NHS England’s Bold Voyage: Pioneering a Net Zero Travel and Transport Revolution

Summary

Climate change poses a threat to public health and the capacity of the NHS to provide its critical services both in the immediate future and beyond.¹ Consequently, the NHS emerged as the first national health service globally to pledge to decarbonise its operations, establishing a definitive goal of achieving net zero by 2045 for its overall carbon emissions, with an 80% decrease targeted between 2036 and 2039.² This commitment was solidified through the Health and Care Act (2022).³

Increased frequency and severity of flooding and heatwaves, along with deteriorating air quality, are among the consequences the UK is already facing due to climate change, which has led to an estimated excess mortality of 2,803 in England during the unprecedented heat of summer 2022.⁴ In contrast, achieving our national net zero goal could result in over 2 million life years saved through enhanced air quality, healthier urban environments, and a more robust health service.⁵

The NHS fleet is the second largest in the nation, comprising over 20,000 vehicles that travel more than 460 million miles annually. This fleet, along with commissioned services and employee travel, directly contributes to the 36,000 annual deaths attributed to air pollution. The burden of this is disproportionately felt by individuals with existing health conditions, the elderly, and children.⁶

The NHS acknowledges its role as a cornerstone institution and is undertaking proactive measures to address the intertwined issues of climate change and air pollution. Indeed, numerous actions aimed at lowering carbon emissions also mitigate air pollution, resulting in direct and measurable health improvements while addressing health disparities. The societal benefits associated with implementing the commitments outlined in this strategy are assessed at over £270 million annually, with more than £59 million saved each year by the NHS, which can be reinvested into patient care.

The strategy has been crafted through comprehensive consultation with clinical groups, patients, public health specialists, and representatives throughout the NHS. There is robust support from the workforce of 1.4 million employees, with more than 90% expressing a desire to see the NHS fulfill its net zero ambitions.⁷

By 2035, the NHS aims to fully decarbonise its fleet, with ambulances following suit by 2040. Key milestones will mark the transition of NHS travel and transportation:

• By 2026, sustainable travel strategies will be devised and included in trust and integrated care board (ICB) green plans.
• From 2027, all new vehicles owned and leased by the NHS will be zero-emission vehicles (excluding ambulances).
• From 2030, all new ambulances will be zero-emission vehicles.
• By 2033, emissions from staff travel will be reduced by 50% through shifts towards more sustainable modes of transportation and the electrification of personal vehicles.
• By 2035, all vehicles owned and leased by the NHS will be zero-emission vehicles (excluding ambulances), and all non-emergency patient transport services (NEPTS) will be conducted using zero-emission vehicles.
• In 2040, the entire fleet will be decarbonised. All owned, leased, and commissioned vehicles will be zero-emission.

This strategy outlines the measures and modelling that support these commitments, detailing each of the primary components of the NHS fleet and highlighting the benefits for patients and staff. A forthcoming net zero travel and transport implementation toolkit and technical support document will also be made available to trusts and systems to facilitate local and regional execution.

1. Introduction

Providing high-quality healthcare nationwide necessitates a complicated network of transportation systems linking hospitals, clinics, communities, and suppliers, accounting for nearly 10 billion road miles per year (3.5% of the UK’s total) that are directly associated with the NHS. As the largest employer in Europe and the fifth largest globally, one in every 25 working-age adults is dedicated to delivering care. The health service is distributed across 18,000 buildings for acute care, mental health, ambulance, and community services, with an additional 9,000 sites in general practice. The NHS owns and leases more than 20,000 vehicles for various care settings, forming a fleet second only in size to that of Royal Mail in the country.

The NHS is actively confronting its responsibility to combat air pollution and carbon emissions, responding to the health crisis posed by climate change. As medical science evolves, health requirements change, and society progresses, the NHS must continuously advance. This strategy presents an ambitious yet feasible plan to decarbonise NHS travel and transport, optimising returns on investment and delivering significant health improvements.

