Meeting the sustainability goals of the NHS Long Term Plan

David Powlesland, senior manager at the Carbon Trust, asks what role does the health sector have to play in tackling the climate emergency?

The coronavirus pandemic has caused a global crisis that has already tested the strengths of the world’s healthcare systems, with devastating consequences in some regions. It is a stark warning that our healthcare systems are extremely vulnerable and are increasingly going to be required to respond to the impacts of another great global crisis – climate change.

Left unchecked, the climate emergency will have a catastrophic impact on public health. More frequent extreme weather events threaten agricultural productivity and will drive climate migration as people flee malnutrition. Rising sea levels will lead to an increase in water-borne illnesses such as cholera, and changes in vector ecology have already increased the transmission of mosquito-borne diseases. If infrastructure, such as hospitals and water supplies, struggle to adapt to climate change, this will impact our capacity to respond to these public health threats.

According to the World Health Organisation (WHO), the direct cost of climate change to the healthcare industry is predicted to be between US$2-4 billion per year by 2030, with an additional 250,000 deaths per year. It is therefore imperative we act now to protect healthcare systems from the worst impacts of climate change.

Why the NHS matters
In June 2019, the House of Commons passed legislation requiring the UK’s emissions of greenhouse gases to be cut by 100 per cent relative to 1990 levels, by 2050. This ‘net zero’ target will have far reaching consequences for every sector of the UK’s economy, and healthcare is no exception.

The NHS is one of the largest organisations in the world, it has over 1.3 million direct staff – and makes up a significant part of the UK’s economy and workforce. It is also the largest public sector emitter of carbon emissions in the UK, responsible for around five per cent of the UK’s total CO2 emissions. In 2017, the NHS emitted over 27 million tonnes of CO2 emissions (Scope 1, 2 and 3).

Initiatives have already been put in place in the NHS to limit its contribution to climate change. In 2008, NHS England established its Sustainable Development Unit (SDU) to help organisations embed and promote sustainable development in order to reduce emissions, save money and improve the health of people and communities. NHS Wales and NHS Scotland are also undertaking their own sustainability initiatives by carrying out comprehensive carbon footprinting and decarbonisation strategies.

Since its inception, the SDU has set out roadmaps – such as the NHS Green Plan for the NHS’ sustainability agenda – developed tools and policies to complement their strategy, and has carried out extensive research to adapt the organisation to climate change. Good progress has already been made since the SDU was set up – for example 85 per cent of NHS waste no longer ends up in landfill and over 23 per cent of this waste was recycled in 2017. Water consumption in the NHS has also been reduced by over 21 per cent.

The NHS England Long Term Plan, launched in 2019, committed to reducing the NHS carbon footprint by 51 per cent (against a 1990 baseline) by 2025, and reducing it to 80 per cent of 1990 levels by 2050. Other commitments include rolling out the use of low emission vehicles and eliminating heating fuels such as coal and oil, as well as minimising usage of single-use plastics. As of this year, carbon emissions from NHS England have been reduced by 34 per cent (against a 1990 baseline), despite the number of patients treated by the NHS having increased.

These achievements look promising, but it should be noted that much of the progress on mitigating carbon emissions comes as a result of grid decarbonisation, and more renewables coming online, as opposed to being the result of any direct action by NHS England. Nonetheless, the momentum generated must be carried forward.

What’s next?
An NHS Net Zero plan is currently in development within a programme called ‘For a Greener NHS’. This will set out how the will achieve the ambitious sustainability targets in the NHS Long Term Plan, and progress towards Net Zero. The SDU has been working with other healthcare and climate change experts to review over 600 submissions it received through a consultation on how to achieve Net Zero. Ideas range from encouraging plant-based diets and sourcing local food, to clean energy production and increasing use of technology to manage conditions.

A similar NHS Wales Decarbonisation Strategic Delivery Plan is also due to be published in 2020. These strategies should refocus the basis and aims for decarbonising the NHS and ensure the governance arrangements are set to enable rapid progress to be made.

To help with meeting the sustainability goals of the NHS Long Term Plan, the Carbon Trust has been working with organisations within the NHS to prepare ‘green plans’ – live strategy documents designed for NHS organisations to take a coordinated, strategic and action-orientated approach to sustainability. These plans are valid for up to five years and involve setting out an organisational vision, action plan and monitoring system.

Uptake of green plans across the whole of the NHS will be crucial if it is to meet its decarbonisation ambitions. Committed leadership, clear direction and strategic influence at the decision-making level are essential for effective sustainability governance. A sense of project ownership throughout the organisation will also be needed to help implement the decarbonisation strategy across the NHS as effectively as possible.

Examples of decarbonisation projects being carried out include: NHS trusts’ procuring services from zero emissions couriers in Newcastle-upon-Tyne, substituting anaesthetic gases of high global warming potentials with more benign alternatives in Bristol, and encouraging healthier travel modes in Manchester. Other promising ideas include maintaining the increase in numbers of virtual consultations that have been occurring during the Covid-19 lockdown.

The ‘For a greener NHS’ programme aims to be collaborative as a Net Zero plan develops. Although a formal consultation finished earlier in the year, staff are still encouraged to get involved by sharing sustainability ideas and practices on social media with the hashtag #greenernhs. If you want to get more involved, the SDU have set up local networks to engage on the sustainability agenda. To find out more go to

The Carbon Trust is an independent, expert partner of leading organisations around the world that are seeking to deliver sustainable, low carbon economies. To learn more about their work with the public sector click here.

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