Four out of 10 NHS managers have not yet begun to develop plans to reduce carbon emissions in the health service, despite green targets set by the Department of Health.

Only 55 per cent of trusts surveyed were confident they could reduce energy consumption, with fewer than half (43 per cent) believing they were likely to increase the energy efficiency of their estates, according to an NHS Confederation poll.

Just one in five thought they would be likely to invest in alternative energy sources, such as renewable schemes or combined heat and power plants, which provide both heat and energy for buildings, according to the research.

The news came as the director of a new NHS body dedicated to promoting sustainability said the NHS was set to miss one of the DH's key goals. The NHS Sustainable Development Unit, which was established by strategic health authority chief executives and began work this month, will assist the 10 SHAs to improve the energy efficiency and sustainability of the NHS.

Its director David Pencheon warned that he did not expect the health service to hit a DH target to reduce the amount of energy the NHS buys in for heating, lighting and running sites by 15 per cent by 2010.

He said: "The NHS is getting bigger at a faster rate than it's getting efficient. The leadership role of managers is profound here - this is going to be senior managers' legacy."

NHS Confederation chief executive Gill Morgan called on central government to provide "clear leadership" and extra help with the upfront costs of alternative energy sources.

"While there is lots of support and guidance the NHS can draw on, one clear national climate change strategy for the [service] would be another step in the right direction," she said.