Skip to main content
Creating a new NHS England: NHS England and NHS Digital will merge on 1 February 2023. Learn more.

Part of Sustainability Annual Report 2020-21

Digital sustainability case studies

Current Chapter

Current chapter – Digital sustainability case studies

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

NHS Digital Call/Recall COVID-19 Vaccinations Programme

NHS Digital Call/Recall COVID-19 Vaccinations Programme is the programme used to invite and remind patients to book their COVID-19 vaccination. NHS Digital has deployed the successful use of SMS text messaging to invite people to book their COVID-19 vaccinations. This service has enabled many individuals to book their COVID-19 vaccinations quickly and efficiently.

Previously, letters were being used to invite people for their vaccinations. Sending letters to the nation’s population consumes large quantities of paper, and the same information was available digitally or could be requested using the 119 call centre. Financial savings are also considerable here. Text messages equate to a quarter of the cost of letters. Letters are still sent to those who the system only has postal addresses for, or those who require letters for accessibility purposes.

The text messaging service was successfully piloted and is now being used in parallel to letters as a more rapid mechanism for notifying people of their eligibility for vaccination. As of 26 March, more than 7.5 million text messages had been issued, resulting in an estimated reduction of 173.3 tonnes of CO2e compared to if letters had been used instead (4). This is a huge saving in carbon equivalent to taking 34 passenger vehicles (5) off the road for a whole year. 

The programme identified that by the time letters had arrived at a peoples’ addresses, the largest spikes in vaccination booking rates had already occurred, in part due to media announcements. Letters still played an important role for the 15 to 20% of each cohort that the service does not have a valid mobile phone number for, demonstrating that reasonable steps have been taken to encourage citizens to get their vaccine. Using SMS text messaging also enabled people to book their vaccinations more quickly, which has been a large factor in the success of vaccinations being rolled out so quickly across the population.

Footnote 4

Assumes one letter contains three pages of paper at 1 gram of CO2e per page, and roughly 20 grams of CO2e per letter sent in the UK (Source: 23gCO2e multiplied by 7,535,885 (number of texts sent) = 173,325,355 gCO2e, divided by 1e+6 = 173.3tCO2e

Provision of MS Teams to the NHS

NHS Digital introduced Microsoft Teams for all NHSmail users in March 2020, to support new ways of working during the Covid-19 response. Teams is a secure communication tool to allow instant messaging and audio and video calling.

The aim of Teams is to enable safe and effective collaboration whilst also reducing the amount of time and costs incurred by healthcare professionals in attending meetings in person. Staff are now able to join the meeting remotely via Teams, allowing them more time to focus on patient care and other priorities. Travel costs incurred by meeting attendees have also been reduced because of remote access to meetings.

Teams is heavily utilised by organisations with NHSmail users hosting over 24 million Teams meetings between 23 March and 13 December 2020.

Teams has also benefitted patients; Rotherham NHS Foundation Trust have delivered voice therapy using Microsoft Teams. When patients were surveyed after their virtual voice therapy appointment, 100% felt they received the same quality of therapy as a face-to-face appointment. The average saving to a patient for a six-session block of therapy travelling in a petrol-powered car is 13kg of CO2 emissions.

This just the start of carbon savings as over time, video appointments will reduce the need for physical consultation rooms meaning organisations can move to smaller, more carbon efficient premises.

NHSmail case studies demonstrating the use of Teams across healthcare sector organisations are available on the NHSmail website

NHSmail for care homes

In the past, it was challenging for care homes to communicate with other healthcare sector organisations, and this led to some insecure and delayed communication methods. 

An example of this is transfers of care, with care homes struggling to get the necessary information they needed for new or returning residents from hospital. Care homes often had to wait to receive the information in the post or even arriving as hardcopy via taxi, causing delays in appropriate care and increased administration tasks for staff.

7,500 care homes have onboarded onto NHSmail since March 2020, meaning that those care homes now have access to secure email as a quick way for hospitals to communicate patient information. This has been recognised in the industry with the collaboration between NHS Digital, Accenture and Healthy London Partnership being nominated two years in a row at the Health Service Journal Awards, winning the Best Consultancy Partnership with the NHS award in 2020.

Case studies demonstrating the reduced administration time, for care homes using NHSmail, are available on the NHSmail website.  


The NHS App provides a simple and secure way for the public to access a range of NHS services from their smartphone or tablet enabling people to manage their care at a time, and from a place, most convenient to them. The NHS App helps sustainability by

Reducing CO2 emissions

As a result of patients managing appointments and completing online consultations through the NHS App, fewer visits by car or taxi are made to GP practices. In financial year 20/21, 247,000 GP appointments were managed, and over 200,000 online consultations were completed through the NHS App (reporting up to December 2020), resulting in a reduction of approximately 386 tonnes of CO2. Additional CO2 savings are expected to be linked (but have not been estimated) to the notifications and messages capability of the NHS App, the 12.9m record accesses and 2.9m prescriptions ordered through the NHS App in financial year 2020/21.

Improving quality of life

Over 8,000 positive user comments were received in financial year 20/21 citing how the NHS App had saved people time through fewer trips and calls to their GP or pharmacy. This was as a result of being able to access information quicker in the NHS App than through other channels. Users also noted that the NHS App provided a more convenient way for them to access health services, especially where they worked unsociable hours or had busy schedules. Users of the App expressed this gave them greater autonomy over their health, care and wellbeing.

Promoting feelings of safety during the COVID-19 pandemic

Over 1000 positive comments were received in financial year 20/21 that specifically related to how users felt the App had supported them during the COVID-19 pandemic.  Some users described the NHS App as a lifeline, some said the App helped them maintain access to health and care services, and information whilst remaining at home, and some said the App made them feel safe and feel supported.

Reducing duplication of systems

The NHS App is now integrated with two Personal Health Record and two Online Consultation providers with further suppliers having expressed interest. These integrations prevent duplication of development at a local level minimizing wasted resources in development and management.

National Booking Service (NBS) - Book a Coronavirus Vaccination

NHS Digital deployed the ‘Book or manage your coronavirus (COVID-19) vaccination service’ in January 2021. To date, around 39 million people have used the system to book their coronavirus vaccination appointments.

Easy access to booking a jab on the system has significantly reduced the burden on hospitals by reducing hospitalisations and severe ill health. It has also reduced the burden on GPs and associated back-office staff as the public are able to book their appointments online without the need to contact local surgeries.

Local site managers upload appointments on the system based on available vaccines and vaccine expiry dates. This means that the public are signposted to centres with available jabs resulting in reduction in wasted trips saving carbon. It also means that there is less wastage of vaccines as those nearing their expiry are utilised first.

The current system may also be repurposed in the future to include other vaccinations such as boosters and the flu jab. The infrastructure is already in place to allow this to happen.

Find my NHS Number

This new service was deployed in February 2021 and allows individuals to request their NHS number using a simple application. In turn, this has made it easier for individuals to book other services such as a coronavirus vaccination or use it for other purposes such as filling in forms for children attending school trips.

This has reduced the burden on GP back-office staff as, previously, the primary route to requesting an NHS number was through local GP surgeries. Initially, some GP surgeries would not give NHS numbers over the phone, so the public had to travel to their local surgery so use of this system has also reduced carbon.

To date 1.3 million numbers have been sent with over 80% (around 1 million) sent by text and less than 10% by letter, thereby ensuring the new service is as carbon neutral as possible, whilst ensuring access for all. 

Last edited: 24 February 2022 11:57 am