Making the NHS sustainable for our communities

With the NHS about to embark on the largest hospitals building programme for decades, Katja Lacey explains why there exists a unique opportunity for the NHS to help create sustainable communities which promote health and well-being

The health and social care system in this country is huge. It represents over 10 per cent of the country’s economy, nearly 10 per cent of the workforce and around five per cent of all road traffic. Despite an increase in clinical activity and the challenge of managing significant transformational changes, the NHS has made significant progress. Carbon emissions reduced by 18.5 per cent between 2007 and 2017 and water footprint by 21 per cent between 2010 and 2017.

However, despite these improvements, there remains a significant challenge if we are to deliver the Climate Change Act target of reducing the carbon footprint of health and social care by 34 per cent by the end of this year and 51 per cent by 2025.

The new Hospital Infrastructure Programme, the largest hospital building programme in decades, is our once in a generation opportunity to help achieve these targets.

The largest hospitals building programme in decades
Many hospitals across the country are facing huge estates challenges. Building a hospital involves significant resource and, once built, hospitals then require a lot of energy to run. They also produce huge amounts of waste that needs to be carefully disposed of.

There is, quite rightly, a growing pressure on hospital design to become more sustainable and to ensure that both the build process and the running of the hospital are as environmentally friendly as possible.

The environmentally friendly alternative hospital build
There is an environmentally friendly alternative to the historical approach to hospital builds. New approaches are emerging across the globe to help achieve a net zero building design. The objective in all buildings which emerge from the new Hospital Infrastructure Programme must be to achieve energy performance targets of 320 kWh/sqm or less.

This can be realised through various means. For example, the choice of materials for construction, choosing renewable energy sources, using modern methods of construction and using consistent designs across hospitals. Specifically, this means a new hospital should, for example, use high reflectance roofing and paving, site facilities in accordance with solar orientation and prevailing wind and prioritise the health impacts of material extraction, transport, use and disposal.

A good example of an environmentally friendly hospital build can be found in the US. The Gundersen La Crosse campus in Wisconsin installed geothermal heat pumps under their car park. This takes advantage of the moderate temperatures underground and a 300-ton heat pump, along with 156 wells buried about 400 feet underneath the parking lot, provide an efficient heating and cooling source year-round. This results in a savings of 70 to 80 kBTU per square foot annually, by far the largest energy saving component of Gundersen's new hospital. This is something that every new hospital build in the UK should be emulating. As well as this, the Gundersen La Crosse campus also installed a highly insulated building shell – covering windows, walls, ceilings and so on - resulting in large savings and reducing their reliance on fossil fuels. Again, something all new hospital builds should seek to replicate.

The benefits of a well-designed, net zero building not only include a reduced carbon footprint, but also an improved environment for patients and staff, with increased natural light and noise reduction methods resulting in huge benefits in terms of health outcomes.

Building hospitals is not the only opportunity for the NHS
Better design of new towns not only improves the health and wellbeing of residents but also helps create sustainable communities. Within the NHS Long Term Plan, it’s recognised that the NHS has a wider role to play in influencing the shape of local communities. It is now well-established that new developments need buildings that help to break down the traditional boundaries between different services to support an integrated approach to health and sustainability.

More widely we can draw on lessons from NHS England’s Heathy New Towns programme, which showed that better planning and designing improves the health and wellbeing of residents but also helps create sustainable communities. This can create a win-win for housing developments which are so often proposed around new hospitals.

Co-location of NHS services, such as primary care or public health, within these communities, through community hubs and other health and well-being services, can bring wide benefits to the local population. To be successful, these services should be co-developed, with input from public health professionals, local planners and local people, to adapt this to local needs, including the integration into people’s homes.

As our work on the Heathy New Towns programme for NHS England showed, embedding health and healthy living into the fabric of where we live can have strong returns for citizens, the NHS, social care and wider government. We found that every £1 of spend on heathy new towns created a £3.2 return across the public purse. These principles must now be applied to our new hospitals and their surrounding developments, where the same benefits can be realised.

The Health Infrastructure Programme represents the one chance to make buildings and social assets which promote sustainability, helping to turn around some of the financial difficulties the NHS is facing. This is an opportunity that we cannot afford to miss.  

Katja Lacey is a healthcare expert at PA Consulting.

Event Diary

Following the 2017 Naylor Report into NHS estates, it has been estimated that estate upkeep costs have reached approximately £10bn in annual funding for 2019/2020.

More recently, ERIC (Estates Returns Information Collection) data collection has contained some deeply alarming news about the condition of NHS buildings and equipment.

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