Case study: Carbon reduction and the NHS (Gleeds Sustainability Briefing Note 6)


A summary of ‘Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England’

By making changes and investments in carbon reduction today we also invest in a more stable and sustainable energy market for the future

The carbon footprint of the NHS is 18 million tonnes per year. These emissions come from a wide range of day-to-day activities needed for the healthcare network, including travel, procurement and building operations.

A 40% rise in emissions has occurred since 1990 in spite of efforts to increase efficiency and this percentage is predicted to continue rising. To comply with new government regulations concerning carbon emissions, the NHS must tackle this huge undertaking with sustainable and innovative solutions.

A leading example is needed to champion carbon reduction among large organisations, and the NHS is willing to step forward as a leader.

Why should action be taken now?

In 2008 NHS launched a Saving Carbon, Improving Health campaign to consult NHS staff, NHS organisations and partner organisations to assess the levels of awareness, commitment to climate change, and carbon reduction.

With more than half of the consulted organisations responding, and an impressive 95% strongly supporting the NHS in becoming a leader in carbon reduction, the time for action has come.

There is no debate that climate change is one of the most-pressing issues in the world today. With strong scientific evidence pointing towards human influence on this possibly-disastrous phenomenon, a time to mitigate and take responsibility for our actions has come. Reduction of carbon emissions will help to alleviate the effects of climate change, but requires carbon reduction across a wide portion of the population and strong leaders are needed.

Health dangers associated with climate change

The health dangers associated with climate change could place a strain on the existing healthcare network. Climate change threatens to increase rates of respiratory illness, allergies, widen the range of communicable and insect borne diseases and cause more destructive natural disasters. Adverse effects have already been observed as the nation’s temperature begins to rise and heatwaves become more frequent and intense. More than 1,500 people died during the 2003 UK heatwave.

Unless action is taken to reduce carbon emission we can expect to hear more news of hunger, water shortages and devastation around the world.

Carbon Reduction Commitment

The coming Carbon Reduction Commitment will affect large healthcare facilities with mandatory carbon reduction and emissions trading. By preparing now for the implementation of this governmental framework, a smoother transition can be made once the scheme is fully in place. By reducing carbon emissions, the NHS will be investing in a more-sustainable energy future and will reap the immediate financial and other tangible benefits of highly-efficient energy management.

The willingness of the NHS staff and organisations to step forward as carbon reduction leaders will have lasting effects on the nation’s population. There are also long-term financial benefits to carbon reduction; as energy, water and waste costs are decreased and managed more efficiently so are the funds allocated to these resources and services. By making changes and investments in carbon reduction today we also invest in a more stable and sustainable energy market for the future.


The adjustments necessary for carbon reduction within the NHS should be strongly rooted in sustainability and focus on major areas incorporated with healthcare. These reforms will be based upon the following principles:

  • Respecting the limits of our environment. Living within these limits and attempting to enhance biodiversity and the environment for the enjoyment and utility of future generations
  • Ensuring a strong healthy and just society that can meet the unique needs of all people in today’s population and tomorrows
  • Achievement of a sustainable economy which supports those making environmentally sensitive investments and holds individuals and organisations responsible for not maintaining a sustainable mindset
  • Promotion of governance to engage people’s creativity, energy and diversity
  • Implementation of policies based on sound scientific evidence and with forethought for the uncertainty and future needs of the population

With these considerations in mind the NHS has outlined goals for the areas where carbon reduction will have profound effects.

Energy and carbon management

None of the steps taken towards carbon reduction will be effective unless they are supported by the habits of the NHS staff

While many have taken steps to lower energy costs from their homes, larger organisations and facilities should also be taking these steps towards carbon reduction.

Buildings associated with the NHS produce 3.7 million tonnes of carbon dioxide each year. In the hope of reducing emissions energy performance should be reviewed and reported annually to staff, the public and stakeholders. A more-efficient means to reduce energy usage is to measure carbon output rather than initial energy usage. This approach accounts for the whole energy cycle and not just the usage of that energy.

A strategy for carbon management and energy resiliency is needed so that a sustainable and more environmentally-conscious future can be achieved. Development decisions should be made on a whole life cost basis and low carbon solutions incorporated wherever possible. These steps made by the larger organisations should encourage NHS staff to reduce their own carbon footprint and promote green habits in the workplace and in daily life.

Procurement and food

Transport of goods to NHS establishments accounts for more than half of the NHS carbon footprint - nearly 11 million tonnes of carbon dioxide. This is greater than the amount of emissions from building use and travel combined. An integrated and preventative approach to procurement will help reduce this vast section of the NHS carbon footprint.

