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Pioneering Sustainable Healthcare: Lessons from the UK’s First Passivhaus Health Centre

The power of collaboration: integrating Passivhaus certification, modern methods of construction in the UK’s first Passivhaus Health Centre for a Greener NHS

The UK healthcare sector is taking a significant step towards a sustainable future with a Greener NHS (www.england.nhs.uk/greenernhs). 

CHP’s £3.3m Foleshill Health Centre (FHC) in Coventry is the first example of a UK health centre achieving Passivhaus Classic certification – the leading international low-energy building standard. This case study explores the key takeaways from this pioneering project, specifically focusing on the benefits of Passivhaus design principles and modern methods of construction (MMC) in delivering high-performance, environmentally friendly, sustainable healthcare facilities.

Foleshill Health Centre pushed the boundaries of energy efficiency in primary care, the project utilised a proven methodology to achieve exceptional results. Constructed from prefabricated modules by Portakabin, the entire build process was completed in only 10 months, a 30% reduction in time compared to traditional methods. This rapid construction timeline was advantageous during the challenges presented by the COVID-19 pandemic in 2020-21. 

Foleshill Health Centre opened to patients in August 2021.

Passivhaus for energy efficient buildings

Passivhaus certification is a rigorous energy-efficient building standard that prioritises airtightness, high-performance insulation, and maximising passive solar gain. 

CHP chose the Passivhaus approach because of its overall sustainability ethos with low running costs, ultra energy efficiency, and health benefits. Foleshill Health Centre demonstrates significant reductions in heating and cooling costs, creating long-term financial benefits for the NHS.

Passivhaus at Foleshill Health Centre

graphic of passivhaus building showing air flow and heat source pump
  • Photovoltaic panels on the roof provide electricity and there are no fossil fuels on site.
  • All the lighting is provided by energy efficient LED lamps.
  • The building is highly insulated, so it’s warm in winter and cool in summer.  There is a small heating system using air source mechanical heat recovery pumps connected to small radiators.
  • The insulation exceeds the building regulation fabric insulation values by about 40%.  The building is very airtight – the leakage rate roughly equates to a hole the size of a golf ball across the whole building.
  • Fresh air is circulated 24/7.   All rooms have 100% fresh air from ducts in the ceiling, supplied from ventilation that recovers heat from stale air leaving the building via the mechanical heat recovery unit.
  • Foleshill’s energy efficient features include triple-glazed windows, which can be opened if required.
  • The windows have brise soleil shading that breaks up the sun’s rays to reduce direct summer sunshine entering the building contributing to the comfortable internal summer temperatures.

Project Overview: Achieving Sustainability Through Innovation

Constructing a new NHS health centre is a complex undertaking to provide a community asset for patient care. From a technical and planning standpoint, success hinges on a well-coordinated approach to working with stakeholders and the build partners, considering timescales, budget constraints, and the needs of the clinical team transitioning into the new space.

As a Department of Health and Social Care (DHSC)-owned NHS Company Community Health Partnerships works in partnership with local health and care systems. Our purpose is to provide innovative and sustainable spaces for patient care.  Our modern buildings are underpinned by their quality, value, and adaptability.  The NHS estate has a crucial role to play in supporting the delivery of a sustainable health service.  CHP funded the construction of Foleshill Health Centre and owns the building.

Since Foleshill Health Centre opened in August 2021 the team at CHP and our partners have hosted visits from staff at DHSC, leaders from NHS England, National Estates and Facilities teams, regional NHS organisations, and Sustainability leads.  In addition, the CHP Programme Manager has given many presentations including to DHSC, the Institute of Healthcare Engineering and Estate Management (IHEEM), Constructing Excellence, and sustainability organisations such as the Passivhaus Trust (www.passivhaus.org.uk). 

Foleshill Centre from west white render wood style claddin and black sunshades

Certificates

  • Awarded Passivhaus Classic certificate in October 2021
  • The current EPC A rating is 12 close to net zero.
    An EPC rating of 0 (net zero carbon) is possible with additional roof mounted photovoltaic panels as there is sufficient roof space.
  • Achieved BREEAM Excellent with Innovation credit for exemplary energy performance.

