King’s Mill Hospital

Sustainability Design Report

Supervisors
Dr. Feng Fu: Dr. Shiqiang Yan
[email protected] [email protected]

Report created by group 15

Abbas Raza [email protected] 180011243
Qais Rezai [email protected] 180006223
Heidar Rizouki [email protected] 160006545
Inan Sakar [email protected] 180016305
Suzi-Izamar Saliha [email protected] 180052629

Project
The Kings Mill redevelopment

Clients
Sherwood Forest Hospitals NHS (National Health Service) Trust

Contractor and developer

Skanska
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TABLE OF CONTENTS
......................................................................................................................................................................... 1
1 Abstract....................................................................................................................................................3
2 Introduction..............................................................................................................................................4
3 Project background..................................................................................................................................4
4 Sustainable construction..........................................................................................................................4
5 Aspects of sustainable construction.........................................................................................................5
5.1 ENVIRONMENTAL.............................................................................................................................5
5.2 ECONOMIC........................................................................................................................................5
5.3 SOCIAL..............................................................................................................................................5
6 Carbon Dioxide (CO2), the main sustainable construction’s enemy..........................................................5
7 Concrete and sustainable construction....................................................................................................6
8 Social aspects............................................................................................................................................6
8.1 A conscious community for better conditions..................................................................................6
8.2 Outdoor gyms for social facilitation..................................................................................................7
8.3 Transportation for more sustainable conditions..............................................................................8
9 Economical aspects................................................................................................................................10
10 PFI – Private Finance Initiative............................................................................................................10
11 Environmental aspects.......................................................................................................................11
11.1 Starting point for innovations.........................................................................................................11
11.2 Increasing energy production with photovoltaic panels.................................................................11
11.3 Fighting pollution by going green...................................................................................................12
11.4 Waste..............................................................................................................................................16
12 BREEAM ASSESMENT FOR THE QUALITY CERTIFICATION OF THE PROJECT........................................18
13 Initial BREEAM score before our contribution....................................................................................19
14 BREEAM score after our improvements.............................................................................................19
14.1 Management..................................................................................................................................19
14.2 Health and wellbeing......................................................................................................................20
14.3 Energy.............................................................................................................................................20
14.4 Transport........................................................................................................................................20
14.5 Water..............................................................................................................................................21
14.6 Materials.........................................................................................................................................21
14.7 Waste..............................................................................................................................................21
14.8 Land usage and ecology..................................................................................................................22
14.9 Pollution.........................................................................................................................................22
14.10 Innovations.................................................................................................................................22
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15 Conclusions.........................................................................................................................................23
16 Appendix.............................................................................................................................................23
16.1 BREEAM results before our contribution........................................................................................23
16.2 BREEAM Results after out contribution..........................................................................................24
17 Bibliography, references, and material consulted..............................................................................25

1 ABSTRACT
This report will evaluate the sustainability of SANSKA’s redevelopment of the King’s Mill Hospital,
while also suggesting additional innovations to improve sustainability further. For example,
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photovoltaic cells, Biogas buses, recycling material and green walls and many more. These
innovations have resulted in a BREEAM rating of 81.7%, an increase from the previous score of
74.5%

2 INTRODUCTION
The construction industry contributes to a large proportion of global CO2 emissions due to the
multitude of machinery and vehicles required in every process. Furthermore, the large quantities
of finite materials used has a significant adverse effect on the environment. As a result, numerous
laws and regulations are being used to encourage constructions companies to be more mindful to
the environment and consider a more sustainable approach. This report will assess the
sustainability of the King’s Mill Hospital redevelopment by demonstrating the use of the
sustainability framework. This framework involves analysing the environmental, social and
economic impacts of the suggested innovations and current schemes already implemented.

3 PROJECT BACKGROUND
King’s Mill Hospital in Nottinghamshire provides healthcare for 300,000 people. The site was
originally an American Service Hospital during the Second World War and successively undergo
redevelopment planning by SANSKA ended in 2011. At the moment of the redevelopment, the
project has been rated Excellent by the NHS Environmental Assessment Tool (NEAT). The
innovations proposed in 2011 were at maximum levels and performance to maximise socio-
economic benefits and minimise environmental impact. This design project aims to add additional
improvements to the structure through innovative ideas to make the building more innovative,
performant, eco-sustainable and socially competitive.

4 SUSTAINABLE CONSTRUCTION
Sustainability is a relatively new discipline that was created to connect human beings and
surroundings. It is related to the social, economic, and environmental aspect, and each of them is
disciplined in such a way that they offer better conditions for all the parts.
Sustainability can be applied to many fields, but a relevant component is the one connected with
constructions from the design part to the realisation of the project. The construction industry has
a massive impact on the environment. It is the field that: most produce waste that needs to be
disposed in particular sites uses a consistent amount of energy during all the cycle of building a
structure and is one of the main part responsible of CO2 emissions. Adopting sustainable
constructions is not an easy process because the contractor or developer not only need to end
submitting a valuable green building but is also need to operate in conditions that better protect
and take in consideration the importance of preserving the environment.
The critical element of sustainable construction is not only in the environment but also in the cost,
thus reducing the cost is still one of the priorities of owners and developers. Even if the initial cost
may be more relevant for green buildings than for the standard ones, the operative cost is
incredibly reduced, which make these technologies so promising. Adopting green energy systems
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at the expenses of fuel and carbon energy will help reduce the cost from many points of views.
Owning a renewable system in small or large scale will decrease the taxes paid to the government
and using green material will create less waste, thus fewer taxes regarding waste management. A
green building also has less maintenance cost because its principle is to reflect and be a
continuation of the surrounding environment. Commonly, the green building uses solar or wind
energy and involves green roofs and vertical walls which tend to reproduce the nature and thus
have fewer human interventions; this implies that they are more capable of maintaining
themselves.

