Changes to the ecological environment because of human-induced carbon emissions have directly affected the population health, resulting in a rise in health inequalities and communicable and non-communicable diseases (World Health Organization, 2023; Marshall and Allen, 2023). This has added to the pressure faced by an already stretched NHS (McMichael et al, 2006; Hajat, 2017; Holgate, 2017; Watts et al, 2021).
NHS leaders recognise spiralling costs and the threat of climate change with the need to ensure that services are financially, socially and environmentally viable (NHS England, 2023). Furthermore, an independent investigation conducted by Lord Darzi sparked concerns about the state of NHS (Darzi, 2024).
The lack of policy decisions is resulting in a delay in implementing strategies to reach the UK Net Zero goals outlined in the UK climate policy update (Burnett et al, 2023). Some of the policy decisions contradict the new Labour manifesto, which emphasises the urgent need for NHS reform to create a more preventative and sustainable service (Labour Party, 2025). Additional pressures have also been imposed on organisations with the release of the new green plan guidance (NHS England, 2025), which denotes all organisations must refresh their green plans by July 2025 to evidence how they will achieve the Net Zero goals.
Nurses have a critical role in achieving Net Zero targets as they represent 60% of the health professional global workforce and have a crucial influence in care delivery and mortality reduction when dealing with climate sensitive diseases such as malaria, dengue fever and schistosomiasis (World Health Organization, 2020). This was also evident during the COVID-19 pandemic, where research showed that nursing staffing levels determined better patient outcomes (Okeahalam et al, 2020). Therefore, it is essential to direct nurse research to recommend solutions to engage the nursing workforce to meet Net Zero targets and goals, thus ultimately improving the safety and quality of patient care (Royal College of Nursing, 2025). This article offers suggestions for the nursing workforce on how to drive research and advance the NHS Net Zero Agenda.
Sustainability has become a key focus in healthcare, leading to the introduction of new roles—from directors to practitioners—as well as dedicated departments and teams working towards the Net Zero agenda (NHS England, 2022). Yet, it is evident that there is a struggle with translating environmental sustainability into clinical practice because of a lack of professional awareness in the nursing community (Anaker and Elf, 2014; Goodman, 2016; Luque-Alcaraz et al, 2024). However, in recent years, the escalating impact of climate change on global health has prompted urgent calls for action from the nursing profession (Royal College of Nursing, 2019).
In 2024, the Nursing and Midwifery Council (NMC) announced their support to tackle the climate crisis with a commitment to updating nursing standards to include a sustainability plan (NMC, 2024). The NMC acknowledged the high carbon emissions produced by healthcare and the responsibility healthcare professionals have in influencing its reduction. Furthermore, NHS England launched the environmentally sustainable healthcare e-learning programme to support professionals and organisations to improve their knowledge and awareness around the importance of sustainable practice (NHS England, 2024). Recently, there has been a development in nursing scholarships, secondments and curriculums launched by key nursing partners such as the Queen's Nurse institute (QNI) and the Royal College of Nursing (RCN), which focus on sustainability, demonstrating a positive change towards enhancing the sustainability agenda in clinical practice. However, as training continues to develop, there remain barriers to implement sustained changes particularly through nurse leadership (Luque-Alcaraz et al, 2024) and limitations posed because of existing pressures on NHS resources, time and resulting concerns about the health and wellbeing of staff.
Climate change and healthcare procurement
The NHS is responsible for approximately 4% of the total carbon footprint of the UK (NHS, 2019). Recognising the healthcare sector's contribution to greenhouse gas emissions, the NHS has committed to Net Zero targets for both the emissions it directly controls (2040) and indirectly controls (2045). This commitment guides new models of care delivery with a focus on carbon emission reduction, estimating that proposed changes could result in 44 170 lives saved per year (NHS England, 2020).
Currently the NHS supply chain relies on 80 000 global suppliers to provide necessities such as food, medical equipment, medicines and pharmaceuticals, contributing to approximately 62% of the NHS carbon footprint (NHS Supply Chain, 2024). Therefore, research could play a significant role in identifying more sustainable new models of care.
In 2008, the UK government passed the Climate Change Act in a commitment to lowering carbon emissions. To meet these commitments, the NHS introduced the Sustainable Development Unit (SDU) to ensure transparency in continued monitoring of NHS carbon emissions. The SDU identified procurement as the largest contributor to carbon emissions, emphasising the need for a paradigm shift. This saw the introduction of the Net Zero supplier roadmap providing a detailed timeline and guidance for suppliers to align with the NHS sustainability goals.
Despite ambitious targets, some critics argue that a fundamental shift from the current ‘take-make-dispose’ approach is essential for true sustainability. To achieve a sustainable and cost-effective healthcare system, the NHS is exploring the circular economy framework. This framework promotes systemic change by extending the life of products and minimising waste through repair, refurbishment and remanufacturing. Given the substantial budget allocated to the Department of Health and Social Care, the circular economy offers a potential solution to balance environmental impact and fiscal responsibility.
