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Introduction

The NHS is legally bound to reach Net Zero, but paediatricians face structural and workforce barriers that limit their ability to contribute. Without strong leadership, governance, and resourcing at every level - from government to frontline teams, progress will remain uneven.

Meeting statutory obligations and empowering clinicians will ensure the NHS delivers a net zero service that protects children today and secures their future. Below we have outlined the role of each of the key bodies required to make the net zero NHS commitment a reality.

1. Government and UK Health Departments

Role and responsibility

• UK-wide commitment: All four nations of the UK have committed to achieving a Net Zero NHS by 2040 at the latest.
• Legal duty in England: The Health and Care Act 2022 places a statutory duty on commissioners and providers of NHS services to address Net Zero emissions targets.
• National leadership requirement: Central government must provide continued statutory guidance, clear metrics, and sufficient funding to enable delivery.
• Cross-sector responsibility: Achieving Net Zero in health depends on coordinated action across transport, housing, education, and energy policy.

Barriers

• A lack of integrated national strategy currently limits the ability of the NHS to implement sustainable change at pace.
• Inconsistent national policy alignment: sustainability targets are not always embedded in financial or regulatory frameworks.
• Limited capital funding restricts decarbonisation of ageing NHS estates and transport infrastructure.

What next?

• Provide dedicated investment for estates decarbonisation, sustainable transport, and digital infrastructure
• Continue the Greener NHS programme with full DHSC support, ensuring statutory compliance
• Embed sustainability within financial incentives and regulatory frameworks, aligning performance with Net Zero obligations
• Fund climate and health education across undergraduate and postgraduate training in all four nations

2. Health organisations

For example, NHS England, Devolved NHS Bodies, Trusts, ICBs and Clinical Departments and National Institute for Clinical Health and Excellence (NICE)

Role and responsibility

NHS England guidance requires:

• Direct NHS emissions (Carbon Footprint) to be net zero by 2040, with an 80% reduction by around 2032.
• Wider emissions (Carbon Footprint Plus) to be net zero by 2045, with an 80% reduction by around 2039.
• All trusts and ICBs to have submitted board-approved Green Plans by July 2025.
• Under the Health and Care Act 2022, trusts and ICBs must deliver on Net Zero commitments through Green Plans.
• Green Plans must be approved at board level, published publicly and monitored.
• Estates must have heat decarbonisation plans by 2026.
• All NHS transport must be zero-emission by 2040 (ambulances by 2030).
• Procurement frameworks now mandate carbon reduction planning and supply chain transparency.

Barriers

• Variation in board leadership and governance structures means sustainability is not equally prioritised across regions.
• Fragmented data and inconsistent reporting undermine accountability and limit scalability of best practice.
• Trusts with resourced sustainability teams achieve greater progress, while those without rely on overstretched clinicians to drive change.
• Outdated hospital estates and limited funding create practical obstacles to decarbonisation.
• Workforce pressures mean sustainability projects often compete with urgent clinical demands.

What next?

• Strengthen national accountability structures to ensure delivery of Net Zero commitments.
• Mandate senior sustainability leads at ICB and trust level with protected resources.
• Standardise carbon measurement and reporting frameworks across the NHS.
• Embed sustainability and quality improvement training within national curricula.
• Apply a sustainability lens to prevention, prioritising interventions that deliver health, social, financial, and environmental benefits.
• Incorporate lifecycle emissions assessments into evaluations alongside effectiveness and cost.
• Engage children and young people (CYP) in sustainability planning.
• Protect and enable full use of Supporting Professional Activity (SPA) time for sustainability and service improvement projects.
• Design rotas that allow consultants and trainees to engage meaningfully in non-clinical development.
• Support multidisciplinary team-led projects rather than relying on individual clinicians.

Resources

• - Health Declares offers a guide to declaring a climate emergency in the health sector.
• - This brings together hospitals, health systems, and health organizations from around the world under the shared goal of reducing the environmental footprint of the health sector and contributing to improved public and environmental health
• - A network for sustainable health care in Wales.

3. Royal Colleges (including RCPCH)

Role and responsibility

• Provide national leadership, advocacy, and professional standards to embed sustainability across training, appraisal, and service delivery.

Barriers

• Clinicians often lack consistent education, recognition, and structured support for sustainability work.
• Clinical appraisal systems rarely prioritise sustainability.

What next?

• Embed sustainability competencies into curricula, training, CPD and appraisal processes.
• Provide guidance, tools, and case studies to spread innovation at scale.
• Advocate nationally for stronger trust- and ICB-level leadership on sustainability.
• Create networks for clinicians to share learning and best practice across specialties.

4. Healthcare professionals

For example, paediatricians and wider child health multidisciplinary team

Role and responsibility

• Integrate sustainability into everyday clinical practice where practical, lead projects, and advocate for children’s health.

Barriers

• High clinical demand and workforce shortages limit time for sustainability initiatives.
• SPA (Supported Professional Activities) time is often underutilised or unavailable due to rota pressures.
• Lack of formal training in climate and sustainability leaves clinicians underprepared.

What next?

• Incorporate sustainability into clinical decision-making, e.g. reducing unnecessary tests, prescriptions or waste.
• Use quality improvement projects to align better care with lower carbon impact.
• Partner with children, young people, and families in co-designing sustainable services.
• Utilise SPA time and CPD to develop and lead sustainability projects.
• Act as advocates for children’s health, raising awareness of the climate emergency locally and nationally.

Resources

• - The Royal College of Emergency Medicine has set up an initiative to measure and reduce the environment impact of Emergency Departments in the UK. The framework outlines evidence-based actions with the guidelines and resources required to help achieve them. Their resources are hosted on an
• - This is an award-winning, tried & tested leadership and engagement programme to transform healthcare by cutting carbon, improving patient care and staff experience and saving money.
• - A non-profit network of health care providers (including doctors and nursing staff) whose mission is to transform the European healthcare sector so that it reduces its environmental footprint, and becomes a community anchor for sustainability and a leader in the global movement for environmental health and justice.
• - An online community of healthcare professionals who are passionate about reducing the environmental impact of paediatric care.