The NHS finance directors' top priorities include efficiency, maintaining or improving access, quality, and service redesign. However, carbon reduction is not likely to be identified as a priority. The NHS needs to address the government's targets for reducing greenhouse gases and the NHS carbon reduction strategy in order to meet the short-term target of reducing the carbon footprint by 10% by 2015. The long-term goal is to match the UK targets of a 34% cut in carbon dioxide by 2020 and a massive 80% cut by 2050. The NHS Sustainable Development Unit, the Department of Health, the Carbon Trust, the Department of Energy and Climate Change, and KPMG provided support for this briefing. The daunting size of the challenge is not enough to motivate finance managers, but there are specific drivers that will put carbon reduction on their agenda.