Can we deliver Net Zero Carbon hospitals?

Online panel discussion highlights challenges facing healthcare trusts in delivering on the Government's Net Zero Carbon target

  • Industry leaders recognise that HBNs and HTMs may have slowed the process of innovation required toward net-zero carbon
  • Engagement at board level and behavioural change are key to achieving the industry’s sustainability goals
  • Better use of existing hospital stock needs to be an essential part of delivering the targets

The panel featured (clockwise) James Dixon, Michael Ralph, Stephen Maddocks, and Rosemary Jenssen

Healthcare design guidance could actually be stifling efforts by trusts to reduce their carbon emissions in line with the Government’s ‘net zero’ target, it has been claimed.

Industry leaders who recently took part in a virtual discussion on the delivery of Net Zero Carbon hospitals said Health Building Notes (HBNs) and Health Technical Memoranda (HTMs), which are considered to be best practice, can also slow the process of innovation, particularly toward the Net Zero target.

And they also called for widespread behavioural change and improvements in the methods used to clean the air and heat water within healthcare buildings.

COVID-19 has been a big accelerator for behavioural change in terms of people’s behaviours and expectations, the acceleration of digitisation, and the use of technology

Hosted by Stephen Maddocks, healthcare lead at sustainable engineering consultant, Cundall; the panel included Rosemary Jenssen of Jenssen Architecture; James Dixon from The Newcastle upon Tyne Hospitals NHS Foundation Trust; and Michael Ralph of NHS England & NHS Improvement.

Cundall’s environmental sustainability and design consultant, Caimin McCabe, also took part.

More to be done

During the debate the panellists shared their views on the issues standing in the way of building Net Zero Carbon hospitals, including the restrictions imposed by current guidelines; and they called for increased engagement at board level and a change in behaviour when interacting with the healthcare system.

Ralph said the environment is one of the key areas of focus moving forward, besides health, adding that has been ‘an awful lot of good work in this area’.

However, he acknowledged that the visible amount of real change on the ground has been criticised.

“The process of HBNs and HTMs being reviewed is a lot slower than everyone would like,” he said.

“But that’s been recognised with the latest push for building designs and the new schemes coming up.

“That is being reviewed and all the documents that are going to be coming out are based on the Net Zero Carbon philosophy.”

And he noted that the NHS’s Sustainable Development Unit was looking to set the key parameters of policy for how all healthcare is delivered, including how to change the system by introducing virtual clinics to cut out unnecessary travel.

In relation to net-zero carbon, the most-sustainable thing you can do is actually design a building that can change over time, contract and expand, and take on new models of care without physically changing that building

Dixon added: “HTMs and HBNs have been the bible in the past, but from our point of view we need to invest the time and money in [Net Zero Carbon], and if that means working with our experts and authorising engineers to challenge some of the accepted elements of HTMs, then we’d like to think we could.”

He highlighted that the climate emergency is a health emergency and went on to discuss how HTMs provide important guidelines to ensure safe water and safe air. But he acknowledged that current methods for cleaning the air and heating the water were not efficient.

And he said there are other systems that have been successfully tested around the world that clean air and heat water, providing a safe environment for patients while reducing energy consumption, making Net Zero Carbon hospitals achievable.

Changing behaviours

Commenting on how achieving Net Zero is a wider context than just the built environment, Jenssen said there is a need for behavioural change in the embedded culture of healthcare organisations and among their staff.

“From my perspective it’s absolutely about behavioural change”, she said.

“We’ve all got a responsibility to support delivery of Net Zero Carbon, and the built environment is just one element of that.

“If people within those buildings don’t behave in appropriate ways, or use them in that way, then we are not really going to achieve the goal.”

She added: “COVID-19 has been a big accelerator [for behavioural change] because of the guidance and documents that have arisen as a result, but also in terms of people’s behaviours and expectations, the acceleration of digitisation, and the use of technology.

“There have been step changes that we should embrace and use to our benefit moving forward and targeting Net Zero Carbon.”

Ralph agreed, saying there is an increasing focus on lifestyle and culture from within the sector, and with an increase in virtual clinics and apps that enable tests like cardiograms, a lot more things will soon be able to be done remotely.

Commenting on the Newcastle upon Tyne Hospitals NHS Foundation Trust’s priorities, Dixon added that demand reduction is the number one priority, along with embracing low and zero-carbon technologies to meet that demand, and, finally, offsetting unavoidable emissions as a potential last resort because, at this point, it is not possible for large city centre hospitals to reduce completely to zero.

The trust is looking at the potential of offsetting locally with carbon sequestration and tree planting, the benefits of which can be linked directly to the overall health of the local community.

And it has become the first NHS organisation in the UK to declare a ‘climate emergency’, committing to reaching carbon-neutral status by 2040, so board-level commitment was another key factor.

There is an attitude that you have to build new to get better and yet there are many examples of older buildings outperforming the new

Looking at the difference in guidelines between the UK and Australia, McCabe, who is based in Cundall’s Melbourne office, explained that Australia does not have the same focus on net-zero carbon as the UK and there is not a standard set of rules across the country.

Improving outcomes

However, the Australian industry has embraced the idea of Public-Private Partnerships (PFIs in the UK) and these ‘have been instrumental in advancing evidence-based design changes in improving healthcare outcomes, not only in treatments, but in the adoption of building technologies as well’.

“We don’t have the same focus on net zero as the UK has, and there’s no national energy strategy like the UK has,” he added.

“But what we do have is a ratings system called NABERS which rates your performance in actual operation from a greenhouse gas emissions perspective.

“We have NABERS energy for hospitals and that’s starting to be used as a driver to ensure that the hospitals being built meet at least a minimum performance outcome.

“On top of that we’re also being asked to do lifecycle assessment to look at the embodied energy of things. That’s starting to change things and get people working together to solve the problem.

“In the UK you refer to it as Design for Performance and it is starting to gain traction.”

The panel agreed that the UK needs this kind of post-occupancy data moving forward, but acknowledged that it is getting better at these evaluations, at capturing the information, and using it intelligently to inform designs.

As the discussion wrapped up, Jenssen pointed out that ‘one of the things we need to also remember is that we are not going to rebuild the whole of the NHS estate by 2030, or even 2050’, adding that better use of existing hospital stock needs to be an essential part of delivering on the target.

“In relation to net-zero carbon, the most-sustainable thing you can do is actually design a building that can change over time, contract and expand, and take on new models of care without physically changing that building,” she added.

“We need to spend time considering how we better use our existing building stock.”

McCabe agreed, saying: “There is an attitude that you have to build new to get better and yet there are many examples of older buildings outperforming the new.

There is still a lot of waste in both the design consultation process and the delivery on site lacking innovation, so there is lots of progress that we can make through getting better standardisation

“Just because a building is old doesn’t mean it should be knocked down and started again because you’re actually potentially adding more carbon to the atmosphere through the manufacturing process.”

Repeating best practice

Jenssen concluded by saying that modern methods of construction like standardisation are absolutely fundamental to this approach, as shown in the P21+ and P22 repeatable rooms programme which supports greater innovation because the kit-of-parts is already agreed and architects can move forward and look more widely at how they can deliver better patient flows.

“There is still a lot of waste in both the design consultation process and the delivery on site lacking innovation, so there is lots of progress that we can make through getting better standardisation,” she added.

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