UK was barely 45 million, rather than the 70 million of today), it represents an inefficient approach that a health service struggling under the weight of waiting lists and ever-increasing patient expectations can ill-afford. So, at the SEC, rather than build a series of rooms that, for most of the day, will remain empty, patient care pre- and post- surgery takes place in the same room in most cases.
As Adam puts it: “Nobody’s in the discharge lounge at the start of the day; nobody’s in first stage recovery at the start of the day; nobody’s in the admissions lounge at the end of the day — so it’s wasted space… [A patient spends] something like two and a half minutes in an anaesthetic room. You’re building an 18m2 room for two and a half minutes — why are we doing that? The room should be something that’s multi-use.
“These rooms are your admissions, your discharge lounge, first stage recovery, second stage recovery, your anaesthetic — they are everything. So, you come in, you go into a medipod, you get prepped for surgery, you go and have your surgery, you come back to a medipod, you recover, you go home or, in a few cases, to a ward.”
Using space in this way has meant that, instead of building a series of patient rooms, MTX has maximised the OR space — fitting seven ORs into a space that, historically, might have contained half that number — just one of the many ways in which the collaboration between MTX and the Trust have worked in partnership to construct a 21st century surgical building that looks to the future instead of simply doing things the way they have always been done.
More, and larger ORs
Fitting a higher number of ORs into the space has not meant any compromise in terms of OR size. Indeed, thanks to the way the SEC has been designed, the seven ORs on Level One are significantly larger than the UK average (which sits at between 55m2 (the minimum required) and a modern standard of around 62m2), coming in at between 70-80m2.
Two of the ORs on Level One are cutting-edge, hybrid ORs that combine ‘conventional’ surgical suites with medical imaging equipment, allowing surgeons to carry out imaging, biopsy, diagnosis, and surgery in the same room — again removing the need to transport a patient between a series of different rooms. In fact, clinicians will be able to adopt a fully hybrid approach, with angiography and fluoroscopy capabilities. While not CTs or MRIs, the technology in these theatres will enable uploading of CT/MRI imaging and will be able to perform 3D CT-like imaging. These functionalities aim to reduce patient and staff radiation doses. Furthermore, the ORs incorporate the Tegris OR Integration platform (supplied by Swedish company Getinge AB) which will enable clinicians to remotely view and collaborate on surgeries from anywhere in the world, and adds another dimension to John Radcliffe’s functionality as a teaching hospital.
The instrument and clinical waste workflow
Another key aspect to the surgical workflow at the SEC concerns the supply, storage, and output of surgical instruments, supplies, and waste. The new Sterile Services Department will be located in the basement (Level 0) and is another area where, rather than do things as they have always been done (to wit: giving over significant floorspace to the storage of large stocks of clinical supplies — bulk-sourced by a procurement department — that may or may not get used before they expire and need to be disposed of), OUH and MTX have instead looked at the way things are done in the United States — particularly at urban hospitals in cities such as New York, where, as is in the case in cities such as Oxford, space is at a premium.
Instead, at the SEC, aside from a small store of essentials, everything needed for the day’s surgeries will be supplied to the SEC on the day as specified by a surgeon preference card that will list the surgical instruments and implants required, suture materials, and other supplies, as well as details of any preferred surgical techniques and other important information.
Clean instruments and other clinical supplies will then be brought in via the building’s sub-basement and transported via a dedicated ‘clean’ elevator to the relevant floor. Under the auspices of a Surgical Navigator — a key member of staff who sits between off-site and on-site operations at the SEC — surgical carts containing the surgical instruments and clinical supplies needed for a specific operation that day will be placed in the sterile corridor adjacent to the OR, ready to be wheeled in and used accordingly, with some operations requiring multiple carts. Once the surgery is completed, the carts containing the ‘dirty’ materials and clinical waste will be wheeled into another corridor, then taken either off-site for disposal or back to the SSD for cleaning, again via an elevator and the sub-basement.
As with other aspects of the SEC, this workflow method seems like a sensible, even obvious way of doing things in an efficient, effective way — albeit at odds with a more ‘traditional’ surgical model.
MMC
Prior to our visit, while I was unsure what to expect of a building constructed from prefabricated modules, I had imagined that there would be obvious ‘joins’ between modules, or that one part of the SEC would be indistinguishable from another.
In reality, walking around the SEC, knowing that the building was made from a collection of modules, I found it impossible to see any joins, or indeed to distinguish, for example, Level One of the SEC, with its generously sized medipods, wide corridors, and expansive ORs, from a new hospital building that might have been constructed using traditional construction methods over a much longer timeframe.
Each floor of the SEC is comprised of between 70 — 75 precisely manufactured steel-framed modules, placed by cranes with up to 500-tonnes capacity and bolted together with steel bolts, before concrete flooring is either poured in over a mesh frame, or placed in the form of slabs. Lift shafts and stairwells are precast.
Far from being a series of identikit boxes, the MTX team tells me that every component module is bespoke. However, as the modules are, to all intents and purposes, essentially empty shells when they are lifted into place, the process of designing the building by no means stops once the modules are in position. Indeed, the function of Level Four of the SEC was still under discussion at the time of our visit, and if, in the future, a change of use is desired by the Trust for any of the floors (or parts thereof), the modular construction allows for this.
As Adam puts it: “None of these partitions are load bearing. So, if they wanted to rip this back to a shell and refit it in 25 years, they can do that.”
In readiness for its upcoming opening later this year, Level One of the SEC is in an advanced stage of fitting out, with its ORs already host to some highly impressive, high-tech kit. Climbing the stairs (no mean feat in full safety wear as noon temperatures in Oxford threatened to top 30°C), we reached Level Two (i.e. the first floor of the SEC), which will also see the installation a further five ORs and one procedure room, together with more patient medipods in this case primarily for thoracic, plastic, endocrine, breast, ophthalmic, urology, and gynaecology surgeries. At the time of writing, Level Two is due to open in 2027.
Level Three, meanwhile, contains all the plant for the SEC — comprising of multiple air-handling units and all the other electrical and mechanical equipment needed to maintain the optimum functioning of the building. MTX have also built an electrical substation a short distance from the SEC (the second the company has built on the John Radcliffe Hospital site), and power (all 3,200 amps of it) flows into and around the building via impressively massive (and extremely heavy) busbars — solid metal strips that are used to gather and distribute large amounts of electrical current, significantly reducing the number of cables used across the SEC.
Closing thoughts
What MTX has achieved at John Radcliffe Hospital with the SEC is seriously impressive. In creating a modern surgical facility in such a short amount of time, to an extremely high, bespoke spec, the company has set a template not only for how NHS Trusts should be expanding and upgrading their estates, but also how they should be approaching elective surgical care in the 21st century. We left Oxford with the hope that other NHS Trusts — and indeed the government itself — will take notice of what can be achieved in a relatively short space of time with a combination of modern construction techniques and some innovative, future-facing thinking.