On every project you will see the words “collaboration” and “joined up working”. In live estates—particularly hospitals and complex commercial buildings—those words are either true in practice or they are not. When construction, MEP and consultancy operate as separate tracks, the gaps show up quickly in noise, dust, downtime and rework.

This article is about what we have learnt from projects where the three disciplines have genuinely worked as one team, and from those where they have not. It is not a checklist, more a set of observations that we now try to build into every new commission.

1. Shared planning beats parallel planning

When construction, MEP and consultancy each build their own programmes then “align” them, the result is usually compromise and confusion. Interfaces fall between the gaps, responsibilities are unclear and any change ripples painfully through multiple versions of the truth.

On the better projects we have seen, there is one planning conversation and one master programme, with construction, MEP and consultancy leads sat at the same table. Logic is challenged from all sides and ownership of key interfaces is agreed early rather than left to the first conflict on site.

2. Design conversations must include people who will build and commission

It is still too common to see beautiful design workshops without the people who will actually build, isolate and commission the systems. In live estates this is especially risky—MEP changeovers, access constraints and sealed zones are design issues as much as site issues.

Integrated teams bring construction managers, MEP supervisors and commissioning engineers into design meetings. They are able to spot clashes, unsafe sequences and impractical access routes long before they are discovered behind a hoarding at two in the morning.

3. One risk register, not three

Separate risk registers for client, main contractor and consultants often hide the same issue described in three different ways. On live sites this makes it harder to see which risks genuinely threaten operations and which are manageable.

Where we have seen better outcomes, there is a single project risk register that all parties contribute to and maintain. Live environment risks—decant, infection prevention, utilities, access—are given the same weight as cost and programme, and mitigation is owned by named people across companies.

4. Clarity on who decides what (and when)

Integrated teams are not about blurring accountability. They work best when it is clear who holds the pen on design, who is responsible for buildability and who signs off risk and change. In live estates the time available for decisions is often short, so knowing where decisions sit is crucial.

On projects that work well, we see simple decision maps agreed early and revisited at gateways. Clinical, estates and operational voices are included where needed, and project teams know when an issue can be solved within the room and when it needs escalation.

5. Shared behaviours matter more than logos

Finally, integrated working is as much about behaviour as it is about structures. We have seen joint venture and alliance arrangements that struggle because people behave as separate companies, and more traditional set-ups that feel integrated because people behave as one team.

The common features are simple: honest conversations about what is happening on site, a willingness to share problems early, and a focus on protecting the live environment rather than protecting individual positions. Those behaviours can be encouraged by contracts and governance, but they cannot be replaced by them.

In short, putting construction, MEP and consultancy in the same room early, giving them shared information and shared accountability, and setting expectations around behaviour makes a noticeable difference in live estates. It does not remove risk or challenge, but it gives everyone a better chance of dealing with them before they affect patients, staff or building users.