Creating cleaner air for the UK’s most polluted hospitals

The Clean Air Hospital Framework is the world’s first step-by-step guide for hospitals to create cleaner air. Larissa Lockwood, head of Health and Air Quality at Global Action Plan, explains

Back in 2018, Great Ormond Street Hospital asked environmental charity Global Action Plan: “What would a Clean Air Hospital look like, and how would it operate?” We discovered that there was no single, comprehensive guide for minimising air pollution inside and around hospitals, so we answered that need by creating one together.

Combining Global Action Plan’s expertise from almost a decade’s worth of air quality initiatives with Great Ormond Street Hospital’s expert knowledge of running a world-leading hospital, the framework was created with a well-considered approach to what is practical and possible within a hospital setting.

The resulting Clean Air Hospital Framework is a free, comprehensive guidebook of 215 possible steps – established with extensive staff input – that hospitals can take to minimise air pollution from everyday activities and advise patients about air quality and their health, as well as working in partnership at the local and national level towards  broader societal change for cleaner air.

Cleaner air where it matters most
Our hospitals should be places that improve our health. Last year’s report by British Lung Foundation - Toxic air at the door of the NHS - revealed that 2,220 GP Practices and 248 hospitals in the UK are in locations with air pollution above WHO standards.

The Clean Air Hospital Framework offers a straightforward plan to make it easier for hospitals to act on air quality. It takes a broad look at every aspect of a hospital to find specific areas of improvement, so they can operate with the cleanest air possible.

Unpacking the framework
The Clean Air Hospital Framework is a succinct, easy-to-understand compilation of information and actionable suggestions built on the everyday experience of staff delivering on-the-ground services within a busy NHS trust. It includes a presentation that can be used to explain the framework to staff, as well as a guidebook, which focuses on seven key areas to improve hospital air quality: travel; procurement and the supply chain; design and construction; energy generation; local air quality; communication and training; and hospital outreach and leadership.

Each area has its own sub-list of actions that can be taken to improve air quality. The list of actions is widely varied - some can be done in the short-term, while some take time and planning, some require funding or wider systemic changes and some are simple changes in everyday care practices.

The Clean Air Hospital Framework encourages hospitals to be ambitious, and to set one-, two-, five- and ten-year targets, and to ensure interdepartmental cooperation so the actions taken become a part of overall hospital strategy. 

Hospitals can track their progress using scoresheets provided within the framework and calculate their air improvement rating based on the number of actions they take on. This is used to prioritise which air improvement actions to undertake in each hospital’s clean air action plan.
The framework was created with the purpose of being replicable and adaptable for each and any hospital. Great Ormond Street Hospital – an acute trust - has been a pioneer in incorporating the framework into their own system, but all hospitals have unique designs, specialisms, operations and locations bringing unique air quality challenges. The framework caters for all eventualities by directing hospitals to review all areas of their hospitals that may be prone to air quality issues, with a range of solutions proposed from which the hospital can choose the solutions that work best for them.

Implementing the framework
Great Ormond Street Hospital has taken the lead – already achieving over 150 points within the framework and working towards a further 200 points in the short to medium-term. They are progressing from a hospital rated ‘starting out’ ‘to one rated ‘good’ on 540 points.  

Great Ormond Street Hospital has done this by using the Clean Air Hospital Framework to create a clean air action plan – agreed at senior level - that sets out actions they are delivering and ambitions they are aiming for.

They are already delivering: driver, contractor, clinical staff and play service training; artwork with patients and families; indoor and outdoor air monitoring; play street with varied local and wider partners; research projects linking health and air quality; clean air contractual provisions; staff induction and online training; and case studies shared through wider NHS structures.

The hospital is also planning for: i;ncreased charging infrastructure; electric patient transport; zero tailpipe deliveries; BREEAM ‘excellent/outstanding’ construction; increased onsite renewables; patient clean air advocate development; and innovative clean air strategic and technological partnerships.

Hospitals have a fantastic opportunity to reduce air pollution emissions and teach the most vulnerable people how to reduce the health impacts of air pollution. Many measures can be taken at no cost to the hospital, but we appreciate that time is a precious commodity. The Clean Air Hospital Framework saves hospitals time in researching what anti-pollution action to take by listing activities graded by impact. If the health sector can minimise its air pollution with limited resources, it creates a powerful precedent to demand action from more major polluters.

What next?
Since the framework was launched in March 2019, it has had almost 500 downloads and we know that at least six other hospitals are already using the framework to create their own bespoke clean air hospital action plans.

Our ambitions for the framework are to mobilise all hospitals within the UK to create their own clean air action plan. The framework is also being shared internationally with the Global Green and Healthy Hospitals Network to encourage its use around the world. Open-sourcing our Operation TLC energy efficiency programme for hospitals with this network resulted in over 200 hospitals downloading this advice, and we aim for similar results with the Clean Air Hospital Framework.

Our projected goal of 50 hospitals adopting the framework could result in 1.6 million patients a year getting vital advice on health and air pollution. Additionally, operational changes in these hospitals defined within the framework could reduce emissions of nitrogen oxides equivalent to replacing 54 million miles of diesel and petrol driving with electric vehicles. The ability for the framework to be implemented quickly, and with a range of actions, means that air quality changes can begin to occur immediately.

The Clean Air Hospital Framework has been shortlisted for a Sustainable Cities Award in the Healthier Places category, with the awards ceremony in mid-July, only four months after its launch. For such a young initiative to get such recognition already is surely a sign of exciting things to come.
Hospitals can pledge to become clean air hospitals and download the framework for free at
For hospitals who would like additional support through the implementation process, Global Action Plan and Great Ormond Street Hospital are available to provide on-site aid through workshops, coaching, staff training, planning sessions, and peer-to-peer discussions.
Find out more by calling 020 7420 4444.

Further Information:

Event Diary

Join us at Manchester Central on 10-11 October 2023 for Healthcare Estates, the annual event for healthcare engineering and estates and facilities professionals.
Registration, and more details about the event including the full Conference Programme and Exhibitor List can be found at: