BA Architecture Dissertation; Stakeholders’ Engagement towards the use of BREEAM in Healthcare by Shivani Patel

ARC3060: Dissertation in Architectural Studies

Newcastle University

Stakeholdersâ&#x20AC;&#x2122; Engagement towards the use of BREEAM in Healthcare

Is BREEAM Certification encouraging Architects and Consultants to design for a Sustainable Future towards Low or Zero Carbon Energy Healthcare in the UK?

Shivani Patel

160297335

Contents

Acknowledgements

Introduction

Chapter 1: Literature Review 1.1 The Evolution of BREEAM 1.2 The BRE 1.3 Stakeholders

7 8 9 10

Chapter 2: Methodology 2.1 Interviewee Selection Criteria 2.2 Analysis of Findings 2.3 Case Studies

13 14 18 19

Chapter 3: Findings 3.1 Engagement and Contribution of Stakeholders towards addressing BREEAM 3.2 Complying with BREEAM 3.3 Effectiveness of BREEAM in Healthcare

21 21

Chapter 4: BREEAM Certified Healthcare Projects (Case Studies) 4.1 Houghton Le Spring Primary Care Centre 4.2 Dumfries and Galloway Acute Mental Health Unit (Midpark Hospital) 4.3 Elective Orthopaedic Theatres

31 31 33

Conclusion

Appendix A: Interview Questions

42 42

Endnotes

Bibliography

List of Illustrations

23 25

Acknowledgements I would like to thank the individuals who spared their time to take part in interviews for this dissertation research; Architect at Ryder Architecture, Architect at CMPG Architects and the consultant at Yonder Limited. I would also like to thank the Senior Lecturer and dissertation tutor; Dr Neveen Hamza, for providing guidance and feedback on my research. I appreciate the time you have dedicated.

Introduction

the recognition of the Climate Change Act, the government are determined to meet the overall target of reducing at least 80% of carbon emissions by 2050 compared to 1990.1

Healthcare are one of the largest building types to emit tonnes of CO2 every year compared to the average annual CO2 emissions by other building types; courts, education, industrial, offices, retail, prisons, multi-residential and data centres. Since July 2008, all health authorities now required ‘BREEAM Excellent for new buildings and Very Good for refurbishment, subject to certain capital cost thresholds,’ in the UK.4 However, a pre-assessment is still required at the OBC (Outline Business Case) stage to arbitrate if a BREEAM assessment is viable.

With buildings being the largest contributing factor in the release of carbon emissions, the BRE (Building Research Establishment) developed BREEAM (Building Research Establishment Environmental Assessment Method) as a research assessment tool to offer guidance to projects and stakeholders on delivering sustainable buildings.

BREEAM has been driving reduction in CO2 emissions since the scheme first released in 1990. ‘BREEAM assessed buildings achieve an average 22% reduction in CO2 emissions, and over the next five years, the BRE has committed to work with industry to deliver over 9,000 certified buildings with emissions savings in excess of 900,000 tonnes of CO2’.5

The BRE; a building science centre in the UK, owned by the BRE trust provides training and services to

11 years on, researchers have concluded areas of exploration within BREEAM and some with Healthcare, on

Through

enable construction professionals and clients to bring a ‘positive change in the built environment’. The BRE is owned by the BRE trust which is a thirdparty, charitable organisation founded in 1921.2 BREEAM is one of the products they provide, as the ‘world’s leading sustainability assessment method for master planning projects, infrastructure and buildings.’3

the engagement of stakeholders. The aim of this dissertation is to promote BREEAMâ&#x20AC;&#x2122;s intentions as the worldâ&#x20AC;&#x2122;s leading sustainability assessment method, and discuss the effects of its use in reducing carbon emissions through BREEAM Healthcare and the effectiveness of the assessment method by stakeholders, particularly architects and consultants, through the findings of interviews and case studies. In addition, providing a better guideline for them when approaching sustainable assessment methods and suggesting ways of improving the assessment method to further deliver BREEAM certified healthcare buildings to deliver a reduction in UKâ&#x20AC;&#x2122;s carbon emissions. This dissertation begins with a review of literature, followed by the research methodology presenting the backbone of the interviews conducted to provide a first-hand experience feedback from architects and consultants which will be led into the presentation of interview findings. Then, the third chapter will approach the BREEAM certified projects undertaken by these professionals and analyse how they were handled with regards to them being BREEAM targeted projects.

Chapter 1 Literature Review 1.1 The Evolution of BREEAM

This

section provides an insight into the evolution of BREEAM, the BRE and stakeholders involved in the process of built projects. The initial approach for implementing the first scheme in 1990 for BREEAM was targeted towards reducing CO2 emissions through simply rewarding good practice and employing individual energy saving measures. The document was very small, looking at a limited number of issues on carbon reduction, in comparison to the recent, elaborate, almost 400-page manual.6 However, this only included a checklist of energy efficiency features which was limited in scope, making it ‘inflexible and not adaptable’7 for many building types. This approach was replaced

by a whole building assessment tool in 1998 called EsiCheck;8 a whole building modelling software. EsiCheck was based on historical, experimental and observed data which was difficult to be shown in calculation and unable to deal with innovation. Then in 2002, a dual approach was adopted, assessed through a building fabric and form calculator, based on standard operation of design team dynamic modelling resulting in locational defaults. The change from a simple rewarding scheme to a whole building assessment drove BREEAM to major developments in its scheme to a ‘more robust methodology’9 , proficient of ‘quantifying predicted carbon emissions savings at a whole building level’.10 In 2003, the Government Construction Clients; a group of representatives from all government bodies involved in construction, published a threeyear Sustainable Action Plan which aimed to achieve certain objectives to promote ‘best practice and efficiency throughout the public sector’.11 One of the themes in the newer, revised Sustainability Action Plan 20122015 was Climate Change Mitigation (Minimising energy in construction and use), where the performance of all relevant projects should be assessed against established energy consumption benchmarks such as those set by BREEAM and all new builds should receive BREEAM 2011 Excellent; with at least one of these new projects achieving BREEAM Outstanding 2011.12 Additionally,

BREEAM Accredited Professionals (AP) should be the ones to provide input into all new build projects of £5m or more depending on the number of available AP’s.13 In the same year, the Energy Performance of Buildings Directive (EPBD) was selected, ‘requiring the member states of the European Union (EU)’14 to affiliate with a ‘whole building calculation methodology for the assessment of carbon emissions.’15 With this requirement, came the 2006 version of Building Regulations Part L which embedded this approach and therefore mirroring the existing BREEAM scheme of calculation methodology, downplaying the significance of a third party, sustainability scheme. As of 1st July 2008, BREEAM became a legal requirement by all UK health authorities; including the Department of Health, NHS Wales, Health facilities Scotland and the Department of Health Social Services and Public Safety of Northern Island; integrating BREEAM into the design process of healthcare buildings as a systematic method to encourage and assess sustainability in healthcare.16 BREEAM Healthcare 2008 replaced the existing NEAT; NHS Environmental Assessment Tool, which was also developed by the BRE in 2002 for NHS Estate, for use in England and Wales. NEAT was a self-assessment tool which had not been updated since it was created and therefore did not have a quality control measure at the end of its assessment. BREEAM Healthcare on the other hand was a

‘robust’17 certification scheme which followed other BREEAM schemes, with methodologies regularly updating in response to present and future, predicted building performance in carbon emission savings. In 2011, BREEAM Healthcare 2008 was replaced by BREEAM New Construction 2011, then 2014 and currently 2018. BREEAM New Construction moved away from the definitive healthcare assessment criteria; simplifying into generic assessment criteria applicable to all building types. BREEAM New Construction schemes have been regulated to follow the Building Regulations methodology to prevent unnecessary obstructions for design teams but most importantly; award credits in performance through recognised improvement beyond the ‘regulatory minimum performance requirements for CO2 emissions.’18 This can be seen in the BREEAM New Construction 2011 manual which introduced a triple metric approach which awarded credits on ‘performance against energy demand and primary energy parameters’ in addition to the originally assessed CO2 emissions parameters.19 The employment of a heavily researched, environmental or sustainability assessment tool offered a type of framework in a building project to refer to and measure the performance of buildings as a way to go beyond building regulations and enhance sustainability, evaluated by Lambrechts, Gelderman, Semeijn & Verhoeven.20

scheme document and some may be familiar with the recent document and this creates a lack of continuity in all the stakeholder’s understanding, which differentiates their opinions of certain aspects of BREEAM, what they have to offer and their assessment method. As mentioned, BREEAM is supposed to be a conversation within the wider society, with responses of what can be done better, rather than an argument of what is right and what is wrong.

