In West Sussex this week, a small renewable heat company was handed the means to build a UK factory. Naked Energy makes solar-thermal collectors, tubes that draw heat directly from sunlight rather than converting it to electricity first, and the near £9 million came jointly from Great British Energy and Barclays Climate Ventures. Forty skilled manufacturing jobs, roughly a hundred more in the supply chain, and a chief executive talking about British engineering leading a global market. It is a modest story by the standards of industrial policy, but a coherent one. The state identified a technology with export potential and energy security benefits, and it wrote a cheque.

That coherence is worth sitting with, because it is largely absent from the equivalent conversation inside the NHS. Gas heating accounts for around forty per cent of the NHS's own carbon footprint, and that figure has barely moved in five years, falling by roughly one per cent since 2019. Much of the estate still runs on plant that predates the health service's Net Zero commitments by decades, some of it in hospital buildings well over a century old. NHS England has set a target date of 2028 to remove oil-fired heating entirely and has asked every trust to produce a heat decarbonisation plan. The ambition is not the problem. The money to deliver it, at the pace the ambition implies, is.

The pattern here is familiar to anyone who has followed NHS capital spending over the past decade. Lord Darzi's independent review found that £4.3 billion was pulled from NHS capital budgets between 2014 and 2019 to plug gaps in day-to-day running costs, a raid that left the maintenance backlog more than doubling, from roughly £6 billion in 2019 to nearly £14 billion by the time the current government took office. Ministers have since pointed to a four-year capital settlement running to 2029/30 as evidence that the cycle has been broken, and to a new £1 billion national decarbonisation framework opened for tender this spring. Both are real. Neither changes the fact that this year's NHS capital guidance describes only limited availability of funding, restricting most trusts to minor refurbishment rather than the kind of estate-wide heating conversion that would actually shift the emissions figures.

What the Naked Energy deal exposes, then, is not hypocrisy so much as a genuine inconsistency in how the state deploys long-term capital. Great British Energy can back a single private company's factory on the strength of an export and energy security case. The NHS, holding an estate with a far larger energy footprint and an equally strong claim on both counts, has to build its case project by project, trust by trust, against a capital envelope that keeps being described as constrained even when headline figures look generous. Individual trusts have shown what is achievable when the funding does arrive. Imperial College Healthcare has secured over £110 million in decarbonisation grants since 2020 and cut building emissions at one site by more than a quarter in a single year after installing heat pumps. That kind of result should be the template rather than the exception, and it depends entirely on capital reaching the estate at the scale gas heating requires.

There is a narrower, more immediate argument too. Gas is not just a carbon problem for the NHS but a financial one, and hospitals with ageing, inefficient heating systems are the most exposed to the price volatility that GB Energy cites as the rationale for backing Naked Energy in the first place. Every winter that volatility resurfaces as an unbudgeted pressure on trust finances, competing directly with clinical priorities. A funding model confident enough to underwrite private manufacturing capacity ought to be at least as confident underwriting the public estate that would use the resulting technology. For NHS leaders watching this week's announcement, the lesson is not that Great British Energy has done anything wrong. It is that the same seriousness of intent has yet to be matched, at comparable scale, inside their own buildings.