With new building assessment methods looming for the NHS, Stuart Shepherd highlights a key shared learning resource

You could be forgiven for thinking that sustainability in healthcare construction is the preserve of a group of early adopters. Not so, as is clear from an April 2001 letter from then minister of state for health John Denham to NHS managers.

Congratulating his readers on a 20 per cent reduction in energy use during the 1990s, the minister highlights mandatory targets calling for further reductions in energy consumption as well as new energy efficiency performances, to be reviewed in 2010, on all capital developments, redevelopments and refurbishments.

The introduction of the NHS environmental assessment tool in 2002 set a further requirement to measure the impact of builds and refurbishments on NHS estates. New construction projects must achieve a NEAT rating of excellent at several key stages.

Now, five years on, NEAT itself is up for redevelopment, as senior sustainable development policy adviser at the Department of Health (estates and facilities) Lorraine Brayford explains: 'We want to align ourselves to a number of government initiatives - such as those issues embedded in the draft strategy for sustainable construction, the work of the Department of Communities and Local Government on sustainability for non-domestic buildings and regulations that reflect the drive to greater carbon efficiency - while always keeping sight of the fact that what the NHS puts up is there to provide healthcare.'

In this context, sustainable built-environment research and consultancy group BRE has been asked by Ms Brayford to develop a new NHS-specific environmental assessment method, due for publication in summer 2008. It is likely to specify a number of performance indicators, including recycled content in new builds. Targets of between 10 and 20 per cent have been mentioned as a figure for this but the final decision will no doubt be informed by current projects such as the Barts and The London Hospitals trust new hospitals programme.

Here recycling consultant the Waste and Resource Action Programme has been working with main contractor Skanska and its NHS clients to bring higher levels of recycled content into the construction process of the UK's largest private finance initiative healthcare scheme to date.

WRAP construction project manager for procurement Jim Wiltshire says: 'We found that something like 19 per cent of the value of all materials going into the project were being derived from recycled content. By focusing on between five to 10 product areas that bring the most benefit at no extra cost there is the potential to take that figure as high as 30 per cent.' Standard brick and blockwork, roofing, flooring and service pipes, for example, can all contain anything between 25 and 80 per cent of recycled content.

'Pointing out to contractors the high recycled content values of many mainstream materials is a real eye-opener that helps them get over any initial hesitation and realise the potential to do more,' he adds.

Consultation groups have revealed that many trusts that tried to take an early lead in this area received conflicting advice on how to add sustainability to the system.

With this in mind a learning network for sustainable healthcare construction, SHINE, was launched in December 2006. Run by three organisations - CIRIA, a construction research and guidance body; Forum for The Future, a sustainable living charity; and The Sustainable Development Foundation, with a focus on procurement practices - SHINE offers free guidance modules, training and case studies.

SHINE director Jon Bootland says: 'NEAT and the mandatory energy targets are just part of a wider set of drivers for sustainability. That is why we take a wider view of the issue and look to get sustainability into the process at all stages, including design and consultation, and considering social and economic aspects.'

This integrated approach takes account of the health and well-being of a building's occupants. 'It improves staff retention and benefits the patients,' says Mr Bootland. 'Work at Sheffield Hallam University suggests that good ward design in a new build can reduce length of stay by 16 per cent, a saving on resources that on some projects would pay for the works within 18 months.'

Mr Bootland sees shared learning as a means of resolving problems that arise when trusts pass too much of the decision-making to the contractor. He says: 'Procuring a complex hospital build is a difficult job done typically by clients who are not experts in construction. While they might want a sustainable facility that delivers good health outcomes, the drivers for the builders will all be cost-related.

'With SHINE providing training and helping NHS organisations to help themselves, they can have a clearer understanding of what they want and how to ask for it.'

Bidders given early notice of stringent targets

Sustainabilty is one of six key themes being applied to a North Bristol trust hospital development.

Preferred bidders for the£336m PFI scheme on the current Southmead site are on notice that the trust will be looking for a strong focus on sustainability in the competitive project scope and design process.

'Following advice from WRAP and building consultant Davis Langdon, we have incorporated a number of elements, such as site waste management, into our documentation,' says Tricia Down, trust deputy director of projects.

'We are also including a 20 per cent target for the value of recycled content in construction materials. While this might seem quite stringent, our work with WRAP persuades us that the selected contractors should readily achieve it.'

The trust is seeking guidance from the Carbon Trust and has appointed Nifes, an environmental consultancy group, to sit on its evaluation team. North Bristol is also seeking a 45 per cent saving on its current consumption of energy .

'We have made it clear that we want the new hospital to be as future-proofed as possible,' says Ms Down.

'Our consultants will see what the bidders come up with and tell us where they are not pushing the boundaries hard enough.'