Collaboration as a strategy to meet NHS 2032 targets

To meet 2032 targets the NHS needs to green most, if not all of its top 211 CO₂ fossil fuel emitters in under a decade i.e. the Trust’s that use 10mKwH or more of gas per annum.

Since 1996 the NHS has been implementing carbon and energy reduction projects, and now we have exemplar “fossil fuel net zero” hospitals emerging at Eastbourne, Bridlington and others. The challenge of greening over 200 hospitals by 2032, in a time of low capital, challenged revenue budgets, and annual Government decarbonisation grants that are soft capped, cannot be overstated.

Almost all technologies that would allow an NHS Trust to get to net zero involve risk. Even heat pump technology is in its early days and has yet to prove its resilience at scale in a hospital environment – albeit introducing an additional annual running cost.

Trusts wishing to share risks to reduce failure, costs and project management overhead are able to collaborate through NHPower. Collaboration shares the risks of failure so that no Member faces the “all or nothing” risks associated with cutting edge technology or unsuitable underground conditions.

Collaborating Trusts would benefit a knowledge sharing forum with like minded Members serving a common purpose and would go forward together to share grant applications, procurement, finance, project management, technical support, site infrastructure upgrade preparation, and ongoing energy management.

The net zero routes immediately available are few and in essence include:

1. Geothermal energy
2. Hydrogen
3. Electricity
4. Decarbonisation of gas at the point of use
5. District energy

The large NHS emitters are being categorised on the basis of the most suitable available route to net zero based on geography. This is because geothermal energy and hydrogen availability are geographical and based on the geology or socio infrastructure of a particular location.

When mapped we can see that some Trusts are in the enviable position of being close to Hydrogen and geothermal energy sources purely by their location.

Geothermal Energy
All large emitter sites have been run through the British Geological Survey’s database and about 100 sites have geothermal potential. The piloting wave of 5 projects is in procurement and will investigate and install geothermal energy under a flexible procurement route called an Innovation Partnership. This allows careful phasing and management of discoveries and risk.

Hydrogen
So far two main hydrogen areas are worth progressing and Trusts which have a chance to get Hydrogen will be approached to participate in the collaboration during this year in specially set up workshops. Whilst liquid hydrogen will be available this year, we are targeting 2027 for the completion of the first tranche of piped Trust connections. Sites will need conversion to 100% hydrogen and a review of their resilience arrangements. The first workshops to investigate the interest in collaboration will occur this year with sessions planned at Iheem in October 2023.

Decarbonisation of gas at the point of use
In the absence of geothermal or Hydrogen energy sources, technologies to decarbonise gas on site are being investigated. (See box). Other low carbon fuels are also being considered

District heating
The NHS 211 main emitters are each surrounded by an ecosystem of mental health and community facilities (over 1600 of them) that all need to get to net zero too. Whilst district heating is not in itself necessarily any cleaner than any other heat source, there are a number of systems heated from burning waste or low carbon fuels or which could use geothermal or hydrogen fuels and these are being included in the programme.

Risk
The strategy for managing risk is collaboration. Any single project to convert a site to net zero involves risks and costs. A standalone project must manage the risks itself, and whilst NHS Trusts are largely autonomous, the NHS shares big risks and the NHPower programme is no different. Whilst other collaborations may arise, the only current option for net zero collaboration in the NHS is NHPower

Existing technologies and energy reduction methods
This article does not discuss these as the technologies are available, and every Trust understands the need for energy reduction improvements. There are now many heat pump installations, though they are being closely monitored as the NHS has little experience of resilience of heat pumps over time and all weather.

Other benefits of collaboration
It is clear that net zero will be very different to the current energy model. Instead of setting up controls once and just relying on boilers, net zero installations will require active management and a programme of reducing temperatures over time. This calls for comprehensive energy management, which currently enjoys certain taxation benefits when carried out for a Trust and can be included within the collaboration. Every estates manager appreciates the benefits of a comprehensive and effective BMS system with good building insulation without air leaks. In the net zero world this will no longer be optional, to the benefit of all that use the hospital.

About the Author
Clive Nattrass is the programme manager of NHPower, appointed by a taskforce of governmental, Iheem, and NHS representatives to design and implement a programme to get the NHS to net zero in fossil fuels. Clive has a pedigree in this field having founded the Carbon and Energy Fund, which is the main route to energy infrastructure improvement in the NHS.