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NHS Net Zero Travel and Transport Strategy

NHS Transport Hierarchy
NHS Transport Hierarchy

NHS England has published a Net Zero Travel and Transport Strategy.

The strategy explains that climate change is bad for people’s health. For example, the excess mortality during the record-breaking temperatures in Summer 2022 was 2,803 people.

It therefore makes sense for the NHS to decarbonise, and the Health and Care Act 2022 commits it to doing so.

The NHS targets are:

  • 80% reduction in total carbon footprint by 2036 to 2039 and
  • Net Zero by 2045

The strategy notes that the NHS has the second-largest fleet in England, after Royal Mail. The NHS has 20,000 vehicles, which travel over 460 million miles every year.

This fleet directly contributes to 36,000 deaths from air pollution every year – which is quite shocking.

The benefits of implementing the travel and transport strategy are quantified at £270 million per year, with £59 million saved per year by the NHS.

Is the Transport Strategy all about Electric Ambulances?

When organisations commit to decarbonising transport, my fear is always that they will default to electric vehicles with no meaningful change in behaviour.

I would like to see modal shift. The benefits of shifting to walking and cycling include less air pollution, less congestion, and better health for people doing physical activity.

If we carry on with electrified business as usual, we fail to solve most of our current transport problems.

So is the NHS strategy all about electric ambulances? Not quite.

There is a lot about electric vehicles, but also some element of modal shift notably for staff travel. The strategy notes that the NHS has influence but not control over staff travel.


Some of the key dates identified by the strategy are as follows:

  • 2026 – NHS trusts to develop sustainable travel strategies
  • 2027 – all new vehicles owned or leased, except ambulances, to be electric
  • 2030 – all new ambulances to be electric
  • 2033 – staff travel emissions to be reduced by 50% through modal shift and electric cars
  • 2040 – all owned, leased and commissioned vehicles will be electric

The strategy calls electric vehicles ‘zero-emission vehicles’, but I’ve avoided that term because it is misleading. There are emissions in the manufacture of electric vehicles and in the production of the electricity used to power them.

The strategy itself admits that electric vehicles only reduce greenhouse gases by 70% in operation compared with petrol and diesel vehicles.

Breakdown of NHS Transport Emissions

Breakdown of NHS transport emissions
Breakdown of NHS transport emissions

The table above breaks down the NHS’s transport emissions between ambulances, business travel and staff travel.

It is notable that staff commute makes up 58% of total emissions.

Staff Commuting

The strategy notes that the NHS is the largest employer in Europe, with 1.4 million staff.

‘Most NHS staff commuting journeys currently occur in single occupancy vehicles. A shift to less carbon-intensive modes of transportation such as public and active travel will not only reduce greenhouse gas emissions and air pollution, but also deliver significant health and wellbeing benefits to the individual and wider society’.

para 2.3 of the strategy

There are more words about the benefits of active travel, which are well-known.

The problem with all of this is that it is the responsibility of national government and local authorities to deliver the infrastructure which makes active travel safe and attractive. It’s not in the hands of the NHS.

Staff commutes by active travel will be encouraged by cycle to work schemes, where employees can lease a bike for a fixed term by sacrificing a part of their salary. This seems quite weak.

Policies, Interventions and Roadmap

NHS Net Zero Travel & Transport Roadmap
NHS Net Zero Travel & Transport Roadmap

The Roadmap to Net Zero Travel and Transport is shown in the graphic above.

This part of the strategy gives some examples of progress already made, including electric cargo bike courier services used by Oxford University Hospitals and Gateshead Health Trust.

Practices in Sheffield, Exeter and Newquay use ebikes for commutes and patient visits.

NHS use of ebikes
NHS use of ebikes


The strategy is mainly about electric ambulances. They are better than diesel ambulances.

The majority of transport emissions are from staff commutes. While there are good intentions here to achieve modal shift, the NHS does not control the levers to achieve that modal shift.

The key driver for modal shift is safe and attractive infrastructure, and that is up to government and local authorities.

Another elephant in the waiting room is patient and visitor transport emissions, which are outside the scope of the NHS strategy.

NHS Net Zero Travel and Transport Strategy