Awoken to the critical importance of sustainable healthcare, the NHS is now in a pivotal phase for turning ambition into action.
Sobering reminders of climate change, and continued pressures on all of our health services, have reinforced the importance of maintaining the momentum behind decarbonisation initiatives to ensure targets are met.
The NHS has set itself two targets for delivering net-zero carbon healthcare and aims to be the world’s-first net-zero national health service.
The first target refers to the emissions the NHS controls directly (scope 1 and 2). These include NHS facilities, fossil fuels, anaesthetics, NHS vehicles, electricity, waste, water, and metered-dose inhalers, with a goal to reach net zero by 2040 and an 80% reduction by 2028-2032.
For emissions which can be influenced by the NHS (scopes 1, 2, and 3) such as medical devices, construction, IT, transportation, manufacturing, and business services, the goal is to reach net zero by 2045, with an 80% reduction by 2036-2039.
The keystone moments
While these targets may appear ambitious, it is important that we recognise the keystone progress moments of 2022, which mark significant advancement for green innovation.
From June 2022, for the first time ever, every NHS trust in England has a board-approved Green Plan in place.
This includes 212 NHS trusts and covers more than 1,000 hospitals and healthcare facilities.
Sobering reminders of climate change, and continued pressures on all of our health services, have reinforced the importance of maintaining the momentum behind decarbonisation initiatives to ensure targets are met
Furthermore, in May 2022, a team at Solihull Hospital performed the world’s-first net-zero-carbon operation.
Operating theatres are an important focus in carbon reduction as they account for 25% of a hospital’s carbon emission output.
Finally, the Small Business Research Initiative for Healthcare (SBRI Healthcare) awarded a total of £1m to 10 pioneering MedTech and digital innovations to support the delivery of net zero in the NHS.
However, despite these successes, there remain areas of risk and of opportunity that have not yet been properly addressed or explored by the Government and NHS trusts.
And these areas are what the NHS will need to continue to focus on moving through 2023.
A challenging journey
Decarbonisation will be a priority and one of the greatest challenges the NHS will face in delivering net zero.
Currently, healthcare buildings contribute 15% of the total NHS carbon footprint, which means that reducing emissions in this area will be essential if the health service is to reach its net zero goal.
October 2022 saw the opening of Phase 3b of the Public Sector Decarbonisation Scheme and more than 30 NHS healthcare facilities secured at total of £329m for energy-efficient innovations and heat decarbonisation.
Decarbonisation will be a priority and one of the greatest challenges the NHS will face in delivering net zero
While the NHS is estimated to save one million tonnes of carbon as a result of these recent investments, capturing the building-level data required to identify low-carbon heating alternatives is largely still in the early stages of implementation across NHS trusts.
And additional funding will be crucial to enabling the continuation of the scheme and the development of the appropriate tools and analytics so that all NHS facilities can undergo decarbonisation.
Non-pharmaceutical medical interventions, such as green social prescribing, work to address the importance of being outdoors for people’s mental and physical health
Safeguarding infrastructure
Climate change risk management and adaptation will play an important role in protecting the NHS from physical risks posed by increasingly-frequent extreme weather events and climate anomalies.
Heat presents a key risk to the NHS, with the summer heatwaves of 2022 shining a light on the vulnerabilities present within building infrastructure.
And, with a third of the NHS estate having been built before 1965, there is a serious maintenance backlog issue, risking catastrophic failure and disruption to clinical services.
Matthew Taylor, chief executive of the NHS Confederation, warned that ‘with climate change, these temperatures could become increasingly-common, and even an annual, occurrence. Without targeted support and adequate Government long-term investment, the British summer risks becoming even more difficult for the NHS to navigate than winter’.
Additional funding will be crucial to enabling the continuation of the scheme and the development of the appropriate tools and analytics so that all NHS facilities can undergo decarbonisation
Addressing these structural weaknesses and safeguarding healthcare buildings from moreextreme weather will become a much-more-pressing matter for the NHS in 2023.
Alongside emissions reduction efforts, social value continues to be a high priority on the sustainability agenda for the NHS.
Driven by the public procurement note (PPN 06/20), social value delivery within the NHS supply chain provides a mechanism to align targets, obtain scope 3 footprints, and deliver additional value to the communities served by national healthcare.
The efficacy of social prescribing
Another key initiative is social prescribing, which presents significant opportunities for public health benefits through engagement with integrated care systems (ICSs).
This alternative treatment method works to reduce demand on healthcare facilities and strengthen community support.
Non-pharmaceutical medical interventions, such as green social prescribing, also work to address the importance of being outdoors for people’s mental and physical health.
These programmes work to reduce health inequalities, improve mental health outcomes, and develop green social activity pipelines within communities.
Heat presents a key risk to the NHS, with the summer heatwaves of 2022 shining a light on the vulnerabilities present within building infrastructure
In this way, social prescribing will be key, not only in reducing pressure on existing NHS services, but also in putting the focus on preventative care as opposed to reactive care, such as treating pre-diabetics through lifestyle changes to prevent diabetes.
Continued investment into robust community care and support will be key for NHS sustainability in adopting joined-up, efficient, and low-carbon care models for the future.
The impact of green technologies
Finally, continued investment in innovative technologies and new processes will be a point of focus within the healthcare sector.
We are already seeing how the implementation of new equipment and drugs has improved the efficiency of surgery and lowered carbon emissions.
For example, the use of anaesthetic gas, desflurane – which is responsible for 2% of all NHS emissions and is more than 2,500 times more potent than carbon dioxide – is currently at its lowest levels across the NHS and is set to be decommissioned by early 2024.
Social prescribing will be key, not only in reducing pressure on existing NHS services, but also in putting the focus on preventative care as opposed to reactive care
To date, interventions replacing it with clinically-appropriate and safe alternatives has saved the NHS an estimated 60,816 tonnes of carbon emissions per year.
Similarly, the piloting of 21 zero-emissions vehicles – six of which are dedicated to mental health response – by eight ambulance trusts is helping to reduce demand on traditional double-crewed ambulances.
A national rollout of this scheme would significantly reduce NHS vehicle emissions and move trusts towards the 2040 target.
To continue to move at pace against trusts’ Green Plans, 2023 should be a year of shared learning, keystone commitments, and data-driven action.
Efforts of NHS staff up and down the country, along with the support of Royal Colleges and leadership, have proven the potential and scalability of several solutions.
And now is the time to commit and reap the associated wider societal, environmental, and financial benefits.