Environmental sustainability in the NHS 10 Year Health Plan: The need for green
This is the second in a series of blogs about how the proposals in the recently published 10 Year Plan measure up against some of the most pressing health concerns in the UK.
Overview
The NHS 10 Year Health Plan sets out a vision for transforming healthcare delivery in England, aiming to improve outcomes, reduce inequalities, and modernise services. Yet, as the climate crisis intensifies, the environmental sustainability and climate resilience of healthcare must be recognised as a core components of public health strategy – not peripheral concerns.
The connection between health systems, climate change, and human health is deeply intertwined. Every time care is delivered, health systems generate greenhouse gas emissions—contributing to climate change and, in turn, harming human health. This creates a feedback loop where worsening health drives greater demand for care, further increasing emissions. To break this cycle, decision-makers must create health systems that are both low-carbon and resilient to climate impacts.
Sustainability in the 10 Year Plan – what’s there?
The plan proposes several big shifts to how the NHS operates which could have positive spillovers for the environment in terms of carbon, greenhouse gases and other environmental impacts. In the short to medium term, moving from hospital to community based care and from analogue to digital, are both likely to have a direct impact on energy and transport emissions; around 3.5% of all road travel in England relates to patients, visitors, staff and suppliers, so the scope for improvement is considerable.
Perhaps the area with the biggest potential, both in terms of health gains and environmental impact is the emphasis on prevention. Ultimately, decreasing the need for healthcare is more efficient than providing low-carbon emitting healthcare. The first Insight in this series discusses the “Sickness to Prevention” shift in more detail.
What’s missing?
The Plan lacks any specific proposals or calls to action related to explicitly decreasing NHS carbon emissions or improving climate resilience. Instead, it refers back to the NHS’ Net Zero plan from 2020 without commenting on the progress towards the commitments set out e.g., being net zero by 2040, with an ambition to reach an 80% reduction by 2028-2032.
The Plan also fails to acknowledge the NHS 4th Health and climate adaptation report published in March 2025, with no mention of how the proposals and recommendations in both plans interact. Given that all these changes will require investment of scarce NHS resources, there’s a risk that decarbonisation and adaptation activities are deprioritised amid the competing reforms and in the absence of explicit environmental considerations when implementing the high profile 10-year plan overhauls.
“In a similar vein, we will prioritise the NHS’ existing commitments set out in Delivering a Net Zero Health Service – including achieving net zero by 2040 for the emissions the NHS controls and by 2045 for the emissions it can influence. It will continue to partner with Great British Energy on solar energy for public sector buildings. All NHS bodies will be expected to decarbonise, reduce environmental impact and increase resilience to climate risks in line with the climate change duties set out in the Health and Care Act 2022.”
NHS 10 year plan
We welcome the recently published “Five years of a greener NHS: progress and forward look” report which states that the NHS is on track to reach the interim 80% reduction by the less ambitious deadline of 2032. Reassuring progress has been made towards a more sustainable health system; yet, the publication of these separate reports hints at a somewhat siloed approach that may hinder further improvements.
In addition to decreasing the carbon footprint of healthcare, it’s imperative to take action to combat the climate-related health risks that are likely to accelerate due to the climate crisis. The ‘Cleaning up our air’ section of the 10-year plan recognises the health impact of air pollution, especially given that it disproportionately affects people living in deprived areas.
But, what about other extreme weather events that are likely to become more frequent like heatwaves, flooding and storms? These will impose considerable direct and indirect health impacts, like cardiovascular disease, respiratory disease and mental health conditions to name a few. As a result, healthcare utilisation patterns are likely to change, e.g., increased demand for emergency services and reduced access to routine care.
What’s needed?
Previous OHE research investigated high-priority activities that NHS, UK government and industry should undertake to support an era of green pharmaceuticals; here we make some suggestions for NHS decision-makers to consider implementing alongside the big shifts proposed in the 10-year plan. These recommendations are informed by recent publications on this topic, including Olawade et al. (2025), UKHACC (2024) and Smith (2025). Some similar initiatives are already underway in some capacity across NHS ICBs, but there’s scope for accelerating and expanding them to realise the benefits sooner.
| Easy wins | Ambitious goals | |
| Embed sustainability in clinical decision-making | Integrate sustainability prompts into electronic health records (EHRs) and clinical guidelines (e.g., flagging low-carbon treatment options using tools like the Medicine Carbon Footprint Formulary) | Develop and mandate carbon impact assessments for all clinical interventions and procurement decisions, with sustainability embedded in NICE guidelines |
| Encourage plant-based catering in NHS facilities | Transition to plant-based menus in NHS facilities for staff and patients and encourage consumption of fruits, vegetables legumes and nuts to prevent ill health and support recovery | Promote the uptake of plant-based diets to reduce carbon emissions and generate additional health benefits |
| Retrofit NHS buildings | Conduct energy audits and implement LED lighting and smart thermostats in priority buildings | Retrofit all NHS buildings to meet net-zero carbon standards, including insulation upgrades, renewable energy installations, and heat pump systems. |
| Strengthen governance, accountability and reporting | Commit to providing more frequent (e.g., annual) updates on progress towards NHS net zero goals | Reinforce commitments to the Health and Care Act 2022 (for NHS England) and ICB Green Plans regulatory frameworks through the introduction of financial incentives and public disclosure of progress |
| Improve infrastructure for active travel | Encourage active commuting through provision of staff incentives for walking/cycling, secure bike storage and end of journey facilities | Collaborate with Active Travel England and local authorities to create integrated active travel networks |
| Increases access to green space and encourage nature-based prescribing | Expand and invest in green spaces on NHS grounds and promote green social prescribing through existing GP services | Ensure key NHS sites have accessible green space to improve population health and embed nature-based prescribing into primary care pathways, supported by partnerships with local conservation groups |
To close the sustainability gap, creating a health system that is both low-carbon and resilient to climate impacts must be a strategic priority woven into every NHS decision, not a side note. A greener NHS is not only achievable – it’s vital. For the health of our communities and the planet, the time to act is now.
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