Annual State of the NHSScotland Assets and Facilities Report for 2012

Annex C

Review of Energy Performance

A reduction in energy consumption will make a significant contribution towards the Scottish Government's aim to reduce greenhouse gas emissions as described in the Climate Change (Scotland) Act 2009. A reduction in energy consumption is also very important in the context of increasing fuel costs and the impact of the resulting cost increases on the delivery of core NHSScotland services. The current cost of energy for NHSScotland's hospitals is circa £70 million per annum. Considerable overall energy price rises are expected over the next decade and no change in the current levels of energy consumption in the NHSScotland would likely to see a doubling of energy costs to around £140 million per annum by 2020. Hence, energy performance is a key issue which will be monitored and reported on annually through this NHSScotland State of Assets and Facilities Report.

As in previous years the 2010-11 Annual National Environment Report continued to report that NHSScotland has a good track record of reducing energy consumption year on year measured over the last 25 years. The climatically adjusted energy consumption for 2010-11 was 3.1% down from the previous year making a cumulative reduction of 45% in energy consumption for the last 25 years.

A new HEAT target (Phase 2) came into operation from April 2010 which requires a year-on-year energy efficiency improvement of 1% on all energy sources based on an overall improvement by 2050 of 33% (or one third) on the comparative performance as at 2009-10 base year. This equates to a 10% reduction in energy performance by 2020.

In previous years, the Key Performance Indicator (KPI) used to report energy consumption in hospitals has been GJ/100m³ (heated building volume). However, most other non-domestic building types report energy consumption as kWh/m² and this is the KPI suggested in the new Public Sector Sustainability Reporting Guidance issued by the Scottish Government in January 2012. It is proposed to use this form of KPI in future years for NHSScotland reporting.

During 2010/11, the average energy performance across NHSScotland hospital estate was 473 kWh/m² (61 GJ/100m³)^[2] . However, it would be misleading to recommend an absolute target KPI for all hospitals based on this figure. The NHSScotland estate is diverse, having a wide range of hospital types, such as large teaching hospitals and small community hospitals, and from widely varying construction periods, i.e. from the turn of the previous century to today.

There is also a HEAT target (Phase 2) in relation to carbon dioxide (CO₂) emissions. This is a 3% year-on-year reduction in CO₂ from fossil fuels, based on a 2009/10 baseline. In 2010/11, the climatically adjusted CO₂ emissions from fossil fuel sources were 4.6% down from the previous year. Going forward, there is a need to report on all CO₂ emissions from NHSScotland estates and this will be reflected in reporting for 2011/12.

The table below shows the average energy performance KPIs for hospitals for the different NHS Boards and Special NHS Boards for the last 2 years and future values if the present energy reduction targets are carried forward and met.

Note that Boards marked with an asterisk (*) have only one hospital site. KPIs for these Boards may be misleading as they are being compared to Boards with a mixture of hospital sites.

It should also be noted that the large increase in KPI for the State Hospital Board for Scotland relates to major construction work being undertaken on that site during 2010/11. Future consumption figures for this site are expected to be substantially lower as the new buildings have been built to a much higher energy performance specification.

As evidenced by the 1.5% KPI reduction from the 2009-10 base year, Boards continue to produce savings against a backdrop of national resource constraints. Energy prices continue to rise above inflation levels and are beyond the control of Boards. Therefore, whilst we expect energy consumption to continue to decrease, this may not be reflected in a similar reduction in energy costs.

Assuming all hospitals achieve their HEAT targets, there would be an average 10% reduction in energy consumption by 2020. Across the NHSScotland Estate, this would lead to a minimum annual reduction in energy expenditure of approximately £7million^[3] per annum. As this is based on current utility costs, this saving would be expected to rise year on year. It should also be noted that the above figure does not include additional savings from reduced environmental taxes and levies (e.g. Carbon Reduction Commitment Energy Efficiency Scheme) and potential Renewable Heat Incentive (RHI) and Feed-in Tariff (FiT) revenues.

Achieving these challenging energy reduction values will require significant investment in energy efficiency improvements across the NHSScotland estate.

The table below shows the potential cost savings (energy costs only) that could be achieved by each Board based on a 10% reduction in energy use.

Energy reduction projects currently under consideration across the NHSScotland estate include:

1. Conversion of existing oil-fired heating systems to alternative fuel sources, e.g. natural gas and biomass. As well as affording carbon and cost savings, this would also increase security of fuel supply, particularly at off gas grid sites. This has the potential to save approximately £3 to £4million per annum, and would require around £10 to 12million of investment.
   
   This could reduce the present KPI by c 39 kWh/m².
2. A review of other heating equipment across NHSScotland, followed by a prioritised programme of replacement or refurbishment. This includes Combined Heat and Power (CHP), high-efficiency boilers, burner units and controls, and alternative fuels and energy sources. This has the potential to save approximately £20million per annum and would require approximately £180million in investment.
   
   This could reduce the present KPI by 36 kW/m².
3. Upgrading of dated inefficient lighting installations to modern counterparts and controls. This has the potential to save around £3million per annum and may require approximately £12million in investment.
   
   This could reduce the present KPI by 10 kW/m².
4. Review of existing motors and drives, and installation of modern high efficiency motors, drives and controls where appropriate. This has the potential to save c £5million per annum and may require c £20million in investment.
   
   This could reduce the present KPI by 16 kW/m².

The 4 projects above are almost exclusive of one another; therefore the potential energy savings could be directly cumulative. In combination the projects (if implemented in full) have the potential to reduce the present average KPI by c100kWh/m² (from c 473 to c 372 kW/m²), an overall improvement of c 22.5% on 2009-10 figures. At an overall cost of c £224million, and with potential savings and earnings of c £32million per annum, a payback of c 7 years could be achieved. Savings are exclusive of any potential RHI and FiT revenue, and of any reductions to environmental taxes and levies.

In addition, the following items are kept under constant review:

• Superior energy performance requirements for all new builds and refurbishments, in line with NHSScotland sustainability aims;
• Installation of appropriate renewable energy and low carbon designs, such as wind turbines in rural areas, heat pump techniques, and combined heat and power systems where they are suited to healthcare environments;
• Alternative renewable and low carbon energy sources to increase security of fuel supply and flexibility.
• Potential Community integration projects to alleviate fuel poverty and inequality, such as District Heating and Smart Grid techniques;
• Application of new and innovative techniques as they emerge onto the market (e.g. smooth surfaced LED lighting, and phase change materials) that are suitable for use in healthcare environments;
• Continuation of Board energy and carbon management initiatives, such as: proactive energy monitoring and targeting, keeping staff informed, and instilling good energy housekeeping habits.

Given the continuing trends in clinical practice, particularly less hospitalisation and shorter lengths of stay, increasing care at home and self care, Boards can be expected to rationalise and reduce the size of their hospital estate over the next decade with consequential energy expenditure savings.