Substantial progress has already been achieved, with NHS Innovation producing the world’s first zero-emission emergency ambulance in the West Midlands, and Sheffield Children’s NHS Foundation Trust becoming the first NHS trust nationally to completely decarbonise its fleet. Seven ambulance trusts are testing 21 zero-emission emergency vehicles, six of which are designated for mental health response, improving emergency response times and relieving pressure on conventional double-crewed ambulances. Additionally, 12 new electric 19-tonne trucks are currently being trialled across the NHS, while the London Ambulance Service NHS Trust has acquired 42 fully electric rapid response vehicles. South Central Ambulance Service has obtained 10 electric tactical response vehicles, and for the first time ever, drones have been employed to transport essential chemotherapy to the Isle of Wight, decreasing a 4-hour travel time by road and sea to a 30-minute flight, reducing waste and treatment delays while also cutting carbon emissions.⁸

The availability of petrol and diesel vehicles is anticipated to decline sharply starting in 2024 as the Government’s legally binding annual targets on zero-emission vehicle sales commence. New diesel or petrol vehicles (under 3.5 tonnes) will become unavailable after 2035. Considering the scale and complexity of the fleet, NHS organizations must begin preparations early to ensure that the transition to zero-emission vehicles maximises operational cost savings as well as health and societal advantages.

This strategy will directly enhance patient health by decreasing detrimental air pollution. NOx and PM (nitrogen oxide and particulate matter compounds) represent one of the most significant environmental threats to health in the UK, with 36,000 fatalities each year attributed to long-term exposure.⁹ This pollution is linked to adverse effects on lung development in children, cardiovascular diseases, strokes, cancers, and worsening asthma conditions.¹⁰

Vulnerablegroups, including individuals with pre-existing health issues, seniors, and young children, face an excessively elevated risk from poor air quality. There are also significant disparities in exposure levels among different demographic groups. Those most likely to encounter heightened levels of exposure are often inhabitants of areas near busy thoroughfares and typically belong to lower socioeconomic categories. This disparity intensifies health inequities.⁹ By curbing hazardous emissions across all forms of travel and transportation, the NHS will play a pivotal role in enhancing air quality and alleviating an unnecessary source of health risks and inequalities.

In-depth engagement with the NHS personnel and industry specialists has been instrumental in shaping this strategy. Given its essential obligation to safeguard public health and wellbeing, it is vital for the NHS to address its own contributions to air contamination and climate alteration stemming from its transportation activities.

The subsequent sections of this strategy give an outline of the strategies and methodologies employed, the dimensions of the NHS fleet, business commuting, the transitional framework for NHS travel and transportation, and the economic rationale for taking action.

2. Approach and methods

2.1 Scope

This strategy delineates the economic, health, and societal advantages of decarbonizing NHS travel and transport, specifically:

• The NHS fleet; vehicles owned or leased by the NHS, which encompass emergency ambulances, non-emergency patient transport services (NEPTS), and vehicles for secondary, community, and primary care.
• Business travel; encompassing trips in personal vehicles for NHS-related business (referred to as the grey fleet) and alternative business travel modes (for instance, commissioned transport services).
• Staff commuting; employee travel between their residences and workplaces.

The emissions from the NHS fleet and business travel are integral to the NHS Carbon Footprint, representing emissions directly managed by the NHS. The NHS has pledged to cut these emissions by 80% by the years 2028 to 2032, aiming for net zero by 2040.

Staff commuting emissions fall under the NHS Carbon Footprint Plus, capturing emissions indirectly associated with NHS activities, which the NHS can influence but does not control directly. The NHS has targeted an 80% reduction in these emissions by 2036 to 2039 and a net zero goal by 2045.

Although not the main focus of this strategy, the described policies and initiatives are also pertinent to other facets of NHS travel and transport within the carbon footprint, including patient and visitor travel, commissioned health services, and the NHS supply chain. Initiatives aimed at enhancing patient choice, reducing the necessity for unnecessary trips through improved efficiency, and advancing care in communities closer to patients’ homes are not specifically included in this strategy.

Table 1 displays the annual CO₂e emissions linked to the various sources addressed by this strategy. The predominant contributor to the NHS Carbon Footprint is the emissions from emergency ambulances, estimated at roughly 102 kt CO₂e/year. For NHS Carbon Footprint Plus, emissions from staff commuting are most pronounced, approximated to be around 560 kt CO₂e/year.

