In today's #Coda22 podcast, Nick Watts - chief sustainability officer at the NHS - talks about the NHS's response to climate change.

1. For a Greener NHS
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2. For a Greener NHS
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The peer reviewed NHS carbon footprint outlines the
location, source and quantity of carbon emissions
Carbon emissions by source Carbon emissions by activity type and care setting

3. For a Greener NHS
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The NHS trajectory to net zero by 2045, with annualised
targets and an 80% reduction commitment
National electricity decarbonisation
National supply chain decarbonisation
National vehicle efficiency
International carbon reduction efforts
Digitisation and low-carbon models of care
Preventative medicine and reduced health inequalities
Reduction of nitrous and anaesthetic gas emissions
Transition to low-carbon inhalers
Active travel and increased physical activity
Improved air quality
Zero emission vehicles on NHS sites
Buildings energy efficiency and on-site renewables
Reduced food waste
Efficient use of procured goods
Supply chain alignment to net zero commitments
Low carbon product substitutions
Research, Innovation and Offsetting

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1) Securing the financial and governance requirements to
deliver a net zero NHS
Governance
• NHS Sustainability Board – progress against carbon trajectories are reported annually. Membership includes Directors
across NHS England both nationally and in each of the regions.
• Health and Care Act, 2022 – new duties for every hospital and system in the UK, and statutory guidance powers to
accelerate delivery.
• Localised Net Zero Strategies - every Trust (218) and Integrated Care System (42) in the country has now developed
its own net zero strategy, aligned to the national trajectory.
Capacity & Finance
• Operational Capacity – central, regional, ICS, and trust-level capacity across the country with dedicated budget and
teams.
• Capital Expenditure – £657 million annually, supporting decarbonisation of fixed and mobile assets.

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2) Developing a world-class analytics function to drive
healthcare decarbonisation

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2) Developing a world-class analytics function to drive
healthcare decarbonisation

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2) Developing a world-class analytics function to drive
healthcare decarbonisation

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Key interventions:
• Financing & delivering decarbonisation across estate: £657m+ additional government funding secured since 2020.
• Standards for new-builds: Net Zero Hospital Standard sets performance criteria, applying to all projects over £15m
• Expanding renewable energy capacity: In 2022, the NHS energy bill tripled to over £1.5bn. On-site solar generation is
the most effective ways to reduce emissions, cut energy bills, and improve NHS resilience to energy shocks. 56 Trusts are
planning to install on-site solar within the next three years. Work has begun with HMT and DHSC to trial Power Purchase
Agreements for UCLH, Manchester Foundation Trust, and Newcastle Foundation Trust with a view to scaling if successful.
3.1) The NHS Estate is responsible for 36% of public sector
power consumption, and 15% of our emissions
Carbon
footprint
Four step approach to decarbonise NHS estate
The NHS estate includes over 1,100
hospitals across 18,000
acute care, mental health,
ambulance, and community services
buildings; 8,800 GP practices spread
over 9,000 buildings;
and new construction programmes
such as Community Diagnostic
Hubs and New Hospitals Programme.
% of Total 15%
22/23 Reduction
Target
482 ktCO2e

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We are tackling air pollution and transport
emissions by:
• Electrifying the standard fleet: by 2030
the Government will ban the sale of new
internal combustion engines, which we
must be ready for. We are working with
Trusts to ensure electric vehicles are
purchased as the fleet turns over (approx every 7 years), and with BEIS, DfT
and the Office for Zero Emission Vehicles on charging infrastructure. The NHS
has published updated terms and conditions for its transport contracts, with
milestones towards a zero emission fleet in 2035.
• Emergency Response Vehicles: decarbonising the emergency response
fleet requires innovation. The NHS has the first two zero emission Ambulances
(one fully electric, one an electric-hydrogen hybrid) and 23 zero emission Rapid
Response Vehicles, currently being trialled and evaluated across the nine
Ambulance Trusts. From 2025 onwards, the NHS will update its National
Ambulance Standard to preferentially purchase zero emission vehicles.
• Modal shift: Pre-pandemic figures suggest that in 2019 only 15.5% of NHS
staff commuted to work via public transport, 4% by active travel, with the
majority arriving at work by private car. We are supporting Trusts to establish
cycle leads (74% now have them in place, up from 52% in 2020), and cycling
salary sacrifice schemes (96% of now have them in place, up from 64% in
2020).
3.2) Travel & transport represents 14% of the footprint, with
3.5% of England's road travel relating to NHS travel
Carbon
footprint
Road transport is responsible for the majority of the 36,000 deaths that occur every year
in the UK, and for 14% of the NHS carbon footprint, with 60% of this from patient and
visitor travel, and 40% from staff commuting and the owned NHS fleet. The NHS has
the second largest fleet in the country, behind Royal Mail, with 12,000 owned vehicles
and 30,000 commissioned and leased.
% of Total 14%
22/23 Reduction
Target
463 ktCO2e