Every opportunity to manage the efficiency of the procurement process should be examined in hopes to reduce wastage pre-emptively. Collaboration with NHS Purchasing and Supply Agency (PASA), the Department of Health (DH), the Sustainable Development Commission (SDC) and the NHS Sustainable Development Unit (SDU) should work in partnership to aid in low carbon solutions to procurement. In order to prepare for the use of carbon as a commodity and compliance with coming governmental framework, the NHS should financially prepare for alternative and local solutions to procurement issues.

The procurement of pharmaceuticals should be examined extensively in order to assure minimal wastage due to the high carbon footprint of drug procurement. Sustainable, organic and local foods should be commonplace in all NHS establishments.

Low carbon travel, transport and access

The key to reducing the NHS carbon footprint from travel is early organisation and continued monitoring of the travel habits of both staff and hospital visitors. Routine evaluation of these habits should accommodate the needs of all of those going to and from the hospital or clinic. Measures should also be taken in order to move healthcare closer to home through opportunities such as telemedicine and allowing those able to to work from home.


Water usage and expenses should be monitored much like energy. In order to reduce the carbon footprint of this natural resource solutions must be integrated into the design of new buildings and investments made in the refurbishment of others, with technologies to detect early leaks and heat water more efficiently.

These solutions should be adopted by the entire NHS framework. The routine purchasing of bottled water should be avoided. The price and convenience of a half litre of bottled does not accurately reflect the high carbon footprint associated with the travel, manufacturing and energy needed to produce a beverage that just as easily comes from the tap.


Climate Change is a global problem and an integrated and supportive regional approach will be far more effective at mitigating its affects and challenges

Waste cost the NHS £71.2m in 2007-2008. With the price of disappearing landfill space increasing solutions are needed to address and reduce waste. These solutions and management will in turn save money and reduce carbon emissions.

Waste should be monitored and measured annually so that targets to reduce landfill volumes can be accurately reported. These targets should be sensitive to clinic activities and by working with NHS SDU and the DH practices for the reduction of waste can be more aptly applied. Policies for re-use and sterilisation of tools should be implemented as an alternative to single-use disposable products.

Appropriate goals should be set to reduce the amount of waste from clinical areas, amounts of hazardous waste and domestic waste going to landfill. An extensive recycling programme can also alleviate the amount of waste needing to be disposed of.

Designing the built environment

In preparing for the future, all new builds and refurbishments undertaken by the NHS should be designed to withstand the unknown and ongoing effects of climate change. All new builds should aim to be low carbon by 2015.

In order to incorporate these carbon minimising strategies into the built environment, a Low Carbon Design Taskforce should be founded to develop guidelines and best practice management. Building design should also reflect all other facets of sustainability and encourage green habits by those frequenting the facility.

Organisational and workplace developments

None of the steps taken towards carbon reduction will be effective unless they are supported by the habits of the NHS staff. Organisations should make available information associated with lowering the NHS carbon footprint and especially the promotion of green habits such as use of public transportation. Carbon management should be viewed as a career opportunity within the NHS and also incorporated into the higher education curriculum so that carbon awareness is promoted at the undergraduate and graduate level.

Role of partnership and networks

As one of the most-extensive networks in the UK, the NHS should set an example for other large and small organisations and promote carbon reduction. The development of a regional sustainable network between the NHS SDU and NHS/DH increases the likelihood of local coordination and in turn provide support for the NHS.

Climate Change is a global problem and an integrated and supportive regional approach will be far more effective at mitigating its affects and challenges.


NHS organisations are encouraged to register with the Good Corporate Citizenship Assessment Model and have a Board approved Sustainable Management Plan. Corporate responsibility should include a commitment to sustainability and carbon management should be incorporated into each NHS organisation’s governance. The regulation and monitoring of steps taken to reduce carbon emissions must be enforced from within the NHS for them to be truly effective and make the strongest impact.


As the implementation of the Carbon Reduction Commitment draws near the NHS should strive to become fully carbon literate and numerate. These two new forms of literacy will make NHS organisations more able to prepare financially for the cap and trade scheme imposed by the government. Clinics and hospitals should work with their local communities to promote a sustainable and regional healthcare economy.

Six reasons why NHS organisations need to act now to reduce carbon emissions

  • To comply with new legally-binding government framework and national targets
  • The strength of scientific evidence to act now on climate change
  • The health co-benefits now for patients and populations and for the health system itself
  • The importance of cost reductions and energy resilience
  • The willingness and commitment of NHS organisations and staff to act now
  • The need for the NHS to be a leading public sector exemplar

Legal disclaimer: This paper was prepared by Gleeds referencing the NHS Sustainable Development Unit, 2009. Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England Report. It is for general information only and neither Gleeds nor any of their partners, employees or other persons acting on their behalf makes any warranty, express or implied and assumes any liability with respect to the use of the information or methods contained in this report to any person or party.

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