SUSTAINABILITY
Hospital estates strategy and the climate emergency
The UK construction sector is gearing up to make Whole Life Carbon (WLC) calculations integral to design decisions and standard reporting, to help meet the UK, and the NHS’s emission reduction targets. Tim den Dekker, Joe Jack Williams, and Ian Taylor from Feilden Clegg Bradley Studios discuss the outputs from a study of a 35-year-old typical NHS hospital building to review the range of considerations faced by an NHS Trust and its Estates department in the context of WLC and cost.
The strategic direction set out in Delivering a ‘Net Zero’ National Health Service1 requires hospital Trusts to decide how to reduce carbon emissions. A quick calculation using the figures in this document suggests that operational and embodied carbon relating to buildings makes up approximately 1% of the UK’s carbon footprint. NHS Trust Estates teams therefore have an important role in reducing UK emissions. A high proportion of NHS building stock is old and dilapidated. Shedding light on important estate management decisions that NHS Trusts need to make to save carbon and meet changing demand patterns and clinical standards, our study found that the bulk of the emissions reductions to meet UK and NHS targets will need to come from savings in future embodied carbon. This finding is consistent with the UKGBC Net Zero Whole Life Carbon Roadmap’s call for the mandatory embodied carbon limits, which could be delivered by Part Z,2 a ready-made proposed amendment to the Building Regulations.
Measuring return on invested capital Emissions reductions must be considered a part of measuring return on invested capital to evaluate different development options. We found that a retrofit consisting of envelope and systems upgrades to reduce heating/cooling demand and improve efficiency gives the highest carbon savings per £ spent. In contrast, a new-build – which could also provide for high-acuity uses, improve space standards, and future flexibility, in addition to having better envelope performance and heating/ cooling systems – significantly increases upfront embodied carbon, with little impact on WLC, and is therefore poorer value from the perspective of carbon saved.
On the financial side, higher revenues
are a likely result of building improvements leading to better well-being and clinical outcomes that should result in shorter hospital stays and higher patient
FCBStudios’ Stirling Prize-shortlisted retrofit of the Manchester School of Art included envelope, systems, and space standard upgrades (much like Retrofit* and RetrofitExtend* in this study).
March 2022 Health Estate Journal 29
throughput. These improvements are expected from both new-builds and envelope and systems retrofits, although the analysis to support this hypothesis was outside the scope of our study. What we did find, however, is that savings in heating costs alone cannot be relied on to provide a return on any investment to improve building fabric and/or systems.
Rule of thumb proposals Based on our findings, we propose that as a rule of thumb, new-build should be reserved for high acuity functions that have unique requirements unable to be met by existing building stock. These requirements, for say theatres, imaging, and intensive care, would typically include deep service zones, longer spans, high load capacities, and low vibration tolerances. All other accommodation should as far as possible be provided in existing buildings, retrofitted as necessary.
We recommend that this proposal is incorporated as strategic guidance in the next version of the Delivering a ‘Net Zero’ National Health Service document.
Factors beyond the study’s scope Other factors that should feature in decision-making, but were beyond the scope of this study, include the impact on clinical activities caused by disruption from construction (refurbishment or new- build) and decants, and by the retention of building fabric and potentially sub-optimal space standards, levels of servicing, and adjacencies. Furthermore, the carbon reduction measures of this study should be considered alongside the many other significant opportunities identified in Delivering a ‘Net Zero’ National Health Service, such as preventative medicine, a shift to low carbon asthma inhalers, and zero emission vehicles. The outcomes from our study are
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