1. Lord Carter’s ground-breaking report,
published in February, highlighted how the
NHS could generate £5 billion worth of
savings for acute hospital trusts in England,
which spend around £55.6 billion per
annum. With hospital estates spending
some £750 million on energy each year, one
of the key recommendations was for all
Trusts to have a strategic estates and
facilities would plan that would reduce their
energy costs and contribute to the savings
target required to be achieved by 2020/2021.
Combined Heat and Power (CHP) systems
were among the technologies highlighted.
Cynergin, one of the leading energy savings
companies (ESCOs), is working in
partnership with Trusts across the country
to invest in the latest technologies that not
only boost their environmental credentials,
but will also drive down their energy costs
and deliver tangible savings.
With their 24/7, 365 day a year
functionality, hospitals are, by their nature,
high energy consumers. Heavily reliant on
electricity, hot water, steam, cooling, and
air-conditioning, they are ideal candidates
for CHP systems, which can produce the
energy required for these functions.
Indeed the number of hospital Trusts
investing in CHP systems is climbing
steadily, and for many combined heat and
water. CHP systems waste less fuel than
a combination of grid electricity and local
boilers, and produce less CO2. As the
health sector is a heavy energy user, the
potential benefits for the NHS are
significant (see Figure 1).
Cynergin has collaborated on a
number of CHP projects, understands
the technology, and has various projects
at different stages that can provide
a valuable insight and showcase exactly
what can be achieved. As Dr Howard
Stone, a director at Cynergin explains,
there are five key stages that hospitals
need to consider and go through before
they can sit back and reap the rewards
of their investment. These are:
Experience shows
a strong case for CHP
Carbon and energy reduction
With considerable pressure on NHS Trusts to make energy and cost savings, and simultaneously to reduce
their emissions and carbon footprint, energy services company and Energy Performance Contract (EPC) specialist,
Cynergin, takes a look at how Trusts across the country are ‘overhauling their energy infrastructures and moving
towards greener technologies with CHP systems at the heart of many projects’.
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Health Estate Journal
September 2016
power forms a major part of their overall
strategy for reducing energy and their
dependence on the National Grid. Lower
and more predictable energy bills are
clearly attractive for any estates manager
looking both to balance the books and
meet environmental obligations.
A simple process
The principal benefit of a CHP system is to
save money and have a reliable
continuous source of heating, hot water,
and electrical power for lighting and other
services. The process is relatively simple; a
CHP system burns fuel – typically natural
gas –to generate electricity, and useful
heat is generated for heating and hot
Figure 1: CHP systems’ benefits for
NHS Trust users
ᔢ Lower energy bills.
ᔢ Combats escalating price rises and
volatility in the energy markets.
ᔢ Reduces fossil fuel consumption.
ᔢ Reduces emissions.
ᔢ Lowers carbon footprint.
ᔢ Affords greater security of supply and
the required quantity of hot water.
ᔢ Availability of grant funding.
Cynergin says many NHS Trusts are ‘overhauling their energy infrastructures and
moving towards greener technologies with CHP systems at the heart of many projects’.

2. ᔢ Type of contract
ᔢ Feasibility and business case.
ᔢ Detailed design
ᔢ Installation.
Maintenance
Dr Stone said: “We believe in adopting
a collaborative approach right from the
start, so that our clients end up with a
project that fits into their overall estates
and facilities strategy and maximises
their savings.”
Let us now look at some Trusts’ recent
‘real-world’ experience of carbon and
energy reduction projects which have
harnessed the benefits of CHP.
Maidstone and Tunbridge Wells
Hospitals, Kent
Maidstone and Tunbridge Wells NHS Trust
has already been through the tender
selection process and is now ready to
present its proposals to the hospital board.
A large acute Trust in Kent, the organisation
covers a huge area, and provides a full
range of general hospital services as well as
more complex care to people living in the
south of West Kent and the north of East
Sussex. The Trust’s core catchment areas
are Maidstone and Tunbridge Wells and
their surrounding boroughs, which are
served by two sites – Maidstone Hospital in
Barming and the newer Tunbridge Wells
Hospital at Pembury, the latter a PFI hospital.
