'Directors and managers of today's organisations need to recognise that they are there not only to create cost-efficient and financially successful health businesses but also to lead services in a way that saves the world from further degradation and climate chaos'

As chief executives of acute trusts and primary care trusts either bask in the warm glow of their annual health check reports or feeling the icy wind of the financial turnaround teams, another even more challenging target is looming over the horizon - climate change.

The Stern review has certainly changed the political climate for good. Boards need to recognise that and act now.

Environment, food and rural affairs secretary David Miliband has said that the public sector needs to take the lead on these challenges to meet statutory carbon emission targets. Where are the health service leaders on this?

The Stockholm Environment Institute and Best Foot Forward's Material Healthreport produced for NHS Estates is now nearly three years old - but who has been discussing it at board level? How many organisations know what their ecological footprint is? Which organisations have implemented action plans to reduce their footprints? Which have performance 'dashboards' that highlight total resource flow, mass balance and carbon emission reductions?

Potential public health disaster

The environment should be a major focus for everyone who leads and manages a health organisation. However, the report on criteria for assessing standards for the 2006-07 annual health check it is silent on the issue. The Department of Health and the NHS have been ambivalent, and do not seem to see that they can have a major impact on the ability of the UK to meet these targets, or recognise their pivotal role in what is a looming and potentially massive public health disaster.

Should we be planning to close facilities and move services to the community? Perhaps not - what are the environmental costs and benefits of these moves? Has anyone actually done a robust environmental assessment of the changes? Do large hospitals next to commuter rail stations and bus services offer a better solution than those integrated with other communal facilities in towns and cities? Are more community hospitals a low-carbon solution, or do they add to the problem?

What about the workforce issues and the global market in health workers? Some people are travelling long distances to work (and several out-of-hours services rely on doctors from the EU, which results in huge carbon emissions). Should we go beyond travel plans and be challenging local organisations to map carbon emission flows and demonstrate approaches that have a low carbon impact?

Community shift and climate change

If there is going to be a reduction in facilities in hospitals and a move to more local services, then let's make sure it stacks up in relation to climate change. Every reconfiguration process that the DoH speeds through should have that as a primary aim.

In March last year, the DoH launched a web-based toolkit to promote good corporate citizenship, which aimed to help NHS managers 'embrace sustainable development and tackle health inequalities through their day-to-day activities'. Anna Coote, the Sustainable Development Commission's health commissioner, has done her best to raise the profile, but what has happened on the ground?

An environmental strategy for the NHS, published last July, explains how the NHS can achieve cost savings and better-quality services 'by adopting a more sustainable, environmentally friendly approach'. The National Institute for Health and Clinical Excellence produced evidence on improving health through transport in March 2005.

Similarly, the healthy urban development unit launched by Sue Atkinson, director of public health for London, aims to work with the capital's government and local councils to 'create healthy, sustainable communities across the capital', where new health service buildings are influential in local regeneration. So why are these exemplars the exceptions, and why are all contracts - including PFI projects - not being geared to reducing carbon emissions?

Directors and managers of today's new health service organisations need to recognise that they are there not only to create cost-efficient and financially successful health businesses, or to improve the health of their local communities, but also to lead services in a way that saves the world from further degradation and climate chaos.

Martin Pearson is an independent healthcare consultant and former health service director.martinjpearson@ntlworld.com