Community Health Partnerships vision for Foleshill Health Centre

The CHP Board and Executive had the vision and commitment to build Foleshill Health Centre.  Partnership working is key – it’s not just that CHP is used to collaborative working because of the LIFT model.
Read: NHS LIFT Estate

CHP teams have a ‘can do’ attitude demonstrated by our values:

  • A Commitment to working together to deliver solutions for our customers and partners.
  • Accountability and leading by example.
  • Respect by actively listening and giving feedback, sharing information and knowledge.
  • Promoting inclusivity by valuing everyone for who they are and acknowledging their skills.
  • Communicate effectively and be open minded.

CHP and the build team learnt a great deal from building Passivhaus Foleshill Health Centre in 10 months in 2020 and 2021 during the COVID-19 pandemic and would like to share this knowledge.

Strategic planning - partnership and a shared vision

CHP decided on an offsite modular solution from the outset, including Passivhaus, working with a Passivhaus-accredited Architect (Tooley Foster) and Portakabin as the main contractor. Early engagement with the design and contractors’ teams was critical to the success of the project. Both were engaged in late 2018 as part of the initial design and concept stage of the project.

The construction sector is traditionally adversarial, but it doesn’t have to be like this. The FHC build delivery partners had a collaborative approach and worked as one team.  CHP, main contractor, architect, cost consultants, Project Managers, and the full supply chain of the project needed to understand the project, the vision and be behind it.

In addition to statutory regulations, additional guidance documents inform the design of healthcare facilities.

  • Health Technical Memorandum (HTM): These NHS guidelines define minimum standards for healthcare building design, construction, and use. These cover aspects like room layouts, ventilation, hygiene control, and accessibility for patients with disabilities. Early adherence to HTMs avoids costly rework later.
  • Health Building Notes (HBN): give best practice guidance on the design and planning of new healthcare buildings and the adaptation or extension of existing facilities. They provide information to support the briefing and design processes for individual projects in the NHS building programme.

There are additional considerations when constructing health centres including:

  • Infection control: Designing with hygiene in mind is paramount. Utilise materials with easy-to-clean surfaces and use suitable ventilation systems with defined airflow rates.
  • Security and safety: Implement robust access control systems, fire safety measures, and emergency evacuation plans. Ensure the building incorporates features like slip-resistant flooring and adequate handrails to minimise patient falls.
  • Testing and commissioning: Thoroughly test all building systems – plumbing, electrical, ventilation – before occupancy. Ensure medical equipment is properly calibrated and integrated with the IT network.
  • If the tenants are known at the start of the build, involve them in the design process early and keep them involved.
  • Keep the future NHS tenants up to date with what is happening with the build, for example, newsletters, videos, site visits, etc.
  • Contract for services: Get the contract to provide health services in the building signed early.
  • What are the key strategic objectives?
  • CHP decided on offsite modular early to meet Passivhaus standards, working with Portakabin, the main contractor, and Tooley Foster the architects from the start.
  • Get the experts from the wider team involved in the brief, for example, the sustainability lead for Portakabin; identify, engage, and use the main contractor’s supply chain.
  • Use new technology: point of use water heaters in FHC reduce the risk of legionella and work well in larger health facilities.
  • CHP has commissioned a further study to consider how Passivhaus principles could be applied to our existing health estate. The soon to be published document explores how this could be achieved, and at what cost. This builds upon the 2016/17 desktop study based on two existing LIFT buildings.
  • Consider the project needs for adaptable/generic space in the future, especially for buildings larger than Foleshill. Be clear about space needs from the outset for different organisations or clinical specialities.

Budget

Be realistic at the beginning in both cost and time. Accurate budget setting is key, as it defines the value for money, evaluation should be based on whole life cost not just the capital investment.

CHP took a whole life cost approach to the build. The upfront cost is higher for a Passivhaus building but the whole life cost approach and rising energy costs means the breakeven date was earlier than expected. Shifting the focus beyond initial construction costs to a lifecycle perspective is crucial. Lessons learned indicate that Passivhaus certification and energy-efficient features lead to significant cost savings over the life of the building.

Currently it costs more to build to Passivhaus standards, but the operational costs are significantly reduced with an energy-efficient building and with the increases in energy cost the operational savings are significant.

There are no fossil fuels on-site, so Foleshill has weathered the rising fuel costs issues compared to other new NHS buildings. There has been an 11.58% year on year increase in energy costs over the last 10 years, with the energy market still showing signs of volatility in 2024/25.

