Talk title: NHS Heat & Western General Hospital, Edinburgh
Speaker: Daniel Mill, NHS Lothian
Event: CIBSE Scotland Conference 2026: Heating the Future, 27 May 2026
Video: https://youtu.be/sD6lhOQSh_w

[00:00] And that's quite a presentation to follow. Brilliant energy. I think that's one of the things that we really take from that. So I'm Daniel Will, I'm the Head of Energy and Sustainability for NHS Lothian. Been reflecting on, there's been so many good presentations today and if I was to have the time, I'd probably redo mine again because there's so much to build on from today. But I guess why am I here today and what do I bring?

[00:27] Well, NHS Lothian, we're a big operator of sites, 120 sites. In fact, helpfully, if we go back to the last presentation, you can imagine we go from Dunbar, the very east to the very west. So your heat network highway fits perfectly across our state. So when's it going to be ready? That's the kind of question. So yeah, we're an operator, consumer is our big, yeah, effectively, we're a big energy consumer.

[00:55] So what I'm here to do is just give you a bit of an insight about a project that we've been working on for a number of years. I think it adds a little bit in terms of understanding the complexities of actually the big anchor loads, connecting them. How do we make sure that we have sites that are ready to move forward? And as I say, just share a bit of our experience. So, start off with a little bit of context as ever.

[01:21] I mean, like all big public sector organisations, we've got strategies galore. We've got lots of written reports and paperwork and so on that set out what we're going to do. But then we add that up, we've got Scottish government ones, we've got heat. So all of that comes together beautifully. In some ways, what's really important to us is this is our sustainability framework, the image on the right. And what you see is that the built environment is one of our key focus areas.

[01:46] And that I'll explain more in the next couple of slides. But again, it's just that point. We are all working in a huge landscape of complex policy, legislation, and so on. And sometimes that can take us away from the very simple things that we just need to all collectively work on.

[02:03] But to give you a little feeling of scale, because I think this has been such an interesting piece so far. There's a lot of, I guess this is about optimism as well. There is a lot of good things that have been happening today. A lot of it has been happening in the past, a lot of it has been happening almost by mistake, or it's been happening through, you know, sort of lots of good policy measure, legislation. But I think it is always good to have a level of optimism around where we've come from to where we are now. And what you can see here is our carbon emissions back from our baseline of 1989 up to last year's emissions report.

[02:34] So you can see we made a big jump at some point. What I still find absolutely crazy is we were still burning coal at points, which is, you know, almost, it seems like, you know, we were still burning coal at points, which is, you know, almost, it seems like, you know, it seems like kind of like a different world. Thankfully it kind of is, but it's still just, we're seeing that transition. Electricity is a major component of what has been going on in here. That transition of us decarbonising the grid. So that's again, it's not all been about our good work within NHS Lothian, though we've done lots.

[03:03] There's the stuff that's happened externally to us. So we are about to shy 60,000 tonnes of carbon a year. This shows you why is building so important. We are approximately 87% of our reported emissions comes from buildings. And again, trying to put that into context, we spent 35 million on energy last year. The bit that's interesting I always think from this graphic is actually the fleet and the business fleet travel.

[03:30] You pick that 2%, 2% together, that was approximately 16 million kilometres our fleet travelled last year. It's only 4%. It just goes to highlight the amount of work we have to do within buildings. So as I said, we're a big organisation. Guess what? We've got three big sites, or it's our big sites that really contribute. And I'm sure there's lots of others. I know there's others from NHS and other public bodies here who will have a sort of similar dynamic where we've got effectively three quarters of our estate covers, sorry, three sites in our state covers three quarters of our emissions.

[04:12] These two graphics came out of, you know, three years ago. These two graphics came out of three years ago. We had a piece of work done around our net zero pathway and 240 pages of really interesting technical description around heat pumps and solutions and so on. In many ways it boiled down to these graphics, which we found so powerful in explaining this to, if you like, our stakeholders, finance directors, the wider community. And it really is, the challenge is heat.

