FEATURE: How the NHS can spend less on energy and more on people

Energy reduction strategies rely on detailed evaluation and adoption of innovative technologies, says Jan Ponsford of Virtus Consult

Things have improved significantly since a government greenhouse gas emissions survey of the public estate in 2010 found that the worst offenders included many of the country’s hospitals.

But there is still much that can be done, according to Jan Ponsford, director at Virtus Consult, a specialist in energy reduction strategies.

He explains: “Before you can cut energy consumption, you have to know what energy is being used, what is being wasted, and where any savings can most easily be made – it’s not always obvious and requires a detailed evaluation of the entire estate.

The value lies in balancing the time taken for the expected savings to cover the initial expenditure on implementing the changes

“Reducing energy consumption is often conflated with reducing carbon emissions.

“Organisations can become focused on large renewables projects and their ability to reduce the reliance on traditional fossil fuels, rather than a drive to cut energy consumption.

“It’s easy to get behind big projects like large photo-voltaic arrays or waste to energy, but it is much harder for facilities managers to ‘sell’ the idea that many small changes can deliver huge potential savings over time.

“Investing in new low-energy lighting is unlikely to grab the headlines, but management teams need to recognise that lots of small changes the facilities managers can make will have a massive impact.

Comprehensive evaluation is key

The estate evaluation needs to be detailed. It has to consider every aspect of the energy-efficiency equation and include every source of information, from half-hourly electricity bills to waste management policies.

“To establish the all-important baseline, the evaluation must take into account the facility’s energy spend and carbon emissions from mechanical and electrical activities, buildings, infrastructure, land, waste, transport, and even the organisation’s people,” said Ponsford.

He added that there are three aspects of a good evaluation:

  • Power usage: The site survey will consider metering and sub-metering by department in healthcare facilities due to the large potential disparity in usage. It is important to monitor and benchmark performance, comparing the in-use performance of a building to its historical energy use or the energy use characteristics of similar healthcare facilities
  • Initiatives: More tactical, but it is still critical to consider heat recovery, use of renewables if relevant, including energy from waste, lighting systems, electrical equipment, voltage optimisation, and improvements to the fabric of the building and its surroundings
  • Operational: The survey should consider the energy use awareness of the staff, the lifecycle maintenance, waste reduction strategies, procurement services, transport and, ultimately, the culture of the organisation – does everyone share the desire to cut consumption?

Organisations can become focused on large renewables projects and their ability to reduce the reliance on traditional fossil fuels, rather than a drive to cut energy consumption

Working with those with the day-to-day responsibility for energy consumption, purchasing and wastage, along with operational activities; the assessment can look in detail at the policies in place and the baseline information needed to make recommendations.

“The necessary information starts with the buildings, their age, construction and condition, their occupancy profile and any plans to redevelop if appropriate,” said Ponsford.

“A thorough inspection of the building fabric and its thermal properties, along with rooves, windows, doors, flooring etc, forms an important step of the final evaluation.

“If no asset register is available for the mechanical and electrical systems, a thorough review of heating, ventilation, cooling and lighting systems will be needed.”

He added: “The temperature and humidity set points, and whether they change during the year, in different locations across the estate will help shape the overall consumption picture and highlight potential changes.”

Annual savings and payback time

The problem for many management teams and facilities managers is the investment required to make the necessary changes against the estimated payback time.

When more money is constantly required for clinical activities, spending on energy reduction can become piecemeal and ineffective.

“It is critical to demonstrate when many changes are undertaken together, the savings can be immediate, with payback periods as short as 4-5 years. After that, it’s all big savings,” said Ponsford.

“Even a typical small trust estate is capable of reducing energy consumption by as much 18%, with a reduction in energy spend as high as 24%.”

A thorough inspection of the building fabric and its thermal properties, along with rooves, windows, doors, flooring etc, forms an important step of the final evaluation

A comprehensive evaluation, combined with a committed implementation plan using the right specialist contractors ensures it is possible to achieve guaranteed savings, which not only reduce consumption, but carbon emissions.

“There is the potential to save millions of pounds over the period, which can be better invested in improvements to medical facilities and even patient care,” said Ponsford.

From design to reality

“Much is made of low-energy building design, but when they are built and occupied, there is a gap between the predicted performance and the actual energy consumed,” he warns.

