- In a complex health and care environment, long-term sustainable solutions are being overlooked in favour of fast fixes to meet budget, time and regulatory requirements.
- Improving sustainability outcomes within health and care developments requires long-term investment beyond upfront costs and a more holistic approach to sustainability goals.
- Collaborating, knowledge sharing and flexible spaces are essential to achieving progress and delivering infrastructure that minimises environmental impacts while meeting future generations’ needs.
As the NHS repair bill soars to almost £14bn, 1 NHS trust leaders find themselves in a challenging predicament: building healthcare services fit for the 21st Century whilst meeting NHS net zero targets against significant funding constraints. In the face of these challenges, are quick fixes really delivering long-term sustainability or the best outcomes for the patients of today and tomorrow?
In this article, we challenge existing thinking about the repair and development of healthcare infrastructure and consider how to overcome time and budget constraints to deliver better outcomes for people and the planet.
The NHS has set itself an ambitious task: to become the world’s first net-zero national health service by 2045. While an overhaul of medical supply chains, transport solutions and models of care will help the service tackle its carbon footprint, a significant step towards meeting its net-zero ambitions will be through the development of new infrastructure.
Being more sustainable cuts down future healthcare costs for preventable conditions. Climate change matters to our health and care systems, not just because of its impact on the planet but also because of its direct health risks.
Globally, the healthcare sector accounts for approximately 4-5% of greenhouse gas emissions, and the World Health Organization reports that nearly 1 in 4 global deaths per year are the result of modifiable environmental risks. Addressing environmental factors can significantly reduce the burden on our healthcare systems and improve public health outcomes.
Proper sustainability practices are worth the investment because they lead to tangible health benefits. By reducing greenhouse gas emissions and mitigating environmental risks, we can prevent a range of health issues, from respiratory conditions to cardiovascular diseases, ultimately decreasing the need for future healthcare interventions.
By being more sustainable, we not only protect our planet but also enhance the wellbeing of our communities, making it a crucial component of our health and care strategies.
It’s an issue that matters to the people who work in and use our health services too; NHS research has found that 92% of the general public believes it is important for the healthcare service to be sustainable, while 87% of NHS staff support the ambition for the NHS to reach net zero.
Although there is a consensus on the collective need to take action on climate change, agreement on the solutions required to maximise success is often less straightforward, including developing and upgrading NHS infrastructure. Too often, leaders are being forced to paper over the cracks, diverting vital funds away from long-term strategic infrastructure plans towards immediate clinical needs and critical repairs.
The NHS Net Zero Building Standard provides a blueprint for a greener future through the development of sustainable, resilient and energy-efficient buildings. While this framework provides a compass on the path to decarbonisation of the NHS, the vital decisions about construction, materials and technology are at the mercy of budgets and deadlines — a reality that can create a gulf between aspiration and tangible, sustainable reality.
While many trust leaders have looked to temporary construction solutions to plug gaps and deliver expansion space at speed, there are limits to their effectiveness, which is why we are making the case for taking a more long-term and holistic approach to sustainability:
Let’s be honest — sustainability comes at a cost.
Committing to investing in a sustainable solution requires bold decision-making at a time when the NHS is facing the most severe financial health deterioration in a decade. 2 It’s important to be clear: the solutions needed to ensure sustainable construction and long-term sustainable outcomes don’t come without increased costs, but is it really a cost that can’t be justified when you take a long-term view on both budget and the planet?
The saying “Buy it nice, or buy it twice” implies that to spend less, sometimes you have to spend more, and this is just as true of high-quality, sustainable design that delivers value beyond today’s requirements. By getting the blueprint right and building sustainability into the fabric of a building, you can avoid future scenarios that require costly bolt-ons of sustainable technology and infrastructure that compensate for poor building performance.
SUSTAINABILITY IN ACTION:
Birmingham Dental Hospital and School of Dentistry was designed with sustainability at its core. Adopting a Heavy Thermal Mass as part of the construction, which dampens the effects of heat gains and losses, results in a more stable and comfortable environment.
Combined with The Chartered Institute of Building Services Engineers ‘Adaptive Comfort Model’ which includes a programme of staff education, including dress code and the use of mix-mode ventilation, drives good low-energy performance of the building, maximising the passive envelope solution.
Managed lighting systems, advanced metering, energy and building management systems provide the necessary data to inform strategic reviews of energy performance, allowing the NHS trust to identify areas of high consumption and target continual improvements.
Flexibility is the key to future-proofing the NHS and building long-term sustainability.
One fundamental of developing healthcare facilities fit for the 21st Century is that they should be flexible enough to accommodate future advancements in medical technology and meet the evolving healthcare needs of an ageing population. If we are to take lessons from recent years, increased flexibility can also foster a more strategic response to health crises, like a future pandemic. As highlighted by BBC News, the ability to flex space to meet the health and care needs of the community is crucial for adapting to changing demands 3.
This flexibility starts in the fabric of the building, from devising adaptable building engineering that streamlines the repurposing of spaces to investments in digital dashboards that provide real-time insights into efficiency and sustainability metrics.
