Hospitals' Huge Eco Impact: Paths to Sustainability

Hospital visits usually involve a medical emergency or appointment. The last thing on most patients' minds will be how the building works. We expect the lights to be on, medical equipment to work, a comfortable room temperature, healthy food, an appropriate layout with efficient routes between departments and all the other features that make the healthcare system run smoothly.

But many decisions about how hospitals will operate are made long before we enter the door - and have significant consequences for their environmental footprint.

In England, the NHS contributes 4% of the country's total carbon emissions, equating to 40% of all emissions from the public sector . In addition to carbon, NHS operations demand immense quantities of natural resources .

This translates into significant environmental impact embodied in buildings - depending on how a hospital's material form (think walls, floors, ceilings, windows, pipes, wires) is designed and built.

Construction materials must be manufactured, transported to a building site and used by construction crews. Here, raw inputs come from mines, quarries or other extraction sites where environmental injustices are perpetuated on land and local communities.

Then there are operational impacts, like electricity, water, medical equipment (PPE, hospital beds, syringes), medical gases and food. These essentials are also manufactured, require infrastructures (from the electricity grid to food systems) and are often constrained by previous building design decisions.

Today, the UK's NHS is facing major capacity pressures on healthcare services , with hospitals expected to handle significant increases in visits. And in January, the Labour government announced three waves of funding for new NHS hospital construction , with 16 hospitals greenlit as part of wave one.

While investment in NHS hospitals is necessary, it brings more greenhouse gas emissions from the operational running of the building and its construction (that includes the extraction and manufacture of raw materials and is referred to as embodied carbon) and its raw materials. embodied and operational environmental impacts.

Ensuring hospitals' sustainability starts with their design. So, what would designing a more sustainable hospital really involve?

For the past 18 months, I have been attending design meetings and interviewing the design team working on a wave one hospital, North Manchester General. It's one of the major acute hospitals of Manchester University NHS Foundation Trust (MFT), whose forward-thinking leadership welcomed my research into hospital design.

I have found that sustainability is predominantly integrated into the hospital design through adopting external technical specifications, like the NHS Net Zero Carbon Building Standard , and by aligning with local trust sustainability strategies. In this case MFT's Green Plan .

I've also seen how North Manchester General's design must adapt to standardisations from the government's New Hospital Programme. That's a national initiative coordinating new hospital design and construction, including by working with suppliers.

Adhering to existing statutory requirements related to sustainability - including building safety , social value , net zero carbon , and biodiversity net gain - also features in design considerations.

While reducing carbon emissions remains a focus of North Manchester General's designs, I've witnessed increasing interest in the broader environmental footprint - particularly water and waste. The bar for sustainability is being set high.

But several key areas deserve further consideration in the design process - and the government's national approach -- to minimise their overall emissions and translate sustainability ambition into action.

For NHS hospitals, and sustainable cities generally, one of the most important decisions is whether to undertake renovation and retrofit of existing buildings as opposed to demolition and rebuild.

Modernising existing buildings not only lowers the carbon emissions associated with materials and construction that come with starting anew, but also reduces impacts associated with construction - while inviting radical innovations like airflow retrofit and modular and mobile facilities .

North Manchester General is a Victorian hospital, which, like historic homes and museums, has stood for well over a century. With the right care, maintenance and design, its older structures could be cost-effectively upgraded, while incorporating flexibility for future innovations into retrofit.

Retaining parts of the existing estate - and only demolishing where absolutely necessary - respects the carbon footprint of the building structure already invested in hospitals and allows for sustainable adaptation rather than the significant environmental footprint of replacement.

Designing 21st-century healthcare

Looking ahead, a "fabric first" approach to new hospitals will prioritise the performance of the building's envelope - walls, roofs, insulation, windows - before relying on technology to manage energy use. While high-efficiency models like Passivhaus (an approach to designing buildings that requires minimal-to-no energy for heating and cooling) often come with a slightly higher initial cost, they deliver long-term benefits in energy efficiency and cost savings .

Beyond driving down operational impacts, investing in building fabrics could be coordinated by the New Hospital Programme to ensure localised suppliers can ethically source these materials. This could enhance buildings' lifespan while improving UK healthcare and construction supply chains' resilience.

Sustainable hospital designs will change alongside the NHS' model of healthcare. For example, smaller , more agile hospitals and community health services are becoming future priorities. While some major treatments (think open-heart surgeries) still require acute hospitals, future designs should think small and flexible, while learning from sustainable innovations that improve health outcomes and reduce environmental footprints.

Take Alder Hey Children's Hospital in Liverpool, where every ward has a kitchen and chef who cooks food to order, helping children recover faster and drastically reducing food waste. Capturing and systematising such learnings should be a priority for future hospitals.

Will ever-larger hospitals become a thing of the past if preventative care, mobile surgical facilities and similar innovations become embedded in a future-fit, 21st-century NHS? Perhaps new hospitals' target operating models need more flexible spaces, and lower overall floor areas, as healthcare shifts towards a community-oriented approach.

Designing-out reliance on new materials and energy use through retrofit and fabric first approaches, while designing-in flexibility and best practices from contemporary hospitals, will help lower environmental footprints and place the NHS estate at the forefront of sustainable healthcare systems globally.

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James Scott Vandeventer received funding for this research from the British Academy and Leverhulme Trust (SRG-2223/230837), as part of the 'Conceiving sustainable space' project.