HOSPITAL CONSTRUCTION
Figure 3: ETL’s ‘systems approach’ to supporting NHS clients on Net Zero, as applied on NHP ‘wave 1’ schemes at Whipps Cross and Epsom St Helier.
provided? What is the evidence base for the priorities and guiding principles adopted?
n What is the appetite for risk versus embracing innovation?
Net Zero From our experience in co-designing sustainability strategies, we know that radical transformation is needed to achieve Net Zero targets. This includes harnessing MMC to create facilities that meet exacting environmental standards. MMC selection must consider embodied carbon, manufacturing pollution, transport, operations, and obsolescence –and can have significant implications for clinical and financial sustainability. Upfront costs must be weighed against lifecycle costs, including clinical operations and facility management, as well as environmental credentials.
MMC carbon footprints can include a significant contribution from transportation, due to the volumes and/ or distances involved. Carbon footprints (as well as social value) may be somewhat opaque, due to complex supply chains. Manufacturing standards can support improved energy efficiency and overall building performance. In theory, less material may be wasted. Modules in some cases are created for a limited life, simply followed by disposal. This is the case with many of the pods we currently put into buildings, and will have to break up to remove once their service life is complete or modifications are required.
Rating for sustainability is ‘complex’ Rating MMC for sustainability is complex. We need to look at the entire cycle – from materials to facility obsolescence, and from health interior environments to impacts on the natural environment. Figure 1 shows six key areas to focus on, and examples of considerations within each.
Operational considerations: clinical strategies for low carbon Operational considerations for the MMC strategy need to be in line with the clinical strategy, including clinical future-
66 Health Estate Journal February 2022
readiness and its contribution to Net Zero. This alignment will also encompass the digital strategy. ETL is supporting several NHS clients on Net Zero, identifying appropriate interventions in clinical strategy and briefs aligned to RIBA stages. As healthcare planners we ensure that operating models and clinical solutions are holistically sustainable – clinically, economically, environmentally, and socially – through: n Integrated healthcare delivery pathways, reducing travel and overnight stays.
n Processes and new ways of working, reducing inefficiencies.
n Environments supporting community wellbeing for economic and social benefit.
n ‘LEAN’ adoption, eliminating waste in over-supply of resource.
ETL’s systematic approach adopted on two NHP pathfinder schemes – Whipps Cross and Epsom St Helier - is outlined in Figure 3. We worked with Trust leads to harness digital transformation, system- wide integration, and new ways of working to deliver sustainability benefits.
Conclusion No matter how it is built, a hospital needs to work very well for all of its users. MMC for hospitals requires specific healthcare planning strategies, while the MMC strategy for a healthcare facility is uniquely complex.
Regina Kennedy
Regina Kennedy, Healthcare Strategy and Planning director at ETL, is a healthcare planner with a background in architecture and programme management. Having worked both client-side and as a consultant, she has led Planning and Design teams in the initiation and delivery of healthcare projects. Her responsibilities have included brief development, clinical stakeholder engagement, business case, multidiscipline feasibility studies, decant and transition planning, and managing the design process. With her background in teaching and research, her interests include process improvement, health futures thinking, and evidence-based design.
Healthcare planning and design are both very specialist areas of expertise, and adding MMC offers great opportunities, as well as significant risk. An MMC strategy is best developed from the very start of a healthcare project, with inputs from healthcare planners who understand MMC, and will in turn inform healthcare planning activities. This requires close collaboration between architects and healthcare planners, contractors, and the supply chain. If MMC is to be adopted across the
NHP, will HBN rooms sizes be updated in line with a standard grid? How will modules be developed to allow flexibility? Will we need to rely on complex global manufacturing supply chains? What trade-offs are considered acceptable? What are our collective key priorities, and what are we doing to ensure healthcare planners have the knowledge to support MMC strategy developments? Our industry needs to step up to the challenge presented.
References 1 The target percentages mentioned have yet to be confirmed and issued to our industry.
2 Currently imported from European suppliers.
3 This was developed for our parent organisation, Guy’s and St Thomas’ NHS Foundation Trust, and continues to evolve.
4 Itself demolished in 2001, 29 years after opening its doors.
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