For queries on the status of this document contact info@whe.wales.nhs.uk or telephone 029 2031 5512

Status Note amended March 2013

A strategic guide to water and sewerage policy

1993

STATUS IN WALES

Applies

About this publication

Strategic Guides are an occasional series

of publications prepared by NHS Estates.

This is the fifth in the series dealing with

environmental subjects. The earlier

guides dealt with waste management,

energy management, environment

policy and combined heat and power.

The guides are written specifically for

general managers and chief executives

but fully reference more detailed

technical publications as appropriate.

This guide is to assist managers in

consideration and formulation of policies

and strategies for the supply of water

and sewerage services to healthcare

premises. It supplements, but does not

replace, the-more detailed technical

guidance and analysis given in Health

Technical Memorandum (HTM) 27:

‘Cold water supply storage and mains

distribution’, ‘The control of Legionellae

in health care premises - a code of

practice’ and the revised ‘Encode 2’, to

be published later in 1993 (produced by

NHS Estates and published by HMSO),

and ‘Untapped Savings or Money Down

the Drain - A Water and Sewage

Management Audit Guide’ (to be

published by the Audit Commission).

NHS Estates wish to acknowledge that

this guide partially draws upon

‘Untapped Savings: Water Services in the

NHS’ - Audit Commission NHS

Occasional Paper No 5, and to

commend that document to readers.

The contents of this guide are endorsed

by the NHS Management Executive for

the NHS in England and the Welsh

Office for the NHS in Wales.

NHS EstatesDepartment of Health1 Trevelyan SquareBoar LaneLEEDS LS1 6AE

Welsh OfficeCrown OfficesCathays ParkCARDIFF CF1 3NQ

Foreword

The NHS in England and Wales currently

spends £52m a year on water and

sewerage. These costs rose sharply

during the past three years and are

predicted to increase by 50% by the

turn of the century. In terms of

consumption, the NHS is one of the

most important customers of the water

companies. A typical 450 bed district

general hospital uses 240,000 litres a

day, mainly in toilets, staff and patient

washing, sterile supplies departments,

boilerhouses and kitchens.

The Government Consultation Paper

‘Using Water Wisely’ suggested that

there is considerable scope for

eliminating wastage of, and reducing

demand for, water. Indeed, it has been

estimated that the NHS could reduce

water and sewerage costs to deliver

cumulative savings of up to 30%, or

£15m per annum at present levels.

The White Paper ‘This Common

Inheritance’ set out the principles and

objectives underlying Government policy

for protecting and improving the

environment. The Government also

undertook to ensure better use of

resources in the Government estate and

the public sector. The NHS, aside from

its part in fulfilling this commitment, has

a responsibility to promote public health

by reducing the impact of its own

activities on the environment. Increased

efficiency also has the benefit of

releasing resources for patient care.

Managers should give a much higher

profile to the management of water and

sewerage if the increasing consumption

of water, and the cost of water and

sewerage, are to be contained. Policies

for water, which include specific

consumption targets and set strategies

as to how they can be achieved, should

be adopted. The responsibility for

management of water and sewerage

should be clearly identified. Investment

in water saving measures, particularly

where the payback is either immediate

or less than one year, should be

considered.

Managers cannot, of course, achieve the

savings on their own. All staff can make

a contribution, and most will want to.

People are increasingly conscious of the

needs of the environment but do not

always know how to put this

heightened awareness into practice.

However, staff in all departments can be

made more aware of the ways in which

they can save water and of the need to

sustain these efforts.

Contents

About this publication

Foreword

Regulation page 2

A strategy for water page 3

Staff awareness page 4

Avoiding waste page 5

Leaks page 6

Monitoring consumption page 7

Sewerage page 8

Saving money page 9

Appendix: Red List chemicals page 10

Reference material page 11

About NHS Estates page 12

Regulation

The Department of the Environment and the Welsh Officehave responsibility for general policy and legislation forwater services in England and Wales.

The Water Act 1989 was the start of a series of regulatoryand statutory instruments governing the use andprotection of water resources. In 1991, NHS Crownimmunity on water and sewerage was relinquished.Directives from the European Community (EC) have alsoinfluenced environmental legislation.

