Public opinion on the NHS net zero ambition: 5 years on, what has changed and why?

5 years have passed since the NHS became the world’s first health care system to commit to net zero. 2040 is the target for net zero for emissions within NHS control, and 2045 for emissions it influences. These targets are a crucial part of the UK’s response to the health threats of climate change – a topic high on the agenda at COP30 (the United Nations Climate Change Conference) starting next week.

This year’s updated NHS carbon footprint shows good progress, with directly controlled emissions 14% lower than in 2021. Successful actions include phasing out highly polluting anaesthetic gases and shifting to renewable energy across the NHS. Yet there is further to go, and public support will be critical to achieving the NHS net zero goal.

At the Health Foundation, since 2021 we have been tracking public awareness and opinion on NHS net zero in our nationally representative annual polling with Ipsos. So how have public perceptions changed, and what are people’s reasons for supporting or opposing this ambition? In this blog we share the findings from our survey undertaken in May 2025, just before the 10-Year Health Plan was launched.

Majority support for NHS net zero 

Public opinion on the NHS and climate change changed little between our 2024 and 2025 surveys (Figure 1). Nearly half of people (46%, similar to 44% in 2024) think the NHS has a responsibility to reduce its impact on climate change, though 22% disagree. This is despite comparatively low awareness of its contribution to climate change – only 22% think the NHS is contributing to the problem, while 23% disagree. 

23% of the public were already aware of the NHS net zero commitment before our survey, the highest level since 2022. When the NHS’s net zero ambition is explained, there is majority support for the policy (60%), similar to the last 3 years. Support was highest (at 70%) in 2021 when the survey was carried out shortly before the UK hosted COP26, which had a major focus on health, and the NHS had recently made its net zero commitment. 

Those who feel positive about improvements to the general standards of NHS care in the past year are more likely to support the net zero NHS goal (75%) than those who feel negative (52%). Similarly, opposition is higher among those with negative views of the standards of NHS care (22%) compared with those with positive views (9%).

However, the degree of support for NHS net zero differs slightly by political views. There is overall support among people intending to vote Labour, Liberal Democrat, Conservative, Green and those undecided (ranging from 46% to 85%). The exception is those intending to vote Reform UK, who are the only group more likely to oppose than support the policy (38% oppose, 33% support). 

In 2025, for the first time, we explored people’s reasons for supporting or opposing the NHS net zero ambition. Among those supporting the net zero ambition, the main reasons are feeling this will help reduce the UK’s contribution to climate change (61%); help the NHS use resources more efficiently and save money (53%); and help reduce the impact of climate change on people’s health (52%). Meanwhile, among those opposing the NHS net zero ambition, the main reasons are feeling the NHS should focus on other priorities (67%); the NHS should be exempt as it delivers essential services (48%); and perceived impact on patient care (46%).

People want sustainable actions to reduce waste 

Two-thirds of people (66%) feel the NHS often wastes money, so our survey also asked how people think the NHS should reduce waste and improve efficiency. While using resources efficiently helps deliver care more sustainably, these questions were not framed around net zero. High priority was nonetheless given to some actions with sustainability benefits, including reusing medicines and equipment (24%, ranked fourth), and reducing inappropriate prescribing (18%, ranked seventh). Those intending to vote for Reform UK were more likely than average (and more likely than those intending to vote Labour or Green) to prioritise reusing medicines and equipment (30%). 

What’s the reasoning behind the numbers?

Our polling shows there is still strong public support for the ambition to reduce the environmental impact of NHS care. While there may be low awareness of the NHS’s contribution to climate change, and its net zero ambition, there is still widespread understanding that greener care can be more efficient and cost-effective – as shown by the reasons people give for supporting NHS net zero once it’s explained to them.

Other surveys have found that people want climate action: there are high (and rising) levels of public concern about climate change, and desire to see the government do more. In this context, it is perhaps unsurprising that among the reasons people give for supporting NHS net zero, they often cite reducing the UK’s contribution to climate change and reducing the impact of climate change on people’s health.

However, with support for NHS net zero lower than its peak in 2021, attention must also be paid to why some people oppose environmentally sustainable care. General pessimism over the standards of NHS care may underlie concerns that progress towards net zero care could impact care delivery or distract from efforts to improve the quality of essential services. To allay these concerns, it’s important to highlight interventions which have both improved patient care and reduced environmental impact.

Reducing waste in the NHS received most support among people intending to vote for Reform, despite them being the only group to oppose a net zero NHS. Changing the framing to speak to the issues people are most concerned about (eg efficiency) – rather than focusing on the increasingly politicised ‘net zero’ – may build support for the necessary actions and policies to achieve sustainability goals. 

What do these findings mean for the NHS and net zero? 

The 10-year health plan was a missed opportunity to communicate the quality and efficiency co-benefits of environmentally sustainable care. While the plan reaffirmed the NHS net zero commitment, it failed to consider how the three shifts at the heart of the vision for the NHS can be done sustainably. In the coming weeks, as national policymakers publish further detail about how the plan is to be implemented, it’s vital that environmental sustainability is fully integrated into practical delivery.

The government and the NHS must address the public’s priorities on both climate and health care by proactively and accessibly communicating how sustainable care protects health, improves quality and reduces waste. While all eyes are on global decision making on climate change at COP30 this month, here in the UK it’s clear that public support will be critical for the NHS to achieve high-quality, low-carbon, climate-resilient care over the coming, crucial decade.