Net Zero progress
NHS Carbon Footprint Plus (4.7 MtCO2e). Working with NHS staff, Royal Colleges and
industry, major progress has been made since 2020 to reduce NHS Carbon Footprint medicines’ emissions. Overall, the total emissions from inhalers, nitrous oxide and volatile anaesthetics have reduced by 470 ktCO2e or 33% since 2019/20. Actions taken include: l Working with the Royal College of Anaesthetists and Association of Anaesthetists to decommission desflurane in favour of safe and clinically appropriate alternatives has delivered a 41 ktCO2e (98%) reduction in desflurane emissions
l Improving respiratory care and optimising the use of inhalers, which is supporting patients to better manage their respiratory conditions and reducing direct emissions from inhalers l Emissions have fallen by over 340 ktCO2e (33%) since 2019/20
l Progress is expected to continue following the recent publication of updated asthma clinical guidelines from NICE, which further support better outcomes for asthma patients and a lower environmental impact
l Efforts to reduce nitrous oxide waste through leaner supply and stock management, with emissions reductions of over 80 ktCO2e resulting in £2.3 million in avoided costs per annum compared with 2019/20
Next steps l Work to reduce nitrous oxide waste continues with £600,000 invested during 2025, contributing to a total of £1.5 million since 2023. This investment and widespread implementation to reduce waste could save up to £4.5 million per year, building on the existing £2.3 million savings to date. l Efforts will continue to promote best
practice in respiratory care, supporting the use of clinically appropriate low-carbon inhalers, when supported by individual patient choice. The NHS will collaborate with inhaler manufacturers to foster innovation of the next generation propellants for metered-dose inhalers, ensuring availability for patients who need them, while ensuring supply resilience and best value for the taxpayer.
l The NHS will continue to implement the Net Zero Supplier Roadmap milestones proportionately within national medicines frameworks.
Travel and transport The NHS fleet is the second largest fleet in the country, consisting of over 20,000 vehicles travelling over 460 million miles every year. In 2019/20 emissions from travel and transport were calculated at approximately 655 ktCO2e. In 2024/25 emissions were estimated to be
around 700 ktCO2e or 14% of the NHS Carbon Footprint. 140 ktCO2e of these emissions are associated with the ambulance fleet, 30 ktCO2e with NHS owned and leased fleet, and 520 ktCO2e with other transport and transport services. In October 2023, the NHS Net Zero Travel and Transport Strategy was published setting out a roadmap to decarbonise travel and transport, with a clear vision of achieving a zero- emission fleet by 2040. Doing so is expected to deliver annual operational savings of £59 million and over £270 million a year in wider health and societal benefits.
Progress l Zero-emission vehicles (ZEVs) have been widely adopted across the NHS fleet, with 1 in 10 now being ZEV, compared to 1 in 100 in 2021.
l Ambulance Trusts have concluded a successful pilot of 21 zero-emission emergency vehicles. As a result, ambulance services are increasingly adopting electric
vehicles. For example, Yorkshire Ambulance Service NHS Trust has ordered 35 fully electric non-emergency Patient Transport Service vehicles that provide a full day’s operational service with 130 miles range from a single charge. In addition, 12 electric 19-tonne trucks are now in operation across the NHS.
l Drones have been piloted across the country, including in the delivery of vital chemotherapy drugs to the Isle of Wight, reducing a four-hour journey time by road and sea to a 30-minute flight, minimising waste, treatment delays and reducing carbon emissions.
l In July 2025, the Department for Transport and the Department of Health and Social Care (DHSC) announced the NHS ChargePoint Accelerator scheme, which will support the installation of on-site electric vehicle charge points on NHS sites. This is expected to deliver average operational savings of £5.2 million annually and £130 million over the next 25 years, and a further £96 million in wider social benefits from reduced vehicle emissions and improved air quality.
Next steps l From 2030, all new ambulances will be zero emission.
l From 2027, all new vehicles owned or leased by the NHS will be zero emission (excluding ambulances).
l By the end of 2026, all NHS Trusts and ICBs are required to develop a sustainable travel strategy.
Patient and visitor travel accounts for over 40% of total NHS transport emissions. The NHS will continue to work with local authorities and transport organisations to develop ways to accurately measure and understand travel patterns to support more inclusive and sustainable travel options for all those travelling to and from NHS sites.
Estates and facilities The NHS is the UK’s largest single public energy user, with an annual energy bill that has nearly doubled since 2019 to over £1.4 billion for Trusts alone, supplying energy to over 13,500 buildings spanning 27 million m2
. Overall estates emissions
have reduced by 10% since 2019/20. Across the secondary care estate energy consumption has reduced, with emissions associated with the consumption of grid electricity dropping by over 220 ktCO2e (21%). Emissions associated with electricity will continue to fall as the government delivers against its clean energy mission and the
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www.clinicalservicesjournal.com I December 2025
© Raymond Orton -
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