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Road to recovery

Alan Short

A detailed health check of England’s NHS estate has revealed that energy efficiency measures could save enough over five years to fund 9000 heart bypasses. Treatment is already well under way

The NHS is responsible for 18% of non-domestic buildings’ emissions in the UK, equivalent to a metered energy cost of £600m in 2011. To improve energy efficiency, the Department of Health NHS Energy Efficiency Fund (NHS EEF) provided £49.3m for over 100 energy efficiency projects delivered in 2013-14 to 48 NHS organisations in England. The objective was to retain the resulting benefits within the organisations for direct re-investment to frontline patient services. Cambridge University was appointed to manage the Fund and report on the outcomes. The final report, which I authored, has just been published; the collection of actual data continues.

So where did the investment go? What savings have been made and how has that money been spent? A wide variety of projects was implemented: building fabric improvements; upgrades to mechanical and electrical services; low energy lighting schemes; switching away from fossil fuels and on-site energy generation. The pie charts (below) show the distribution of funding and expected energy savings in the first year, across different project categories. Interestingly, the figures show that investment and savings do not wholly align.

The £3.7m invested in building management system controls are projected to save £5.6m over five years and £10m over 10; lighting upgrades are expected to save £5.19m in five years and £9m in 10 from £3.9m initial investment are shown in the table opposite. Organisations securing multiple interlinked projects should realise £17.97m in five years out of their combined £11.3m of initial investment and £29.4m in 10 years. Good organisation and forward planning will pay dividends.

The projects were expected to reduce the entire NHS building energy related carbon footprint by approximately 2.4% (2012 data), saving 160.5m kWh a year. Discounted savings add up to £69.8m in the first five years of operation, equivalent to 63,800 tonsillectomies or 9,000 coronary heart bypass grafts.

Other than carbon savings and the immediate cash-releasing benefits, some less quantifiable, but no less significant, benefits accrued from the original investment. These were very diverse, from using savings to buy new diagnostic equipment and so increase patient throughput, to releasing land for a new pathology laboratory following the removal of a defunct underground oil tank.

Studying efficiency
Thirty one case studies have provided richer insights into the implementation of the EEF. These include combinations of projects by type (lighting case studies, CHP, electrical optimisation projects’ case studies), and four singular cases, three of which involved significant investment in multiple projects. The fourth project involved a unique EEF project combination covering electrification of the vehicle fleet, purchase of tele-conferencing facilities and installation of solar photovoltaic panels. The case by case exploration consisted of interviews, conversations and site visits with trust estates staff who had led project implementation.

Southend University Hospital NHSFT was among the case studies analysed in detail. The organisation was well prepared to bid, having an energy masterplan in place. It won funding of £1.6m for 17 interconnected projects of building energy performance, including works on the heating, ventilation and air conditioning systems, thermal insulation of the envelope, and lighting. The hospital used the EEF works as an opportunity to make wider improvements on several wards and the restaurant, while minimising disruption and economising on contractor costs. Managing so many separate projects presented complications, especially during the handover stage when the project manager’s contract ended. The hospital noted the difficulty of getting access to patient-occupied areas and highlighted the need to engage with stakeholders early over shutdown periods. Southend was one of the few hospitals with formal post-project evaluation procedures in place, comprising surveys across hospital staff over the 24 months following the completion of the works.

Salisbury NHSFT, was awarded £800,000, for improvements which include LED lighting, high efficiency chillers and solar panels; all delivered to schedule due to careful pre-planning. Changes to the building envelope and improved LED lighting have improved the quality of the patient and staff environment. Heat obtained from the CHP facilities is partially used to improve the pool temperature (used for therapy and exercise), which is especially useful since it is a non-seasonal benefit for patients. Retrofits are anticipated to save £158,000 and 12m kgCO2 of emissions annually.

Within the EEF scheme, 20 projects contained lighting upgrades. This included large schemes that only involved lighting, such as a £1.7m job for upgrading 7000 lamps and those where lighting was part of a wider programme. Total investment in lighting was approximately £8m. While LEDs are expected to return significant energy savings in a like-for-like comparison with existing lamps, several factors influence the cost-benefit analysis of these schemes. These include auxiliary costs such as replacement of fittings, removal of asbestos and ceiling improvements. The key cash-releasing benefit of the lighting schemes is the reduction of energy use, although lower maintenance costs are probably an additional benefit. The main non-cash benefit is the lighting quality, improving conditions for patients and staff.

Future issues
The analysis of the EEF projects and their implementation revealed issues for the future. Drawn from the findings were recommendations to policy makers and stakeholders involved in similar processes:

Energy efficiency knowledge and skills available to organisations may vary dramatically between external consultants and  in-house staff with different levels of energy efficiency understanding. NHS organisations should review the relative cost of bringing in external expertise against the savings available from an in-house capacity to diagnose energy performance and to deliver effective strategies. Moreover, engaging with university building science research departments provides a great chance for improvements, especially for University Hospital Trusts.

  • Existing data at the scale of individual buildings is almost absent. The available data is too high level to permit meaningful diagnostics and post-intervention comparison. Organisations need to collect more detailed information, especially since monitoring equipment is increasingly affordable and data analysis tools increasingly user-friendly.
  • The process needs time to unfold to ensure successful outcomes. The EEF timetable rendered unviable all applications requiring external permissions. For example, organisations were unable to secure the necessary permissions for renewables installations in the EEF timescale. If policy-makers want to encourage the use of renewable energy sources across the NHS estate, they must allow enough time for negotiations with local authorities.
  • Timely clustering of interconnected projects should be encouraged: it can maximise returns and minimise disruption to patient

Retrofits at Salisbury are anticipated to save £158,000 and 12m kgCO2 emissions a year

Ideal formula
The researchers believe the successful formula is: collect data at as fine a grain as possible; understand the building stock; improve the building fabric, lighting and controls; then – and only then – pursue renewable energy sources to satisfy the healthily reduced demand. To be in line with the 28% carbon emissions reduction required by 2020 compared to a 2013 baseline, an emissions reduction of 0.1628 MtCO2 annually is required (around 4% savings every year). An investment of nearly £50m in the Energy Efficiency Fund from 2014 is expected to reduce emissions by 0.1006 MtCO2e. Therefore investment in retrofit projects achieving around 1.6 times the EEF savings every year would save this level of emissions. There is everything to play for. We are nearly two thirds of the way there. •
Alan Short is professor of architecture at Cambridge University and author of the NHS Energy Efficiency Fund Final Report


£69.8m savings in first five years of operation
£3.7m investment in BMS control systems
£10m saving on BMS control systems over 10 years
£50m EEF investment in retrofit from 2014


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