Balance is key as healthcare sector faces up to climate change - Alasdair Rankin

The NHS is a massive organisation. That may be obvious but as a result of its national reach and the scale and range of services it provides, it has a huge estate.

For an organisation whose primary aim is the provision of healthcare, the NHS is also a significant property management organisation.

Government figures for the financial year 2020/21 show that the NHS in Scotland operates buildings in excess of 4.7 million square meters. Carbon Dioxide emissions in the year equated to approximately 8.9 per cent of Scotland’s CO2 output. This is despite significant reductions over the last 30 years.As we become more aware of, and concerned by the scale of the climate emergency, the size of the challenge becomes clear. Buildings are clearly a major part of this, however, we have to look at the bigger picture.

The whole process needs examining – from travel and integration of the care estates into our communities to provision of services and the impact of the development, production, and delivery of medicines and not least, the production and disposal of equipment and PPE.

Alasdair Rankin, managing director, Aitken Turnbull Architects

As with all situations there is clearly an issue of balance. While we acknowledge the importance of responding to the climate emergency, we must continue to provide safe and appropriate environments for the delivery of healthcare. Medicines, complex procedures, and PPE are all vital parts of this.

We also need to broaden our approach to consider not just operational carbon, but embodied carbon. Returning to the scale of the NHS Estate – of that vast estate 81 per cent is over 10 years old and 50 per cent is over 30 years old. While there are clearly operational efficiencies in new buildings, their construction creates significant new carbon production. The adaptive reuse of existing building stock to provide new facilities allows us to avoid the creation of significant new carbon production, while improving the operational efficiency of the original building. There are additional benefits in the reduction of waste and demolition.

In a recent project jointly for NHS Lothian, City of Edinburgh Council and Police Scotland, we completely refurbished the existing 1990s building, improving its efficiency while meeting the more stringent contemporary guidance for healthcare environments. Existing healthcare buildings are often within established communities and their reuse avoids the continuation of the pattern of moving hospitals and health buildings to the edge of towns and cities and the transport and accessibility challenges this brings.Those of us who commission, create and deliver healthcare environments have known for many years that the cost of maintaining existing and delivering new buildings was a constant challenge for the cash strapped sector.

We have all seen healthcare staff delivering amazing levels of care despite the environment they work in, rather than being assisted and supported by it. We also know that well-designed, well-maintained environments have a beneficial impact on the wellbeing of staff and patients as well as a positive impact on recovery.We must find a way to address the climate emergency without impacting on the delivery of healthcare, without creating additional barriers and difficulties for staff or patients and crucially without diverting funds from the delivery budget to address the estates challenges.

Alasdair Rankin, managing director, Aitken Turnbull Architects