Planning matters

In July 2022, the NHS became the first health system in the world to embed net zero into legislation, through the Health and Care Act 2022. Identifying a route to net zero emissions for a complex system as large as the NHS is particularly challenging. The targets set are ambitious, and include reducing NHS emissions to net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032. To support the co-ordination of these carbon reduction efforts, the 2021/22 NHS Standard Contract set out the requirement for trusts to develop a Green Plan to detail their approaches to reducing emissions. The subsequent ‘Delivering a Net Zero National Health Service’ report published by NHS England in July 2022 provides a detailed account of the NHS’ modelling and analytics underpinning its latest carbon footprint, trajectories to net zero and the interventions required to achieve that ambition. The report serves to illustrate the huge scope and range of areas and interventions which form part of the NHS’ overall net zero targets but, as a town planner, also shines a light on the extent to which the continued development of healthcare estates must play a critical role. Along with specific guidance in terms of travel and transport, the supply chain, medicines, research, innovation and offsetting, estates and facilities are top of the list of direct interventions required to decarbonise the NHS. Pathway to net zero for the NHS Carbon Footprint Delivering a ‘Net Zero’ National Health Service, NHS England, July 2022   This largely reflects the fact that the estates and their supporting facilities currently comprise 15% of the total carbon emissions profile of the NHS. Delivering a net zero health service will therefore require work to ensure new hospital buildings are net zero compatible, as well as improving the existing estate. Planning is a key component in the implementation of these changes. At Lichfields our work over recent years spans the full breadth of the healthcare estates sector, from masterplanning new healthcare campuses to obtaining planning permission for new hospitals and other, more fine-grained, development management projects. Based upon this experience, a number of trends are becoming apparent which could each have a crucial role to play in the transition to net zero estates. Broadly, and with a few examples, these fit into one of three key categories: 1. New Build The most obvious, but also complex and expensive, means of creating new low carbon facilities for the future is to build new state-of-the-art energy efficient buildings. Lichfields obtained planning permission in 2021 for the redevelopment of Berwick Community Hospital in Northumberland on behalf of Northumbria Healthcare NHS Foundation Trust. Located in the heart of Berwick's historic conservation area, this new hospital designed by P+HS Architects will extend to around 10,000 m², costing £30 million and re-providing all existing hospital services currently available in the town, as well as an accredited endoscopy suite and GP practice. The Environmental Impact Assessment prepared by Lichfields explained that the development adopts a fabric first approach to utilise ‘passive’ measures in the design of the hospital building. This includes measures such as enhanced U-Values, natural daylighting, exposed thermal mass for temperature stabilisation and natural or assisted natural ventilation where possible. The low and zero carbon technologies utilised will include a combination of heat pumps and photovoltaic panels. In addition, a gas supply will not be required for the building as the proposed ‘ambient loop’ system moves from traditional gas burning plant to de-carbonised in the future. Therefore, there will be no on-site emissions produced by the central plant in the future, which also helps to improve local air quality. Berwick Community Hospital (Copyright P+HS Architects)   2. Refurbishment and Reconfiguration Secondly, an alternative to the comprehensive demolition and redevelopment of brand-new facilities is the repurposing of existing buildings, whilst upgrading and updating their environmental performance. Lichfields has worked with Bam Construction Ltd and NHS Property Services on one such scheme at Whitby Hospital, which opened in September 2021. The previous Whitby Hospital was constructed in 1979 as a comprehensive centre for all major health services. As service models have changed and evolved over the years, delivery in the community, in people’s homes and the creation of specialist centres have each reduced the activities which are undertaken in a generalist community hospital. At a cost of around £13 million this scheme, designed by Medical Architecture, sought to refurbish and configure the existing site and reduce its extent to around 4000 m². Again working within the constraints of a Conservation Area, the scheme demolished the surplus accommodation across part of the site, and focused development on the existing hospital tower, which was comprehensively refurbished and modernised to provide 21st century healthcare accommodation for 19 in-patient beds. A purpose-built extension to the tower provides a new entrance to the consolidated hospital, with better accessibility and legibility for those using the site. The resulting development was designed to achieve BREEAM ‘Very Good’. Whitby Hospital, by Bam and Medical Architecture (Copyright: Eye Level)   3. Decarbonising Existing Facilities Finally the most light touch form of intervention which is still likely to deliver real-world improvements in the environmental performance of healthcare estates, is the decarbonisation of existing buildings. In this regard, the Government’s ‘Public Sector Decarbonisation Scheme’ can provide grants for public sector bodies to fund decarbonisation and energy efficiency measures on large public buildings such as schools and hospitals. Phase 1 of the Scheme provided £1 billion in grants as part of the Chancellor’s ‘Plan for Jobs 2020’ commitment to support the UK’s economic recovery from COVID-19, supporting up to 30,000 jobs in the low carbon and energy efficiency sectors. Funding through Phase 1 was awarded for the decarbonisation of North Tyneside General Hospital, equating to some £22 million. Working with Breathe Energy Ltd, Lichfields utilised a variety of development management processes, including planning applications, prior approvals and permitted development rights, to transform the performance of one of North Tyneside’s largest buildings through the introduction of a range of decarbonising measures; aiming to save 3,470 tons of CO2 per annum. This included obtaining prior approval for the installation of photovoltaic panels totalling an output of circa 975 kW, as well as planning permission for new air source heat pumps and boiler upgrades. Each of these approaches in itself can make a meaningful contribution to the NHS’ net zero target. However they also serve to illustrate both the variety of interventions available (in terms of cost and complexity) and the need for a bespoke site solution, cognisant of the local planning context, in order to achieve best value from both an environmental and financial perspective. Please get in touch with Lichfields’ Health and Education team if there are any ideas you would like to discuss for your own estates. You can see the full range of our expertise and experience on healthcare projects within our Sector Guide.