1.2 The BRE

Through access to a webinar on, ‘A Healthy Approach to Certification’ led by the World Green Building Council, Martin Townsend from the BRE spoke about the evolution of the BRE and the use of their rating tool; BREEAM. Evidently from this, the BRE presented BREEAM as a research and assessment tool, which isn’t fully set in stone but progressing and adapting, as issues are raised locally and worldwide and from personal experiences, to target current environmental issues and reduce the impacts of them in the future. This may explain the reason why not everyone entirely understands the array of criteria BREEAM has to offer in delivering sustainable buildings, since it’s regularly changing. Some stakeholders may grasp an older

‘The unique thing about the BRE is we don’t just create our schemes and write our standards, we actually do lots of physical testing and lots of physical research to make sure the standard we have is based on true science. So, as a research charity, it is about helping industry to actually create buildings on our site, to test them to make sure that they are the buildings that the industry is building and to make sure that we are driving that change, so the standards we write from a BREEAM perspective are based on that industry first-hand experience, but I think what is important to share as well, is when we start to look at the world, it’s about making sure that when we talk about sustainability it isn’t just a conversation that’s happening in the [inaudible] market, it’s a conversation that is active worldwide. When we look at the work, we do it’s about making sure that conversation around sustainability and the schemes that we write support the world in terms of the challenges they face.’ [BRE]

Is an environmental certification method really working in the building sector? Wangel, Wallhagen, Malmqvist & Finnveden addressed the structure and content of the BREEAM assessment system, focusing on simplicity and validity.21 They identified the limitations in regards to the compliance of the system and established the magnitude to which a certification process would lead to further sustainable effects. One imitation they concluded was through the structure of the system, determining the hierarchy and relevance of issues based on whether they were mandatory or not. This created a mental division of mandatory and non-mandatory issues within categories, so certification could be achieved through addressing only some of the sustainable issues which may have been easier to obtain than others, neglecting larger issues such as the energy or environmental performance of the building.22

1.3 Stakeholders

The BRE produced various documents over the years which outlined how their service is performing in the building realm by stakeholders. Proceeding with a brief document on the assessment method and rating system, released by the BRE in 2011.23 This summarised that BREEAM ‘addresses wide-ranging environmental and sustainability issues and enables developers, designers and building managers to demonstrate the environmental credentials of their buildings to clients, planners and other parties’24 through its ‘straightforward’, ‘transparent’ and ‘flexible’25 scoring system. The key words they adopted to describe their scoring system, currently establishes how the BRE perceived their system

to be employed by the stakeholders, and gestures an easy to understand system. Despite the release of documents published by the BRE highlighting what BREEAM is and how it can be easily used, it was assumed that stakeholders would revise updates from the progressively rigorous building regulations. Pan & Garmston concluded there was a non-compliance in practice and a lack of knowledge and implementation of these regulations in buildings reported in England and Wales.26 This would therefore suggest a gap in the comprehension and engagement of stakeholders in environmental design, including, the employment of the BREEAM New Construction. schemes, even though it is a government requirement. One might think, projects aren’t using BREEAM or a sustainability assessment method due to it being hard to use, therefore the BRE are consistently making it easier to use. Without regards to the stakeholders understanding of BREEAM. This could also claim that stakeholders have different interests and expertise and how they value certain sustainability issues, or how each of their priority levels used in the sustainability assessment can vary between stakeholder to stakeholder, deduced by AlWaer, Sibley & Lewis,27 affecting their involvement and collaboration in the process, for instance, consultants. Consultants can have varying opinions and values of environmental issues, overvaluing consequences without

reason by suggesting alternatives or selecting ‘easier’ options to avoid them overall, says Enríquez-deSalamanca. It could also be a ‘wellintentioned manipulation’28 where, environmental consultants accredit higher values than standard natural resources to prevent complications in the process. The way BREEAM assessment and criteria categories work, the project is offered 0 credits for meeting minimum standards of building regulations.29 As this requirement is exceeded, more credits are rewarded on the extent to how well they are met or achieve certain specified criteria, outlined in the BREEAM scheme. Ultimately resulting in a positive energy performing building. To exceed this criteria, particular decisions need to be made alongside the project team members and this decision-making involves maintaining communication and informing team members on updates to regulate the design stage of the project. This means everyone should be on the same wavelength. Schweber and Haroglu insinuate that the effect an environmental assessment method has on the design of a building is affected by ‘prior experience of working together; better project team collaboration; greater communication and coordination; higher levels of commitment and engagement; the early involvement of key actors; prior experience in sustainable construction; and prior experience with BREEAM. and sequentially decision-

making’.30 Wiesmeth mentioned that sustainability issues were often bought together with stakeholder engagement,’31 which concurs with Pucci, Casprini, Galati & Zanni investigation, studying simultaneously how the impact of a stakeholder and their engagement on the proactive environmental behaviour and the role of the stakeholder and personal value was considered significant in the practice’s ethos of innovation within the context of sustainable development.32 They concluded that practices with a proactive sustainability ethos, engaged multiple stakeholders in developing eco-innovations, resulting in a key driver in the process. However, an investigation of hospital building sustainability through a life cycle approach by Stevanovic, Allacker & Vermeulen, concluded that architects required an appropriate, ready-made environmental method as a necessity from an early stage to aid them in the evaluation of current sustainability issues of hospital in order to design well performing, sustainable systems. Since they felt that hospitals had complex requirements and highly maintained equipment, an accessible sustainability tool would be best suited in the building process.33 The analysis of the literature has suggested a gap in the engagement of stakeholders, with the last reference directing the gap between the practice’s collective sustainability ethos and the individual architect’s sustainability interests and perceptions. Has the integration

of an environmental sustainability tool enhanced the collective’s awareness? Has the regular BREEAM, governmental updates and the findings of environmental issues played a role in the engagement and commitment of stakeholders? Is BREEAM certification encouraging architects to design a sustainable future towards low or Zero carbon Hospitals?

Chapter 2 Methodology

first phase being the selection of interviewees through a decision process, eradicating those who do not correspond to the interview criteria, fig. 1 followed by the collation of interviewee feedback. The second phase consisted of an analysis of the responses to conclude findings, essential to informing the dissertation question through a qualitative, comparative study. The third phase presents three case studies, associating each interviewee in the discussion of the key energy strategies used the respective BREEAM healthcare projects to determine the effectiveness of BREEAMâ&#x20AC;&#x2122;s integration in the performance of the healthcare projects.

The

methodology approach adopted by Hamza & Greenwood;34 Schweber & Haroglu;35 Stevanovic, Allacker & Vermeulen,36 was through an interviewing process, most conducted semi-structured interviews after identifying an interviewee sample focus group. Lambrechts, Gelderman, Semeijn & Verhoeven;37 Wiesmeth;38 Schweber & Haroglu,39 employed a comparative case study approach, classifying specific case studies into either BREEAM certified projects or gained particular ratings through similar comparative research questions. The method of investigation in answering this dissertation question is based on three phases. The

2.1 Interviewee Selection Criteria

The methodology approach selected for this dissertation, is elite interviewing. Particular individuals were selected on the basis of their companyâ&#x20AC;&#x2122;s adoption of sustainable building projects, specifically high performing, BREEAM certified hospitals. Individuals who were extensively involved in the design stage incorporating BREEAM process were to be interviewed, implying architects and consultants who would be involved as early as stage 0 of the RIBA plan of work 2013. Elite interviewing would be the best possible method since the criteria is very specific which requires particular individuals. The selection criteria for the interviewees is represented in fig. 1

Interviewee Selection Process Research practices which have BREEAM certified projects Has the practice been involved in a BREEAM certified Healthcare Project? No

Yes Has the project been certified an Excellent or Outstanding rating? Yes Has the practice adopted methods to reduce carbon emissions in buildings?

