Energy and carbon management

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1 Energy and carbon management Key actions 1. Regular Board level reviews of performance in energy efficiency and carbon reduction should be reported annually to staff, the public and other stakeholders 2. Carbon measurements should replace energy measurements as the target for reduction. 3. All NHS organisations should create a strategic plan to develop resilient and more renewable energy sources to ensure a guaranteed energy supply, whilst managing their overall carbon footprint. 4. All NHS capital developments should be assessed to ensure options are evaluated on a whole life cost basis. Low carbon options may include renewable energy, passive cooling, ultra-efficient lighting, sustainable transport and natural environment. 5. Every NHS staff member should be able and encouraged to take responsibility for energy consumption and carbon reduction. Vision A low carbon quality healthcare environment that is sustainable, resilient, and safeguards high quality patient care. Introduction NHS buildings and estate are very significant and visible consumers of energy and generators of carbon emissions. To reduce carbon emissions by 2050, in line with legally binding targets, the NHS will need to put carbon management at the heart of its operations. Every pound spent on carbon intensive energy will be expensive, taxed (CRC), and will be one pound less for direct patient care. A sustainable health service will use much more efficient facilities, much lower carbon processes, and much less energy intensive care pathways. Much

2 higher levels of renewable energy should be encouraged at all NHS sites. Redundant ways of delivering care will need to be decommissioned regularly. A significant proportion of healthcare delivery including prevention, diagnosis, treatment, long term care, and rehabilitation is likely to move closer to home. This will support the trend of moving as much treatment and professional care as possible to prevention and empowerment. There will be transformational changes in the way the NHS delivers its core function with all the incentives (increased technology, changing demography, societal expectations and a much lower carbon society) supporting change in the same direction. Building energy use and you Every 24 hours, 1.3 million NHS employees use thousands of buildings in hundreds of health centres and hospitals to see nearly 1 million patients. A significant part of the energy use in all NHS organisations is under the control of staff through the management of activity and processes. However many staff have a perception that they only control a much smaller percentage of the energy used, both directly and embedded. Understanding this is crucial to shifting the attitude and behaviour of staff across the NHS and encouraging everyone to be more carbon literate. Who has the responsibility for meeting energy and carbon targets? NHS Boards Every member of staff Decision makers involved with capital and revenue spending decisions Building professionals involved in the design process for existing buildings and capital projects, including LIFT, PFI and Procure 21 Trust advisors responsible for capital projects, services and refurbishments Senior managers responsible for setting NHS organisations policies and managing the organisation Estates staff involved with the maintenance and management of existing services and capital projects NHS staff members responsible for signing off contracts Suppliers and contractors in the NHS supply chain NHS buildings consume over 410 million worth of energy and produce 3.7 million tonnes of CO 2 every year. 1 There are many opportunities for energy saving and efficiency, allowing the savings to be directly reinvested into patient care. Leading NHS organisations go beyond achieving minimum standards of performance they are investing in the energy resilience of their estate. This is particularly important in view of the current supply climate, escalating fuel 1 NHS England Carbon Emissions; Carbon footprint study, Cambridge: Sustainable Development Unit, Sustainable Development Commission & Stockholm Environment Institute 2

