Giving a mid-morning presentation at the online conference, titled ‘The next steps for Net Zero and sustainability in the NHS’, Lord Markham was introduced by session Chair, Alifia Chakera, who is head of Pharmaceutical Sustainability, Health Infrastructure and Sustainability Division, at the Scottish Government. She explained that the Infrastructure and Sustainability team is ‘a relatively young, addition’. She said: “We are really looking at population health models and infrastructure concepts, and at the way we frame decision making to embed sustainability. Sustainability for us isn’t just environmental sustainability; it also lends to resilience, being fiscally responsible, and delivering high-quality patient outcomes. So, when we talk about sustainability, at least in Scotland, we’re talking about the whole gamut.”
A focus on energy and the estate
Prefacing Lord Markham’s presentation, Alifia Chakera explained that with the Minister unable to present ‘live’, attendees would see a recorded presentation. She said: “Let’s now hear from Lord Markham — who has 30 years’ experience, and now has the responsibility of being Parliamentary Under Secretary at the Department of Health and Social Care.” She explained that the DHSC speaker would be covering energy, and ‘the challenges around energy and the NHS estate’.
Appointed Parliamentary Under Secretary of State at the Department of Health and Social Care on 22 September 2022, Lord Markham has extensive experience across the public, private, and voluntary sectors. He was previously Lead non-executive director at the Department for Work and Pensions, and for the Ministry of Housing, Communities and Local Government, and Deputy Leader of Westminster Council. In his current role he is the Minister responsible for the NHS estate (including Net Zero), the New Hospital Programme, NHS Finance, and Technology and Innovation.
Thanking Westminster Health Forum for inviting him to speak, Lord Markham said diary pressures had made it impractical for him to speak live, but he emphasised his keenness to address the day’s ‘vital theme’ of Net Zero. He said: “The Prime Minister has been clear he wants the UK to continue leading the charge on climate change — and it’s great to have the opportunity to talk about the NHS’s role in that. Today,” he continued, “I understand you’re also hearing from NHS England on the next steps for Net Zero across the NHS’s entire carbon footprint.” As lead Minister for NHS estates and capital, he said his focus would be ‘the critical role of infrastructure in achieving these objectives”.
Three main areas of focus
Explaining that he planned to focus on three main areas — all tied to the NHS’s ‘world-leading commitment to achieve a Net Zero estate by 2040’, he said the three were, firstly — energy savings, and ‘the huge opportunities open to Trusts’ from investment in measures like solar, LEDs, and heat pump installation; secondly — building standardisation — and particularly the vital work being undertaken through the New Hospital Programme, and, thirdly, ‘the significant capital investment in heat decarbonisation happening across the existing NHS estate’. Before moving to discuss the three themes, Lord Markham said he wanted to ‘briefly touch on the wider context’. He explained: “Britain today is a clean energy superpower; figures from the Department for Energy Security and Net Zero show that our renewable energy capacity has increased five-fold since 2010. We’ve had the fastest reduction in emissions of any major economy, down almost 50% since 1990, and — looking ahead to 2030 — we also have the most ambitious target for any major economy, a 68% reduction — far beyond both the US and EU targets.” He continued: “I won’t need to remind this audience of the major external challenges. We saw what happened in 2022 when Putin weaponised energy, and the full impact this had on energy bills worldwide, the NHS included. For these reasons, the (UK) Prime Minister, Rishi Sunak, has been clear that energy security is a major priority.”
Lord Markham continued: “At COP 28 the Prime Minister was also clear that fighting climate change is not just a moral good; it is a fundamental to our prosperity and security.” Lord Markham said the current Government wants to ensure that the UK is ‘at the forefront of this global movement as a key energy superpower’. He added: “I think that’s an ambition we can all get behind.” The NHS had ‘a critical role’ to play in supporting these ambitions. “When you look at the facts,” Lord Markham said, “it’s easy to see why — the NHS acute estate alone occupies some 27 million square metres across over 10,000 buildings. Energy-wise, that means about 11.2 billion Kilowatt Hours of consumption every year, and an annual energy bill for NHS Trusts now averaging over a billion pounds.” There was, he noted, also ‘a huge variation beneath these numbers’, it being ‘sobering to think’ that coal-fired boilers were only very recently removed at Goole and Nottingham City Hospitals.
