Putting planned maintenance top of the list

Healthcare services are facing unprecedented challenges on numerous fronts, and identifying a roadmap for Net Zero emissions for a system as large as the NHS is challenging. The government’s focus is for the NHS to be the first Net Zero healthcare service in the world by 2045. Underpinning the delivery of care and a comfortable environment for patients as well as employees is an essential cooling and heating infrastructure. The NHS currently contributes approximately 4-5% of the UK’s total carbon emissions. Decarbonisation is expensive, but a good HVAC maintenance strategy that informs and influences how healthcare estates operate can ensure that the buildings and plant sited within them operate efficiently, are compliant, and are at lower risk of unexpected incidents and ‘outages’, which can incur high costs.

Complex and energy-intensive

HVAC systems in healthcare estates can be some of the most convoluted systems — little wonder when in many cases such estates have vast air-conditioning, ventilation, and heating systems across many locations. They also use significant amounts of potable water and energy. Many systems are run continuously. A robust and detailed maintenance programme is crucial to provide insight into the health of your estate. It will reduce long-term maintenance costs, ensure the expected lifecycle cost return on your investment is achieved without premature failure, and help maintain decarbonisation. The fluctuating availability of fossil fuels, combined with their harmful effect on the planet, means they are no longer financially or ethical viable. Boosting resilience and energy efficiencies in existing equipment can help build greater resilience in health estates, and contribute to the transition towards more sustainable technologies and meeting Net Zero targets.

All NHS Foundation Trusts have a statutory responsibility for managing their assets. Trusts — like any other organisation — need to stay on top of legislative requirements, and to reduce their emissions and carbon footprints while delivering high standards of care. It is a difficult balancing act. Chiller or air-handling unit failures and other unplanned reactive works can prove costly, as well as resulting in disturbances to the day-to-day running of, in many cases, vast estates and delivery of patient care. Healthcare estates managers need to be initiative-taking and innovative.

Many Trusts have in place an estates and facilities strategy to ensure that their estate delivery is fit for purpose, cost-efficient, and sustainable, while addressing future needs. Managing any health estate and all its facilities is complex, and requires a comprehensive and robust strategy to be in place.

All four countries in the UK have a Health Technical Memorandum 03-01 (HTM) in place. These are a documents published by the Department of Health and Social Care (DHSC) which offer comprehensive guidance and suggestions relating to the design, installation, and operation, of specialised buildings and the engineering technologies used.
The documents comprise two parts — Part A and Part B. The former applies to the design, specification, installation, and acceptance of healthcare ventilation systems, whereas Part B covers all systems regardless of age, and requires that the existing installation should be compliant with all new requirements, even retrospectively.

A specialist field

Air-handling units and chillers in a healthcare environment is a specialist field. The HTM guidelines are there to protect the health of all stakeholders, and the HTM guidelines play an especially important role in the healthcare space and how it functions. For example, HVAC systems have a pivotal role when it comes to determining infection rates in an Intensive Care Unit, in addition to providing a generally comfortable and safe environment for patients, staff, and any visitors. Maintaining a good and safe indoor air quality is an important strategy.

During the pandemic, Aermec’s R&D team responded by designing the FCZ-H sanitising fan coil unit to help mitigate the transmission of viruses including COVID-19. Virus particles are small enough to pass through HEPA filters, but can be targeted effectively through air-purifying devices. By integrating a UV lamp within the fan coil, viruses including COVID and SARS were proven to be broken down biologically, and that changing a building’s operation reduces the risk of pathogen transmission.

Fan coil units able to destroy pathogens

Padua University’s Department of Microbiology and the University of Camerino’s Department of Chemistry and School of Pharmacy subsequently carried out tests that showed that the technological core of Aermec’s FCZ-H fan coil units was capable of destroying pathogens without compromising the heating or cooling capabilities of the unit. Environmental issues were addressed by reducing the power consumption down to 4 W, and avoiding the use of refrigerants in indoor ambient temperatures.

In Wales, the HTM acknowledges that healthcare estates have an important contribution to make in reducing running costs and improving energy efficiency while assisting the NHS to meet the necessary reductions in carbon emissions and climate mitigation. Scotland has a similar technical memorandum, to ensure appropriate healthcare-specific engineering governance that provides for the safe and efficient operation of healthcare facilities. It also requires a PPM programme led by manufacturers, and, in the absence of this, a programme is required to be drawn up, while a set of procedures should be created to cover each critical engineering service. It stresses the need for planned maintenance, so that any piece of equipment or plant is out of service for as short a time as possible.

There are six health and social care Trusts in Northern Ireland that come under the Health and Social Care (HSC) body. The NHS has a target of reaching NHS Zet Zero by 2045. NHS England and Scotland have announced that they aim to achieve Net Zero by 2045, while Wales has committed to a 34% reduction by 2030. Improving the HVAC infrastructure is a significant contributor to reaching those goals.

Northern Ireland has yet to set a target, but its Climate Change Act 2022 sets a target of at least a 100% reduction in Net Zero greenhouse gas emissions by 2050.

