University Hospital of South Manchester / Britain’s greenest hospital spends money on services not energy
Area of work:
Health, Sustainable Buildings, Retrofit, Energy Efficiency
Awards Year: 2012
Hospitals are large energy consumers, but cutting energy consumption can’t be allowed to negatively affect frontline patient services.
UHSM has demonstrated that it is possible to make significant cuts in energy use and CO2 emissions whilst keeping the hospital warm and well-lit, and the money freed up by saving energy can be spent on patients instead.
Overall use of non-renewable energy cut by 36%
CO2 emissions down by 28%
Financial savings of about £390,000 a year
"Every pound saved on energy is a pound freed up to spend on patient care. Every tonne of carbon saved has a direct benefit to the local community and environment. There is no other game to be played in town."
Paul Featherstone, Director of Estates and Facilities
Hospitals consume large amounts of energy, with a continuous need for heating and air-conditioning to keep patients comfortable, good lighting for staff to work in, significant amounts of electronic medical equipment and lots of laundry to be done. Rising energy prices and the Carbon Reduction Commitment (CRC) mean that high energy use results in high bills, so reducing energy use and using renewable sources of energy can free up money to be spent on front-line patient services.
The University Hospital of South Manchester NHS Foundation Trust (UHSM) has taken significant steps to reduce its energy use, through a combination of technical and behavioural changes, which has resulted in much lower energy bills and CO2 emissions.
UHSM is a major acute teaching hospital trust providing services for adults and children at Wythenshawe Hospital and Withington Community Hospital, and community services as well. The Trust is recognised in the region and nationally as a centre of clinical excellence, and for the quality of its teaching, research and development. The Trust’s fields of specialist expertise include cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, cancer services and breast care services.
UHSM has approximately 5,800 members of staff, including those employed by its Private Finance Initiative partner South Manchester Healthcare Limited. The Trust treats about 442,000 patients a year and has an annual income of £348 million. Its real-estate comprises of a mixture of ultra-modern facilities and some buildings dating back to the early 1900s. The combined floor area of the whole hospital estate is in the region of 130,000 m2, comparable in size to large shopping centres such as Lakeside or Meadowhall.
Every member of staff can make a contribution to the Trust being Britain’s Greenest Hospital. We all have a personal responsibility to encourage that and promote the associated benefits.
Susan Osborne, Director of Communications
In 2007 UHSM began implementing a structured carbon management programme, led by the Director of Estates and Facilities with the support of the Trust Energy Manager and other senior management. This programme was informed by the Carbon Trust and resulted in the production of a Carbon Management Implementation Plan (CMIP), which was endorsed by the board of directors. The programme started by monitoring energy use and then implementing a range of technical measures to improve efficiency through changes to the building fabric, the lighting and the heating systems. Renewable sources of heat were also installed, and a range of highly visible ‘green’ activities were started at the hospital. Staff have also been engaged in behaviour change to reduce their environmental impact, and schools have been engaged through the ‘Saving Planet Wythenshawe’ programme.
Energy audit and carbon reduction plan
At the start of its carbon management programme, UHSM established a baseline for its energy consumption, derived from energy billing data that is normally collected for any large site like a hospital. Several detailed energy audits were also commissioned to thoroughly analyse buildings’ energy usage, to determine how much energy could be saved. The audits typically included an inspection, survey and analysis of energy usage, and identified options to reduce energy input without affecting the use of the buildings. Audits covered heating, lighting, ventilation and fabric of buildings, along with understanding how staff used the buildings, so as to identify energy-inefficient practices. Critical to the success of energy use monitoring was the installation of automatic meters across the hospital site, so usage in different buildings and departments could be accurately measured.
Energy efficiency technology
To reduce energy consumption, a targeted programme of investment to improve insulation commenced, starting with priority areas such as the boiler house and parts of the hospital with old single-glazed windows, which were replaced with double-glazed units using low-emissivity glass. Efficiency measures that followed covered two main areas: lighting and heating. Improvement of lighting efficiency was achieved using several techniques, starting with replacing older T12 and T8 fluorescent lights with more efficient T5 lights. Sensors were also installed to turn off lights in rooms when they are not occupied, and the lights in corridors were rewired to allow the Trust’s Building Management System (BMS) to turn groups of them off in response to changing daylight levels.
Heating systems were initially improved by addressing the issues identified in the energy audits. Like many NHS Trusts, UHSM uses a network of steam-based heat mains to distribute heat from a number of centralised boilers. The audit identified numerous areas where repairs or upgrades were necessary to bring the system up to current standards for efficiency; by taking action on these points, significant energy savings were delivered. The steps taken included installing new heat exchangers, to more effectively transfer heat from the steam system to heat water for use in buildings, replacing or repairing steam traps and condensate pumps, and insulating pipework. Improved zone controls for heating were also installed, along with new burners and flue economisers for the gas boilers, to improve efficiency and capture waste heat from the flue gases.
Ashden Award for Sustainable Buildings
Greater London Authority
Related to the heating system is the ventilation system, where the main improvement was to add inverters to motors to vary the frequency of their electrical supply, so controlling their speed and allowing ventilation rates to be adjusted as required. This saves electricity by allowing the ventilation motors to run more slowly some of the time, and also saves on energy for heating as the rate of air change in the buildings can be reduced.
