SUSTAINABILITY
Exposure to commercial project environments – where time, cost and accountability can be more explicit – can bring different mindsets to complex programmes.
Steve Heape
Why external support often makes the difference Another recurring theme is the role of external advisors and frameworks. Large sustainability programmes require specialist expertise – technical, commercial, legal – that many trusts simply do not have in-house. Trying to deliver complex energy projects without that support can leave trusts exposed. As Clarke points out, contractors will always arrive with their own preferred contracts and commercial positions. “If you don’t have a framework or experienced advisors, you risk signing up to what suits the contractor, not what’s best for the trust,” he says. External support can also provide continuity and momentum, particularly when internal capacity fluctuates.
Funding helps – but it is not the whole story Grant funding has undoubtedly accelerated sustainability activity across the NHS. Programmes such as the Public Sector Decarbonisation Scheme have enabled projects that might otherwise have been unaffordable. But funding alone does not guarantee success. Several participants caution against assuming that money is the primary driver. “There’s a tendency to think that if funding exists, projects will naturally follow,” Clarke says. “But without the right people, governance and delivery model, there’s a risk that funding just sits there or worse, is forfeited.” In some cases, funding can even add pressure – with tight delivery windows and complex reporting
requirements. Trusts that lack the internal capacity to manage those demands can struggle to capitalise on available support. Despite the challenges, successful sustainability projects can deliver benefits beyond carbon reduction. By forcing organisations to confront underlying issues – ageing infrastructure, undocumented systems, poor data – they can catalyse wider improvements. “Some of these projects reveal problems with the estates
infrastructure that would otherwise have been kicked down the road,” Clarke observes. “That can be uncomfortable, but it’s often necessary.” At SaTH, the district heating programme exposed secondary system issues that were then addressed as part of delivery. The result was not just lower carbon emissions, but a more resilient energy system.
The real lesson If there is a single lesson to be drawn, it is that sustainability projects fail less often because of technology or cost, and more often because of people and systems. They require leadership that persists, not just approves. Dedicated resource, not goodwill alone. Governance that enables decisions, rather than diluting responsibility. And delivery models that recognise the realities of operating live healthcare environments. As pressure mounts to decarbonise at pace, these lessons matter. Because the question is no longer whether sustainability projects are necessary – but whether organisations are set up to deliver them.
Steve Heape leads Project Development at the Carbon and Energy Fund (CEF) and is a leading figure in the UK’s healthcare decarbonisation landscape. He has spent over a decade developing and delivering large-scale low-carbon energy infrastructure across NHS estates, including heat pumps, geothermal, solar PV, CHP, and energy performance contracts. Steve also chairs the IHEEM Sustainability Advisory Panel and is deeply involved in innovation around net zero hospitals, district energy and new clean-energy business models. He is passionate about turning complex energy challenges into deliverable, investable solutions.
March 2026 Health Estate Journal 41
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