Heat pump use in healthcare on the rise
Lord Markham said: “Over 300 NHS sites still report using oil for heating. At the more positive end of the spectrum, we’re now seeing a multitude of heat pumps installed, everywhere from Yeovil to York. Look at this in terms of carbon emissions, and in its benchmark year of 2019, the NHS’s carbon footprint was 6.1 megatonnes, equating to over 30% of public sector emissions. Add in the NHS supply chain, which is 60% of the extended footprint, and at the time the NHS had a total impact on carbon emissions equivalent to that of Croatia.”
While this clearly posed ‘a major challenge’, Lord Markham acknowledged that the NHS had already ‘done an incredible job of rising to this challenge’. He said: “We are also now in a fantastic position where all 212 NHS Trust across England have Green Plans in place, setting out a clear pathway on issues like Net Zero.” This, he said, is all aligned with a central Net Zero Estates Plan produced by NHS England, and a new NHS Net Zero Building Standard for all major NHS projects — ‘the first of its kind for a health system’. Lord Markham said that according to the latest NHS Annual Report, the NHS is now on track to meet its target trajectories on carbon for the coming years. He told delegates: “Incredibly, the NHS has reduced its emissions by a quarter since the 2019 baseline — down to 4.5 million megatonnes of carbon dioxide equivalent.” This is ahead of the five megatonnes needed to stay on track the NHS 2014 target — which he dubbed ‘an excellent achievement showing that the NHS is leading the way to Net Zero’.
The Minister stressed that this government remained committed to ensuring that it continues to lead the way, and that sustainability ‘remains permanently embedded in the very fabric of the NHS’. He said: “Through the Health and Care Act we placed the first ever climate change legal duties on the health system anywhere in the world. In doing so we compelled action on energy and the environment across all Trusts and Integrated Care Systems.” Now, he added, the Government was ‘going further’. He explained: “At COP 26 the Government committed to include climate issues in the forthcoming review of the NHS constitution. I can confirm that we will now bring forward a ‘green NHS constitutional value’ to meet this commitment.” This will sit alongside the NHS’s existing values, such as compassion, respect, and quality of care, and ‘underwrite the NHS’s efforts on the environment’. Importantly, Lord Markham said, it will commit everyone in the NHS — from nurses, to porters, to senior decision-makers, ‘to strive to protect the environment, while of course prioritising the needs of patients and the taxpayer’.
Investment and behavioural change
The Minister confirmed plans to bring forward a wider consultation this spring, including on this new environmental value. All this meant sustainability would be ‘permanently woven into the very fabric of the NHS’. Lord Markham said: “The action we can now flexibly take through investment and behavioural change must live up to these values and duties.” He said he would now explain how Government is backing the NHS to ensure that this happens — ‘starting with energy efficiency and savings’.
“When it comes to efficiency,” he explained, “small measures can have a big impact. I’ve mentioned to this forum before the huge savings on offer from things as simple as LED installation, which offers around a 25% yearly return on investment.” According to the latest data, LED coverage across the NHS now stands at close to 50% — over double the figure back in 2019. Lord Markham stressed, however, ‘the need to go further’. With this in mind, he said he the DHSC would be investing an additional £20 m in LED installation across the NHS over the next two months, and funding 48 projects to add an additional 125,000 LEDs across the estate, bringing a great boost in efficiency, and a £5 m annual energy bill reduction ‘for at least the next 10 years’.
The Minister said: “This will also mean a recurring carbon saving of 14 kilotonnes a year, yet this is just the start, and we remain committed to getting LED coverage up to 100% as quickly as we can.” He continued: “It should be highlighted that efficiency isn’t just about equipment; there’s also the critical question of how energy is managed and coordinated, at both a local, and an ICB level.” This was ‘partially about technology, and having good building management systems, but also about having the right people and the right skills, all in the right place’. As of 2023, less than half of NHS Trusts in England had dedicated Energy managers, and there had been very little coordination at regional level. Lord Markham said: “We and NHS England are agreed this must improve, and NHSE is working with Crown Commercial Services to explore options for ensuring that every ICB in the country has dedicated energy management expertise.” The Minister believes that this kind of coordination oversight is essential to reducing both costs and carbon emissions.
On the topic of cost savings and efficiencies, Lord Markham said the NHS had recently announced that it will roll out a new ‘centralised approach to buying energy’, which would help slash the NHS energy bill by up to £100 m a year, ‘freeing up vital money for other objectives.’ He said: “This is because there are currently over 200 different energy contracts in place in Trusts across England. That degree of variation is rightly something to rationalise and standardise. I want to pay tribute to the work across NHS England and Crown Commercial Services that has secured this excellent outcome.”