Table 1. Emissions from across NHS travel and transport modes.

Broad travel category	Category	Emissions (ktCO2e/year)
Owned / leased fleet	Double-crewed ambulances (DCA)	102
Owned / leased fleet	Emergency response vehicles (ERV)	10
Owned / leased fleet	Non-emergency patient transport services (NEPTS)	26
Owned / leased fleet	Other	39
Business travel	Secondary care grey fleet	87
Business travel	Primary care grey fleet	52
Business travel	Other (eg, travel associated with commissioned NEPTS services)	84
Staff commute (Carbon Footprint Plus)	Staff commute	560

2.2 NHS fleet and business travel

In order to provide high-quality care, the NHS utilizes a large and diverse fleet of clinical and non-clinical vehicles, ranging from compact cars and light commercial vehicles to NEPTS, rapid response vehicles (RRVs), and emergency ambulances. The structure, annual mileage, and emissions of the NHS fleet are detailed in table 2 below.

Table 2. Composition, ownership, annual mileage, and emissions of the NHS fleet.

Fleet type	Number of vehicles	Ownership	Annual mileage (million miles)	Emissions (ktCO2e/year)
Double crewed ambulances	4300	74% owned, 26% leased.	129	102
Other emergency response vehicles	1500	60% owned, 40% leased.	19	10
Non-emergency patient transport	2800	10% owned, 90% leased.	51	26
Other owned or leased vehicles	12200	18% owned, 68% leased, 14% hired	125	39
Total owned or leased fleet	20,800	n/a	324	177

A thorough assessment of fleet telematic data, a review of governmental policy, and comprehensive stakeholder interaction have guided the formulation of this strategy. Vehicles exhibit a wide array of operational patterns and duty cycles along with diverse average daily or journey mileage. For instance, emergency ambulances typically have an average annual mileage of 28,800 and a minimum of 15 hours per day during which the ignition is off. Conversely, ERVs display a lower average annual mileage (12,900 miles), fewer deployments, and increased downtime compared to ambulances. Both categories of vehicles generally return to the ambulance base following their shifts.

Acute, specialized, community, and mental health trusts own or lease roughly 12,200 vehicles, including employee pool cars, Park & Ride shuttles, and estate support vehicles, in addition to utilizing a substantial grey fleet where staff employ their own vehicles for business activities – such as traveling between locations or making community visits (including to patients’ residences). These trips represent a particularly major source of emissions for primary and community care organizations (annual mileage for acute, specialized, community, and mental health trusts is estimated at 256,000,000 miles, along with a further 155,000,000 miles across primary care organizations).

The speed of transition within the fleet and regions will vary according to vehicle type, market evolution, geographic context, and operational duty cycle. The analysis supporting this strategy has facilitated the identification of those components of the NHS fleet that are amenable to a prompt transition and those…parts that might necessitate additional intervention and creativity. For instance, NHS England’s Zero Emission Emergency Vehicle (ZEEV) Pathfinder initiative has commenced showcasing the operational and financial feasibility of transitioning most emergency response vehicles to zero emission models.

By 2022, the adoption rate of low emission vehicles stood at 82% and 90% for ambulance and non-ambulance trusts respectively, with 1.1% and 4.5% classified as zero emission vehicles. The turnover of vehicles fluctuates between 5 and 14 years depending on the type of vehicle.

Electric vehicles lower greenhouse gas emissions by 70% compared to their petrol and diesel equivalents (even when derived from the existing electricity grid) and do not generate air quality pollutants from the vehicle’s exhaust (as illustrated in Figure 1.). Moreover, electric vehicles contribute to less noise pollution, especially at reduced speeds. This decrease in greenhouse gas emissions is expected to rise as the carbon intensity of the electricity from the national grid diminishes.

Figure 1. Emission savings comparison of electric and diesel/petrol vehicles.

