By Lynne Blundell
28 June 2010 – The healthcare sector is the monster of sustainability, using vast quantities of water and energy, day and night. And it will stay that way until there is a major commitment from government to provide incentives to the sector, including funding and resources to address its inefficiencies industry experts say.
According to a recent report by consultants Davis Langdon hospitals are among Australia’s most complex and most energy-intensive facilities, using at least twice as much energy per square metre as commercial office buildings (others claim it is close to 10 times) and around six times as much water.
Similar figures have been gathered in other countries with data from the United States Department of Energy showing that healthcare uses approximately four per cent of all energy consumed in the US and that one average sized US hospital emits approximately 18,000 tons of carbon dioxide annually.
One of the main problems in addressing this massive consumption is that the usual drivers for sustainable refits, such as tenant retention and increasing the building’s value, do not really apply to hospitals, particularly major publicly owned facilities.
But according to construction consultants Davis Langdon there is growing recognition that the rationale for green healthcare facilities encompasses not just economic advantage, but also improved patient outcomes, reduced medication costs, reductions in cross-infection rates, better staff health and reduced staff turnover, and community benefit through decreased environmental impacts.
“In response to this, expenditure on sustainability has grown by 2-2.5 per cent of total construction costs on most major hospital projects over the last five years. This is likely to increase as health departments continue their push towards more sustainable buildings,” Davis Langdon says in its report.
Moves to address the sustainability issues of healthcare facilities are slowly emerging. Last year the Green Building Council of Australia introduced the first healthcare Green Star ratings tool and NABERs is working on developing a ratings tool for the sector, with a NSW pilot tool just completed.
But as Green Star executive director Robin Mellon told The Fifth Estate, healthcare is not an easy sector in which to effect change and there has not been a certification completed in the sector to date.
“Response to the Green Star tool has been quite slow. We’re not surprised by that – healthcare is a very slow ship to turn,” says Mellon.
“But there is general recognition that healthcare is very materials, water and energy hungry and uptake [of the Green Star tool] has been better over the last few months.”
Facilities of varying size from major hospitals to general practice super clinics were showing interest with 15 currently looking at getting certification.
“There is increasing recognition that for healthcare facilities to be more sustainable doesn’t require all the latest technology. There was a fear of this at first but it is good passive design that we are really looking for.
“Some of the older buildings actually have this – with verandahs all around to provide shading and good ventilation and natural light,” says Mellon.
The Green Star Healthcare V1 ratings tool has eight categories for assessment. These include management, indoor environment quality (IEQ), energy, transport, water, materials, land use and ecology, and emissions. Energy has the highest weighting with 24 per cent of points available, followed by IEQ with 20 per cent and then water 12 to 15 per cent depending in which State the facility is located.
According to Dr Paul Bannister, managing director of energy consultancy Exergy, which has been working on the NABERS healthcare pilot ratings tool, a key factor holding back hospitals from addressing energy consumption is that energy is a very small part of their total running costs – sometimes as low as 0.8 per cent. This is despite the fact that they can use up to10 times as much energy per square metre than commercial offices, says Bannister.
“Hospitals are very expensive places to run and they are always short of funds. When they have any they are more likely to spend it on their main priorities such as getting more beds,” says Bannister.
Another barrier to change is the institutional nature of the sector.
“When the NSW government policy was to reduce energy use by 25 per cent a few years ago nothing like that was achieved. They tried to introduce energy performance contracts and the healthcare sector was a big focus of these. Some were successful and a number went ahead but in the end they got very watered down.
“This is largely because hospitals are not driven by the usual commercial incentives such as client or tenant demands,” says Bannister.
Infrastructure in the sector is also often very outdated, with 50 year old chillers not uncommon. And co- or tri-generation plants, often hailed as the perfect solution for hospitals because of their 24 hour demand for power, is not necessarily the right answer, says Bannister.
“Hospitals can be places where co-generation or tri-generation works well but it can also be spectacularly inappropriate if there is not a large enough load. There is quite a history of white elephants plants out there. These plants also require a lot of maintenance and are very attention-seeking projects from an engineering perspective. And hospital engineers are very thinly spread – they are always on a knife-edge, with very difficult jobs. I have a lot of sympathy for them,” says Bannister.
