Getting to grips with climate change: how can the NHS get to net zero?

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There’s never been a shortage of people in the NHS who care about climate change. There are countless examples of people working locally to reduce the environmental impact of the services they provide. What has been missing until recently is a clear message from national leaders that sustainability is mission critical rather than something to put on the ‘and also’ list. Thankfully this now looks like it may be set to change.

Last weekend, Sir Simon Stevens, chief executive of NHS England, launched a major new initiative aiming to build a ‘greener NHS’ with the goal of reducing greenhouse gas emissions to net zero. The initiative combines a call for evidence asking staff, patients and others to share ideas; changes to the NHS standard contract encouraging providers to take actions such as switching to less polluting anaesthetic gases; and a new expert panel that will examine how the NHS can get to net zero, due to report in October. The panel brings together experts in environmental sustainability with health system leaders, including The King’s Fund’s chief executive Richard Murray.

There are a lot of unknowns about the path to net zero. For example, one important task the panel has been set is to establish the earliest realistic date by which the NHS would be capable of becoming carbon neutral. However, there are also many things we already know well enough.

'All groups – from frontline clinicians to strategic leaders working across entire regions – will need to play a part in understanding what health care might look like in a net zero future'

We know that reaching net zero is likely to involve making changes to how and where care is delivered, and in some cases changes to what care is delivered. Making improvements to physical infrastructure such as buildings and energy sources is important, but this can only get us so far (direct energy use in NHS buildings accounts for less than a fifth of overall NHS carbon emissions). All groups – from frontline clinicians to strategic leaders working across entire regions – will need to play a part in understanding what health care might look like in a net zero future.

We know an increasing amount about some of the service changes that would help to take us in the right direction. For example, the Centre for Sustainable Healthcare has supported clinicians to examine how care within specific clinical areas – including in mental health, kidney care, anaesthesia and surgery – can be delivered in a less carbon-intensive way. And the Sustainable Development Unit has produced assessments of practical steps that could save the NHS money at the same time as reducing carbon. Yet implementation of these changes is far from universal. This suggests that achieving net zero will involve spreading and scaling-up good practice as much as pure innovation.

We know that the NHS will not be able to get to net zero without focusing on its supply chain. More than half of the NHS carbon footprint is attributable to embedded emissions in drugs, medical devices and other goods procured by the NHS. The NHS needs to look at what happens at its own end of the supply chain (for example, by improving medicines management) but will also need to work closely with pharmaceutical firms and other providers to help them to play their part.

We know that the NHS workforce can act as a powerful agent for change. There are 1.3 million people working in the NHS and survey data shows that a large majority strongly support the principle that the NHS should take action to reduce its environmental impact. Grassroots initiatives such as NHS Sustainability Day and networks like the Climate and Health Council illustrate the potential to mobilise this huge pool of support. Connecting people and giving staff the information and agency they need to take action in their own workplaces will be critical.

'There are systemic barriers that make it harder for people working in the NHS to prioritise the kind of far-sighted strategic thinking needed to achieve net zero'

Finally, while harnessing grassroots initiative is great, we know there are systemic barriers that make it harder for people working in the NHS to prioritise the kind of far-sighted strategic thinking needed to achieve net zero. At the root of this is the ever-present tendency for longer-term transformation – however important – to take second place to responding to immediate operational pressures: the ‘tyranny of now’. Integrated care systems are being seen as the principle vehicle through which strategic planning will happen in future, and it is important that these emerging partnerships are protected from the short-termism that has too often dominated in the past.

The intention to set a goal to reach net zero is highly welcome and necessary, but it will only be delivered if carbon reduction becomes a metric through which we judge the success of ongoing attempts to transform the way care is provided, rather than being seen as an additional ‘ask’ that sits aside from core business.

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