Can the 10-Year Health Plan make the NHS environmentally sustainable?

In a health system in which short-term thinking dominates, the government is developing the 10-Year Health Plan to make the NHS ‘fit for the future’. The next decade is critical for the NHS, not only to meet society’s growing health care needs but also to make progress on its legally binding net zero emissions targets and make health care low carbon and climate resilient. By the end of 2032, the NHS needs to cut its direct emissions by over 80%. 

Promisingly, the ‘three shifts’ underpinning the 10-year plan all have the potential to drive a sustainable NHS. However, capitalising on this opportunity will need conscious effort to avoid environmental concerns being deprioritised in the upheaval of major NHS reform. 

How can these shifts be implemented sustainably and set the NHS on a path towards net zero while making the health service work better for patients and staff? 

From hospital to community 

Shifting more care from hospitals into the community aligns with more sustainable care delivery. The NHS carbon footprint for primary and community services is just over half that of acute care, even though they deliver three times as many patient contacts. Primary and community care can help to avoid the inappropriate use of carbon-intensive hospital care through their vital role in delivering preventative care, managing illness, coordinating care and providing continuity. 

However, expanding activity in primary and community care could increase emissions from these settings (for example, through medicines, equipment, buildings and travel) if not managed well. Take medicines for instance – the largest source of primary care emissions – where there is significant scope to reduce harmful or unhelpful prescribing through shared decision making between patients and clinicians and by decreasing variation in prescribing practices.

But GP practices will need implementation support to scale and spread initiatives to improve care quality, reduce emissions and lower costs. Climate adaptation must not be neglected: with an estimated 800 UK GP practices already at risk of flooding, ensuring the primary care estate is resilient to more frequent and extreme weather events will require planning and investment.

From analogue to digital 

Digital technology can support more sustainable health care delivery by enabling the shifts to community-based and preventative care while improving processes in hospital-based care too. Virtual appointments and remote care delivery reduce emissions from travel. Digital tools can also help staff make optimal clinical decisions, which may reduce emissions if better outcomes and efficiencies are achieved. For example, an AI-enabled remote monitoring intervention has helped people with cystic fibrosis and their clinicians to identify signs of deterioration early, providing the opportunity for earlier treatment and potentially avoiding carbon-intensive hospital admissions.

At the same time, digital technology has an inherent environmental cost. The development, use and disposal of these technologies (particularly those that use AI) can generate significant emissions, consume huge amounts of water and energy, and contribute to the electronic waste stream, which is set to grow by over 30% by 2030. Increasing reliance on technology for care delivery could also leave NHS services more exposed to the risks of climate change, as seen when two hospitals’ IT systems failed during extreme heat in 2022. 

The implementation of digital technology must be driven by patient and staff needs and meaningfully improve clinical pathways to outweigh the environmental cost – which must be measured as part of evaluating technologies. Following ‘green digital’ principles can make the shift to digital low carbon and climate resilient by design. These can include lean approaches to digital product design, energy use and data storage, and adopting circular economy approaches. The NHS Net Zero Supplier Roadmap and the government’s Design for Life roadmap, the latter of which sets a path to phase out avoidable single-use medical technology, are steps in the right direction.

From treatment to prevention

Secondary and tertiary prevention efforts – spotting disease earlier and supporting the management of illness – that sit within the NHS’s control will be an important part of the plan. Preventing and reducing health complications and more resource-intensive care needs can also support environmental goals. However, assumptions that ‘personalised prevention’ – newer approaches based on digital monitoring and genetic and clinical data – will be more effective are largely untested and shouldn’t be relied upon as the primary solution. 

The NHS can use its influence as an anchor institution to bring about health and climate co-benefits, for example, by ensuring that the 199 million meals it provides to patients, visitors and staff each year are healthy and sustainable. Working in partnership, NHS organisations can coordinate action to improve air quality and reduce health inequalities. There are also public health sustainability and cost-saving opportunities to be maximised. For example, supervised toothbrushing programmes in Scotland have resulted in substantial reductions in children’s tooth extraction-related admissions while delivering carbon emission reductions (as fewer operations are needed) and financial savings.

Ultimately, cross-government action on the wider determinants of health, such as housing and transport, is needed to improve health, reduce inequalities and achieve net zero simultaneously. The government must make these links explicit throughout its wider health mission. 

Developing the 10-year plan with sustainability in mind

The ‘three shifts’ are laudable goals, but the detailed policies needed for delivery must be designed with sustainability in mind. Not doing so could mean failing to deliver better health care more efficiently and putting the NHS net zero ambition in jeopardy, leaving patients and services more vulnerable to climate change. The 10-year plan is a historic opportunity to improve the quality and sustainability of care and make it truly fit for the future. It must not be squandered.

Explore our immersive scenario of an imagined future NHS, which we’ve designed to help policymakers think long term about the changes needed to achieve a net zero health service. Our workshop guide can help you use this online tool to support discussions in your team, organisation or more widely.