Where progress has been made in recent years is water conservation. But on the energy side things have remained stagnant with little movement for the past decade, says Bannister. Much more could be done to improve end use efficiency through better lighting systems, replacement of chillers and better building controls – something which accounts for 25 per cent of the total energy consumption of healthcare facilities.
“What is needed is a big drive from government with more funding and resources. Making facilities run more sustainably requires people internally and externally.
“I’m dubious about the will of government when it comes to sustainability. It is not really being driven very hard and is definitely not being driven in healthcare. There is a massive opportunity if governments would provide the money and resources,” says Bannister.
Paul Megram, Rider Levett Bucknall director based in Queensland, told TFE that with a major expansion of healthcare facilities in Queensland, sustainability was becoming more of a priority.
Hospitals projects in Queensland include redevelopment of the Cairns and Mackay hospitals, construction of the new Gold Coast University Hospital and Queensland Children’s Hospital in Brisbane and expansion of healthcare services in Cairns and Townsville.
“Hospitals run 24/7 and anything that reduces their energy and water consumption will be increasingly important. Sustainable design is becoming a major focus particularly when annual operating costs are 30 per cent of capital costs. Anything that can cut this cost is a major driver in planning and design,” says Megram.
In addition to a reduction in running costs, hospital design increasingly takes into account the reduction of travel distances for staff within the buildings and indoor air quality, both vital for staff wellbeing and productivity.
But despite the awareness of sustainability in new facilities, the emphasis was very much on cost management, not on getting Green Star Points, says Megram.
“The Queensland policy is focused on sustainability and every effort is being made to develop facilities in a sustainable way but they are not chasing Green Star points,” says Megram.
“The private sector has invested in sustainable design partly because of financial payback and partly because of their corporate responsibility. But healthcare needs value for money – health funding is very tight.”
Rider Levett Bucknall does use the Green Star requirements as a guide though, aiming to achieve as much as possible given the cost constraints.
“Indoor environment quality is big in green Star and we’re trying to achieve it. Natural lighting is an aspiration – it’s very difficult to achieve in large buildings with very big floor plates. Natural ventilation is also difficult as there are issues with having windows that can open in hospitals,” says Megram.
Water management has been a big focus in Queensland healthcare facilities. This was particularly true during the worst of the drought years when collection and re-use of water became a key feature. Other areas where advances are being made are the use of low VOC (volatile organic compounds) materials, provision of recycling facilities, more allowance for pedestrians and cyclists and selection of materials based on their embodied energy and lifecycle assessment.
Michael Manikas, associate principal and sustainability leader with Davis Langdon, says both hospitals and universities are showing strong interest in the embodied carbon in their buildings.
Davis Langdon is working with NSW Health to determine embodied carbon in its facilities and is also helping several universities and a healthcare facility get Green Star certification.
The company is currently developing an embodied carbon metrix. It has already determined that it would take 11 to 23 years of operation for healthcare facilities in NSW to produce the same amount of carbon as that embodied in the buildings.
“There is growing interest in embodied carbon. Hospitals are really more concerned with getting more beds than getting Green Star but in NSW especially there is increasing focus on Green Star accreditation. NSW Health is looking first at embodied carbon to build a case for Green Star,” says Manikas.
Doing things such as changing concrete mixes and replacing aluminium with a material that has a bamboo laminated core were making an impact on embodied energy. One building was able to reduce embodied carbon by 17 per cent through changing materials.
And while Green Star doesn’t include points for embodied energy this is not far away. Robin Mellon confirmed that Green Star is moving in this direction.
“There is a lot of work going on in lifecycle analysis. Ideally we would love to see it added to Green Star and would like to see something in place in the next couple of years,” says Mellon.
“It will be great when we can see the operational, construction and materials impact of a building.
“It could be that we have it [embodied carbon] as an either/or choice in materials category. We know we need to keep this sort of approach simple as it scares the pants off people. It needs to be approachable.”
The Fifth Estate – sustainable property news