2.3 Staff commuting

As Europe’s largest employer, a significant number of the 1.4 million NHS staff and healthcare professionals continually need to commute to and from work. This results in approximately 560Kt CO2e emissions annually. The majority of NHS commuting journeys currently occur in single-occupant vehicles.¹¹ Transitioning to less carbon-heavy transportation modes, such as public and active travel (as demonstrated in Figure 2), will not only mitigate greenhouse gas emissions and air pollution but also yield considerable health and wellbeing advantages for individuals and society at large.

Engaging in physical activity offers extensive health benefits, including enhanced cardiovascular, metabolic, and musculoskeletal health; diminished risk of falls and certain cancers; and improved mental health outcomes, including a reduced likelihood of depression and dementia.¹² Engaging in 30 minutes of walking or 20 minutes of cycling on most days has been shown to decrease all-cause mortality by at least 10%. Individuals who utilize active travel methods for commuting tend to show improved psychological wellbeing compared to those who use cars, have a 30% reduced risk of type 2 diabetes, and a 10% lower risk of cardiovascular disease.¹³ People commuting via active modes generally report higher satisfaction with their journey to work than those using cars ¹⁴, and increasing physical activity can alleviate stress, enhance health and wellbeing, and diminish absenteeism at work.¹²

It is crucial for NHS organisations to consider the specific requirements related to workforce shift patterns and local working hours. Moreover, much of the care provided by the NHS must occur in-person, and some travel methods may not be appropriate for specific groups, individuals, or locations. Additionally, numerous NHS employees commute by car because they require their vehicles to travel between NHS facilities or visit patients during their duties. This underscores the vital role of locally-customized strategies and place-based leadership in ensuring a fair and equitable transition.

Figure 2. The sustainable travel hierarchy.

3. Policies, interventions, and roadmap

A variety of interventions are needed to facilitate the shift towards more sustainable travel, necessitating united, collective action both across the NHS and in partnership with non-NHS entities.

These interventions are predicated on the tangible progress achieved to date, including electric emergency vehicles currently operational across the nation and drones employed to deliver chemotherapy medication for the very first time. Trusts are also acting on supply chain logistics; for example, Oxford University Hospitals Foundation Trust,¹⁴ and Gateshead Health Trust ¹⁶ are introducing electric cargo bike courier services to supplant diesel van transport between locations. Gateshead Health Trust has managed to save carbon and alleviate congestion through the use of e-cargo bikes for delivering samples and supplies across the area. Oxford University Hospital Trust found that employing an e-cargo bike to transport chemotherapy treatments enhanced reliability and efficiency, while also mitigating the impact of rush hour traffic on and around the hospital premises. Progressive and inventive solutions are being executed nationwide, such as at Guy’s and St Thomas’ Foundation Trust.which has revolutionized the manner in which it conveys essential medical provisions. A riverboat service operating twice daily transports surgical equipment along the River Thames, with the final leg of delivery to hospital locations completed by electric cargo bicycle. By removing three diesel-powered delivery trucks from circulation, the initiative helps to save 37 tonnes of CO₂e each year.¹⁷

Ambulances and other emergency response vehicles are vital in providing urgent care and must always have the ability to act swiftly. To achieve this, these vehicles possess specific operational requirements, design specifications, and related infrastructure needs. Consequently, the measures detailed in this strategy for ambulances guarantee the maintenance of high-quality care and patient safety, whilst facilitating the necessary innovation and assessment during the transition to electric emergency vehicles. Recognizing the differences between ambulances and standard cars and vans, all new ambulances are set to be zero emission by 2030, with interim goals to ensure a completely zero emission NHS ambulance fleet by 2040.

Currently, there are 7 ambulance trusts trialing zero-emission emergency vehicles, and the world’s first zero emission ambulance operates in the West Midlands. Following positive feedback from staff and patients regarding the vehicles, trusts such as South Central, London, and North West Ambulance services have begun to further incorporate electric vehicles into their fleets. The NHS will continue to expand on this achievement, with ambulance trusts preparing to pilot the first group of zero emission ambulances nationwide, utilizing the insights gained alongside those from the ZEEV pathfinder programme to guide an effective broader implementation and transformation across the fleet, supported by revised specifications and procurement methods.

