Resilience of ‘Nightingale’ hospital wards in a changing climate:
Abstract: The National Health Service (NHS) Estate in England comprises more than 30 Mm2 with 18.83 Mm2 of acute hospital accommodation on 330 sites. There is concern about the resilience of these buildings ...
Summary (2 min read)
- In England, 22% of National Health Service (NHS) acute hospital buildings pre-date 1948,1 and on some sites the majority of wards are of this type.
- In the post-2008 economic climate, however, the possibility of wholesale replacement is much diminished.
- 9,11 Thus although the NHS Heatwave Plan advocates a ‘passive approach’ to coping with heatwaves, it also suggests that the NHS should ‘target vulnerable areas (patients, medications, IT) with air conditioning’.8.
2 The Nightingale ward as a recurrent hospital building type
- The first use of the ‘Nightingale’ ward in British hospital design dates from the 1860s, although its roots are found in 18th-century French hospitals.
- It was advocated by various figures, not least Florence Nightingale, nurse, reformer and writer.
- Wards arranged as long, rectangular single-storey blocks, cross- and stack-ventilated by tall opposing windows, seemed to yield the most benign environments.
- Recent computational fluid dynamic modelling work has indeed demonstrated that significant rates of air change can be achieved.
- There was until the 1960s no national design guidance for hospitals, but some common patterns are recorded in Table 1.
3 Bradford Royal Infirmary
- Bradford Royal Infirmary moved to new buildings on the city’s western outskirts between 1927 and 1937.16.
- The hoppers had a double folding hinge enabling almost all free area to be realised .
- Orientation and layout Typically north/south pavilions, with separate ‘sanitary tower’ to one side, accessed via ventilated lobby.
- The below-window ventilators have been blocked; the convectors are modern replacements of the original ‘hospital’ radiators.
4.1 Internal temperatures
- The internal temperatures in four distinctly different spaces are currently being recorded at hourly intervals using Hobo U12, Hobo pendant and Tiny Tag loggers.a.
- During the monitoring period, the ambient temperature was not especially warm, reaching a maximum value of just 24.18C (see sections 4.2 & 5).
- Overall therefore it is evident that the temperatures in all the spaces were rather well controlled and well within the wide range recommended for wards by Health Technical Memorandum HTM03-01 of 188C to 288C,10 despite reduced ventilation capacity.
- The temperatures measured by each sensor are plotted against the running mean of ambient temperature, with the category envelopes overlaid, in Figures 8 to 11.
4.2 Energy use and CO2 emissions
- To predict the annual energy demands and resulting CO2 emissions of the Nightingale bHere and elsewhere comfort is as defined by the BSEN15251 categories and not by patient, staff or visitor perceptions.
- Further, predicted maximum, mean daytime and mean night-time operative temperatures were 28.28C, 23.68C and 22.98C, respectively, very similar to the monitored maximum, mean daytime and mean night-time operative temperatures were 28.28C, 23.48C and 22.78C.
- The model predicted 179 annual hours above the BSEN15251 Cat I upper temperature threshold.
- Across all UK hospitals these other elements would be about 44% of total energy demand.
- Notwithstanding this uplift, the adjusted energy demandc of about 25GJ/100m3 is well below the NHS target of 55–65GJ/ 100m3 for refurbished buildings and, indeed, below the target of 35–55GJ/100m3 for new buildings.
5 The refurbishment options and performance in current climate
- Current economic circumstances place a particular premium on light-touch refurbishment of NHS sites; similarly, a wholly reasonable concern to improve the patient experience also means that cosmetic changes can be favoured over more substantial interventions.
- The results were assessed using the CIBSE overheating criterion for night-time and the HTM03 criterion for all hours, except the option with the fan (Option 2), which is not amenable to analysis using HTM03.
- Rather importantly, however, the refurbishment reduces the impact of higher ambient temperatures and solar gain, resulting in a reduction in the peak temperatures (Table 4).
- Option 3 has the same insulation standards and shading as the other options, but seals all the windows.
- Primary heating and cooling is delivered through the installation of radiant ceiling panels (Table 3).
6 Performance in a future climate
- The standard temperature files for the current weather in Bradford, the Test Reference Year (called 2005TRY) and the Design Summer Year (called 2005DSY), were developed by the University of Exeter using the customary CIBSE methods as described by Levermore and Parkinson.
- Thus, as the years go by, the difference between the temperatures in typical and extreme years is accentuated.
- This approach is consistent with that taken previously by the authors.
- The results clearly indicate that neither the existing or refurbished building will overheat in typical years, as judged by the HTM03 and BSEN15251 criteria but in the 2050s warmer night-time temperatures may be experienced (although these might be ameliorated easily with a refined window opening regimen).
- What might be regarded as an archaic and redundant hospital building type, problematic in its plan geometry, reveals a degree of resilience to summertime overheating in gThis is the adjacent 5 km grid to the one containing the Bingley meteorological station.
- The narrow sections, high floor to ceiling heights, and the potential for cross ventilation, plus the mass inherent in the masonry and concrete construction, deliver the basic resilience.
- The addition of a slow fan (Option 2) further reduces the hours outside the Cat I envelope.
- The anxieties expressed relate to the facilities management issue of cleaning and infection control.
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Cites background from "Resilience of ‘Nightingale’ hospita..."
...Whilst the Addenbrooke’s tower in Cambridge, with or without a simple retrofit, ceiling fans, is used to develop themethodology, it has already beenused to assess the climatic resilience of Nightingale wards located in the North of England  and to evaluate a range of fabric and energy-system refurbishments....
Cites methods from "Resilience of ‘Nightingale’ hospita..."
...The current lead author has also used the BSEN15251 method to evaluate measured hospital bedroom temperatures (Lomas and Giridharan, 2012, Lomas et al., 2012) and the method is used here for assessing both living rooms and bedrooms; interestingly, the room type does not influence the category…...
Cites background from "Resilience of ‘Nightingale’ hospita..."
...Refurbishment of existing hospital buildings could improve thermal comfort [21, 22] and solar shading options may help to reduce internal temperatures....
...Modern or temporary buildings may perform worse in terms of thermal regulation than older buildings [22, 28, 21, 29]....
...However, increased use of mechanical cooling would undermine the NHS Carbon Reduction Strategy and contravene the Climate Change Act [21, 22]....
Related Papers (5)
Frequently Asked Questions (2)
Q1. What are the contributions in "Resilience of ‘nightingale’ hospital wards in a changing climate" ?
Short et al. this paper investigated the resilience of the NHS Retained Estate and proposed economical and resilient strategies for its adaptation in a changing climate to maintain what current guidance considers acceptable thermal conditions.
Q2. What future works have the authors mentioned in the paper "Resilience of ‘nightingale’ hospital wards in a changing climate" ?
The future weather years were created from the UKCP09 future climate projections assuming an A1B global emissions development scenariof using the method evolved by the University of Exeter for the ‘ Prometheus ’ research project. It can be seen that the occurrence of higher temperatures increases gradually in the TRYs but quite rapidly in the DSYs. The results clearly indicate that neither the existing or refurbished building will overheat in typical years, as judged by the HTM03 and BSEN15251 criteria but in the 2050s warmer night-time temperatures may be experienced ( although these might be ameliorated easily with a refined window opening regimen ). The BSEN15251 approach, which accommodates human adaptation to the prevailing ambient conditions and thus their preference for warmer conditions in free-running buildings as the ambient conditions become warmer, indicates that the refurbishment options that do not incorporate cooling will remain comfortable in both typical and extreme years right up to 2080s.