BUILDING ENGINEERING SERVICES


A practical route to improved performance


Improving the environmental conditions within NHS and healthcare estate buildings – while reducing operating costs and carbon emissions – is an increasingly critical focus for NHS Estates teams, healthcare engineers, and Sustainability leads. With the NHS committed to achieving Net Zero by 2040 for direct emissions, Vincent McMonagle, MEP Clerk of Works at 6RG, says the need for precision, evidence-led interventions in building performance is ‘more important than ever’.


For Estates and Facilities managers working across both clinical and non-clinical settings, delivering occupant comfort (especially in patient-facing spaces) while controlling costs is a balancing act. Rising energy prices, tighter capital budgets, and growing scrutiny of public sector performance, demand new approaches. A practical route begins with understanding how the building’s MEP (Mechanical, Electrical, and Plumbing) systems are truly performing. As Lord Kelvin famously said: “If you can measure it, you can improve it.” Capturing an accurate ‘fingerprint’ of an NHS building’s services guides performance expectations, and provides the foundation for informed, measurable improvements in comfort, operational efficiency, and carbon reduction.


n Step 1: Create a fingerprint of the MEP system This initial stage is non-intrusive: observe and record system performance ‘as is’ without initiating adjustments. This baseline snapshot will serve as the benchmark for future improvement. The key driver of this stage is to resist fixing or adjusting the found systems; the task is to get a complete picture of what is happening, and then make the remediation plan. NHS Estates staff and building maintenance engineers


play a key role at this stage; their lived experience and operational insights often reveal recurring comfort issues or system anomalies not evident in BMS data alone. A ‘no- blame’, collaborative environment is vital to ensuring that knowledge-sharing is equally prioritised with fault-finding. Key system elements to fingerprint and record include: n BMS data: Setpoints, schedules, overrides, and trend


logs across heating, ventilation, and air-conditioning systems.


n Water flow rates: In heating and chilled water circuits. n Airflow rates: Supply/extract volumes versus design criteria.


n Temperature zoning: Identifying hot/cold spots across wards, admin areas, theatres, and waiting spaces.


n Plant asset register: Equipment age, commissioning status, and current condition (e.g., AHUs, pumps, boilers, chillers, and VAVs, etc.).


n Updated schematic drawings of MEP systems.


n Step 2: Evaluate energy use by volume, not cost With energy procurement across NHS Trusts often managed via framework contracts, cost-based analysis can be misleading. Instead, focus on energy volume to benchmark performance: n Gas consumption (kWh or m³). n Electricity consumption (kWh).


Gather 12 months of data from energy bills, AMR (automatic meter reading), or Building Management Systems. This volume-based data will form a stable, year- on-year comparison, and is essential for carbon reporting and compliance.


n Step 3: Compare against design and commissioning data


Review the building’s fingerprint against the original design intent, specifications, and any available commissioning records. Common issues in NHS buildings include:


Photos of good management and areas for improvement of systems that all exceed their expected lifecycle, but are working, and could be improved further with some minor works.


Below left: Example of a well-insulated LTHW pump with a side stream filter to help manage water quality in a large system.


Below right: A supply air damper open and the extract being closed, which will make the space feel imbalanced and could affect temperature.


September 2025 Health Estate Journal 77


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