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Part of Sustainability Annual Report 2019-2020

Digital sustainability

Our sustainability programme is focused on the use of digital technologies and tools to enable carbon savings across both NHS Digital’s own delivery and now to the wider health system.


Our sustainability programme is focused on the use of digital technologies and tools to enable carbon savings across both NHS Digital’s own delivery and now to the wider health system.

This is emerging as the critical component of NHS Digital’s response to the sustainability agenda and we are contributing to the wider agenda across the health and social care system. Given the criticality of this, and the specific focus on sustainable infrastructure as a central part of delivery, our Sustainability Programme is now overseen by the Deputy CEO and MD of IT Operations Group in NHS Digital. We will be enhancing the support to this element of the Sustainability Programme, both locally in NHS Digital, but also in contributing to the healthcare sustainability agenda, focused particularly on the digital and technology infrastructure aspects.

Infrastructure and Cloud Services

Our low-carbon platforms journey has highlighted a need to select green platforms to power our digital health services and server provisioning. This involves selecting platforms which offer efficient cooling, use of renewable electricity and Power Usage Efficiency (PUE). The journey outlined in the below represents a huge saving of circa 4,000 Tonnes CO2e.

Early benefits of these changes commenced nearly 10 years ago but has accelerated over the last few years to alternative ‘co-located’ hosting services and with the adoption of modern cloud services through the ‘Cloud First’ agenda and developing strategies.  

Numerous technical interventions have been used to achieve efficiencies including:

  1. Consolidating and decommissioning ‘legacy’ data centre cabinets that are no longer required and planning for further reductions in the future. 20 cabinets have been decommissioned in HM Land Registry facilities with 39 more by the end of March 2021.
  2. Commissioning more efficient data centre services such as through the Crown Hosting agreement.
  3. Using cloud services where appropriate and migrating existing legacy workloads into the cloud to further reduce data centre footprint. There are now 58 services on native cloud reducing the need for additional data centre capacity and 1350 virtual machines migrated from co-located data centre to cloud.

The key developments are illustrated below. 

Efficient low-carbon platforms


NHS Digital moved existing physical and virtual infrastructure estate to co-located data centre with Her Majesty's Land Registry.


NHS Digital's physical server footprint is reduced using virtualisation technology to decrease electricity and carbon footprint.


Two new strategic data centres are commissioned at Crown Hosting and Cloud First initiative announced at NHS Digital.


New services commissioned to run on cloud. Data centre consolidation and migrations to cloud are commenced.


Migrations to the cloud and data centre consolidations continue. Reduce HMLR cabinet footprint by 50% in financial year 2020.

In order to further enhance the efficiency of a cloud-based approach, we have procured and implemented cloud management systems and tools to help the organisation optimise our cloud environments. These tools and systems work across multi-cloud environments and enable NHS Digital to tag resources, alert on cloud consumption and identify areas for optimisation and cloud rightsizing. It also helps us to identify opportunities to buy and reserve capacity to optimise costs.

Major public cloud suppliers are showing ambition in greening their offers and progress is being made in data provision. We are therefore developing a target to only use platforms which operate on 100% renewable electricity by 2025.

Alongside our advances in adopting a ‘cloud first’ approach and therefore realising sustainability benefits as part of our overall strategy for infrastructure services, we are also continually improving our adoption of contemporary cloud and infrastructure tools and processes, which includes considerations of developing our software and products in a similarly more efficient way to reduce infrastructure costs. In the coming year, we will take a more strategic stance in optimising the use of both local organisations’ infrastructure and their cloud-based solutions. We will work with other NHS partners to drive the optimisation of infrastructure consumption and efficiency across the health and social care technology arena. We are implementing an energy efficient cloud-first strategy. This is one of the principles governed through NHS Digital’s Enterprise Architecture Board (EAB) and our EAB principles are used across the system and implemented by our Technical Review Group.

