With thanks to Sarah Cox – Partner, Carter Jonas (Leeds) – for providing this valuable insight.
The climate crisis is a potential health crisis. And yet healthcare, if only due to the substantial construction, transport, heating and air condition emissions that such a large organisation generates, is a not insignificant contributor to climate change. The NHS admits, according to The Guardian (Toynbee, P 2021), that it is responsible for 5% of the UK’s carbon emissions. And as the former head of NHS England was quoted as saying in the article, health services jointly contribute the same level of emissions as the country currently ranked as the world’s fifth-largest emitter.
Buildings aside, healthcare is responsible for other significant pollutants. There is an irony in the fact that asthma inhalers, increasingly necessitated by air pollution, release an incredible 3% of all NHS emissions, through their use hydrofluoroalkane as a propellant (NHS England, 2024). But progress is being made: switching 10% to dry powder inhalers has already reduced CO2 emissions by the equivalent of taking 120,000 cars off the road (Toynbee, P 2021).
It is a considerable undertaking for an organisation as large as the NHS to achieve net zero, especially taking into account funding and other constraints. But in its policy document Delivering a ‘Net Zero’ National Health Service, the NHS has committed to doing so by 2040 and is already making significant progress. From meat-free Mondays in canteens, to the first baby born with a gas-and-air system that captures the polluting gas instead of emitting it, changes are taking place throughout the country (NHS England, 2022).
Although there are many challenges, there is substantial best practice emanating from the NHS. Earlier this year, plans for what is believed to be the UK’s greenest hospital were approved (Dunton, J 2023). The new Velindre Cancer Centre in Cardiff is being developed to comply with the Wellbeing of Future Generations (Wales) Act 2015 and its design utilises low embodied carbon and bio-based materials that support a circular economy and promote health and wellbeing. The centre will be all-electric and is manufacturing components off-site to reduce site waste and minimise transportation. Its landscape strategy is to keep the site as wild as possible by retaining existing habitats and creating new habitats alongside new landscaped spaces such as orchards and a community kitchen garden for producing food for consumption (Makosinski, J 2023).
It was encouraging, too, to see plans to power Torbay Hospital with a £3.1m solar park approved last May. The 3.9 hectares of solar panels will provide 3.2 megawatt peak of power and will last for approximately 25 years (BBC News 2022).
I have worked with NHS Trusts on a number of sustainable initiatives, including Leeds Teaching Hospitals NHS Trust, which includes both Leeds General Infirmary (LGI) and St James’ Hospital. The Trust has many existing challenges to overcome to enable it to meet net zero in the next 17 years. Specifically, as far as the built environment is concerned, LGI comprises a medley of interlinked premises from the iconic 1868 Sir George Gilbert Scott designed buildings to the modern Martin and Jubilee wings, the latter accommodating a helipad.
And yet sustainability is at the heart of the Trust’s built environment strategy, which aims to achieve net zero operational carbon and minimal embedded carbon, conservation of resources and nature-based design solutions. Already the Trust has succeeded in promoting active travel, improving biodiversity and green spaces, investing over £20 million in energy saving projects and facilitating remote GP appointments (Leeds Teaching Hospitals NHS Trust, 2023)
Construction is a major contributor to emissions, accounting, according to the 2019 Global Status Report for Buildings and Construction, for almost 40% of CO2 emissions (UN Environment Programme, 2019). And so it has been important to gain planning consent for construction projects which have lower emissions rates. Leeds and other hospital trusts are creating new community diagnostic centres (GOV.UK 2023). Many of these centres use modular construction, which can reduce emissions by approximately 54%, according to a recent joint study between Cambridge University and Edinburgh Napier University, commissioned by modular manufacturer Tide Construction (cited in Herron D, 2023).
Regarding sustainability, another important factor of these new community diagnostic centres is that they are planned to integrate effectively into a community. Not only does this limit cross-contamination (an important post-Covid consideration) but it also supports local high streets. A consideration in the built environment world post Covid has been the need to respond to an increased awareness of local community. And as some high streets declined in 2020 through lack of footfall, changes to the planning use classes (The Town and Country Planning (Use Classes) (Amendment) (England) Regulations 2020) were made to facilitate the change of use from one high street use to another.