3 costs and the potential impact of peak oil 2. Switching to lower carbon forms of energy and power supply helps to future-proof both the infrastructure and the opportunity to transform service delivery. Those organisations that are taking action to improve their use of resources are reaping the benefits of cost savings and improvements in organisational performance. The consultation shows that many NHS organisations would still value more advice and support to reduce the carbon emissions from building energy use and the DH and NHS SDU will respond to this call by publishing appropriate guidance. The current energy efficiency targets for the NHS 3 are designed to save the NHS around 65 million a year. Since the energy targets were introduced in 2000, NHS investment and clinical activity levels have significantly increased. Since , the percentage of Trusts meeting the highest level of energy efficiency ranking has increased from 27% to 55% in However, at the other end of the scale, 28% of Trusts are still rated as unacceptable 4. Regulatory requirements The way energy is used to provide heating, lighting and power to equipment in NHS buildings is subject to a variety of standards and regulations, the most important is the 2008 introduction of the Building Research Establishment s Environmental Assessment Method BREEAM Healthcare B(4)H 5, which is a mandatory environmental compliance tool for buildings with carbon emissions as one of its key benchmarks. All new NHS buildings should go further than BREEAM s excellent rating and now seek to achieve outstanding. Carbon trading schemes The EU Emissions Trading Scheme (EU ETS) 6 is a Europe wide emissions trading scheme to help the EU meet its Kyoto Protocol commitment to make an 8% reduction in emissions by compared to 1990 levels. The UK has committed to reduce its emissions of greenhouse gas by 12.5% below 1990 levels by The scheme requires sites with a thermal output capacity of over 20 megawatts which includes about 70 NHS sites in the UK to register and report their emissions. The Carbon Reduction Commitment (CRC), a UK emissions trading scheme being established as part of the Climate Change Act offers financial incentives for the type of carbon reduction measures set out in this strategy. The CRC is 2 The Oil Depletion Analysis Centre (ODAC) [Online] Available at: [Accessed 08 January 2009] 3 an overall 15% reduction in primary energy from cited in Carbon/energy management in Healthcare: best practice advice for the NHS in England on meeting the mandatory carbon/energy targets , London: Department of Health 4 Health Building Note Estatecode - Land and Property appraisal, London: Department of Health 5 BREEAM guidance from DH [Online] Available at: abledevelopment/dh_ [Accessed: 08 January 2009] 6 European Union Emissions Trading Scheme, (EUETS) [Online] Available at: [Accessed: 19 January 2009] 3

4 due to take effect in April The DH is currently considering the best way in which the NHS can be part of the CRC. Public reporting of energy efficiency Since October 2008, all NHS sites over 1,000 m 2 are legally required to display a Display Energy Certificate under the provisions of the Energy Performance of Buildings Regulations This gives a summary and comparable indication of building efficiency. The public reporting of efficiency, sustainability and carbon reduction will increasingly be the norm, ensuring NHS operations are increasingly accountable and open to scrutiny. The Energy Performance of Buildings Regulations will be reviewed in 2010, which will set a 25% improvement target on all energy consumption for all new builds and refurbishments 8. Trusts need to take these requirements into account now when planning new capital development schemes and should refer to the DH Health Technical Memorandum Sustainable Health and Social Care Buildings: planning, design, construction and refurbishment for guidance. 9 In addition, in order to focus greater attention on carbon within individual Trusts, the current standard energy measure in gigajoules per cubic metre could be converted to kilograms of carbon dioxide per square metre. This would allow carbon to be reported at Board level alongside energy use. Additional incentives to meet tighter energy performance requirements will come in the form of the EU Energy Services Directive 10 The importance of data The DH online Estate Returns Information Collection (ERIC) currently collects data on direct energy usage and some indirect usage. The data collected will be amended to establish metrics which allow each NHS organisation to benchmark their actions and set themselves targets for reduction based not just on energy use but also on travel and procurement activities.. Investing to save All investment decisions need to be underpinned by whole life costing. This means estimates of the cost of energy over the whole building or equipment lifetime should be included. This is an important example of the right economic incentives helping to achieve a lower carbon NHS. The Carbon Trust has published a Guide To Help Reduce Carbon Emissions From 7 The Energy Performance of Buildings (Certificates and Inspections) (England and Wales) Regulations, London: HMSO. 8 The Energy Performance of Buildings (Certificates and Inspections) (England and Wales) Regulations, London: HMSO 9 Health Technical Memorandum 07-07: Health and Social Care Buildings: planning; design; construction and refurbishment, (HTM)Department of Health: London: HMSO 10 Energy services directive [Online] Available at: [Accessed 08 January 2009] 4

