- 9. Client focus: NHS England
Finding opportunities for estate-scale decarbonisation
Preparing projects for funding, looking at big and small opportunities and empowering people with carbon literacy were the key points made by NHS England director of estate sustainability and workforce Fiona Daly on how the NHS is working towards net zero.
Fiona said that achieving net zero within the NHS brings broader benefits for society. “Climate change threatens the core purpose of the NHS with poor environmental health contributing to major diseases including cardiac problems, asthma and cancer,” she explained.
Action on climate change will bring direct improvements for public health and health equity.
The NHS has huge potential to support the UK in achieving net zero by 2050, according to Fiona. “The NHS is responsible for 5% of emissions in the UK and emissions from its estate make up a third of all public sector energy emissions,” she said.
“In October 2020, the organisation set out Net Zero NHS and became the world’s first health service to commit to net zero. Under that plan, the NHS will reach net zero for directly controlled emissions by 2040, with an 80% reduction reached by 2032. The target set for achieving net zero for indirect emissions is 2045 with an interim target for an 80% reduction of 2039.”
The task is no small undertaking: the NHS operates 2,700ha of hospital estate spread over 1,140 hospitals, 8,000 primary care facilities and 11,000 community pharmacy sites.
Fiona said that the NHS Estates’ plans for net zero are split into three buckets – new builds, existing facilities and leasehold properties. “We launched a new building standard in 2023 for new builds to look at operational, embodied and whole life carbon to ensure we meet our 2040 target,” she explained.
However, Fiona said that focus on existing facilities is vital in order to meet the targets the NHS has set, as most of the facilities that will exist in 2040 are already in operation.
To address these challenges, a detailed four-step Net Zero Delivery Plan was launched in 2021 with a focus on circular economy thinking, electrifying fleets, building investments and promoting active travel.
According to Fiona, having a detailed plan and telling people exactly what they need to do is critical “and this does exactly that”.
For leasehold properties, a green leases framework has been set up to help aid conversations with landlords.
Being ready for when money becomes available
The big challenge for the NHS in delivering on this is funding.
Fiona’s team has been successful in securing over £2bn of additional funding for 114 net zero projects and she attributed that achievement to the ability to build strategic partnerships and their capability as a proven delivery partner.
She also said that her team positions itself to be ready for when money becomes available and urged the wider industry to look at how it does this. “I've been working in sustainability for about 18 years and money [in additional funding pots and grants] becomes available at weird times but you need to be ready to use it, take hold of it and deliver on it,” she explained.
By having projects scoped and ready to go, Fiona’s team were able to secure £40M for lighting and solar projects recently.
However, Fiona said that it is not all about big investments and there are also day to day decisions around management of NHS Estates that are critical to achieving the net zero ambition. Her team has put together a document called Greening the Business Case to address that. “This brings together energy impacts, carbon impacts and social aspects of building a business case for financial decisions,” explained Fiona.
Systems thinking for resilience
Making NHS facilities climate resilient is also a focus for Fiona’s team.
“It is not just about our buildings getting flooded, but flooding means we can't get people to our hospitals, we can't get people to our primary care facilities,” she said. “We've worked with the Environment Agency to develop a tool to better understand our flood risk. But we need to also look at the impact from overheating too.”
Nonetheless, it is not all about policies and plans, Fiona sees carbon literacy and putting sustainability at the heart of NHS practice as critical. “We have around 1.4M people working for the NHS and around 120,000 of those are built environment professionals,” she said. “We have to recognise that a lot of our staff work under high stress but we have been developing sustainability modules to ensure people have a better understanding.”