While potentially having a higher capital cost, Passive -accredited buildings can offer significant long-term benefits.  These benefits include:

  • Resource efficiency Sustainable options often prioritise water conservation or energy-efficient features, contributing to the overall Passivhaus goals.
  • Durability and extended lifespan Sustainable materials are often designed and manufactured to last longer, reducing replacement costs over time.
  • Lower maintenance needs Sustainable fixtures may require less frequent maintenance, leading to reductions in Facilities Management staff time and resource savings.

Buy high-quality furniture, such as ergonomic office chairs, to promote staff comfort and wellbeing.

Have a budget and agreed timescales for NHS IT connections.

  • Financial monitoring: Implement a robust system for tracking project costs. Regularly compare actual expenditures to the budget and address any deviations promptly.
  • Risk management Identify potential risks that could cause delays or budget overruns, such as unexpected ground conditions or material price fluctuations.
  • Agile project management A flexible management approach allows for adjustments to address unforeseen challenges or opportunities to integrate new technologies during construction. 

Design Considerations

Set the budget appropriately. Be pragmatic and realistic. 

Develop a detailed project schedule outlining key milestones, construction phases, and equipment procurement timelines. Identify potential delays and establish contingency plans.

Consider phased construction, particularly for larger health facilities. This allows for sections to be completed and services relocated while construction continues on other sections, minimising disruption.

Develop a detailed project schedule outlining key milestones. Prefabrication in controlled environments with MMC reduces on-site construction time, minimises disruption to existing services, and should lead to a more predictable budget.

Early collaboration with suppliers ensures timely delivery and minimises price fluctuations that could impact the budget.

Technical

  • Ensure enough time from consent to approval; it took two years from the outline business case to the full business case for FHC.
  • Make sure due diligence is done very early.
  • Encourage and support the involvement of key stakeholders – ICS, Trust, GPs, and clinicians.
  • CHP worked with the business case writer engaged by the then Clinical Commissioning Group as part of the FHC project team; have the best team in place, with the right expertise.
  • Plan the business case layout, text and information required from the start with attention to detail.
  • Work collaboratively with the people approving the business case to identify and solve issues at early stages, especially on projects deviating from normal practice, such as Passivhaus.

NHS England required the FHC team to use the Design Quality Indicator (DQI) process (www.dqi.org.uk) to ensure the solution was Useful, Durable and Beautiful. The five DQI stages allow the project team to engage with a wide stakeholder group, consider the needs of stakeholders at early stages, test solutions, and ideas to ensure the building meets users’ needs.

Build progress and time savings

The Foleshill Health Centre was watertight in three days from the module delivery in Dec 2020. This meant work could continue at pace inside the building in the colder months.

Modern Methods of Construction helped reduce time on site because so much work was done during the factory build in York, so fewer trades were required on site at Foleshill during the 2020 and 2021 lockdowns.

Built with 14 specially designed Portakabin modules to Passivhaus standards, there were only 25 weeks between 10 December 2020, when the modules were delivered on-site in Coventry, and practical completion of FHC on 4 June 2021. This was an estimated saving of 13 weeks compared to a standard delivery programme.

Foleshill Health Centre from the west

Partnership and collaboration - a shared vision

One of the key success factors of FHC was the collaborative and partnership approach to design and construction. Unlike traditional methods, a team of experts from different disciplines worked together seamlessly. The teams from CHP, Tooley Foster (Passivhaus architects), collaborated with cost consultants AECOM, with Portakabin functioning as the design, development, and build contractor, creating a single point of accountability for cost, schedule, and quality.  The project also benefited from the support of the locally-based LIFT Company, Arden Estate Partnerships and gbpartnerships (the LIFTCo Management Services Provider).

This integrated approach ensured efficient project management and allowed the design to be optimised for the chosen modular construction method.  The collective effort demonstrates the importance of strong partnerships in realising ambitious and sustainable healthcare infrastructure projects.

For the FHC construction, the CCG/ICS wanted a modern health centre in an area of high health need where patients could access primary care close to their homes. Coventry and Rugby GP Alliance (GP Provider organisation) wanted a high-quality new space for an expanding GP team and patient list.  They wanted to future-proof the space for expansion over the medium term as the demographics in the Foleshill area of Coventry changed.

