Is delivering a net zero NHS still a priority in the current context of extreme pressures on health services? When you look at the potential impact of net zero holistically, the answer is clearly ‘yes’. Done well, decarbonisation is not only good for the planet but can also help us deliver better patient outcomes and reduce costs by prompting a fundamental re-examination of how we deliver care. However, many find carbon reporting complex, time-consuming and difficult to prioritise amid relentless frontline demands.
In response, NHS Arden & GEM has been working with the Sustainable Healthcare Coalition to develop a care pathway approach to decarbonisation, using digital tools that enable organisations to more easily identify and implement meaningful carbon reduction initiatives.
The World Health Organization warns that climate change could contribute to approximately 250,000 additional deaths per year between 2030 and 2050. Increasingly frequent extreme weather events risk overwhelming health systems by damaging infrastructure and exacerbating demand. These tangible impacts have led to legally binding NHS net zero targets (2040 for direct emissions and 2045 for the wider supply chain), now enshrined in the Health and Care Act 2022.
Despite an upward trend in reporting requirements, greener procurement processes and an ambitious Green Plan mandate, the NHS is not currently on track to meet its net zero commitments. According to the NHS Sustainability and Efficiency Programme 2023, nearly 50% of NHS decision-makers report that their trust lacks the skills needed for accurate carbon and sustainability reporting and is struggling to gather precise data. Accurate data and reporting are essential in identifying opportunities for innovation, building trust among staff, partners and patients, informing decision-making and demonstrating the impact of decarbonisation. Yet, we need to spend less time gathering data and more time implementing actions and deriving value from it.
A care pathway approach
Examining decarbonisation across entire care pathways, rather than in departmental or organisational silos, allows us to assess the full range of scope 1, 2, and 3 emissions, highlighting significant opportunities for carbon savings. Although care pathways vary, successful strategies can often be rapidly scaled elsewhere, accelerating overall decarbonisation.
Clinical pathways have significant carbon impacts; for example, renal replacement therapy contributes approximately 3.4 tonnes CO₂e per patient per year, highlighting the need for more comprehensive pathway-level measurement tools. The Sustainable Healthcare Coalition has been working on care pathway decarbonisation projects which are also improving patient outcomes, including:
- Pre-eclampsia – working with Oxford Health Innovation Network to assess the carbon impact of introducing a new diagnostic test for pre-eclampsia which confirms whether a patient is genuinely at risk. Giving clinicians greater confidence in this decision results in 90kg of carbon saved per avoided admission. This amounts to a potential carbon saving of 1000 tonnes per year across the population considered at risk of pre-eclampsia and provides a better experience for many patients who are able to complete their pregnancy at home.
- Colorectal cancer – mapping the carbon impact of the colorectal care pathway to show the impact of a prehabilitation programme developed by a colorectal surgeon. The app-based programme is designed to improve how patients experience each step of the pathway including pre-surgery radiotherapy and chemotherapy, post-surgery recovery and subsequent treatment. The typical pathway had a carbon cost of 915kg per patient which reduced to 770kg with the app. Crucially, the overall number of bed days was reduced by 15-20% and the percentage of patients who completed the pathway successfully through to discharge rose from 83% to 88%. This digital intervention has improved patient outcomes, use of resources and carbon footprint.
Applying the care pathway analysis has also helped organisations understand the impact of new treatments which may cost more initially but deliver better patient outcomes, as well as long term cost and carbon savings, by preventing disease progression and reducing the demand for more resource and carbon-hungry interventions later on.
Delivering value from data
Net zero initiatives can quickly fall into the silo working trap, with each health organisation doing its own carbon calculations. The potential for duplication is huge. Drawing on the learnings from the Sustainable Healthcare Coalition projects, we developed a Net Zero Health and Care Pathway Tool which fast-tracks data collection, analysis and monitoring to help individual organisations and ICBs deliver decarbonisation. It incorporates carbon calculations based on best practice, meaning organisations can simply ‘plug in’ their activity data and the carbon calculations will be done for them (although a manual override is available), removing one of the key barriers to effective carbon analysis. The tool has been co-developed with clinicians, sustainability experts and NHS data scientists to give users confidence that the data is robust and can reliably be used to inform decisions.
Net Zero Health and Care Pathway Tool
© NHS Arden & GEM CSU 2025
Data can be analysed across specific sites or sectors, as well as care pathways across organisations, and used in predictive modelling to test different scenarios, highlighting interventions that reduce emissions and operational costs. This immediately puts the focus on getting value from data and identifying positive action, whether at community, acute or system level.
One early adopter of the tool is Sheffield Teaching Hospitals, which is currently using it to evaluate their cardiology treat and return clinical pathway through targeted pilots. The initiative aims to yield cost savings, energy reduction, emissions cuts and efficiency improvements, with an estimated ROI of £2–£3 for every £1 invested.
Without the ability to track emissions accurately and monitor progress continuously, even the most robust Green Plans and regulatory initiatives can fall short. There is still a long way to go if the NHS is to meet its sustainability ambitions, but by drawing on the evidence gained through effective care pathway projects, and removing duplication through effective digital tools, NHS organisations can more easily identify inefficiencies, adjust strategies in response to real-time data and ensure that every sustainability decision is supported by concrete evidence.
By Dr Olu Akinremi, senior transformation programme lead at NHS Arden and GEM CSU