Published in 2013 by CIBSE, TM54: Evaluating Operational Energy Performance of Buildings at the Design Stage, provides clear guidance on how to evaluate operational energy use more fully at the design stage.

One key consideration is accurate estimating of the operating hours and occupancy pattern of the building, which is unique in the case of healthcare facilities.

The guidance sets out how the operational energy can be estimated and covers lighting, heating, ventilation and cooling, along with the provision of hot water.

Crucially, it also asks designers to consider the consumption profile of lifts and escalators, small power loads, catering, server rooms and other plant and equipment, which can often be overlooked with current calculating methods.

“The UK has huge talent in designing buildings to achieve PassivHaus and Breeam certification, but there remain basic improvements possible on older buildings that will consistently deliver greater energy efficiency and relatively short payback periods,” said Ponsford.

Even a typical small trust estate is capable of reducing energy consumption by as much 18%, with a reduction in energy spend as high as 24%

The real pinchpoint for NHS energy managers and facilities managers is typically how to fund the changes needed, not what changes need to be made.

“While many funding options are available, it has to be recognised that a ‘one solution fits all’ approach will not work, given that no two trusts are ever the same and no opportunity should be overlooked,” said Ponsford.

“Funding options are assessed on a project-specific basis, considering building type, usage, location, trust requirements and preferences.

“The energy-saving measures being considered will also impact the potential funding solutions.”

The options usually fall into a number of categories, with the simplest perhaps the trust capital funding the improvements.

Borrowing directly from the Green Investment Bank or SALIX, which offers interest and fee free loans, are popular choices, with energy cost savings used to pay the loan.

Salix requires NHS programmes to payback within five years and less than £120 per tonne of CO2 over the lifetime of the project.

Salix funding covers over 100 energy-efficient technologies including boilers, combined heat and power, LED and lighting upgrades, as well as heat recovery systems.

It is also possible for the improvements to be financed through third-parties, which could include ‘off-balance sheet’ options like an Energy Services Company (ESCo) agreement, a Short Term Operating Reserve (STOR) arrangement, a Special Purchase Vehicles or Programme Partnership Arrangements.

The UK has huge talent in designing buildings to achieve PassivHaus and Breeam certification, but there remain basic improvements possible on older buildings that will consistently deliver greater energy efficiency and relatively short payback periods

“For trust managers it is all about building the business case for the whole project, considering the procurement and application process with indicative timescales;; levels of funding; risks; interest levels; payback periods; any restrictions on using different types of financing together; any potential contractual or legal issues; and any significant dates, such as when a particular fund closes.

“Experience dictates the best funding solution is the one that meets the trusts’ needs and satisfies legal and statutory requirements while delivering the least risk for all stakeholders and the best value.”

From the evaluation and gathering the baseline information, implementation for the raft of simple changes will typically take 6-9 months, he added.

Once the business case has been made and accepted, a tender process will select the contractors most experienced in delivering similar projects and guaranteeing the predicted savings and payback period.

“The project should ideally involve the energy consultants that initially undertook the evaluation, as they will understand the organisation’s objectives, economic drivers, operational structure, existing knowledge and experience – all beneficial to the successful delivery of the project within agreed timescales,” said Ponsford.

He added: “Energy efficiency projects within the healthcare sector rarely have an end point as a lot of monitoring and verification is required to ensure targets are hit.

“Perhaps the most important aspect in the fight to cut energy consumption is continual improvement as new technologies emerge or become more affordable.

“It has to be recognised that hospitals are complex buildings with unique energy requirements. They are occupied every minute of the day, by a lot of people, many of whom are unwell and potentially at risk from poor environmental conditions.

“This situation requires control of the buildings’ thermal environment and indoor air quality, especially those spaces used for treatment and convalescence, which can require large amounts of energy.”

Perhaps the most important aspect in the fight to cut energy consumption is continual improvement as new technologies emerge or become more affordable

This is to say nothing of the medical equipment, like MRI scanners, that use a lot of electricity, and the optimisation of which can typically result in a 10% reduction of hospital energy consumption, according to research in Norway.

“The value lies in balancing the time taken for the expected savings to cover the initial expenditure on implementing the changes,” said Ponsford.

This requires a more-nuanced and experienced approach, but the savings can be immediate and significant.

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