The measures for secondary, primary, and community care organizations emphasize staff vehicle electrification and the adoption of active transportation modes, reflecting the relatively small number of owned or leased vehicles within the fleet and the considerable portion of business travel conducted in staff-owned vehicles (e.g., visits to patients’ residences and community sites). The measures will additionally lower the significant greenhouse gas emissions linked to staff commuting habits.

The suggested actions encompass salary sacrifice and cycle-to-work schemes, allowing employees to lease a new vehicle or bicycle for a predetermined duration in exchange for a portion of their salary. This arrangement reduces tax, national insurance, and pension contributions for both the employee and employer, making new vehicles more financially accessible for staff. Salary sacrifice can also be utilized to lessen the expense of other high-value acquisitions including annual public transport passes, as evidenced at Newcastle Hospitals Foundation Trust.¹⁸

Numerous GPs are already decreasing business travel by offering online consultations to patients who prefer to connect digitally with their doctor initially, yielding favorable outcomes. GPs are also taking steps to diminish the carbon footprint of unavoidable trips (e.g., home visits). Practices in Sheffield,¹⁹ Exeter²⁰ and Newquay²¹ have seen advantages from staff using e-bikes to visit patients and commute, with local collaborations permitting access to discounted programs for staff members. Some personnel at Sloan Medical Centre in Sheffield acquired their own e-bikes through the practice’s cycle-to-work scheme following a trial in collaboration with the local government.¹⁹

The speed of transition will vary regionally and across different segments of the NHS’ travel and transport system. This is attributed to variations in vehicle types, geographical conditions, working patterns, and operational duty cycles. Trusts and ICBs must evaluate which measures are most relevant and feasible within their local contexts. The following sections delineate the policies and measures across various organizations, the overall transition roadmap, and conclude with the anticipated emissions trajectory over time.

3.1 Ambulance trusts

NHS ambulance trust fleets are specialized and extensive, comprising approximately 4,300 DCAs, 1,500 additional emergency response vehicles, such as rapid response and mental health units, alongside other vehicles supporting NHS functions. The scale, intricacy, and operational planning model of ambulance fleets imply that greater assistance may be necessary to support electrification. Significant initial actions that have already been taken include the ZEEV pathfinder program and the introduction of the world’s first electric ambulance. By 2024, new national specifications will be unveiled to create a zero emission option for ambulance trusts. To build on the success of these initiatives, all ambulance trusts will:

Effective planning

Develop a sustainable travel strategy to be incorporated into future Green Plans by 2026 (backed by updated statutory Green Plan Guidance). These should encompass an assessment of infrastructure requirements, including recharging.

Innovate and evaluate

Implement trials of the first series of zero emission ambulances, followed by evaluation and large-scale transformation. This will ensure ongoing high levels of patient safety while facilitating a broader rollout.

Update specifications

Collaborate with the National Ambulance Programme Board to develop and publish new national specifications for zero emission DCAs and RRVs, informed by trials of the current generation of battery electric DCAs and RRVs.

Sustainable procurement

Integrate the acquisition of zero emission vehicles into procurement practices, ensuring vehicles involved in contracted services and any owned or leased ones are aligned with the roadmap objectives and interim goals.

3.2 Integrated care boards (ICBs) and integrated care systems (ICSs)

Given the crucial role of ICSs in uniting local organizations to strategize and deliver services, they are ideally positioned to spearhead local partnerships that support the development of travel infrastructure and services essential for enhancing sustainable travel.

Each ICB possesses a tailored green initiative and a net zero representative at the board level, in charge of ensuring its implementation. ICBs are urged to collaborate with their ICS allies to prioritize the ensuing actions to advance the shift towards reduced emission travel:

Effective strategy formulation

Craft a sustainable travel plan to be integrated into future Green Plans by 2026 (aided by refreshed legal Green Plan Guidance). This should encompass an evaluation of the infrastructure needs for patients, personnel, and the community.

Collaborative alliances

Establish alliances with local councils and transport authorities to optimize funding and infrastructure prospects, representing the ICS member organizations.

