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The NHS is still a long way from net zero

To truly reduce health inequalities, experts say the national health service must solve its carbon emissions problem.

By Sarah Dawood

The NHS is a sprawling organisation that employs roughly 1.2 million full-time staff in England across more than 3,000 buildings. Despite the immeasurable benefit it provides people across the country, its sheer size also makes it a significant polluter.

The health service is responsible for roughly 20 million tonnes of carbon dioxide emissions annually (4 per cent of England’s total carbon footprint) and spends more than £50m a year on carbon permits, which give organisations permission to emit a certain amount of greenhouse gases.

Its contribution to climate change is complex. Energy efficiency and transport-related air pollution are the obvious starting points, with many of its huge hospitals being culprits and its transport fleets in need of upgrading. More than half of NHS emissions – 59 per cent – are linked to its supply chain and procured goods such as medicine and equipment. Indeed, chemicals used in medications can be deceptively harmful – certain “puffer” asthma inhalers emit the same amount of carbon as driving from London to Sheffield, and a single bottle of the common anaesthetic desflurane carries the same footprint as burning 440kg of coal.

But there is hope. The NHS is the first national healthcare system globally to commit to net zero goals, which it aims to reach by 2040, and has laid out a comprehensive strategy. It has also already cut its carbon emissions by 30 per cent since 2010. Speaking at the NHS Confederation Expo in Liverpool last month, experts discussed how meeting net zero targets is imperative, especially given the intrinsic link between health and climate change.

Air pollution is a prime example, with the university King’s College London estimating that 36,000 people die every year from it in the UK. In 2013, nine-year-old girl Ella Adoo-Kissi-Debrah, who lived near the South Circular Road in south-east London, died after having an asthma attack. Following a coroner’s inquest last year, she became the first person in the UK to have “air pollution” listed as a cause of death.

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“There is no health without a sustainable climate,” said Jackie Daniel, former nurse and now chief executive at Newcastle upon Tyne Hospitals. The NHS trust has set out a comprehensive sustainability strategy. Last year, it managed to cut 36,000 patient journeys through pharmacy deliveries and reduce its anaesthetic gas emissions by nearly a quarter.

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Investing in home deliveries and remote appointments can make a significant difference to emissions without compromising patient care. Seventeen per cent of NHS emissions are linked to travel. In 2021, remote consultations increased due to the pandemic, and helped the NHS save 276 kilotonnes of carbon, according to Nick Watts, chief sustainability officer for NHS England. With health secretary Sajid Javid pushing for doctors to revert to in-person GP appointments as the default, this could see environmental progress regress.

For many, virtual appointments are more convenient and cheaper, while helping to reduce the NHS appointment backlog. Amid the rising cost of living, Camilla Kingdon, president of the Royal College of Paediatrics and Child Health, noted that it costs a family on average £31 to bring a child to an outpatient appointment.

“Health inequalities map exactly onto sustainability,” she said. “The same groups of society who are suffering most from climate change are also suffering most from the cost-of-living crisis.”

But rather than insisting on virtual consultations, Watts said that providing “patient choice” was crucial for clinicians to balance care and sustainability. “We need to do a better job of ensuring we’re providing access to every patient that requires it,” he said.

Nearly a quarter of the NHS’s emissions come from buildings. Newcastle Hospitals has committed to several energy efficiency measures, including installing low-carbon district heating (pipes that distribute heat from a central source to multiple buildings), upgrading electricity infrastructure and introducing water monitoring to detect and fix leaks. A major retrofit project is needed across the entire NHS estate to bring all buildings up to standard.

In the meantime, John Selwyn Gummer, who chairs the climate change committee and is a member of the House of Lords, said there are simple solutions that all trusts should be taking, starting with “getting rid of puffer inhalers”. Those containing hydrofluorocarbon (HFC) propellants are particularly harmful and could be replaced with more climate-friendly powder inhalers, he said.

A more indirect but still substantial factor is the inefficient use of resources. Undertaking unnecessary medical tests, appointments or prescriptions all carry a footprint. Education is needed, said Watts, to encourage healthcare staff to “make low-carbon decisions every day”. Research shows that the vast majority of NHS staff want to instil sustainability into their everyday practice, with nine in ten supporting the NHS’s net zero goals, according to NHS figures.

One option could be to gamify the process by granting hospital wards “points” for reducing their emissions while still delivering quality care, he said. Another could be to include sustainability within the medical curriculum, so young doctors learn about how to instil it into their practice from the outset, added Kingdon. Mandatory staff training could also help to increase staff awareness. At Lancashire NHS trust, for instance, sustainability is part of the induction process and staff are required to include environmental actions within their personal development goals.

Mas Amin, a GP and national clinical leader in population health and sustainability at Health Education England (HEE), said that healthcare professionals need to be taught how to weave carbon savings into all parts of a patient journey. This starts with prevention and empowering self-care – “If people don’t need us, that’s a good thing,” he said. If patients do require care, there should be quicker routes to specialists, reducing administrative inefficiency. Treatment should then be limited to what is necessary, shifting away from the mentality of doing “extra tests”. An NHS-wide online learning platform using this cycle as its basis is currently in development.

Cutting carbon emissions can not only safeguard our planet, but also our health. If our national health system can take action to limit pollution and global warming-related illness, it will inadvertently reduce the burden on itself in the future. “We’ve got to get to the realisation that the climate emergency is a health emergency,” said Daniel of Newcastle Hospitals. “It is inextricably, absolutely part of everything we should be doing.”

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