A net zero NHS – from recommendations to action

The NHS is already feeling the effects of climate change, from heat-related deaths to weather-related disruption across services. By the 2050s, extreme heat could triple heat-related A&E attendances and cost the UK over £4bn a year. 

As the first health system to set net zero goals, the NHS is a world leader in its approach to the climate crisis. Reaching these targets is vital to delivering high-quality health care now and into the future. While direct emissions have already been reduced, tackling the wider contributions to climate change from the supply chain, travel and medicines requires fundamental shifts in policy and care delivery to embed environmental sustainability into the NHS. 

To reflect this, we have made environmental sustainability an important cross-cutting issue in our new Strategy to 2030. We recently funded a report by the King’s Fund and the Centre for Sustainable Healthcare that sets out a new approach to national leadership and accountability for an environmentally sustainable NHS. Learning from 5 years of policy and action towards the net zero target, it explores how to strengthen accountability across the NHS.

Following the report’s publication, we held a workshop with senior leaders from the NHS and the broader health policy landscape to discuss how to move from research to action. Here, we share four key takeaways from the report and workshop. 

Embed sustainability to drive long-term goals

Environmental sustainability risks being crowded out by intense pressure to deliver short-term operational savings and productivity gains. The senior leaders we spoke to were clear that the barrier to work on environmentally sustainable health care is not scepticism or a lack of goodwill. Across the system, there is strong appetite to embed sustainability, with many staff and leaders recognising this as fundamental to building a more resilient, efficient and future-proof NHS. 

However, it can be difficult to secure funding for actions with longer term returns, such as estates upgrades and commissioning for sustainable models of care. To tackle this, a shift is needed from an annual financial balance towards longer term planning for value, efficiency and resilience. Embedding sustainability into strategic commissioning would help ensure service, investment and improvement decisions are judged by their contribution to longer term resilience and value. This would create greater space for environmentally sustainable solutions, where returns from actions such as reusable medical equipment could be realised over time.

Include sustainability in regional performance management processes 

The report identifies regional performance management approaches as an opportunity to embed firmer accountability for delivering net zero targets. However, leaders at our workshop highlighted that the call for a stronger regional role in supporting sustainability is in tension with the current reform agenda. The abolition of NHS England and changes to regional teams and integrated care boards (ICBs) have reduced capacity in many of the functions essential to delivering long-term change. 

Responsibility for delivering net zero targets must be distributed more widely across regional and system leadership roles for achievement to be feasible. Regions need to be equipped to do more than ‘tick the box’ on sustainability through performance management conversations – leaders need a clear mandate, practical support, access to timely data on emissions and measures of sustainability and the capacity to follow up with systems and providers to implement change.

Integrate sustainability into national accountability mechanisms

Both the report and many participants at the workshop raised the need for strong signals from national NHS leaders that environmental sustainability should be an integral priority. This needs to be supported by better aligned wider policy and financial incentives, as well explicit references to environmental sustainability in oversight and accountability frameworks. 

These signals should encourage leaders to look beyond short-term performance pressures and prioritise medium-term outcomes, making clear the links between environmental sustainability, efficiency, government priorities and high-quality care.

Communicate the risks of climate change

Climate change is no longer a distant or abstract risk. The effects of heat, extreme weather and changing patterns of infectious disease are already being seen in GP surgeries, hospital waiting rooms and communities across the UK. In 2024 alone, heat contributed to more than 60,000 deaths across Europe. These impacts carry a heavy human cost – and translate into growing financial pressure for the NHS. Heat‑related mortality currently costs the NHS £6.8bn annually, projected to rise to £14.7bn/year by the 2050s. The 2022 heat-related disruption at Guy’s and St Thomas’ shows how climate risks can quickly become risks to patient care and service delivery.

Emphasising the link between these risks and more immediate priorities, such as the cost of care and increased A&E attendance, can make the urgency of action on environmental sustainability more compelling. Senior leaders shared how this framing has helped to secure leadership buy-in and strengthen the argument that sustainability is core to a safe, effective and future-ready NHS care instead of a separate environmental ask.

Uphold the net zero goals in the Health Bill 

The recently published Health Bill goes some way to reaffirm the NHS net zero agenda. It maintains the existing climate duties on trusts, foundation trusts and ICBs, but the equivalent duty on NHS England will not transfer to the Secretary of State for Health and Social Care on the basis that ministers are already bound by the Environmental Principles Policy Statement. While this suggests legal continuity, it raises questions about whether current net zero priorities will be sustained. The new secretary of state should clarify how key NHS England functions, including the Greener NHS programme, will move into the Department of Health and Social Care (DHSC) and reaffirm that delivering a net zero NHS remains a central priority.

National teams in the reshaped DHSC should also ensure environmental sustainability is not treated as a separate or secondary agenda. Integrating it into both local and national agendas is an opportunity to accelerate and maximise the co-benefits of reducing the NHS’s environmental impact. Embedding environmental sustainability into regional roles, performance frameworks and the Model Region Blueprint would bring it into core functions and help ensure the net zero goals are met.

The message from the report and discussion is clear: the NHS will not meet its net zero commitments unless environmental sustainability is treated as central to how the system, its staff and its leaders are governed, led and performance managed.