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3.3) We will reduce 5% of emissions by action on inhalers &
anaesthetics while identifying next high emitting medicines
Carbon
footprint
Inhalers (direct emissions, 3% of overall footprint):
£24.2m has been invested via the Investment and Impact
Fund to drive, with Asthma+Lung UK, prescribing of lower
carbon inhalers which for most patients are clinically
equivalent, and improve respiratory care. 134ktCO2e
projected reduction this year (~20% of inhalers
emissions)
Anaesthetic gases (direct emissions, 2% of overall footprint):
Nitrous Oxide: improved supply and stock management, repairs to manifold leaks, and demand reduction have led to a
43ktCO2e footprint reduction between 18/19 and 20/21. Focus is now on targeting trusts with high level of wastage to
reduce further emissions and save costs.
Volatile gases: Desflurane use has reduced
from 22% (Jan 19) to 5% (Jan 22) saving
60ktCO2e (~78% of volatiles emissions)
annually. Now aiming for a full phase out in
partnership with the Royal College and the
Association of Anaesthetists.
CO2e emissions resulting from volatile anaesthetic gas use: by month and 12 month rolling average
Medicines represent 25% of the total footprint. We are focusing on tackling emissions
from the highest carbon medicines:
Research is underway to identify next highest emitting medicines and define future priority actions
% of Total 25%
22/23 Reduction
Target
456 ktCO2e

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3.4) We are leveraging NHS spend to drive action among
our suppliers and achieve a net zero supply chain
The NHS works with over 80,000 suppliers. We are introducing increasingly ambitious
requirements for our suppliers to achieve a net zero supply chain by 2045.
These requirements have been outlined in our Net Zero Supplier roadmap, which was
endorsed by the NHS Public Board in September 2021. The key milestones are:
2023/
24
2027
2022
Since April 2022, all NHS procurements
now include a minimum 10% weighting
on net zero 2
For suppliers to qualify for contracts above
£5 million, the NHS will require a publicly
available carbon reduction plan3
(expanded to all contracts in 2024)
The aim is clear: by 2027, the NHS will no
longer procure from suppliers who do
not have a public net zero target by
2045 on all scopes of emissions
At product level, work is underway to identify high carbon products
and alternatives. Products currently considered to be removed
from the NHS Supply Chain catalogue:
Product Alternative
Virgin copy paper Recycled paper
Virgin fibre paper towel Recycled paper towel
Plastic straw Paper straw
Plastic cutlery Wood cutlery
Plastic and polystyrene cups Paper cups
Polystyrene food packaging Pulp based packaging
Carbon
footprint
% of Total 36%
22/23 Reduction
Target
566 ktCO2e

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3.5) The Clinical Transformation Unit will work closely
with clinical communities to identify low carbon care
models
The Unit works with three distinct clinical communities: specialty specific national programmes (eg. mental health), cross-
cutting national programmes (eg. personalised care) and clinical specialties (eg. GPs).
Identifying carbon hotspots and interventions for carbon reduction, for example:
GIRFT - Adopting best practice pathways nationally has the potential to save almost 1,000,000 bed days, associated
with emissions of around 36ktCO2e, through avoided inappropriate procedures, reduced length of stay and emergency
readmissions.
• Pathway mapping is underway to identify specific carbon hotspots in High Volume, Low Complexity pathways such as
cataracts, hip and knee surgery, which will allow targeted interventions to reduce carbon emissions.
Virtual Wards - Virtual wards demonstrate how digital transformation enables low carbon models of care.
• If each patient in the targeted 24,000 virtual ward beds spent one less day in hospital for every two days spent on a
virtual ward, those bed day reductions would be associated with around 166ktCO2e of emissions per year.
• Work underway to ensure Virtual Ward operational plans embed net zero principles across their operating model
including end user devices.
Outpatients transformation- aims to reduce the number of face-to-face appointments by 30m in 22/23 and 34m in 23/24.
This would save 130 and 147 ktCO2e in 22/23 and 23/24 associated with patient travel; saving money for patients and the
NHS as well as reducing emissions.

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3.6) By leveraging £31m in innovation funding,
developing leadership capabilities, and assuring
progress, we act as a key enabler for decarbonisation
Cultivating future net zero leaders and supporting existing leaders
in net zero clinical transformation:
• The Chief Sustainability Officer’s Clinical Fellowship scheme provides
net zero leadership and management training.
• 12 new fellows start in September as part of the second cohort. This
will include pharmacists, dentists, nurses, AHPs and doctors in
training embedded across NHSE/I, CQC, BMJ, HEE, NICE, and
MHRA.
• Board Level Net Zero Training is being developed in partnership with
the Leadership Academy, with the first cohort due to start in autumn
2022.
Research and innovation are key to delivering our net zero ambitions, and investment now will accelerate
action:
• Leveraged £31m of funding from NIHR, MRC, and the NHS to innovation and research, including £20m for net zero
healthcare and £5m to phase 1 and phase 2 SBRI innovation funding. Phase 1 included innovations such as electric
drone medication delivery, and Envirolieve – a handheld, portable breathing system which allows a patient to
rebreathe Entonox - that will likely save at least 60% of Entonox gas exhaled during a procedure.
Our data and analytics function annually updates the NHS carbon footprint and supports the system to track
emissions:
• Quarterly Greener NHS data collection established to monitor health benefits, cost savings, and emissions
reductions quarterly, with response rates of 96% across the system
• Greener NHS Dashboard delivered to benchmark and track progress
• The Green Plan Support Tool provides guidance to trusts, and allows them to assess their progress against a broad
range of metrics, and compare this against national and regional averages

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