How hospital lighting can help patients and save energy

A panel of NHS facilities and energy managers and lighting professionals come together to discuss how lighting in hospitals can be tackled to improve patient outcomes and save energy

NHS Trusts are in the midst of a period of huge technological change. The rise of LEDs and controls are enabling Trusts to benefit from huge energy savings and improved quality of light, with paybacks of under five years. At the same time, there is a growing awareness of the potential health benefits of biodynamic and circadian lighting, yet there are still very few examples of this cutting-edge thinking appearing on patient wards. Is this because there is a reluctance to innovate within Trusts or is it because the science behind circadian lighting is still not fully understood?

Lux, in association with Aurora, invited a panel of industry experts, with participants including facilities managers and engineers from NHS Trusts, lighting designers and consultants, to its Healthcare Forum to discuss the issues in a roundtable discussion. Key areas covered included:

• What are the real benefits of investing in new lighting technology for healthcare?
• What are the key mistakes to avoid when upgrading lighting?
• What's the latest knowledge on how lighting influences patient outcomes?
• How can we make healthier lighting a reality in healthcare facilities?
• How can healthcare bodies get funding for lighting upgrades?

Lack of investment

Trusts face wide-ranging challenges, from aging buildings, with lack of investment in lighting over the years, through to tough financial constraints. “We have buildings with a diverse age – from the 1920s and 1930s through to new build,” said Rob Hocking, electrical team leader at Southend University Hospital NHS Trust. “We need to standardise lighting systems so that we can reduce stock and react quicker to call-outs.”

“The funding is starting to come through now, but there has been a lack of investment in new technology,” said Kevin Tinson, estates operations manager at Oxford University Hospitals NHS Trust. “We have one hospital using T12 lamps, with two shipping containers full of T12 replacements. We are faced with a lot of work to catch up.”

Operation TLC

Staff teams at Barts Health NHS Trust have created better environments for patients, and saved on the Trust’s bills by reducing energy waste as part of Operation TLC. Since 2013, nurses, doctors, facilities, security and cleaning staff have taken three simple actions:

T – turn off equipment when not in use

L – switch off lights where possible

C – close doors and windows

 Operation TLC has now run for two years, reaching the Trust’s six hospitals in East London.

“Thorough measurement has shown that Operation TLC delivers long-term cost savings at the same time as improving patient experience,” said Alex Gerard, programme officer at Global Action Plan. “Savings of £100,000 in the first year alone paid for the programme.”

As part of Operation TLC, more wards began to adopt a “Quiet Time”. This meant staff dimmed the lights, encouraged patients to retire to their rooms, and visitors were asked to let patients rest. Patients reported fewer sleep disruptions. Nurses also noticed that visitors and patients had better interactions when visitors returned. It has benefits for staff too, giving them some time to catch up, reflect and plan for the afternoon while their patients rest.

Damian Oatway, senior sustainability engineer at Manchester Royal Infirmary said there was a resistance to anything new. “Unless the technology is proven and you can justify investment in terms of energy savings, it’s difficult. Exiting PFI contracts are also a problem because they often stipulate like-for-like replacement.”

Quality of LED lamps had also been an issue for Trusts in the past. “We have had to replace a batch of 250 LEDs, despite them being CE-marked,” said Ehsan Sattar, assistant director of projects and estates energy manager at Royal Marsden Hospital. “It’s a challenge when there are so many different products, colour rendering capabilities, lifetimes and lead times. How can we ensure the quality?”

Shyel Stark, product manager at Aurora, called on Trusts to pick the right partner and look for those suppliers that can offer back-up support and warranties.

“The quality of LEDs is much improved,” said Dina Chowdury, senior lighting designer at Lighting Design House. “You can get LEDs with 2700K colour temperatures now and CRIs of 90 which perform like halogens. But whereas halogens can all run on the same transformers, every LED lamp has a different driver. Standardisation is needed because otherwise the NHS will be left with an inventory problem.”

Not just about energy

While energy savings may be the initial driver for upgrading to LED, with typically 45% of a hospital’s electrical load coming from the lighting, the Forum highlighted a range of other issues. “The improved product life means that there is less likely to be an impact on operations, there is greater awareness of the effect of lighting on seasonal affective disorder and dementia and the role of flicker in patients with autism,” said Paul Davidson, Aurora’s group technical and project manager.

There also needs to be better guidance on what works and what doesn’t and what is considered best practice. This would help me to convince people further up the chain and get funding"

Damian Oatway

Lighting Design House is a big advocate of biodynamic lighting and has introduced the technology into its own offices with positive results. “In hospitals, the ideal is to have LED panels to achieve general lighting of 150 lux on wards, which can be automated with manual override at the nurse station,” says Chowdury. “Patients would then have local task lighting via a bedside light, with colour options that they can control. The perfect formula is a pinch of blue to kickstart activity, a dollop of sunlight, some swirls of visual delight, a pinch of amber red later in the day and a big dollop of darkness to aid sleep.”

Damian Oatway felt that lighting has such a big influence in hospitals that there was a role for a lighting manager within Trusts. “There also needs to be better guidance on what works and what doesn’t and what is considered best practice. This would help me to convince people further up the chain and get funding.”

There was generally a lack of lighting expertise within Trusts. “It’s up to me to advise and get the estates team to buy into improvements and install them. It can be a slow process,” said David Willey, energy manager at Whittington Hospital NHS Trust.

Where’s the money coming from?

Funding will always be an issue within the NHS, and experiences differed around the table. “The money is there if we can get a payback of four-and-a-half years or less,” said Oatway. Others were finding funds difficult to come by, with expenditure on new buildings meaning less money for lighting upgrades.

Funds for energy improvements are available through Government-backed organisation Salix Finance as interest-free loans. “A new NHS funding team has been created this year and LED installations account for the greatest number of projects so far,” said Sameen Khan, client support officer at Salix. “Savings can be achieved with paybacks of less than five years.”

The Lux Healthcare Forum was sponsored by Aurora