The Water Act 1989 provided for the establishment ofseveral regulatory bodies. Their functions are now definedby the Water Industry Act 1991 and the Water ResourcesAct 1991, as follows:

regulates the charges levied by the water servicesindustry, oversees the standards of service provisionand protects the interests of water consumers. Ithas ten regional Customer Services Committees(CSCs) which identify customer concerns and reportto the Director General of Water Services;

b. the National Rivers Authority (NRA), in England andWales, has wide powers to maintain and improve“controlled waters” (that is, most inland and coastalwaters) including the regulation of discharges intothose waters, and to protect water resources mainlythrough an abstraction licensing system;

c. the Drinking Water Inspectorate (DWI) regulates thequality of supply of drinking water.

a. the Office of Water Services (OFWAT), which

A strategy for water

The adoption of a policy for water and seweragemanagement iS an essential first step, together with thepreparation of an annual report which identifies objectivesand achievements The policy should Include strategiesfor:

• securing water consciousness in all staff and theirsustained participation in continuing efforts to usewater efficiently;

• installing services and equipment which minimise theuse of water in all new buildings and upgradings;

• installing adequate numbers of water meters,correctly sized and regularly checked formalfunctioning;

• monitoring water consumption every month andinvestigating variations promptly;

• logging of larger sites for one week once a year toprovide flow profiles to aid future planning, metersizing and assessment of distribution losses;

• proper checking of water bills and, in the firstinstance, raising any dissatisfaction with the watercompany’s Customer Accounts or Customer ServiceDepartment. Should the dispute remain unresolvedthe relevant Customer Services Committee (CSC) ofOFWAT should be contacted;

• examining opportunities to reduce standing chargesand tariffs (such as avoiding over-sized meters, stormwater charges etc);

• setting targets and establishing yardsticks againstwhich performance can be measured;

• establishing water demand profiles to indicatehigher than expected consumption of water atparticular times. Where the equipment andtechniques required to prepare water demand

profiles are not available in the NHS, specialistconsultants would normally be used;

• taking advantage of alternative supplies, from lowercharging water companies and natural supplies suchas boreholes, springs and rainwater from roofs;

• regular checking for, and prompt action toeliminate, leaks.

An audit of water by consultants may also producesignificant savings.

Management of water is an estates responsibility.Management models will need to be flexible as numbersof NHS trusts increase and health authorities relinquishprovider responsibilities. While, in many cases, in-housestaff will continue to manage water (and energy), othermeans are available such as:

• buying in expertise from the private sector;

• consortium arrangements with neighbouring units;

• partnership and profit sharing arrangements for theentire estate management function.

Staff awareness

The involvement of staff at all levels in water efficiencycampaigning is an imperative. Too often they take thesupply of water from a tap for granted, and are unawarethat water supplies are metered and that the volume ofwater used has to be paid for, in addition to standingcharges.

Staff education and awareness campaigns can convey andreinforce the message that reducing water consumptionby simple good housekeeping saves money that can beused for patient care. Publicity material (posters, shortvideotapes etc) which identifies simple measures that staffcan take to avoid wasting water have proved effective insome NHS units. Water consciousness can be linkedeffectively with energy efficiency and environmentalcampaigns.

It is essential to ensure sustained participation in suchcampaigns. Regular feedback of monitoring andachievement information in an attractive and readilyassimilated form, but such as to avoid complacency whereperformance is good, can be useful in this respect. Thisis particularly so where savings can be related to directreinvestment in patient care. Further ideas to securecontinued staff participation are given on page 4 of‘A strategic guide to environment policy’ (NHS Estates,November 1992).

The illustrations in this document were speciallycommissioned from Peter Smith of Leeds, and may befreely copied or used as a basis for staff awareness postersetc.

Avoiding waste

There are a number of ways in which water is commonlywasted and which a water strategy and continued staffawareness can tackle:

• taps left running (one fully open tap costs about £4per hour);

• dripping taps (two drips a second represents 38,000litres - £40 - per annum);

• urinals flushing too frequently (automatic systemsreplace potentially wasteful manual ones and can beadjusted to optimum frequency);

• use of cooling water when equipment is not in use;

• air conditioning humidifiers running uncontrolled todrain and spinning disc humidifiers malfunctioning;

• excessive boiler blowdown;

• excessive regeneration of water softening plant;

• excessively frequent draining of, and evaporationloss from, uncovered hydrotherapy pools (butmicrobiological safety must not be compromised andthe advice of the Control of Infection Officer shouldbe sought);

