DECARBONISATION
The right strategy for decarbonisation
The NHS estate is one of the largest and most complex public sector property portfolios in Europe, encompassing acute hospitals, laboratories, community facilities, and administrative buildings. While estates teams have delivered numerous efficiency improvements in recent years, achieving Net Zero will require much deeper transformation. Ian Johnson, public sector lead at Ortus Energy, examines the structural challenges facing NHS estates managers and explores how expanded renewable generation, programme-level delivery, and new financing approaches could accelerate progress.
Few organisations manage infrastructure as extensive or operationally critical as the NHS. Across England alone, the NHS estate comprises thousands of buildings delivering clinical care, research, diagnostic, and administrative services. Hospitals are among the most energy-intensive building
types in the public sector. Clinical environments require tightly controlled ventilation systems, sterilisation processes, imaging equipment, and specialist medical technologies operating continuously throughout the day and night. These operational requirements result in substantial and constant electricity demand. The complexity of the NHS estate further compounds
the decarbonisation challenge. Unlike many commercial property portfolios developed under a single strategic framework, NHS buildings have evolved over decades in response to changing healthcare delivery models, emergency capacity requirements, and varying investment cycles. As a result, estates teams must manage a built
environment characterised by: n Ageing infrastructure. n Mixed construction types and building vintages. n Constrained urban hospital campuses. n Complex mechanical and electrical systems. n Fragmented estate governance structures. n Critical 24-hour operational requirements.
These factors make decarbonisation significantly more complicated than in many commercial property portfolios. For NHS estates teams, the challenge therefore involves two parallel objectives: reducing energy demand wherever possible, while also decarbonising the electricity that healthcare facilities must inevitably consume. The latter challenge increasingly requires new approaches to energy generation and procurement.
Progress to date – valuable but incremental NHS estates teams have already delivered significant improvements in building energy performance across many facilities. Common interventions implemented by Trusts include:
n LED lighting upgrades. n Improved building management systems. n Plant and boiler replacements. n Insulation improvements. n Early-stage heat pump projects. n Rooftop solar installations.
September 2026 Health Estate Journal 75
These initiatives have produced measurable carbon and cost reductions while demonstrating that energy projects can be delivered safely within operational healthcare environments. However, many of these projects fall into the category of relatively straightforward energy efficiency measures. Typically, they:
n Fit within existing capital budgets. n Avoid complex procurement processes. n Minimise disruption to clinical operations. n Focus on individual buildings rather than estate-wide systems.
Such interventions are essential and represent meaningful progress. Yet they do not fundamentally alter how energy is generated or supplied across the NHS estate. In many respects, the NHS has already captured much of the ‘low-hanging fruit’ in building efficiency improvements. The next phase of decarbonisation will inevitably require deeper changes to energy infrastructure.
Lessons from the private sector Large commercial and industrial estates are increasingly addressing similar challenges around energy resilience, carbon reduction, and rising electricity costs. Many organisations with energy-intensive operations, including logistics centres, manufacturing plants, and food distribution facilities, are deploying on-site renewable generation as part of long-term energy strategies. A useful example comes from the retail logistics sector.
Solar offers several advantages for complex operational environments.
AdobeStock / tong2530
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