COMMENT VIEW POINT What’s in a label?

While BREEAM has made significant progress in many areas of the built environment, it is struggling to have the same impact in healthcare. So is a new approach needed to incentivise sustainable design? Mott MacDonald’s UK healthcare lead Gordon Hudson discusses the issues


hen the Department of Health embedded BREEAM into the design process for healthcare buildings in 2008, it did so with the aim of producing better conditions for staff, outcomes for patients and overall environmental performance. Unfortunately, it isn’t fully achieving this vision. Together with John Holmes and Graham Capper from the School of the Built Environment at Northumbria University, I have undertaken research that shows only 15 per cent of NHS buildings have achieved BREEAM certification. Breaking this down, of the 110 buildings that are BREEAM certified, half received an ‘Excellent’ rating and a third were judged as ‘Very Good’. To put this into context, more than 150 office developments in the UK are rated ‘Outstanding’ on the BREEAM scale. So why is this the case? One reason is a lack of value in BREEAM labelling. Looking again at the office sector, BREEAM has made a big difference in normalising sustainability and elimi- nating false claims. However, hospitals aren’t competing to rent out floor space, so the key commercial driver that’s made BREEAM such a success when it comes to office developments is not a factor. We need to take a deeper look at the role buildings play in healing and recovery. While there will always be certain design and engineering constraints – operating theatres and wards should be mechanically ventilated for example – designers can specify health- ier materials, combat noise and vibration, embrace natural light and pursue energy efficiency. All these factors can play a part in helping patients get better faster, which in turns frees up bed space and reduces operational costs. BREEAM doesn’t allow much flexi- bility in its assessment however, as the context of the site and clinical function often result in a bespoke approach to sustainabil- ity that cannot be easily measured in a standardised assessment matrix scoring.

The healthcare-specific BREEAM credits introduced in 2008 were not compulsory and not universally used, with generic assess- ment criteria replacing them three years later. With no specific conditions to meet anymore, facilities have been designed to stan- dards that only partially apply. With tight budgets prevalent in the healthcare sector, low priority has been given to obtaining points that do not contribute to improved patient care. However, it may also be true that BREEAM has made the design of buildings too prescriptive. Our research also found that many projects were doing the bare minimum required to pass the 70 per cent ‘Excellent’ banding. It would make more sense to take a


More freedom is needed for designers and clients to set the sustainability agenda for each project, Hudson believes © DLT Photography

I’d love to see the NHS and BRE work together to figure out what the next 20 years should look like. There are big opportunities for the NHS to link social and economic benefit with outlay

comprehensive approach to the design of healthcare buildings that encourages creativity and innovation. What is needed is more freedom for designers and clients to set the sustainability agenda for each project and embrace the robust evidence that is needed to prove performance and delivery. This might mean that labelling could be a little inconsistent, yet the label itself it not the real aim in healthcare – the ultimate goal is better outcomes for patients, staff and communities.

I’d love to see the NHS and BRE work together to figure out what the next 20 years should look like. There are big opportuni- ties for the NHS to link social and economic benefit with outlay. BRE needs to be more challenging, looking at each site in more detail and how each building will be used. 



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