TILTING AT WINDMILLS
Phil Gusack reports on the AfH workshop on Sustainability in Hospitals on 19th June, 2008.
As we celebrate the National Health Service’s 60th birthday, we should note the enduring virtual canonization of Florence Nightingale. Twenty years after air conditioning became standard in British offices, shops and cars, a large part of the NHS Estate still attempts hygiene and comfort through open windows. The Estate consumes the same energy as 525,000 homes (Department of Health figures) which means NHS hospitals use roughly twice as much energy as of British homes per sq metre (my figures). The relevant dilemma is not whether open windows are better than air-con but where Architect-Engineer teams who embark on new schemes can turn next, not just to make the NHS Estate more energy efficient, but also to clamp down on carbon emissions.
St Mary’s Hospital, Isle of Wight
The NHS Estate has its own energy history. One year after Greenwich District General Hospital, DHSS’s boldest design experiment, opened in 1972, war erupted in the Middle East. Three months later, to combat striking coal miners, Britain was put on a three-day week. Goodman re-branded Harness, a Greenwich-based 70-hosital roll out, as Nucleus, its flagship, St Mary’s, Isle of Wight, designed by Ahrends Burton Koralek, is an obvious case-study for hospital energy research. Compared to two hospitals of roughly similar floor area – the pre-HOK Barts (old and crumbly) and Norfolk and Norwich (new and shiny) – on a £ per sq metre basis, St Mary’s costs the most!
The facts and figures of NHS energy costs are full of surprises. For example, when I asked attendees at this workshop what they thought the total NHS hospital fuel bill is, the standard answer was: ‘Oh billions.’ It isn’t!
The total for England’s 1,320 hospital sites in 2005-06 was £385 million. It cost much more to clean them – £550 million. Sure it would be in everyone’s interest if the fuel bill could be reduced – more money for medicine. And oil prices have shot up since then. But even if the fuel bill will double soon, it is a thin slice in a pie chart of NHS hospital turnover of roughly £50 billion.
Hospital turnover 2005/06 diagrams. Dark Side Of The Moon by Phil Gusack at IHEEM Harrogate conference, 2007
NHS hospitals are big business. Taken together, bigger, for example, than Tesco. The typical hospital has a turnover equal to that of Arsenal FC. Unlike most Hospital Trusts, these businesses understand how their future depends on their architecture.
Arsenal FC’s Emirates Stadium
With it’s usual foresight, AfH planned this workshop to coincide with the record prices of diesel, protest truck convoys and French trawler to blockade Brit yachties and Gordon Brown’s declarations that (a) the UK will get 7,000 more wind turbines and (b) the world needs 1,000 more nuclear power stations!!!
Three Mile Island / Chernobyl radiation cloud
These days, I track sustainability do’s and don’ts in Ambridge, radio home of ‘The Archers’ and a key transmitter of DEFRA propaganda. Right now the big question is about the anaerobic bio digester. Will it be small and fuelled by farm waste, or big and supplemented by biomass crops. Over at Highgrove, Charles and Camilla’s homebase, the cows eat organic and fart less, and the Aston Martin runs on bio-ethanol. According to Sir Michael Peat, the Prince's private secretary, "The bio ethanol from our supplier happens to be made from wine. I think our wine is surplus English wine. It is wonderful. It is not even corked!" [Telegraph 30th June]
Cheers!
Not everyone thinks climate change is a big problem. Nigel Lawson (Nigella’s dad), for instance, argues that (a) it is more a matter of solar cycles than emissions, (b) the Saudis have much more oil than they claim and (c) prospecting for uranium has not yet been done properly. But he is obviously now in a discredited disappearing fringe. His recent book An Appeal to Reason: A Cool Look at Global Warming, was, he admitted, rejected by every British publisher he has offered it to. [Sunday Times, 20.04.08]
Now, of course, Labour, Conservatives and Lib-Dems all agree on the basics – emissions cause global warming and must be reduced. The brief statement that:
‘We already have a target to make new homes zero carbon from 2016. I believe that we can go further. And I can announce today that new non-domestic buildings will become zero-carbon from 2019.’
is, arguably, the only part of Alistair Darling’s 2008 Budget speech that nobody wants to argue with. Whether or not it is ‘vanity policy’ (ie so he can claim Labour leads the world), it is exactly what the UK Green Building Council said the government must do late last year.
Meanwhile, DH has been diligently pushing energy efficiency via a succession of policy statements, technical memoranda and targets. And there are pilot schemes, such as Antrim Area Hospital’s wind turbine.
The 40 metre high 660 kW Vestas turbine operational at Antrim Area 360-bed hospital since February, 2005. Engineering consultants: White, Young Green.
It took the Antrim team three years to get the turbine feasibility tested and impact approval, three months to get the tower up and three days to install the turbine. It’s the largest hospital turbine in the UK, and can provide all the electricity the hospital needs at night and two-thirds of the daytime load. It cost £497,000 and saves £90,000 a year.
David Cameron’s Notting Hill turbine. Reported cost: £15,000. Reported annual fuel bill savings: £200.
Antrim’s turbine was easy to find via google, but researchers still face three systemic obstacles:
Devolution:
UK devolution means there are four versions of the NHS, and although they do more or less the same thing, they do not necessarily record data on buildings in the same way;
Survey Paranoia:
DH has a love-hate relationship with data anyway, fuelled by Conservative taunts that time spent form-filling would be better spent on patient care, as if facility managers should spend their spare time on the wards, and all data requests are vetted by the shadowy ROCR;
Knowledge Fantasies:
Despite the plethora of green / eco / zero carbon advocacy groups and hubris about ‘knowledge communities’ there are still no archives, libraries, databases or even websites offering comparative information on hospitals, let alone energy innovative hospitals!
