Designing net zero buildings: is the NHS on the launchpad?

The built environment is facing its NASA moment. When US president John F Kennedy pledged in 1961 to put man on the moon within a decade, the technology and know-how in which to make it happen wasn’t there, but the will was. Navigating the nation’s property infrastructure to net-zero whole-life carbon evokes JFK’s challenge. It’s now a year since the NHS became the world’s first national health system to commit to become carbon net-zero for the emissions it can control by 2040. The will of the NHS is clearly there, and its estate must be one of the rocket boosters. With an initial target to reach an 80% reduction by 2028 to 2032, the multi-year roadmap was the first from the NHS to set out a list of milestones to decarbonise its healthcare services and infrastructure to help the UK reach its overarching climate goals. But the last year has writ large the complexity of the journey when set against the plethora of outdated properties used by the NHS from a different era, not least GP surgeries in large converted Victorian homes, former bungalows and converted offices. One giant leap Bridging the gap between the ambition and the unique, very practical challenges of reaching net zero in healthcare buildings will take innovation and partnership like the NHS estate has never seen. Current design specifications don’t make it easy. The requirement for smaller windows to reduce energy loss, for example, directly conflicts with the needs of patients and NHS teams; and with the international building standard for environmental sustainability which encourages more daylight. Front doors which are constantly opening and closing as patients walk in and out of surgery sites make it incredibly difficult to minimise heat loss and reduce energy use in the colder months – of which there are a lot in the UK. Another key factor is the cost and financial viability of the design elements required to push buildings closer to net zero. A timber frame for a medical centre will drive down carbon considerably but would send insurance rates skyrocketing. Bridging the gap between the ambition and the unique, very practical challenges of reaching net zero in healthcare buildings will take innovation and partnership like the NHS estate has never seen At a time when the cost of raw materials is rising, the financial pressures don’t end with construction. Notoriously complex offset payments ‒ the last resort to compensate for the emission of carbon which can’t yet be designed out, due to lack of innovation – remain a crucial part of the budget. Government has pointed the way, with the 2019 Health Infrastructure Plan, which set out the broad approach to improving the NHS estate, and the recent launch of an Estates Net Zero Carbon Delivery Plan. All work is seeking to meet the government’s budgetary guidelines and NHS’s mandatory design requirements, so that new developments remain viable and affordable for the long-term. Beyond 2026 Assura’s portfolio has long included buildings with sustainable technologies, such as West Gorton Medical Centre’s photovoltaic panels and heat retaining insulation, or Ardudwy Health Centre with an insulated timber frame and biomass boiler. All our new developments are BREEAM Good or Excellent already, but we are driving towards 2026 from when we have pledged to deliver only buildings which are net-zero for both their construction and operation. As part of our SixbySix social impact strategy and our World Green Buildings Council Net Zero Buildings Commitment, we are supporting this work with investment into moving every property we own to EPC B or beyond in the same timeframe. These pilot schemes have shown us, first-hand, that developing net-zero buildings should not cost the earth. Meeting this goal cost-efficiently means thinking about natural ventilation, moving to more sustainable lighting and heating systems, improving insulation, and building performance. Simple changes such as setting windows back into their frame or reducing glazing on south-facing sides reduces heat gain and leads to natural cooling. While making buildings more modular and rectangular helps to match a timber frame more effectively ‒ probably the single biggest component in reducing embodied carbon. Within reach Unlike the challenge facing NASA in the early 1960s, many of the design solutions required to achieve net-zero medical buildings are well within the NHS’s grasp. These changes don’t demand an inordinate budget, and we already have the know-how to implement them. The giant leap for the NHS will be making these changes quickly across all schemes, so that innovation can be focused on the more complex elements. The will is there, the technology and materials are not – yet. But if there’s an estate with the scale to meet the challenge and the health imperative to blaze the trail on net zero, it is that of our NHS. Jonathan Murphy is chief executive of Assura