5 ASPECTS OF SUSTAINABLE CONSTRUCTION

Sustainable construction is made of three pillars: environmental, economic, and social. Each of
them is defined in the construction by specific terms and needs to fulfil specific requirements to
deserve the name sustainable.

5.1 1.1 ENVIRONMENTAL

From an environmental point of view, sustainable construction should have a low environmental
impact. This purpose can be achieved by using environmentally friendly material, reducing the
production of hazardous waste and reducing the carbon emission. Studies have proven that
construction is responsible for at least 35% of the worldwide energy consumption and produce at
least 40% of the CO2 emissions. These percentages do not only involve the construction phase but
take into consideration the lifetime of the building that is created. An accurate design of the
construction phase is essential as well as self-conscious maintenance of the building.

5.2 1.2 ECONOMIC

Sustainable construction has a significant economic aspect. Constructions and renovations are still
expensive areas because they require a considerable amount of prime material. Proper
considerations in the design process can reduce the overall cost of the building, and the acquisition
of material produced with renewable sources can decrease the initial cost of the building.

5.3 1.3 SOCIAL

Sustainable construction plays an essential social role in many communities. Better environmental
and economic conditions motivate people to better live and work in that specific environment.
Adequate social conditions are strictly related to their surroundings. Living in an economical and
financial sable environment will promote high well-being conditions and will help generate new
ideas for even better set-ups. A healthy environment will stimulate people in spending time in that
specific place and will also promote the desire of keeping the ambient at high standards.

6 CARBON DIOXIDE (CO2), THE MAIN SUSTAINABLE

CONSTRUCTION’S ENEMY
As mentioned before, constructions and maintenance are responsible for an incredibly high
percentage of CO2. This emission mainly comes from the energy component related to the
building. Energy is essentially used for putting in functions the apparatus for the construction of
the building and for heating the space and the water in existing buildings. Another component
more contained but still considerable is regarding the transportation of the material for the
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construction site. Paying attention to the CO2 emission has vital importance because at the
moment, carbon dioxide is the main responsible for global warming.

7 CONCRETE AND SUSTAINABLE CONSTRUCTION

The production of CO2 is also related to concrete which is a material primarily used in
construction. It is responsible for a massive part of carbon emission because its production
requires much energy. Due to its structure, cement must be recycled in specific landfills. Thinking
of treating all the surplus of concrete as waste will require many new areas where concrete
recycles points can be created. Better usage of the concrete waste is for it to be crushed and used
along with asphalt, bricks and rocks to produce gravel for new construction or aggregate for the
foundations of roads. Generally, big contractors work on more sites simultaneously so to decrease
the cost of material concrete can be transported and used on other sites. If transport is an
essential component of the process because the material must be transported from the company
where it is bought till the site, at least cost can be saved by not buying new material.

8 SOCIAL ASPECTS
8.1 A CONSCIOUS COMMUNITY FOR BETTER CONDITIONS
Studies as proven that extended stays in hospitals can impact people’s mood. Three common
problems seen in people in hospitals, especially those who are elder are; delirium, dementia, and
depression. Other studies show the impact of medium-long hospitalisations in children and
teenagers. Children admitted to hospitals experience post-traumatic stress disorder (PTSD). At this
point, it is indispensable to assume that hospitals structure should take into consideration not only
the physical illness of their patients but also their mental state during their stay at the hospital.
Eurostat statistics from 2018 show that in the UK, the average stay for a patient in hospitals is
around seven days. Respecting the proper routine as much as possible is an indispensable
requirement in hospitals but is difficult to archive due to the different environment. Here comes
the need to look for activities that can generate the stimulus of living an everyday life even when
the circumstances are different.
Art is known to have many beneficial effects on mood; it reduced anxiety and stress levels and
increased confidence and a sense of purpose. Similarly, another study found that creating art had
many beneficial effects, including increased happiness and confidence, reduced anxiety, stress
relief, and a greater sense of accomplishment.
Some Children’s Hospitals already promote this therapy practice to offer children some enjoyable
time during their long staying in the clinic. The project to improve the well-being and health
conditions at King’s Mill Hospital is to plan and organise some art courses or art classes in which
the patients can freely participate. These classes can be extended to visitors or outsider which can
participate in the project by paying a fee or a membership subscription. To make the project more
sustainable local artist can be asked to teach and hold the courses as volunteers. Besides, the
Hospital can look at come partnership with college and universities where the students in
exchange of credits and work experience can get involved and teach to young and old patients.
The handcrafted products created by the patients can be sold at the charity shop and the money
collected from the sales, art classes and additional donations can be used to buy new, performant
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apparatus for the hospital. The charity shop can collect second had items, and with the help of
local artists, students, and volunteers produce items that can be sold in the shop. In this way, the
cost of material used to produce item that can be sold will be minimum or almost inexistent. By
involving young students in these activities, older people can forget about their age and feel less
oppressed by their mental and physical conditions. Art activities do not involve only painting or
sculpting but also handcraft activities as knitting, crochet, sewing and handcraft. Different ages will
be more interested in different activities and material so having students and local artist involved
in the project will make more realistic and quicker the research of the best activity for that specific
age range.