Such standardisation was something Ministers want to see right across NHS operations, ‘whether it brings net benefits for cash, carbon, or both’. Lord Markham said: “That’s true on energy purchasing, and also true on our ground-breaking New Hospital Programme, and its own sustainability objectives. The biggest hospital building programme in a generation, it represents a huge commitment to strengthen the NHS through decarbonisation and efficiency.” Since 2020, the Government had committed to investing £3.7 bn by the 2024/25 financial year, and it expects the programme as a whole to be backed by over £20 bn for hospital infrastructure.
National approach to standardisation
“Crucially,” Lord Markham added, “many of these hospitals will be constructed using our national approach to standardisation, Hospital 2.0. By embracing improvements such as common design pod principles, and Modern Methods of Construction, we will decrease the average time to develop and build hospitals by just under half, from 11.5 years to six years, and accelerate government assurance processes.” This standardised approach also offered what he dubbed ‘fantastic potential for NHP’s commitments on Net Zero and sustainability’ — explaining why NHSE had recently published its Net Zero Building Standard, which aims to limit carbon emissions and provide tools to measure and report on whole-life carbon for all major NHS infrastructure projects.
Going forward, Lord Markham said all NHS projects would use the standard toolkits to set and report against project-specific carbon targets, with NHP using the data reported under the Standard to monitor the carbon footprint of projects throughout the design, delivery, and construction phases. He explained: “All NHP projects will be tracked in their progress against delivering Net Zero by 2040, along with the rest of the NHS estate.
“Given this,” he added, “I can reaffirm the Government’s intention to have electrically-powered hospitals by 2024, not just in NHP, but across the wider NHS estate.” This approach would see the NHS move forward towards Net Zero alongside the national grid, ‘augmented by on-site renewable power where viable’.
Lord Markham admitted that ‘addressing our energy objectives on the wider estate can be even more challenging in its way than building new hospitals’. He said: “That’s why I’m delighted that this government has invested over £800 m in public sector decarbonisation scheme funding for the NHS since 2020.” In all, 94 projects had installed everything from a solar system at New Cross Hospital in Wolverhampton as part a £30 m grant, to a major heating and cooling system and energy efficiency upgrade project at Queen’s Medical Centre in Nottingham, with brand new air and ground source heat pumps backed by over £40 m in government funding. “Crisply,” Lord Markham added, “this investment comes at no opportunity costs for the NHS capital budget. It is wholly funded from energy departmental budgets. That means we’re still investing directly in other NHS promises. This financial year alone,” he continued, “that equates to £4.2 bn in upgrading modernising NHS buildings. Indeed in many cases that investment can and should be synergistic. This means we can tackle the NHS’s £12 bn backlog maintenance bill, and confront serious issues like RAAC at the same time as we decarbonise.”
An ‘unprecedented investment in clean energy for the NHS’
The DHSC was currently awaiting the results of the latest PSDS round, but given the Department of Energy Security and Net Zero’s sector cap, the Department expected the Government would be investing at least an additional £200 m across the NHS over the next two years — bringing the total targeted NHS Net Zero capital investment to over £1 bn since 2019, ‘an unprecedented investment in clean energy for the NHS’. Lord Markham said: “It’s an investment that places the NHS on a firm footing as it moves forward towards its interim target of an 80% reduction in direct emissions by 2032. As noted earlier, the data does now show that the NHS is on track.”
While all of this was ‘fantastic news’, the Under Secretary of State said the NHS ‘must not underestimate the challenge ahead’. He said: “We will need to be innovative and open minded, and I continue to have promising discussions with parliamentary and ministerial colleagues on the potential of everything from deep geothermal energy for hospital sites, and district heating solutions, to innovative financing models that might further assist with measures like solar and LEDs. We all have a vested interest in ensuring that our NHS is sustainable, and able to get on delivering care in a way that will make current and future generations proud. I hope my comments today show that we’ve already taken great strides towards that goal.” He concluded: “With the right investment and the right collaboration, I’ve no doubt we will continue to do so as we move forward towards that 2040 target.”