5 Existing Non-Residential Buildings 11 which uses a whole life cost analysis to evaluate low carbon systems and components. In 2006, the Department of Health published HTM 07-02: EnCO2de 12 to give guidance to NHS organisations and their supply chain on how to achieve low carbon outcomes through energy efficiency, resource efficiency and low carbon technologies. Mechanisms to share best practice There are many examples of sustainable innovation and design and numerous initiatives promoting good practice in carbon reduction in the NHS. NHS partners SHINE 13 and Community Health Partnerships are currently delivering a joint programme across the LIFT (Local Improvement Finance Trust) companies. 14 There are nearly 50 LIFT companies across England as well as Knowledge Transfer Networks to share innovation and best practice. These organisations and networks have a crucial role in transforming the NHS into a sustainable and low carbon organisation. Local solutions NHS organisations should investigate potential low carbon energy solutions which best suit their own circumstances. A small rural organisation may benefit most from installing biomass technology for heating, whereas a large urban hospital may benefit more from a Combined Heat and Power (CHP) installation. It is important to investigate the wider benefits for the community. For example, excess heat from CHP plant can sometimes be diverted into a district heating scheme which can provide affordable heating for the benefit of the wider community. Partnership solutions are also becoming more evident with community based District Energy Schemes 15 and Community Heating Schemes 16. Improving monitoring and control NHS organisations should develop the ability to monitor their energy use effectively through the use of modern and fully integrated power management 11 Low carbon refurbishment of Buildings, London: The Carbon Trust 12 Health Technical Memorandum 07-02: EnCO2de- Making energy work in healthcare: environment and sustainability, (HTM07) Department of Health, Carbon Trust, Building Research Establishment, NHS Scotland Property and Environment Forum, Welsh Health Estates, Northern Ireland Health Estates: London: HMSO 13 SHINE aims to help NHS Trusts improve the sustainability of their buildings by providing a learning network with guidance, case studies, events and training, covering all aspects of sustainability and how it can be delivered through NHS procurement processes 14 Organisations such as Community Health Partnerships develop investment in and help deliver innovative ways to improve health and local authority services. The main activity of Community Health Partnerships has been to deliver the LIFT Initiative which provides clean, modern, purpose-built premises for health and local authority services in England. 15 District Energy Schemes [Online] Available at %20section%207.pdf [Accessed 19 January 2009] 16 Community Heating information from the Energy Savings Trust [Online] Available at [Accessed 19 January 2009] 5

6 and control tools linked to localised smart metering. The Carbon Standard 17 developed by the Carbon Trust, for instance, will reward organisations for developing an integrated infrastructure of energy monitoring and control. This sort of metering will allow all NHS staff to understand how they can contribute to energy savings, by giving staff appropriate control over energy use of lighting, heating, cooling, and information technology. NHS organisations should routinely provide information on energy and carbon costs for each facility to building users. Renewable energy The most energy efficient technologies should be considered as part of the business case for investment in energy and carbon reduction. This will include all available technologies for managing electricity, heating, insulation, cooling, hot water, and ventilation. Organisations should move towards much higher levels of renewable energy use as these come on stream. The size of the NHS (especially its collaborative buying power) means it should be an active partner in stimulating this inevitable transition towards renewables. At an organisational level, there should be routine and regular reviews of the potential for increasing the use of renewable energy. This should include the use of renewable energy generated onsite, near onsite or offsite. As the Carbon Trust s Partnership for Renewables 18 makes clear, in certain areas the NHS estate is becoming increasingly valuable for the commercial generation and use of renewable energy (wind, ground coupled heat pumps, and biomass). Changing to a low carbon NHS In order to meet the challenging targets set by the Government for 2050, it will be important to limit the size of the NHS estate where feasible and make the remainder extremely low carbon operation. This will only be possible if there are dramatic changes in the way we manage health and illness, by moving specialist care much closer to home and ensuring modern diagnostic, therapeutic and communication technology genuinely substitutes for high carbon care rather than simply supplementing it. This will support the increasing trend towards a much more patient centred management of health and disease. Modern technology and public expectations should support this radical transformation towards a sustainable and low carbon health service as quickly as possible. The Carbon Trust s NHS Carbon Management Programme 19 can provide free technical and change management support to NHS Trusts in England to help them understand their carbon footprint, and to produce a Board approved Carbon Management Plan. The Carbon Management Plan will address carbon emissions from buildings, travel and procurement, and will provide a 17 Carbon Trust Standard [Online] Available at: [Accessed 08 January 2009] 18 Partnership for Renewables [Online] Available at: [Accessed 08 January 2009] 19 Carbon Trust, NHS Carbon Management Programme [Online] Available at: [Accessed 17 February 2009] 6

