Meat-free menus are to be promoted in hospitals as part of a strategy to cut global warming emissions across the National Health Service.

The plan to offer patients menus that would have no meat option is part of a strategy to be published tomorrow that will cover proposals ranging from more phone-in GP surgeries to closing outpatient departments and instead asking surgeons to visit people at their local doctor's surgery.

Some suggestions are likely to be controversial with patients' groups, especially attempts to curb meat eating and car use. Plans to reuse more equipment could raise concern about infection with superbugs such as MRSA.

Dr David Pencheon, director of the NHS sustainable development unit, said the amount of NHS emissions meant it had to act to make cuts, and the changes would save money, which could be spent on better services for patients.



"This is not just about doing things more efficiently, it's about doing things differently, because efficiency is not going to get us to big cuts," said Pencheon. "What will healthcare look like in 2030-2040 in a very low carbon society? It will not look anything like it looks now."

Last year the NHS published what it believes is the biggest public sector analysis of carbon dioxide, the biggest greenhouse gas, which showed the organisation's emissions in 2004 were 18.6m tonnes and rising. This accounts for more than 3% of all emissions in England, and if the NHS was a country it would have been ranked as the 81st biggest polluter in the world that year, between Estonia and Bahrain.

One-fifth of the emissions were from transport, one-fifth from buildings, and the remainder from procurement, including drugs, medical equipment and food.

On Tuesday, Pencheon and the NHS chief executive, David Nicholson, will publish the strategy - Saving Carbon, Improving Health - which will set targets to cut the organisation's carbon footprint, and proposals to meet them. It follows a government pledge last year to cut greenhouse gas emissions by 80% by 2050.

The plans cover all aspects of patients' care, from building design to transport, waste, food, water and energy use.

Among the most talked-about is likely to be the suggestion that hospitals could cut carbon emissions from food and drink by offering fewer meat and dairy products. Last year, the United Nations climate chief, Rajendra Pachauri, provoked a global debate when he said having a meat-free day every week was the biggest single contribution people could make to curbing climate change in their personal lives, because of the chemicals sprayed on feed crops and the methane emitted by cattle and sheep. Last week, the German federal environment agency went further, advising people to eat meat only on special occasions. Pencheon said the move would cut the relatively high carbon emissions from rearing animals and poultry, and improve health. Last year the NHS served 129m main meals, costing £312m, according to Department of Health figures. "We should not expect to see meat on every menu," said Pencheon. "We'd like higher levels of fresh food, and probably higher levels of fresh fruit and veg, and more investment in a local economy."

Other proposals that will impact directly on patients include urging people to drink less bottled water, more phone-in surgeries by GPs, greater sterilisation and reuse of equipment, and encouraging patients, visitors and staff to leave their car at home.

Many ideas are already being pioneered by one or a few trusts but will be spread more widely, including automatic lights and taps, renewable energy such as biomass and wind turbines, and green travel plans - such as facilities for cycling or new bus routes and bus stations at hospitals. A blueprint for low-carbon buildings is also being considered, and longer term the NHS could develop its own energy grid supplied by renewables on its land.

Staff will also be encouraged to work from home more often, incentives could be introduced for workers to use smaller-engined cars for business mileage, departments could be given their own energy bills with the offer that employees can keep a share of cost savings they make, and hospital pharmacies could hold lower stocks and courier in specialist drugs on demand to cut waste.

The NHS will also use its massive purchasing power - £20bn a year - to persuade suppliers to cut emissions, and pharmaceutical companies will be asked to make drugs with a longer shelf-life to reduce the amount of out-of-date stocks.

Longer term, to make bigger cuts, the NHS will have to make more radical changes, in particular giving more healthcare in or closer to patients' homes, said Pencheon. One idea being examined was for surgeons to travel to GP surgeries for follow-up consultations, to reduce the need for many patients to travel to outpatients departments, said Pencheon.

"If you're going to get me radical I say the default place for health is in the home, and the person who delivers it is yourself: that's the ultimate low-carbon health service," he said.

The report will argue that reducing carbon emissions will cut bills for equipment, medicines, energy, water and waste services, and improve health - in the short-term for example by encouraging people to walk, in the long-term by helping to reduce the impacts of climate change.

"Unless we all take effective action now, millions of people around the world will suffer hunger, water shortages and coastal flooding as the climate changes," it says.

"As one of the world's largest organisations, the NHS has a national and international imperative to act in order to make a real difference and to set an important example."