8.2 OUTDOOR GYMS FOR SOCIAL FACILITATION

In the climate of a hospital, there are physiotherapy facilities, however only for patients
prescribed. The idea of adding an outdoor gym in green space would promote not only health and
wellbeing but also the social aspect place, which is just as important. An active lifestyle with a
zero-emissions eco-friendly aspect that uses no human resources apart from setting up and
maintenance is found to be sustainable. The social aspect is boosted due to the interactivity of the
gym. Adults and children often socialize while exercising thus strengthening the interpersonal
relationships between the community and hospital offering motivation, support, and
encouragement to stay fit. Studies have proven that loneliness and depression are commonly
found amongst hospital users and staff. It has been reported that exercising outdoors in fresh air
has a more significant impact on mental wellbeing as well as physical. It provides all the physical
benefits such as blood flow, cardiovascular health, strength, flexibility, and endurance. Exposure to
sunlight allows the body to absorb vitamin D, which is vital for healthy bones and helps the
absorption of calcium. For mental health, it has found that the relationships between working out
outdoors, the sunlight and the sensory stimulation has a salutogenic effect on the human body

and reduce stress.

The green space would roughly need to be 20x10 metres due to 1.5m space needed for each
machine, ten machines total. The idea of power-generating gym equipment was suggested;
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however, it was found that it would only provide 200 watts of power per hour which is not much.
The cost and non-renewable fuel that would need to be used to construct a power generating
outdoor gym would outweigh the pros of a power generating gym. It would be more likely to
break down as well as the cost for maintenance.

8.3 TRANSPORTATION FOR MORE SUSTAINABLE CONDITIONS

Public transport is an effective way of reducing greenhouse gas emissions produced by cars and
other vehicles. Buses and trains can transport lots of people in one go, and the buses are usually
more energy-efficient than cars. Nottingham city transport can count on a large scale of biogas
alimented busses. These buses benefit the environment by offering several improvements to
sustainability. Biogas alimented mechanism can utilise food waste to function, and they provide
84% fewer emissions than standard diesel buses. Hospitals produce around 20 tonnes of food
waste per year, which can be used as alimentation for the buses instead of being disposed of and
increase the waste management taxes of the hospital. Using food waste as combustible allows to
reduce CO2 emission by 3.5 million kg per year and NOx emission by 36,000 kg per year, excluding
the fact that it is incredibly cheaper than diesel.

These buses are already equipped with many features to benefit the public, and some more plans
could be introduced to increase public transport use:
 USB charging ports
 High-quality seating
 Free Wi-Fi
 Quieter engines
 Free bus fares for staff
 More bus stops on hospital site

The hospital already has a free shuttle bus service that is eligible for staff only and runs every hour
between 3:15 pm – 10:15 pm. Currently, the service only transports staff from the hospital back to
their homes in Mansfield and only runs at night. An improvement can be made to this service to
allow more staff to take advantage of it and to reduce CO2 emissions by reducing the number of
cars that circulate. The shuttle service can be made operative seven days a week morning and
night according to the staff shift timetable. This service allows the staff to get to work and return
home more comfortable and will also allow them to save money and time. The current shuttle
service route only travels from the hospital to other locations. Two-way routes and an increased
number of stops is proposed in this design to increase the functionality of the service. Additional
routes can be proposed to allow more staff to benefit from this system. Sutton-in-Ashfield, Berry
Hill, Stanton Hill and Harlow Wood are some of the ones that are proposed, but staff survey can be
used to identify better which areas host most of the staff. The buses used in the service will be
biogas buses, as mentioned before. However, biogas buses would be more suitable due to their
long-range capabilities. Bus timetables and routes will be available to staff at the reception desk.

Currently, there are only

two bus stops on the
hospital site and the
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closest train stations to the hospital is more than 30-minute walk away. Increasing the number of
bus stops will also add more bus routes, allowing more staff or visitors to use the bus service.
Additional bus shuttle from the hospital till the train station can be designed to simplify the access
to the hospital.
Cycling is the definite leader in the sustainable transport methods as it does not harm the
environment, is excellent for exercise, and is much cheaper than a vehicle. Therefore, introducing
several cycle dockings stations and bike storage areas to allow more people in the local area to
cycle to the hospital is an incredibly sustainable idea. This project would work similarly to the
Santander Cycles in London, whereby the first 45 minutes of use will be free. Currently, there is
only one staff bike shed on-site, so more will need to be added for both staff and public use. Bike
docks can be added at the train station as well to allow staff and visitor to cycle from the train
station to the hospital. Bike options are cheaper than bus services because they do not require a
driver. The cost of a bike shelter is around £1500, and the cost for a docking station with 27 bikes
is approximately £200,000. Cycling produces no greenhouse gas emissions and reduces the use of
cars in the local area, excluding the fact that it supports a healthy lifestyle. The hospital can offer
prices to staff who persist in using the bike to reach the hospital.