Yes

Has the architect or consultant been largely involved or have extensive experience in the BREEAM process of a Healthcare project?

Yes Email individuals with brief introduction of research method, dissertation question and sample interview questions Fig.1 Interview Selection process

A brief explanation regarding the main issues and the dissertation question was emailed to 6 individuals/ practices; from which only 3 showed interest in taking part in the interview process (Fig 2). Due to the restricted number of potential interviewees at present, and with the limited interest, the small sample size was proceeded with. Interviews would indicate the professionalâ&#x20AC;&#x2122;s understanding of BREEAM, their perception and prospect of BREEAM Healthcare, in addition to identifying the background of the BREEAM healthcare project, reasons for certification and awarded credits in particular categories of the scheme.

Interview Criteria BREEAM Project

Interview 2 Houghton Le Spring Primary Care Centre

BREEAM Rating Occupation

Interview 1 Dumfries and Galloway (Midpark) Hospital Excellent Senior Architect

Company/Practice

Ryder Architects

Yonder Limited, (previously at Willmott Dixon)

CPMG Architects

Years of Occupation

5 Years

10 Years

21 Years

Fig.2 Interviewee selection criteria

Outstanding Senior Sustainibility Consultant

Interview 3 Elective Orthapeadic Theatres Excellent Architect

The interviews are partly structured to provide a conversation starter and a simple structure to follow if the conversation diverted from the original theme. Questions were generated from issues and points raised from the literature review.

call-based interview and focused on the decision making, involvement and participation of architects and consultants in the design process of BREEAM certified Healthcare projects which reflected their view on the effectiveness of BREEAM in the current environmental climate.

The following are, areas of exploration underlying the questions in the interviews: 1. Engagement and contribution of stakeholders towards addressing BREEAM 2. Compliance with BREEAM criteria 3. Implementation of BREEAM in healthcare Although interviews were semistructed, questions were asked based on the flow of the conversation, depending on the previous answer to allow for deeper insight and questioning the reasoning behind their views and opinions. This was done to make the interviewee feel comfortable and at ease, talking about their and the companyâ&#x20AC;&#x2122;s involvement in the design process. The views and opinions given are all their personal responses and provide first hand views on the subject. Therefore, the interviewees have asked to remain anonymous throughout the main body of this dissertation. These interviews lasted from twenty minutes to two hours taken as face to face interviews as well as one phone

2.2 Analysis of Findings

The interviews will be used to form theories and speculations based on the architects and consultant’s responses, along with qualitative reasoning using direct quotes given in the interviews and commonalities read through literature. The findings will present the main research questions, followed by the professionals’ responses, in understanding the central topic of conversation to conclude in each area of exploration. The interviews have been audio recorded and fully transcribed to provide accurate quotes from the interview and to avoid a personal interpretation or subjectivity of their words. These interviews don’t provide

full knowledge of the project or views of all members in the practice/project but just the interviewee’s involvement and their views of the project and process. From the literature review, the findings will be restricted to presenting the areas of exploration. The findings will analyse feedback from architects and consultants since they are largely concerned with creating design and energy strategies. These will be presented together since they both shared similar responses in many cases. Each quote will end with e.g. [1] showing this is from interviewee 1, (see fig.2)

BREEAM healthcare specific scheme, updates and developments to the New Construction schemes can be discussed. Fig. 3 shows the initial background information collected from the practiceâ&#x20AC;&#x2122;s personal website during the interview selection stage which aided the selection of the interviewees.

2.3 Case Studies

During the selection of the interviewees, BREEAM certified healthcare projects was an essential criterion as it would inform how BRREAM influenced the design decisions made, to be awarded credits in particular categories of the BREEAM scheme, declaring what makes nonBREEAM assessed hospitals different to BREEAM certified hospitals? The case studies chosen, presents a common denominator; all of the healthcare projects used BREEAM Healthcare 2008 and therefore uses the same BREEAM criteria which provides a control variable during the comparison study. For the reason that the projects use the first

Case Study

Houghton Le Spring Primary Care Centre

Elective Orthopaedics Theatres

BREEAM Scheme

Dumfries and Galloway Acute Mental Health Unit (Midpark Hospital) Healthcare 2008

Healthcare 2008

Certification Stage

Design/ Interim

Final

Design/Interim

BREEAM Rating

Excellent

Outstanding

Excellent

Score

74.3%

85.31%

78.81%

Client

NHS Dumfries & Galloway

NHS South of Tyne and Wear

Team member interviewed

Ryder Architecture

Yonder Consulting

Nottingham University Hospitals NHS Trust CPMG Architects

BREEAM Assessor

Ove Arup and Partners

___

Mark Pendry, Gleeds

Year of certification

2015

2012

2014

Key Features

- Natural ventilated windows, - Views out - Daylighting strategies - District energy system Low carbon distruct heating system - Low water use appliances

- Extensive consultation - Innovative thermal wall - Ground source heat pumps to deliver natural heat from the ground to the entire building - Excess heat transfer to adjacent sports centre - Solar panels to heat water - 96% of all construction waste redirected from landfill - Materials with low environmental impacts through their life cycle - Reduced light pollution - Installed renewables; photovoltaic panels, ground source heat pumps, wind turbine to generate electricity - Rain water harvestation - Exposed concrete soffits; naturally cooled at night using an innovative solution alongside infection control requirements

- Acoustic design - Carbon emissions reduction - Efficient water usage - Life cycle costing - Materials rated A+ or A - Site waste management plan - waste prevention - Land reuse - High Considerate Constructors Scheme performance

Fig.3 Case studies BREEAM features

[including] clients from day 1, users, consultants, builders, [and] everybody’s got to be involved from day. As architects, we get involved quite early on. Then everyone else that sort of joins in as well, we consult with the architectural liaison. We are involved in the whole process.’ [3]

Chapter 3 Findings

‘Hospital boards and trusts are usually experienced clients, so they will be experienced enough to say we want this particular project to meet a certain level. The process comes in from the client at a very early stage in the realm of healthcare. They [contractor] will agree to hit those minimum standards and its working with them to deliver that. So, it will be in the project brief, the brief that comes to us at a very early stage where that’s with the client and innovated over to the contractor, it’s just a continuous element.’ [1]

3.1 Engagement and contribution of stakeholders towards addressing BREEAM

i. Architects

Architects

were asked about their engagement in the BREEAM process. Contribution and involvement between project team members from an early stage allows for much greater, initial understanding of the client’s requirements and the analysis of the project and its context from the beginning with various team commitment.41 The responses given were quite positive to the fact that they acknowledged how the involvement of all stakeholders from an early stage would benefit in delivering the criteria. ‘For BREEAM to work, there’s got to be commitment from everybody

ii. Consultants With architects collaborating with clients and contractors as early as stage 0 of the RIBA Plan of Work,42 it was experienced by the consultant in previous projects that they would normally be involved at stage 2, which is about the latest stage they want to be involved at to be fully engaged with the design and project requirements. ‘We like to be involved as early as possible in the RIBA stages. Stage 1 is perfect, stage 2 is about the latest that is ideal. If we’re involved beyond that it can get a bit difficult. Stage 2 is when we would normally be involved if

we’re being engaged properly and at that stage, we do a pre-assessment and then into stage 4 we would do a design stage assessment and then a post construction assessment to hand over.’ [2]

