ROOF REFURBISHMENT
Before (top) and after images of the roof of Milton Keynes University Hospital.
None of that was luck. It came out of what the survey established before anyone specified anything, which is where the rest of this article goes.
What the targets require, and what has to deliver them Two sets of numbers frame every roofing decision on an NHS site, and they pull in opposite directions. The first is the target. Under Delivering a Net Zero
NHS, the NHS Carbon Footprint – covering emissions the service controls directly – is committed to Net Zero by 2040, with an 80 per cent reduction between 2028 and 2032. The wider NHS Carbon Footprint Plus follows by 2045. Those are not aspirations sitting in a strategy document. The Health and Care Act 2022 placed duties on Trusts and integrated care boards to have regard to climate change in the decisions they make, and the NHS Net Zero Building Standard has applied to upgrades of existing facilities, not just new builds, since October 2023, bringing whole life carbon reporting into the business case. The second is the condition of what has to deliver it.
The 2024/25 Estates Returns Information Collection put the cost of eradicating backlog maintenance in England at £15.9bn, up 15.7 per cent in a single year, with the high risk element rising 28 per cent to £3.5bn. Backlog is measured against condition B, the minimum acceptable standard. Not good, not fit for the next 25 years. So that figure is the cost of getting back to acceptable, and each year it is deferred the same work costs more and moves up a risk band. The point where those two meet is the building fabric. NHS England’s five year progress report shows estates emissions down 10 per cent since 2019/20 and emissions
104 Health Estate Journal October 2026
from grid electricity down 21 per cent, largely because the grid itself has decarbonised. Gas, which accounts for around 40 per cent of the NHS carbon footprint and is mostly heat, has fallen by 1 per cent over the same period. Electricity has been getting cleaner without Trusts having to do very much. Heat will not. That is the case for treating roof renewal as a decarbonisation project rather than a maintenance one. A roof that has to be replaced anyway is one of the few moments when a Trust can improve fabric performance, add generation, and clear a backlog liability from the same access and the same programme. Miss it and the next opportunity is 25 years away. Flat roofs defer well, right up until they do not. Nothing
visible happens for years and then a great deal happens at once, usually in the middle of a winter storm and usually above something clinical. A roof does not stay a roof problem for long. It becomes a decant, an infection control conversation, and an emergency capital request, in that order.
The roof: what a survey has to establish Two questions decide what the money buys, and both should be answered before either the roofing or the solar scheme is specified.
n How much service life is left The first is decided by evidence rather than appearance. Core samples show whether the insulation below is wet
or dry, and that single result decides whether the existing build-up can be overlaid or has to come off. An overlay leaves the existing construction in place and applies new waterproofing over it, which removes the strip-out cost, removes the waste stream, shortens the programme,
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