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  1. Spotlight on Policy
3 December 2019updated 16 Sep 2021 4:50pm

Decarbonising our NHS

The National Health Service is the fifth-largest employer in the world. With 1.7 million members of staff, only the US Department of Defense, the Chinese People’s Liberation Army, Walmart, and McDonald’s have more. Given the sheer size of its workforce, the number of large buildings under its authority, and the various energy-intensive technologies it uses, the organisation’s carbon footprint represents a pressing challenge, especially within the context of the UK’s commitment to net zero emissions by 2050. Across its operations, the NHS produces approximately 20 million tonnes of CO2 a year – around 5 per cent of the UK’s annual total.

Healthcare professionals have a “moral obligation”, says James Dixon, head of sustainability at the Newcastle upon Tyne Hospitals NHS Foundation Trust (NUHT), to reduce the “effects of carbon emissions and pollution from our activities.” In June, NUHT became the first NHS trust in the UK to declare a “climate emergency”, with its board setting a target of reaching carbon-neutral status by 2040. Dixon hopes other trusts follow suit, committing to using renewable energy sources and improving waste management and recycling where possible.

Chris Naylor, a senior policy fellow at The King’s Fund, a think tank, says that the best way to reduce the NHS’s carbon footprint is to switch the focus of healthcare delivery from “cure to prevention”. A healthier society, “with better investment in the things that help to keep us well”, would ease the pressure on public services. While Naylor says healthcare is still necessary “in the case of an emergency”, ensuring that people make more health-conscious lifestyle choices will reduce the regularity of hospital visits.

In the meantime, Naylor says the NHS needs to get “smarter” about its procurement processes for products, medicines, and equipment. Too often, he suggests, “short-term” thinking about “upfront costs” wins out over “life cycle” analysis when it comes to what the NHS invests in. He says: “The NHS needs to think about the environmental costs associated with manufacturing a product and how it can eventually be disposed [of].”

 Surgical equipment is one area, Naylor notes, in which the NHS could improve. “Over the last 20 years, there’s been a big shift towards using disposable instruments and a lot of that is to do with infection control. But perhaps it’s time to re-evaluate the commitment to that direction.” More advanced sterilisation processes and technologies, Naylor says, could “reduce hospitals’ unnecessary contributions to landfills”.

In a hospital setting, particularly as an emergency unfolds, awareness of the use of lighting and other appliances can often take a backseat. Technology, says Dr Cathy Lawson, a fellow at the Centre for Sustainable Healthcare, could help to take the pressure off humans to remember to switch things off. “The introduction of low-energy lighting, such as LED lights, and the use of occupancy sensor-activated lighting where appropriate would help to reduce emissions. [Hospitals] could also potentially introduce an automatic shutdown of computers in non-clinical areas when they’re not in use.”

Just under half of the NHS workforce, according to a report from The Nuffield Trust, a healthcare charity, is made up of non-clinical roles. On-site shops, canteens and cafes, James Dixon points out, should be viewed as “very much part” of the organisation’s mission to decarbonise. NUHT, as part of its climate emergency response, has moved to ditch single-use plastic cutlery and trays in our in-house catering outlets. “It is a small change that can make a big difference.”

Transport – of patients and medical supplies and in terms of staff commutes – is another significant contributor to the NHS’s net carbon emissions. By its own estimates, the NHS accounts for around 10bn road journeys each year – 3.5 per cent of the total made in the UK. In a bid to cut back on this, some NHS trusts, such as Oxford University Hospitals NHS Foundation Trust, have introduced free shuttle buses between sites, or subsidised discounted bus and rail passes.

Travelling to work, though, does not produce anywhere near as many carbon emissions as an ambulance responding to an emergency call at high speed. The electrification of more trusts’ fleets, argues Peter Allum, lecturer in paramedic science at the University of Plymouth, is a must for any government. “Nobody would argue against ambulances needing to drive quickly in an emergency,” he says, “but, as fossil fuel prices rise, the logical step is to reduce the consumption, adapt to alternative fuel sources for vehicles, or supplement fuel use with recycled energy.”

Allum adds that the development of “eco-driving skills”, namely driving techniques that reduce a vehicle’s carbon output, could also help ambulances produce fewer emissions. These include driving at a “constant speed, rather than stopping or accelerating suddenly” and “proper vehicle maintenance”. He notes that “even something as simple as tyre pressure” will have an impact on how much fuel a vehicle uses. While many trusts are rolling out this sort of training to ambulance crews, he says, “it’s still not everywhere”, and introducing “standards” is crucial to making sure that energy-efficient driving and vehicle care becomes “second nature”.

Decarbonising the NHS, according to Chris Naylor, should represent a rare point of consensus for politicians and the public. “When it comes to climate change,” he says, “there is a tendency to fixate on the more obvious culprits… like coal-fired power stations and unnecessary short-haul flights. But the tricky thing we have to get our head round is that something hugely positive and necessary for society, like healthcare, can also have some negative side effects.”

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