As consultants can be BREEAM Assessors or Accredited professionals through training,43 they can aid the BREEAM pre-assessment stage to ensure the best energy strategy is recognised to establish and progress this design strategy into the interim stage of certification and the post construction stage certification. When asked how the engagement of consultants at an earlier stage would benefit the BREEAM process, the consultant felt BREEAM was supportive of the development of a sustainable project from its initial stages right through post construction, through the incorporation of different members of the project team from its early stages, as it allowed them to recognise the BREEAM process through experience, and determine the involvement of the right people at the right stages for a better outcome rating. ‘We went for years with design teams just feeling like it was a really difficult, awkward, extra task but now people are more familiar with what they need to deliver and how they need to deliver has become much easier.’ [2]

The consultant continued to explain how the implementation of

BREEAM, gathered stakeholders to collaborate and contemplate decisions antecedently and take preliminary measures to ensure all key stakeholders were integrated in the process to progress and establish the steps taken to present a sustainable project to the client effectively. ‘BREEAM has become a lot more effective because people think about these things early on, getting people engaged early on, and getting for example, the security consultant involved early, an architect would get straight on that now and do it rather than being asked post planning; have you done that, and they’ll [say]… I don’t know, we need to do that. Now they are a bit more aware. So, in that respect, it has become more effective when it’s managed well. I think it provides an easy, simple demonstration of sustainability to a client.’ [2]

Consultants were involved early on and the client’s requirements were analysed to make sure the consultants provided the right service and were committed to the required target. In anticipation, they tried to understood the brief; the authority’s requirements, policies, planning conditions, building context and so on. This contrasts with AlWaer, Sibley & Lewis, in that a stakeholder’s personal sustainability interests would affect the delivering of the client’s requirements;44 ‘They give us the brief, we will understand that in the context; if it’s client requirements, we’d sort of ask

and find out what their expectation are in terms of rating and time frames… [and] understand what the project’s desires were and what the budget was and try to understand in context and requirements and hopefully our services would reflect driving towards the requirement their after.’ [2]

3.2 Complying with BREEAM Assessing a building’s compliance with BREEAM criteria is undertaken at pre-assessment, design stage assessment and post construction assessment45 to identity improvements and recognise the approved working criteria. The consultant encourages projects to have licensed BREEAM Accredited Professional (AP)46 to assist the decision making during the design process when targeting and assessing BREEAM criteria. ‘We [consultants] would propose a scope of works and our proposal would include BREEAM preassessment at the design stage as supposed to construction stage. The Pre-assessment is sort of like scoping out our strategy design stage and

post construction and then going into a more formal assessment of those credits. [2] We’d encourage them to have a BREEAM accredited professional… being engaged with them and more support…making sure they’re making the right appointments. [2] With NHS projects, when they’re only producing something for OBC, it maybe that all they want is the preassessments to demonstrate that it’s not economically viable, sometimes that can be the case if it’s a small project in a difficult location, they would end up having to specify things that are a bit overkill for a small building.’ [2]

When complying with a BREEAM rated project, compared to a non-BREEAM rated project, the architects mentioned they had a system they followed to ensure the requirements were being fulfilled through BREEAM criteria. This statement differs from what Pan & Garmston concluded with the noncompliance in practice and a lack of knowledge and implementation.47 ‘There is an audible process in BREEAM...where we provide evidence to criteria, which is reviewed and verified by a BREAAM assessor. This collated information is then passed onto the BRE who then reviews all information and certify compliance or seek further confirmation.’ [3]

‘The decision to target a BREEAM rating is taken early on in a project’s lifecycle by the whole project team and in particular the client. A BREEAM tracker is prepared and reviewed and targeted so that the rating could be achieved, and this is then used to gain the points and… ultimately the rating.’ [1]

During BREEAM assessment, the evidence of decision making needed to be collated and passed onto the BRE to analyse what BREEAM rating is achieved. However, the design team found the collation of evidence demonstrating decision-making confusing, since they were unsure how these decisions needed to be documented and found themselves unnecessarily noting everything down to gain credits for something that had already been done. Therefore it became more of a checklist system rather than performance oriented. ‘I couldn’t think of any project that doesn’t make decisions based on resource efficiency. Even if we’ve not been involved in stage 0, 1 or stage 2, even stage 3, it doesn’t mean those decisions haven’t been made. The problem we have with BREEAM is we have to document that those decisions have been made so what we end up doing is documenting it retrospectively so we’re not actually making any positive impact on the project going forward by writing down what we’ve already done.’ [2]

The

consultant

would’ve

liked

BREEAM to outline what decisionmaking evidence is required and in what format, to reduce or even prevent the design team going back to redocument standard decisions. The credits given for the decision making should be better instructed by BREEAM and how it needs doing to make it less time consuming from the early stages, and prevent seeming like a task rather than genuine decision-making. Most of the time, the consultants suggested simple design options early in the design process such as the number of stories or the area of the layout; scoping options, as the type of decisions which happened very often in the design process but don’t get documented formally for BREEAM. ‘We can go back and demonstrate it but for the design team it’s just paperwork, it doesn’t actually change anything about the way they are doing these exercises.’ [2] ‘In BREEAM 2011, they were really or prior to that, very descriptive about what they wanted and they’ve moved away from that because they recognised that every project is different but I think they are running the risk of not being prescriptive enough and just getting paperwork done for the sake of it without any move or input to it, there could be a bigger focus on getting meaningful results out of the activities they want.’ [2]

The consultant mentioned, that it gets

difficult to keep track of all evidence, such as recording completed by the contractor, particularly when the law regarding the requirement of recording sheets (site waste management plan or resource management plan) changes to non-mandatory. It becomes difficult to collate all the evidence if not all stakeholders complete their part of the evidence if they aren’t inclined to do so. ‘What a construction site might typically do is monitoring transport records which can be a big exercise plan, so a lot of construction companies would monitor visitors to site, distance travelled for delivery of materials. So, BREEAM creates this extra paperwork.’ [2]

3.3 Effectiveness of BREEAM in Healthcare

BREEAM offers a fairly simple assessment method, following set guidelines within each criterion in various categories for credits to be awarded, in accordance to how it’s been targeted and how well the project has superseded the minimum points, resulting in the certification of a particular BREEAM rating. One of the architects, mentioned that BREEAM’s point system isn’t any different to other accreditation system and asks whether following this system and getting awarded a certificate at the

end is being sustainable or whether BREEAM should propose to be a continuous methodology stating why design strategies are done in a particular way and why they would claim to be sustainable; ‘a written justification rather than a tick box’, [1] which would allow a margin, open for interpretation. ‘I think what BREEAM tries to… eliminate that interpretation so that you design and construct the building in a certain way and the way the assessment happens is that you compile all the evidence for meeting the criteria.’ [3] ‘There are big points to score on reducing energy consumption and hospitals have a lot of kit, they have a very controlled environment, so they use a fair amount of energy… [what] we looked at, on early doors was to have as many points as possible because originally the intention was the baseline Very good but we’ll see if we can get to Excellent. One of the crucial things we met but couldn’t do it in the end was the energy performance [Midpark Hospital]. It’s effective enough to make you think, but there are some limitations of BREEAM as a quite generic standard, it is tailored to every specific type of building to new builds and extensions but it isn’t tailored to i.e. healthcare BREEAM certification.’ [1]

Easy credits can be gained elsewhere instead of targeting certain criteria under the Energy category of the

scheme document, which is why BREEAM sets up minimum number of credits needed to achieve certain BREEAM ratings to reduce the chances of the assessment system being cheated. For example, 5-7 cred its achieve BREEAM Excellent, 8-11 credits gain Outstanding and 12 credits gains the project BREEAM Net Zero carbon emissions.48 This demonstrates compliance within Ene 01 Energy Efficiency category, which surpassed the national building regulation level. These minimum standards in other categories become difficult for healthcare projects which have different requirements and cater towards the needs of the patients, where the minimum credit requirements are questioned and dealt with alongside the BREEAM licensed professional. Schweber stated ‘many BREEAM credits are over-determined in the sense that they simultaneously meet BREEAM requirements and respond to other demands such as building codes, planning requirements, client demands and personal commitment of project team members.’49 ‘ …a lot of buildings have extra facilities like showers and bicycle stalls and to get the points, you increase the number of them. In healthcare, you can provide a certain amount of bicycle parking and staff will have shower facilities but you’re not going to provide that for outpatient visitors and it’s unlikely that people are going to cycle to hospital if there is seriously wrong with them, there are limitations again that BREEAM doesn’t take into

account so you kind of have to drop them and say we’re not likely to meet those levels based on the occupancy of the building because it’s a very specific function that you’re using.’ [1]