Involve clinical staff, patient representatives, NHS management, and sustainability experts from the initial planning stages. Their combined input on workflow needs, patient demographics, environmental responsibility, and future service aspirations is crucial.

The success of any complex healthcare construction project hinges on effective leadership and a collaborative team environment.

  • Strong project leadership A dedicated project leader with experience in healthcare construction provides clear direction, fosters open communication, and manages stakeholder expectations.
  • Collaborative team culture Encourage collaboration and build relationships between architects, engineers, construction crews, clinical staff, and sustainability experts ensuring a holistic approach that addresses all project issues. Meet face-to-face when you can, to help develop the team.
  • Empowered teams Empowering team members at all levels to contribute their expertise and identify potential issues fosters a sense of ownership and leads to better decision-making.

Effective Communication - building trust and transparency

Clear and consistent communication fosters trust among stakeholders, minimises misunderstandings, and ensures everyone is working towards the same goal.  Keep communication open, supportive, adaptable and a ‘one team’ approach.

Schedule regular meetings with all stakeholders, including clinical staff, NHS management, patient representatives, architects, engineers, and construction crews. These meetings should have a clear agenda, dedicated time for updates from each stakeholder group, and opportunities for open discussion and question-raising.

Providing clear and concise information, even if it’s not always positive, builds trust. This includes keeping stakeholders informed of potential delays, budget adjustments, or unforeseen challenges. Early communication allows for collaborative problem-solving and mitigates the risk of misunderstandings or frustration.

Avoid technical jargon and acronyms that may not be understood by everyone involved. Present information clearly and concisely, using visuals and diagrams where appropriate, to ensure everyone grasps the project’s progress and complexities.

Effective communication is a two-way street. Actively listening to concerns and feedback from all stakeholders demonstrates that their input is valued. This fosters a sense of collaboration and ownership over the project’s success.

Consider appointing a dedicated communication lead working with the build partners to manage information flow, develop communication strategies, and serve as a central point of contact for stakeholder enquiries.

The garden of Foleshill Health Centre
Foleshill Health Centre from the south with window shades reducing heat gain within the building by deflecting sunlight.

Telling the Story of Foleshill Health Centre: A Greener NHS Success Story

  • Multi-channel communication Utilise a variety of communication channels to reach all stakeholders effectively.  Plan for and maximise opportunities for shared promotion, news updates, social media, and trade press, working with the NHS clients and the build partners.   
  • Visual storytelling High-quality photography captured the construction process, completion, and the building in use. Videos, including drone footage and timelapse, further enrich the story.
  • Awards and recognition A dedicated plan for award submissions, collaborative application writing, and data collection culminated in Foleshill winning 14 awards and receiving numerous commendations and shortlistings.

Preparing for Patients - commissioning and handover

The DQI process highlights the importance of engaging with the local community throughout the planning process. This fosters a sense of ownership and encourages responsible healthcare practices within the community.

  • Keep the local population and key stakeholders involved from the neighbourhood around the building. Arrange site visits during the construction phase and an official opening. 
  • The speed of the modular build at Foleshill Health Centre meant fewer people on site, fewer trade vans, and less local congestion.
  • Update the local community, and local organisations especially if the new health facility is on a brownfield site or a former public sector site.
  • Training and familiarisation Provide clinical staff with training in advance of occupation on the new building’s features, including emergency procedures, access control systems, and medical equipment operation. This fosters confidence and ensures smooth operation when they move in.
  • Testing clinical workflows Once the equipment is installed and the facility is operational, conduct trial runs to test clinical workflows and patient flow. This allows for adjustments and identification of potential bottlenecks before patients arrive.
  • Sustainability training Include sustainability principles and procedures for using the energy-efficient features of the new health centre into staff training. This fosters a culture of environmental responsibility within the clinical team.
  • IT User Training Ensure all staff receive proper training on the new IT infrastructure and any new healthcare software implemented in the facility. This minimises disruption to patient care upon transitioning.

Develop patient education materials highlighting the health facilities’ sustainable features and how patients can contribute to responsible energy use during their visits.

