engineering professionals will be interested to note that, according to the report, ‘Engineering solutions to upgrade our buildings represents a total of 473 ktCO2

e in potential emissions

savings’. Section 3.1.1 elaborates: “Here, the £50 million NHS Energy Efficiency Fund (NEEF) will upgrade lighting across the NHS estate, acting as a pilot for future work, and saving £14.3 million and 34 ktCO2

e per year. Delivering 100%

LED lighting could be achieved with an additional non-recurrent investment of £492 million, which would be paid back over a 3.7 year period, providing an estimated net saving of over £3 billion during the next three decades. A wide range of interventions focused on air conditioning and cooling, building fabric, space heating, ventilation, and hot water, could all be rolled out throughout the secondary care estate over the next 5 to 10 years, saving some £250 million per year (once all interventions are implemented by 2034).”

Need for ‘socio-technical interventions’

The report continues: “Crucially, a significant portion of the investment required to deliver this will overlap with that for work underway as part of the regular maintenance and upkeep of the estate.” Also needed will be ‘a range of socio-technical interventions’ to optimise how the NHS uses its buildings. Intelligent, real-time energy monitoring and control, including the use of artificial intelligence, would contribute up to 2.3% of the total required reduction in carbon emissions, with an upfront investment of £259 m paid back within two years, and a net annual saving of £120 m once all interventions are implemented by 2034. It adds: “Finally, better use of roofs and adjacent ground space will support a shift to on-site renewable energy and heat generation across the estate, bringing a potential saving of 580 ktCO2

e per year.”

Royal Manchester Children’s Hospital has, the report notes, invested in an on- site renewable energy project, and saved £80,000 in lifetime energy costs and 380 tonnes of carbon, while increasing the resilience of its power supply. Installation of photovoltaics across the entire NHS estate would, the publication claims. reduce the NHS Carbon Footprint by 1.6%. However, the associated investment costs are high – £1.9 bn paid back over 15 years, with a net saving of £1.2 bn – and would need to be considered for early implementation to maximise benefits. In the first instance, the NHS will remove all coal and oil heating systems from its sites ‘as soon as possible’, with complete phase-out over the coming years. Finally, the service will purchase 100% renewable energy from April 2021.

To help organisations understand what

Present day emissions In-year actions New build

Upgrading our buildings Optimising building usage

On-site generation of renewable energy and heat National electricity decarbonisation Research, innovation, and offsetting

7 47 8

n Present-day emissions n Emissions reduction n Emissions increase n Residual

0 20 40 60 80 100 120 140 160 180 CO2 emissions (ktCO2


Figure 4: Interventions to reduce emissions in the primary care estate, and estimated carbon savings, compared with 2019 baseline.

action they need to take, a net zero carbon capital planning tool for NHS Trusts is being tested with 15 organisations, alongside new clinical waste and energy management strategies.

The primary care estate

The report’s next focus – in Section 3.1.2 – is ‘Reducing emissions from the primary care estate’. There are currently approximately 7,000 GP practices in England, spread over some 9,000 buildings, with total emissions for the primary care estate last year reaching 167 ktCO2e. Figure 7, on page 22 within this section (see Fig 4 in this article), again highlights the biggest potential opportunities for emission reduction, with ‘Upgrading of buildings’ (59 ktCO2


‘National electricity decarbonisation’ (47 ktCO2

usage’ (34 ktCO2

e), and ‘Optimising building e) the ‘standouts’.

This section acknowledges that ‘additional resource will be required to support older primary care buildings across England to become more energy- efficient’. Engineering interventions such as improved building insulation, lighting, and heating, could save 59 ktCO2


annually; improvements to building instrumentation and energy management, 34 ktCO2

and heat pumps, 7 ktCO2

e, and installing photovoltaics e. The report

says that while ‘further work is required here’, one important resource is the Green Impact for Health toolkit, produced by the Royal College of General Practitioners and the educational charity, SOS-UK. Reportedly used by 754 GP practices in 2019/20, it ‘provides accessible and comprehensive guidance on available emissions reduction interventions’.

Other key areas for action Travel and transport

Section 3.2, on ‘Travel and transport’, indicates that around 3.5% (9.5 billion miles) of all road travel in England relates to patients, visitors, staff, and suppliers to the NHS, contributing around 14% of the system’s total emissions. This includes approximately 4% for business travel and fleet transport, 5% for patient travel, 4% for staff commutes, and 1% for visitor travel. Among the interventions to reduce travel-related emissions expected to have the biggest impact are: Electrification of patients’ and visitors’ vehicles (1,636 ktCO2

e), National vehicle efficiency improvements (1,463 ktCO2 e),

and Electrification of the rest of the NHS fleet and staff vehicles (1,022 ktCO2

e ).

Forecasted increases in vehicle use are, ‘in part, offset by rapidly evolving vehicle efficiency standards’. One of the key targets is for 90 per cent of the NHS fleet to be using low, ultra-low, and zero-

Present day emissions

Forecasted change in vehicle use National vehicle efficiency improvements Air quality, business mileage and fleet Reduced travel from digital care pathway redesign Preventative medicine and reduced health inequalities Active travel from staff, patients, and visitors Zero emission ambulances

Electrification of patients’ and visitors’ vehicles Electrification of the rest of the NHS fleet and staff vehicles

1636 1022 3402

1734 1463

235 159 62

98 461

n Present-day emissions n Emissions reduction n Emissions increase n Residual

0 1000 2000 3000 4000 5000 6000 CO2

emissions (ktCO2

Figure 5: Interventions to reduce travel and transport emissions, and estimated carbon savings, compared with 2019 baseline.

February 2021 Health Estate Journal 41 e) 59 34 167 2 11



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