9 ECONOMICAL ASPECTS
The review of the economic sustainability aspect branches out and focuses on unemployment,
consumer confidence and the introduction of money into the local economy by purchasing from
local businesses. A redevelopment project such as King’s Mill Hospital would be critical to an area
like Mansfield as it has a significant impact on the economic activity of the local area.
During the construction phase, 500-700 operatives would work on-site at any one time, a third of
that number were residents. Mansfield, where the project is situated, is an ex-mining community
deprived of work. Employing the residents reduced the unemployment rate within the area. This
increased the economic growth of Mansfield as the consumers of the region were residents
boosting their confidence to spend, increasing expenditure within the area. During the time of
construction, their ethics were held highly by the union. They made sure the subcontractors were
not underpaying the operatives.

More measures were taken to boost the local economy further. Local businesses were employed
to supply various aspects of the work, such as the decoration and artwork for the hospital. Not
only for that, but local businesses were also used to supply the materials needed for the project,
where possible. This encouraged local economy growth and aimed to reduce the unemployment
rate further as more jobs were created for businesses to respond to an increase in demand and
meeting larger quotas than usual. In turn, this would ensure the supply process would be quick as
there would not be a considerable impact of travel time, importing goods from an area that is
further out.
To additionally expand on the growth of the economy, vocational training back-to-work schemes
were offered to the community for them to gain skills to stay in employment even after the

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project was finished. Offering these schemes in an area of high unemployment is a sustainable
idea as it has a positive economic impact increasing the standards of living for the locals.

Life cycle modelling was used to analyse the cost of sustainable technology to see if the benefits of
sustainable ideas outweigh the cost. Many alternatives are proposed, and the idea is chosen based
on this analysis. With renewable energy plant costing a large amount, carried out. Using this
energy-efficient scheme, King’s Mill Hospital saves £120,000 approximately per year in electricity,
9000MW per hour. Also reduces carbon emissions by 400 tonnes per year compared to a regular
hospital.

10 PFI – PRIVATE FINANCE INITIATIVE

The hospital is part of a design, redevelop, finance and operation contract for three hospitals until
2035 where private sectors are responsible for the delivery of the project. This works by releasing
projects for contractors to bid on packages, and after completion, the project will be leased to the
government over a set number of years with an interest rate set by the private investors. The
benefits of this method of contracting a project out are that costs can be covered easily by private
investors, but it will leave the government in a large amount of debt. These projects are viral in the
UK. Thames Tideway is contracting and building the new London Super Sewer using the same
scheme. The sewer will be leased out to the government for 100 years.
These projects are good because the government does not have to pay a large sum upfront, but it
incurs a monthly price that can quickly accumulate and exceed multiple times the cost of the
project itself over the years. Therefore, this idea is not economically sustainable as taxpayers end
up paying the debt. On the other hand, the scheme enabled the hospital to receive state-of-the-
art equipment and eco-friendly technology. It also allows projects to commence much faster than
a government-funded contract as funds will not need time to be gathered.

11 ENVIRONMENTAL ASPECTS
11.1 STARTING POINT FOR INNOVATIONS
With the redevelopment of King’s Mill Hospital, new strategies were put in place to make the
energy consumption of the hospital more efficient. The SANSKA proposals expected to annually
consume less than 55 GJ/100m3 while the refurbished sections of the hospital expected to
consume less than 65 GJ/100m3. These energy efficiency performances were possible due to the
newly built geothermal system, ventilation system and the lighting system.

The ventilation system is designed to minimise the amount of energy consumed by the fan by
recycling the heat from the outgoing air. There is fresh, natural ventilation throughout the
hospital, which exceeds the NHS standards and helps control any pathogens which are needed in a
hospital environment.
The energy consumed from the lighting is also made more efficient with the use of fluorescent
lamps which consumes 75% less energy than incandescent bulbs and last from 6 to 15 times
longer (Joseph Castro, Live Science Contributor, July 26, 2013). Daylight sensors are integrated into
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the design to control the light intensity, which reduces the need to consume any unnecessary
energy. To better manage the usage of energy, the staff are provided further training to promote
the efficient use of hospital facilities.

The lake-source geothermal heat pump system installed can produce 5.4Mwatt of energy for
cooling and heating. These heat exchangers are submerged adjacent to King’s Mill reservoir, and
they are connected to 42 heat pumps in the hospital which help regulate the temperature (Slim
Jim Geo Lake Plate, n.d.). This is the largest geothermal lake loop in Europe which fulfil the
hospital’s entire heating and cooling demands. The heat exchange is much more efficient than any
other renewable energy technology (SANSKA, Case Study 40, 2008). For every 1 kW of energy
used, from 4 to 7 kW are produced by the system making it more competitive than conventional
heating and cooling technology. This system has enabled the hospital to cut down on CO2
emissions by saving a total of 2,078 tons of carbon per year, making the hospital more sustainable.
The geothermal plant is very efficient and saves 9,600MWh of gas and electricity annually and
approximately £126,500 in costs every year.

