Decarbonising and adapting healthcare to heat in Flanders

Flanders’ 8000 healthcare facilities – ranging from hospitals to kindergartens and elderly care homes – are significant energy consumers. Hospitals alone account for 55% of sectoral emissions.

The climate impacts experienced by health infrastructure translate into high energy costs, which affect operational budgets. The current infrastructure is not designed or prepared for prolonged periods of higher temperatures caused by climate change. This creates significant challenges for care and welfare facilities, which serve vulnerable groups such as older adults, patients with chronic conditions, psychiatric patients, infants, or young children. These populations are more susceptible to heat-triggered non-communicable diseases (such as dehydration and heat stroke) or exacerbation of pre-existing conditions (e.g., kidney disease, diabetes, cardiovascular or respiratory disease).  Youth care and patients in general may experience sleep problems and increased aggression during heatwaves. Care staff also face additional strain, as working in hot conditions becomes harder while their workload often increases during these periods.

Balancing hygienic ventilation with energy efficiency is another critical issue. Care homes and hospitals consume around 20% of their energy on ventilation. At the same time, they must remain resilient against future outbreaks of aerosol-transmitted diseases, as highlighted by the COVID-19 pandemic.

Belgium's federal structure means healthcare infrastructure falls under regional competence. The Flemish government integrated climate and health objectives through several policy instruments:

• Belgian National Environment and Health Action Plan (NEHAP)
• Preventive health goals on environmental health and the Flemish Climate Health Plan
• Energy and Climate directives
• ETS1 (Emissions Trading System) funds allocated specifically for healthcare decarbonization
• EU Recovery and Resilience Facility (including Relance and Repower funds)
• Post-COVID recognition of ventilation as critical health infrastructure

The programme was developed with an integrated approach, combining mitigation and adaptation efforts. (“climate mitigation, health resilience and strategic infrastructure planning”)

The programme pursued three interconnected objectives:

1. Achieve climate neutrality in healthcare infrastructure through comprehensive energy audits and targeted investments

2. Enhance health resilience by improving indoor climate quality, with a focus on:

• Summer comfort to protect against heatwaves
• Ventilation for infection prevention and air quality
• Passive cooling strategies

3. Enable data-driven planning through a centralized platform that allows facilities to develop multi-year investment strategies based on ROI (return of investment) calculations

The programme delivered an integrated audit system with several components:

1. Audit programme – 2.673 energy audits completed

• Assessment of the necessary measures needed to achieve climate neutrality
• Framework contract with consultancies to ensure quality
• Quality control conducted by  the Flemish Energy Company

2. Summer comfort audits – 112 completed

1. Optimization of natural ventilation
2. Improvements to buildings’ envelope
3. Passive cooling strategies

3. Ventilation audits – 378 completed

• Launched during COVID-19
• Handbook developed for organizations to guide indoor air quality maintenance
• Assessment of the necessary measures  needed for balancing energy efficiency with health requirements

4. Digital infrastructure platform

• Managed by the Flemish Energy Company (veb)
• Centralizes all audit data collected from 2.505 buildings
• Enables multi-year master plans for investments in energy efficiency and renewable energy
• Enables adjusting of strategies as climate projections or financial conditions change
• Guides ROI simulations towards investment decisions
• Tracks actual vs. projected energy savings
• Monitors progress towards neutrality

5. Financial support

• Free energy audits, removing the cost barrier
• Subsidies for measures
• ROI calculated for both carbon reduction and financial savings
• Selection criteria prioritizing:

1. Carbon reduction potential
2. Bundling of multiple measures in a single construction period
3. Cost-benefit ratio

The programme’s model entailed a multi-actor governance

• Flanders Department of Care: leadership and funding allocation, development of the program, quality control, managing subsidy calls, and coordination across stakeholders.
• Flemish Energy Company: co-development of the program, development of the framework contract and the quality control, data platform operation, and collection of energy consumption data
• Framework contract involving consultancy: conducting audits under a framework agreement
• Care organizations: measure implementation
• Umbrella organizations: co-development of the program tailored to the care sector, and awareness-raising among care organizations

Success factors:

• Integrated approach combining climate, energy, and health objectives
• Removing the costs associated with energy audits
• Data-driven decisions: the platform enabling evidence-based investment planning
• Framework contracts: reduced administrative burdens

Limiting factors:

• The implementation timeline requires sustained political commitment
• Conflicting priorities between carbon reduction and health needs

Investment:

• €103 million public Investment (2019-2025)
• Co-financing from EU Recovery funds, ETS1, and regional budgets 
• 2 FTE coordination at Department level
• Organizations bear implementation costs (offset by subsidies and savings)

Climate and environmental benefits:

• 88,398 tons CO2 reduced annually
• 3,643 energy-saving measures implemented
• Progress toward climate neutrality in the healthcare sector
• Air quality improvement

Societal benefits:

Health benefits such as:

• Improved thermal comfort protecting vulnerable populations from heat stress
• Enhanced indoor air quality reducing infection transmission

Economic benefits:

• €31 million annual energy savings
• Funds reinvested in care quality and further sustainability measures
• Reduced operational costs strengthening financial resilience

System benefits:

• Centralized data supporting planning
• Capacity building

2019-2025

There is a wide range of types of measures, ranging from installing sun shading to providing heat pumps and insulating the building envelope. The lifespan is linked to the type of measure.

Flemish Department of Care

Hannah Bohez

hannah.bohez@vlaanderen.be

Flemish Energy Company (VEB)

An Brouns

an.brouns@veb.be

Handbook for air quality (BE): https://www.vlaanderen.be/publicaties/ventilatie-in-woonzorgcentra-kwaliteitshandboek