This project was complicated by the existing hospital on the site remaining open and functional during the construction period.  Detailed planning with the stakeholders ensured the demolition and the construction was undertaken with no unplanned disruption to the hospital’s operations. The extension to the dining room was completed without interruption to this facility. The works were carried out over and around the existing facility without undue interruption to its operation.  The piling for new support columns was carried out with restricted headroom, while the new structural steel was erected in position through the existing building.  The works have been finished to a high standard within a difficult working environment.