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The first ever Health Day at COP28 shone a spotlight on the intersection between climate and health. The World Health Organization, along with 40 million health professionals, called for immediate and bold action to phase out fossil fuels, protect the communities most vulnerable to the impacts of climate change and, importantly, develop low-carbon, climate-resilient health systems. The NHS in England is viewed internationally as a leader in working towards a low-carbon health system, having been the first national health care system to set a net zero target, in 2020. But does the public recognise the contribution of health care to the climate crisis, and do they support the net zero NHS policy? 

Support from the public is essential to maintain momentum towards a net zero NHS, ensure sustainability is not deprioritised by the other challenges facing the health service, and encourage clinicians and health leaders to make and scale up shifts to more sustainable models of care delivery. The Health Foundation and Ipsos have tracked public perceptions of the NHS net zero plans annually since 2021. Our most recent survey – carried out in May 2023 – shows how the public’s views of the NHS net zero agenda are evolving against this backdrop.

The public does not clearly see the links between the NHS and climate change

There is a compelling case for urgently decarbonising the NHS. Mitigating climate change is essential to protect human health, and the NHS’s contribution to climate change is significant, accounting for 4% of England’s total carbon footprint. Our polling finds a majority of people (61%) think the NHS is not well prepared for climate impacts, such as heat waves and floods, on people and services. However, there is limited understanding of the impact of health care on the environment, with just 19% agreeing the NHS contributes to climate change and more than half saying that they either don’t know whether it contributes to climate change (12%), or neither agree nor disagree (44%).

The public is less likely than in previous years to agree the NHS has a responsibility to reduce its impact on climate change. 39% agree it has a responsibility to do so (down from 46% in 2022), and 25% disagree (up from 21%). Only 15% agree that the NHS should make reducing its impact on climate change one of its top priorities (down from 19%), with 49% disagreeing.

Support for the NHS net zero ambition has fallen to 60%

Awareness of the NHS net zero policy remains low. 18% are aware of this policy (down from 23% in May 2022). Nonetheless, once the NHS net zero aim is explained to people, 60% support this, 25% neither support nor oppose, and only 12% oppose it. There has, however, been a decline in support for the NHS net zero policy, compared with 2021 when 70% supported it. Opposition has also increased from 6% in 2021.

Why might awareness and support for the NHS net zero goal have declined?

It is difficult to know exactly why awareness and support seem to have fallen. Levels of public concern about the climate crisis, and the NHS’s role within this, may be shaped by external events. Recent Ipsos polling found that 77% of Britons are concerned about climate change, down from 84% in July 2022, which may be due to the timing of the previous survey, which was conducted during last summer’s UK heatwave. Public awareness of the NHS’s contribution to climate change may have decreased after the UK-hosted COP26 in 2021 highlighted the NHS’s responsibility to address the climate crisis.

The current negative perceptions of the standard of NHS care, described in our recent public perceptions long read, may also have contributed to the public deprioritising environmental sustainability. The public is far more likely to prioritise the NHS addressing staff workload (40%), increasing staff numbers (39%), and improving waiting times for routine services (34%), than the NHS minimising its impact on climate change and the environment (2%). Issues of workforce and waiting times may feel more urgent and relevant to care delivery than mitigating climate change, which can seem abstract. However, in 2021 polling, public support was high for several actions to reduce carbon emissions of healthcare, even with trade-offs, for example providing more environmentally friendly food in hospitals, even if this means there are fewer options available (65%).

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

While it is hard to predict future trends, the fall in support for the net zero NHS ambition is worth noting, particularly when considering how best to communicate and get support from the public for sustainability initiatives in clinical care delivery. It is clear, however, that the public remains concerned about climate change and wants to see a better health service. And there are ways to address both of these things. As the case studies in our recent long read on net zero care illustrate, many actions needed to move towards lower carbon health care can improve patient outcomes and system efficiency while reducing costs. Policymakers, ICS and trust leaders, and health care professionals should maximise these opportunities for co-benefits – for example, by aligning sustainability with other long-term priorities at a strategic level, embedding sustainability into quality improvement initiatives and education, and involving service users in developing more sustainable models of care which improve their experience.

Clear messaging from the trusted sources of the NHS and health care professionals highlighting how sustainable care can be better for patients and the health system could be critical to building awareness and support of the net zero health care agenda with the UK public. In turn, public support can spur health leaders and policymakers on to take further action needed achieve the target.

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