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Is BREEAM working in the health sector? Gordon Hudson

Only 15% of NHS buildings receive BREEAM certification. The rating assessment tool does not take account of healthcare's specific design issues.

In 2008 the Department of Health embedded BREEAM into the design process for healthcare buildings. The aspiration to improve the sustainability and performance of NHS buildings has been and still is admirable. However, research undertaken by myself, John Holmes, Graham Capper, both from the School of the Built Environment at Northumbria University, shows that it isn’t working. Only 15% of NHS buildings had achieved BREEAM certification. Is it time to change the way we assess healthcare buildings and thereby encourage and recognise greater sustainable design?

Of the 110 NHS buildings that were BREEAM certified, 52% received an ‘excellent’ rating and 37% a ‘very good’. But consider how many UK office developments have received an ‘outstanding’ rating – 19, Houghton-le-Spring Primary Care Centre is still the only healthcare building to achieve this. As its designer, we at Mott MacDonald are very proud of this fact! However, the achievement draws attention to design practices on projects. While design and delivery teams sign up to the BREEAM approach, our research hints that most work to the standards, and not to surpass them. The certified projects have crept over the 55 or 70 hurdles for ‘very good’ and ‘excellent’.

BREEAM replaced the NHS Environmental Assessment Tool (NEAT), a healthcare-specific assessment tool which was used to benchmark existing premises and improve the environmental sustainability of new designs. NEAT included credits specifically for specific healthcare issues/considerations such as stakeholder consultations and access to services, and management of clinical waste. It also included many of the same criteria as BREEAM – management, transport, materials, energy, land-use and ecology, pollution, internal environment and water. NEAT was self-assessed rather than independently audited and one of the reasons for moving to BREEAM certification was the desire for conformity commonality across the all building sectors.

The sector specific BREEAM healthcare credits introduced in 2008 were not mandatory and not universally used. They were revised in favour a generic assessment criteria used across all building sectors in 2011. There are relics of the healthcare criteria in BREEAM – but they lack the muscle needed; ‘arts’ was the only ‘distinguishing’ feature of healthcare left. ‘Community CHP’ was part of a ‘low and zero carbon assessment’ and ‘good corporate citizenship’ is often reported separately by NHS Trusts.

With no real healthcare-specific hoops to jump through designers have been designed to standards that only partially apply; healthcare is a field with very particular requirements and constraints. Credits for daylighting levels, views out and natural ventilation are not routinely achieved often it seems, scope for ‘excellent’ scores is limited to energy performance rather than other innovative design features. In a sector with notoriously tight budgets, going beyond the minimum to obtain points when they will not contribute to improved patient care is understandably a low priority. But it might also be that BREEAM has made design of buildings too prescriptive, stifling creativity and innovation rather than inspiring design.

Assessments methods intended to promote sustainable buildings need to liberate and reward project teams to design facilities that are not only properly fit for purpose – that they are energy efficient and well connected, but also provide the best environment for patients and staff. Owners should be liberated to take a more active role in deciding what aspects of the design should be prioritised. We should invite innovations that have the potential to transform healthcare provision – that challenge and change standard practices through replication on other projects. The box-ticking scenario to get something ‘over-the-line’ is not the best way to create the change we need.

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