SUSTAINABILITY
Up-front £ capital cost (all other)
Up-front £ capital cost (fabric, systems)
Whole life £ operational heating cost
FCBStudios’ retrofit of Senate House at the University of Bristol saved approximately two-thirds of the upfront embodied carbon over the new-build alternative.
DoNothing* (Opt 1)
Retrofit* (Opt 2)
RetrofitExtend* (Opt 3)
Newbuild* (Opt 4)
NewbuildFlex* (Opt 5)
Figure 6: Upfront capital cost (fabric and systems, and other) with 60-year lifetime (operational) heating cost.
in the study, it is reasonable to assume that these shortened lengths of stay translated to greater patient throughput, more clinical activities being performed, and reduced cost / increased revenue. The same is likely for this NHS hospital
study. Improvements to air quality, temperature, and natural light (achieved with all options other than DoNothing*) and space standards (RetrofitExtend*, NewBuild* and NewbuildFlex*) are all expected to improve patient, staff, and visitor wellbeing, and shorten times to discharge. Again, shorter stays likely result in greater throughput, capacity, and therefore income, to the Trust. We estimate that the upfront capital cost of Retrofit* could be earned back over 60 years if it leads to an overall reduction of approximately 1-2% in length of stays. Anything better than this should result in a shorter break-even period and a positive return on capital invested in Retrofit*.
A note on COVID COVID, and the possibility of similar pandemics in future, have underscored the need for: n Better ventilation, which can be
achieved with the building systems modifications of all options other than DoNothing*.
n Social distancing, which can be more easily achieved under the improved space standards of RetrofitExtend*, NewBuild*, and NewbuildFlex*.
n Flexible layouts that can respond effectively to changing infection control requirements, best delivered via NewbuildFlex*.
These principles seem to indicate that
NewbuildFlex* is the most attractive from the perspective of managing COVID, but this needs to be considered in conjunction with all types of returns (including environmental, operational, and clinical).
Summary and further discussion The relative importance of the three return types in the table at the start of this section (carbon emissions, heating costs, and clinical emissions) will help inform a Trust’s preferred strategic option. Whether the escalation of the climate emergency will in time make clinical space standard upgrades of RetrofitExtend*, NewBuild*, and NewbuildFlex*sufficiently unaffordable
FCBStudios’ Dyson Centre for Neonatal Care in Bath.
FCBStudios’ retrofit of the Richmond Building at the University of Bristol saved approximately two-thirds of the upfront embodied carbon over the new-build alternative.
March 2022 Health Estate Journal 33
Hufton & Crow
Craig Auckland / fotohaus
Rebecca Noakes Photography
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