Ethical sourcing

Embed the acquisition of zero-emission vehicles into procurement methods, ensuring vehicles involved in contracted services, as well as any owned or leased vehicles, adhere to the roadmap objectives and interim targets.

3.3 Secondary, community, and primary Care

Secondary and community care trusts manage or lease a collective fleet of approximately 10,000 vehicles, comprising staff pool vehicles, Park & Ride shuttles, and support vehicles for estates. They also operate an extensive grey fleet. The primary care fleet is predominantly grey fleet, with an estimated yearly mileage of 155,000,000 miles. Providers in secondary, community, and primary care should adopt the following strategies and measures:

Effective strategy formulation

Devise a sustainable travel approach to be incorporated into future Green Plans by 2026 (supported by revised statutory Green Plan Guidance). This should include a review of the infrastructure requirements for patients, staff, and the community.

Salary sacrifice

• All vehicles made available through NHS vehicle salary sacrifice schemes are to be fully electric by 2026.
• Develop and market cycle-to-work salary sacrifice programs, including e-bikes.

Ethical sourcing

Incorporate zero emission vehicles into procurement processes, ensuring that vehicles in contracted services, along with any owned or leased vehicles, are compliant with the roadmap targets and interim goals.

Providers in secondary, community, and primary care should assess their local circumstances and contemplate the adoption of the following policies and strategies:

Cross-cutting initiatives

• Incorporate an introduction to sustainable travel and the travel hierarchy during staff orientation.
• Maximize the utilization of route planning tools to enhance efficiency in NHS travel.

Electric vehicle transition and business travel

• Create pools of electric vehicles and e-bikes, providing staff access for business trips and/or commuting.
• Investigate programs to encourage low carbon business travel reimbursements (e.g., electric vehicles, active transport, public transportation).

Sustainable commuting

• Formalize carpooling arrangements for staff commuting (via third-party provider or internal mechanism).
• Ensure secure bicycle storage and changing facilities while enhancing on-site and off-site walking and cycling pathways.
• Establish staff incentives for utilizing sustainable travel modes (e.g., discounts at on-site shops and cafes).
• Consider offering salary sacrifice options for public transport passes to make commuting more economical.
• Evaluate the provision of regular shuttle buses or complimentary public transport between sites for trusts operating across multiple locations.

3.4 The NHS net zero travel and transport blueprint

The roadmap provided below outlines the key milestonesto achieve net zero travel and transport within the NHS, contributing to the NHS Carbon Footprint objectives. Through a staged rollout of zero-emission vehicles and eco-friendly travel options in NHS travel and transport operations, the NHS aims to decarbonise its fleet by 2035, with ambulances reaching this goal by 2040.

Roadmap for Net Zero travel and transport

The roadmap illustrates the subsequent milestones:

2024: Release of new national specifications for zero-emission ambulances

2026:

• Development and integration of sustainable travel strategies into NHS organisations’ Green Plans
• All vehicles available through NHS vehicle salary sacrifice schemes will be electric

2027: All newly acquired or leased vehicles by the NHS will be zero-emission (excluding ambulances)

2030: All new ambulances will operate on zero emissions

2033: Enhanced adoption of active travel, public transport, shared transport, and zero-emission vehicles will decrease staff commuting emissions by 50%

2035:

• All vehicles owned or leased by the NHS will be zero-emission (excluding ambulances)
• All non-emergency patient transport will be conducted in zero-emission vehicles.

2036: More than 50% of the ambulance fleet will comprise zero-emission vehicles

2040:

• NHS Net Zero Carbon Footprint goal – the entire fleet will be decarbonised (dependent on the full decarbonisation of the electricity grid, aligning with Government policy)
• All business travel will be zero-emission

2045: NHS Net Zero Carbon Footprint Plus goal

Download the roadmap as a PDF (556Kb)

4. The societal, financial, and public health rationale for action

This segment examines the total cost of ownership for electric vehicles (purchase costs, residual values, fuel, and maintenance expenses) in comparison to petrol and diesel vehicles. It also considers the various types and costs of electric charging stations necessary to facilitate electrification. The section concludes by highlighting the broader health and societal advantages linked to the shift towards more eco-friendly transport methods.