  • Sensor monitoring CHP funded a three-year monitoring phase using sensors to gather usage and data for NHS England.  This monitoring provides an assurance that the building is performing as designed and allows early warning of issues.
  • Design Quality Indicator (DQI) process (www.dqi.org.uk) Stage Five focuses on evaluating the building after it has been completed and occupied by users. It essentially functions as a Post-Occupancy Evaluation (POE) or Building Performance Evaluation (BPE).  The purpose is to assess how well the building design meets the needs of its users and achieves the initial goals set during the project’s earlier phases. This feedback loop helps improve future designs.  Stage five activities include:
    • Conducting workshops with building occupants to gather feedback on the building’s functionality, comfort, and aesthetics.
    • Analysing data on energy use, maintenance needs, and occupant satisfaction.
    • Comparing the building’s performance to the initial design goals set in earlier DQI stages.
    • Identifying areas for improvement in future design projects.
  • After the health centre is operational, conduct a post-occupancy evaluation to gather feedback from staff and patients. This feedback can be used to identify areas for improvement and inform future healthcare centre construction projects.

Future Projects: What would CHP do differently next time?

Foleshill is the first Passivhaus health building in the UK, and the forecast operational savings are significant. If a programme of standard Passivhaus facilities was planned the cost saving in design, delivery, procurement, and element cost would be amplified and outturn is likely to achieve a build cost similar to a traditional build.

Constructing a health centre to meet net zero would be a key consideration

Carbon Net zero targets and a GreenerNHS

The NHS aim to be the world’s first net zero national health service was instigated on 1 October 2020, as Foleshill Health Centre’s 14 off-site modules were being constructed in Portakabin’s manufacturing facility in York. It was therefore too late to incorporate those aims for the Foleshill Health Centre project. 
Read: Greener NHS www.england.nhs.uk/greenernhs.

Foleshill leads the way for carbon emissions reduction in the NHS. 
Energy consumption at Foleshill is equivalent to an average four-bed house but it is four times the size. 
The energy consumption is less than a third of a similar size conventional health centre.

Design and build to reach net zero

The Passivhaus Trust have three classes – Classic, Plus and Premium, with the latter including renewable energy to achieve a true net zero performance in operation.  

Procurement savings

CHP used the NHS SBS modular framework to select the contractor. This framework allows for direct award thus saving significant time and cost in the procurement stage. NHS SBS frameworks were also used for principal members of the project team. Whilst neither framework included Passivhaus experience as an option, the frameworks provide a good selection of organisations that could then be explored for passive understanding/accreditation.

Sustainable materials and features

Building with responsibly sourced, low-carbon materials like recycled steel or sustainably managed timber minimises the environmental impact of the construction process. There is growing availability of such materials without compromising structural integrity.

Additional sustainable features such as  water reduction. water conservation systems, and natural lighting solutions contribute to long term cost savings and a reduced environmental footprint.

Outdoor space and biodiversity

Views of greenery and access to outdoor spaces create a healing environment for patients and improve staff wellbeing, contributing to a Greener NHS and set an example for the local community.  

100% renewable energy

Aim for all power needs to be provided by on-site generation including using photo voltaic panels. Consider how energy storage could be incorporated into the design solution.

Future Proofing

Healthcare evolves, so design flexible spaces that can adapt to changing technologies and service models. Modular walls and adaptable infrastructure can accommodate future expansion or reconfiguration of services.

Foleshill Case studies

Foleshill Health Centre, appears in a HM Government publication Promoting Net Zero Carbon and Sustainability in Construction – Guidance Note (page 39 PDF) published in September 2022. This guidance supports The Construction Playbook (PDF Sept 2022) first published in December 2020.

Foleshill Heath Centre is a case study in the ‘State of the Estate 2021/22′ report (PDF) published by the Government Property Function.  This report summarises progress in improving the efficiency and sustainability of the government estate in accordance with the 2008 Climate Change Act.  

Read: State of the Estate in 2021-2022 – GOV.UK (www.gov.uk)

Partnership working at Foleshill Health Centre

CHP are proud to work with our NHS and delivery partners on the first UK health building built to meet Passivhaus standards.  This innovative, sustainable building continues to provide high quality care for the people of Foleshill in Coventry.  Foleshill Health Centre has won or been highly commended in 14 awards since it opened in August 2021.

Foleshill Health Centre NHS Partners: NHS Coventry and Warwickshire with Coventry and Rugby GP Alliance.

Delivery partners:  Community Health Partnerships, Portakabin (Main contractor), Tooley Foster Architects (Passivhaus experts), AECOM infrastructure consultants and Arden Estate Partnerships Limited (development management part of gbpartnerships).

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