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Last year, the NHS launched its first ever Carbon Reduction Strategy. Apart from a few mischievous media comments (homing in on the gentlest of hints that hospitals might in the future be serving less meat as part and parcel of providing lower-carbon meals), it has been very well-received both within the NHS and beyond.

But a strategy is just a strategy, however good it may be, and there are an awful lot of senior managers inside the NHS who are going to take some persuading that climate change now needs to be moved rapidly up their agendas.

With the prospect of serious cuts in health spending from 2012 onwards now looking like a certainty, I’ve already come across a number of people who are convinced that “the environment� is going to be on a downward rather than an upward curve as managers focus on “getting the basics right�.

Sounds ridiculous, doesn’t it? But from their point of view, all the threats associated with accelerating climate change are “out there� somewhere in the future – and even the combined threat of rising energy prices and the Carbon Reduction Commitment (the price to be paid for every tonne of CO2 emitted by the bigger NHS Trusts), still leaves many unpersuaded about the need for radical change now.

It’s not just that short-term target-driven mandates always trump longer-term discretionary initiatives. Behind this all-too-familiar dilemma lies a much more profound problem, an inability to think very much at all about the future – with or without accelerating climate change. The vast majority of health professional and politicians, for instance, know that the current model of healthcare (more money needed, year on year, to address seemingly limitless demands for improved services) is broken. But it’s very rare indeed to hear any of them talking about this in public.

I’ve come to the conclusion that a fairly generalised lack of imagination about the shape of the future is one of the reasons we make so little progress on key policy challenges. Not least climate change.

Together with the NHS’ Sustainable Development Unit, Forum for the Future is hoping to do something about this, with its “Fit for the Future� project – examining four different “scenarios� for low-carbon healthcare in 2030. All four are pretty challenging (it’s not, after all, as if climate change isn’t going to be a dramatic or painful part of our lives in 2030, come what may), but “Service Transformation� obviously sounds a great deal more manageable than “The Environmental War Economy�!

You can check them out on our website - a bit of provocation, not just for health professionals!