Driving the Healthcare Estates Net Zero Agenda

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  • Driving the Healthcare Estates Net Zero Agenda
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Heather Evans


Heather Evans


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In January 2020 just before the health emergency hit, the NHS launched its Greener NHS campaign alongside its NHS Net Zero Expert Panel.

The campaign, ahead of the forthcoming 26th UN Climate Change Conference (COP26) to be hosted by the UK and Italy in Glasgow later this year, outlined how the NHS would accelerate action to meet the Paris Agreement goals. With the NHS responsible for 25 megatonnes worth of carbon in 2019, 4% of England’s total carbon footprint, and with 15% of that coming from NHS estates and its supporting facilities services[1], there was a clear directive that healthcare estates need to clean up their acts.

With over 60% of the UK healthcare estate being more than a quarter of a century old[2], many of our hospitals were built long before the environmental agenda was at the forefront of design.  For the existing estate, the embodied carbon of these buildings has already been spent; therefore the sustainability journey means looking at ways to lessen the operational carbon footprint through improving energy efficiency, reducing consumption and switching to greener energy sources, balancing environmental cost in an OPEX cost line rather than CAPEX of a new build.

For new healthcare builds, including the 40 hospitals that the Prime Minister announced to be built by 2030, and additions to existing estates, the remit is twofold – to incorporate sustainability into the design and build whilst managing the operational carbon, considering future procurement with carbon targets set, measured and evidenced. Linking the carbon cost to other key value drivers such as social value and community impact is essential in each project and business case scenario.

At RLB sustainability is an integral, rather than bolt on, part of the service we offer to our clients. Having worked across the healthcare remit from masterplanning to supporting business case delivery, project and cost management and estates maintenance and management, we know that adopting sustainable practices, whether being introduced into an existing build or planned to a new build, can seem difficult within budget constraints.  However, we also know there are small steps that can be made for the longer gain.

Five ways to reduce carbon footprint in a healthcare setting

Ensure that sustainability is part of the conversation as early as possible

The Government’s Value Toolkit and the Construction Playbook both highlight the need to look more holistically at our builds, retrofits and fit outs – across our industry. Rather than working in silos to look at projects on a case-by-case basis, we need to think of the longer life of buildings and incorporate sustainable elements that bring longevity and look at cost in the larger framework rather than just unit price. Looking wider than construction and including engagement and behavioural change can have huge benefits in reducing carbon.

Rationalise and baseline existing assets

It is vital that buildings operate as efficiently as possible, addressing under-utilisation through decreasing estate footprint and therefore energy consumption and carbon. Understanding the baseline enables a roadmap towards net zero carbon to be developed.

Utilise whole life value approaches

Applying an integrated whole life value approach allows for informed decisions in relation to estate assets over the long term and delivers real savings. Simply put, whole life value means considering capital costs, energy, carbon and operation/life cycle replacement costs from the outset.

Hit the hotspots on embodied carbon

At RLB, we utilise our in-house tool to determine the embodied carbon of each construction material. Focusing on the proportionally most significant areas drives decision making; consider structural (e.g. recycled steel, timber frames), concrete and aggregates (e.g. recycled content and low carbon alternatives).

Innovate and future proof

Adopting best practice from other sectors, preparing for rapidly changing technology and installing adaptable infrastructure to move towards electrification of the estate allows for a future proofing approach.

With an ambition to reach net zero for the NHS footprint by 2040 and a commitment to reduce emissions by 2028-2032 by 80%, sustainability is firmly on the NHS built environment agenda.  For those of us working hand-in-hand with the NHS, it is our responsibility to take these steps with them and support their ambition to make our healthcare estates a healthier and greener environment for all.

[1] https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/

[2] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/607725/Naylor_review.pdf


Heather Evans
Heather Evans

Partner – National Head of Sustainability