In addition to the work on monitoring and efficiency, UHSM has also installed equipment to supply heat from sustainable sources. The conventional gas-fired central boilers have been supplemented by the installation of two 2 MW Uniconfort biomass boilers, which are fed from a walking-floor container of woodchips, with a buffer to allow continuous operation while the container is being changed. The container is parked on a weighbridge, which automatically sends data back to the fuel supplier so they know when to deliver another full one. In addition to the main biomass boilers, a smaller 200 kW biomass boiler and a 50 kW ground source heat pump have been installed in buildings that are not connected to the steam distribution system. All biomass fuel is supplied from FSC certified sources within the UK.
The implementation of the CMIP, including all the technical changes described above, would not have happened without a significant change in organisational behaviour. This started at the top, with endorsement of the CMIP by the USHM directors, and their active support for the roll-out of the programme and involvement of the whole hospital community in cutting energy consumption.
The success of the carbon reduction programme has led to wider behavioural change. Staff became interested in looking at other environmental issues, and several ‘softer’ environmental projects were started. These include staff and crèche allotments, an on-site farmers’ market, a cycling club, improved parking for cycles on site and the use of hawks for pigeon control. While most of these projects do not deliver large energy savings, they are very visible and engaging, and have contributed to UHSM’s recognition as ‘Britain’s Greenest Hospital.’ There is now substantial interest among staff to explore other opportunities to save energy and enhance the green credentials of the Trust.
Outside the hospital, UHSM has also been working with local schools in the ‘Saving Planet Wythenshawe’ programme, aiming to inspire children to do what they can to reduce their environmental impact at school and at home.
The hospital have the foresight to think about the future when making plans. They bring ideas to the governors to improve energy efficiency and save money.
John Churchill, publically elected Hospital Governor
How much does it cost?
Since starting implementation of the CMIP in 2007, UHSM has spent £3.3 million on energy efficiency and renewable heating equipment (which included a grant of £1.3 million to install the two 2MW biomass boilers), with a further £0.5 million still to be spent to reduce energy consumption and carbon emissions further.
How is it promoted and maintained?
Maintenance of the buildings and equipment at UHSM is carried out by Sodexo Corporate Services Integrated Facilities Management under a Private Finance Initiative contract. The Trust’s estates teams help ensure that Sodexo staff are kept up-to-date on the goals regarding energy use, as regular maintenance is required to keep systems operating at optimum efficiency. Behaviour change requires maintenance too, and by ensuring that the visible ‘green’ projects keep running, and that new ones are started, UHSM makes sure that the staff are reminded and motivated to keep taking action to save energy at work.
The efficiency programme implemented by UHSM has led to substantial cuts in energy use. Between 2006/7 and 2011/12, the annual electricity use fell by 6% (from 19.8 GWh to 18.5 GWh) and the annual use of heating fuel by 27%. Heating became much less reliant on fossil fuels, with gas use falling by 47% (from 47.2 GWh to 25.1 GWh) and 1.0 GWh of heating oil use being eliminated entirely. Annual biomass use is currently 10 GWh.
You used to be able to stand outside in cold weather and feel the heat coming from the buildings. Now, the outdoor plants struggle in the winter because of the new windows!
Dr Richard Sawyer, Senior Radiologist
The energy savings and the shift from gas and oil to woodfuel at UHSM have resulted in a drop of 5,000 tonnes (28%) in annual CO2 emissions between 2006/7 and 2011/12. Water usage has also been reduced through behaviour change, and the greater numbers of people cycling to work will have reduced traffic congestion and pollution in the surrounding area.
The core social benefit from UHSM’s work is that money saved on energy can be used for front line patient services. The ‘Saving Planet Wythenshawe’ programme is also reaching out to the community, involving schoolchildren and their families in the hospital’s environmental work. The behavioural change among staff has brought other benefits, such as the cycle club helping staff gain confidence to cycle on local roads and lending secondhand bikes from the pool that the club maintains. Members of the cycling club can also call for a pick-up from hospital security if their bike suffers a breakdown between home and work. The other ‘green’ projects at the hospital are also benefitting staff, for example providing them with allotment space to grow food, and access to local produce via the farmers’ market.
We make sure all our computers and X-ray machines are off at the end of the day.
Dr Richard Sawyer, Senior Radiologist
Economic and employment benefits
At current energy prices, the efficiency gains that UHSM has made are saving it about £390,000 a year. The payback period is on average just over seven years; this includes measures that pay back very quickly, such as insulation and improvements to the steam distribution system, and measures that are slower to pay back, such as double-glazing and lighting upgrades.
Potential for growth and replication
Many hospitals across the UK are in a similar situation to that UHSM was in just a few years ago, being responsible for buildings that are several decades old and not up to current standards of energy efficiency. UHSM’s work has shown that it is possible to make significant reductions in energy use over just a few years, and that the payback periods are favourable. The biggest savings for UHSM came from improving its steam distribution system, and as many hospital sites use similar systems this approach is widely replicable. UHSM has already given guided tours to visitors from several other hospitals and also from commercial and industrial sites, which can face similar challenges on energy consumption.
We’ve removed the air conditioning from some rooms, though it can sometimes be a challenge persuading everyone this is the right thing to do.
Dr Richard Sawyer, Senior Radiologist
Behavioural change in senior management is also replicable at other hospitals. Every hospital is facing higher energy prices, so the financial incentives to cut energy use are becoming more compelling. UHSM staff were motivated to change behaviour by a positive message and visible reminders of the environmental work that was in progress. Other hospitals could achieve the same result by making their environmental achievements known in the local press and community, and using visible ‘green’ projects to remind and encourage staff to do their bit.
There is also further work to be done at UHSM’s Wythenshawe site, as not all of the old windows and lights have been upgraded yet, and it is investigating the use of voltage optimisation to further reduce electricity consumption.