Save your energy

The built environment is a hungry beast. In the UK it is responsible for approximately half of our water consumption and it uses 13 per cent of the raw materials in our economy. And what goes in must come out: the built environment is responsible for one third of our landfill waste and half of all carbon emissions – that’s one per cent of the global total . The NHS is part of this behemoth. Since 1997, 88 major hospital schemes have opened and another 24 are underway. This is in addition to thousands of primary care refurbishment and construction projects.
    
So has the biggest ever NHS hospital building programme left a generation of well-designed, sustainable buildings in its wake? Has this massive investment of money and natural resources resulted in healthcare buildings that provide a healing environment? Has it helped create jobs and regenerate local communities? And are these buildings created to cope with, and mitigate, some of today’s pressing problems such as climate change and obesity? Sadly, in spite of some good will and good guidance and a few good case studies, the evidence is patchy.

Energy use in healthcare
The department of health set the NHS a commendable target to reduce primary energy consumption by 15 per cent from 2000 to 2010. If achieved this promises to yield energy savings of around £50m – equivalent to the cost of a small hospital or 7,000 heart bypass operations. However, trends are moving in the wrong direction.
    
Direct carbon emissions from energy use in the NHS estate are estimated to have increased by an average of 2.3 per cent per year between 1999/00 and 2004/5. Energy use in NHS buildings now produces about 3.67 million tonnes of direct CO2 emissions annually and in 2006/7 racked up an energy bill of £427 million. It doesn’t have to be like this. Exemples show how to reduce carbon emissions and save money in the NHS:

• St George’s Healthcare NHS Trust has updated their energy management systems. Coupled with an energy awareness campaign, last year this saved them £350,000 and reduced their CO2 emissions by 20 per cent.
• By building for energy efficiency with natural lighting and ventilation and good insulation, Plowright Surgery in Norfolk uses a third less energy than the DH energy consumption target stipulates. The financial and carbon savings are correspondingly significant.

Reducing carbon emissions
As the Climate Change Bill goes through Parliament, the UK will soon be committed to reducing its carbon footprint by at least 60 per cent by 2050. The NHS will need to respond accordingly and plans are afoot. The Department of Health has committed £100 million for NHS energy efficiency projects, the NHS Environmental Assessment Tool is being updated and a NHS carbon reduction strategy is on the cards.
    
Energy efficiency in buildings is only one aspect of a sustainable NHS building. Indirect carbon emissions from patient, staff and visitor travel and emissions from waste and procurement also need to be taken into account. But sustainable development goes even wider than this.
    
The government’s sustainable development principles are a helpful framework to consider at the very beginning of any construction or refurbishment project to ensure that the maximum contribution is made to the local community, economy and environment. This can improve population health and reduce the demand for health services, improving the NHS’s capacity to be a health-enhancing organisation with a viable financial future.

Sustainable development
As the Commission for Architecture and the Built Environment (CABE) states, no building can be well designed if it does not contribute to sustainable development. A sustainable NHS building would have a number of features, including:

• Designed to promote patient recovery and staff retention
• Accessible by public transport, walking and cycling
• Brownfield site location
• Site and design that preserve and enhance biodiversity
• Adaptable to change, e.g. climate change, new ways of working
• Engages with the local community in the planning process
• Provides community resources
• Uses local labour and suppliers in construction and service delivery
• Uses resources, such as energy and water, efficiently in its construction and throughout its lifetime
• Uses environmentally sensitive building materials that are not harmful to health
• Minimises waste by reusing and recycling building and other materials.

Unfortunately, there is no single UK example of a healthcare building covering all these bases, but there are a few that are on their way. For example, Stockport NHS Foundation Trust is using the NHS Good Corporate Citizenship Assessment Model  to benchmark their performance across procurement, transport, facilities management, employment and skills, community engagement and new buildings. Their new cardiology and surgical unit spent 63 per cent of its £10.3m building budget in the region. They segregate and recycle waste, are a member of the Carbon Trust’s NHS carbon management programme and have a volunteer learning scheme and apprentices on site.
    
SHINE – the learning network for sustainable healthcare buildings - highlights further examples of good practice and provides resources and support to NHS organisations that want to do more.
    
With nearly half of all NHS trusts now registered on the NHS Good Corporate Citizenship Assessment Model and a new NHS Sustainable Development Unit and programme in the pipeline, the future could be promising. However, time is of the essence. As we count down the months until 2010 when the NHS Plan 2000 investment ceases, and scrabble to complete the remaining NHS buildings and refurbishments, it is critical that we create a generation of world class sustainable healthcare buildings to see us into the future.

For more information
www.sd-commission.org.uk/health