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The Road to Net Zero

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The NHS has released a comprehensive document outlining how the organisation plans to tackle climate change by working towards the world’s first net zero national health service. This ambitious target involves reducing carbon emissions directly controlled by the NHS to net zero in 2040 and a commitment to reduce the carbon emissions influenced by the NHS (The NHS Carbon Footprint Plus) to net zero by 2045. But how will this happen? 

Figure 1: Pathway to net zero for the NHS Carbon Footprint Plus Scope  (Delivering a Net Zero NHS 2020)

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The red dotted line highlights what will happen if we continue on the current "business as usual" trajectory, with the blue dotted line highlighting our aim of net zero by 2045 (NHS Carbon Footprint Plus).​ Each section shows potential gains that can be made from various sub-sectors of the health sector. We will go into more detail on this now.


The NHS will remove all coal and oil heating systems from its hospital sites as soon as possible, with complete phase-out over the coming years. Additionally, NHS hospitals will purchase 100% renewable energy from April 2021. In GP practices nationally there will be a focus on improving building insulation, lighting and heating. Further work on building instrumentation, energy management and installation of photovoltaics and heat pumps would follow this.

Wind Turbines on Water
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Significant gains can be made by transitioning the NHS fleet to zero-emission vehicles, reducing unnecessary journeys and enabling healthier forms of travel such as cycling and walking. This will include incentivising staff to use electric vehicles, engineering 90% of the NHS fleet to use low, ultra-low and zero-emission vehicles by 2028 and developing and testing the world’s first hydrogen–electric hybrid double-crewed ambulance through the London Ambulance Service.​​

Supply Chain

A commitment has been made to a 10% reduction in clinical single-use plastics in the short term, increasing walking aid refurbishment to reach 40% of all NHS walking aids used in the next five years and a reduction in paper use in secondary care through digitalisation of notes. Paper that will be used will switch to 100% recycled content paper in office-based functions. Suppliers will be incentivised to reduce their carbon footprint using the NHS’ buying power as leverage. The NHS will conduct a food review to increase local, seasonal and sustainable produce use.

Organic Vegetables



Changing models of care

Out of hospital acute care will be expanded using triage and increased community health practitioner involvement. Variation in use of surgical procedures will be avoided using the ‘Getting It Right First Time’ approach. In the outpatient setting there will be an increase in remote consultation and monitoring use, digitalisation of clinical records and the development of a blueprint for a net zero digitalised system of care. A focus on health prevention and reducing health inequality to reduce subsequent complications will promote carbon savings.

Image by The Climate Reality Project


The NHS will encourage research and innovation to address the residual CO2 emissions in each of the above categories in order to reach net zero. This will include carbon offsets such as planting trees, carbon capture and installation of photovoltaics. Further scrutiny will apply to decision making based on sustainability and ensuring innovation project applications include and articulate their environmental impact.


Annual sustainability reporting and review of this will be mandated in all Clinical Commissioning Groups to monitor scale and progress throughout the road to net zero. This will be accompanied by formation of an expert panel to meet periodically and evaluate areas for improvement and focus more exact dates for each of the improvements to be implemented.

Key focus areas involve anaesthetic gases and metered dose inhalers, specifically reducing nationwide desflurane use to 5% by volume of all volatiles and switching to dry powder inhalers nationwide. Other aims include capturing nitrous oxide for re-use or destruction in the acute care setting.

Image by National Cancer Institute


Development of an induction model for all healthcare professionals will accompany specialist ‘net zero’ training for those in facilities or estate management roles. Upscaling local projects such as Operation TLC’ (turn off equipment, lights and controlling temperature) will provide tangible nationwide improvements. All trusts must produce a green plan and the NHS will use local and national levers to ensure plans are followed through.

Group Planting a Tree

To learn more about what you can do to help us reach net zero click here.

This page was written by Luke Mills. Many thanks for his contribution.

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