11.2 INCREASING ENERGY PRODUCTION WITH PHOTOVOLTAIC PANELS

Hospitals energy requirements are incredibly intense compared to other businesses. The primary
usage of energy is for water heating and for continually keeping lifesaving equipment in function.
A power shortage is critical to a hospital, so typically many backup generators are designed to
keep the apparatus performing at their full potential.
An innovative idea
which will not only
provide an
additional source of
energy but will also
make efficient use of
the roof space are
photovoltaic panels.
The total area of
solar panels which
will be installed on
the roof of the
hospital will be
2059m2. The better
conditions for the sun light absorption is an inclination of 15-20° on the north side of the building.
5kW arrays will be used, which occupy a space of 32m2 each and produce approximately 4500
kWh of electricity a year. The total amount of arrays designed is about 64, producing a total of
288MWh of electricity a year. The solar panels have a total cost of about £450,000. The total cost
can be slightly reduced by considering the incentives the government offers when opting for a
solar energy system rather than a fossil one. Tax credit and rebates are the incentives the federal
government offers to promote a more sustainable choice over the carbon energy. A reduction of
30% on the energy taxes can be applied every year and considering the amount of energy required

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by the hospital this will lead to a considerable saving for the structure and the saved money can be
direct to other purposes.
The Non-Domestic Renewable Heat Incentive (RHI) is a government environmental programme
that provides financial incentives to increase the uptake of renewable heat by businesses, the
public sector, and non-profit organisations. Eligible installations receive quarterly payments over
20 years based on the amount of heat generated (Ofgem, 2020).
Other beneficial consequences of using a photovoltaic system are the low maintenance required.
The photovoltaic panels only need to be cleaned a few times a year during the dry summer. The
panels are also easily cleaned by the rainfall which a common occurrence in the UK. Due to the
little maintenance, it is expected that the photovoltaic system will have a life expectancy of 25-30
years, making it a worthwhile long-term investment.

11.3 FIGHTING POLLUTION BY GOING GREEN

SKANSKA redevelopment planed already the usage of a green roof to reduce the dark and paved
surface, and in this way reduce the Heat Urban Island Effect and provide habitat for flora and
fauna by promoting a healthy and prosper ecosystem development. For this design project, this
idea was adopted and expanded to external and internal walls.
Through experiments, Akbari et al. (1997) discovered that the cooling load could be decreased by
30% using external vertical greening surfaces, which is equivalent to 3.6-4.8 kWh per day.
Additionally, Djedjig et al. (2017) established that external green walls work as a thermal insulator
and they can help to regulate the
internal temperature of the building
and can save 20% of energy by
reducing the cooling in summer and
the heating in winter.
the image on the left shows the
difference in temperatures of a
conventional wall (left) compared to
a green wall (right). The green wall
does not absorb heat like steel and
concrete, which allows keeping the
building cooler. A temperature
difference can be noticed as well; the
concrete wall on the left is
approximately stored 10 °C more than the green wall, which is only stored a temperature
of28.4°C. Due to this difference, less energy will be used on air conditioning during summer in the
building that is externally covered with green walls. Due to the less energy demanding, less
combustion of fossil fuels is used; therefore, less CO2 is produced and released into the
atmosphere. The green walls not only will decrease the cost and the energy-demanding but will
also improve environmental conditions by cooperating less in the CO2 emission.

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 Green walls can provide structural protection and a solution for reducing run-off during wet
weather. The plants can protect against acid rain and ultraviolet rays and a lot of external weather
conditions that can deteriorate usual claddings and paints. Consequently, they can use rainwater
to reduce surface run-off and flooding.
Green walls can also improve
esthetical conditions.
Buildings can be made to look
more continuous with the
surrounding environment by
having green walls instead of
a straight, dark, grey surface.
It additionally prevents the
building from looking dull and
boring by introducing vibrant
and natural colours. The
hospital redevelopment done
by SANSKA may have
destroyed habitats for the
wildlife in the area; green
walls can replace the habitats
by providing homes for
various species of insects and even birds. Habitat boxes can be built to provide homes for several
species such as solitary bees, butterflies, ladybirds etc. Nesting space and food can be placed in
the green walls for local birds and insects. This reduces the impact on wildlife and nature as well as
increasing biodiversity in the area (Biotecture n.d).
Green walls play a vital role in cleaning the air. They can absorb nitrogen oxide (NO2) and
particulate matter (PM) to make the air less contaminated. Green walls placed in street canyons
“can reduce street-level concentrations in those canyons by as much as 40% for NO2 and 60% for
PM” (Thomas A. M. Pugh, Environ. Sci. Technol., 2012). This shows the significant impact a green
wall can have on physical health and can reduce the number of deaths from human-made air
pollution, which is estimated to be at 4,800 deaths per year.