Originally built on a greenfield site in
1983, Maidstone Hospital has undergone
substantial changes in the past 30 years.
It has had extra wings added, a
self-contained orthopaedic unit built,
a new Eye, Ear and Mouth unit in 2003,
a new Cellular Pathology Centre, stroke
unit, and a refurbished intensive care unit,
surgical training centre, and a new birth
centre.
Notable firsts
Maidstone Hospital’s Oncology Centre
provides specialist cancer services for
the whole of Kent, and also for Hastings
and Rother in East Sussex. The hospital
also has an Emergency Care Centre, and
was one of the first hospitals of its kind
in the country to offer full A&E alongside
a GP out-of-hours service and walk-in
centre under one roof.
The hospital has grown considerably,
and for environmental, as well as cost-
saving reasons, Jeanette Rooke, director
of Estates and Facilities, and her team
have looked at ways of reducing its
carbon footprint and improving its
energy efficiency. The Trust’s Carbon
Management Programme (CMP) has
already reduced emissions by three
million kg /m2
during 2012/13 – a 13%
reduction, with savings attributable to
improvements to thermal insulation,
heating and air conditioning controls,
the replacement of traditional hot water
calorifiers with plate heat exchangers,
energy management software to improve
the monitoring and targeting of energy,
and the installation of energy-saving valves
and boiler monitoring in the laundry.
Plans for further efficiencies
The hospital, however, had plans to make
further efficiencies, after it saw a 2.4%
increase in its energy spend – to
£3,849,104 – between 2014 and 2015 2014-
2015. The Estates Department identified a
number of areas where the introduction of
new technologies could result in further
savings.
“Hospital estates are leading the way
and making a significant contribution to
the government’s commitment to a lower
carbon economy,” Jeanette Rooke said.
“We are looking at the energy savings
process as a long-term approach to
controlling our energy costs. We looked at
technologies that would not only provide
us with energy savings, but would equally
improve resilience levels and reduce our
maintenance costs, while delivering an
improved environment and patient
experience.”
The Estates Department decided early
on on the type of projects it planned to
undertake. These included the installation
of a 200 kW CHP system, lighting
replacement, Building Management
System (BMS) upgrades, variable speed
drives, and steam system upgrades, at
Maidstone, and a new 800 kW CHP
system at the Pembury site. Using the
standard ‘5 Case Model’, they worked
through the core components:
ᔢ Strategic case.
ᔢ Economic case.
ᔢ Commercial case.
ᔢ Financial case.
ᔢ Management case.
The total cost for the projects is in the
region of £4.5 - £5 million with energy
savings expected to be £600,000-£800,000
per annum.
Easy access to EPC suppliers
The Trust elected to work with Essentia,
which was able to provide it with easy
access to EPC suppliers and go to market
quite quickly. Jeanette Rooks says she sees
three key benefits in working with an EPC:
ᔢ Guaranteed savings
ᔢ Technologies.
ᔢ Access to technical, commercial,
and financial specialists.
She explained: “Essentia helped us to focus
on EPC suppliers, and Cynergin’s technical
expertise shone through. The company
understood exactly what we were aiming to
achieve, and its proposals were focused on
how we could maximise our savings.
Cynergin guaranteed the savings we could
Carbon and energy reduction
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Health Estate Journal
September 2016
Delivery of the 800 kW CHP system at the North Devon District Hospital (NDDH)
in Barnstaple.
Installation of 250 kW of solar panels on
the roof of the NDDH in progress.

3. achieve, offered appropriate technologies
that would help drive down costs, and
provided us with access to specialist skills
to help us achieve our goals.”
Once in receipt of agreement from the
hospital’s board, Jeanette Rooke says she
expects work to start straight away and
benefit from savings quite quickly.
George Eliot Hospital, Nuneaton
It is a case of ‘out with the old and in with
the new’ at the George Eliot Hospital NHS
Trust in Nuneaton. The hospital is already
engaged in a two-year rolling programme
to replace its lighting with more energy
efficient LED technology across the site.
