Last year, a major funding commitment from the UK government firmly put ventilation back on the healthcare agenda. Announced as part of the June 2025 Spending Review, nearly £1.2bn was earmarked for urgent infrastructure repairs across hospitals and schools.
Of that, £750m would go directly to more than 400 NHS and mental health facilities to address long-standing maintenance problems.
Positioned under the government’s Plan for Change, this funding marked a clear recognition that the condition of public service buildings had deteriorated to a critical state of disrepair. It also opened a valuable window for NHS trusts and health estate managers to take meaningful action on one of the most important, yet often overlooked, aspects of building health: indoor air quality (IAQ).
With the NHS estate repair backlog reportedly approaching £15.94 billion, there is a pressing need for investment in air quality improvements that support regulatory compliance and patient safety. Encouragingly, ventilation is increasingly recognised as a key part of the solution.
Under the government's Estates Safety Fund, for example, the installation of new air handling units is explicitly identified among eligible works.
Efficient buildings are healthy buildings
In healthcare settings, air quality is a clinical asset. It directly affects patient outcomes, infection control, staff well-being and absenteeism, as well as the long-term resilience of facilities. Yet many NHS hospitals continue to operate with ageing HVAC systems that no longer meet today’s performance, safety or sustainability standards. Structural deficiencies, such as leaking roofs, broken windows and poor insulation, compound the issue, creating ideal conditions for damp, mould and airborne transmission risks.
Poorly ventilated healthcare settings are breeding grounds for moisture build-up and biological pollutants, particularly mould. For immunocompromised patients, this can pose a serious respiratory threat. The Building Engineering Services Association (BESA) has highlighted the link between poorly maintained HVAC systems and the risk of respiratory illnesses and airborne infections, as spores and pathogens can circulate through ductwork and shared airspace.
These issues are exacerbated by outdated or inefficient air handling units (AHUs) and fan coil units (FCUs). Many of these systems were installed decades ago and now fall short of current air quality expectations. Their performance deteriorates over time, leading to inconsistent airflow, inadequate filtration and rising energy consumption.
HVAC upgrades for immediate IAQ concerns
Full system replacement may be necessary in some cases, but when the budget is insufficient, healthcare buildings require a more cost-effective and less disruptive alternative. The good news is, solutions are within easy reach.
Upgrading and retrofitting existing HVAC systems offers a practical and often underused route to better air quality. In fact, around 750,000 medium-to-large-scale HVAC units in the UK, including air handling units (AHUs) and fan coil units (FCUs), are currently operating below their potential. Many of these systems don’t need replacing; they need rethinking.
That’s where service, repair and refurbishment come in. By upgrading core components, such as fans, filters, coils and control systems, the life of an AHU or FCU unit can be extended by a decade or more.
Retrofitting existing HVAC systems can help improve IAQ and system reliability without triggering major disruption. A phased, in-situ refurbishment approach that makes sense for hospitals, where operational continuity is non-negotiable.
From crisis response to future readiness
COVID-19 brought air quality into the spotlight, but the healthcare sector has long needed ventilation systems that go beyond minimum compliance. Guidelines like BS 40102 and Eurovent’s IAQ recommendations are raising the bar for what good looks like, focusing on CO₂ levels, airflow rates and temperature stability.
The NHS’s own technical bulletins are pushing estates to integrate higher-performance filtration and cleaner, quieter HVAC technology.
Proactive service models
The success of any upgrade depends on how it is managed over time. Carrier’s life cycle asset management approach helps estates teams move from reactive repair to intelligent, predictive care. Using platforms like Abound HVAC Performance, building managers gain access to real-time system insights, allowing them to spot inefficiencies before they escalate and plan maintenance around actual performance data.
This isn’t about ‘nice to have’ technology; it’s about making better decisions to reduce downtime, energy consumption and unplanned costs. When trusts are under pressure to deliver better outcomes with tighter budgets, that kind of foresight makes a measurable difference.
It also supports sustainability goals. Refurbishing existing systems reduces waste, conserves materials and avoids the carbon impact of manufacturing and transporting new equipment. With energy costs still volatile and NHS climate targets on the horizon, retrofitting rather than replacing makes sense.
Turning government funding into long-term gains
With the government now directing millions toward fixing healthcare buildings, the timing is right to act. But this funding won’t stretch far unless it’s used wisely. Investing in HVAC upgrades, particularly those that combine refurbishment with smart monitoring and service, offers a low-risk, high-impact way to improve care environments.
As we look to the future, the case for smarter ventilation has never been clearer. Healthy buildings are essential to healthy outcomes. By focusing investment on HVAC refurbishment and IAQ improvements, supported by digital tools and expert service partners, NHS estates can take meaningful, manageable steps toward safer, more resilient facilities.
With the funding currently available, estates teams must act decisively to triage building services needs in the same way clinical teams prioritise patient care. By identifying where ventilation and air quality improvements will have the greatest impact, trusts can turn emergency maintenance into long-term, measurable improvements in safety, sustainability and operational performance.
At Carrier, we’re committed to helping trusts make informed, effective decisions about their HVAC assets, backed by service expertise, reliable data and a deep understanding of real-world estate constraints. In a sector where every decision counts, our goal is to put the air we breathe at the centre of the conversation.