4.1 Ownership Costs and Charging Infrastructure

Over their lifecycle, electric vehicles are already more economical than petrol and diesel counterparts and are anticipated to achieve full price parity by 2026.²² For instance, Figure 5 portrays the value difference between petrol/diesel and electric vehicles for a typical emergency response vehicle utilizing current figures.

Figure 5. Value distinction between electric and petrol/diesel vehicles.

Extensive ambulance telematics data has been utilized to assess the scale of electric vehicle charging infrastructure necessary to support a zero-emission emergency fleet. These vehicles would require charging while at rest for other purposes, necessitating dedicated charging capacity at all ambulance stations and emergency departments. Estimates indicate that such a fleet would need roughly 5,500 charging points of various power levels across 1,500 NHS locations.

The majority of other NHS vehicles could charge slowly during the overnight hours, when the electricity demand at NHS sites is minimal and costs are lower. This charging approach would eliminate the need for upgrading the electricity supply at most NHS locations. Additionally, given current usage patterns, vehicles would typically require charging once or twice weekly, allowing multiple vehicles to utilize each charging point.

Some NHS locations might also necessitate upgrades to electrical capacity to accommodate increased electric vehicle usage. These enhancements are part of the wider decarbonisation of the national grid. The upgrades will facilitate the transition in travel and transport and are also applicable to NHS energy and estate decarbonisation (e.g., replacing boilers with air source heat pumps).

The anticipated cost for upgrading the grid and electrical infrastructure is just over £100 million to satisfy the demands outlined in this strategy. Changes mandated by Ofgem from April 2023 in tandem with RIIO-ED2 are predicted to considerably alter current connection fees by reducing or eliminating customer contributions to reinforcement expenses for new connections to the distribution network.²³ Consequently, the capital investments needed to enhance electrical capacity at NHS sites are expected to be incorporated within the larger effort to decarbonise the national electricity grid.

The quicker the NHS fleet transitions, the swifter and more significant the net revenue savings that can be achieved, alongside faster and larger overall reductions in harmful emissions. Based on the government’s projections for fuel and electricity costs, annual savings tied to electric vehicles from decreased maintenance and fuel expenditures will be realized in the short term, with substantial increases anticipated from 2032 as the ambulance fleet expands.electrifies. As the price of new electric vehicle acquisition is about to align with diesel and petrol alternatives, and the requirements for charging infrastructure presenting a small capital strain, the comprehensive execution of the NHS Net Zero Travel and Transport Strategy is projected to lead to an annual saving of over £59 million, with these funds reinvested directly into patient care.

4.2 Advantages for health, society, and the NHS

In addition to the direct financial savings anticipated for the NHS from the electrification of travel and transportation, there are health advantages tied to decreased air pollution and heightened physical activity due to active travel. The primary pollutants linked to the health ramifications of air pollution consist of nitrogen oxides and particulate matter PM2.5. Furthermore, there are broader societal gains associated with diminished carbon emissions, lowered pollution levels, and reduced traffic congestion. Beyond the expected annual operational savings of £59 million, the broader advantages of moving towards net zero NHS travel and transportation are estimated to surpass £270 million annually (Table 4).

Table 4. Long-term annual health and societal advantages as well as NHS savings from the NHS Travel and Transport transition.

Activity	Annual health advantages (£m)	Annual societal advantages (£m)	Annual direct NHS savings (£m)
NHS fleet and business travel	2.1	77.6	59.0
Modal shift	38.3	112.7	0.0
Electrification of personal vehicles	1.3	45.2	0.0
Total	£41.7m	£235.5m	£59.0m

The decline in business travel and the alteration in commuting habits will be supported by broader changes beyond the NHS’s jurisdiction (e.g., enhancements to local public transport systems). It is anticipated that a substantial portion of the funding required to cover these costs would come from Government initiatives (e.g., £2 billion of funding available through the Cycling and Walking Investment Strategy²⁴ and the £3 billion accessible through the National Bus Strategy).²⁵ This underscores the significance of NHS services collaborating with local transport authorities to optimize the advantages of the place-based approach of Integrated Care Systems (ICSs) to guarantee sustainable and comprehensive transportation planning.