Saving energy and cuttings costs is an
on-going commitment for the hospital,
which is stepping further up to the mark
with a project to replace its old plant room
and invest in a low temperature hot water
(LTHW) system with new gas-fired boilers
and a CHP system.
The hospital is working closely with
Cynergin, and, once the project is
completed in March 2017, the George Eliot
will see its carbon emissions reduced by
1,900 tonnes per year and reap savings of
£450,000 per annum. The timescale for the
George Eliot’s project has moved along at
a good pace. The Trust’s board approved
the outline business case in November
2014. Despite stiff competition from four
other bidders, Cynergin was awarded the
contract five months later, as it was the
only company that offered full removal of
steam. The contract will be managed by
Cynergin over a 15-year period.
Funding was achieved via an interest-
free loan from Salix Finance, and internally
generated capital. “We are working very
well with Salix Finance,” explains Kirstie
Webb, Capital Projects manager. ”They
offered very good advice, and provided us
with a good route for funding. Salix
Finance have been very supportive, and
takes a keen interest at every stage of the
project, and we anticipate working with
them again on future projects.”
Work is now well underway to replace
the hospital’s aged steam system with
a low temperature hot water system with
new gas-fired boilers and a CHP system –
which will reduce the hospital’s
maintenance costs and providing it with
a far more efficient and resilient system.
Sharing ideas and knowledge
Kirstie Webb said of the project: “It is
going remarkably well, and that is due to
the fantastic relationship with Cynergin,
and to sharing ideas and knowledge.” All
health and safety process are in place,
and Cynergin took much of the load off
the hospital’s own estates staff. The new
gas main has already been installed, and
pipework is in the process of being fitted.
The new boilerhouse was constructed
offsite in sections, and will be craned into
place when required and located behind a
sub-station in an area not used by the
hospital. There has been minimal
disruption, which Kirstie Webb attributes
to Cynergin’s meticulous planning and
project management skills. She said:
“Cynergin is very hands-on. There is good
collaboration on both sides. It is very
much a team effort, with good lines of
communication, and we are kept well
informed.” The CHP system is on target for
installation in December and the project is
scheduled for completion in early March
2017, at which point the hospital will be
completely ‘steam-free’.
Northern Devon Healthcare NHS Trust
In April 2012 the Northern Devon
Healthcare NHS Trust (NDHT) published
its Estates Strategy, which outlined its
environmental plans for its sites. Since
2002 the Trust has been active in
addressing a sustainable agenda. NDHT
identified several areas that required
investment, including issues with the
maintenance of buildings, as well as
some major mechanical and electrical
infrastructure improvement work.
A commitment was made to allocate
£1.5 m each year for the next five years to
address outstanding maintenance issues.
Electricity-saving initiatives were also
identified, including the fitting of improved
controls that would reduce the energy
needed to provide heating and hot water.
Energy performance contracts costing
£4.6 m are now underway at four of the
Trust’s sites – the North Devon District
Hospital (NDDH) in Barnstaple,
Holsworthy Community Hospital, South
Molton Community Hospital, and Bideford
Community Hospital.
The NDDH is an acute hospital that
provides a ‘24/7’ accident and emergency
service, as well as a range of general
medical services including cardio-
respiratory, stroke care, and
gastroenterology. General surgical services
include orthopaedics, and vascular and
colorectal specialties. NDDH is recognised
by the Royal College of Surgeons as having
one of the highest rates of day case surgery
in England, while in 2012 it was designated
as a trauma unit within the South West
Trauma Network. A very successful
ophthalmology service is provided from
NDDH, using the latest procedures and
techniques to treat glaucoma and macular
degeneration. In 2014/5 NDDH opened
England’s first purpose-built dementia ward
in an acute hospital, and a new
chemotherapy and day treatment centre,
following a four-year fundraising campaign
inspired by the local community.
