SUSTAINABILITY


modules over time are best compared in the cumulative emissions charts for the different strategic options, as shown in Figure 3.


Value for money / return on investment All options other than DoNothing* require additional capital investment, which needs to generate a return. We briefly consider three types of return: environmental (emission reductions); building operations (reduced heating costs), and clinical performance (better outcomes and associated revenue), and these are set out in Figure 4. Figure 4 shows that Retrofit* likely


gives the best carbon value for money. All alternatives to DoNothing* have similar lifetime heating cost, whereas further research is required to establish which option provides the best clinical value for money per £ spent. Retrofit* is the most financially efficient


way of saving whole life carbon emissions, providing the best ‘carbon value for money’, as shown in Figure 5. In fact, NewbuildFlex* appears to


achieve no WLC improvement over DoNothing*. The WLC emissions improvement for Newbuild* is also limited. DoNothing* should not be considered an acceptable option; it delivers no clinical standards improvements, and it will not provide the reductions in operational emissions required from the NHS built estate.


No carbon benefits from greater inherent flexibility There appear to be no net carbon benefits from the greater inherent flexibility of spaces in NewbuildFlex* over NewBuild*. Greater flexibility to reconfigure space in NewbuildFlex* leads to reductions in B5 (embodied carbon from refurbishment), but these are more than reversed by the increases in all


120% DoNothing* (Opt 1) 100% 80% 60%


RetrofitExtend* (Opt 3)


40% 20% 0%


Retrofit* (Opt 2) Reduced


Whole Life Carbon Reduced Whole Life £ Expenditure


Reduced Whole Life Carbon Reduced Whole Life £ Expenditure


NewbuildFlex* (Opt 5)


Newbuild* (Opt 4)


Increased Whole Life Carbon Increased Whole Life £ Expenditure


Strategy


Option 1 – DoNothing* Option 2 – Retrofit*


Option 3 – RetrofitExtend* Option 4 – Newbuild*


Option 5 – NewbuildFlex*


Approximate Investment (Capital


spending) -


££


££££ ££££


£££££


Estimated Value for money / return on investment


Carbon saving


-


3 3 3 3 3 7


× 7 ×


Reduced heating cost


-


7 7 7 7


Clinical


performance improvement


- 3 3


3 3 3 3 3 3


3 3 3 3 Figure 4: Estimated relative value for money / return on investment for each option.


other lifecycle modules. This is because a larger building is needed to achieve the flexibility under NewbuildFlex*, which leads to higher emissions in construction (A1-A5), future repair (B3), future component replacements (B4), and heating (B6).


Retrofit Figure 3 shows that retrofitting – upgrading fabric and changing building systems from gas heating to electric heating – substantially diminishes the overall impact of operational carbon emissions. A phasing out of gas used in other clinical and non-clinical processes in favour of less carbon-intensive electricity should be a priority. We carried out a supplementary study to evaluate whether for Retrofit* and RetrofitExtend* it makes carbon sense to wait until the end of the replacement cycle to replace currently installed heating systems. It does not. All things being equal, the preference in this case is to replace the heating systems as soon as possible to maximise the available operational carbon savings. In our calculations we have allowed


for typical lifespans for systems and products in all options. It is possible, however, that PassivHaus quality standards in RetrofitExtend*, Newbuild*,


and NewbuildFlex*, result in systems and products with longer lifespans being selected. We have not allowed for this in our study.


Heating cost return on investment For all Options, lifetime reductions in heating cost resulting from fabric improvements fall far short of being able to recoup the capital expenditure on these fabric improvements over the life of the building. The reasons for this include: (1) Whole life heating costs are a


relatively small proportion of upfront spend on fabric improvements (see Figures 6 and 7). (2) A switch from inefficient gas to more efficient electricity (with fabric upgrades) has a small impact on heating costs because of the continued low price of gas compared with electricity (see Figure 7). We have based this analysis on gas and electricity price projections by BEIS and the European Commission, assuming no future carbon taxes. Different assumptions may alter these conclusions. DoNothing* has the least efficient building fabric and systems, and is heated by carbon-intensive gas. Figure 7 shows how the whole life (operational) heating cost picture is distorted in favour of DoNothing*, because gas is substantially cheaper than electricity per kWH. A regulated minimum gas price to favour electric heating, and a tax on carbon emissions, may help drive demand away from the use of gas for heating. For these reasons, reduced heating costs are currently not a likely avenue for financially recouping investment in fabric and systems improvements. Instead, the financial returns of such capital investment are likely to come through improved clinical outcomes. This is discussed in the next section.


75% 100% 125% Whole Life £ expenditure (over 60 years)


Figure 5: Comparison of projected 60-year Whole Life Capital Expenditure (£) with WLC (Carbon).


32 Health Estate Journal March 2022 150% 175%


Clinical return on investment A study of clinical outcomes at FCBStudios’ Dyson Centre for Neonatal Care in Bath found that better lighting, air quality and temperature, space configuration, and finishes, in the new building resulted in improved wellbeing of staff, babies, and mothers. Babies slept 7% more on average. Although not measured


Whole Life Carbon (over 60 years)


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