5. Upcoming steps

The direction, scope, and velocity of the changes detailed in this strategy have been shaped by foundational modeling to amplify the considerable economic, health, and societal benefits associated with achieving net zero.

This strategy emphasizes the necessity of formulating sustainable transportation strategies and the advantages of cooperating with non-NHS organizations. While additional trials and assessments are needed for specific components of the fleet (e.g., ambulances), the strategy establishes policies and measures to kickstart the transition of the general fleet, including the grey fleet in the coming years. These policies and measures will build upon the extensive advancements accomplished so far.

The empirically grounded targets presented in this strategy lay out ambitious and feasible objectives for net zero emissions. Within the larger UK Government framework for reducing carbon footprints, this Net Zero Travel and Transport Strategy ensures that the NHS is well-equipped to fulfill its obligations under the Health and Care Act (2022) and to become the world’s first health system with net zero travel and transport.

6. References

1. UK Government. UK Climate Change Risk Assessment. 2022.
2. NHS England. Delivering a Net Zero National Health Service. 2022.
3. UK Government. Health and Care Act 2022. 2022.
4. UK Health Security Agency, Office for National Statistics. Excess mortality during heat-periods: 1 June to 31 August 2022. 2022.
5. Milner J, Turner G, Ibbetson A, Colombo PE, Green R, Dangour AD, Haines A, Wilkinson P. Effect on mortality of pathways to net zero greenhouse gas emissions in England and Wales: a multisectoral modelling study. The Lancet Planetary Health. 2023 Feb 1;7(2):128-36.
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7. NHS England. Public and staff perspectives. 2022.
8. NHS England. Drone deliveries of critical chemotherapy to the Isle of Wight. 2022.
9. Committee on the Medical Effects of Air Pollutants. Long-term exposure to air pollution: impact on mortality. 2009.
10. Gowers AM, Miller BG, Stedman JR. Estimating Local Mortality Burdens linked to Particulate Air Pollution. London: Public Health England; 2014.
11. Department for Transport. National Travel Survey: 2021. 2022.
12. The Role of Active Travel in Enhancing Health. 2017.
13. World Health Organization. Walking can Assist in Decreasing Physical Inactivity and Air Pollution, Save Lives and Mitigate Climate Change. 2022.
14. Chatterjee K, Chng S, Clark B, Davis A, De Vos J, Ettema D, Handy S, Martin A, Reardon L. Commuting and wellbeing: a critical review of the literature with ramifications for policy and forthcoming research. Transport reviews. 2020 Jan 2;40(1):5-34.
15. Oxford University Hospitals NHS Foundation Trust. Pedal Power Enhances Service And Greener Deliveries. 2021.
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17. Greener NHS. Supply chain – London. 2023
18. Benefits Everyone. Trust Travel Scheme.
19. Greener Practice. E-bikes create a buzz at a Sheffield GP Practice. 2022.
20. Exeter Chamber. NHS Doctors Ride Their Bikes For Home Visits Thanks To Co Bikes. 2021.
21. NHS Physicians Abandon Vehicles for E-Bikes to Accelerate Home Visits. 2020.
22. Department for Transport. Zero Emissions Vehicle Mandate and non-ZEV Efficiency Requirements Consultation-stage Cost Benefit Analysis. 2023.
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24. Active Travel England. The second cycling and walking investment strategy (CWIS2).
25. Pickett L, Dallas M, Stewart I. The National Bus Strategy: Bus policy in England outside London. The House of Commons Library. 2022.

7. Glossary

• CO2 – Carbon dioxide
• CO2e – Carbon dioxide equivalent
• DCA – Double crewed ambulance
• ERV – Emergency response vehicle
• EV – Electric vehicle
• ICB – Integrated care board
• ICS – Integrated care system
• Kt – Kilotonne
• NEPTS – Non-emergency patient transport services
• NOx – Oxides of nitrogen
• NWAS – North West Ambulance Service NHS Trust
• PM – Particulate matter
• RRV – Rapid response vehicle

Publication reference: PRN00712