Recognising the significance of the climate crisis and the role the NHS has to play in contributing to the UK's efforts to reduce carbon emissions, this publication draws on survey results and a series of conversations with trust leaders and national policy makers to explore the barriers and enablers to change for trust boards, and to share good practice.

In our annual State of the provider sector survey, we look at the past year's policy developments and provide commentary on the sector's contribution. This year we asked trusts a series of questions on how they are progressing environmental sustainability within their organisation in line with national policy developments. The survey was open during September and was sent to all chairs and executive directors of trust boards. 172 trust leaders from 114 different trusts responded to the survey, accounting for 54% of the provider sector. All regions and trust types were represented in the survey.

We would like to thank all our contributors for their time and for sharing the ways in which they are going about tackling the climate crisis. We hope our report proves a useful contribution to a vital debate on the role of health services in reducing carbon emissions, tackling climate change and adapting to its impact.