Estates managers are responsible for the implementation of the programmes of inspection, audits, and repairs of their entire estate. This includes repair of buildings, mechanical and electrical engineering installations (HVAC), and regular reviews to ensure efficacy and compliance. The very nature of healthcare estates means they are critical facilities. The COVID pandemic had a significant impact over the last few years, and there are still persistent supply chain issues across the globe, but regular maintenance inspections and preventative measures minimise the risks of failures that could comprise a critical asset. No Estates or Facilities manager can afford to have their assets fail because they overlooked maintenance. The cost of an incident — be it interruption to power, or equipment overheating — can have serious implications. Maintenance programmes actively reduce the risks of reactive repairs and maintenance work that can affect a Trust’s operations.

Scheduled maintenance —
an ‘insurance policy’

Scheduled maintenance programmes are essentially an insurance policy to reduce unscheduled equipment failure. While reactive maintenance can deliver a speedy but costly fix, a PPM in place can decrease the risks of assets failing and the knock-on consequences.

It makes sense to have a plan in place which is reviewed every 12 months. Most health estates managers know exactly what they expect from their HVAC service and maintenance providers, and produce their own playbooks outlining not just procedures, but also their expectations. These often include their service and maintenance provider aligning with their own corporate values, including environmental strategies.

Routine inspections will ensure that there are no issues before problems occur. Good maintenance not only provides security and reliability, but also establishes resiliency so that your estate can function as expected. HVAC assets — including air-handling units, chillers, heat pumps, condensers, and energy management systems, but also water quality and peripheral devices such as grilles and louvres — can be high-value, and a substantial investment. Estates managers look for longevity of products, which can only be achieved through a planned approach to their overall maintenance. Aside from the long-term financial benefits, supporting vital systems such as heating and cooling is fundamental.

Cooling

It is imperative that chillers and air-handling units are not just correctly specified, but also commissioned as a system, and maintained to avoid equipment failure. Planned Preventative Maintenance (PPM) plans can mitigate disruptions and minimise operational, as well as financial, risks. As a mission-critical infrastructure, healthcare estates are reliant on reliable sources of power — consistent access to the national grid, with equipment able to handle any interruptions to power and water. Uninterrupted power supplies may comprise generators, batteries, and related switching equipment, but any built-in redundancy can be negated if due diligence is not deployed, and the equipment is not regularly monitored and tested.

Implementing a thorough maintenance regime is crucial, and to acquire a comprehensive view of the estate’s landscape every aspect of the HVAC system should be covered.

Types of maintenance

Maintenance can be broken down into three categories:

Scheduled maintenance.
Predictive maintenance.
Condition-based maintenance.

Many estates have further categories covering a wider range of equipment and facilities, such as Reactive Repairs Maintenance, whereby when faults are reported, these can be allocated a priority — from ‘routine’ to ‘urgent’. The former will usually attract a pre-set response time.

Irregular or cyclical maintenance is carried out with already planned recurrent maintenance, while backlog maintenance includes outstanding maintenance which has been identified through service reports or risk assessments. Additionally, Minor Works can cover items across estates that require adaption, enhancements, or new installations.

Scheduled maintenance will cover routine check-ups as previously mentioned, along with detailed inspections that will flag up any issues before they become a fundamental problem.

The schedule will be dictated by the manufacturer’s recommendations or industry best practice, but an Estates manager or their Trust may well have their own itemised check list for added security.

Predictive maintenance is an increasingly popular strategy, where ‘smart’ tools are used that gather and monitor data from various points of HVAC equipment to prevent it from failing. Such maintenance is also designed to monitor costs and keep them under control, empowering Estates and Facilities managers to make more informed decisions.

Condition-based maintenance

Condition-based maintenance, meanwhile, tends to focus on data and various formulae that will enable engineers to make a judgement on the condition of chillers or AHUs, and assess the likelihood of a component failure. Similar equipment can be expected to operate the same, but when operating several estates over different sites and locations, no two environments will be identical, and other factors that can affect performance may come into play.

It is also prudent to bear in mind that not every piece of equipment will require the same level of maintenance. Each item of equipment may have a different lifespan, for example. Some estates may focus on a seasonal plan depending on location and geoclimatic conditions — such as coastal locations which present salt-laden environments, or the harsher conditions on the Shetlands, where vertical rain can present challenges to equipment sited externally, and may require more frequent attention to particular systems.

Contracts are important, and it is important to ensure that they are specific. Ideally, each site should have a playbook that details exactly how equipment will be maintained. Our industry often reiterates how a good PPM is the strongest defence, and can provide real value in terms of promoting longevity and optimal functionality — and it can. Although labour-intensive and reliant on investment, a PPM enables Estates managers to reduce reactive maintenance, and to ensure that their organisation’s estate and assets are maintained to a desired or needed level. Realistically, however, maintenance is not always ‘preventative’, as certain conditions may require a total replacement, which is not ‘preventative’ at all. A checklist to take stock of your estate’s unique needs is not only a prerequisite, but will also address health and safety concerns.

