SUSTAINABILITY
Far right: Green roofs and green landscaping around healthcare buildings help to reduce surface temperatures.
Near right: Incorporating water features and nature-based landscaping solutions can help with passive design outcomes.
Ola Bialas
Ola Bialas worked in two UK-based building design consultancies and an EU-based architectural practice before joining Hoare Lea as a Sustainability consultant in 2022. Ola studied architecture at Karków University of Technology, taking part in the international student programme at the University of Tennessee, College of Architecture and Design, and then specialising in building physics and environmental design, as part of University of Bath MSc programme. Ola is an accredited
Passivhaus designer and chartered environmentalist, and has project experience across a broad range of sectors including healthcare, commercial, residential, education, industrial and mixed-use masterplan developments. Her main areas of interest and expertise are in comprehensive building analysis, dynamic thermal modelling and Design for Performance, motivated by working towards ambitious sustainability targets, and zero carbon performance. Ola was part of the UKGBC Roadmap to Climate Resilience, where she undertook research into overheating modelling.
Unfortunately, in a lot of the cases, it is extremely difficult to achieve an equilibrium that would satisfy all these requirements. For existing buildings, this is even more challenging, usually resulting in conflict, where only two aspects can be achieved at any time, with one aspect compromised. Regulatory requirements must be met as patient safety is vital. Yet that usually mean that there needs to be a choice between lower energy or higher internal temperatures, particularly in smaller spaces with high occupancy such as waiting rooms, wards, doctors’ offices and staff break rooms.
Conditioning considerations Considering the tensions between different standards and requirements, as well as the building’s location, active measures such as increased rates of mechanical ventilation or provision of air tempering may be needed. Both solutions would naturally increase the energy demand of the building, and the carbon emissions associated with that. However, they are less energy and carbon intensive than the addition of air conditioning. Air tempering systems provide ventilation with reduced
temperature through a mechanical ventilation unit with heat recovery, and use a fixed cooling capacity coil that operates based on sensors in the room. As occupants of the building do not have control over the air flow rate and temperature of the air provided, the risk of inefficiencies in the system operation due to human error are minimised. This also prevents ‘excessive cooling’, as supply temperature is lowered rather than set to certain targets. For example, with an air tempering system, an internal room temperature would reduce from 28°C to 26°C, but occupants would not be able to cool the room down to 18°C, like they would be able to with an air conditioning system. Active cooling and air conditioning might be necessary in some healthcare buildings, particularly in urban locations like London. This, however, should be treated as last resort, and a combination of passive design measures with some active measures should be prioritised. This will ensure longevity of the building, and resilience to future climate scenarios, as well as a reduction in operational energy and carbon emissions. With an already overwhelmed healthcare sector,
vulnerable people might increasingly face more difficult conditions. It is particularly concerning because this environmental change does not occur suddenly over a day, week, or even a month – it has been unfolding over the past
64 Health Estate Journal October 2025
few decades, and is expected to continue for many more. Overheating is an increasing problem within our NHS buildings, as reported in the latest NHS Estates Return Information Collection (ERIC).3
Over the past four years,
the number of overheating incidents prompting a risk assessment has risen by more than 60% compared with the preceding four-year period. We risk being like the frog in tepid water now, that becomes the frog in hot water later. If the overheating risk in hospital happened immediately, it would have likely already been addressed, but because it was, and still is, happening gradually - we are at risk of acting too late.
Active and passive measures Our report recommends initially adapting hospitals – where possible and feasible – with passive measures, and adding active measures when and where funding allows. These measures include air tempering and air conditioning. While healthcare buildings are being adapted to improve comfort for patients and staff, we must also work to reduce carbon emissions to prevent further environmental degradation. Implementing urban greening, enhancing air quality, reducing noise and light pollution, and incorporating water features and nature-based landscaping solutions will enable us to fully capitalise on the benefits of passive design measures. Simply put, if the air outside the hospital is cooler, it’s more likely you can open the window to cool it down. The phrase, ‘take care of the pennies, and the pounds
will take care of themselves’ perfectly describes what needs to be done in terms of climate change and climate resilience. Everyone has a small but significant role to contribute to the goal of creating comfortable Net Zero hospitals. We should not wait for perfection but make every action count.
References 1 Mentaschi L, et al. 2022. Global long-term mapping of surface temperature shows intensified intra-city urban heat island extremes. JRC Publications Repository. https://publications.jrc.
ec.europa.eu/repository/handle/JRC123644.
2 UK Green Building Council. 2025. UK Climate Resilience Roadmap.
https://ukgbc.org/our-work/topics/resilience- roadmap.
3 NHS England. 2023. Estates Returns Information Collection, Summary page and dataset for ERIC 2022/23. https://digital.
nhs.uk/data-and-information/publications/statistical/estates- returns-information-collection/england-2022-23.
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