Healthcare estates include key infrastructure to keep our society functioning, but many are ageing, and, in a number of instances, lagging behind those in other sectors when it comes to sustainability. Does support go far enough for these estates to upgrade and adopt low carbon energy solutions considering the UK’s ambitious 2050 carbon targets? Hannah Kissick, associate at international M&E consultancy, CPW, argues that not only is more funding needed, but also that it is time for ‘a fabric first’ approach.
With 25% of all carbon emissions defined as being produced by the built environment, the construction industry can effect real change on the road to Net Zero. At the same time, with dozens, if not hundreds, of crumbling NHS buildings, a significant hospital building programme in progress, and with Net Zero targets looming, the healthcare sector is now more reliant on the construction industry than it has been in a generation. With this in mind, the healthcare sector has a massive responsibility to match its development programmes with its sustainability efforts, which is where decarbonisation will make all the difference. We need to ensure that individual development plans for healthcare estates tie in with forwardthinking shared energy plans across both the public and private sector, but tight budgets mean that the reality is far more challenging than the theory.
The funding solution
With capital budgets for the NHS increasingly squeezed, the drive for the decarbonisation required to enable healthcare estates to even get close to Net Zero by 2050 needs to be led by funding from central government. Fortunately, the UK Government and its non-departmental public body, Salix Finance, have recognised this, creating a number of funding schemes dedicated to enabling the wider public sector to reduce its carbon emissions.
The Low Carbon Skills Fund provides grants to help public bodies produce a heat decarbonisation plan (HDP) alongside specialist consultants in the first instance. This involves carrying out an analysis of the public body’s building or estate, and developing a strategy to move the site away from a natural gas or oil-fired heating strategy towards a lower CO2-emitting alternative. Once this plan is in place, the next step is the Public Sector Decarbonisation Scheme (PSDS), which provides grants to implement heat decarbonisation and energy efficiency measures. This source of funding is not only available to those with a HDP already in place, but also those that have independently completed the required calculations, measuring potential costs and predicted CO2 savings.
Phase 1 of the PSDS provided £1 bn in grants over the financial years 2020- 2021 and 2021-2022, and Phase 2 £75 m of grant funding for the financial year 2021-2022, with a stronger focus on heat decarbonisation. Phase 3 is set to provide £1.425 bn of grant funding over the financial years 2022-2023 to 2025- 2026, with Phase 3c having opened for applications last month. Naturally, the public bodies competing for these grants require support from experts in the field. At CPW we have supported many NHS and education sector clients with more than 15 applications across both funding streams, developing successful HDPs and design strategies. The PSDS supports the aim of reducing emissions from public sector buildings by 75% by 2037, an objective that can be tackled in various ways.
One way that CPW has had success – especially in healthcare settings – is with a ‘fabric first’ approach. Incorporating the learnings and principles of Passivhaus, this looks to reduce the energy demand first, and then find a suitable solution to make the remaining demand low or zero carbon. Utilising thermal imaging and heat flux monitors, it is possible to assess the thermal performance of buildings, which is particularly helpful when dealing with older buildings where construction documentation can be hard to come by. These technologies allow us to see where heat is escaping, how it’s travelling within a building, and how well a room holds its temperature
Survey’s findings
Surveys will often show general inefficiencies in existing systems, or building elements that are not fitted or working properly, and changing these can usually provide energy reductions without any significant capital expenditure. This can be as simple as changing control strategies or upgrading draughty windows and doors. Cold bridges can account for up to 30% of a building’s heat loss, and are impossible to see with the naked eye, so thermographic surveys helping to identify why a building may have an unexpectedly high heat load are essential for finding these heat-saving wins.
By using innovative modelling techniques, we are able to observe current energy usage and emissions, and make accurate comparison between the current state of play and proposed interventions, such as air or ground source heat pumps, or renewable energy such as solar panels. Heat pumps are often seen as the best answer to a low carbon heating solution, but this is not always the case. While heat pumps can be three times more efficient than gas options, electricity is currently almost four times more expensive. Therefore, moving straight to an electric solution could be more expensive for the end-user, and a difficult transition during an energy crisis.
Prioritising energy demand reduction
This is where the fabric first approach – and making energy demand reduction the priority – comes into its own. When working on healthcare projects, the key is to provide a range of options to improve the energy efficiency of the building fabric before recommending low or zero carbon heat sources, ensuring that all plans are suited to their wider Net Zero strategies.
Future-proofing and forward thinking also need to be carefully considered, leaving space for adjustments should advances in technology make sources such as hydrogen a more attractive option.
It is also important that there is ongoing close collaboration, not just between the healthcare provider and the consultants on the project, but also with the supply chain. For example, CPW works in lockstep with manufacturers to ensure that all data in our modelling is accurate in order to provide reliable estimates to our clients, preventing unwanted and potentially costly surprises.