• cistern and storage tank overflows running to drain;

• defrosting food with running water;

• use of baths rather than showers (the latter use onlyabout one-third as much water and are also moreenergy efficient);

• excessive use of water for WC flushing (modern -particularly low-level - suites, cistern dams and ballvalve adjustment should be considered);

• excessive supply pressure (in excess of that requiredto reach the top of a multi-storey block and maintaina good flow rate - sometimes via booster pumps)

can cause unnecessary leaks, waste energy anddamage some equipment;

• excessive vehicle washing;

• use of potable water rather than alternatives, whereavailable, for horticultural purposes (mulching -which both conserves moisture and helps preventweeds which waste it - and drought resistant shrubsand perennials can also reduce the need for frequentwatering);

• leaks.

The Building Services Research and InformationAssociation (BSRIA) are researching the feasibility ofrecycling water and believe it may be an economicpossibility for larger users such as hospitals. Where hotwater is recycled there may also be benefits from heatrecovery.

Leaks

Almost a quarter of the water put into the supply iswasted through leaks in mains, service reservoirs anddistribution systems. A substantial amount of loss occursin customers’ pipework and some can also be attributedto poor plant and equipment maintenance (for example,pumps, valves and flanged fittings). Water mains becomethe responsibility of customers at the main supply

meter(s). All leaks that occur after this point incur costs tothe customer for both water and sewerage charges; ineffect, you pay twice! They can also cause severe damageto building fabric and foundations.

It is estimated that leaks in hospitals are typically of theorder of 15 to 30%. Leaks will never be entirelyeliminated but can be considerably reduced. Thepotential recurring savings in many district generalhospitals could be about £15,000 per annum.

Long-term leaks can be more readily identified bythe use of performance indicators and comparison ofconsumption with other similar hospitals; regularconsumption monitoring will help identify new leaks asthey occur. A full range of leak detection methods shouldbe employed:

• visual inspection;

• monitoring consumption;

• leak correlating equipment;

• use of performance indicators (PIs). The AuditCommission developed a PI for water consumptionfor their recent study - litres per patient bed-day;

• water demand profiles.

Under both the Water Byelaws and the Water Industry Act1991, it is the customer’s responsibility to ensure thatwater is not being wasted. A balance should, however,be struck between the cost of identifying leaks and thereduction in water and sewerage charges arising fromtheir elimination.

Monitoring consumption

Accurate information on base and regular waterconsumption is essential to better management ofresources. It is important to establish that the underlyingbase consumption is correct. One way that this can bedone is to monitor the consumption of water in the earlyhours of the morning when there is minimal demand.

Information can be collected by a building energymanagement system (BMS) or manually. A BMS supervisesand controls technical installations such as heating,ventilation, air conditioning plant and, in some Instances,lighting and process steam to laundries. It can be linked tometers in order to monitor the consumption of water, andto sensors to monitor the temperature (important incontrolling Legionellae) and volume of hot or cold water instorage tanks.

Sub-metering can determine the amount of water used bymajor departments such as sterile services, catering andmanufacturing pharmacies. Comparison of meterreadings with previous corresponding periods which showapparent rises in consumption unrelated to increasedactivity (which may, for example, indicate a leak) can beinvestigated.

Where a BMS is not used, a regime of regular meterreading should be established.

The Audit Commission has developed yardsticks ofperformance on water consumption (Figures 1, 2 and 3).

Sewerage

The Audit Commission estimate that some 54% of NHScosts for water and sewerage is consumed by sewerageservices. Whereas water is metered in to a site, sewage isnot usually metered out.

Standing charges for sewerage depend on the size of theincoming water meter(s) and volume of water consumed,less, in many cases, a negotiated allowance for water thatis not returned to sewer. This allowance varies from 0%to 30%. ‘Using Water Wisely’ suggests that about 95%of the water used in households, commerce and serviceindustries is returned to sewer. Hospitals have a higherrate of evaporation due to the operation of steam boilers,laundries, kitchens, swimming and hydrotherapy pools andhumidification. Management should assess this and,where appropriate, negotiate rebates.

Water and sewage companies categorise discharge todrain as either domestic or non-domestic/trade. Hospitalsare classified as domestic customers by the watercompanies, but parts of the site, such as the laundry, couldbe reclassified as trade. Private laundries are readilygranted trade effluent status and private laundries locatedon NHS premises have also been similarly classified.Unfortunately, there is no consistent approach by thewater companies.