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 Green walls can potentially
economically help to neighbour
residential and commercial
properties as it may attract
more customers and properties
with more greenery in its
environment generally have
more excellent value. This can
help the hospital amenities such
as the pharmacy, cafes, and
supermarket boost their
business. This is evident at
Moyo Hair & Beauty Aveda Exclusive Salon in Dublin, where the installation of their green wall
increased sales by 40%. The idea of external green walls can also be applied indoor. The picture
below illustrates the main walking hall of the hospital. Planning on covering the white surfaces
with vertical green gardens not only will create an environment that will recall less the climate of a
hospital but will create a natural airflow indispensable in this environment where the smell of
disinfectant and medicine is pungent.
The plants work as a natural clean air system and promote a better breathing atmosphere and a
healthier environment overall. They can also help to reduce noise pollution, which is quite
relevant, especially in gathering spaces as main halls or waiting rooms. Changing the colour of the
wall can also have a psychological impact on patients and visitors. Green is a colour that has been
used in the past to help influence people’s moods as it carried associations with nature, growth,
and recovery. Green walls can help with allergies by filtering out allergens from furniture and
indoor machinery. They will nor represent an issue for people that are suffering from hay fever
because plants such as one striking ornamental grass which is sterile and does not produce any
pollen or non-toxic grass-like plants such as Libertia and Ophiopogon can be used.
Green walls can be installed as a continuous or modular system. They are very similar to each
other. However, the modular system allows for less frequent maintenance and does not require as
much water and nutrients. Continuous systems can be more flexible, and lightweight compared to
modular systems. Nevertheless, modular tray systems are more suited to be built on the hospital
as it requires less maintenance, and its irrigation can be controlled better. The installation can be
done on an existing structure, or a steel or timber frame can be built if required. Softwood batons
and a drainage channel are placed with a breathable waterproof membrane on top. Once the
hanging rails are in place, to the pre-grown modules can be added the irrigation pipes at the top of
each row of modules.
It is recommended that general maintenance is carried out at least once a month, and a full check
is done at least four times a year. Necessary maintenance to be carried out is irrigation, drainage,
treating damaged plants, removing dead plants, checking for diseases, and ensuring adequate
lighting. Irrigation can be quickly done by a fully automated irrigation system to save time and
money. Lighting will not be a problem because the windows/wall ratio is around 60% which confer
to the structure a large amount of light. The green wall will also have to respect the fire rating.
Ensuring that the green system is sufficiently moist will make it resistant to ignition.
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Green walls have a considerable installation cost which can be reduced by implementing a large
scale of green walls surfaces and depending on the level and quality of maintenance it could
continue to be quite costly, although costs can be reduced by compromising in certain areas.
The plants are relatively small for a tray system but to not create problems with allergens, bare
plants like grass will be used for the system. These kinds of plants are not incredibly expensive and
do not require high maintenance as more artistic plants. The maintenance cost will be reduced as
well because they do not need to be replaced so often.
The average cost of implementing a green system is about £500 m2. This price can be decreased
by redirecting the raining water into the irrigation system of the plants. The raining water does not
need any depuration process to be used in the irrigation system so it can decrease the initial cost
and the maintenance cost because no additional water must be bought to maintain operative the
vertical garden. Consulting living wall specialists will allow obtaining more specific prices. ANS
Group Global Ltd stated that for a 200 square metre green wall, it would cost around £100,000,
including the design, production, installation, and plants. 12-month maintenance is included in the
cost of the contract.

11.4 WASTE
Not only for this project but in general waste represent an essential element in sustainability
where humans have not found an effective solution. It is a delicate topic because it involves not
only the contamination of landfill but also the contamination of water and air. Due to the high cost
of renovation, incinerators did not increase the quality of the filters used to depurate the air. The
same can be applied for the water; releasing the contaminated water in the environment without
making it undergo an adequate depuration process will affect the ecosystem.
Recycling has become more influent in the last ten years, but the recycling percentage in the world
is still relatively low, with a value that goes between 50 and 55% in better-organised countries.
People are not aware of the recycling system, and this does not help to make the process more
sustainable. Plastic is a material that could be recycled infinite time, but if not disposed of
correctly in the specific centres where it can undergo this process it becomes a dangerous hazard
for the ecosystem because it is not a degradable material.
Inform people of the importance of the recycling process is the primary step to progress in
sustainable waste management.
Hospitals consist of many different departments, and they all produce several types of waste,
some which cannot always be recycled. Therefore, the first step in hospital waste management is
to sort the waste for storage into various categories:
 Infectious (contamination with blood or bodily fluids)
 Pathological (human tissue or body parts)
 Sharps (needles and blades)
 Chemical (solvents and disinfectants)
 Pharmaceutical (expired medications)
 Cytotoxic (genotoxic waste)
 Radioactive
 Recycle
 General
On average UK hospitals produce 0.5kg of waste per patient and roughly 600000 tonnes of waste
per year. This waste must be transported away from the hospital to the specific recycling points. It
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would be an innovative idea to use electric or biogas vehicles to reduce daily emissions. Once off-
site, the waste can be disposed of in several different ways:
 Incineration
 Disinfection
 Microwaves
 RFD (refuse-derived fuel)
 DMR (dry mixed recycling)
 Plasma technology
Most of the waste is disposed of by incineration because hospital waste is difficult to process and
recycle. Incineration is the most common disposal method used by the NHS, due to its simplicity,
cost and velocity; however, it produces the most CO2 emissions out of any of the other methods.
Other contaminants as smoke and fine particles are released in the ambient with the incineration
process. Replacing this system with the usage of landfill still require much space, and due to the
nature of the wase, the site will be quickly contaminated. Methods like plasma technology use
extreme amounts of plasma energy to turn waste into usable by-products; however, the energy
required means it is not the most cost-effective or sustainable idea. It is difficult to improve the
sustainability of the waste disposal, as there is no feasible alternative to incineration with the
current technology available, nonetheless minor changes to the disposal chain can make a
significant difference.

