Net zero in healthcare buildings: Lessons from assessing the strategies of 214 NHS trusts in England

• The NHS leads in net-zero building goal but faces challenges in plans monitoring. • 214 NHS trusts net-zero strategies in England have been investigated. • Net-zero building standardised measurement tools are needed. • A rating matrix is presented to highlight best performing NHS trusts. • Key Performance Indicators effectively guide climate mitigation actions. Although there is an overabundance of net-zero building frameworks, simple strategy and performance management guidelines for healthcare buildings are scarce. This study presents a novel approach to uncover barriers to achieving net-zero healthcare buildings. It first highlights the importance of standardising and simplifying net-zero frameworks through literature review. Then, it presents a new checklist-based, and user-friendly performance assessment net-zero (PANZ) matrix. This is demonstrated through its application to the main national healthcare service provider in the UK: the National Health Service (NHS). The matrix assesses the performance of the 214 NHS trusts through the Plan-Do-Check-Act (PDCA) model. The credibility, ambition and feasibility of the trusts’ net-zero strategies are assessed and linked to ISO 14068 carbon neutrality principles. This matrix is designed to scale net-zero performance assessment across other building operators globally. It is found that, although the NHS is leading the healthcare sector worldwide in setting net-zero targets, the viability of its trusts’ strategies is questionable, with average scores of 54 %, 41 %, and 8 % for measures of credibility, ambition, and feasibility, respectively. Process streamlining, the use of environmental management systems (EMS), decarbonisation schemes rollout, and applying key performance indicators (KPIs), are the main steps to ensure effective application of net-zero strategies. Implementing these steps by adhering to the PDCA cycle improves the feasibility scores to 24 %, 43 %, and 63 %. This research shows that consistency and comparability across different regions are needed to achieve net zero, especially within complex buildings such as for the healthcare sector.