Charges on the trade effluent tariff depend on the toxicityof the effluent. The opportunities to reduce the charge bylowering toxicity levels (for example, by purchasingdifferent sorts of detergent) should be taken.

One water company has identified a separate storm watercharge whereby hospitals pay additional sewerage chargeson storm water that goes to drain. With other companies,this cost is included in the overall charge. This may beavoided, for example, by using storm water for wateringgardens. In the future, some hospitals may be able torecycle such water.

The second North Sea Conference agreed a reduction ofabout 50% in dangerous substances discharged to theNorth Sea via rivers and estuaries between 1985 and1995. The need remains to reduce inputs of persistentand toxic (most dangerous) substances which are liable toaccumulate in living tissues. ‘The Red List’ (see Appendix)includes heavy metals such as mercury and cadmium,certain pesticides, chlorinated industrial chemicals andsolvents.

The NHS should base control of any potentially pollutingprocesses or practices on the best information available.Prevention is better than cure and can also be cheaper.Action taken to institute or change appropriatemanagement practices may avoid more costly end-of-pipesolutions to respond to damage caused. This strategy alsoreduces the risk of prosecution.

NHS management should:

a. audit the discharge of substances to drain;

b . test the effluent discharge according to criteria usedby the water and sewage companies;

c . manage the discharge to drain, based on theinformation gained under steps (a) and (b) above.

This process can be enhanced by educating staff on thereasons for managing the discharge of substances todrain.

The ‘environmental performance assessment’ in the Waterand Sewage Management Audit Guide, shortly to bepublished by the Audit Commission, can aid in theidentification of those departments which may requireincreased levels of management of their discharges.

Saving money

The economic use of water and sewerage services willreduce costs substantially but the strategy should alsoconsider cost-effective ways of minimising the actualexpenditure on water used. The main areas where savingsmay be made are:

correct meter sizing. Over-sized meters can result inexcessive standing charges for both water supplyand sewerage;

regular checking and maintenance of meters.Broken or otherwise malfunctioning meters can leadto distorted usage figures;

careful checking of water bills and comparison withcustomer readings of metered supply;

negotiating advantageous rates of charge withwater companies. Charges vary from company tocompany;

exploring other sources of supply such as boreholesand springs which may provide an economicalternative to the mains supply;

ensuring that on-site surface (storm) water is utilisedwherever possible and that water company chargingassumptions take account of this for both watersupply and sewerage;

reclassification of some NHS premises, such aslaundries, as “trade” for sewerage purposes andadopting policies to minimise the toxicity ofdischarges.

Appendix

Red List chemicals

The main sources of regulation of substances dischargedto sewer are the Trade Effluent (Prescribed Processes andSubstances) Regulations 1989, the Control of Pollution(Special Waste) Regulations 1980 and the Duty of Careprovisions of the Environmental Protection Act 1990. Inaddition to flammable and immiscible substances, thefollowing must not be discharged to sewer:

• mercury and its compounds;

• DDT;

• hexachlorobutadiene;

• endrin;

dichlorovos;

• altrazine;

triphenyltin compounds;

azinphos methyl;

• cadmium and its compounds;

•

•

•

•

•

•

•

•

•

•

•

•

•

•

pentachlorophenol;

aldrin;

1, 2-dichloroethane;

simazine;

trifuralin;

malathion;

gamma-hexachlorocyclohexane;

hexachlorobenzene;

dieldrin;

polychlorinated biphenyls;

trichlorobenzene;

tributylin compounds;

fenitrothion;

endosulfan.

•

•

•

Reference material

This Common Inheritance.

Using Water Wisely.

The above are published by HMSO and available fromHMSO bookshops and accredited agents.

Strategic guide for waste management (currently underrevision for republication as ‘Strategic guide to clinicalwaste management’).

Strategicrevision).

guide to energy management (currently under

Strategic guide to environment policy.

Strategic guide to combined heat and power.

The strategic guides are published by the Department ofHealth’s NHS Estates Executive Agency, 1 TrevelyanSquare, Boar Lane, Leeds, LS1 6AE. Telephone 0532-547000.

