Decarbonising the estate

This article was originally published in HefmA Pulse, you can read it here.

The energy and environment team, led by Cameron Hawkins, is a relatively recent initiative for NHS Property Services (NHSPS). Cameron has been in post for just two years, but with the benefit of starting from an almost blank canvas, he and his team have developed a strategy that is being rolled out across the country and is already producing results.

The energy and environment strategy launched in 2019/20. It is a broad-ranging, three-year plan, comprising around 200 actions across several key themes, including transport/travel efficiencies, increasing recycling/reducing waste as well as single-use plastic, improving water efficiency and, of course, reducing carbon emissions.

One of the first tasks that Cameron had to tackle was something he terms the ‘enabling works’. This includes establishing a baseline against which to measure progress and more resilient data, which is essential to monitor and provide evidence of progress as well as the delivery of results. As there is a good dataset back to 2017, that has been chosen as the baseline. NHSPS is continuing to work with NHS England and Improvement (NHSE/I) on improving the data. “To monitor our progress is so important,” Cameron tells Pulse. “With so much to do, it is good to be able to look back and see how we are performing.”

How are they doing?

In April 2020, NHSPS announced new energy supply contracts to move its entire building portfolio to 100% renewable electricity, as well as a flexible procurement strategy for electricity and gas that means this has been achieved at no additional cost to tenants. In fact, operating costs have been reduced. Cameron says NHSPS is on track to achieve 12% cost savings, equating to around £8.5m over the first two years. The move will offset over 37,000 tonnes of carbon dioxide per year. This initiative has been hugely successful for NHSPS and provides a case study for sharing best practice.

Moving to renewable energy is a great step. Reducing energy use is another, and this requires wider engagement with the building occupiers, that is, healthcare providers whose primary focus may be on patient care and not necessarily the energy-efficiency of the building.

NHSPS has introduced an engagement programme, which resulted in around 5,000 tonnes of carbon saving last year. This involves upskilling engineers and providing them with energy packs to work with the tenants in NHSPS buildings to advise on steps they can take to be more energy-efficient in how they occupy the building.

So far over 50 NHSPS sites have been upgraded to LED lighting through its ‘invest to save’ programme. In 2019/20, the upgrade of 30 sites to LED lighting brought a saving of £549,000 and the equivalent of 830 tonnes of carbon dioxide. This programme allocates the capital funding solely to schemes where the carbon reduction potential is substantial.

Finally, less than 1% of waste is now going to landfill.

On the radar

Decarbonising heat, particularly across large and dated hospital estates, many of which were originally designed to run on steam, is a big step. NHSPS is looking at Power Purchase Agreements and a mixed portfolio of on-site and off-site solutions, including, for instance, heat pumps, biomass, solar and hydrogen.

Removing gas entirely should be a focus, but it is also a challenge, which Cameron feels will not be met fully until hydrogen is widely available and cost-effective. However, reliance on gas can be reduced, particularly in the warmer months, when energy from solar power and heat pumps can be utilised.

With its high number of buildings, NHSPS is wellplaced to look at on-site solutions, which will also facilitate more renewable energy into the market place and help to ease pressures as the grid starts to decarbonise. However, these solutions do bring their own challenges. In the case of solar power, for instance, the condition of the roof, security and access for maintenance are all considerations.

Heat pumps are more expensive than gas and are not so effective in colder weather. Cameron also admits to a degree of nervousness about heat pumps. Whilst the focus is on carbon it should not be forgotten that refrigerants also contribute to global warming. Indeed, they can be even more harmful to the environment than carbon. Therefore, there is a potential for considerable damage from leaking heat pumps.

Electric vehicles

The country is moving towards electric vehicles at speed, following a significant push in the government's ten-point plan for a ‘Green Industrial Revolution’ in November, which brought forward the date from which sales of new petrol and diesel vehicles would be banned to 2030.

Electric vehicles do present a conundrum for the healthcare estate. One immediate question that must be answered is how much charging capacity is required and necessary on site and how does that affect the Trust’s carbon emissions? If the electricity is not from renewable sources, this will increase carbon, although it is within the organisation’s scope to address this and it is a requirement of the net zero carbon plan for the NHS across the board to purchase 100% renewable energy by April 2021.

