Climate proof design

Delivering safe and technical facilities to give healthcare a cooler future will save lives say Padraig McMorrow, Associate Manager, Architecture, and Andrew Street, Studio Principal, Architecture, Arcadis IBI Group

The 2022 global heatwave, where temperatures hit a record 40 degrees in the UK, highlighted the serious risks to the UK’s most vulnerable and particularly to those recovering in healthcare facilities. As the country hit boiling point and a nationwide drought was declared, healthcare sta worked around the clock to keep people as comfortable as possible, and ultimately, alive.

Simply put, patients need to be kept in an environment with a cool and stable temperature for their safety and comfort. Ideally, this would be in a sealed, airconditioned space; however, this is an energy-intensive strategy that doesn’t necessarily aid recovery.

In addition, multiple highly specialised technological considerations, both for patients and healthcare professionals, add to the challenge of designing healthcare facilities. These technical requirements vary as buildings are designed for di erent clinical and operational services, specialist equipment, workplace and therapeutic requirements, patient comfort, and high-risk and secure unit considerations.

The question is: how can we deliver safe and highly technical healthcare facilities for the good of patients and the planet? And can architects design buildings that actively contribute to patient recovery?

How a building promotes health benefits can range from individual to individual. But what’s best for the patient experience isn’t necessarily optimal for building e iciency. Examples include operable windows and highly e icient air ventilation needed by healthcare buildings, which leads to higher energy use relative to residential environments. These are key factors a ecting the operational energy cost of healthcare estates.

Climate change and the impact on healthcare environments

Most healthcare buildings require air conditioning to deal with our increasingly extreme climate.

Where indoor ambient temperatures exceed 26˚C, a risk assessment is carried out and action is taken to keep vulnerable patients safe. The UK’s Chartered Institute of Building Services Engineers (CIBSE) Technical Memorandum 52 requirements dictate that building design must maintain a stable temperature and avoid overheating.

According to National World, the latest figures for 2020/21 published by NHS Digital “show more than 4,100 overheating incidents were recorded across 104 NHS Trusts – the second highest since current records began.”

To reach operational carbon targets developed by a range of built environment organisations including Royal Institute of British Architects (RIBA)photovoltaic, London Energy Transformation Initiative (LETI), and World Green Building Council, we must design buildings optimally to limit how o en energy-intensive air conditioning systems operate. At the risk of worsening already volatile conditions, a combination of poor environmental management with energy-intensive mechanical systems fitted to ine icient buildings is simply not an option.

While variances in thermal comfort can negatively a ect anxiety, mental health and stress, so too would recovering in environments with insu icient daylight or operable windows. Studies show that a connection to nature and a sense of control over our environment benefits health and recovery—even if it’s only perceived.

It makes sense then that hospital rooms enabling patients to view green space and open windows could help them recover more e ectively. The window becomes ‘therapeutic’.

Energy demands rise

Arcadis IBI Group (Arcadis IBI) leads healthcare building design across 60 global studios, including healthcare buildings operating year-round in some of the hottest and most extreme climates in the world.

Cooling energy consumption for these spaces is rising, and 2021 saw the largest annual increase in demand of the past decade. Energy demand for space cooling has increased at an average pace of 4 per cent per year since 2000, twice as quickly as for lighting or water heating. Higher energy consumption for cooling a ects peak electricity demand, especially during hot days when equipment is operating at full capacity.

Building orientation and window shading are the two primary techniques we use to reduce the load on a building’s mechanical systems. Reducing the building’s space cooling energy demand is our first step in decarbonising any building in a hot climate. Additionally, we apply Passive House solar design principles to reduce the risk of overheating and limit unwanted solar gains reaching glazed building surfaces.

Engrained in the architectural design of healthcare buildings from inception are optimum window size and location, room programming and building operations.

Avoiding added costs

By identifying key design parameters, which can reduce unwanted heat gains in early design stages, we can avoid added costs at later design stages. We also can incorporate more decarbonisation parameters, including photovoltaic panel space allocation to generate maximum renewable energy for cooling. Energy recovery through mechanical ventilation allows us to transfer cooling energy from exhaust air to incoming warmer air. The same principle is used in cold climates to retain heating energy. By building to Passive House standard, we can drastically reduce the cooling energy requirements in hot climates with high insulation and airtightness levels. Conversely, Arcadis IBI have significant experience building to international

Passive House standard in heatingdominated, colder climates of Canada.

By applying these high-performance building techniques to hotter climates, we can apply fabric-first principles to reduce the energy demand to cool spaces and deliver buildings that are comfortable, functional, future-proofed and decarbonised.

On a wider scale, our approach to landscape and urban design integrates ‘green’ and ‘blue’ areas into cities, reducing the ‘urban heat island’ e ect and the cooling energy required in buildings alongside areas of vegetation or water.

A solar farm future?

According to the Greener NHS programme’s Third Health and Care Adaptation Report 2021, “the portfolio of government-owned NHS property comprises more than 3,000 properties with 7,000 tenants across England, representing around 10 per cent of the NHS estate. NHSPS is developing new reporting metrics to ascertain the extent that overheating impacts their portfolio.

Meanwhile, several NHS Trusts across the UK are looking at partnerships with local authorities to install solar farms to run their healthcare estates more e iciently. In the West Midlands, a Trust and Council have made a joint planning application for a solar farm. The farm is projected to be the size of 21 football pitches and aims to power one of the Trust’s hospitals with renewable energy.

Reviewing the challenges and providing solutions requires constant creative solutions and cross-system leadership at a national level. To build climate-resilient health systems and institutions, leaders play a key role in raising the profile of climate change and holistic recovery methods for patients while reducing emissions.

Ultimately, our goal is to reach a point where passive internal air quality is improved so that patients can recover faster in optimal temperature-controlled environments.

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