The following actions could be taken to make waste management more sustainable:
 Staff to be trained in waste sorting to prevent errors
 Repair damaged beds, chairs etc. instead of discarding
 Increase RFD disposal to create biogas for buses
 Increase DMR disposal for reuse
 Proper storage of waste to prevent harm to the public

12 BREEAM ASSESMENT FOR THE QUALITY

CERTIFICATION OF THE PROJECT
‘’BREEAM is an international scheme that provides independent third-party certification of the
assessment of the sustainability performance of individual buildings, communities and
infrastructure projects’’ (www.breeam.com). This certification is applied for a different type of
structures; from new, refurbishment and renovation. To obtain the certification, the performances
of the building will be examined by impartial experts who will attribute a rating range from
Acceptable (In-Use scheme only) to Pass, Good, Very Good, Excellent to Outstanding. Obtaining an
Excellent or Outstanding rating is difficult because many aspects need to be taken into

16
consideration and not always it is an easy process, especially in giant constructions. BREEAM aims
through its certification to mitigate the impacts of buildings on the environment by promoting a
green approach and stimulate the demanding of green buildings. BREEAM is divided into
categories, and each of them is subdivided into smaller categories. The evaluation of each of them
will generate a scoring which will lead to the ranking of the final project. To better approach high
standards, it is essential to start considering sustainability in the project in the earliest stages.
Being an already existing building does not allow to make any significant changes in categories as
land use and materials. The solutions proposed for increasing the sustainability of the project are
not absolute. However, they were taken in consideration based on the existing and the main
purposes of the report: reduce CO2 emission, increase the amount of green energy that the
hospital can use and create a more sustainable social environment. The improvements in these
categories generally are interconnected with others which will generate an improvement in the
general score.

13 INITIAL BREEAM SCORE BEFORE ANY

CONTRIBUTION
For the BREEAM score, it was decided to give the redevelopment of King’s Mill Hospital a rating of
excellent with a total score of 74.5%. From this, the new goal was the achievement of 80% with
innovative contributions. Areas which required significant improvements were identified to
increase the BREEAM rating. A decision was made to improve the energy, pollution, transport,
health, and wellbeing along with the land use and ecology in order to achieve the proposed goal.

14 BREEAM SCORE AFTER OUR IMPROVEMENTS

14.1 MANAGEMENT
Management Total credits Credits archived
Man 01 4 4
Man 02 4 4
Man 03 6 6
Man 04 4 4
Man 05 3 0
Tot 21 Tot 18
Service life planning and costing is the section that can be updated and can generate
improvements after the building was already constructed. It can involve a sustainable analysis of
the existing and propose innovative ideas to increase the performance of the other categories. A
responsible construction practice can be archived by ensuring the contractor works, taking in
consideration a sustainable construction process and is certified for green buildings. This can also
be extended to construction site impact. Operating with types of machinery that reduce the noise
pollution and the CO2 emission is an effective way to reduce the impact of the constructions on
the environment and the ecosystem. Sustainable procurement is an action that can be taken on
new buildings by ensuring the consideration of sustainability from the beginning of the design
procedure.

17
14.2 HEALTH AND WELLBEING
Health and wellbeing Total credits Credits archived
Hea 01 6 6
Hea 02 5 3
Hea 03 2 0
Hea 04 3 1
Hea 05 3 3
Hea 06 2 2
Tot 21 Tot 15
Visual comfort has been relevantly improved in this project with new considerations. The
window/wall ratio was already maximised in the SANSKA redevelopment, so an additional
component for this section comes from the indoor vertical garden. This innovation improves the
esthetical part, which has an impact on people's mood and on the pleasure of spending time in the
environment. This system also increases the air quality using the plant system to depurate the air
naturally, decreasing in this way the use of ventilators this reduces the amount of energy required
by the building. The external green wall has the function of improving the thermal comfort,
reducing the Heat Urban Island Effect and function as a noise barrier reducing in this way the
acoustic pollution. The indoor green wall also archives the same considerations.
14.3 ENERGY
Energy Total credits Credits archived
Ene 01 12 11
Ene 02 2 2
Ene 03 1 1
Ene 04 3 3
Ene 05 2 2
Ene 06 3 3
Ene 07 N/A N/A
Ene 08 2 0
Ene 09 N/A N/A
Tot 25 Tot 22
For this project, the reduction of CO2 emission and the increase in the amount of renewable
energy the building could use were the main aspects. Implementing the energy system with the
solar system helped to generate more energy and reducing the taxes the hospital must pay to the
government. Because the air is depurated with the green wall system, it can be said that this
contributes to reducing the overall level of CO2 emitted. Energy monitoring was already taking in
consideration by the SANSKA redevelopment, and the only improvement that can be done is
ensuring that the apparatus that is performing this task is the best technology existent now. The
usage of energy for lightening is improved by using more performant typologies of light bulbs and
using a sensor for the light activator. SKANSKA geothermal system can be checked, and
components that do not perform well can be changed to increase the performance of the energy
producer.
14.4 TRANSPORT
Transport Total credits Credits archived
Tra 01 5 5

18
 Tra 02 1 1
Tra 03 2 2
Tra 04 1 1
Tra 05 1 1
Tot 10 Tot 10
The quality of transport has been increased relevantly for this project. Improving the shuttle bus
service has allowed giving a high score to the section regarding the public transport accessibility,
proximity to amenities and cyclist amenities.
14.5 WATER
Water Total credits Credits archived
Wat 01 5 0
Wat 02 1 1
Wat 03 2 2
Wat 04 1 1
Tot 9 Tot 4
Due to the unique and high-standards water quality needs to archive in the hospital, this section
was not involved in the development of improvement. An eventual check can be run on the
procedure proposed by the SANSKA redevelopment in 2011 and eventually improve those
technologies with new ones. A little change that can be done to the water process is to redirect
the water used for hand wash to the flushing system of the toilet. The water used for hand wash is
relatively low contaminated, and it can be used to flush the toilets, so no additional water needs
to enter the system for that purpose.