Health Technical Memorandum (HTM) 27 - ‘Cold watersupply, storage and mains distribution’ (HMSO, 1978 -to be re-issued following revision as HTM 2027).

The control of Legionellae in health care premises - a codeof practice (to be re-issued in revised form as HTM 2000).

Encode 2, which provides detailed practical informationand technical advice designed as support for theprocedures and programmes established for energy

efficiency in Encodeand sewerage).

1 (and also includes advice on water

The NHS Estates publications above are currently underrevision and will be published in their revised and updatedversions by HMSO. They will be available from HMSObookshops and accredited agents in due course.

Untapped Savings or Money Down the Drain - A Waterand Sewage Management Audit Guide. To be publishedby Audit Commission (Publications), Nicholson House, LimeKiln Close, Stoke Gifford, Bristol, BS12 6BR.

Untapped Savings: Water Services in the NHS - AuditCommission NHS Occasional Paper No 5, May 1993.Published by HMSO and available from HMSO bookshopsand accredited agents.

The Water Act 1989.

The Water Industry Act 1991

The Water Resources Act 1991

The Trade Effluents (Prescribed Processes and Substances)Regulations 1989.

The Control of Pollution (Special Waste) Regulations 1980.

The Environmental Protection Act 1990.

The above are published by HMSO and available fromHMSO bookshops and accredited agents.

About NHS Estates

NHS Estates is an Executive Agency of the Department ofHealth and is involved with all aspects of health estatemanagement, development and maintenance. The Agencyhas a dynamic fund of knowledge which it has acquiredduring 32 years of working in the field. Using thisknowledge NHS Estates has developed products which areunique in range and depth. These are described below.

NHS Estates also makes its experience available to the fieldthrough its consultancy services.

Enquiries should be addressed to: NHS Estates,Department of Health, 1 Trevelyan Square, Boar Lane,Leeds LS 1 6AE.

Some other NHS Estates products

Activity DataBase - a computerised system for definingthe activities which have to be accommodated in spaceswithin health buildings. NHS Estates

Design Guides - complementary to Health BuildingNotes, Design Guides provide advice for planners anddesigners about subjects not appropriate to the HealthBuilding Notes series. HMSO

Estatecode - user manual for managing a health estate.Includes a recommended methodology for propertyappraisal and provides a basis for integration of the estateinto corporate business planning. HMSO

Capricode - a framework for the efficient management ofcapital projects from inception to completion. HMSO

Concode - outlines proven methods of selecting contractsand commissioning consultants. Both parts reflect officialpolicy on contract procedures. HMSO

Works Information Management System -a computerised information system for estatemanagement tasks, enabling tangible assets to be put intothe context of servicing requirements. NHS Estates

Option Appraisal Guide - advice during the early stagesof evaluating a proposed capital building scheme.Supplementary guidance to Capricode. HMSO

Health Building Notes - advice for project teamsprocuring new buildings and adapting or extendingexisting buildings. HMSO

Health Guidance Notes - an occasional series ofpublications which respond to changes in Department ofHealth policy or reflect changing NHS operationalmanagement. Each deals with a specific topic and iscomplementary to a related Health TechnicalMemorandum. HMSO

Health Technical Memoranda - guidance on the design,installation and running of specialised building servicesystems, and on specialised building components. HMSO

Encode - shows how to plan and implement a policy ofenergy efficiency in a building. HMSO

Firecode - for policy, technical guidance and specialistaspects of fire precautions. HMSO

Nucleus - standardised briefing and planning systemcombining appropriate standards of clinical care andservice with maximum economy in capital and runningcosts. NHS Estates

Concise - software support for managing the capitalprogramme. Compatible with Capricode. NHS Estates

Items noted “HMSO” can be purchased from HMSOBookshops in London (post orders to PO Box 276, SW85DT), Edinburgh, Belfast, Manchester, Birmingham andBristol or through good booksellers. Details of theirstanding order service are given at the front of thispublication.

Enquiries about NHS Estates products should be addressedto: NHS Estates Publications and Marketing Unit,Department of Health, 1 Trevelyan Square, Boar Lane,Leeds LS1 6AE.

NHS Estates consultancy service

Designed to meet a range of needs from advice on’theoversight of estates management functions to a muchfuller collaboration for particularly innovate or exemplaryprojects.

Enquiries should be addressed to: NHS Estates ConsultancyService (address as above).