Can we deliver Net Zero Carbon hospitals?

In the midst of one crisis, it can be easy to overlook another, but as the global focus on healthcare facilities intensifies, it has become increasingly clear that we cannot consider solutions for the Covid-19 pandemic without also considering how it can link to solving the climate crisis, writes Stephen Maddocks.

At face value, the answer to whether we can deliver Net Zero Carbon hospitals is a simple one. Yes. However, we can only do this with improved regulations, and crucially, with government and full board-level support.

At a roundtable hosted by Cundall last week, James Dixon, head of sustainability at The Newcastle upon Tyne Hospitals NHS Foundation Trust, said that there has always been support for action on sustainability within his organisation, but it wasn’t until the “truly terrifying” 2018 IPCC report on the impacts of global warming, that he was able to lobby to get the board to take it seriously.

Dixon said he used to be “the crazy in the room” pushing for sustainability, but now it’s the board pushing for delivery. In June 2019, Newcastle Hospitals became the first healthcare organisation in the world to declare a climate emergency. In doing this, they have recognised the threat that climate breakdown poses to public health and are leading the way for other leaders in the sector to do the same, and for designers of new and refurbishment schemes to table innovative solutions to net zero.

This is a promising start, and with the UK government’s commitment to reaching net zero carbon by 2050, we can expect to see a greenification of primary and community care facilities in the years to come. This will involve a greening of NHS estates and a reduction in emissions, as well as redesigning care pathways to support fewer outpatient appointments and more treatment at GP centres. What we do not know is when this will happen, and this is largely down to out-of-date industry regulations.

The built environment for UK healthcare has for many years been designed and informed by the Health Building Notes and Health Technical Memorandum published by NHS England and NHS Improvement. These give best practice guidance on the design and planning of our healthcare facilities and define standards, codes, and requirements for all aspects of healthcare buildings, including Acute, Primary, Specialist, Mental Health, Social, Community and Emergency care.

However, while these guidelines do address sustainability, as they stand now, they are by no means stringent enough to facilitate complete compliance with net zero ambitions. That said, there has been a lot of good work in this area, and we can expect to see standard updates agreed upon for HBNs and HTMs in reference to Net Zero Carbon in the near future.

These improvements to HBNs and HTMs alongside increased engagement at a board level, will mean an increase in investment of both time and money from the sector. It will facilitate decisions on sustainability to be taken at the design, procurement and construction stages of development and encourage the reuse of existing building stock as a sustainable solution.

There is no magic bullet to get to an NZC solution, but reducing demand is a good first step. We have seen significant technological improvements in recent years that have contributed to improving overall patient health and patient experience, as well as reducing the demand for in-hospital services. For example, a GP can now conduct an electrocardiogram and send the results online to a centralised cardiology team who can make a diagnosis. This allows the GP to advise on treatment and prescribe appropriate initial medication and eliminates the need for hospital attendance in the early stages of treatment, reducing demand for in-hospital services and the associated emissions. Perhaps in the future, technology will allow that electrocardiogram to be taken remotely via an app or wearable technology, reducing demand even more.

While some technological improvements and the benefits they bring are imminent, other solutions require more technical, multi-sector solutions. Acute hospitals present unique technical challenges not found in other sectors, and it is foreseeable that manufacturers and suppliers have an equal part to play in pushing forward innovative solutions. For example, the system resilience associated with life safety systems in Acute hospitals may mean that the battery technology associated with electric vehicles could be utilised in a healthcare context.

Also, while the UK has made huge steps in decarbonising the electricity grid, heavy process systems such as steam sterilisation, which demands a lot of energy, may still be required. This means alternative methods of generating steam will need to be developed.

The NHS is widely regarded as the best in the world with exemplar standards that many countries aspire to achieve, but we still have a lot of work to do in order to deliver NZC hospitals. It starts with full board-level support, and they in turn are responsible for inspiring our design teams by investing time and money into the development of sustainable solutions. Achieving net zero is no longer just an energy consumption issue, it is a chance to re-evaluate how we design and operate our hospitals in a greener, more patient-friendly way.

Stephen Maddocks is a partner and healthcare sector lead at Cundall