UK's National Health Service leads by example, commits to net zero

A view of a sign dedicated to the National Health Service (NHS) in Hilly Fields, London, Britain, 11 April 2020. EPA/WILL OLIVER

The board of the UK’s National Health Service has endorsed a multi-year plan to become the world’s first carbon net zero national health system by 2045.

The decision, a first among world health services, comes after a report published by the NHS Net Zero Expert Panel, led by Dr Nick Watts, executive director of The Lancet Countdown on health and climate change, and comprising public health and climate experts as well as patient and staff representatives. NHS chief executive Sir Simon Stevens said:

2020 has been dominated by Covid-19 and is the most pressing health emergency facing us. But undoubtedly climate change poses the most profound long-term threat to the health of the nation. It is not enough for the NHS to treat the problems caused by air pollution and climate change – from asthma to heart attacks and strokes – we need to play our part in tackling them at source.


The context. This commitment comes amid indisputable evidence of the health impacts of climate change and air pollution, and “aims to save thousands of lives and hospitalisations across the country”. It takes place in the context of a massive mobilisation by health professionals on the climate emergency after 40 million professionals sent a letter to the G20 leaders in May. But also increased efforts by WHO and specialised NGOs like Healthcare without Harm to mobilise the sector at a global level and support it with practical guidance, for instance on climate-resilient and environmentally sustainable healthcare facilities. On 9 November, the Race to Zero Climate & Health Dialogue will bring both local and global actors together to envision how a healthy, equitable recovery from Covid-19 can drive rapid decarbonisation.

Why it’s critically important. The health sector is much larger than most people think, often the biggest or second-biggest sector in developed economies at around 10 per cent of the GDP. It is also a major contributor to carbon emissions, with responsibility for about five per cent of the total globally, twice the level of aviation. The NHS emissions alone represent the carbon footprint of a country like Croatia. By deciding to set an exemplary pathway with a target that is ten years ahead of the UK government’s nationwide objective for 2050, the NHS becomes the first public health administration in the world to formulate such a forceful ambition. It sets the example for all health institutions, showcasing that providing quality medical care alongside cutting carbon emissions to almost zero is a realistic, achievable, and necessary goal. Dr. David Pencheon, professor at the University of Exeter and former director of sustainability at the NHS told Geneva Solutions:

The responsiblity to play a leading role in reducing environmental degradation can no longer be “morally offset” by the noble cause of saving lives. The health sector must become part of the solution to decarbonize by 2050. If emissions are not brought down to net zero by then, the science basically says it’s game over.

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A trusted, frontline operator. With 1.3 million staff on the frontline every day with patients and families and hundreds of facilities, the NHS is also the largest employer in the UK. Medical professionals represent one of the most trusted voices in society and are listened to by the public. They can make the link between what still seems to many an abstract notion with the concrete health threats and the benefits of climate and clean air policy.

Setting the bar at the highest level. With a Sustainable Development Unit in place since 2007, the NHS has already cut its own direct carbon footprint by 62 per cent compared to the international-standard 1990 baseline, and by 26 per cent when indirect factors are included. It has now formally adopted two new targets:

  • for the NHS Carbon Footprint (emissions under NHS direct control), net-zero by 2040, with an ambition for an interim 80 per cent reduction by 2028-2032, and;

  • for the NHS Carbon Footprint Plus, (which includes the wider supply chain), net-zero by 2045, with an ambition for an interim 80% reduction by 2036-2039.

Fig.1 \[P.11 Delivering a ‘Net Zero’ National Health Service NHS England, 2020\].png

In contrast with greenwashing practices, the NHS goes further than most by not only including all scopes required by the Greenhouse Gas Protocol, but also the travel to its facilities of patients and visitors. It also excludes compensation through the purchase of carbon offsets, unlike many companies. The figure below details the sources of emissions, and highlights the fact that the supply chain and personal travel represent three-quarters of the footprint.


How do we get there? The NHS team plans for the following interventions over the next period:

  • New ways of delivering care at or closer to home, meaning fewer patient journeys to hospitals.

  • Working with their suppliers to ensure that all of them meet or exceed NHS’ commitment to net zero emissions before the end of the decade. The writing of contracts is a very powerful tool, and business will adapt because it’s innovative.

  • Greening the NHS fleet, including working towards road-testing a zero-emissions emergency ambulance by 2022, with a shift to zero-emission vehicles by 2032 feasible for the rest of the fleet.

  • Reducing waste of consumable products and switching to low-carbon alternatives where possible.

  • Making sure new hospitals and buildings are built to be net-zero emissions by supporting the construction of 40 new ‘net zero hospitals’ as part of the government’s Health Infrastructure Plan.

  • Fixing the heating and lighting, notably by completing a £50 million LED lighting replacement programme, which, expanded across the entire NHS, would improve patient comfort and save over £3 billion during the coming three decades.

  • Building energy conservation into staff training and education programmes.

In this coming phase, a transformation of healthcare will be needed beyond efficiency gains. The NHS considers that reaching the country’s ambitions under the Paris Climate Change Agreement could see over 5,700 lives saved every year from improved air quality, 38,000 lives saved every year from a more physically active population and over 100,000 lives saved every year from healthier diets.

The bottom line. Seeing the largest health services come on board of climate action and endorsing science-based targets is excellent news that brings hope. Not only can they impact their own carbon footprint and contribute to the delivery of many health co-benefits associated with reduced emissions, but their role as a trusted profession without conflict of interest and a major economic player has the potential to accelerate the tipping of societies in the right direction to reach the Paris agreement goal. As laws generally codify already existing practices, getting a critical mass of organisations developing the best practices will finally help to set the ground for more ambitious legislation across many countries. David Pencheon:

Technology is not the problem, it’s all about the political decision. Don’t ask if, but how. Telling future truths is courageous and necessary. With a clear target defined, the focus shifts to back-casting and designing the roadmap towards the future you’ve got to create, engaging with everyone to get them on board and over the hurdles.