Carbon net zero by 2040: is the NHS on track?

Back in 2020, the NHS made history by becoming the first national health system to commit to becoming carbon net zero. They announced that they wanted to eliminate direct carbon emissions by 2040 and their indirect emissions by 2045. But five years later, how far has the NHS come?

At the end of September, the Greener NHS team published a progress report setting out what has been achieved so far, and what still needs to be done to meet their net zero targets.

There’s plenty to celebrate. The NHS has made progress in reducing its direct carbon emissions – with a 14% reduction since 2019/20. Some of the biggest wins come from changes in clinical care. Emissions from inhalers and anaesthetic gases – which make up 20% of the NHS’s direct emissions – have reduced by 33%. These changes are benefitting both the environment and the NHS budget – for example, better nitrous oxide waste management alone is saving £2.3 million a year.

Other successes include:

• the near-complete phase-out of Desflurane (a particularly potent greenhouse gas used for anaesthetics) made possible by clinical alternatives, clear national prioritisation, and strong advocacy and support from anaesthetists

• a 32% drop in clinical waste emissions, avoiding £22 million in costs

• half of the secondary care estate now using LED lighting

• solar energy generation tripling since 2019, with new solar projects expected to save £260 million over their lifetime.

These are all issues within the direct control of the NHS. In general, changes made have been supported by targeted investment and tend to pay for themselves over time. Importantly, these changes are not just about carbon reduction – they provide more efficient use of resources, improve care environments for patients and deliver long-term financial savings.

Despite these successes, there is still a long way to go. While the NHS carbon footprint has declined, the same is not true for ‘Carbon Footprint Plus’, a much larger measure which includes emissions from things like supply chains and construction that the NHS doesn’t directly control. In fact, supply chain emissions, which make up the largest share of the NHS’s environmental impact, have only just returned to pre-pandemic levels. And even though NHS vehicles are becoming more eco-friendly, NHS fleet emissions have not fallen either. While the NHS is just on track to meet its 2032 interim targets, the next phase will be more challenging. 

This report from the Greener NHS team shows us that the NHS is making progress. But we also know that it’s slow and difficult work. To meet the target in 15 years, there needs to be sustained effort and this work needs to be prioritised across the system. National policy can play a bigger role in catalysing action to achieve a net zero NHS. One critical dimension of this is accountability. At The King’s Fund, we’ve been working with the Centre for Sustainable Healthcare and the Health Foundation to understand how stronger accountability can help maintain momentum and ensure sustainability remains a core priority. We’ve been exploring some of the difficult questions that lie ahead with system leaders and clinicians:

• What’s needed to drive progress – stronger sticks or better carrots?

• How can responsibility for sustainability be shared across the workforce rather than left to a small group of sustainability leads?

• What’s the best way to measure progress – by outcomes like carbon reductions or by tracking processes and behaviours?

• How do we strike the right balance between local autonomy and national direction?

From our conversations so far, it’s clear that sustainability must be embedded into everything the NHS does – not treated as a separate issue. Organisations making the most progress are those that integrate sustainability into procurement, estates, clinical care and workforce planning. We’ve also heard that stronger national leadership could accelerate change and ensure sustainability is prioritised more consistently, particularly in organisations lacking buy-in from senior leadership. And while the NHS workforce is passionate and committed, many staff feel constrained by lack of time, resources or organisational support. Investing in training and creating space and support for innovation will be key to supporting bottom-up action.

The NHS has made a strong start on its net zero journey and there’s good reason for this to continue. Sustainability brings clear benefits – from reduced costs to improved patient care – and many of the building blocks for meaningful change are already in place. What’s particularly encouraging is how closely sustainability aligns with wider system priorities and government plans – from prevention and digital transformation to more care delivered in the community, as set out in the NHS 10 Year Health Plan.

But progress isn’t guaranteed, particularly at a time when longer-term benefits often take second place to more immediate imperatives. Continued focus and momentum will be essential to ensure changes that make sense financially, clinically and environmentally are not held back by short-term decision making.