Healing the Health Service
Published: 10 November, 2010
As one of the country’s largest users of building-services plant, the National Health Service offers huge potential for saving money and carbon. Ken Groves shares his perspective.
The NHS is one of the largest employers in the world, second only to the Indian railways. Its thousands of hospitals and healthcare facilities across the country use vast quantities of energy to keep essential building services plant running.
Many of its buildings date back to Victorian times or were built in an era when energy efficiency was not a priority. Even more modern hospitals may have poorly implemented control and monitoring systems, partly as result of a lack of high level overview.
With energy prices rising steeply, there is a risk of costs escalating out of control and overwhelming NHS budgets. In the new era of stringency in public services that we are facing, this could have serious implications for patient care.
With the ever-present concerns about the use of energy and its impact on the environment and Government targets to reduce carbon emissions, it is time to bite the bullet and address the energy issue head on.
Estimates of the amount of energy wasted in the healthcare sector vary, but it is thought to be between 25 to 50%. This represents a staggering amount of money. Eliminating even a quarter of the waste would save hundreds of millions of pounds.
The idea of starting with a clean slate is attractive. However, it is simply not feasible to demolish all the older, inefficient buildings and replace them with high-efficiency facilities.
There is, however, an alternative.
There are substantial opportunities to save energy in the running of existing hospital buildings. With relatively small investment, it is possible to reduce power consumption significantly, at the same time as improving the quality of the healthcare environment for staff and patients.
The supermarkets have pioneered in this area, and I believe there are important lessons to be learned for the hospitals sector. One of the main stumbling blocks to getting control of energy usage is the haphazard way hospital cooling plant and building services develop over time.
There may be many different systems, subject to independent monitoring and control strategies. Given this, it is hard to deal with the building as a single entity, which is of course the ideal approach.
The solution is to wrap a single intelligent control system around all the existing plant. This enables managers to have a window on the entire estate, and control all elements (air conditioning, heating, refrigeration, ventilation and so on) from a single point. This approach can embrace old and new buildings, and all levels of plant.
A basic challenge in relation to HVACR equipment is to ensure it is only used when needed and delivers the correct environment for patients and staff.
The starting point is to identify plant that is not operating to design specification and then optimise performance. It is surprising how much plant does not operate as intended, either as a result of poor maintenance and servicing or, in the specific case of refrigeration and air-conditioning plant, due to it being under- or over-charged with refrigerant. In both cases, equipment will operate inefficiently and be forced to work harder, drawing too much power for the duty compared to its original specification.
At the most basic level, hundreds of millions of pounds could be saved from hospitals’ costs by addressing the little things. There are myriad examples, but to name a few.
• It is estimated that 10% of Europe’s electricity consumption goes to power equipment on standby, much of it overnight. Why keep PCs and photocopiers on standby consuming power when there’s no-one in the office? The NHS has legions of electrical systems and equipment on almost permanent standby. Devices such as RDM’s Data Manager can control this, and make an immediate impact.
• So often, the last person to leave forgets to switch off the lights in the office, so they are left on all night. This can easily be remedied, again with immediate savings which continue to accrue.
• Lights on wards and in offices are often left on all day, even though the Sun is shining through the windows. Again, cost-effective controls can put a stop to such flagrant waste.
Once these opportunities are identified and solutions put in place, the approach can be replicated across an NHS Trust — indeed across the whole of the NHS estate.
Further up the scale, another powerful option is using variable-speed drives to precisely control cooling and building-services plant. As well as cutting costs, VSDs also extend the life of plant and reduce maintenance, due to the smoother operating regime.
The key is to identify where there is waste through effective monitoring and then solve it by intelligent control. It is the approach we have pioneered in relation to supermarkets. As hard-headed commercial organisations, they have made controlling energy use a priority and adopted systems that deliver substantial savings.
Why hasn’t the hospitals sector got to grips with the energy issue in the same way as the supermarket sector?
For a start, some of the factors inhibiting progress are outside the control of estates and facilities managers. Political initiatives, the organisational changes in the move from central control to trust and, ultimately, foundation status, have served to muddy the focus on such fundamental housekeeping. There is also the over-riding imperative to provide clinical excellence without interruption in the healthcare setting.
Retail businesses, on the other hand, have a much more stable and predictable set of drivers, and can therefore more easily adapt to change.
Another important area where hospitals can learn from the approach of private business is in monitoring for planned maintenance. Retailers have pioneered the use of remote monitoring to constantly check the performance of ACR plant on a site — or across a network of sites. It can include real-time feedback on thousands of items of plant, including temperatures, pressures, energy used and so on.
Automatic light switching is another area where supermarkets have taken a lead. Many retail sites operate three shifts: trading; stocking and empty. In power terms for a healthcare site, this would represent 100%, 50% and 0% per cent of usage. However, many healthcare establishments operate always on 100% of the time.
The variable-switching system applied to a hospital environment would be dayshift, evening and night shifts. Managers decide in advance what areas can be powered down when not in use, rather than rely on staff to switch off lights when they leave for the day.
Manual over-ride with timers can ensure the lights are powered on when needed, but switched off again when not. None of these initiatives impact negatively on staff or patients, but their effect on the bottom line for running costs can be dramatic.
Simply making sure a hospital’s cooling and heating systems are not fighting each other can save huge amounts of wasted energy. It is not uncommon for heating to be left on until, say, 9.30 a.m., with the air conditioning coming on at 8.30 a.m. This is literally burning money. By considering the operation of a building as a whole, healthcare managers can use control systems to identify these expensive mismatches and eliminate waste.
Payback times for the Data Manager are generally measured in months. The exact figure will obviously depends on the specific application, but payback within 12 months is not unrealistic. With energy prices predicted to rise, payback times will get even shorter.
The essential ingredient in an effective strategy is transparency. You must ensure that what is actually happening in the buildings and facilities is made visible. This is where the supermarkets have pioneered with RDM, and it is has been key to their success.
Today’s triple-play approach of monitoring, control and remote management is already delivering substantial cost savings and reduced energy usage for major UK organisations. It is a short step to applying this approach in a clinical setting.
Ken Groves is business development manager with RDM.