From Green (plan) shoots to sustainable outcomes within healthcare estates

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  • From Green (plan) shoots to sustainable outcomes within healthcare estates
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Heather Evans


Heather Evans


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At the start of the 2022 came the deadline for NHS Trusts across England to publish Green Plans, defining their pathways over the next three years towards becoming sustainable healthcare settings. This will quickly be followed by the publication of Green Plans by the Integrated Care Systems (ICS), which will be embedding sustainable healthcare across counties and wider communities.

Far more than just a masterplan, the Green Plans look to outline clear strategies and actions for each individual Trust and ICS, looking at everything from how to build and reconfigure with the lowest possible carbon and energy footprint, through to sustainable procurement, green travel, sustainable use of medicines and sustainable models of care, to adapting to a changing climate, and delivering local, healthy and sustainable meals.

Reducing carbon emissions runs as a golden thread in the template for the Green Plans. With the NHS having long term targets to be net zero by 2045 for its entire footprint – the NHS Footprint Plus – the Green Plans are the pathways to achieving these goals. When you consider that the NHS contributes 4% to the carbon footprint in England, this has potential to make a big difference.

Like many other sectors within the built environment, we are striving to achieve best value from our capital invested in sustainable measures, so every pound invested achieves maximum impact. With patients always at the heart of every healthcare setting, and many NHS estates designed and built way before sustainable outcomes were thought about, ensuring that a greener NHS is achievable can be challenging for many Trusts.

Having worked closely with the team at University Hospitals of Leicester NHS Trust (UHL) to develop its Green Plan and as part of a group working on the net zero plans for their estate, we know of the challenges and opportunities of building greener.

Key considerations for NHS Trusts’ Green Plan implementation journey

Implementation rather than just Publication 

Unlike the Sustainable Development Management Plans that preceded them, the Green Plans need to be seen as more than just a direction of travel. With real targets, clear actions and accountabilities for implementation supported by appropriate financial and human resources. This needs to be at the core of every Trusts’ business vision supporting their drive to build healthcare estates for the future.

Commitment and investment from Leaders and Senior Management Teams

And of course, with this investment is the commitment to a sustainable mindset. Every action taken at Trust or ICS level should be driven by a pursuit of best practice and sustainable outcomes. This requires investment in people and building capacity to deliver change.  The choices are complex; procurement routes should be considered holistically, including the relative merits in terms of value created, with value looked at from multiple perspectives – Community, People, Environmental and Economic.

This can play out in numerous ways e.g. the transition to virtual appointments and care in the community/closer to home. This can bring numerous benefits in terms of patient travel and waiting time, cost, and travel carbon footprint, but also changes the need for space in the hospital setting. The clinical need for space is a key element in deciding what to build or indeed not build, and this becomes more complex when taking decisions to install high energy diagnostic and preventive spaces, rather than consultation rooms. Projects should consider flexible space to permit future adaptability, reducing the need for extensive future alterations or extensions.

Holistic viewpoint

For many NHS Trusts following the Construction Playbook and other government guidance, looking at their long-term estate plan and balancing the other elements of procurement that sit alongside sustainable outcomes is essential. At RLB we are working with NHS Trusts to do just this; demonstrating how each element – be it cost, sustainability, time or social value – are intrinsically linked, and impact the other. Ensuring that costs are analysed with long term value rather than short term spend and assessing how investment up front can save money and time across a buildings lifecycle can help support business case planning and investment as well as progressing the green agenda.


Finally, measurement. Although most trusts are used to recording data for their ERIC returns and to support business cases, much of this data is around existing energy usage, efficiency within hospitals and the like. Working towards real sustainable models of care involves a holistic measurement and analysis of the wider data including embodied and operational carbon social value arising from procurement, staff travel, patient travel and clinical and wider hospital practices.

A case study in sustainability: Vascular Limb Salvage Clinic, University Hospital Leicester

One project that illustrates how NHS Trusts can think longer term about their sustainability outcomes is the University Leicester Hospital NHS Trust’s Vascular Limb Salvage Clinic (VaLs).

In 2017, the University of Leicester and University Hospitals of Leicester received a charitable donation to fund research into peripheral vascular disease and establish a Vascular Limb Salvage Clinic.

The Clinic, that opened later that year, treats referrals from health professionals for those with peripheral arterial diseases for assessment and early intervention with the aim to prevent amputation and hospitalisation.

Used as an early intervention clinic, the facility is part of the Trust’s long term sustainability strategy preventing hospitalisation, surgeries and amputations and aftercare. This in turn, reduces the energy consumption of patients staying overnight in a clinical setting, travel to and from the hospital for pre and post operational procedures, use of medicines and anaesthetics and ultimately reducing the environmental footprint of the hospital. 74% of patients who walked through the clinic’s doors did not have any limbs amputated within a year after treatment. This is an impressive 15–19% improvement when compared to those outcomes in the pre-clinic and alternative pathway data. The exciting challenge is now how to measure the social and environmental benefit of this investment alongside the clinical benefits.


We all know that we have to work towards a Greener NHS, not just as policy is driving us there but as a sector we can no longer manage and maintain our hospital estates without sustainable models of care being at the heart of everything we do. The Green Plans serve as enablers and will be the leading edge of a series of deeper approaches to planning, building and operating net zero carbon and sustainable hospitals, meeting the changing needs of the community through this century. 


Heather Evans
Heather Evans

Partner – National Head of Sustainability