Sustainability
Achieving NHS Carbon Footprint PLUS
Elliot Dixon highlights the NHS’s ‘untapped goldmine’ for achieving Net Zero and improving quality of care.
Since the NHS began its journey toward Net Zero, most sustainability efforts have focused on Scopes 1 and 2 of the Greenhouse Gas Protocol (GHGP), categorised as the ‘NHS Carbon Footprint’.1
These include:
l Transitioning from fossil fuels to green energy (e.g. heat pumps, solar power)
l Electrification of fleet vehicles l Reducing emissions from anaesthetics
Emissions contributors within Scopes 1 and 2 are ‘known’ to the everyday adult, suggesting why these have received so much focus - boilers have been in practically every UK home for years, both heat pumps and solar power have received huge media attention and Government incentives, as have electric cars. Some impressive achievements are detailed in the Greener NHS ‘Five years of a greener NHS: progress and forward look’2
published in September 2025: “Since 2020, on-site renewable energy
production has more than tripled… Over half of NHS buildings now use energy-efficient LED lighting… EV charging points have increased from 1,500 to over 4,200.” However, for context, NHS Carbon Footprint emissions for 2024/25 are estimated to be 4.7 MtCO2e, reducing from an estimated 14.5 MtCO2e in 1990.2
Whereas emissions from
‘NHS Carbon Footprint PLUS’, specifically supply chain emissions from ‘medical’ and ‘other’ supply chain, are estimated to be 12.4 MtCO2e in 2024/25. This includes Medical Devices which are encompassed in a range of categories including ‘clinical equipment’, ‘clinical consumables’ and ‘other equipment’. The NHS Carbon Footprint PLUS, now generates almost three times more emissions than the NHS Carbon Footprint. We cannot diminish the excellent
achievements so far; clearly there has been significant progress made – but they come at a cost. Scope 1 and 2 projects often require
significant upfront and ongoing investment, both financially and in employee time, combined with operational disruption to generate a long-term return in carbon reduction. The NHS must also consider the payback period of the financial investment with these projects – are some investments recovered at all? An example of this is transitioning a vehicle
fleet from petrol to electric. Not only is there a financial investment in new vehicles and their maintenance, but an infrastructure investment required to charge these vehicles – an immediate investment for installation and an ongoing long-term investment for maintenance. Other considerations include managing the sale / trade-in / scraping of previous fleet vehicles, managing the contractors who install the infrastructure onsite (health and safety etc.), and adapting NHS operations to account for the reduced vehicle range and charging times. Project viability should be assessed /
measured using the Triple Bottom Line framework — measuring the combined financial, societal, and environmental return on investment / impact. Balancing the number of Scope 1 and 2 projects is therefore critical, but the NHS must ask: what other areas can deliver immediate savings / benefit without significant resource investment and disruption?
Scope 3 NHS Carbon Footprint Plus: The NHS’s overlooked sustainability goldmine In contrast, Scope 3 emissions, particularly those linked to Medical Devices, can offer a radically different proposition: low investment, minimal disruption, and (almost) immediate return on investment. While Scope 1 and 2 emissions support
care delivery, Scope 3 Medical Devices are directly involved in treatment. If implemented appropriately and successfully, medical device quality improvement projects can improve clinical outcomes and reduce emissions simultaneously. This not only helps to reach Net Zero targets but supports other NHS challenges such as the growing deficits, budget pressures and rising demands for care.
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www.clinicalservicesjournal.com I December 2025
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