14.6 MATERIALS
Materials Total credits Credits archived
Mat 01 6 3
Mat 02 1 1
Mat 03 4 3
Mat 04 1 1
Mat 05 1 1
Mat 06 1 0
Tot 14 Tot 9

Except for the material involved for the construction of new parts of the building, this section
could not be taken into consideration for significant improvements in the actual design. A
consideration of what would have been done from the beginning of the project can be given. The
material used for construction would be provided from responsible sources of material, and the
maximum use of them would be done. Consideration of recycling the concrete was given in the
relative section in this report so will not be discussed here again. More approachable insulation
material can be used for this project such as recycled paper insulation, clay aggregate or flax and
hemp insulators.

14.7 WASTE
Waste Total credits Credits archived
Wst 01 4 4
19
 Wst 02 1 0
Wst 03 1 0
Wst 04 N/A N/A
Wst 05 1 0
Wst 06 1 1
Tot 8 Tot 5
Construction waste management is a component that would have been touched in case of new
development. Ensuring that the construction materials are efficiently disposed and efficiently
reused where possible is requisite that should be guaranteed in every single construction site.
Better description regarding this section has been given in its relative part in this report.

14.8 LAND USAGE AND ECOLOGY

Land use and ecology Total credits Credits archived
LE 01 2 1
LE 02 2 1
LE 03 2 1
LE 04 2 2
LE 05 2 0
Tot 10 Tot 5
This section of BREEAM is one of the ones that should take in consideration mainly in the design
part of the project. A slight improvement in it was achieved with ideas that could reduce the
impact on the biodiversity of the site. This was achieved with the outdoor green walls, and its
procedure was explained in the relative section.

14.9 POLLUTION
Pollution Total credits Credits archived
Pol 01 3 3
Pol 02 3 1
Pol 03 5 5
Pol 04 1 1
Pol 05 1 1
Tot 13 Tot 11
Improvements for this section comes mainly from improvement in other sections. SKANSKA
redevelopment already contributed substantially to the surface run-off section, so further
improvement will be to upgrade the technologies used at that time. NOx emissions are decreased
by improving the heating and cooling system.

14.10 INNOVATIONS
The main innovations for this project come from the solar system, the green wall system, the
improvement of the bus shuttle and using the food waste as an energy generator with addition to
the cyclising system. Each of these was specifically described in their relative sections with other
small innovations. All together allows giving the innovation section in BREEAMS a score of 8/10.

20
15 CONCLUSIONS
In this design project, the initial goal was of improving the BREEAM rating from 75.4% to 80%.
With the innovative ideas, the score for management, health and wellbeing, energy, transport and
innovation have been improved. The innovations classified the project as excellent with an
indicative total score of 81.7%, which surpasses the initial goal of 80%.
It needs to be specified that there is additional space for further innovation, and the ones
proposed can always be improved by new technology. Being operative in the sector can help to
make a better decision and allows to take in considerations essential factors not relevant from the
theoretical point of view.
The scopes proposed for this report have been archived. A reduction in the CO2 emissions, the
design of e new green energy system and an improvement in the socio-aspect related to the
building has been verified.

21
 16 APPENDIX
16.1 BREEAM RESULTS BEFORE OUR CONTRIBUTION

Environmental
16%
No. credits Indicative no. % credits Section Indicative
Section available credits achieved Weighting Section Score
14% Achieved
Management 21 17 80.95% 12.00% 9.71%
Health
12% & 21 13 61.90% 15.00% 9.28%
Wellbeing
10%
Energy 25 18 72.00% 15.00% 10.80%
Transport 10 8 80.00% 9.00% 7.20%
8%
Water 9 4 44.44% 7.00% 3.11%
Materials 14 9 64.29% 13.50% 8.67%
6%
Waste 8 5 62.50% 8.50% 5.31%
Land
4%
Use & 10 5 50.00% 10.00% 5.00%
Ecology
Pollution
2% 13 11 84.62% 10.00% 8.46%
Innovation 10 7 70.00% N/A 7
0%
Man- Health & Energy Transport Water Materials Waste Land Use & Pollution Innovation
agement Wellbeing Ecology

Section score available Section score achieved

16.2 BREEAM RESULTS AFTER OUT CONTRIBUTION

Environmental No. credits Indicative no. % credits Section Indicative
16%
Section available credits achieved Weighting Section Score
Achieved
14%
Management 21 18 85.71% 12.00% 10.28%
Health & 21 15 71.43% 15.00% 10.71%
12%
Wellbeing
Energy 25 22 88.00% 15.00% 13.20%
10%
Transport 10 10 100.00% 9.00% 9.00%
Water 9 4 44.44% 7.00% 3.11%
8%
Materials 14 9 64.29% 13.50% 8.67%
Waste
6%
8 5 62.50% 8.50% 5.31%
Land Use & 10 5 50.00% 10.00% 5.00%
Ecology
4%
Pollution 13 11 84.62% 10.00% 8.46%
Innovation
2% 10 8 80.00% N/A 8

0%
Man- Health & Energy Transport Water Materials Waste Land Use & Pollution Innovation
agement Wellbeing Ecology

Section score available Section score achieved

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