7 timeline, along with clearly defined responsibilities, for implementing carbon saving projects. To date the programme has helped 49 Trusts to identify reductions in their emissions of 125,000 tonnes of CO 2 per annum, with an associated cost saving of around 14 million. 7

8 Case Studies [1] The Pilgrim Hospital in Lincolnshire will reduce the estate s carbon footprint by up to 50% by installing a biomass boiler. The boiler will run on locally-sourced renewable woodchips and will be up and running by The hospital currently produces between 10,000 and 12,000 tonnes of carbon each year from heating. The new biomass boiler aims to reduce the carbon produced from heating to around 6,000 tonnes. A combined heat and power plant will further reduce the hospital s carbon footprint by generating its own electricity to provide lighting and power for the hospital, as well as additional heat. The work is being funded through a grant from the Department of Health s Energy Efficiency Fund 20, following a successful application by United Lincolnshire Hospital NHS Trust, as well as a 205,000 grant from Lincolnshire County Council s LIGHT Project. [2] Buildings designed with passive ventilation have improved resilience to energy supply failure and are more energy efficient than mechanically ventilated buildings. In an acute hospital up to 70% of net floor space could be entirely or partially naturally ventilated. Concern regarding airborne disease and cross infection appears to be a major driver for installing fully mechanically ventilated systems in health premises. Consequently, other public buildings have installed more naturally and passively ventilated systems. The UK National Institute of Health Research has found that there may not be as large a risk as many believe. Modelling, carried out in a 200 bed hospital configured to current NHS service delivery policy, shows that increased energy performance, and therefore carbon saving, is achievable whilst saving on energy bills. [3] The combined heat and power (CHP) scheme at Birmingham Heartlands & Solihull NHS Trust enables the hospital to generate its own electricity in a purpose designed Energy Centre. The electricity is generated from a gaspowered engine and the heat comes from hot water. Combining the two is where the carbon savings come from. Rather than rely on separate boilers to heat water for their central heating systems, the buildings connected to the energy network exploit the heat the engine generates as it produces electricity. This project was part of a 5 million energy efficiency programme that is recording savings of 688,000 a year and cutting emissions of carbon by 20 For more information see Energy Efficiency Fund [Online] Available at: abledevelopment/dh_ [Accessed 08 January 2009] 8

9 1,627 tonnes per year the equivalent of a forest of 2,503 trees as well as reducing other harmful green house gases such as sulphur dioxide. [4] In a pioneering project the Rotherham NHS Foundation Trust is using an innovative procurement approach, Forward Commitment Procurement (FCP) to harness the benefits of ultra efficient lighting technology and to significantly improve the efficiency and functionality of ward lighting. The project forms part of the Trust s Future Wards programme which is a major ward reconfiguration and refurbishment programme that will run over a seven year period from 2009, with an estimated saving of energy greater than 50% of conventional lighting systems.. FCP is a practical supply chain management process that is helping us to deliver the best possible solution for the new wards, not only in terms of energy efficiency and carbon reduction, but also in terms of patient experience and best value, said Martin Aizlewood. Estates Manager/Environmental Officer, The Rotherham NHS Foundation Trust 9

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