Class E, a change to The Town and Country Planning (General Permitted Development) (England) Order 2015, came into use on in September 2020. It incorporates, under the term ‘commercial, business and services’, a broad range of previously standalone use classes including A1-A3 (retail, food and drink and financial and professional services), B1 (office space), parts of D1 (including clinics, health centres, creches, day nurseries, and day centres) and D2 (gyms and most indoor recreations). Any changes between these uses now no longer requires a full planning application.
So increasingly, healthcare facilities are occupying previously under-utilised retail units on high streets and in shopping centres which provides a local amenity, benefits community development and can help regenerate high streets – with the added benefit of freeing up much-needed space in hospitals.
Even within planning and development alone, the potential for change in the NHS is considerable. And with the drive to achieve net zero by 2040 so strongly embedded in NHS thinking, this together with change through other aspects of the NHS’ output has, and will continue to, help us tackle climate change.
Sarah Cox is a Partner of Carter Jonas and head of planning in its Leeds office. Sarah is a chartered town planner with over 20 years’ experience in managing the planning process on healthcare, residential, mixed-use, commercial and leisure developments in a variety of locations on behalf of a diverse client base including developers, investment funds, social housing provider landowners and public companies
References
BBC News (10 May 2022) Green light for Torbay Hospital’s £3.1m solar park plans https://www.bbc.co.uk/news/uk-england-devon-61396634 (accessed 16 January 2024)
Department of Health (2003) Agenda for Change: Proposed Agreement on Modern Pay and Conditions for NHS Staff. www.doh.gov.uk/agendaforchange/proposedagreement.htm (accessed 22 June 2023)
Dunton, J in Building Design (22 March 2023) White Arkitekter gets final go-ahead for Cardiff cancer centre https://www.bdonline.co.uk/news/white-arkitekter-gets-final-go-ahead-for-cardiff-cancer-centre/5122354.article (accessed 16 January 2024)
GOV.UK (31 October 2023) Government to deliver 160 community diagnostic centres a year early https://www.gov.uk/government/news/government-to-deliver-160-community-diagnostic-centres-a-year-early (accessed 16 January 2024)
Herron, D Are modern methods of construction in the UK more sustainable? https://www.osborneclarke.com/insights/are-modern-methods-construction-uk-more-sustainable (accessed 16 January 2024)
Leeds Teaching Hospitals NHS Trust (2023) Green Plan and Decarbonisation Strategy. www.doh.gov.uk/agendaforchange/proposed agreement.htm (accessed 22 June 2023)
Makosinski, J in Building Better Healthcare (2023) UK’s most-sustainable hospital reaches planning milestone https://www.buildingbetterhealthcare.com/uk-s-most-sustainable-hospital-reaches-planning-milestone-207730#:~:text=Velindre%20Cancer%20Centre%20is%20being,and%20promote%20health%20and%20wellbeing (accessed 16 January 2024)
Newcastle (SHINE) Report 2020/21
NHS England (2022) Delivering a ‘Net Zero’ National Health Service. https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf (accessed 22 June 2023)
NHS England (2024) Improving health outcomes for respiratory patients while reducing carbon emissions https://www.england.nhs.uk/greenernhs/whats-already-happening/improving-health-outcomes-for-respiratory-patients-while-reducing-carbon-emissions (accessed 16 January 2024)
The Newcastle Upon Tyne NHS Foundation Hospitals Trust: Sustainable Healthcare
Toynbee, P in The Guardian (2021) The NHS leads the world in green healthcare. But it faces a political roadblock https://www.theguardian.com/commentisfree/2021/oct/21/nhs-green-healthcare-staff-emissions-infrastructure (accessed 22 June 2023)
UN Environment Programme (2019) 2019 Global Status Report for Buildings and Construction Sector. www.doh.gov.uk/agendaforchange/proposed agreement.htm (accessed 22 June 2023)
