Land and buildings

Outcome statement

Supporting healthy people and places by decarbonising the design, construction, use and disposal of our buildings; and being stewards of our land and waters.

Governance and delivery

Why is this important?

Policy context

The Net Zero Government Operations Policy includes a range of actions which are relevant for NSW Health buildings. The policy requires agencies to align with Green Star certification standards for buildings and fit-outs above $10 million. Health Infrastructure is working towards aligning with Green Star certification standards in the planning for future projects. From 1 July 2026, all new office buildings commissioned for or by the NSW Government must be all-electric and all-electric office buildings will be preferred for new leases in Greater Sydney. By 2035, all office buildings owned or leased by the NSW Government must be all-electric. Green Lease targets must be included in all new and renewal lease transactions where the NSW Government will occupy a total of at least 4000m2 of office space in a single building for a minimum three-year lease term. All other new non- residential buildings commissioned for or by the NSW Government must be able to operate without fossil fuels by 1 January 2035. When reaching end-of-life. and where feasible, agencies must replace gas-fired plant and equipment with electric or other fossil fuel alternatives by 2035, or earlier if cost effective.

In 2025 NSW Health will investigate the feasibility of rolling out an energy and water performance tool, such as NABERS5, across all health facilities. The Policy also requires all new and existing government owned and leased office buildings to achieve and maintain minimum NABERS ratings. This also applies to government-owned data centres where they are suitable for rating.

The Decarbonising Infrastructure Delivery Policy (effective April 2025) applies to all NSW government building projects over $50 million and ensures upfront carbon emissions generated during the production of materials and construction is a key consideration across all project stages. The policy also provides a mechanism for consistent measurement of upfront carbon across government projects using Infrastructure NSW’s Embodied Carbon Measurement for Infrastructure Technical Guidance. Alongside the Decarbonising Infrastructure Delivery, the Protection of the Environment Policy (Sustainable Construction) enacts the reporting requirements of the former and is expected to be finalised late 2025.

Since 1 October 2023, the NSW Government’s Sustainable Building State Environment Planning Policy has applied to new non-residential developments over $5m or alterations/additions over $10m. Under this policy, projects need to consider energy efficiency, passive design, measurement and reporting of embodied emissions and other sustainability requirements. Certain State Significant Development Applications (SSDAs) are also required to prepare a Net Zero Statement, which demonstrates how a building is either being delivered as fossil fuel free or will transition to being fossil fuelree by 2035, with additional information required regarding renewable energy generation and storage and energy efficiency measures.

Whole of life carbon

The Australian health system produces 7 percent of the country’s carbon emissions with the construction and operation of infrastructure being a major contributor. Embodied carbon in buildings made up 16 percent of Australia’s built environment emissions in 2019⁶. Without action, upfront emissions (including construction and product stage emissions) from infrastructure are projected to account for the majority of infrastructure emissions.

NSW Health LHDs, SHNs and Health Infrastructure are committed to taking decisive steps to lower carbon emissions across the health asset base. NSW Health buildings are designed to be places that heal. They enhance clinical service delivery and patient wellbeing, create supportive environments for workers and visitors, and provide public space and connectivity. As we move forward, health buildings must be designed in ways that support a reduction in operational energy and waste, as well as reduce the upfront carbon within the building materials.

New buildings and redevelopments

Health Infrastructure has taken steps towards tackling this challenge as outlined in its Sustainability Commitment⁷. In order to identify carbon hotspots, Health Infrastructure undertook a whole-of-life carbon analysis of the Ryde Hospital Redevelopment. It found embodied carbon was responsible for almost two-thirds of the carbon emissions of the building. It clarified that, for new hospitals and other facilities, the key opportunity for reducing upfront and embodied carbon is via structural design and lower carbon materials, with additional opportunities in interiors and building services.

In 2023, Health Infrastructure released updated guidance and minimum sustainability requirements for all capital projects. Requirements call for:

• project-specific sustainability plans developed as part of master planning and is updated throughout construction
• energy efficiency targets and renewable energy solutions
• full electrification of new builds
• climate risk assessments conducted early in project planning and via consistent methodology with a climate adaptation plan for risks above a certain level.

With new legislation coming into effect, these requirements will increase over time with an update to HI’s guidance expected in 2025 to align with a shift towards Green Star certification for projects in line with the Net Zero Government Operations Policy requirements.

In 2023, Health Infrastructure, in partnership with Government Architect NSW, developed the Design Guide for Health: Spaces, Places and Precincts.8 The Design Guide confirms the importance of good design, master planning, site selection, and careful specification of systems and materials in reducing embodied and operational carbon in health infrastructure.

Health Infrastructure is currently expanding its carbon data collection, analysis and reporting systems, to ensure carbon considerations inform building design and engineering decisions at the outset of projects, where they have maximum impact.