Planned preventative maintenance on ventilation systems is not just about leak detection per se — of course leaks can result in toxic gases being released into the environment, and can endanger a building’s occupants. A chiller or air-handling unit leaking refrigerant also consumes more electricity. Although the NHS is rolling out a centralised approach to buying energy in a bid to slash costs, individual estates can, by taking preventative measures, significantly reduce their energy consumption, since leakages are estimated to consume up to 20% more electricity. Bearings, filters, and fans, are just some of the other components that need checking attention.

Other high priorities to attend to on any estate can include:

Robust documentation of tasks and tracking.
Identifying any potential equipment issues.
Checking for excessive vibration, signs of corrosion, and unusual noises, and for clogged filters.
Detailed audit trails.
Lubricating and cleaning equipment, and replacing components when necessary.
Awareness of battery failures.
Water quality in open and closed water systems, and L8 compliance.

The list is by no means exhaustive. Strong testing protocols should also be in place, with regular testing so that you and your staff are well prepared and able to ensure continuity and uptime of chillers and AHUs. Component availability also needs to be considered. Some Estates managers are concerned about the difficulty of replacing components; this became apparent during the pandemic, with shortages continuing to affect the supply chain. Any PPM programme should factor this in, with critical spares essential to maintaining maximum equipment uptime. Consideration should also be given to remote but regular monitoring of major plant such as chillers and heat pumps by service-providers, which will help provide an early warning of issues that could result in a failure.

The F-Gas Regulations

Estates managers need to be fully up to speed with the latest F-Gas Regulations. An F-Gas is any fluorinated greenhouse gas (HFC). F-Gases have high Global Warming Potential (GWP). The UK is phasing down HFCs, which means that the availability of these refrigerants will reduce, and that only recycled material will be permitted. By 1 January 2030, a ban will come into force on refrigerants in chillers recovered, reclaimed, and / or recycled with a GWP greater than 2500 for service and maintenance.

The processes for F-Gas Regulations compliance can seem laborious. Conversely, however, identifying which equipment leaks, from where, and by how much, means interaction with equipment suppliers to reduce leakage rates, prolong equipment life, and allow more time to manage phase-out plans. A PPM can increase the capital costs of your estate, and while it can be tempting to cut corners, short-cuts can be detrimental and costly in the long term.

Health estates are diverse and complex, and their maintenance, multi-faceted. Technological changes can also have a significant impact, for instance in the size and scope of equipment.

New fan and compressor technologies and, for example, Variable Speed Drives (VSD) to regulate air flows, can bring significant energy savings, as well as greater control of airflows.

The Internet of Things is helping to transform healthcare estates, and smart energy management systems can provide greater control and boost efficiencies by monitoring and controlling energy usage and energy management, and aiding energy optimisation, as does Building Information Modelling — which facilitates correct sizing of equipment, efficient use of space, and optimal operational efficiencies. The increasing use of AI technology means, for example, that the HVAC system can adapt to its operating conditions within set parameters to maintain both a comfortable internal environment, and minimise energy consumption. The healthcare sector has a responsibility to contribute to and inspire environmental sustainability. Investing in energy-efficient technologies and practices is a win-win, and can have a positive impact for all stakeholders, while minimising your estate’s environmental impact.

Benchmarking

It also pays to benchmark — you cannot manage what you don’t know, and improvements cannot be made if there are no measurements available as a point of reference. CIBSE produces HVAC energy benchmarks for hospitals in its TM46: Energy Benchmarks, and in its Guide F: Energy Efficiency in Buildings guide.

Comparing gas and electricity usage to those of other similar hospitals’ estates may be useful, as will reviewing Energy Performance Certificates, which can provide pointers as to where energy consumption is greatest. Tracking electricity usage over the summer against published cooling data, and analysing the information, will help determine if there is a relationship between energy consumption and the need for cooling. Identifying the largest HVAC loads can help generate the largest savings and paybacks.

Existing asset registers offer a valuable insight into maintenance plans for each piece of equipment, while air-conditioning and chiller inspection reports, and an inventory of refrigerants, can also provide information on your plant’s capacity and the areas it serves. This in turn will help Estates managers to develop an energy savings strategy, minimising unnecessary plant operation.

What about aged equipment? Estates and Facilities managers are adept at optimising the operation of older equipment to increase longevity and increase efficiencies. It is worth considering possible retrofit improvements to existing equipment. Aermec can help with a solution for chillers with its Aersave smart compressor. This can be fitted retrospectively, and will significantly increase energy savings on chillers. Compressor upgrades could be considered to enable VSD control, and whether, for example, a Turbocor oil-free compressor can be used to provide better load efficiencies.

Bearing climate change in mind

Climate change also needs to be borne in mind; the need for comfort cooling in estate environments is predicted to increase. Incremental changes are expected to have a strong effect on the energy requirements of estates; after all, their heating and cooling requirements are related to temperature and variable weather conditions.

Although there are few services that can pay for themselves, following a predetermined schedule that focuses on the regular maintenance or your cooling and heating equipment does. Reductions in energy consumed, increased longevity of equipment, minimised equipment failure risk, and addressing health and safety requirements, provide security for all stakeholders, as well as financial benefits in a vital service that has high demand.