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Mind the Gap....healthcare buildings and the challenges of a low carbon future

Date: Oct 08, 2010

Go to your favourite search engine, type in phrases like ‘CO2’, ‘carbon reduction targets’, ‘healthcare buildings’, and ‘European policies’, and you’ll find a fairly consistent message. Consider just these three findings from a quick Google work-out:

The Intergovernmental Panel on Climate Change (IPPC) reported in 2007 that global greenhouse gas emissions were set to increase by 25% to 90% between 2000 and 2030, even with current climate change mitigation policies.

The UK’s Learning Network for Sustainable Healthcare Buildings (SHINE) website tells us that the NHS produces 3.4 million tons of CO2 every year.

The European Commission is concerned that most sectors of the economy are not doing enough, fast enough, to meet current CO2 reduction targets.

So – the best evidence is that global warming is real, and mostly man-made; health systems, and the buildings at the heart of them, are hugely energy hungry; European public sector targets for CO2 reduction aren’t really getting serious ‘traction’.

Why is it so difficult to translate from evidence to policy and then to practice? And what can we do about this gap between ambition and delivery, specifically in the healthcare building sector?

There’s no doubt that healthcare policy makers and planners talk up the notion of sustainable buildings, and it’s equally true that architects, designers, construction firms and suppliers do try to meet their clients’ needs. In many countries we can point to some interesting recent examples of hospitals, clinics and other healthcare buildings that show some innovation, whether in energy production and use, materials, food systems or transport planning. But equally, we can also see many examples of what we might call the ‘low carbon gap’, where ambitions start off high at policy level, become diluted through the design and planning phases, and end up depressingly under-powered by the time the health building is constructed or refurbished. Of course, the same phenomenon is present in many policy areas, but few are as urgent or potentially costly as a failure to move swiftly to a future that is low carbon.

The Low Carbon Buildings Healthcare project team used the occasion of the Dutch Centre for Healthcare Assets’ June 2010 conference to look for some reasons for the low carbon gap, and to explore some possible, practical answers.

First, why aren’t better low carbon solutions available? Discussion revealed that the innovative goods and services needed to bridge the gap struggle to come into the market, in many cases because demand for these new goods and services is neither visible nor credible to potential suppliers – those buying goods and services simply tend to accept what is already available, and don’t do enough to manage the supply chain to deliver the innovation that is really needed. Furthermore, very often the ‘customer’ is several steps removed from the (understandably risk-averse) procurement professionals and project managers who specify and procure the goods and services.

It looks unlikely, therefore, that we can simply sit back and wait for the market to deliver. At some point, the CEOs and boards of healthcare organisations will have to insist that low carbon solutions are given the highest priority. To do that, they need to have some practical examples of success to point to. And there are some! In the UK the ‘Forward Commitment Procurement’ (FCP) supply chain management tool has been developed to create a visible, credible demand for low carbon solutions. In essence, it is a process for project planners to identify their unmet needs, inform the supply chain well in advance, convince suppliers that the plans are serious, and then purchase the solution when it delivers. But FCP is only one approach: a pilot project at Erasmus hospital in the Netherlands has been working on a number of initiatives that link operational staff much more closely with procurement professionals, thus setting the bar higher than it would usually have been.

The Low Carbon Buildings Healthcare project is looking to identify the barriers to successful procurement of innovative goods and services for healthcare buildings, and we’d like you to contribute to the debate. You can answer here, or go to our online survey http://questionpro.com/t/AfJRZH7zP. Maybe you don’t agree that there is any problem, or perhaps you have a different answer – either way, we’d be interested to hear from you.

And perhaps you have some examples of successful implementation of low carbon technologies in healthcare buildings. If so, let us know here – this forum is for knowledge exchange as well as active debate.

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Dr Jonathan (Jack) Frost, Director Johnson Matthey Fuel Cells Says:

Nov 09, 2010

The problem highlighted here is the 'elephant in the room' that is so often ignored in the Climate Change debate. Nearly everyone agrees that reducing carbon emissions is a good idea but no one sees it as their top priority. Successful suppliers are very good at spotting what the customer really wants and making sure they provide it more effectively than their competitors. If the customer is saying lower carbon would be nice but actually winning the contract is all about having the lowest up front capital cost and lowest execution risk then its suicidal to add an innovative low carbon dimension to the proposal.

Of course low carbon solutions frequently have better whole life costs but tenders are rarely configured to value lower whole cost more highly than low capital cost and even where the tender says whole life costs matter grim experience shows that this is not borne out in practice Perhaps even more insidious is the chain of transferred responsibility described so well above. The professionals in the chain (consultants, designers, project managers) find it much easier, and from a liability perspective much safer, to specify well proven designs and technologies. These are the very designs and technologies that are responsible for our high carbon world.

A way to close the 'low carbon gap' described above is to make having the best whole life carbon performance of the building or its subsystems a source of substantial competitive advantage for the supply chain. To my mind nothing would bring low carbon options to market more quickly than customers saying, other things being equal, the lowest carbon solution wins the contract. The challenge for supply chain managers is to find ways to credibly engage the supply chain in the delivery of innovative low carbon solutions. Present approaches all too frequently lack this essential credibility and generate little competition amongst suppliers

Grant Mills, Research Associate, HaCIRIC, Department of Civil and Building Engineering at Loughborou Says:

Nov 12, 2010

The need to reduce carbon across the whole healthcare system requires a great deal of integrated working between clinical, building and transport infrastructure decision makers. An understanding of the scale and distribution of services is critical and the question is how can infrastructure capacities meet population demands to achieve the highest possible quality. I would be very interested to hear if anyone has done or heard of a whole system carbon study? Most that I have read only deal with a small sub-system or narrow built component, rather than looking at a whole-system-life view? HaCIRIC wrote a recent conference article that again only address a small part of a much larger picture.

Our study of a single Midlands healthcare region shows that shifting only a few care specialities closer to home can have a significant carbon saving. Our research of the area which has a population of some 660,000, has found that shifting 190,000 patient journeys closer to home can have a significant carbon saving - more than 5 million KgCO2 across the whole system. For patients, this means a total travel distance reduction of 3.6 million kilometres a year. These gains could be even greater as more radical care pathway changes are adopted or if patients are more frequently treated in their homes using remote technologies. All of this suggests considerable opportunities for reducing carbon. It presents GP and acute commissioners with some important challenges in working together with their partners to reduce carbon.

A big problem is that existing healthcare planning tools are often inadequate and inflexible to scenario model the implications for transport carbon of shifting services. We need more research so healthcare planners can really understand the options and trade-offs between different service configurations and carbon emissions.

Strategic Health Authorities and PCTs in the UK are being devolved and as a result Local Authorities, Fioundation Trusts and GP Consortia must work together to build a unified whole system approach to healthcare access and planning to ensure emissions are understood, planned for and kept to a minimum. More detail: go to HaCIRIC International Conference Proceedings pp141-150 http://www.haciric.org/static/doc/events/HaCIRIC10_Conference_Proceedings.pdf Grant Mills is Research Associate, HaCIRIC, Department of Civil and Building Engineering at Loughborough University.