Health Infrastructure is also working closely with health, government and industry stakeholders to stay across developments and innovation and ensure that the building decarbonisation approach adopted by NSW Health continues to align with government-wide and industry practices and provides consistency of approach for delivery partners.

Health facilities and hospitals in construction are at various stages of becoming fully electric, installing solar systems and EV charging infrastructure, supporting waste minimisation and trialling low carbon materials, such as low carbon concrete. Projects that will feature significant sustainability initiatives when they become operational in 2025-26 include John Hunter Hospital, the Sydney Children's Hospital Randwick, the Children's Hospital at Westmead and the Wentworth Health Service Redevelopment.

Other projects currently in design will also integrate energy and water minimisation, decarbonisation and waste innovation. Renewable energy and climate resilient design features will be prioritised throughout the asset lifecycle. Health Infrastructure is working closely with government and industry partners on longer term initiatives such as the reuse and repurposing of assets and materials, and the broader application of low carbon and recycled materials.

What we learnt from the consultation

The consultation process confirmed what is working well in the system and identified priorities and areas that require improvement.

What is working well

Initiatives that are reducing health system emissions associated with the construction of buildings and infrastructure, include:

• Greening urban spaces by increasing tree canopy and green cover across Greater Sydney, delivers benefits for patients, visitors, and the local community—while also helping to mitigate the impacts of urban heat. One example is the partnership between Western Sydney Local Health District and Landcare NSW, which brought together a dedicated team of volunteers to plant more than 3,110 trees at Westmead Hospital.
• Design guidance which prioritises Environmentally Sustainable Development and the delivery of future focused sustainable infrastructure.
• Community, consumer and staff participation and engagement in service planning and design, ensuring all facilities are fit-for-purpose and focused on futureproofing.
• Innovations involving recycling healthcare products into new products, for example the transformation of healthcare textiles (scrubs, polos) into green ceramic tiles led by Hunter New England Local Health District, in partnership with Noveco Surfaces; increasing the use of recycled materials in healthcare buildings.
• Initiatives that reduce waste through recycling furniture and medical equipment, for example the Waste Action Reuse Portal pilot, led by South Western Sydney Local Health District (SWSLHD) which has repurposed $53,000 worth of district assets and diverted more than 65 tonnes of waste from landfill.
• Investment in infrastructure that supports rainwater capture, storage (e.g. tanks) and reuse across NSW Health facilities. For example, the reuse of reverse osmosis plant reject water to flush hospital toilets at Tamworth Hospital which saves 2.5 million litres of clean water per year.
• Establishment of gardens to support staff and patient wellbeing, for example the newly established vegetable garden and play area at Ellimatta House providing Child and Adolescent Mental Health Services within Mid North Coast Local Health District. The space supports children and teens with complex needs to be outside in a comfortable space and engage with mental health clinicians.
• Improved end-of-trip facilities that provide staff access to shower facilities, change rooms, secure bicycle storage and e-bike charging infrastructure to assist with reducing transport related emissions.

What will be different in 2030

• Further collaboration with the NSW Government and key stakeholders to continue to green infrastructure and urban landscapes at local and precinct scales. The initiatives reduce urban heat impacts, stormwater pollution and run-off, and improve habitat and connection to nature.
• Collaborating with the NSW Government and key partners, including Transport NSW, to continue to provide access to public transport and active travel corridors while shifting to a low-carbon future, including the provision of appropriate charging infrastructure for low-emission vehicles.
• Continuing to develop guidance to strengthen climate risk assessments and adaptation planning. Enhancing adaptive capacity and strengthening resilience across all NSW Health organisations.
• Update design guidance which includes specifications to reduce embodied and operational carbon within health infrastructure.
• Future focused facility design which supports new models of care (including virtual care), service changes and optimised asset use.
• Replacement of existing gas-fired plant and equipment with electric or fossil fuel alternatives, where cost-effective.
• Deeper engagement with Aboriginal people in building design, construction, land use and management processes to strengthen knowledge and culture sharing. There is growing recognition that the principles of stewardship and caring for Country will be critical in our transition to a high quality, environmentally sustainable and climate resilient health system.
• Adopting a circular economy approach and embedding circular design principles across all stages of the asset life cycle from pre-design, design, procurement, construction, through to post- construction; keeping materials in use for longer and preferencing products containing recycled content.
• Design planning that applies waste hierarchy principles to avoid and reduce waste and supports appropriate waste segregation, collection and storage, for example recycling, organics and e-waste streams.

Supporting initiatives

Case study: Wentworth Health Service Environmental Initiatives

The $30 million Wentworth Health Service Redevelopment will provide a purpose-built facility with a comprehensive 19 bed inpatient unit and urgent care outpatient services for the residents of Wentworth and neighbouring communities in Far West NSW. Maximising the facility’s connection to Country and environmental sustainability are key features of the design.

