NET ZERO
model is increasingly difficult to reconcile with the pace of decarbonisation now required. The NHS is working to long-term Net Zero commitments, but many estates decisions are being made within much shorter funding, operational, and clinical planning cycles. At the same time, NHS sites are not the only
organisations seeking greater electrical capacity. Demand is rising across multiple sectors as businesses electrify operations, expand data infrastructure, and invest in low-carbon technologies. The system is not catching up fast enough to match these ambitions, and this competition for network capacity means waiting passively for reinforcement can put schemes at risk, particularly where delivery is tied to grant funding windows, backlog maintenance programmes, or critical clinical upgrades. These pressures are not unique to healthcare, but they are particularly acute for NHS estates. Hospitals are energy-intensive, operationally complex, and required to maintain continuity of service at all times. Unlike some commercial developments, they cannot easily pause activity, reduce resilience, or defer essential functions while infrastructure catches up. Many sites also contain a mix of old and new buildings, critical plant, constrained land, and competing clinical priorities, which makes energy transition more complex than a straightforward technology replacement programme.
How projects are adapting in practice In our work with healthcare estates, the most successful projects are increasingly those that treat grid constraints as a design parameter from the outset, rather than a problem to be solved at the end. This starts with understanding the true demand profile of a site: what loads exist today, how they vary across the day and year, and how future clinical, estates, and decarbonisation plans will change that profile over time.
On one major hospital development, early analysis
of the proposed energy strategy showed that the initial projected electrical load could be materially reduced by challenging assumptions about future demand. Rather than simply designing around the highest possible load, the project team looked at how building performance, phasing, local generation, storage, and heating and cooling networks could work together to smooth demand and ultimately the predicted load by almost 40 per cent, significantly reducing the scale of grid reinforcement required. That type of approach can make the difference between a scheme that is theoretically low carbon and one that is practically deliverable. Demand reduction remains one of the most important
first steps. Improving building fabric, controls, lighting and operational efficiency can help reduce the scale of additional electrical capacity required. Smarter design can also help smooth peaks in demand, reducing the pressure on constrained infrastructure and improving the business case for investment. A critical part of this process is testing assumptions about future load. Not every forecast demand should automatically be treated as fixed. For example, estates teams may need to consider whether all fleet or staff EV charging needs to be delivered on the hospital site, or whether some requirements are better met through depots, home charging, or wider local infrastructure. This kind of challenge can materially reduce projected demand while still supporting the transition to low-carbon transport. When linked to phasing this can become more powerful, as aged estate buildings come offline or as EV uptake and heat electrification occur, the capacity and loading profiles can be altered to match.
October 2026 Health Estate Journal 77
Phasing and sequencing are also becoming critical. Rather than assuming that every intervention can be delivered at once, estates teams may need to prioritise the loads that deliver the greatest carbon, resilience or clinical benefit. This can mean staging heat decarbonisation, aligning works with plant replacement cycles, or designing energy centres that can expand over time as capacity becomes available.
On-site solutions can also play an important role. Solar PV, battery storage, local energy centres, and other forms of distributed energy infrastructure may not remove the need for improving a grid connection, but they can help manage demand, improve resilience, and reduce exposure to future energy cost volatility. The key is to assess these options as part of an integrated energy strategy, rather than as standalone technologies, weighing up the cost benefits of the capital required against the potential to reduce the reinforcement scale, cost, and timeframe. The most effective strategies often combine several
interventions rather than relying on one technology. A microgrid, for example, can help coordinate local generation, battery storage, heating and cooling assets, and building controls, so that demand is managed across the site rather than building by building. Thermal storage can also help smooth peaks, storing energy when it is available and releasing it when clinical demand is highest. This can reduce pressure on the grid connection while improving resilience and operational flexibility, with the
Many Trusts plan to make greater use of electric vehicles across their fleets.
Pressure on the grid connection can be reduced through the use of thermal storage.
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