Commentary: Can NHS become world's first net zero healthcare system?

SHEFFIELD, England: The National Health Service (NHS) – which makes up 4 per cent of the United Kingdom’s total carbon footprint – is aiming to reach net zero by 2045. If it succeeds, it’s likely to become the world’s first healthcare system to do so.

To that end, NHS trusts and other healthcare providers are currently publishing their three-year “green plans” for reaching net zero, as mandated by the NHS. These are designed to flesh out the broader aims laid down in the NHS’s overarching green roadmap, published in 2020.

The NHS’ focus is on transforming its entire systems – from human resources to IT – to align with net zero, while continuing to provide high quality clinical care and tackling inequality. Its net zero targets fall into three areas, or “scopes”.

Scope one refers to emissions as a direct result of healthcare activity, such as surgeries and inpatient treatments, ambulances and medications. Scope two covers indirectly purchased resources (such as energy) for the purpose of delivering services, like heating and furnishing clinics.

But we feel the real challenge is to significantly reduce scope three: Emissions from indirect activity, including the medical supply chain (even the overseas parts), how patients and workers get around, and how waste is managed.

With a view to tackling scope three, the NHS roadmap requires that trusts no longer buy medical equipment from suppliers not aligned with net zero. But this needs to go much further.

Academics are part of this process to decide how best the NHS can maintain quality of care, cost effectiveness and sustainability. Our research is developing tools to help healthcare leaders reach net zero without compromising their budgets – or their patients’ safety.

With that in mind, here’s an overview of what the new green plans need to be addressing.

WHERE SUPPLY CHAINS EMIT MOST CARBON

Medicines account for 25 per cent of NHS carbon emissions, many of which come from single-use plastics, inhaler gases and anaesthetics. As well as reducing unnecessary production of these, cutting carbon could involve giving out fewer prescriptions – sometimes referred to as “de-prescribing” – while making sure that medicines are distributed as close to home as possible.

We can use digital modelling tools to hone in on where exactly in the supply chain most carbon is emitted, and tweak the system accordingly. Wirral University Hospital’s green plan, for example, involves switching away from using nitrous oxide in hospitals in favour of more climate-friendly pain-relieving anaesthetics.

Successful decarbonisation will need to take the full range of NHS primary care services into consideration – from pharmacies to optometrists. Trusts must also track and monitor emissions from manufacturers, food and catering suppliers, and care delivery businesses like community nursing: while constantly evaluating the environmental and social consequences.

At Leeds Teaching Hospital, for example, leaders plan to make 20 per cent of their fleet vehicles electric.

REDUCE CARBON, MAXIMISE HEALTH AND WELL-BEING

It’s worth emphasising that of the more than one million people who work for the NHS and its community services – which represents around 7 per cent of the workforce in some regions – many are in roles where their primary focus is still managing an ongoing pandemic.

These workers need support from leaders to develop better ways of working linked to net zero, including planning for walking and cycling to and from work. The green plan from Chelsea and Westminster Hospital in London, for example, plans to increase flexible working options, as well as monitoring how many staff cycle or walk to work in order to encourage sustainable commuting.

It’s also crucial that extra money be used to make environmental changes at a community level. Sustainability is not only about reducing carbon: It’s also about maximising health and well-being.

For example, reducing respiratory diseases will be partly achieved by lowering pollution and planting more trees. That means the NHS must work with urban planners to create more biodiverse green spaces and cut unnecessary car journeys. Leeds Teaching Hospital, for example, is expanding its staff shuttle bus service, which saved approximately 272 tonnes of carbon in 2019 and 20.

ENSURE GREEN PLANS BENEFIT MOST VULNERABLE

As we’ve seen during the pandemic, socially disadvantaged groups often suffer more when systems change. For example, we’re already aware that – in spite of technology playing a vital part in continuing medical services during the pandemic – the shift to digital methods of clinical contact has alienated some older patients from primary care.

Plans like those of King’s College Hospital to offer every patient in England the option of digital primary care (for example, being assessed over video call) recognise that some patients will still want and need to be seen in person.

Acknowledging that health and sustainability go hand in hand is the first step to ensuring that these green plans benefit more vulnerable communities: those who are poorer, of diverse or marginalised ethnicities, and at the end or beginning of their lives.

Plus, if the NHS’ ambition to be the first net zero health service is to be realised, a significant injection of public and private finance will also be required. The UK government has so far allocated £12 billion (US$1.54 billion) to sustainability projects in the UK, but this hasn’t been reserved for the healthcare sector – and is likely to be insufficient to achieve the transformation that’s needed.

Sally Fowler Davis is an associate professor in organisation in health and care at the Sheffield Hallam University. This commentary first appeared on The Conversation.