Another architect made a similar claim that BREEAM aren’t really relevant to a specific building type and provide no flexibility in discussing the changes to apply for healthcare project; nor is there any specific building typologies such as operating theatres, hospital wards or A&E departments. Hospitals are very highly controlled environments which need to be operable 24/7 and maintained regularly. Hospitals cannot fall back on generators and therefore makes it difficult to create energy efficient solutions. ‘Some of the criteria are irrelevant and you can argue that now, you lose the points. It is not up for negotiations. I know BREEAM has typologies but I think they are virtually the same and there’s no flexibility within them. They should make each project bespoke. So, if you’re doing a hospital, and there aren’t any transport links, and everybody’s going to come by bus then it’s not achievable because getting a bus route into there, it’s going to cost millions of pounds every year. The cost outweighs the benefits.’ [3]

Since the UK health authorities now ask for a BREEAM assessment; during the tendering process, the contractor will take on further precautions to meet the requirements and they will equate that to cost, which means the

building will be more expensive than the tendering price. The design team will create efficient design strategies working with the consultant and BREEAM assessor, but generally a BREEAM project will cost more as certain targets are set outside a defined requirement and budget. ‘Future hospital projects will be more expensive in order to meet those levels unless the contractors are good enough to find methodologies to save money elsewhere.’ [1]

This makes it difficult to target most criteria in the fundamental categories such as Energy, and design teams are picking the most easily rewarded criteria, explaining why two BREEAM Excellent building are not the same, since they may have been given points in different categories. Does this make it a sustainable building? In many cases, cost effective design options are prioritised. ‘OBC have requirements for the NHS, [which]… only require the preassessment. If that’s all they require then there is no one asking for anything, [therefore] it’s sort of ‘if we haven’t been asked it, then why would we do it’… A lot of these projects have quite a tight budget and BREEAM is an additional cost. Just the assessment cost might be too much for them. If they’ve got a change in specification. A lot of people are just not interested…’ [2]

With

BREEAM

New

Construction

2018 being released; the consultant hoped to see improvements in certain sections of the scheme document, after being addressed during a 2018 BREEAM consultation. ‘…there’s been a few changes but it’s a bit disappointing that some of them were thought to be very significant but they don’t seem to be really significant. BREEAM should be driving improvements but perhaps aren’t fast enough at doing it or consult with enough or the right people.’ [2]

Even though many more improvements and changes were discussed during this major consultation process, the consultant felt that BREEAM was unable to address them all. Yet the BRE only made small improvements during the lengthy duration of the consultation to what they thought were significant issues, particularly the Energy category in the scheme document, which shows, that the assessment method and calculation process may need configuration since a number of the professionals that were interviewed mentioned loopholes or gaps in the criteria assessment system. ‘The improvements that I would make; starting off with one of our biggest credits that we have problems with, there are a lot of loopholes in the Energy 1 credit, and a lot of ways to manipulate what we want out of it.’ [2] ‘BREEAM sets out in those themes and chapters what it wants you to do,

so you just take that on board and see how you can manage that so in order to get the lowest points in energy.’ [1] ‘…they rely on this methodology; NCM, (National Calculation Method), …a result can be manipulated, so if something’s going to be Excellent they have to get a certain number of credits and they have a specified system and if it’s not coming out with enough credits, it’s not necessary that you have to advise a new system to be used and that can be a very expensive option so it’s not always viable but you may be looking at the modelling and looking at what inputs we’ve made and how that can be improved. Energy 1 will be better to have their own process of the way they look at reducing C02 rather than replying NCM methodology.’ [2]

The architect suggested though there were fewer major improvements in the 2018 scheme, a couple of good moves were made with the transport and ecology. ‘…Previously you use to get penalised if you were in a rural area and had no bus services, no amenities, you’re probably busy on weekdays so technically you would get penalised on ecology and your site performance would be rated poorly but it doesn’t necessarily mean that that site is unsustainable and its sort of on the wider planning strategies and in the new BREEAM 2018, they’ve taken a view of not what the site actually is, but the potential for the site is and how they would address it. So, ecology isn’t

just about what’s already there but instead …you’ve been scored on what you’re doing over and above that or to make up for what you’re losing and the focuses on that rather than just being scored for taking a greenfield site. Same for transport, you don’t get penalised for having poor bus services because you can’t do anything about that. Instead what you’re awarded for now is by looking at what will benefit the site and getting scored accordingly. So, you still get points for having good amenities but it’s more about… the transport planner will be there to advise what would benefit the site and if that was an electrical vehicle, charging points would have to be something we’d look at putting in, so they’re relying on consultants providing advice to improve the site rather than just penalising it for what it already is inherently.’ [1]

The new scheme document has altered the process of selecting materials and achieving credits by introducing the Life cycle assessment, in the Materials category (Mat 01).50 As explained by the consultant, life cycle assessment (LCA) is a review of twhe life cycle impacts of materials from an environmental and social point of view. It uses a similar material selection spreadsheet to the Green Guide but rather than analysing every element and generating a rating, the LCA uses a database called Impact, which has been collated by the BRE, as another decision-making tool. This method encourages ‘consideration of

impacts during manufacture, design, procurement, installation, in-use and end-of-life.’51 ‘The BRE are moving towards using this life cycle assessment rather than the Green Guide as its more accurate and more specific. It’s another paid service and what they want you to do is to start using this early. That’s one good change they’ve done but the problem is that they’ve done it quite complex, it’s quite an expensive service for a smaller project. It’s just a bit unfair really. If you’ve got a very simple building, it doesn’t take a formal exercise to determine that one product is better than the other environmentally so to some extent it’s overkill and there sometimes needs to be a bit of flexibility with that sort of arrangement. They do have a second scheme for simple buildings but not many buildings fit into it so we’ve never used it here just because we generally have some sort of renewable and if that’s the case, we generally can’t do that sort of building.’ [2]

Fig.4 Houghton Le Spring Primary Care Centre

Fig.5 Interior, open plan space, displaying the thermal wall,left (painted in white)

Chapter 4 BREEAM Certified Healthcare Projects

4.1 Houghton Le Spring Primary Care Centre

Willmott Dixon, the contractors who have been carbon neutral since 2012, said the highlight of the building (fig.4) was the extensive stakeholder consultation events to plan the design of the building;52 discussing plans with the local community. Thus, enabling them to engage and contribute their thoughts into the conversation. Willmott Dixon’s commitment towards reducing their carbon footprint and carbon emissions from business growth and maintaining carbon neutrality, has expedited the project to BREEAM Outstanding with the collaboration of stakeholders sharing the similar philosophies and interests, alongside encouraging other stakeholders to drive their emissions down. Willmott Dixon have completed over a hundred healthcare projects; upgrading acute mental health and community care facilities with a few BREEAM certified projects. In regards to Willmott Dixon, the consultant expressed that… ‘BREEAM brings collaboration between energy and architecture to… get them thinking about the impact they have on each other.’ [2] ‘The client for Houghton Le Spring was driven for sustainability, he wanted something that would last in the future; that was exceptional and something that stood out and was a ground breaker, so that’s why they wanted to push for BREEAM Outstanding. He had a comfortable budget which also

helped. In selecting methodologies, NHS have selected BREAAM as a sustainability standard. It is the trusts and clients’ decision to pursue that further.’ [2]

The client had established two challenges; the first to maintain an interior temperature below 25oC and secondly to provide a low carbon solution. This was solved through a 50m long thermal wall; designed by Breathing Buildings (engineering consultancy) and awarded the BREEAM innovation credit due to its unique design and low energy usage. The thermal wall was created as a way to provide ventilation to the consulting rooms and the open plan waiting area inside; highlighted in red.53 (fig.8) During the summer, (fig.6) the thermal wall passively cools the incoming air by directing the cold air at night, through cooled shafts in the wall to decrease the warmer, outside temperature. This colder air is brought in the next day.54 In the winter, (fig.7) breathing buildings designed a mixing ventilation strategy using their unique e-stack units, which involves the cold air from the outside diluted with the interior warm air in the building before it spreads towards the occupants. 55