While modular construction or temporary structures may deliver pace, they often lack the versatility and pragmatism of bespoke infrastructure solutions, where rooms can be repurposed without shutting down the entire building. As regulations change and health requirements shift, who is to say that temporary solutions, like short-term modular constructions, won’t face a similar fate as RAAC-hit facilities are today? 4
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Prime’s design of Community Diagnostics Centres prioritises future-proofed engineering. Specific earthing requirements enable rooms to be adapted to the exact electrical requirements for cardiology facilities, should they need the flexibility to adjust spaces in the future.
Against challenging economic conditions and tightening budgets, shifting focus from upfront costs to whole-life costing presents a significant hurdle. However, short-term thinking doesn’t always deliver value for money. By considering the long-term savings from energy efficiency and reduced maintenance and operational costs, trusts can reveal the true value of sustainable healthcare infrastructure — building not just for today’s needs but for future generations.
Go beyond carbon — it’s time to broaden the metrics of sustainability.
To date, much of the focus on sustainable infrastructure has been on reducing carbon emissions and measuring a building’s upfront carbon footprint. Innovations in the form of smart technologies, waste management improvements, sustainable materials and revised procurement practices are all helping organisations improve their sustainability metrics.
While assessing embodied carbon is a critical step in the journey towards more sustainable development, expanding focus beyond net carbon zero to encompass broader sustainability metrics will more effectively address the environmental challenges facing us all.
The United Nations’ Sustainable Development Goals encompass the broadest spectrum of goals 5, connecting sustainability to good health and wellbeing, increased equality and greater protection of the natural environment, among many others. In Prime’s own sustainability journey, we are continuing to expand our impact, embedding sustainability practices not just into the projects we deliver but in the culture of the organisation; you can read more about our journey so far here.
At present, considerations of the natural environment and social impact don’t have the same standardised measurement structures and frameworks as carbon emissions, making it more challenging to quantify and communicate their impact. But just because something is challenging, it doesn’t mean you shouldn’t do it.
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Even before the NHS Net Zero Building Standards were created, Prime was embedding sustainability initiatives into projects. In a recently completed project, Prime’s commitment to sustainability targets saw us achieve BREEAM Excellent design stage certification and bettering the benchmark of upfront embodied carbon emissions for the scheme.
Sustainability solutions included introducing bioretention-raised planters and a rain garden with a filtration system. This innovative system collects rainwater from roof areas to slow water flow back into the drainage system, enhancing biodiversity, amenity and water quality. Together with the retention of existing trees and planting new hedgerows and shrubs, the project smashed through the 10% biodiversity net gain ambitions, all achieved within the original project budget.
Integrating biodiversity enhancements into our projects, creating green spaces that support local ecosystems and delivering air quality improvements are crucial steps. The societal benefits of improved access to healthcare facilities, job creation and the development of spaces that foster improved wellbeing are also crucial.
By embracing a broader sustainability perspective, we can create healthcare infrastructure that not only minimises environmental impact, but also enriches the lives of those it serves. Isn’t that an ambition worthy of energy and resources?
You don’t have to have all the answers — progress depends on collaboration.
Investing in sustainable solutions isn’t just about the financial cost; it’s as much a strategic investment in knowledge. Just as the return on investment in sustainability isn’t just about efficiency savings — it’s about building a better future for generations to come. But that doesn’t mean you need to have all the answers to complex solutions or feel forced to settle for less creative out-of-the-box solutions. This crisis is collective, and solving it requires collective effort.
Whether it’s leaning on the advice and expertise of sustainability experts, finding funding and development partners prepared to invest their own capital into achieving sustainable solutions or building the support of stakeholders for green initiatives, uniting around a common purpose is critical to success. With an informed, collaborative pathway, trusts can select the best fit for their unique circumstances.
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Leveraging resources and frameworks like LETI’s Climate Emergency Design Guide and BREEAM’s Sustainable Building Certification help to elevate sustainability performance throughout a project’s lifecycle.
Yeovil Community Diagnostics Centre was designed in line with LETI and RIBA 2030 Climate Challenge benchmarks for embodied carbon as part of Prime’s commitment to building a more sustainable future.
At Prime, we’ve witnessed firsthand how increased knowledge and the support of key stakeholders have empowered trust leaders to make bolder and more strategic decisions about sustainability that push the boundaries of what they thought was possible. By embracing innovative funding solutions and incorporating a more long-term and holistic approach to sustainability, trusts can meet the needs of today without compromising the ability of spaces to meet the health and environmental needs of future generations.
Wherever you are in your sustainability journey, we encourage all leaders to seek advice from industry experts to arm themselves with knowledge about the latest data, guidelines and technologies. Solving this climate crisis isn’t going to happen with incremental change. Instead, we need to redefine what is possible and harness the collective power of health leaders, developers and investors to not only do what is right but also what is necessary.
“To deliver sustainable growth and build a better future for people, society and the planet, collective action and investment must tackle some of the greatest healthcare challenges of our time in a way that transcends short-term interests and political cycles.” 6
World Economic Forum
[1] New backlog maintenance figures shows effect of starving NHS of vital capital, NHS Confederation
[2] Worst financial health deterioration in over a decade for trusts, NHE
[3] The English neighbourhood that claims to hold the secret to fixing the NHS, BBC
[4] Budget: hospital building plans to focus on RAAC-hit estates, Construction News
