With the UK hosting the UN climate change conference Cop26 later this year, it’s perhaps timely to look at how the NHS – historically said to be the country’s biggest greenhouse gas emitter – is trying to do its bit for the environment.
Given that it employs 1.5m people and accounts for more than 7 per cent of GDP, it’s perhaps no surprise that the health service is also responsible for around 7 per cent – ie roughly 25 tons of CO2e – of the national carbon footprint each year. That’s higher than the global average of just under 5 per cent, and roughly equivalent to the total carbon emissions from Sri Lanka.
These figures for the UK do in fact represent a 26 per cent reduction from 1990 levels, a major feat as over the past three decades the NHS has actually experienced a doubling of single inpatient admissions. That means that the ‘carbon intensity’ of services per patient has in fact decreased by 64 per cent.
But the health service still has a way to go if it’s to play a part in helping the UK nationally meet its 2019 legislative pledge to achieve ‘net zero’ emissions of greenhouse gases by 2050.
Many of the environmental challenges are unconnected with the crumbling NHS estate, which accounts for just 20 per cent of the health service’s carbon footprint, although healthcare settings remains crucial. An average GP appointment has a much lower CO2e footprint than an elective inpatient stay, for example.
‘Care miles’ are a major factor, with more than 9.5bn NHS-related miles (by staff, patients and visitors) being travelled a year in England – one in every 20 road journeys is said to be healthcare-related.
Supply chain issues account for most (more than 60 per cent) of the NHS’ footprint, however, and revolve around pharmaceuticals and anaesthetic gases (the latter representing 5 per cent of acute hospitals’ emissions), as well as medical and non-medical equipment.
Simple solutions like switching from hydrofluorocarbon-dependent metered dose inhalers – ie 70 per cent of those prescribed by the NHS – to dry-powdered inhalers, for example, would reduce total NHS emissions by 4 per cent, it has been claimed.
NHS England chief executive Sir Simon Stevens has certainly attempted to address the health service’s carbon footprint over the past 18 months. He flagged up a new initiative last year, just as the pandemic was about to break, with two developments: firstly with the launch of the ‘greener NHS’ programme in January – which built on the NHS Long Term Plan’s ‘digital first’ commitment to better use technology so that 30m outpatients appointments could be made redundant.
He followed this up in October with the publication of the ‘Delivering a Net Zero National Health Service’ report. This echoed the 2019 parliamentary pledge with two “clear and feasible” targets for the NHS, potentially making it the world’s first health service to commit to net-zero emissions:
– reducing emissions controlled directly to net zero by 2040, with an ambition to reach an 80 per cent reduction by 2028 to 2032
– reducing emissions the NHS can influence to net zero by 2045, with an ambition to reach an 80 per cent reduction by 2039
Admirable though these aims may be, Stevens is now stepping down from his chief executive role, so it’s presently unclear what impetus remains to take them forward until his replacement is appointed later this year.
And, targets aside, it’s also unclear – when the NHS is under such pressure during the pandemic – how genuinely useful road-testing the ‘world’s first zero-emission ambulance’ by 2022, completing a £50m LED lighting replacement programme or supporting the alleged construction of 40 new ‘net zero’ hospitals with a ‘net zero carbon hospital standard’ (all highlighted in the report as ‘early steps’ towards net-zero status) will be in achieving the report’s aims.
Subsequent analysis by the LSE’s Grantham Institute highlighted the potential for the NHS to wield its considerable purchasing power – it procures materials from 80,000 suppliers – to influence change by excluding firms that do not aim for zero carbon. But it also pointed up how the report missed the potential role of preventing ill health, and thereby mitigating emissions through reducing hospital admissions and treatments. It is estimated that the NHS spent £6.1bn £on overweight and obesity-related ill-health alone in 2014-15, equivalent to the annual spend on the police, the fire service and the judicial system combined.
Backing up the Grantham Institute’s assertion that the NHS should be weaponising its procurement muscle to counter climate change, only last month a Royal Society of Medicine/Brighton and Sussex Medical School report noted the huge amount of PPE – about 3bn items – used in the first six months of the pandemic had added an extra 1 per cent (106,000 tons of CO2e) to the UK’s carbon burden, with many of the items shipped from China, Thailand and Malaysia rather than manufactured in the UK, adding greatly to the environmental cost.
Meanwhile, details recently emerged of plans to extend the existing contract to manage NHS England’s Integrated Single Finance Environment (ISFE) – run by NHS Shared Business Services (a joint venture between the Department of Health & Social Care and French software consultancy Sopra Steria), and overseeing all the NHS’ procurement responsibilities as well as HR, payroll and finance – by three years, up until March 2024.
This is because planning for a new financial system was delayed by the outbreak of covid-19, and a tender for the new contract will now be published in July – coincidentally just as Sir Simon Stevens steps down from his as NHSE chief executive.
The ISFE is currently used by commissioning bodies “to administer their financial key management and statutory obligations”, and it will be interesting to see whether the tender for its replacement reflects the NHS’ net-zero aspiration regarding procurement in any way.
Encouragingly, current contractor Sopra Steria describes itself as “a major player in the fight against climate change”, and last year committed to achieving net-zero emissions by 2028.
No-one knows what long-term impact Stevens’ net-zero initiative will have, or whether the targets he set will ever be achieved, but it’s worth looking back to comments made by the King’s Fund about another Stevens-backed initiative, the Long Term Plan, in 2019. The thinktank noted that, despite the carbon footprint of NHS England having fallen during the previous decade, the combined negative impact of austerity, Brexit and the 2012 Health and Social Care Act had resulted in a ‘tyranny of now’ scenario, with the term ‘sustainability’ in the NHS more often referring to financial rather than green issues.
That approach is sadly still with us today, with Cop26 fast approaching. The White Paper on the future structure of the NHS, unveiled with great fanfare by health secretary Matt Hancock in February, and which forms the basis for a Bill to be set out in the Queen’s Speech later this month, barely mentions a green agenda at all.
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