Three sites identified
Three of the Trust’s community hospitals
were identified as likely to benefit from
energy efficiency programmes –
Holsworthy Community Hospital, built in
1991; South Molton Community Hospital,
built in 1988 and extended in 1997, and
Bideford Community Hospital, which was
built in 1924 and has been extended many
times. Both Holsworthy and South Molton
have inpatient wards, while and Bideford
is home to a minor injuries unit. All the
hospitals deliver a range of outpatient
clinics and services, including nurse-led
specialist clinics, physiotherapy, and
occupational therapy. “Hospitals are one
of the biggest users of energy, explains
Kevin Ward, deputy head of Estates at
NDHT: “As a public body, we needed to
change, and had a duty to look at how we
could minimise our reliance on fossil fuels
and become less reliant on the National
Grid. The Trust has always been proactive,
and we were looking at energy projects
long before the Carter Report. This report
has served to confirm that we and
Cynergin are taking the right approach,
and Cynergin is helping us drive through
the changes that are necessary.”
Cynergin secured the energy contracts
from Northern Devon Healthcare NHS
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Health Estate Journal
September 2016
New chillers being installed the
Barnstaple facility. The NDDH is an
acute hospital that provides a ‘24/7’
accident and emergency, and general
medical and surgical services.
Indeed the number of hospital Trusts investing in
CHP systems is climbing steadily, and for many
combined heat and power forms a major part of
their overall strategy for reducing energy and their
dependence on the National Grid

4. Trust following competitive tenders. As
well as providing the required technical
expertise required, the company
guaranteed minimum savings for the
duration of the 15-year contract. CHP
systems are at the heart of NDHT’s
strategy, and Kevin Ward believes the
potential for CHP systems is ‘huge’, as the
energy savings benefits ‘can and do make
a dramatic difference for Trusts moving
away from steam’.
Solar panels and new lighting
At the North Devon District Hospital
(NDDH) in Barnstaple an 800 kW CHP
system is currently being installed, along
with 250 kW solar panels on the roof. A
lighting replacement programme is also
underway, and so far some 2,000 LED light
fittings have successfully been installed
and a further 1,000 LEDs are now being
fitted. At the process’s outset, the Trust
had some concerns over logistics, and the
impact upon patients, but work has gone
very smoothly with minimum disruption.
At the three other sites biomass boilers,
solar panels, and replacement lighting
programmes are also underway.
With no gas supply, Holsworthy
Community Hospital is solely reliant on
electricity and oil. The new biomass boiler
will mark a significant step change, and
offer a more resilient solution. The Trust
also ensured that the pellets for the boiler
could be locally sourced locally.
Holsworthy Community Hospital is also
installing 35kW of solar panels fitted, and
renewing its oil fired boiler, to give it an
emergency back-up. A similar project is
underway at South Molton, where, in
addition to a biomass boiler, the hospital is
installing 50kW solar panels and replacing
lighting. The NDDH Trust has already
started to see the benefits. Since January,
across the four sites, the lighting
replacement programme has saved
£46,000, and 174 tonnes of carbon and the
solar panels, £15,000. The biggest savings
are, however, yet to come. When the CHP
system at the NDDH site – currently two-
thirds of the way through the installation
process – is commissioned, Kevin Ward
expects the hospital to realise annual
savings of £300,000- £400,000.
Enhanced reliability
He added: “Not only do we have a more
reliable and efficient addition to the
infrastructure for each site, but when all
the technologies have been installed we
will have more resilient systems thanks to
Cynergin, and expect to be saving £600,000
- £700,000 annually on our energy costs.”
Logistically, the lighting programme has
been the most challenging, but Kevin
Ward is complimentary about the
collaborative working practices, and
Cynergin’s project, management as well
as the work of the Trust’s own Capital and
Facilities Team.
Meanwhile, of the importance of
internal communication to the
replacement programme, with the Trust
communicating to staff the reasons for the
lighting replacement, its benefits, and how
it would put the hospital ‘on a more solid
footing’ for the next 10-15 years, he said:
“It was important that everyone bought
into the lighting project and understood
the benefits. The nursing staff helped with
access, particularly in ‘live’ areas, and
patients were moved only when necessary,
so as to minimise disruption.”