[04:37] There is no defined solution at this point in time. And we do have to work really hard to go and solve this problem collectively. And what you're seeing here in yellow is emissions from electricity, from the grid. It's got that long-term projections, decarbonisation. As yet, and our business as usual, nothing on heat. So that takes me into giving you the example around the Western General.

[05:03] So those of you in Edinburgh may recognise it. So Western General Hospital is our second biggest acute campus. I think it would be, unfair to say that it organically grew. You can see there is just about a bit of everything on this site. We've got 100 year old buildings. In fact, the original poor house was on this. So it goes to show you, this is a real foundation of healthcare in Lothian.

[05:31] So you can see in the centre, what's called the clock tower building, over a hundred years old. We've got buildings that are three years old and we've got everything in between. Really congested. Now when you actually look at that in more of a plan layout architectural, it goes to show how complicated a site of this is. Again, it's not organic. This is, we need a new space. We build something, we add, we add.

[05:57] You would never start off and think that's how I'm going to go and build a really good health, effective healthcare site. But that's the nature of development of our major campuses.

[06:10] So I'm kind of giving you this context, you know, about this. You know, about this. This is the context around these are the challenges that we're really faced with.

[06:17] And as I said, this is an old site. We've got a whole mix of things going on. We set out in 2016 to start a programme of work called our Energy Infrastructure Programme. And we'd highlighted a whole number of issues that effectively set out a need for change. And those were that capacity for new development. So I should have started with, this is all operating off a steam heating network where the steam boilers are 40 years old.

[06:45] The pipe work is even older than me. That's where we're coming from. So we've got issues of capacity. It's not future ready. High carbon footprint, as we highlighted. It's round about almost a third of our emissions. Really poor reliability and resilience. Clearly not something that the NHS takes particularly lightly or enjoys. The increasing legislation and policy, which many of us will all know.

[07:13] And importantly, I think in that steam system, it just does not connect into future low carbon technologies. You can talk to heat pump manufacturers. Yeah, great technologies. Can you replace steam system? It's not plug and play. Then the final point is always worth noting that we're talking here about carbon and energy and cost, but health and safety is a really important aspect of the operations of our types, of all systems.

[07:38] We're talking about all sites, but particularly when you're working in these types of environments with steam and high energy intensity. So what did we do? We set off, we needed a business case. We needed to start doing something about the issues. We had major failures going on, as I say, operating on steam systems. At times you see, I know it's quite unhelpful when our site director decided to have a picture that very much looked like the images of New York, with the steam out behind you.

[08:09] You think that's not really the image we actually want to portray, but in black and white, it did look fantastic.

[08:17] So in 2016, we started off with a business case. We knew we had to deal with resilience. We knew we had to deal with energy costs and we had new developments coming onto site, so we had to have something that was ready. We had some really good work done, some effectively master planning works done with consultants. Holly and Kirkwood were the lead on that one and helped us in setting our better energy master plan. So it'd be quite typical to what you would imagine back in 2016, lots of gas CHP, gas boilers.

[08:47] We had a little bit of wastewater heat recovery as a potential option. That was the forward thinking innovation piece. We're going to have a brand new campus heating system, LTHW. They go, great, we've got that in place. Huge amount of work, really good piece of work. And then we go, right, but we've got a new building and that's going to be online next year. Is this going to be ready in time? Well, no, we're not going to replace 40 megawatts of heating plant. We're not going to place kilometers of steam distribution in time.

[09:16] To show you how complicated that is, that is what our steam systems look like. We've got blue is our north leg, red is what we call our south leg. Back to that complicated. They go in, under, through, round, covered in asbestos, all the lovely things that were developed 50, 60 years ago that make this really challenging. So we had new buildings coming online, or being in the sort of development design phase down, what we call the sort of, that was zone one, so our southeast corner.

