CARBON REDUCTION AND NET ZERO


Architects at the heart of NHS decarbonisation


Laura Carrara-Cagni RIBA, director and co-founder of Cagni Williams Associates and Cagni Williams Energy, explores how architects can assist NHS Trusts and other healthcare providers in developing and implementing Net Zero Carbon strategies, how their expertise can drive cost reductions, and the role of external partnerships.


The National Health Service (NHS) is the UK’s largest public sector emitter of carbon emissions, a statistic that is particularly concerning given its crucial role in the health and wellbeing of millions of people. The NHS operates an extensive and ageing estate, which is not only a source of significant carbon emissions, but also increasingly a source of financial pressure due to rising energy costs, inefficiencies in building design, and the ongoing challenges of maintaining older buildings. In an era of climate change, the push for decarbonisation is more urgent than ever, and the healthcare sector is under increasing pressure to reduce its environmental impact.


NHS ‘in a unique position’ While global climate change targets set an imperative for decarbonisation, the NHS, with its vast estate, is in a unique position to reduce not only carbon emissions, but also to benefit financially from this transformation. The drive for carbon reduction, commonly referred to as ‘Net Zero Carbon’ (NZC), offers a significant opportunity to lower long-term energy costs and operational expenses (the NHS Net Zero Building Standard was published on 22 February 20231


). Alongside this is The


Net Zero Commitment, a voluntary pledge within the UK’s private healthcare sector, with the aim of achieving Net Zero emissions by 2035, and a Net Zero supply chain by 2045. This initiative builds on the NHS’s target of achieving Net Zero by 2040, and supports the UK government’s commitment to net zero by 2050. Architects, with their


expertise in both the design and operational performance of healthcare environments, are key players in this transition. They are well positioned to guide NHS Trusts in achieving NZC through both new-builds and retrofits, ensuring that carbon reduction strategies are seamlessly integrated into the built environment, while also delivering substantial cost savings over time. This article explores how


architects can assist NHS Trusts and other healthcare institutions in developing and


September 2025 Health Estate Journal 43


implementing NZC strategies, how their expertise can drive cost reductions, and the role of external partnerships, including organisations like Salix, which provide funding for energy efficiency projects.


Salix and funding mechanisms: unlocking the opportunity While the technical solutions for achieving Net Zero Carbon are available, one major barrier for NHS Trusts is financing. The upfront capital required for energy- efficient upgrades can be significant, and many Trusts face financial constraints. However, Salix Finance, a non- departmental public body, plays a critical role in bridging this gap – by providing interest-free loans to public sector organisations for energy-saving projects. Salix’s financing model is particularly beneficial for the NHS, as the loans are repaid through the energy savings generated by the upgrades. This allows NHS Trusts to make improvements without the need for significant upfront investment. For example, Salix has supported Trusts in funding projects such as LED lighting upgrades, heating system improvements, and renewable energy installations. According to a recent study by Gardiner & Theobald,


NHS Trusts could save up to £2.8 bn annually over a 15- year period by adopting NZC strategies.2


Many of these


projects offer a 4-5 year payback period, making them financially viable and sustainable in the long term.


Figure 1: Pathway to net zero for the NHS Carbon Footprint scope. (Reproduced from NHS England’s Delivering a Net Zero’ National Health Service (2020).


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