Even if an estate does have renewable electricity, how much will the addition of electric vehicle charging points eat into the available capacity? One way of looking at this is that hospitals don’t have petrol stations on their sites so why should they be expected to have charging points for electric vehicles? The priorities for charging should be for the key vehicles for the hospital and ambulances. High demand vehicles, which are moving around all the time, have the biggest environmental impact, so these should be moved to electric as soon as possible. Offering charging points for patients and visitors may not be necessary or practical. Battery life and technology are improving all the time. Car parking space on NHS sites is always at a premium, so providing charging points - which would encourage people to leave their vehicles on site for longer periods of time - for many sites is not an option.

Other ideas include developing electric car clubs and only allowing electric taxis on site. It shouldn’t be forgotten that there is energy embedded in the vehicle, particularly in the battery, so what happens to that at end of life is something else to be considered and planned for. Autonomous vehicles also loom, and for the longer term, NHSPS is considering whether drone landing bays are the way to go, as drones may present the most efficient means of transporting blood and organs.

Net zero carbon construction

The 40 new-builds that the government has committed to must be net zero carbon. This will require a clear remit to architects. NHSPS is making good progress on a net zero health centre in Devizes, which is an important step and will lift the standard, providing a template for future projects.

Devizes is an Integrated Care Centre that will provide space for Wiltshire CCG to offer primary care in the form of GP and urgent care space to the local community. It is currently awaiting final stage design sign off which seeks an EPC rating of A+, going beyond BREEAM ‘excellent’ to be net zero in operation. The most notable change to a highlevel base spec of BREEAM Excellent is the introduction of more solar panels to make it net zero in operation.

Turning data into information

Historically, this has been a struggle, and not just for the NHS. More data is essential to help all organisations to make informed decisions. NHSPS is taking steps to address this. As well as the work with NHSE/I to improve the resilience of data, NHSPS is streamlining its data reporting. This could enable problems within buildings to be addressed before the tenant even knows there is a problem. Energy usage can be monitored by linking to the Building Management System (BMS) and running diagnostics around performance, for example, of the air conditioning system. Setting up benchmarking to assess good and poor performance with key metrics for electricity, gas, water and waste, will mean NHSPS can target sites that are either over or under the average, understand why and ensure resources are used wisely.

NHSPS is also pushing for minimum performance standards, both at a building and infrastructure level. At a building level this would specify a number of electric vehicle charging points, use of renewable electricity and a minimum EPC/BREEAM rating. This would be both for current sites, refurbishments and when selecting leased space. Infrastructure level will include the above, as well as when backlog maintenance or dedicated energyefficiency upgrades are being undertaken, where perhaps only one section of the building is being targeted. This will include BMS, boilers (including when to move to electric heating), lighting and heat pumps as a starter.

Can it be done?

HEFMA asked Cameron if net zero carbon across the NHS by 2040 is achievable. Yes, but with caveats, was his simple answer.

“We need sufficient funding. I got very excited when the low carbon fund was announced, but the scheme was only open for six weeks and the £1bn allocation was gone. We need hydrogen to come in by 2035. Then the big question is how do we offset the carbon that we have to have? This is one of the most significant challenges for Trusts declaring climate emergencies now. We need a big and robust carbon offsetting scheme, but this is not something that we are hearing much about.”

It is essential to note that any achievements towards the reduction of carbon emissions are not just the remit of operational teams. The involvement of the entire procurement team is central to success, by introducing and implementing the circular economy, and working to decarbonise the entire supply chain. This involves working with suppliers to influence emissions that are not within the direct control of NHS organisations, in what is being termed Scope 3.

As any energy manager knows, the issues of energy saving and cost saving are linked but they do not always sit together. Sometimes they are polar opposites. Cameron has been in the energy sector for 20 years and in that time the emphasis has been on cost savings, but, he says, it now needs to be on decarbonisation. “We have the technologies, so we can do this, but the money needs to be there and the technology needs to be cost effective. Finally, we need to target spend. This is perhaps the biggest challenge, but we will never get there if we don’t.