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Building net zero

March 24, 2023
by Healthcare World

Healthcare World Editor Sarah Cartledge speaks to Rebecca Stubbs, Principal Net Zero Carbon Consultant Mott MacDonald, about the NHS road to Net Zero 

In October 2020, the NHS became the first healthcare service in the world to commit to becoming net zero carbon (NZC). This pledge will see Europe’s largest employer reduce their carbon emissions by 2040, proactively improving public health for the future.

Rebecca Stubbs has been involved in the biggest UK hospital restructuring project in this area. She has advised the UK government on its approach to tackling hospital emissions and has worked very closely with NHS England and the Green NHS team over the past two years, leading the development of the NHS net zero building standard.

HW: How do you describe NZC? 

NZC is a science-based target driven approach to tackling climate change. This means that we are trying to reduce our emissions to levels that are aligned with trajectories of 1.5 degrees. Practically speaking, this will require incremental steps, year on year, to reduce about 90 per cent, if not 95 per cent, of emissions before the specific NZC year. This end dates varies depending on scope of emissions.

Emissions reductions are not linear. The NHS has 80 per cent reduction targets for 2030, which is approaching very quickly. To achieve NZC, we must offset any residual emissions – that is the key difference between NZC and true zero carbon. In true zero carbon, there are no residual emissions! The other key difference is that carbon neutral is different from carbon neutral within net zero. The offset is sequestering carbon – actually removing emissions from the atmosphere and not just paying for them to be mitigated or reduced somewhere else.

As an analogy, if you imagine a balance scales, on one side are the positive emissions into the atmosphere and on the other side the negative emissions that are removing them via carbon sequestering offsets which we need to balance to zero.

HW: How can healthcare institutions assist in mitigating climate change? 

The climate emergency is a health emergency. By lowering emissions, the NHS is able to minimise the negative health impacts of climate change. The NHS is responsible for 4 per cent of UK emissions and so it has taken ambitious steps to reduce this including incorporating it into legislation within the Social Care Act 2022. Estates and facilities are typically about 15 per cent of the NHS footprint and are within direct control of the NHS, whereas much of the NHS footprint is supply chain emissions e.g. through produced goods and services, medicines and equipment, and other induced emissions e.g. patient and staff travel. These are less easy to assess and influence. Facilities are largely ‘in-house’, hence the Net Zero Building Standard for NHS facilities, that Mott MacDonald supported.

NHS ‘facilities’ is a very broad term. It might include GP centres, any kind of operating theatres, containment labs or inpatient facilities. The degree of variability within the estate is huge, therefore, there are both quantitative and qualitative expectations in the NHS Net Zero Building Standard. We must also be respectful of the variability of specialisms in different spaces and create a bespoke approach to accommodate this diversity.

Healthcare facilities and services are also very highly constrained; infection control is pertinent to ensure the highest levels of patient safety are maintained. When trying to decarbonise, it’s very much safety first, which has produced several barriers for basic changes in improving energy efficiency. As a result, a tension is created between optimising patient care in the short term that is likely to adversely impact the health of future generations.

HW: Why are healthcare facilities so challenging to decarbonise? 

We need to capture all the emissions from the construction and from the materiality of these buildings, which is typically about 50 per cent of the total emissions of a building over its whole life. If a building is in place for 60 to 100 years and it is demolished, it will create more emissions to reduce the operational carbon from the construction of a new one. Materials are energy intensive and carbon intensive at the moment, and will be for the next decade. Construction in the short to medium term is really carbon intensive because we haven’t decarbonised raw materials such as concrete and steel, or machinery used on site or in transportation of goods, thus we haven’t decarbonised construction.

It is important that we refurbish existing buildings where we can, but there are challenges in terms of clinical standards. There are many old buildings where immediate changes can be implemented, such as facade upgrades and general amendments, to increase energy efficiency. But sometimes there is little to no benefit in refurbishing a building to establish high energy efficiency because it’s not fit for clinical need. There are some very old, highly constrained buildings belonging to healthcare providers today which are going to be incredibly expensive and disruptive to refurbish, so it’s about a balanced approach across our estates.

HW: Are the answers to the NZC challenge as simple as reducing their emissions? 

No, we also need climate resilient buildings. We have a real challenge in the UK as everyone is focused on heating in terms of the efficiency of hospitals. The equally important question is, how are we going to cool these buildings down? With temperatures rising above 40 degrees during the summer of 2022, cooling is vital across much longer periods of the year, and there are real problems with patient safety trying to keep hospital facilities at the right temperature, especially for vulnerable patients and staff.

The answer is a bespoke, strategic approach to each building. It can take a huge amount of coordination; it is very dependent on those operational constraints of the spaces within the building and how much decant space there might be to allow for refurbishments. Ensuring resilience of energy systems is also crucial within this design and strategy process.

HW: In addition to buildings, does there need to be a focus on any other areas to achieve NZC within a healthcare system? 

Yes, the achievement of NZC within healthcare will be the result of hundreds of projects spanning multiple areas, including procurement, food and nutrition, staff and patient behavioural change, and sustainable models of care, to name a few.

Sustainable models of care is an area of particular interest and focus for us at Mott MacDonald. Historically, healthcare services have been redesigned or transformed to deliver improved patient outcomes, or financial efficiencies, or both. However, through an approach underpinned with NZC and sustainable principles, future models of care can be reconfigured to achieve both these areas as well as reducing their carbon footprints. Examples of this include the adoption of digital solutions to enable the delivery of virtual wards and telemedicine, or undertaking more surgical procedures within appropriate community settings to release hospital theatre space.

Mott MacDonald has been supporting various NHS Trusts with their decarbonisation journeys. The transformation of system-wide clinical pathways is often complex and requires engagement across multiple healthcare professionals, including commissioners, clinicians, finance, clinical governance, estates and facilities, medicines management and most importantly, patients themselves. However, this a worthwhile undertaking with benefits that could be profound for patients, healthcare professionals and for our planet.

In summary, I strongly suggest that all healthcare operators follow the leadership shown by NHS England and formulate a strategy and roadmap of priorities to give clear direction of travel to suppliers for their required contribution, to align collective efforts and step up to this challenge of a generation.

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