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CIBSE North East Building Services Best Practice

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For More Info

and is mixed with warm interior air 1. The thermal wall is closed Controlled Controlledmixing mixingventilation ventilationavoids avoidscold colddraughts draughts led mixing ventilation avoids cold draughts 3. Warm mixed air enters the space Recycling heat Recyclingheat heatfrom fromthe thebuilding buildingreduces reducesthe theamount amountofofadditional additional heatrequired required www.breathingbuildings.co.uk 2. Cold outside air enters the building ng heat from the building reduces the amount of additional heat required 4. Air with exitswarm the space at high-level and is mixed interior air

2012

stainability

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Terminal Wall Awards for Houghton www.breathingbuildings.co.uk www.breathingbuildings.co.uk Primarywww.breathingbuildings.co.uk Care Controlled Centre mixing ventilation avoids cold draughts 3. Warm mixed air enters the space

Breathing Buildings The Courtyard, 15 Sturton Street, Cambridge CB1 2SN

Open Plan Area

4. Air exits the space at high-level

Reproduced with permission Recycling heat from the building reduces the amount of additional heat required from P&HS architects.

BREEAM Awards Controlled 2012 mixing ventilation avoids cold draughts

Breathing Buildings Ltd. Reg Registered Office: The Court

www.breathingbuildings.co.uk Recycling heat from the building reduces the amount of additional heat required

Healthcare Fig.8 Plan of Houghton Le Spring, indicating the thermal wall

Open Plan Area

www.breathingbuildings.co.uk

For More Information Contact Breathing Buildings at: The Legacy Award Sustainability Construction Excellent 2012

CIBSE North East Building Services

Breathing Buildings Best Practice The Courtyard, 15 Sturton Street, Cambridge CB1 2SN

Reproduced with perm from P&HS architects.

Reproduced with permission from P&HS architects.

Tel:

+44 (0) 1223 450 060

(0) 1223 450 061 For Fax: More+44 Information Contact Breathing Building Email: info@breathingbuildings.com Web: www.breathingbuildings.com

Breathing Buildings The Courtyard, Breathing Buildings Ltd. Registered in England and Wales. 15 Sturton Street, Cambridge 2SN No. 05676785 Registered Office: The Courtyard, 15 Sturton Street, Cambridge, CB1 2SN.CB1 Registered

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Breathing Buildings Ltd. Registered in England and Wales. Registered Office: The Courtyard, 15 Sturton Street, Cambridge, CB1 2SN. Registered No. 05676785

efficient, environmentally sound and contemplate materials to facilitate the reduction of carbon emissions. Furthermore, they stated that designing buildings in terms of sustainability was ‘not just a specific BREEAM thing, but more of a culture of having buildings that met the target of sustainability, with less energy consumption than buildings from ten… thirty years ago, just as a standard.’ [1]

4.2 Dumfries and Galloway Acute Mental Health Unit (Midpark Hospital)

Dumfries and Galloway Council outlined their carbon management programme for key projects to reduce ‘energy consumption in buildings, transport and waste to a service level to improve responsibility and accountability and thus improve carbon emissions reduction.’56 In that respect, the architect prioritised this target to narrate a low carbon design strategy. With experience in BREEAM, in account of Ryder Architecture, the interviewed architect reciprocated that BREEAM was not just used as an end assessment tool, but as an encompassing strategy, where the general sustainable considerations of the building should be energy

Therefore making it evident that architects aren’t just designing buildings to be awarded a certification, but are comprehending the effects of carbon emissions that buildings have to manifest these solutions into future developments. This statement corresponded with how the BRE defined BREEAM; a process to engage with stakeholders in recognising the future of buildings and providing a method to acknowledge and insinuate new manner of thinking. Initially at interim stage, the hospital (fig. 9) was designed to have innovative features; unique anti-ligature windows which reduce the risk of harm for patients, while augmenting patient areas to have natural ventilation.57 (fig.10) They also integrated wind catchers to reduce carbon emissions internally.58 Low water-use appliances were installed such as lower flush rates in toilets, and water sub-metering.59 However, BREEAM also posed difficulties in meeting particular

Fig.9 Dumfries and Galloway Acute Mental Health Unit, exterior

Fig.10 Internally daylit Communal space

criteria associating to healthcare, and in this case, it was the biomass fuelled energy system, used for heating and domestic hot water production. When asked why, the architect responded with… ‘…crucial things we met but couldn’t do it in the end was the energy performance. In order to hit the energy, we would’ve had to go to something like a biomass generator; burning wood chips and pellets but it would have to burn so many pellets, they would have to take deliveries of 14m long trailer trucks of pellets every week or so and if that didn’t happen, you would have to fall back on your backup of diesel generators which you can’t/ don’t want to do that, there’s too much of a risk for a hospital to keep services so you don’t want to be falling onto your backup power in the middle of operations or acute clinical procedures. A&E’s don’t want to find themselves using backup power because it will affect the efficiency and how they’re run. So, the decision was made, no we’re going to stick to macro gas boilers, but you lose points there.’ [1]

4.3 Elective Orthopaedic Theatres

Fig.11 Elective Orthopaedic Theatres

Speaking to the architect of CPMG Architects, their ideology is ‘ensuring sustainability is at the heart of our architecture projects’ and articulated ‘in order to create truly sustainable and low-energy buildings, the key principles should be established at inception’. The architect stated that BREEAM was looked into, after the minimum building regulations had been met, to update and increase that minimum benchmark. The architect then depicted that…

manufactured in Holland, so it’s quite carefully so when selecting, one it meets the client’s requirements for hospitals, and you’ve met the insulation requirements and the sourcing requirements.’ [3]

‘… it’s a very… high functional and highly technical building (fig. 11) so it might not look great from the outside but internally it’s quite complicated. We have to think about fabric first principles, which we do anyway at the baseline in the practice, all of our thermal U-values for example are all 25%, higher than the minimum building regulations standard, [and] that’s before we even look at BREEAM and that’s our practice standard, [and] minimum benchmark…Then you look at BREEAM. …any material we select internally is designed to be tested against BREEAM… so we understand the reciting nature which is choosing materials carefully and all that little stuff. So, it’s all recyclable stuff, the doors are essentially certified. Economically, sourcing local materials, that was one of our criteria’s, so for example, a cladding panel we chose was the Eurobond, was manufactured in the UK. [3]

It can be argued that although architects and consultants might consider aesthetics as secondary to energy, Houghton Le Spring demonstrates that both can be simultaneously achieved.

‘...cladding

panels

are

often

‘It’s a fairly heavily air-conditioned… controlled environment. So, to design an air-conditioned environment, all the air conditioning units, all of the materials had a high spec and highly rated and efficient.’ [3]

Conclusion

Beginning with the analysis of literature and identifying what previous researchers concluded, the areas of exploration were identified to further research into and established the need for personal feedback from stakeholders greatly involved in the design process integrating BREEAM. The choice of elite interviewing was crucial in gathering relevant, detailed, first-hand feedback in demonstrating how an environmental assessment method is working on practice, as it’s continuously developing. Alongside the internal workings of BREEAM and identifying how architects and consultants were engaged with BREEAM, and in conjunction with how

BREEAM was encouraging them to create low carbon design strategies to convey their understanding of the built environment’s effect on the reduction of carbon emissions particularly with healthcare. The interview findings iterated what was discussed in the literature review, while new findings and perspectives were discovered; 1. Architects and consultant highlighting the early engagement and commitment of all stakeholders allowed for client requirements to be completely understood to provide better services and a fundamental driver. 2. The positive impact of an early involvement of stakeholders being efficient in the decision-making process. 3. The consultant’s strong opinions on the unnecessary evidence required to demonstrate standard decisionmaking. 4. Loopholes created in the selection of targeting ‘easy’ criteria within the larger, significant categories such as Energy performance being less addressed and the manipulation of results. 5. Less relevant criteria and considerations made for healthcare building type. 6. The BREEAM 2018 New Construction scheme exhibiting advanced methods of selecting materials with the life cycle assessment and solving previous problems, with existing transport and ecology site context.