However, this presents challenges, including limited access to autoclave facilities in healthcare settings and the higher costs associated with purchasing reusable items and outsourcing sterilisation procedures compared to cheaper single-use alternatives. This is particularly difficult to achieve in community nursing services, where there are high levels of waste and often stockpiling of medications, dressings, equipment and continence products. Often patients and families are unable to return items because of infection control policies or do not have the awareness of where to safely dispose items, resulting in items ending up in local tips and landfill.
From a nursing perspective, Kleber (2018) uses the term ‘environmental stewardship’ described as nurses challenging waste disposal within their clinical practice and healthcare systems through shared governance models and collaborations with procurement and ‘green teams’. Baid et al (2023) suggested a ‘hotspot’ approach looking at the lifecycle assessment of certain departments to analyse footprints from a carbon emissions and environmental impact analysis. However, it remains unclear what a nurse can physically do to participate in sustainable practices as decisions are confined to policies and operations of a service. Moustafa and Elsabahy (2022) highlighted that education is the key driving force to make change happen.
Influencing the nursing curriculum
Sustainability in healthcare has become a much-debated topic in recent years with a focus on the role of the nurse and environmentally sustainable healthcare systems (Luque-Alcaraz et al, 2022). Research on sustainable healthcare systems is grounded on theory, although the nurse's role is pivotal in challenging systems, advocacy and acting as positive change agents (NMC, 2018). Anaker et al (2021) supported this view, suggesting that education is fundamental in producing nursing graduates who are equipped with the knowledge, skills and attributes to be responsible societal sustainability advocates. Furthermore, NHS England states that nurses have a crucial role in driving transformational change through research (NHS, 2021), given their position at the forefront of a trusted, public-facing role. A survey conducted by Anaker et al (2021) found that although nursing students are aware of the threats of climate change, they do not necessarily feel equipped with the knowledge, skills and attributes to act. It is suggested that the responsibility lies with educational institutes to make more students aware about climate change to help with advancing the green agenda necessary to advance and propel the green agenda forward. However, Goodman (2016) stated that nurses will need to have an awareness that might be outside of their knowledge scope to embrace sustainability into the workplace, such as understanding the material makeup of personal protective equipment, wound dressings and continence products to inform clinical decisions.
An understanding and awareness of procurement is therefore key to embedding sustainability into clinical practice. Nash (2023) suggested that nurses must understand life product cycles to make clinical decisions on the use of products in practice because of the moral, professional and ethical obligation to protect and promote not only their patients' health, but also the health of the planet. Furthermore, Hayes (2023) highlighted that nurses are in a prime position to drive the green agenda forward through green champions, acting as role models to influence others including patients, service users, managers, educators, unions and political decisions. Suggestions include:
Small changes within a community nursing service can have a significant impact. This can be achieved by taking the time to educate patients and families on the safe disposal of medications and inhalers, using virtual consultation options, and collaborating with general practitioners to reduce overprescribing.
Additionally, it is important to raise awareness of patients who may be stockpiling medications and dressings. The Carbon Literacy Project has identified the need for training specific to healthcare to ‘bridge the gap between climate change policy and action’ (Carbon Literacy Project, 2024).
Nurse leadership and pre-registration change agents
The King's Fund (2020) is clear that to achieve the NHS Net Zero plan, all NHS employees including frontline clinicians and strategic leaders must play a part in its delivery. Equally, nurse researchers should integrate the Sustainability Development Goals (SDG) (United Nations, 2015) into their research to raise awareness and strive towards progressing the SDGs forward. To support this agenda, there has been an increasing focus on healthcare professional leaders and researchers to commit to managing the critical gaps in the science of climate change, policy and advocacy (Watts et al, 2021). There is a clear gap in the implementation of research within community nursing, coupled with a drive to increase its integration. This presents a unique opportunity for practitioners to embed research into practice and enhance overall health outcomes (Mathieson et al, 2018; Li et al, 2019).
The challenge the NHS faces in achieving the Net Zero plan is complex, and its success depends on a new research approach, as well as the generation of new evidence to transform the culture and historical delivery of healthcare services. Therefore, the collective potential of nurses and nurse researchers in delivering the Net Zero plan is paramount. The NHS faces a multifaceted challenge in achieving its Net Zero ambitions, requiring a cultural shift and transformative healthcare practices identified through high-quality research.
Nurse researchers hold substantial potential to drive change, as do pre-registration nursing students. The power of education should not be underestimated, as empowering students to innovate and develop creative solutions while working in partnership with clinical practice is crucial (Fung, 2017). There is the opportunity to equip the future community nursing workforce with research tools and leadership attributes to drive the sustainability agenda forward. Furthermore, with the anticipated need for higher education institutions to embed sustainability into the curriculum (NMC, 2024), now is the time to foster grassroots student researchers in sustainability, aligned with the SDGs, and to promote global citizenship.
Conclusions
By identifying and creating sustainable healthcare practices, addressing health inequalities, and championing the circular economy, the NHS can pave the way for a healthier and more resilient future for all. Collaboration with higher education institutions is key where clinical practice opportunities are integral for student nurses to connect theory, research and practice. All nurses are pivotal in addressing climate change within the healthcare sector. Advocating for a collective and compassionate approach to drive cultural change, involving a substantial percentage of healthcare professionals, is crucial to the future of our NHS and the achievement of the UNSDPs.