Why great sustainability projects stall

Across the NHS and wider public sector, sustainability is no longer a fringe concern. Boards sign off Green Plans, carbon targets are embedded into national policy, and estates teams are under increasing pressure to decarbonise ageing infrastructure while keeping hospitals operational around the clock. And yet, for all the ambition, many sustainability and Net Zero projects struggle to progress beyond feasibility studies and outline business cases.

The paradox is striking. The case for action is often compelling: volatile energy prices, mounting maintenance backlogs, and the growing operational risks of obsolete plant. But even when the technical and financial arguments stack up, projects can still stall — quietly, incrementally, and without a single obvious point of failure.

Those involved in delivering complex energy and decarbonisation programmes say the reasons are rarely simple. Cost is frequently blamed, but in practice it is only one factor among many. More often, the real constraints lie in governance, organisational capacity, confidence in delivery, and the sheer human effort required to push large projects through already overstretched systems.

A recent conversation between highly experienced figures involved in NHS sustainability delivery offers a revealing insight into why some projects succeed while others falter — and what makes the difference.

Leadership matters — but only if it is sustained

One of the most consistent themes to emerge is the importance of senior leadership. Not just formal approval, but active, ongoing engagement.

At The Shrewsbury and Telford Hospital NHS Trust (SaTH), sustainability has been elevated beyond a technical estates issue and embedded into governance structures at board level. According to Shona Baugh, senior sustainability manager at the Trust, this has been fundamental.

“You need a board and a finance director who understand why this matters,” she explains. “If that understanding isn’t there at the top, it becomes incredibly hard to deliver anything meaningful further down.”

But leadership support, on its own, is not enough. Projects can still stall if that support is passive or intermittent. What appears to matter most is sustained involvement — senior figures who remain visible, informed and engaged as projects move from concept to delivery.

Dominic Clarke, who works on sustainability programmes across multiple NHS trusts, has seen the contrast firsthand. “The projects that move most smoothly are the ones where senior leaders stay involved or make a point of being kept informed,” he says. “Where decision-making is close at hand, rather than something that happens at arm’s length.”

When leadership engagement drops away, delays creep in. Decisions are deferred or take longer to make. Risks are left unresolved. And projects that once had momentum can gradually lose it.

The myth of ‘business as usual’

Another reason projects stall is the persistent assumption that sustainability can be delivered alongside existing workloads, rather than as a programme in its own right.

Estates teams in acute hospitals are already operating under intense pressure. Fire alarms, plant failures, infection control, statutory compliance — these demands do not pause for decarbonisation projects. Asking the same teams to absorb major capital programmes without additional resource can quickly become unrealistic.

“There’s a tendency to drop these projects into estates teams and assume they’ll just get on with it,” Clarke observes. “But if no one individual has the bandwidth to own it and equally buy into its purpose, it’s very difficult to keep things moving.”

Baugh agrees. “If I wasn’t doing this role full time, it would be difficult to manage the scheme,” she says. “Running projects like these needs focus, persistence and follow-through.”

The Trust created a dedicated Energy Security and Decarbonisation (ESD) programme, sitting between capital and operational teams. This hybrid structure helped bridge the gap between strategic ambition and day-to-day delivery — but it also required explicit recognition that sustainability work could not be treated as ‘extra’.

Passion, authority, and the confidence to push

Beyond formal structures, the human dimension plays a critical role. Projects succeed, those involved suggest, when there is someone with both the authority and the confidence to push them forward — and to hold colleagues to account when needed.

“It’s not just about having a sustainability role on paper,” Clarke says. “You need someone who actually wants to see it happen, who’s prepared to ask the awkward questions inside and out of the organisation and maintain pressure on colleagues for the requisite support.”

That can be uncomfortable in organisations built on consensus and caution. But without it, momentum is easily lost.

Baugh is candid about the demands of the role. “You do have to be willing to rock the boat a bit,” she admits. “Not in a destructive way, but to keep things moving. Otherwise, it’s very easy for projects to slip down the priority list.”