When asked the consultant on their views on the possibility of low or net zero carbon healthcare concepts in the future, they said it all falls down to cost. Therefore, prompting the question “is the cost of sustainability too high?” Anything is always possible but… [it] depends on how much it costs. If so, is it viable? [That’s] another thing. I think it’s a great move and great target, it fits in with the policy background of where we’re going as a country. It is becoming easier? Yes, I think people are learning more, understanding more about products and energy. Is it a reality financially yet? No, probably not. I think there has been progress [though] and innovative technologies are being used. Whether they’re being used large enough or fast enough, probably not, but this is where BREEAM can come in to incentivise that a bit more. [2] You come to a point where you need to start to look at the credit strategy and working out what credits would be cost effective, desirable within design and realistic in terms of time do to them and the work required by the design team. [2]

When asked whether BREEAM was encouraging hospitals in the future to be low carbon, the architect responded with; I wouldn’t say BREEAM is a driver towards low carbon energy, it’s kind of

an add on, an extra because building regulations and planning approvals are already starting or have been taking on energy performance making sure building going forward are hitting minimum standards in terms of air tightness and daylight factors and u-values. [1]

While mentioning that BREEAM at present, still doesn’t completely take into account the wide range of healthcare building types with their complex functions and requirements, future consultations need to take this into account and possibly consider a varied course of action or set of criteria which is Healthcare specific. While this dissertation helps to provide first-hand feedback from current users and suggest improvements in BREEAM healthcare, future researchers could attempt to identify specific criteria or a course of action to be taken in order to continue reducing carbon emissions in healthcare using BREEAM, in addition to revising ways in which BREEAM can act as a catalyst to stimulate progression and innovative technologies in creating low or net zero carbon energy healthcare at lower costs.

Appendix A: Interview Questions: 1. Introductory questions to acknowledge their current understanding of BREEAM: i. What does BREEAM mean to you? ii. What do you think the main driver for selecting BREEAM is? iii. In the selection of sustainable building assessment methodologies, why and how do you choose to apply for BREEAM Certification? Where in the building process? iv. What is the assessment process of BREEAM? v. How do you respond to clients and constructors regarding project briefs?

2. Effectiveness of BREEAM: i. Has BREEAM improved the performance of new and refurbished buildings? ii. How does it affect or influence the design, planning and construction process? iii. How does BREEAM Certification value a building socially, personally and economically? iv. How do you think sustainable building design impacts the need and aspirations of building users? v. Do you think BREEAM certification is effective? Any improvements to the certification or assessment method?

3. BREEAM Healthcare specific: i. Why is there a lack of BREEAM certified healthcare buildings? ii. In the UK, all health authorities require â&#x20AC;&#x2DC;BREEAM Excellent for new buildings and Very Good for refurbishment, subject to certain capital cost thresholdsâ&#x20AC;&#x2122;, how has this requirement affected their take on future healthcare projects? iii. Why do you think clients or the NHS for example, ask for a BREEAM rating? What are they trying to gain or prove with a BREEAM rating? iv. What makes non-BREEAM certified hospitals different to BREEAM certified hospitals? v. How do you aim to address the following BREEAM categories; Energy, Health and Wellbeing, Innovation, Land Use, Materials, Management, Pollution, Transport, Waste and Water in a healthcare project?

4. Compliance with BREEAM: i. What do you do differently when complying with a BREEAM rated project that is different to a non-BREEAM project? Do you follow a specific system or set of steps for

your practice? ii. How do you know you have complied with BREEAM? iii. What do you do specifically if a project doesnâ&#x20AC;&#x2122;t comply with the target BREEAM rating? How do you decide what aspect of the project you change if so?

5. Views on low/ zero carbon Healthcare: i. What are your views on low or Net Carbon energy building concepts and energy strategies? Are they possible for Healthcare buildings? ii. How do you think BREEAM will impact low and zero carbon buildings? Is the consideration of sustainable hospitals positively influencing a step towards low or zero carbon hospitals?

Endnotes 1

Committee on climate change, Carbon budgets: how we monitor emissions targets <https://

www.theccc.org.uk/tackling-climate-change/reducing-carbon-emissions/carbon-budgets-andtargets/> [accessed 23 December 2018] 2

BRE Group, About us (2018) <https://bregroup.com/about-us> [accessed 03 October 2018]

BRE Group, BREEAM (2018) <https://bregroup.com/products/breeam/> [accessed 03

October 2018] 4

BRE Group, BREEAM Healthcare FAQs (2013) <https://tools.breeam.com/filelibrary/KN5253_

BREEAM_Healthcare_FAQs.pdf> [accessed 03 October 2018] Tom Taylor, Briefing Paper: Assessing Carbon Emissions in BREEAM (2015) <https://tools.

breeam.com/filelibrary/Briefing%20Papers/Assessing-Carbon-Emissions-in-BREEAM-Dec-2015-.pdf> [accessed 05 October 2018] p.2 James Parker, The Value of BREEAM (2012) <https://tools.breeam.com/filelibrary/

BREEAM%20and%20Value/The_Value_of_BREEAM.pdf> [accessed 12 November 2018] Alan Yates, BREEAM – An Environmental Ratings Methodology (2018) <http://projects.bre.

co.uk/epbd/pdf/AlanYates.pdf> [accessed 08 October 2018] Tom Taylor, Briefing Paper: Assessing Carbon Emissions in BREEAM (2015) <https://tools.

breeam.com/filelibrary/Briefing%20Papers/Assessing-Carbon-Emissions-in-BREEAM-Dec-2015-.pdf> [accessed 03 October 2018] p.2 9

Ibid,. p.2

10 11

Ibid,. p.2 Department of Finance, Sustainability Action Plan (2012 - 2015) (2011) <https://www.

finance-ni.gov.uk/sites/default/files/publications/dfp/sustainability-action-plan-2012-2015. pdf> [accessed 11 October 2018] p.6 12

Ibid., p.3

Ibid., p.6

Tom Taylor, Briefing Paper: Assessing Carbon Emissions in BREEAM (2015) <https://

tools.breeam.com/filelibrary/Briefing%20Papers/Assessing-Carbon-Emissions-in-BREEAM-Dec-2015-.pdf> [accessed 06 October 2018] p.2 15 16

Ibid., p.2 BRE Group, BREEAM Healthcare FAQs (2013) <https://tools.breeam.com/filelibrary/

KN5253_BREEAM_Healthcare_FAQs.pdf> [accessed 03 October 2018].p.1 17 18

Ibid., p.4 Tom Taylor, Briefing Paper: Assessing Carbon Emissions in BREEAM (2015) <https://

tools.breeam.com/filelibrary/Briefing%20Papers/Assessing-Carbon-Emissions-in-BREEAM-Dec-2015-.pdf> [accessed 09 October 2018] p.2 19

Ibid., p.2

Wim Lambrechts, Cees J. Gelderman, Janjaap Semeijn & Elles Verhoeven, The role of individual

sustainability competences in eco-design building projects (2018) <https://doi.org/10.1016/j. jclepro.2018.10.08> [accessed 17 January 2018] p.1631 21

Josefin Wangel, Marita Wallhagen, Tove Malmqvist & Göran Finnveden, Certification

systems for sustainable neighbourhoods: What do they really certify? (2015) <http://dx.doi. org/10.1016/j.eiar.2015.10.003> [accessed 17 January 2019] p.210 22

Josefin Wangel, Marita Wallhagen, Tove Malmqvist & Göran Finnveden, Certification

systems for sustainable neighbourhoods: What do they really certify? (2015) <http://dx.doi. org/10.1016/j.eiar.2015.10.003> [accessed 17 January 2019] p.207 23