Data capture
The project partners worked with Salix
Finance to secure funding for the energy-
saving projects, and found Salix’s
compliance tool in capturing captured data
and information on the savings that could
be generated, the associated technologies,
and the paybacks. The estimated savings
were calculated by Cynergin, with an
assessment of the project business case
and savings calculation methodology
undertaken by Salix Finance
Finance of £2.8million was sourced from
Salix Finance, with the Trust funding the
balance; total capital outlay for the EPC
projects was £4.6 m.
The projects at NDHT are all on
schedule. Kevin Ward says he attributes
this to the Trust’s strong relationship with
Cynergin, which who supplies regular
reports and holds weekly meetings. NDHT
is considering further projects for the
future, and says it and hopes to continue
working with Cynergin.
Yeovil Hospital
Yeovil District Hospital in Somerset is an
excellent example of what hospitals can
do proactively to optimise their energy
management. Keen to significantly cut its
energy bills and reduce the hospital’s
carbon footprint, by ‘spending to save’,
Yeovil District Hospital NHS Foundation
Trust entered into a 15-year EPC contract
with Cynergin to introduce new
technologies. These both ensured that it
could meet its operational and
environmental obligations, and delivered
more robust systems.
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September 2016
About Cynergin
Founded in 2000, Cynergin is ‘one of the
UK’s leading consultants and energy
services companies’. It specialises in
delivering ‘performance-based contracts
that offer guaranteed reductions in
energy consumption, carbon emissions,
and improved operational performance
on the estates of large public sector
organisations’.
An old steam duct at the George Eliot
Hospital, which is replacing its existing
plant room, and investing in a LTHW
system with new gas-fired boilers and a
CHP system.
The existing boilers at the George Eliot Hospital in Nuneaton.

5. Like many hospitals, Yeovil District
Hospital had, for many years, relied on
steam plant that was 34 years’ old and
had ‘seen better days’. It also used a CHP
system that provided electricity and
additional heat. Maintaining the boilers
was expensive, and the hospital was keen
to put its facilities on a stronger footing
and ‘revolutionise’ its heating and hot
water systems by replacing them with
more energy-efficient technologies.
“The Trust has struggled for a number of
years with a life-expired steam plant that
had swallowed up resources,” explained
David Shire, head of Estates and Facilities
at Yeovil District Hospital. “There are
hidden costs associated with steam plant
– such as leaks that can’t be repaired, and
flooded ductwork, so we jumped at the
chance to replace the steam system with
a LTHW system.”
Greater resilience the goal
As well as seeking energy savings, the
hospital was keen to have greater
resilience. The work at the hospital (HEJ –
March 2014) entailed replacing the ageing
steam boilers with dual fuel boilers that
provided N1 resilience, installing a new
BMS system, re-plumbing the existing
CHP to maximise heat capture, and
installing an additional CHP system that
could support the increased electrical
demands from new clinical equipment, as
well as the air- conditioning in the
hospital’s newly refurbished areas.
The hospital has also replaced some of
its lighting with approximately 1,000 LED
light fittings, contributing to the overall
savings achieved. “The longest part of the
process was agreeing the contract,” David
Shire explained, “but once that was
complete, Cynergin worked quickly to
progress the project to its completion.”
Cynergin guaranteed £5.8 million in
savings over a 15-year contract, equating
to an annual saving of £390,000 in gas,
electricity. and other utilities. The Trust is
also saving 26,000 tonnes of CO2, the
equivalent of 1,700 tonnes of carbon per
year. “Replacing the hospital’s steam
based heating and hot water system was a
huge logistical exercise, but is proving its
worth. “We have had no problems with the
heating, and no breaks in supply,” David
Shire explained.” The Trust is seeing the
benefits of its new primary heating and
hot water system, and is essentially
receiving the savings for free, since as the
guaranteed savings more or less equal the
capital cost, including the capital outlay.
While working with an EPC provider has
many benefits – not least the guaranteed
savings – but Cynergin has also released
the Trust’s maintenance team from
looking after the steam distribution and
heating systems, giving them more time to
focus on other areas.