Interestingly, both note that exposure to commercial project environments — where time, cost and accountability can be more explicit — can bring different mindsets to complex programmes.

Governance: too much, too little, or just too slow?

Governance is often cited as both a safeguard 
and a stumbling block. Sustainability projects 
frequently cut across traditional boundaries: estates, finance, procurement, sustainability, clinical operations. Without clear ownership, decisions can become fragmented.

At SaTH, governance was deliberately structured to provide clarity. Sustainability performance is reported through established channels, with visibility at senior executive level. That visibility matters.

“The project gets exposure because I’m reporting into a senior executive,” Baugh explains. “That makes a huge difference.”

By contrast, projects that sit awkwardly between departments — owned by everyone and no one — are more likely to stall. Clarke describes situations where too few individuals carry too much responsibility, often without sufficient authority.

“That’s when we get nervous,” he says. “Because if the right people aren’t in the room, decisions are deferred — and projects can suddenly be paused which can lead to programme delays and additional contractor costs.”

The hidden burden on estates teams

One of the least visible challenges is the impact of major projects on operational estates teams. Sustainability schemes often require isolations, shutdowns and intrusive works — all of which fall on teams already stretched by operational demands.

“Every project impacts operational estates,” Baugh says. “Every isolation request, every shutdown — it all goes through the same people who are keeping the hospital running.”

Without careful planning and early engagement, this can create barriers/blockers — not because teams oppose decarbonisation, but because they simply lack capacity.

At SaTH, early engagement helped mitigate this. Estates staff were involved during procurement, not just informed after decisions were made. Contractors were introduced as long-term partners rather than short-term visitors.

“That sense of partnership really helped,” Baugh notes. “People understood that our contractors were here for the long term.”

Why external support often makes the difference

Another recurring theme is the role of external advisors and frameworks. Large sustainability programmes require specialist expertise — technical, commercial, legal — that many trusts simply do not have in-house.

Trying to deliver complex energy projects without that support can leave trusts exposed. As Clarke points out, contractors will always arrive with their own preferred contracts and commercial positions.

“If you don’t have a framework or experienced advisors, you risk signing up to what suits the contractor, not what’s best for the trust,” he says.

External support can also provide continuity and momentum, particularly when internal capacity fluctuates.

Funding helps — but it is not the whole story

Grant funding has undoubtedly accelerated sustainability activity across the NHS. Programmes such as the Public Sector Decarbonisation Scheme have enabled projects that might otherwise have been unaffordable.

But funding alone does not guarantee success. Several participants caution against assuming that money is the primary driver.

“There’s a tendency to think that if funding exists, projects will naturally follow,” Clarke says. “But without the right people, governance and delivery model, there’s a risk that funding just sits there or worse, is forfeited.”

In some cases, funding can even add pressure — with tight delivery windows and complex reporting requirements. Trusts that lack the internal capacity to manage those demands can struggle to capitalise on available support.

Despite the challenges, successful sustainability projects can deliver benefits beyond carbon reduction. By forcing organisations to confront underlying issues — ageing infrastructure, undocumented systems, poor data — they can catalyse wider improvements.

“Some of these projects reveal problems with the estates infrastructure that would otherwise have been kicked down the road,” Clarke observes. “That can be uncomfortable, but it’s often necessary.”

At SaTH, the district heating programme exposed secondary system issues that were then addressed as part of delivery. The result was not just lower carbon emissions, but a more resilient energy system.

The real lesson

If there is a single lesson to be drawn, it is that sustainability projects fail less often because of technology or cost, and more often because of people and systems.

They require leadership that persists, not just approves. Dedicated resource, not goodwill alone. Governance that enables decisions, rather than diluting responsibility. And delivery models that recognise the realities of operating live healthcare environments.

As pressure mounts to decarbonise at pace, these lessons matter. Because the question is no longer whether sustainability projects are necessary — but whether organisations are set up to deliver them.