Major LED installation at Peterborough City Hospital
Peterborough City Hospital is to become a more energy-efficient building thanks to a £3.75 m funding award that will see it switch all lighting to LED bulbs. In all 15,765 bulbs will be replaced with LED bulbs, reportedly halving lighting energy costs and carbon dioxide emissions. The Trust’s Estates and Facilities Team applied to the NHS National Energy Efficiency fund with its LED lighting proposal, and was awarded its full funding request to purchase and install the bulbs.
David Moss, director of Estates and Facilities for the NHS North West Anglia NHS Foundation Trust, which runs Peterborough City, Hinchingbrooke, and Stamford and Rutland Hospitals, said:“We are really excited to have been awarded the funding for this project. It will enable us to significantly reduce our carbon footprint and our energy bills. This is the first major project in our Green Plan for all our hospital sites. As we redevelop our Stamford and Hinchingbrooke sites over the next few years, we plan switch to LED lighting there too.”
End-to-end project at Nottingham’s QMC
E.ON has begun a new 15-year energy efficiency partnership with Nottingham’s Queen’s Medical Centre (QMC), one of the largest NHS hospitals in the UK. The energy supplier will be helping the facility and its operator, Nottingham University Hospitals NHS Trust, reach its target of achieving Net Zero by 2030 by installing a range of energy-saving technologies. These will include a zero-carbon geothermal heating and cooling system, energy-saving windows, and ‘state-of the-art’ building controls. E.ON said: “We’re delivering an endto-end multi-solution project that will benefit the hospital and its patients for years to come, while improving local air quality by reducing harmful nitrogen oxide emissions.”
The QMC project has been supported by funding from Phase 3 of the Public Sector Decarbonisation Scheme, run by the Department for Energy Security and Net Zero, and delivered by Salix Finance. The Carbon and Energy Fund (CEF) facilitated the programme.
In addition to the QMC’s current combined heat and power (CHP) plant, new heat pumps, boreholes, and a heat recovery system, will give the facility ‘a more environmentally friendly source of heating, cooling, and energy’.
The heat pumps use electricity to draw heat from the ground through the 64 boreholes drilled beneath the hospital site, but can also use the air outside to generate heat. Excess heat can be piped down into boreholes and stored or preserved for use at a later date. Any left-over heat can be recycled by the heat pumps. This lowers the demand for fossil fuels, and in turn reduces energy costs for the Trust.
Solar farm the size of three football pitches to be operational this month
A solar farm which will power Wolverhampton’s New Cross Hospital for three quarters of the year is set to be up and running this spring.
The Royal Wolverhampton NHS Trust (RWT), in partnership with City of Wolverhampton Council, has built the solar farm at a former landfill site, the size of 22 football pitches, adjacent to Bentley Way, Wednesfield. Set to open this month, the facility will power the entire hospital site with self-generated renewable energy for around 288 days a year, saving the Trust around £15-20 m over the next 20 years. It will produce 6.9 MWp of renewable energy for New Cross Hospital, and generate an estimated carbon saving of 1,583 tonnes of CO2e per annum.
Over 15,000 electricity-generating solar panels have been installed at the site by main contractor, Vital Energi. Work to secure the 40-plus acre brownfield site included protecting badger setts, and removing methane. The project, combined with existing green technologies, will allow the Trust to move away from reliance on the national grid, and reduce its exposure to rising electricity costs in the next two decades. It also supports its goal of reducing its carbon emissions by 25% by 2025, and of reaching ‘Net Zero’ carbon emissions by 2040.
Pictured – left to right – are Jon Gwynn, Project director, Carbon and Energy Fund (CEF), Ashley Malin, MD, Vital Energi, Professor David Loughton CBE, Group Chief Executive of The Royal Wolverhampton NHS Trust (RWT) and Walsall Healthcare NHS Trust, and Stew Watson, Group Director of Estates at RWT.
Ashley Malin said: “We’re delighted to have transformed a former coal mine and landfill site into this impressive solar farm – the largest single source of green energy on a UK hospital site. The clean energy will power the hospital’s air source heat pumps, and significantly reduce its carbon footprint.”
Work has also been completed on the underground cabling to connect the hospital to the solar farm. RWT has received around £15 m in grant funding for the project – comprising contributions from the Government’s Levelling-Up fund, the NHS, and Salix Finance. The Trust also received a further £33 m to carry out ‘green energy works’ as part of the Department of Business, Energy, and Industrial Strategy’s Public Sector Decarbonisation Scheme