[09:48] We had to move very quickly and go and deal with this. And actually what it really held with was we had to break this project down into phases. This is the kind of the complexity and the level of actually undertaking this work necessitated that we moved forward. So this is always a bit of a scary image and maybe shouldn't be showing it. In some ways, top left is what we were dealing with. You know, that's our distribution and very much a worst case.

[10:14] I can promise you that, plant rooms. And in many simple ways, this is what we were trying to move forward. This to us is heat networks. This is moving away from failing infrastructure to nice and shiny and efficient. But what was interesting thing for us is actually became, and maybe this is the wrong room to be saying this to you, that this was actually more a civil engineering project in the end, although it was all predicated on good mechanical and electrical engineering. And I think it was just an interesting one for us, reflecting on two pipes shown on a drawing, actually the level of complexity unknowns of what's below the ground on an existing site.

[10:48] It was so challenging. And this will sound even stranger where this project actually, COVID did us a favor. There's a better way to say that I'm sure. Our sites weren't operational. It was the only way we could have actually got this done because we were so constrained that there wasn't high levels of activity that allowed us to move forward. Yeah. There's a lot of things to get into here and boy, we found everything under the ground. It was never, ever recorded.

[11:13] But I think it just highlights, this is our cancer center, these are highly service, really important areas we're working alongside members of the public and potentially quite heightened emotional states as well. This really was a complex. So did we actually set out and achieve anything because of the time? Yes. Just about everything. So really good. Yeah. But yeah, it's saved us a lot and this bit, this is all, this is, we did a quick analysis and what's been quite amazing about this was only 15% of the site we dealt with.

[11:45] It saved 2% of our total operational emissions from the whole of our 60,000. We saved almost, yeah, about over half a million. This is just about fixing systems, energy efficiency, making, supplying efficiently. This has got nothing to do with almost low carbon. This is just getting our sites efficient and working better. So what were our lessons learned? We're still not ready for low carbon. We've still got a lot to do.

[12:13] Our sites, they're live, they're operational. We've got huge amounts of, we love regulations. We even create our own ones with SHTMs and SHTNs. It was really important to us, our partners, consultants and contractors are fundamental, really good people, organisations to work with. Can't get away from this, that the large benefits wasn't about carbon. It was about energy. It was about resilience. It was about improving things for capacity, about making them safer.

[12:43] And that's kind of that last bit, really, it was so important for us to align everything. We don't drive these projects of being about energy and carbon. They're about health and safety, about resilience, about all the things that make these things stack up. So what's next? The rest of it. We've still got a lot to do. And we've been working more recently with ACOM, who've been helping us pull together performance specification. We're going into our third phase, de-steaming.

[13:13] It's interesting to just keep on that part. We see this as, and it came up in other ones, this is about a pathway. This is about us walking through phase to phase, breaking down this problem into kind of chunks that we can deal with that are bite size, because the site changes as a whole. Policy and legislation is constantly changing. So we've had to keep this as a very dynamic programme of works. It sort of reflects that. So what's exciting is it looks like we've got a plan to just about de-steam the whole site in the next phase.

[13:46] So I just want to then talk very briefly, what's the remaining challenges? Well, net zero for us at this site is still undefined. And this hopefully has slight links to, we are not going to build heat networks, but I really need them. So what we are focusing this on is how do we be heat network ready? How do we build our heat network on our site? For a point where we hope a heat network is going to turn up. We cannot, we believe, fix the infrastructure on our site to be low carbon.

[14:13] So how do we get ready for when that happens? Our approach to resilience is interesting. If we need heat pumps, we've got a challenge around how that stacks up. We've got to have 200 hours of backup power. It's an interesting challenge of how we view networks, how we view heat pumps from a resilience perspective. Interestingly, I think this operational model is one, with all the regulations that are coming, it takes us into kind of an odd area. We operate this with tenants across our heat networks or our site campuses.

[14:42] I don't want to be regulated by enough people. I don't need Ofgem regulating us as well. So we are kind of in that interesting space around, do we change our service models around our heating systems? It's taking us into another different world. The very final point is alignment of actions, and we've seen it all today. How do we make sure that we are collectively working the public sector? So the anchor loads, like me, are really contributing, how do we finance together?