Our initial delivery during COVID-19 

Our organisation has been at the forefront of delivery of a number of products and services that have helped clinicians, carers, researchers, and patients during the coronavirus pandemic and will continue to develop new tools and services as the situation develops. Many improvements to system efficiency and telehealth have been achieved during this period, rapidly accelerating elements of the Long Term Plan but also contributing to the sustainability agenda through the switch from physical to virtual presence. Examples are described below and further case studies can be found in Annex 2.

Virtual collaboration tools and hardware

NHS Digital successfully deployed Microsoft Teams, a workplace collaboration platform that forms part of the Office365 suite, to over 1.4 million NHSmail users, enabling a step change in virtual collaboration. In addition, we provided training to 159 trusts using the Attend Anywhere software package for virtual consultations.

We supported the use of these tools by helping frontline trusts with laptop procurement, remote access solutions and Health and Social Care Network bandwidth.

Summary care records

Better information sharing has improved the NHS’ response to the pandemic. Summary Care Records were originally smaller more concise records of acute conditions, allergens, and medications. Now, over 90% of patients registered with a GP have Additional Information temporarily (see note below) recorded on their SCR about significant past and present medical history and anticipatory care information to enable better patient care. A better patient experience realises sustainability benefits, by enabling clinicians to provide faster, safer and higher quality care, adding to the well-being of the patient. 

Additional Information in SCR

This change will apply for the duration of the coronavirus (COVID-19) pandemic only. Unless alternative arrangements have been put in place before the end of the emergency period, this change will be reversed. Patients can be reassured that if they have previously opted-out of having a Summary Care Record or declined to provide consent to share their Additional Information, their preference will continue to be respected and applied.

111 online and artificial intelligence triage

In March 2020, we saw an 80% increase of the NHS 111 online service ( This equates to 5.9 million people using our online services in March 2020 and has significantly reduced the burden on hospitals, saving carbon by reducing journeys. Simultaneously the Pathways clinical artificial intelligence triage algorithms have been regularly updated to adapt to coronavirus symptoms and ensure that the right care is offered.


New functionality has been added to the NHS App which could save patient travel. Citizens can now change their nominated pharmacy via the app to specify where prescriptions are sent, saving significant amounts of patient travel.

Other sustainable technology opportunities

NHS Digital is at the vanguard of driving progress in the public sector on embedding sustainability within digital service development design principles. Key opportunities exist around:

  1. The circular economy - limiting embodied impacts through multiple usage lifetimes from ICT equipment – key actions are around stimulating demand for re-manufactured devices and utilising leasing over ownership.
  2. Approaching digital service design from the ‘Net-Gain’ angle is crucial. It ensures that the sustainability impacts of running digital services are more than accounted for through enabled benefits such as travel reduction or estate utilisation.
  3. Data storage and transfer - we must ensure that data is stored efficiently and archived or deleted when possible. Resolution of video, imagery and scans has a huge impact on overall data volumes.
  4. Upstream ethics and supply chain resilience - it's important these are managed through our commercial engagement. Alongside other ethical issues such as modern slavery,  critical raw materials and rare earth metals are non-renewable materials and mining activities cause huge pollution.
  5. Managing the sustainability impacts of the 4th industrial revolution - artificial intelligence and machine learning offer huge efficiency and clinical benefit but are also incredibly energy intensive, so carbon rebound must be managed into the development processes.

NHS Digital is currently in the process of creating a tool which will enable alignment with Her Majesty's Government Green Book requirements by enabling users to clearly measure and articulate the environmental and social benefits of sustainable technology interventions. For example, 80% of a laptop’s energy use is during the manufacturing process – it takes 11m3 of water to produce the cobalt in a single laptop.

Enabling cross sector progress

NHS Digital is collaborating with NHSX on embedding sustainability into their Tech Plan and with NHS England on the Net Zero Carbon Plan digital workstream. These are key places to embed sustainability practices into technology programmes, along with structural intervention points such as the Tech Code of Practice, GDS Spend controls, Digital Maturity Assessments and NICE Evidence Frameworks.

Last edited: 19 October 2020 2:04 pm