The challenge

The NHS emits 18 million tonnes of CO2 each year - the largest carbon footprint of any public service provider in Europe – and high carbon prices will squeeze its budgets unless it changes its practices.

But the NHS also has a key leadership role to play in creating a more sustainable society. Its massive size and reach mean that it can have a great influence on society as it transforms itself into a low-carbon service.


What we did

We were asked by the NHS Sustainable Development Unit  to develop a set of scenarios for healthcare in England in 2030.

We took our Climate Futures scenarios as a starting point, which look at the social, political, economic and psychological consequences of climate change, and interviewed prominent health thinkers to understand their implications for health in the UK. We also performed desk research to assess the current trends in health issues and healthcare from around the world.

We them brought the findings from this research and the interviews to two workshops with healthcare professionals from across different fields (such as NHS trusts, a patient association, and the Department of Health) to develop and adapt the scenarios.

Fit for the Future illustrates the scenarios with storyboards showing how a diabetic would access treatment and support for their condition in each of the worlds.  These help the reader to directly compare some of the implications of each world.



The Fit for the Future report sets out four scenarios for the healthcare system in England in 2030 and makes recommendations to guide development of the NHS. It is the first time the NHS has studied the long-term measures required to maintain a quality health service in the face of climate change.

Fit for the Future offers a set of robust scenarios which managers and clinicians can use to test strategy. Although each is radically different, there are common strategic implications across all the worlds, which form the basis of our recommendations.

These include radically increasing the amount spent on the prevention of disease, promoting low-carbon living to make people healthier and happier, helping people take greater responsibility for their own health, and making greater use of information technology.



“Faced with the real environmental challenge of climate change, the NHS is determined to provide the best healthcare in a sustainable way which reduces our carbon footprint. We are sending Fit for the Future to every NHS organisation, to help us turn our commitment to delivering sustainable healthcare into real action.”

David Nicholson, Chief Executive of the NHS


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