By adopting fabric first as a principle for both retrofit and new-build projects, healthcare estates are able to get the best value for their hard-earned funding, whether that be from central government or their own capital resources.
This was the case with a redevelopment project CPW delivered at Kettering General Hospital. Working with the Kettering General Hospital NHS Foundation Trust, the project consisted of the replacement of ageing site-wide energy infrastructure, and the wider development of a Net Zero carbon pathway for scope 1 & 2 emissions to ensure that the Trust could achieve the NHS Net Zero target of an 80% reduction by 2032, and being Net Zero in operational carbon by 2040.
The main hospital site previously operated on a steam heating network that was more than 50 years’ old, and, by the time of our appointment, was relying on temporary steam boilers and required continuous intervention. The existing private high voltage electrical network, while still in satisfactory working condition, did not have the capacity to accommodate the redevelopment of the hospital, so was supported by ageing standby power generation that did not meet current standards for an acute hospital site.
‘Twin challenges’
These twin challenges meant that the existing site-wide district heating network and high voltage power network needed to be replaced, and supplemented by the delivery of a pathway to Net Zero carbon. This required the construction of a new energy centre comprising low carbon heat sources and standby power equipment, along with a new low temperature district heating network, supplied by a private high voltage power network. The CPW team undertook an analysis of the existing site, including extensive surveys, system validation exercises, and desktop reviews of all available recorded information. This allowed us to carry out detailed modelling of the energy networks, leading to a number of different low carbon heat source solutions being proposed, including biofuel combined heat and power, and high temperature air source heat pumps.
Working closely with the client, a rigorous evaluation and scoring process was conducted to ensure the most appropriate low carbon heat source was selected, considering everything from CAPEX, OPEX, and industry knowledge and skills, to maximising the use of clean energy – something which was of ongoing importance given the stringent targets for Net Zero in operation.
After extensive consultation, the decision was made on a new low temperature district heating network that would be served by ammonia-driven, high-temperature, air source heat pumps (ASHPs) – something which was a first for the NHS nationally. In the short to medium term – allowing for existing building stock to be refurbished to a standard where it could operate at low heating medium temperatures – the ASHPs would operate alongside a high-efficiency gas-fired boiler plant, designed to overcome peak loads and times of high demand. This provided a commercial balance between reducing carbon emissions as far as possible, and minimising the potential for escalating energy costs.
Primary drivers
The primary driver for adopting the use of ASHPs was the use of clean energy in the form of electric, which could be supported on site through the deployment of solar photovoltaic arrays across the entirety of the estate. Other influencing factors included reliability, and ease of maintenance when compared with other solutions such as biomass.
Fulfilling the original brief, the team also developed a pathway for the site to achieve Net Zero operational carbon by 2040. Before this could be developed, we first had to establish a baseline from which projected carbon emissions could be measured – achieved through the assessment of historic energy and carbon reporting data. The catalyst for the Net Zero carbon pathway was the proposed new energy centre and district heating network, which were predicted to achieve a carbon reduction of upwards of 40% over the baseline target.
The team then explored all possible interventions that could be considered to continue the decarbonisation of the site over the next 20 years. This includes demolition of building stock that is no longer fit for purpose, refurbishment of critical buildings to be retained, site-wide services upgrades such as LED lighting replacements, the introduction of energy recovery to air-handling plant, and, finally, large-scale deployment of renewable energy generators – such as solar photovoltaic arrays.
In addition to these projects the pathway considered the continued future decarbonisation of the electrical grid, meaning that the hospital would be fully equipped to hit both local and national decarbonisation targets
With the range of technology now available to expose inefficiencies, a fabric first approach has true merit. Government funding is a great start to ensuring that organisations are on board and able to meet their own sustainability targets. However, in our experience, that funding is often not even enough to cover the fabric improvements we recommend, let alone the full decarbonisation of an estate. Tight budget allocations and capital constraints are restricting the NHS from pushing forward with its decarbonisation efforts, so how can we expect the private sector to take the leap and drive down carbon without the incentive of government funding? Progress is being made, but more needs to be done to ensure that we are able to meet the UK’s Net Zero carbon targets. Otherwise, it will be a case of too little, too late.
Hannah Kissick
Hannah Kissick is as an associate at CPW, an international mechanical and electrical (M&E) and sustainability consultancy with over 300 staff based at 13 offices, where she runs the Innovations team. She has been with CPW for more than 10 years, with her most recent projects including the decarbonisation of estates such as the University of Oxford, West Midlands Police, and the University of Warwick. As part of her role, she researches how the company’s engineers can better incorporate sustainability into their designs, providing design advice on the circular economy, energy reduction, and Net Zero carbon buildings.
CPW describes her as ‘a thought-leader in her field’, delivering training and research design sessions both internally and to industry professionals