World’s First Prefabricated Hospital

IN THE 1850s BRITAIN had slid into the Crimean War with trench warfare conducted in appalling conditions.

Health and hygiene had been pushed aside, with exposés featured by The Times triggering public outcry and the dispatch of Florence Nightingale to aid the troops. Ten times more soldiers were dying from diseases such as cholera and dysentery than from battle wounds.

Responding to ever increasing demands, the War Office commissioned in 1855 Isambard Kingdom Brunel to design the world’s first prefabricated hospital. Within a single month, a detailed design had been produced and a prototype constructed.

Components were swiftly manufactured to Brunel’s specifications in Gloucestershire, then shipped to Turkey for erection. Supervised by a resident engineer, the frame was erected by 18 skilled workmen from England; the balance built by an unskilled workforce. Within six months the new Renkioi Hospital could accept 500 patients, 2,200 within the year.

Renkioi was technically pioneering; adopting wood as the main material, it applied a design for manufacture and assembly (DfMA) approach. The structure had been optimised for manual handling, capable of being carried by two men, with minimal construction detailing and site work in mind.  Plumbing connections, for example, were push-fit to negate the need for soldering

Frame modules were standardised, with ward buildings arranged off a central core corridor to enable indefinite extensions, achieving any desired size to fit any suitable size. Each module (except those designed for stores) was designed to be self-contained both in its permanent and transported state. Kits of parts included drainage, pumps and ventilation systems and a small amount of surplus materials and tools as part of the robust logistical contingency planning.

More significantly, form followed function – Brunel’s first consideration the comfort of the patients.

It may seem a strange principle to enunciate as the very first requirement in a hospital that is should do the sick no harm.

Florence Nightingale attributed the dismal outcome of hospital admission to overcrowding, lack of space per bed, poor diet, foul air and limited ventilation and light. Through considered design Brunel addressed each of these issues, including introduction of mechanical ventilation.

The strength of his plans, meticulously executed, were that they encouraged return to health and discouraged the spread of infection. At the Barracks Hospital, Scutari the mortality rate was 42%. At Civil Hospital, Renkioi, only 3% died.

Renkioi Hospital is often remembered as one of the first large prefabricated building projects and the first prefabricated hospital. Largely forgotten, it was more than this. Renkioi wasn’t just a better project – it delivered a dramatically better outcome.

Modern methods of construction isn’t always a modern as it implies. And whilst focus often gravitates towards speed, efficiency and productivity its not only about doing things better. Whether it be evidenced by history or now at this critical time, real impact is achieved by doing better things.

Adapted from  Renkioi: Brunel’s Forgotten Crimean War Hospital by Christopher Silver (2007) and the Papers of Sir John Hall

Jamie Hillier


With a penchant for tweed and jackets with leather arm patches, Jamie began his career as a quantity surveyor, before climbing the ladder to lead major projects for a Tier 1 contractor.

Eventually expanding his book collection beyond copies of SMM7, Jamie has interest in a broad range of subjects linked to delivering better outcomes for society and the environment.

His strategic insights on MMC and behavioural science have made their way into numerous government, industry and academic publications, including the Construction Playbook, Transforming Infrastructure Performance Roadmap to 2030, the Platform Rulebook and the RIBA DfMA Overlay.

John Handscomb


Construction is in John’s blood. Learning from his father who was a planner and project manager, John began his career by working on some iconic projects in both the public and private sector.

As a procurement expert and integrator of new ways of working, John has pioneered the integration of platform principles, DfMA processes and supply chain within over £5bn projects in the last 15 years, for some of the largest building programmes in the UK. Despite his considerable expertise, John keeps it simple, communicating complicated ideas with ease and helping to equip the industry with new knowledge and skills.

Outside of Akerlof, John enjoys his executive role with technology start-up ScanTech Digital, spending time with his family, taking trips down the football, playing a bit of golf with friends and the odd pint. 

Our name is shared with George Akerlof, a Nobel Prize-winning economist.

His seminal paper, Market for Lemons, demonstrated the devastating consequences of making decisions under the conditions of quality uncertainty and unequal information between buyers and sellers, increasing the chance of buyers ending up with a ‘lemon’.

This 50-year-old concept continues to retain parallels within the construction industry.

Through our insight and experience, we can rebalance this information asymmetry on behalf of our clients, levelling the playing field to deliver better outcomes.