BRE Group, The World’s Foremost Environmental Assessment Method and Rating System for

Buildings (2011) <https://tools.breeam.com/filelibrary/BREEAM_Brochure.pdf> [accessed 22 October 2018] p.2 24

Ibid., p.2

BRE Group, The World’s Foremost Environmental Assessment Method and Rating System for

Buildings (2011) <https://tools.breeam.com/filelibrary/BREEAM_Brochure.pdf> [accessed 15 January 2019] p.2 26

Wei Pan & Helen Garmston, Building regulations in energy efficiency: Compliance in England

and Wales. (2012) <https://doi.org/10.1016/j.proenv.2017.03.135> [accessed 17 January 2019] p.604 27

H.Alwaer, M.Sibley & J. Lewis, Different Stakeholder Perceptions of Sustainability Assessment

(2011) <https://doi.org/10.3763/asre.2008.5107> [accessed 17 January 2019] p. 48 -59 28

Álvaro Enríquez-de-Salamanca, Stakeholders’ manipulation of Environmental Impact

Assessment (2017) <http://dx.doi.org/10.1016/j.eiar.2017.10.003> [accessed 18 January 2019] p.12 29

BRE Group, How to obtain a BREEAM Rating (BREEAM UK). New Construction Technical

Manual SD 5073 (2011) <https://tools.breeam.com/filelibrary/How_to_get_a_BREEAM_ assessment_(with_links).pdf> [accessed 17 December 2018] 30

Libby

Schweber

assessment

and

Hasan

design

Haroglu,

processes

Comparing (2014)

the

fit

between

BREEAM

<https://www.tandfonline.com/doi/

pdf/10.1080/09613218.2014.889490?needAccess=true> [accessed 03 January 2019] p.302 31

Hans Wiesmeth, Stakeholder engagement for environmental innovations (2018) <https://

doi.org/10.1016/j.jbusres.2018.12.054> [accessed 17 January 2019] p.1 32

Tommaso Pucci, Elena Casprini, Antonino & Lorenzo Zanni, The virtuous cycle of stakeholder

engagement in developing a sustainability culture: Salcheto winery (2018) <https://www.sciencedirect.com/science/article/pii/S0148296318305605> [accessed 18 January 2019] 33

Milena Stevanovica, Karen Allackera & Stéphane Vermeulen, Hospital Building Sustainability:

the Experience in using Qualitative Tools and Steps Towards the Life Cycle Approach (2017) [accessed 17 January 2019] p.450 34

Neveen Hamza & David Greenwood, Energy conservation regulations: Impacts on design and

procurement of low energy buildings (2008) <doi:10.1016/j.buildenv.2008.06.010> [accessed 16 January 2019] p.932 35

Libby

assessment

Schweber and

Hasan

design

Haroglu,

processes

Comparing (2014)

the

fit

between

BREEAM

<https://www.tandfonline.com/doi/

pdf/10.1080/09613218.2014.889490?needAccess=true> [accessed 03 January 2019]

Milena Stevanovica, Karen Allackera & StĂŠphane Vermeulen, Hospital Building Sustainability:

the Experience in using Qualitative Tools and Steps Towards the Life Cycle Approach (2017) <https://doi.org/10.1016/j.proenv.2017.03.135> [accessed 17 January 2019] 37

Ibid,.

Hans Wiesmeth, Stakeholder engagement for environmental innovations (2018) <https://

doi.org/10.1016/j.jbusres.2018.12.054> [accessed 17 January 2019] 39

Libby

Schweber

assessment

and

Hasan

design

Haroglu,

processes

Comparing (2014)

the

fit

between

BREEAM

<https://www.tandfonline.com/doi/

pdf/10.1080/09613218.2014.889490?needAccess=true> [accessed 03 January 2019] 40

RIBA, RIBA Plan of Work 2013 Overview (2013) <https://www.architecture.com/-/media/

gathercontent/riba-plan-of-work/additional-documents/ribaplanofwork2013overviewfinalpdf. pdf> [accessed 16 January 2019] 41

Libby

Schweber

assessment

and

Hasan

design

Haroglu,

processes

Comparing (2014)

the

fit

between

BREEAM

<https://www.tandfonline.com/doi/

pdf/10.1080/09613218.2014.889490?needAccess=true> [accessed 03 January 2019] 42

RIBA, RIBA Plan of Work 2013 Overview (2013) <https://www.architecture.com/-/media/

gathercontent/riba-plan-of-work/additional-documents/ribaplanofwork2013overviewfinalpdf. pdf> [accessed 15 January 2019] 43

GreenBook Live, BREEAM Assessors (2019) <http://www.greenbooklive.com/search/

scheme.jsp?id=214> [accessed 16 January 2019] 44

H.Alwaer, M.Sibley & J. Lewis, Different Stakeholder Perceptions of Sustainability Assessment

(2011) <https://doi.org/10.3763/asre.2008.5107> [accessed 17 January 2019] 45

BRE Group, How to get a BREEAM Assessment <https://tools.breeam.com/filelibrary/How_

to_get_a_BREEAM_assessment_(with_links).pdf> [accessed 30 December 2018] 46

BRE Group, Explore BREEAM https://tools.breeam.com/projects/explore/companies.jsp

[accessed 23 December 2018] 47

Wei Pan & Helen Garmston, Building regulations in energy efficiency: Compliance in England

and Wales (2012) <https://doi.org/10.1016/j.proenv.2017.03.135> [accessed 18 January 2019] 48

BRE Group, BREEAM New Construction Technical Manual SD 5076 (2014) <https://tools.

breeam.com/filelibrary/BREEAM%20UK%20NC%202014%20Resources/SD5076_DRAFT_ BREEAM_UK_New_Construction_2014_Technical_Manual_ISSUE_0.1.pdf>

[accessed

November 2018] 49

Libby

Schweber,

construction

The

professionals

effect

(2013)

BREEAM

clients

and

<https://www.tandfonline.com/

doifull/10.1080/09613218.2013.768495?scroll=top&needAccess=true

[accessed

January 2019] 50

BRE Group, SD5078 Draft UK NC 2018 manual (2018) [ONLINE] <https://tools.breeam.

com/filelibrary/Consultations/SD5078_DRAFT-UK_nondom_NC_2018-manual.pdf> [accessed 03 January 2019] 51

Ibid.,

Willmott Dixon, Houghton Le Spring Primary Care Centre (2019) <https://www.willmottdixon.

co.uk/projects/houghton-le-spring-urgent-primary-care-centre> [accessed 03 January 2019]. 53

Breathing Buildings, Case Study- Houghton-Le-Spring Primary Care Centre (2012) <https://

www.breathingbuildings.com/wp-content/uploads/2016/06/houghton-pcc-case-study.pdf> [accessed 09 January 2019] p.1 54

Ibid., p.2

Dumfries and Galloway Council, Carbon Management Plan 2 (CMP2) and Climate Change

Action Plan (2014) <http://www.dumgal.gov.uk/media/20058/Carbon-Management-Plan/ pdf/Carbon_Management_Plan.pdf> [accessed 30 December 2018] 57

BREEAM, Dumfries and Galloway Acute Mental Health Unit (Midpark Hospital) (2018)

<https://www.breeam.com/case-studies/healthcare/dumfries-and-galloway-acute-mentalhealth-unit-midpark-hospital/> [accessed 01 December 2018] 58

Laing O’Rourke, Midpark Hospital named UK’s most sustainable healthcare buildings –

BREEAM (2015) <https://www.frameworks-scotland2.scot.nhs.uk/midpark-hospital-nameduks-most-sustainable-healthcare-building-breeam/> [accessed 15 January 2019] 59

BREEAM, Dumfries and Galloway Acute Mental Health Unit (Midpark Hospital) (2018)

<https://www.breeam.com/case-studies/healthcare/dumfries-and-galloway-acute-mentalhealth-unit-midpark-hospital/> [accessed 01 December 2018] 60

CPMG Architects, Architecture (2019) <https://www.cpmg-architects.com/architecture>

[accessed 10 January 2019].

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