Patient First, the UK's largest patient safety event, will return to London's ExCeL on 21-22 November 2017
A study by cost consultants EC Harris, identifying £1.5bn worth of savings the NHS could make by improving efficiency across its estate, was unveiled at the recent Healthcare Estates conference in Manchester. The current annual bill for NHS estates management stands at £7.2bn and is rising at almost eight per cent every year despite the austerity measures introduced by the coalition government.
Conference delegates responded by urging the Department of Health to renew the publicly funded £50m pilot programme run by several trusts last year to trial energy saving strategies and to bolster the department’s own Encode sustainability design guidance. Trusts that ran the pilot schemes were able to reinvest their savings from reduced energy bills in frontline patient care.
However, DoH spokesman Peter Sellars told the conference there was no more “capital spend available” for another round of energy efficiency schemes, although he said “the ministerial team are always asking us to do more about the energy efficiency agenda.” He urged trusts to look for alternative sources of funding such as the Green Investment Bank.
“The evidence shows that the way we currently manage our estates is not sustainable,” Mr Sellars added.
Experts who spoke at a session organised by the Building and Engineering Services Association (B&ES) identified lots of ‘low hanging fruit’ that almost every healthcare facility can find to quickly and cheaply improve its energy efficiency.
Estates managers were urged to carry out extensive measuring and monitoring to investigate how well their heating and cooling systems were operating. In many cases, they will find they are working against each other because occupants have been changing the temperature settings, the B&ES speakers said.
This situation is often made worse by building users opening the windows because they feel hot, rather than turning the heating down. Even relatively new hospitals could benefit from extensive re-commissioning to eradicate this type of problem, delegates heard.
Facilities managers (FMs) should make sure there was a temperature ‘dead band’ programmed into the controls by optimising the set points to ensure the heating and cooling systems did not end up running at the same time and wasting huge amounts of energy.
Darren Jones of specialist consultancy Low Carbon Europe also told the session that ventilation systems were always overlooked as a source of potential savings. He said that optimising the way air was supplied to just one operating theatre could save a hospital £5,000 in annual running costs.
That could add up to £10m a year if replicated right across the whole of the NHS and would also avoid 80 tonnes of carbon emissions.
He said that any ventilation fan that is over five years old is almost certainly inefficient and a replacement would pay for itself in less than three years. Healthcare FMs could cut running costs by 29 per cent by replacing the fans in their air handling units and the addition of heat recovery to ventilation systems can reduce costs in non-clinical areas by up to 30 per cent. Even more basic measures like having grilles and filters cleaned regularly can save thousands of pounds a year.
Mr Jones urged hospital FMs to measure air flow rates to get an idea of how well their systems were working and look for ‘free cooling’ opportunities – where the system will cool the building without the need for the refrigeration circuit to operate. “When we survey NHS buildings, we often find that the chillers have free cooling circuits that are not being used because the building managers are not familiar with the controls,” said Mr Jones.
He pointed out that partial free cooling was possible even when the outside temperature was as high as 18degC. “We need to train people to take advantage of this so that refrigerant plant only runs when it is really needed.”
Variable speed drives are often installed in plant rooms, but have just been left at a constant speed setting, which defeats the object, Mr Jones added.
David Fitzpatrick, sales and marketing director of Ruskin Air Management, told the conference that, because the primary focus tends to be on operating theatres and critical areas, the well-being of recovering patients and hospital staff can be forgotten.
He said that his company’s research among bed management teams revealed their top priority was to help patients recover more quickly. This means that a high standard of indoor air quality (IAQ) is required in general areas, according to Mr Fitzpatrick. “Things are already pretty fraught in A&E as it is, so having poor air quality is just going to make everyone feel even worse,” he said. “The ventilation, therefore, needs to be able to contend with airborne contaminants and VOCs; as well as cooking and body odours, but it was often not designed with any of those things in mind.”
Ruskin is actively involved in the design and refurbishment of healthcare ventilation systems and Mr Fitzpatrick said that a big problem his team encountered was the fact that an area was often designed for one purpose, but was reconfigured and used for something else at a later date.
“We are seeing increased demand for a mixed approach to ventilation that combines natural, low energy solutions wherever possible with powered ventilation only where it is essential,” said Mr Fitzpatrick. “This provides the necessary amount of flexibility so the system can adapt to changing uses and conditions, but also keeps the initial capital cost down.
“Natural ventilation measures are generally fairly easy to install, but the controls are critical to ensure the system works properly.”
In fact, 80 per cent of ‘quick wins’ in hospitals are linked to making better use of Building Management Systems (BMS) that are already in place, but are not controlling as many of the building functions as they are capable of, the B&ES experts explained.
Maintaining high levels of air purity in clinical and general healthcare facilities remains a major priority, but B&ES indoor air quality expert Peter Dyment said many FMs were missing the growing threat from increased outside air pollution.
The increase in the concentration of diesel particulates, particularly in urban areas, since the government encouraged the adoption of diesel vehicles has led to a worrying rise in respiratory diseases, he said. However, the Health Technical Memoranda (HTM) used to guide NHS managers on a wide range of design issues do not cover contaminants that might enter the building from outside.
“HTM guidance concentrates on the transmission of diseases inside hospitals and a lot more needs to be done about the potential health impacts of outdoor pollution,” he told the conference. “360,000 premature deaths in the EU are already down to worsening air pollution.”
Mr Dyment, who is a consultant for Camfil Farr, cited newly revised guidance from B&ES: ‘Guide to Good Practice – Internal Cleanliness of Ventilation Systems’ (TR/19) as a good source of advice for healthcare premises managers on tackling the threat posed by poorly maintained ventilation systems.
“Many of the measures needed are very low cost, such as cleaning intake grilles, and will payback in hours because of the immediate running cost and health benefits,” he added. Increased use of air filtration will also help trusts maintain good indoor air quality, the conference heard.
Mr Dyment explained that energy saving filters were now a much more significant section of the market ‘growing by 20-30 per cent per year. “They will also last two or three times as long as commodity products,” he said.
Persuading NHS trust boards to spend money on remedial measures is not easy because they are fully focused on frontline patient care, but Mr Fitzpatrick said it was important to avoid talking about the technical issues and express the possible investment in terms of its direct impact on improving conditions for patients and how energy savings can be reinvested in patient care.
One very easy way to cut costs, while also improving ventilation rates, is to replace standard windows with louvred openings. These meet health, safety and security requirements, but can improve ventilation rates by 15 per cent due to their larger ‘free area’, he added. Many conventional windows have to be secured shut for safety reasons.
B&ES Eastern Counties regional manager Mike Malina warned delegates against the use of renewables for ‘token’ reasons and said they should only be considered once an ‘energy hierarchy’ had been put in place first, i.e. measures to reduce energy demand along with energy efficiency improvements to existing systems.
He also said heat pumps could not be deployed as direct replacements for boilers unless other improvements to the building were first carried out such as better insulation and a proper controls strategy. “NHS managers usually say there is no money for energy efficiency measures, but relatively small investments can realise huge savings in such energy intensive buildings,” said Mr Malina.
“There would be no need to raise taxes to pay for more investment in the NHS because energy efficiency improvements pay for themselves and free up more tax payers’ money for frontline patient care,” he added.