NHS consults on new strategy to reduce carbon emissions

BMJ 2013; 346 doi: (Published 30 January 2013) Cite this as: BMJ 2013;346:f627
  1. Matthew Limb
  1. 1London

NHS leaders in England are seeking a fresh “mandate” to speed up the greening of healthcare, warning that targets on reducing greenhouse gas emissions will not be met by current means.

Experts launching a consultation on a new sustainable development strategy for 2014-20 said that a new strategy needed to be far broader in scope and more radical than its predecessor, the NHS carbon reduction strategy of 2009.

Although reducing carbon emissions should remain a core objective, the new strategy should seek “transformational change” and foster genuinely sustainable models of care, they said.

David Nicholson, chief executive of the NHS Commissioning Board, launched the document on 29 January alongside Duncan Selbie, chief executive of Public Health England, and other senior figures.

Nicholson said, “This is an ideal moment for everyone in the NHS to come together to create a far more effective approach to health and care which is environmentally, financially, and socially sustainable.”

The NHS is currently working to achieve carbon reduction targets set in response to the UK Climate Change Act of 2008. In 2009 the NHS carbon reduction strategy set an interim target to cut carbon dioxide equivalent emissions by 10% (of the 2007 level) by 2015, on the way to reaching a target 34% reduction by 2020.

But these targets would not be met by reducing emissions at the current rate, analysis by the NHS Sustainable Development Unit shows. The NHS is projected to reduce its carbon footprint by 5.4% (one million tonnes carbon dioxide equivalent emissions) by 2015, which is 4.6% below target.

Progress has been made in reducing carbon related to energy in buildings, travel, waste, and procurement, says the consultation document.

But David Pencheon, director of the Sustainable Development Unit, told the BMJ that it was “concerning” there had not been more progress. He said that transformational change was needed, “without losing the fact that carbon and energy [efficiency] is still crucially important.”

Views are being sought on seven proposals in the consultation document. A final strategy for the NHS, public health, and social care system to 2020 is due to be published in January 2014.

People are being asked how the strategy could be broadened beyond carbon reduction and how sustainable models of care could be better understood and achieved, including clearer evaluation of the environmental and social effects of particular technologies.

The consultation also says that the health and care system needs to adapt better to the current and projected effects of climate change and to do more to add “social value.”

Carbon reduction efforts should be focused on known “carbon hotspots,” such as commissioning, medical devices, and pharmaceuticals, because these were likely to have a high impact, says the document.

It also raises questions about how best to measure sustainable development, which research areas should be prioritised, and whether challenging “ambitions” on sustainability should be set.

It says that sustainability should be embedded in the leadership and governance of organisations and proposes “empowering staff and leaders at all levels to behave sustainably at work.”

Selbie said that public health would have a major role in sustainability, organisationally and also by improving people’s health and wellbeing.

He said, “This is our opportunity, alongside colleagues in local government, to agree challenging yet achievable sustainable development goals and to support their delivery.”

Pencheon said that although the next strategy, once adopted, should support the achievement of current carbon reduction targets, he did not expect it to set new ones.

He told the BMJ, “One thing the consultation will do is give us a mandate—that’s probably the most important thing. Without a mandate we can do almost nothing; with it we can do almost anything.

“Just by increasing the efficiency of everything we do will not get us to where we need to go. We have to fundamentally address the business of how we deliver healthcare.”

The four month consultation, which ends on 31 May, was launched at a conference at St Thomas’ Hospital, London, on 29 January.


Cite this as: BMJ 2013;346:f627


  • The online consultation response form is available on

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