Looking back, and when asked for any
advice for hospital Trusts looking to start
their own energy projects, David Shire
stressed that planning was key: “Explore
your options, and the type of contracts
offered, but be prepared to test the market
and obtain good references.”
Warrington & Halton Hospital
Faced with an annual energy bill of £2 m,
£11 m in backlog maintenance, and with
a commitment to reduce its carbon
emissions, Warrington and Halton
Hospitals NHS Foundation Trust
successfully entered the NHS Carbon and
Energy Fund (CEF) scheme procurement
process in 2013-14 to install CHP, and is
now working its way through a £4.65 m
Energy Performance Contract (EPC) over
a 15-year period with Cynergin.
Situated to the north of the town,
Warrington Hospital is a 500-bed hospital
with over 3,000 staff, a designated trauma
unit, and has an Accident & Emergency
Department that sees over 100,000
patients each year. Halton General
Hospital, 10 miles away in Runcorn,
has 50 inpatient beds, and an additional
24 beds in an intermediate care ward.
It employs over 1,000 staff, and delivers
a wide range of care for medical and
surgical conditions. Halton also has
a minor injuries unit, provides
chemotherapy services, and houses the
Delamere Macmillan Unit, as well as
a standalone orthopaedic facility.
Over the past few years the two
hospitals have benefitted from over £30 m
of investment. Warrington now not only
boasts a new £1 m specialist dementia
care unit, a £7 m intensive care facility,
and a re-designed labour ward, but has
also seen £2 m invested in its A&E
facilities.
Major investment at two sites
Halton General Hospital, meanwhile, has
benefitted from a £500,000 investment in
the new endoscopy unit, a £1 m
refurbishment of the Macmillan Delamere
Unit, and a new CANtreat cancer centre
and a urgent care centre.
Having met the Foundation Trust’s
criteria. and successfully secured the
tender, Cynergin introduced a number of
energy-saving initiatives, carbon reduction
measures, and upgrades of other facilities
across the two sites which will generate
considerable savings over the next 15 years.
The centrepiece involved centralising
each site’s heating systems with energy-
efficient, dual fuel low temperature hot
water (LTHW) boilers and associated
distribution systems. At the Warrington
site the medium temperature hot water
(MTHW) boilers had been recently
replaced, so these were used within the
project and maintained by Cynergin. A
CHP system to supply 850kW of electricity
and hot water was installed in the plant
room to meet seasonal demand from
spring through to autumn, with the peak
winter demand met by the MTHW boilers.
New building energy management
Systems (BEMS) were also supplied, and a
large number of light fittings in clinical
and non-clinical areas replaced with more
economical and higher efficiency light
fittings. Various water savings measures
were also introduced.
Halton General in Runcorn saw a similar
upgrade programme, with the projects run
concurrently to minimise disruption. The
end result is that the installation of
low/zero carbon technologies is generating
not only financial but also energy and
carbon savings.
Working with Cynergin has delivered a
number of benefits for the Trust, including:
ᔢ Guaranteed energy savings by Cynergin
ᔢ £2.4 million in backlog maintenance
undertaken,
ᔢ 3,610 tonnes of CO² saved per annum –
a 36% reduction, which exceeded the
Trust’s own 30% target.
ᔢ More resilient heating systems.
ᔢ Reduced dependency on the National
Grid.
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Health Estate Journal
September 2016
About Salix
Salix Finance is a not-for-profit,
publicly funded company dedicated to
delivering interest-free loans for energy
efficiency projects in the public sector.
Government-funded Salix has funded
over 14,400 projects with 1,460 public
sector bodies, valued at £462.9 m.
Projects funded will save the public
sector over £116 m on energy bills
annually, and £1.7 bn over the projects’
lifetime. Salix has been helping the
NHS to benefit from reduced energy
costs. Since 2007 it has worked with
54 NHS Trusts and Foundation Trusts
across England, funding projects
valued in total at over £44 m.
Yeovil District Hospital had, for many
years, relied on steam plant that was
34 years’ old, and had ‘seen better days’.
Maintaining the existing boilers
(pictured) was expensive.