The NHS is responsible for around 4% of the UK’s carbon emissions. With over 1,200 hospitals and thousands more health facilities, it is one of the largest estates in the country. That scale alone makes it a critical part of the national journey to Net Zero. But hospitals aren’t just another type of public sector building – they are unique environments with unique challenges.
Every trust is expected to produce an NHS Green Plan, setting out how it will cut emissions. For many estates teams, this feels like a daunting task, especially when day-to-day priorities revolve around patient care and safety, compliance, and keeping services running. But while the challenges are real, they are not insurmountable.
At Energy Systems Catapult, we’ve worked with government and across the public sector and seen first-hand the barriers hospitals face when decarbonising. This blog unpacks the main challenges and outlines how you can get started, even if you feel you’re late to the table.
Until recently, the Public Sector Decarbonisation Scheme (PSDS) offered a clear, time-limited opportunity to secure capital funding. With the scheme ending, trusts are now left with fewer options.
Some teams may turn to regional or Integrated Care Board initiatives, Salix loans (covering Wales), explore partnership models or compete internally for existing capital budgets. But these routes are often very competitive, less predictable and can be slower to materialise. That makes forward planning essential.
The key takeaway is that trusts cannot wait until funding pots are announced or become available to begin thinking about their Green Plans. Having a well-developed plan in place, with clear priorities and a strong statement about the benefits it will deliver, means you can act quickly when opportunities arise.
While the barriers are significant, it’s important not to overlook the opportunities. Decarbonisation is not just about cutting emissions – it can bring co-benefits that directly support NHS priorities. Being ready to present the benefits that resonate most to stakeholders and quickly get buy in can avoid the scramble that many experienced under the final rounds of PSDS.
Framing decarbonisation as a route to better care – not just lower carbon – helps secure wider support across the organisation.
One of the most obvious hurdles is the nature of the hospital environment. Retrofitting an office building may mean temporarily relocating staff or closing off floors. Schools can time disruptive works around summer holidays. But hospitals run 24/7 and most of the space is providing patient care or 24/7 services.
That makes even simple interventions difficult. Upgrading ventilation systems, switching to heat pumps, or improving insulation often requires parts of the building to be sealed off – something that’s rarely possible when wards are full.
Instead, projects must be phased carefully, often over longer timescales and with detailed planning to ensure there’s no impact on patients. It isn’t just about engineering solutions; it’s about choreography, balancing works with the ebb and flow of hospital operations.
Hospitals are complex organisations. Estates and facilities managers may see the long-term value of decarbonisation, but clinical teams are focused – rightly – on patient outcomes. Finance departments must balance competing priorities, while senior leadership teams face pressure to deliver across multiple strategic objectives.
This means decarbonisation projects aren’t just technical; they are deeply political. Securing buy-in requires clear communication, showing how upgrades can improve patient comfort (such as reducing overheating in wards during heatwaves), enhance resilience to power disruptions, and even contribute to better health outcomes.
We’ve found that successful projects involve early and transparent engagement. They bring clinicians into the conversation, highlight the benefits that matter to them, and ensure finance teams understand not just the upfront costs but the lifecycle savings and benefits of taking action now, reducing risks in the longer-term.
For many trusts, the challenge is multiplied by the legacy of Private Finance Initiative (PFI) contracts. In these cases, the hospital buildings are not directly owned by the NHS but managed by a private consortium.
That means any proposed works require negotiation with third parties. Contracts may not explicitly allow for certain types of upgrades, or the financial incentives may be misaligned. For example, a facilities management company paid to maintain a gas boiler may not be motivated to support its replacement with a low-carbon system.
This doesn’t make decarbonisation impossible, but it does demand a different skill set – one that blends technical knowledge with commercial negotiation and stakeholder management. Building strong partnerships and identifying win-win scenarios becomes as important as choosing the right heat source or insulation material.
If your trust hasn’t yet developed its NHS Green Plan, don’t panic. Many are in the same position and the important thing is to start. Here are three practical steps:
This is where the Catapult can help.
We’ve created a set of free guides, backed by the Department for Energy Security and Net Zero, designed with NHS teams in mind. They draw on our experience across the public sector, laying out clear workflows and highlighting the specific challenges hospitals face.
Our aim is to help you build momentum quickly, without unnecessary fuss or jargon. Whether you’re just starting to gather your data or ready to finalise your Green Plan, these resources provide the structure you need to move forward confidently.
Decarbonising hospitals is one of the toughest challenges on the road to Net Zero – but it is also one of the most important. The good news is you don’t have to start from scratch or face it alone.
Ready to start your Green Plan? Download our free guides today and use our heat decarbonisation planning expertise to help shape your Green Plan with clarity and confidence.