Initially funded by charitable giving and local fundraising, there has been a hospital in Leeds since 1767. So, for around 250 years, hospitals in Leeds have led the way in offering patients of the city and surrounding Yorkshire area the very best treatment and care. Since 1862 when the initial commitments were put in place by the Infirmary Board to build a new hospital in Leeds to meet the needs of a fast expanding industrial city, there have been far reaching changes to the level of understanding and knowledge of medical practice. Hand in hand with this change, we have seen the rapid evolution of hospital design and practice to reflect not only the needs of medical science, but also the wider health and wellbeing of the patients who use hospital services. The Leeds General Infirmary as we know it today is made up of a medley of interlinked premises from the iconic Sir George Gilbert Scott designed buildings, commissioned in 1868, with notable additions including the modern Martin and Jubilee wing buildings, the latter accommodating a helipad used by the Yorkshire Air Ambulance. The condition and inflexibility of the healthcare estate (including also the St. James Hospital site located across the city, parts of which dates back to 1846) presents significant challenges in meeting 21st century healthcare needs. The Leeds Teaching Hospital NHS Trust’s Hospitals for the Future Project is delivering two new hospitals in one building at the Leeds General Infirmary – one for adults and a new home for Leeds Children’s Hospital and the UK’s largest single-site maternity centre. the scheme is part of the Government’s commitment to build 40 new hospitals by 2030.   Early design of the new Leeds adults and children hospital building Credit: Perkins & Will/ Penoyre Prasad and Schmidt Hammer Lassen. Leeds Teaching Hospitals NHS Trust The Trust employs 20,000 staff and each year and within the city provides care for more than 130,000 inpatients across 2,000 beds and coupled with this sees more than 100,000-day case patients each year and annually delivers over 1.15m outpatient appointments. Across two A&E Departments, the Trust’s sees over 200,000 ambulance attendances and over 200 air ambulance visits in addition to those who self-present at A&E. With a clear clinical strategy, a process of reconfiguring the estate has now begun. Lichfields obtained outline planning permission in 2020 for the Gilling Dodd designed new Leeds hospital development, and as part of a wider architectural and technical team led by Perkins & Will, Penoyre Prasad and Smidt Hammer Lassen architects, is now working towards the submission and approval of detailed proposals which will see the delivery of a leading, internationally renowned state of the art facility to deliver clinical needs and research throughout the 21st Century. The development will bring together specialist paediatric and maternity services, which are currently spilt across the city. Centralising the services under one roof for the first time will keep families together and enable the Trust to provide integrated family care. Patient care and wellbeing is at the centre of the design with all wards orientating toward the outdoors, maximizing exposure to daylight and good views. Green spaces are an important part of the design, including a new public plaza outside the hospital and garden terraces throughout, with planting inspired by the regional environment. The new hospitals development will also seek to improve access for patients, staff and visitors as well as supporting the redevelopment of a large city centre site that will open up local communities that are currently separated by the impermeability of the hospital buildings, consolidating also parking through the creation of a new multi storey car park which will provide for an increase in the number of car parking spaces available for patients. Cutting-edge twin technology will be used to track the building’s energy performance and other technology will reduce administrational processes helping to increase the amount of time medical and care staff can spend with patients. With embedded systems and controls the new hospitals will be SMART buildings. Sustainability sits at the heart of the new hospitals’ design, aiming for net zero operational carbon and minimising embedded carbon, conservation of resource and the use of nature-based design solutions, the new hospitals will adopt an approach which could never have been contemplated even in more recent times, certainly not in the earlier days of medical care in the city. The new hospitals development proposals are part of a much larger redevelopment and economic regeneration opportunity for Leeds. The new hospitals and existing infirmary is located within the city centre in the heart of the Leeds Innovation Arc, which is a strategic intent of the Leeds Teaching Trust, the University of Leeds, Leeds Beckett University and Leeds City Council to use their knowledge, assets and partnerships as a catalyst to accelerate innovation and economic growth throughout the city. Those parts of the existing hospital estate at the infirmary now outdated and which will become vacated will create a unique regeneration opportunity. The additional benefit of safeguarding those buildings of conservation importance for future uses including the Sir George Gilbert Scott listed buildings. The ambition is to create a new world-class hub for health research and life sciences, but there is the potential for business, residential and hotel accommodation, resulting in economic regeneration and employment benefits. Leeds General Infirmary, Gilbert Scott Building Credit: Lichfields The Leeds city region has much to look forwards to, with an exemplar standard of hospital design and medical provision to the latest technological standards. The development will also act as a catalyst for regeneration, attracting new med tech and related research to the Leeds Innovation Arc, with the added benefit of safeguarding repurposed buildings of conservation and heritage importance. Lichfields has built an enviable track record assisting in the delivery of significant healthcare projects all around the UK and is proud to be helping deliver the Leeds General Infirmary enhancements and those at St James’ Hospital. Some 100 years after the concept for the Leeds General Infirmary, Lichfields was itself established and now 60 years later, we work on the most prestigious proposals providing local knowledge and innovation in delivery of schemes across the sectors, no more so than within the healthcare sector. After 60 years of success in the planning and development industry, we now look forward to a more sustainable future, as we work towards becoming a net zero carbon business. The pandemic has been a poignant reminder of our wider social responsibilities and our need to support a better and more resourced and modern health service. We look forward to another 60 years of creating high quality environments for future generations!