The NHS is undergoing a period of immense and controversial change. While politicians and medical unions heatedly debate its future, estates managers are being asked to save money, save energy and cut carbon. All on tight schedules, tighter budgets and while navigating policy.
Like most public sector organisations, the NHS is asked to cope with huge upheaval with each government. Its size means that the complexities of policy are amplified when staff attempt to implement changes.
New Labour’s policy of replacing the NHS estate via private finance initiatives (PFIs) was waylaid by change of government and recession with the consequential drying-up of funds. Professor Alan Short, who lectures on architecture at the University of Cambridge and is one of a group of academics researching the difficulties involved in making the NHS estate sustainable, believes that “a number of trusts have been stranded” as a result.
So the NHS has had much thrown at it in the way of policy and funding changes in the past. But in the next three years it is being asked to save £20bn. Or 4-5% of its total budget year-on-year. With an annual energy bill of £500m and a CRC league table to think of, NHS estates are a prime target for money-saving measures.
Balancing restrictive bureaucracy with challenging targets is a demanding task. The NHS Sustainable Development Unit (SDU) recommends that “all new buildings and major refurbishments should be designed to withstand significant climate change and weather extremes”.
It continues: “NHS buildings must be designed to promote sustainable behaviours in staff, patients and visitors and they must be adaptable to support change towards low-carbon pathways.”
The SDU’s Karl Heidel admits that newbuilds find it easier to meet energy-saving targets than older stock undergoing retrofits. He adds: “New buildings of course have to come up to exacting low carbon standards and most, if not all, NHS organisations take the commitment to design low-carbon buildings seriously.”
Short says: “It is the biggest estate in Europe, maybe in the world. It’s absolutely vast. But it is surprising how little you have to do to these hundreds of buildings. The first lesson is not to throw away older buildings with thermal mass and clever ventilation systems.”
He adds: “Our [group of researching academics] particular interest is to see how the buildings will perform through the next century. Climate is set to change markedly. It is very difficult to cool huge public buildings without using ridiculous amounts of energy. [It requires] three times as much energy to cool as to heat.”
Current common retrofit measures include focusing on local user controls for heating and cooling and improving system controls and operation, installing insulation and replacing existing glazing or adding secondary glazing.
Imperial College Healthcare NHS Trust has encountered similar problems to many NHS organisations. Its director of estates services, Phil Hudson, thinks the trust’s main problems are twofold. He says: “[Not] knowing the long term future of some parts of the estate … prevents investment in projects which have a payback of greater than say three to five years.”
There is then the eternal problem of obtaining funding. He adds: “As a trust it [Imperial] has limited capital funding and relies on borrowing from schemes such as SALIX. When it becomes a Foundation Trust this situation should improve.”
When retrofitting, Imperial chose to focus on lighting, variable speed drives, building management systems (BMS) and reduced hot water storage via plate heat exchangers. The trust improved its monitoring, targeting and user awareness and feedback.
Behavioural change is also key to reducing energy usage and carbon. However, this prevents challenges due to the ever-changing occupants of a building. Unlike almost any other workplace, as well as a regular set of staff, patients and visitors also impact a building’s energy performance.
Some NHS bodies have begun broadcasting energy usage figures to screens across a site so all occupants, rather than just staff, are aware of how much energy they are consuming. Despite work to lessen energy use, the SDU states that if an NHS organisation uses renewable energy it is often used in addition to the “normal” supply requirements.
Heidel emphasises the importance of measuring energy usage before upgrading a building. He says: “In simple terms, put as much effort into monitoring and targeting as possible. If managers aren’t monitoring their buildings closely then there is no way they can minimise energy loss.”
Short also believes that thinking before taking action is the key to making savings. He says: “You achieve these huge reductions by interfering with the fabric of buildings, not by gluing on lots of fancy renewable technologies. Policy makers think that PV cells are the solution – once you reduce energy [requirements], then yes.”
Sustainability may be key to achieving huge budget reductions, but installing green technologies and infrastructure can represent massive capital outlay. Balancing future saving with current expenditure will always present a challenge.
Heidel says: “Some organisations may see a reduction in funding as a threat to carbon management programmes - this in fact is viewing the situation from the wrong angle. Reducing emissions means saving money with the potential of pumping those savings into front line care. Even if the savings aren’t reinvested, at least savings will have been made.”
This article originally appeared in the May/June issue of Greenbuild. For a free subscription, please click here.
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