26th September 2025
Healthcare accounts for c. 4-5% of UK greenhouse gas (GHG) emissions, 40% of all public sector emissions in England, and over 11% of GDP. It is also the UK’s largest public energy user. Its significant emissions footprint (and that of its c. 1.5m staff), together with its financial leverage, offers extensive reach beyond hospital and health centre walls across the country and, through suppliers, to other nations.
The report assesses progress against two net zero targets:
Net zero by 2040 compared to 1990 levels for the emissions it controls directly (‘NHS carbon footprint’) which includes building energy use, fleet and business travel, anaesthetic gases, refrigerants, waste, water, and inhalers.
Good progress has been made, with a 68% emissions reduction (14% of this achieved in the last five years) putting it on track to reach the interim target of 80% reduction by 2028-2032.
Emissions of GHG inhaler propellants, nitrous oxide and volatile anaesthetic agents have fallen (that of Desfluorane by 98% following its decommissioning and that of Nitrous Oxide by 80ktCO2e (saving £2.3 million)).
NHS estates emissions have fallen by 10% since 2019/20, and those related to grid electricity consumption by 21% (as renewable power sources are increasingly deployed in power generation). However emissions from the use of gas (mainly for heating), which accounts for about 40% of the total NHS carbon footprint, have only fallen by only 1% since 2019/20 and those from the NHS fleet (which makes up about 14% of the NHS carbon footprint) are largely unchanged.
Net zero by 2045 compared to 1990 levels for the emissions it influences (‘NHS carbon footprint plus’) which includes the NHS Carbon Footprint plus the remaining scope 3 emission categories: emissions related to the manufacture and supply of a raft of things including medical devices, clinical supplies, food and catering, medicines and, digital services, as well as travel by staff, patients and visitors.
Good progress has been made on the NHS carbon footprint (scope 1+2 emissions) (above), and NHS Carbon Footprint Plus has reduced by 15% per pound of the NHS budget, and by 7% per finished admission episode (FAE – a period of care from admission to discharge). However, this efficiency has been counterbalanced by increased healthcare utilisation: there were one million more FAEs and more than 50 million more GP appointments in 2024/5 compared to 2019/20. Emissions from staff, patient and visitor travel (40% of all NHS transport emissions) are unchanged. Emissions from the supply chain (delivering over 600,000 products from 80,000 national and international suppliers, and hard to measure) have increased in some areas. Scope 3 emissions, which comprise about three quarters of the total NHS Carbon Footprint Plus, have thus increased, and overall NHS emissions (‘NHS Carbon Footprint Plus’ (scope 1+2+3) have not fallen over the last five years.
What Of the Future?
NHS England must be commended for setting targets, reporting on progress, and refining its methodology to continually drive improvements in the scale and accuracy of data reported. Government action on embedding Net Zero in the 2025 ten year health plan for England, and embedding targets in legislation through the Health and Care Act 2022, is likewise to be lauded.
However, progress in the NHS, and across society, is not fast enough. Absolute NHS emissions are not falling. Further, ‘Net’ Zero means drawing down CO2 from the atmosphere and sequestering it. New data show that this is not possible at the pace or scale to impact global temperatures as needed, and certainly not over the timeframes to which the NHS is working [1, 2]. Nor does the NHS Net Zero plan suggest how its target can be met (other than by some level of support for distributed tree planting). It is time to reconsider the use of the term ‘Net’ Zero, and focus on absolute emissions reductions.
Meanwhile, global CO2 emissions rose 14.4% (from 36.37 to 41.6 to billion tonnes) between 2019 and 2024 while the heating caused by them has suddenly (and separately) accelerated [3]. We are now dangerously close to triggering sudden, irreversible and catastrophic changes in our weather systems [4]. We are indeed, ‘on the brink of an irreversible climate disaster’ where ‘much of the very fabric of life on Earth is imperilled’ [5].
The NHS must play its part in driving the pace and scale of action needed, and has great opportunity to do so – not just through reducing its direct emissions, but by leveraging the 11% of GDP it represents. Greener NHS programme has made steps to address this, but we can and must all play our part. Specialties can collaborate and lead, and examples already exist. The UK Kidney Association, for example, is working to decarbonising kidney care; the Royal College of Emergency Medicine’s Green ED programme is driving more sustainable practice in the emergency department, and the joint Royal Surgical Colleges Green Surgery Report and Green Theatres Checklist provide a roadmap and practical tool for decarbonising surgical care pathways.
Great British Energy is supporting the installation of solar power and battery power to help drive down emissions from power generation. Capital investment and government support must be sustained, and all NHS Trusts must be allowed to enter into new-to-ground green Power Purchase Agreements, which save money for the NHS, and liberate capital to drive the green transition.
Greener NHS has taken steps to address its scope 3 emissions, publishing the Net Zero Supplier Roadmap in 2021, and implementing a 10% weighting for net zero and social value across procurements in 2022. Over 2,000 suppliers signed up to the Evergreen Sustainable Supplier Assessment (a tool for suppliers to demonstrate progress). In 2027, all suppliers will be required to publicly report targets, emissions, and emission reduction plans. As the net zero supplier roadmap is implemented, a full assessment of progress against targets is expected in future years. However, a greater and more rapid ratchet on contract weighting is needed.
Transport infrastructure to expand electric vehicle use must be improved if emissions from travel by patients, visitors and staff are to fall (together with those of the whole population). The NHS is showing leadership: by 2030, all new ambulances will be zero emission vehicles and government investment of £8 million is being provided to support the installation of on-site EV charge points on NHS sites.
But we must advocate beyond our walls, as actions which lower emissions can directly improve public health and thus remove the emissions related to (now redundant) healthcare. While food and catering emissions account for just 3% of the total NHS carbon footprint, the food supply chain itself accounts for a third of global GHG emissions. Plant-based diets are hugely healthy, with a much lower carbon footprint. The NHS can, and should, lead in the provision of such diets to patients and staff and in arguing for changes in public food supply and cost. Active commuting (cycling, walking) lowers emissions, but also directly improves health. The NHS should work with local councils to deliver appropriate infrastructure and to encourage uptake, and governments should do more in this regard.
The UK Health Alliance on Climate Change represents over a million healthcare workers. We stand to help support NHS England in its work, but also to drive and deliver the change needed. We are almost out of time, and must act accordingly.
[1] Available at https://www.nature.com/articles/s41561-025-01742-z (accessed 25th September 2025)
[2] Available at https://www.nature.com/articles/s41586-025-09423-y (accessed 25th September 2025)
[3] Available at https://www.tandfonline.com/doi/full/10.1080/00139157.2025.2434494 (accessed 25th September 2025)
[4] Available at https://www.nature.com/articles/s41467-023-39810-w#:~:text=When%20complex%20systems%2C%20such%20as,assumption%20of%20quasi%2Dstationary%20dynamics (accessed 25th September 2025)
[5] Available at https://academic.oup.com/bioscience/article/74/12/812/7808595 (accessed 25th September 2025)