Upon completion, the project will achieve the following key environmental sustainability initiatives:

• full electrification with 90kWh of solar panels on site'
• a 100% backup power generator will be provided to ensure power supply security
• 56MWH of energy was saved through the installation of energy efficient lighting, HVAC systems, and high-quality passive design construction.

Case study: John Hunter Health and Innovation Precinct Environmental Initiatives

Tangible environmental outcomes are at the heart of the $835 million John Hunter Health and Innovation Precinct (JHHIP). This project will greatly increase capacity for critical care in the Hunter New England Local Health District and is scheduled for completion in 2027. By integrating innovative and responsible environmental practices at every stage- from design and construction to ongoing hospital operations, Health Infrastructure and the Hunter New England Local Health District.

Some of the key environmental sustainability initiatives include:

• the new Acute Services Building will be one of Australia’s first all-electric hospital buildings
• nearly 90,000 tonnes of natural fill material and 1,500 tonnes of other waste materials have been recycled and diverted from landfill
• a whole of life carbon assessment was completed in the design phase
• water-sensitive urban design features have been incorporated to minimise run-off, with a 120,000L storage tank installed to capture rainwater.

Case study: Ryde Hospital Redevelopment whole-of-life carbon study

In 2023, Health Infrastructure partnered with NSW Office of Energy and Climate Change (now the DCCEEW), NSLHD and Arup to analyse the carbon footprint of the Ryde Hospital Redevelopment and suggest decarbonisation opportunities for future capital projects. It found the project’s carbon emissions were made up of 57% embodied (of which 29% was upfront carbon); and 43% operational.

The study demonstrated that:

• the biggest reductions in upfront and embodied carbon will come from structural design initiatives, such as:
• material efficiency: using less material, i.e. shorter spans for beams and more columns with lower thicknesses.
• material substitution: using different materials, i.e. low carbon concrete, timber, etc.
• development of low carbon concrete and material substitution is essential, and NSW Health and Health Infrastructure will need to work with industry to support innovation in these technologies
• electrification, energy efficiency and renewable energy initiatives will also be required to achieve the net zero goal.

Since November 2023, Health Infrastructure projects have been required to capture information relating to the upfront and embodied emissions associated with the delivery of infrastructure. As a baseline of emissions data is collected for health assets over the next 12 to 18 months, carbon reduction targets will be able to be set for new projects in the future.

Case study: Guidance for the reduction of nitrous oxide waste in existing healthcare facilities

The Ministry of Health in collaboration with the Nitrous Oxide Expert User Group, have developed a comprehensive guidance paper on the Reduction of Nitrous Oxide Waste in Existing Healthcare Facilities: Current Builds.

The paper provides evidence-based recommendations for the safe and effective reduction of nitrous oxide waste in healthcare facilities. Strategies include the decommissioning of piped nitrous oxide when appropriate, encouraging safe alternatives for clinical use when appropriate, improving day to day awareness and prevention of leaks, as well as educating and informing staff about the environmental impact of nitrous oxide.

This paper addresses existing hospitals, with a complementary guide for new builds to be released in 2025.

The Expert User Group was established to address nitrous oxide waste in healthcare settings. The group comprises representatives from diverse disciplines, including anaesthetics, paediatrics, midwifery and obstetrics, oral health, and emergency services as well as from engineering departments, capital works, Health Infrastructure, Clinical Excellence Commission, Agency for Clinical Innovation, and the Ministry of Health.

Case study: NatureFix Wellness Zones

The NSLHD Healthy Built Environments team are transforming hospital green spaces into wellness places, with a digital initiative called NatureFix.

Access to nature has profound effects on health and wellbeing, including reducing the risk of developing diabetes, heart disease, high blood pressure, dementia, and loneliness that, over time, can directly benefit hospitals through reduced admissions and length of stay. However, it’s not just contact with nature that’s important – it’s what we do in nature that matters more than the time we spend in it.

The NatureFix initiative provides evidence-led self- guided mindfulness audio routines that are customised to campuses so staff, patients and visitors can engage with the surrounding natural features. The NatureFix Wellness Zones have been installed at Hornsby Ku-ring-gai, Macquarie, Mona Vale and Royal North Shore Hospitals and the Adolescent and Young Adult Hospice at Manly.

Case study: Creating a multi-use space dedicated to young people experiencing mental health issues

One of the 2022/23 Sustainable Futures Innovation Fund recipients, Nate Bennett, established a vegetable garden and outdoor play area at the mental health service in Elimatta House, located in Port Macquarie.

The project attracted interest from colleagues, volunteers and local businesses willing to help construct the garden and play area. The garden and play equipment are custom-made from recycled and upcycled local timbers and supplies.

The vegetable garden also includes a clever composting system to reduce food waste from the facility.

The introduction of the outdoor area allows children to play in a familiar environment and interact within a less intimidating space while they are engaged with clinicians. The Grow and Play project facilitates the uptake of healthy behaviours and is already making a difference to young clients and families.