[15:07] We're still not in the space of us all, I think, really being able to draw and pull together to work in this area, because I need a heat network to come and fix this site for us. So I'll take a breath. Knowing how brilliant Steven is, and the frankness that you set that up so that the audience can see. Thank you.

[15:33] Simon and Daniel are like a match made in heaven, coming together in two parallel sessions. But as mentioned, we do have time for two questions before you lose, Daniel, because unfortunately you're not staying for the panel session. So if there are, I'm sure there are burning questions, we don't all have to be shy all the time. Do you want to go? Is Little France, Edinburgh oil, is it steaming still?

[16:00] No, it never was. It's medium temperature. It's 115, 120 degrees. Spoke to try to reduce that. We are just commencing our business case just now with support from Scottish Government and the Heat Network Support Unit to really move into looking at, I mean, MEL, Miller Hill is what we're focusing on seeing as the opportunity. Because again, it's the same thing. We don't think we can solve it on site.

[16:25] And it does talk to, I mean, it's come up in so many ways. It's funny, we, within NHS Lothian, we have something called the Anchor Programme. And it's actually about us thinking about how can we as a large organisation leverage our spend. I mean, we're 1.9 billion per annum revenue spend. We've got 23,000 staff. How do we actually make best use of that spend profile, the number of people that we have as colleagues, the number that we interact with?

[16:53] And so it's funny that we can start to orientate and align programmes that are probably, they're almost really excited about heat networks because we're saying, oh, the anchor load, and they can then take it. Take it into what is far more of a sort of strategic planning piece around the organisation. So that was a really long, odd response to your question, but yeah, we're really looking at that one. But we don't know, we really need to bring those temperatures down and that's not easy with site. Timing wise, though, I think it might work with the rollout of the NHS Lothian heat network.

[17:24] It might work out perfectly with how long it's taking to retrofit these legacy heat networks. But I just love the health and safety elements that you brought forward. I think it's really important. I think we've got to work on that one. But I think it's really important that we take that forward as well, in particular, also in terms of the congestion on the roads, which is an ongoing issue we have with heat networks, whether it's putting them in the ground or upgrading them, but also the traffic congestion component, which has its own challenges. Final question for Daniel before we go on?

[17:51] Yes, thank you. I'm just interested in talking about the first phase of the project. Anything to add? Yes, absolutely. Yes, thank you. Thank you very much. We're in the middle of the 30-minute break. How are you looking towards the next couple of days? Are you going to manage upgrading the system while also supplying B4 alternatively supply B2 for press start, and continuing expansion while you're simultaneously doing that?

[18:17] What's your plan on that? I'm just curious about the practicality of it. I've got really good design partners who can answer that for me as a first step. We just have to find... Yeah. In many ways, that was the hardest part of it. Now, what we're going to end up doing is we're coming now from the other side and we're probably going to end up with a situation of having two or three on-site heat networks, and then we have to see how the master plan for the site goes because getting from southeast to northwest is a challenge.

[18:49] There is no route through the site. We have one arterial road, which is about the width of a heat network trench, and funnily enough, I'm not allowed to close that hole, that only road through the site. So that's why breaking these things down into phases is kind of the approach that we have to take and go after the bits we can deal with. Slightly, you just have to say, you know what, that's a problem for another day. We've got to keep moving forward or you get stuck in that and transigence of just, oh, this is hard.

[19:17] Let's just bite size, break it down, keep moving, and as I say, at some point I'll be ready for a heat network by the time they've dealt with the same problems externally. We'll see how we go. I'll come back. I'll come back in a few years and tell you how we got on. Excellent. One to keep an eye on probably then is Worthingly Heat Network, who have similar road closure problems, and they're putting in, they're testing out directional drilling to avoid having to dig up as much of the road as we usually do, and that is happening over the next year and a year or two.

[19:45] So I might be one to keep an eye on and learn from them.