By Ray Furlong
The World Tonight
Gordon Brown recently announced a plan to help us all make our homes more environmentally friendly. But it seems public buildings also need an upgrade.
Peterborough Hospital is trying to save energy
Ageing school and hospital stock is in dire need of refurbishment, and most new build doesn't make the grade either, according to the president of the Royal Institute of British Architects (RIBA), Sunand Prasad.
He said: "Recent hospital build in this country has been deficient because the specification and the design of the buildings have not been anywhere near the state of the art for energy efficiency or sustainability.
"It just hasn't featured as a major driver."
Mr Prasad says the reason for these shortcomings is government procurement practises, including the controversial Private Finance Initiatives (PFI) championed by Gordon Brown.
Under these schemes a private consortium builds the hospital and leases it back to the trust.
"Take a PFI contract," said Mr Prasad.
"Even though as a hospital trust you pay a unitary charge to the consortium that has built, and is operating the building, you pay your own energy costs.
"So there is no incentive for the consortium to make highly energy efficient buildings.
"Equally, if you have directly exchequer funded buildings, the budgets are set in advance.
"We all know that energy efficiency measures cost money up front which you get back later.
"But if the budget isn't there at the start, those measures won't be included."
One hospital that has been widely praised is the new wing at Lewisham Hospital in south London, a £60m development that's the first in the NHS to be powered by solar panels, with a design that maximises natural light and ventilation.
But even here there is criticism.
Robin Stott was medical director here when plans were made. He says the building falls short of what was possible.
"We could have done much better - we tried to incorporate reduction in running costs but couldn't get the capital.
"I'm sure if there'd been an explicit statement from the minister and chief exec of health service it could have happened."
There is empirical data to back up the siren voices.
A report earlier this year from the National Audit Office said that of the public buildings such as schools and hospitals built or refurbished over 2005-06, only 9% met government targets for environmental sustainability.
But in a statement, the Department of Health said: "The NHS has already received detailed guidance from the Department of Health on energy usage, waste management, green transport planning and water consumption.
"The construction of new hospital buildings and PFI projects follow energy, sustainability standards and formal environment assessments which have to be met by NHS trusts."
Nevertheless, Neil MacKay, the climate change Tsar for the NHS in England, speaks of the difficulties of persuading managers to deal with the issues.
"Sometimes I get blank looks when I say to people: 'Why aren't you interested in the consequences of climate change and the use of energy?'
"People will say: 'Well, we do', but when you unpack it and explore it they are doing things - but they are not really getting to the heart of things in an innovative, lateral-thinking kind of way.
"The proposition that I offer to NHS organisations is that not only is this a moral, professional issue for those of us working in the NHS - there are sound business reasons why you would want to do it as well."
They have taken these lessons to heart at Peterborough hospital.
I took a tour of the facilities with John Field, a director at Power Efficiency, a company which advises how to reduce carbon emissions from buildings.
He saw various shortcomings at the hospital's two sites - one from the 1960s and one from 1988, as well as a Day Surgery Unit opened three years ago.
"They could do with new boilers, complete replacement of lighting, installation of central lighting controls," he said.
"You could upgrade the fabric of the buildings, which would be extremely costly."
But he also underlined a functioning heat-exchange system that allowed some boilers to remain switched off even on a cold day - as well as simple measures such as only having every other light on in the corridor.
St Clair Armitage, the facilities director, says lots has been done.
"We have had a save-it campaign, we have updated our building management systems, we have updated our boiler controls, and we are using about 15%-20% less energy than we were a year ago."
Other work has not been done because construction has already begun on a new hospital to replace Peterborough's old buildings.
It is projected to use 40% less energy.
But Sunand Prasad is unimpressed.
"Sustainability has not been a priority in any recent hospital build," he said.
"If you compare what is being done with some of the best energy efficiency work on some housing experiments or some cultural buildings, there is no comparison."