The good news is that DH ERIC survey data covering all PCTs and Hospital Trusts in England (only) is available online. The 2006-07 data lists 29 PCTs and 83 hospitals that already have renewable systems up and running. But it does not mean that any of them necessarily fully exploit their properties. Nor does it mean they are anywhere near zero carbon. Nonetheless they generate over 1.2 million GJ, already about 10% of the total the 258 Trusts take from the grid, a very convenient truth that nobody seems to have emailed to Downing Street.
DH has also been ramping up its environmental assessment procedures. NEAT has now been replaced by BREEAM Healthcare – a compulsory (hard-to-cheat) certification process. As presented to AfH by Virginia Cinquemani, it may have given some the impression that DH is now all stick. It is not.
The £100 million carrot, the Energy Efficiency Fund, was announced last year and DH has been deluged with applications from Hospital Trusts. It will help them to improve electrical efficiency, install more insulation and set up new systems such as combined heat and power and bio-digesters.
Good news on the home front: BRE’s Kingspan Lighthouse zero carbon prototype has achieved Level 6 of the Code for Sustainable Homes, so their website claims: ‘It has zero carbon energy supply for space and water heating and all electrical power demand for the home, including electrical cooking and appliances.’ Unlike so many other wacky claimants to the zero carbon title, the Lighthouse has an impeccable scientific pedigree, and you can, if you wish, arrange a visit to see if reports that it leaks are true.
But no matter how little energy it uses, single detached houses cannot solve Britain’s housing shortage. The 3 million new units Britain desperately needs can only be achieved at much higher densities. Since it has windows on all four sides, the Lighthouse does not appear easy to roll-out in terraces. In the context of recession and housing industry implosion, BRE and the UK Green Building Council membership must surely be lobbying to ensure that zero carbon R+D funding is itself sustainable.
A: Building Footprint / B: Gross floor area
C: PV for low energy design / D: PV for typical spec office
The zero carbon target for new housing is 2016. For non-domestic buildings it is 2019. It may be further away, but it is a tougher challenge. The chilling illustrations – Bill Gething’s National Trust HQ design studies – show that even if offices are designed to maximize energy efficiency (C), it still takes two-and-a-half times its own floor area of photo-voltaic panels to generate enough electricity to run the building. Power to run computers etc – process use – is extra. And (D) it would take at least seven times floor area to power a typically air-conditioned spec office.
Not good news for office developers, particularly those assembling sites for new schemes on the assumption that the recession will end before their own businesses do. But it should be good news for the NHS Estate. It has a lot of roof and a lot more land:
A ‘typical’ hospital – the arithmetical average – has 47,000 m2 of roof. If half the roof can be covered with PV panels, at a density of 1 m2 of panel to 1.4 m2 of roof, at roughly £700 / m2 it would cost £11.5 million plus, largely additional to a new build cost of roughly £308 million. In other words, an on-cost of about 3.5%. In return, the PV array should generate 1.6 million kW hours a year.
Antrim’s turbine cost less than £500,000 and generates 1.2 million kWh or 4,300 gigajoules, the unit used in DH stats, or 1,031,654 million calories equivalent to 2,096 million Big Macs.
The bigger question is what DH should do with its unexploited 6,000 hectares in order to replace the 2.8 billion kWh it still gets from the grid. That would take 2,316 Antrim-size turbines – one every 3 hectares. At £1,200 million, it’s only four 2012 swimming pools Aquatic Centres!!
© GMJ Design 2008 www.gmjlondonfutures.com All rights reserved
So if we want to avoid this, we have to accept this:
© GMJ Design 2008 www.gmjlondonfutures.com All rights reserved
4 Questions About Zero Carbon Research and Design:
1. Why is current NHS renewable generation such a well-kept secret?
2. Are ‘Knowledge Communities’ really the turbines of research and communication or are they just heat exchange pumps?
3. Will compliance with Part L (Building Regulations on thermal performance) propel new hospital schemes out of the design doldrums? (Only one small clinic in the 2008 RIBA Awards – no hospitals!!)
4. Will compliance with Part L compromise healing environments, HBN 4-endorsed single-patient rooms or, indeed, any other design priorities that are hard to achieve anywhere anytime?
3 Questions About NHS Hospitals:
1. Will the rate of rebuilding the NHS continue at over £3 billion a year or will recession realpolitiks turn the pipeline into a trickle?
2. Do polyclinics have to be new purpose-made BREEAM’d buildings or can they rent suitable space in convenient locations ie get the GP’s onto the high street and out of the side streets?
3. Is it really possible to define sustainable healthcare buildings if the sustainability of the NHS is itself under fire ie am I alone in thinking that Lord Darzi’s Personal Care Budget idea will pave the way to Dutch-style mandatory private insurance?
2 Reality Checks:
1. Politicians say the NHS is ‘free at the point of need.’ As a serial outpatient my NHS is the point of the needle! Do I care where hospital energy comes from? Yes, but I worry more where my nurse, who walks 20 miles a shift, gets her energy from.
2. Will anyone being rushed to Accident and Emergency care if they see turbines in the hospital grounds? No, because after 60 years of the NHS they will be praying that they don’t end up in a mixed sex ward. Even if NHS 2019 is zero carbon, will it still be zero dignity for its nurses and patients?
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