Knowledge transfer programme
July 04th 2007

Mike Perry, healthcare sector manager – Modern Built Environment KTN discusses an Innovation Programme for the UK’s healthcare built environment and the role of energy systems

To meet the new demands on healthcare services the healthcare built environment is undergoing radical change, funded by unprecedented levels of public sector investment. The shift in emphasis in healthcare requires that buildings used to deliver health services will have to accommodate cost effective changes in use over time and be capable of continuous improvements in performance. The existing healthcare estate is large, comprised 78000 separate sites, including 1200 major hospitals and serving 14 different categories of health function.

With an annual capital spend in 2006–2007 of £6.5 billion and rising, the NHS is the construction industry’s single largest client. Annual spending on repairs and maintenance is more than £520 million. In 2004/05 the annual energy bill was £312m, and is set to increase to the order of £400 - £500m following recent energy price increases. There is significant potential to improve the quality,performance and fitness for purpose of new build and major refurbishment projects, and of existing stock – the largest element of the healthcare estate in the UK.

Joined-up innovation for a better built environment

Improved awareness and understanding of new and emerging technologies can enhance the quality of the UK’s healthcare estate. The challenge is realising this potential, the key to which is creating an effective means for linking clients with sources and suppliers of innovative technologies and processes relevant to the sector.

Although not a new idea, action is being taken now to make it happen more routinely, through the actions of a consortium established by DTI. Comprising BRE, BSRIA, CIRIA and Arup, the programme will implement an industry-led Knowledge Transfer Network for the Modern Built Environment (MBEKTN). The programme will facilitate the exchange of knowledge, stimulating innovation across the built environment, including the three initial themes:

• Healthcare;

• Commercial workspaces;

• Infrastructure.

The mission of the Healthcare theme of the MBEKTN is: To accelerate the transfer and uptake of technology and process innovation in the UK’s healthcare sector, facilitating improvements in the delivery of improved clinical outcomes and improved cost effectiveness.

Challenges for the healthcare sector

Working with key healthcare organisations in the UK, including the Department of Health, the Healthcare programme of the MBEKTN has identified four initial themes as crucial to addressing strategic sector issues, including:

• Energy and sustainability;

• Flexibility in use of the healthcare built environment;

• The application of digital communications to support effective use of healthcare resources.

• Clinical Infection

The energy theme is well defined and tractable. Solutions are available now that can have an immediate effect on improving energy efficiency and, reducing energy consumption and carbon emissions.

Energy efficiency in the UK’s healthcare sector

The healthcare sector in the UK consumes enormous amounts of energy – annual consumption is 82 PJ of primary energy, emitting 3.3M tonnes of carbon dioxide and costing of the order £500,000m.

With increasing energy costs, the imperative to improve energy efficiency is underlined by challenging targets set by Government to reduce energy consumption in healthcare buildings to less than 55 GJ/100m3 for new build or major refurbishment projects,and no more than 65 GJ/100m3 for all existing facilities.These targets are tobe achieved by 2010.

Innovative processes and technologies are available to

help achieve even more significant reductions – conservatively 10%,potentially as great as 50% – in energy consumption in existing stock and to design-in maximum energy efficiency into new build and major refurbishment projects.The Department of Health has recently launched a £100million energy reduction grant scheme. It has been agreed that best practice learning from the successful schemes will be communicated through the KTN.

Energy use in the UK’s healthcare sector

The pie chart above was developed from information in ECON 72 and is based on primary energy, reflecting carbon emissions and costs. It shows:

• About 80% of all electrical energy use is for lighting and motors,with the remainder being for IT and small power.

• Fossil fuel is used for heating, steam and domestic hot water. Heating represents weather related energy use. Heating base load includes domestic hot water and steam loads but excludes laundries.

• Changes in energy use are being driven by the growth of medical IT equipment, increased clinical activities, mechanically conditioned spaces,global warming and the introduction of more energy efficient plant, equipment, control and new or refurbished buildings.

Energy saving opportunities

An earlier pilot scheme carried out by BRE and NHS Estates in 2003 across 23 hospitals and six community buildings showed that:

• 50% of measures required no cost – for example, controls and BMS related schemes. Good housekeeping and staff training accounted for over 21% of energy savings schemes

• 43% of those involved in the pilot identified boiler and boiler house related schemes as offering highest savings, with simple paybacks of up to 5 years

• Lighting accounted for 20% of the NHS energy usage. Lamp replacement and other lighting measures showed substantial savings with paybacks in the range3-7 years, typically reducing lighting energy use by 30%

• Overall 15% savings in primary energy use could be achieved with schemes with paybacks of less than 7 years

Lighting

Lighting is one of the largest energy saving potentials for the NHS, representing c.21% of the annual energy bill. If all lighting in the NHS met good practice a 7% reduction in primary energy and carbon emissions would be realised. A 50% reduction in lighting energy consumption is often achievable, including in new hospitals.Three years is the typical payback period.

Building controls technologies

Controls provide a major opportunity to make energy savings.Many of the controls related savings are low or no cost. Typically energy cost savings of 7% can be achieved by commissioning and operating controls as intended. Further savings result from new controls installations. Improved controls are often installed to overcome discomfort for patients and staff whether it is summer over heating or draughts in winter. Energy savings are often perceived as a bonus rather than the justification for the investment.

Controls technologies include automated meter reading (AMR) systems. These inform energy management and investment decisions and are fundamental to understanding where energy is being used and prioritising where it needs to be reduced. Reasons to engage with the MBE KTN – healthcare:

• Those responsible for developing policy, strategy, and objectives: The Healthcare sector of the MBE-KTN aims to provide a central reference source on recent and emerging innovations of process and technology that will influence the setting of short and long term requirements and objectives for the healthcare built environment.

• Financiers, LIFTCos and PFI teams: Being aware of the most recent built environment innovations – process and technology – will help better inform risk assessment and financing decisions on funding of healthcare projects.

• Clinicians and senior managers from health sector Trusts, eg Foundation Trusts, PCTs, and their private sector equivalents: Informed clients are better able to articulate the requirements of their building projects. The Healthcare sector of the MBE-KTN will provide information to support informed client requirements.

• Building design and specification teams: Those responsible for designing and specifying will benefit from having access to a central reference source on recent and emerging solutions for application in healthcare projects, ensuring that their projects embody cost effective, high performance buildings.

• Practitioners and operations managers:Having access to plain language descriptions of recent process and technology solutions will encourage understanding, fostering market demand for innovative and workable solutions to healthcare building and estate requirements.

• Technology and process innovators and suppliers: A primary objective of the Healthcare sector of the MBE-KTN is to promote the uptake of innovative solutions by promoting familiarity so facilitating the reduction of barriers to market entry.