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Broken BREEAMs?

Built environment sustainability champion Gordon Hudson believes a new strategy is needed to incentivise sustainability design in healthcare, as the current BREEAM approach isn’t matching progress in other sectors.

I’d love to see the NHS and BRE get together and thrash out what the next 20 years needs to look like. There are big opportunities for the NHS estate to link social and economic benefit and outlay.

In 2008 the Department of Health embedded BREEAM (the Building Research Establishment’s Environmental Assessment Method) into the design process for healthcare buildings to create better work places for doctors and their staff, better outcomes for patients, and better environmental performance – from transport to water and energy use. However, it isn’t working.

Research undertaken by myself and John Holmes and Graham Capper, both from the School of the Built Environment at Northumbria University, showed only 15% of NHS buildings had achieved BREEAM certification. Why? Of the 110 NHS buildings that were BREEAM certified, half received an ‘excellent’ rating and a third a ‘very good’. Not bad? Well, consider that over 150 UK office developments have received an ‘outstanding’ rating. Healthcare buildings seem to play in a lower league and we found that few of the BREEAM registered buildings went on to gain a final certification.

One explanation is a lack of value in the BREEAM labelling. In the office sector BREEAM has made a great deal of difference in normalising sustainability and eliminating false claims. But hospitals aren’t competing to rent out floor space. The obvious commercial driver that’s made BREEAM a success in the office sector isn’t there.

Case-by-case action

Or is it? What role does a building play in healing and recovery. There are design and engineering constraints determined by local context, type of hospital and clinical functionality. Operating theatres and many wards have to be mechanically ventilated. Urban locations often don’t afford green, leafy window views. BREEAM doesn’t really allow for these practicalities, it’s true. But designers can specify healthy materials, combat noise and vibration, embrace natural light and pursue energy efficiency. All helping to get patients better quicker, freeing up bed space and cutting operational costs.

Encourage design creativity

The sector specific BREEAM healthcare credits introduced in 2008 were not mandatory and not universally used. Generic assessment criteria replaced them in 2011. With no healthcare-specific hoops to jump through, facilities have been designed to standards that only partially apply. In a sector with notoriously tight budgets, going beyond the minimum to obtain points when they will not contribute to improved patient care is a low priority. But it might also be that BREEAM has made design of buildings too prescriptive.

In our research we found many projects were doing just enough to pass the 70% banding for ‘excellent’, and not necessarily taking the very best steps for that project. It would be far better to take a holistic approach that encourages creativity and innovation.

What are we trying to achieve? I’d love to see the NHS and BRE get together and thrash out what the next 20 years need to look like. There are big opportunities for the NHS estate to link social and economic benefit and outlay.

We’re not advocating that BRE make things easier. In fact, we’re asking for them to be more challenging by looking harder at each site and harder at the use of each building to say: ‘what’s the best thing we can do with the capital that we have?’

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