How should the 10-year health plan respond to the climate crisis?

The 10-year health plan is shouldering a heavy load of expectations: transforming the NHS into a preventive, digitally-savvy, community-focused health system; ending the agonisingly long waits for care; rebuilding a battered workforce. That’s a daunting set of goals already, so factoring in climate change might be a stretch too far, right?

Well, no. Because far from being an additional ask, thinking from the start about the wider global context in which these reforms will play out is something that will help the plan to achieve its core goals.

Delivering health and care services in a way that is sustainable (in any sense of the word) involves helping people to stay well, giving patients the knowledge and tools they need to manage their conditions, reducing avoidable or low value activity, and ensuring that services always make best possible use of available resources (including natural resources as well as money and staff). These principles of sustainable health care are closely aligned with the three big shifts that will form the backbone of the 10-year health plan. By consciously applying a sustainability lens to each of these shifts, we can help to ensure the reforms deliver the widest possible benefits for the population and the health and care system.

'By consciously applying a sustainability lens to each of these shifts, we can help to ensure the reforms deliver the widest possible benefits for the population and the health and care system.'

Take the shift to prevention. Many forms of primary prevention offer the prospect of improving physical and mental health and mitigating the climate and nature crisis directly – for example, supporting people to walk, cycle or use public transport as an alternative to car use; promoting physical activity in green spaces; or improving home insulation. Secondary and tertiary prevention also offer multiple benefits, since intervening early to prevent disease progression and deterioration can reduce the need for more carbon-intensive forms of care as well as improving patient outcomes. Applying a sustainability lens to prevention would involve giving particular emphasis to preventive interventions that deliver these combined health, environmental, financial and social benefits and ensuring that such wider benefits are measured, tracked and reported in order to inform decision-making.

Similar arguments can be made for the shifts to digital and community-based care: there are clear opportunities to implement these changes in ways that could benefit patients and the environment (and in doing so, help tackle environmental health risks such as air pollution or heat-related mortality) – but only if we purposefully look for those points of alignment and emphasise them in the plan. The plan will set the agenda for the NHS over the coming years and influence what gets prioritised, so it’s important that it focuses on changes that will deliver benefits across multiple fronts.

The 10-year health plan will need to address extreme resource pressures in the health and care system, and the gravity of the climate crisis can help to create an additional impetus for change. Case studies of improvement projects involving sustainable care pathway redesign show how removing low-impact or duplicative processes can free up staff time for activities that add more value for patients (all the while saving carbon and money). Often, the staff involved are strongly motivated by the opportunity to protect the environment and improve quality of care simultaneously. Tapping into this motivation can unlock significant energy for change and help to rebuild a sense of agency in the workforce.

Ultimately, the challenge for the 10-year plan is to create a health system that will be resilient for the future.

Ultimately, the challenge for the 10-year plan is to create a health system that will be resilient for the future. In recent years, the NHS has struggled in the face of volatility in energy markets, vulnerable international supply chains and disruption caused by extreme weather events. These challenges will become more common and more severe as global temperatures continue to rise. Capital investment is needed to increase the system’s resilience to these challenges and to achieve NHS net zero targets, but the good news is that the time required for innovations such as local renewable power generation to deliver financial returns is becoming shorter by the year. The recently launched Design for Life roadmap is also a positive step towards reducing the vulnerability of the NHS to supply chain disruption while boosting growth, saving money and cutting waste and emissions.

The latest assessments from climate scientists indicate that the next decade will be make or break. In this context, writing a 10-year plan for anything without thinking about climate change would be short-sighted. When it comes to health the case is even stronger – both because nothing poses a greater threat to human health and because the opportunities for aligning climate and health strategy are so clear.

The government hopes that its ‘mission led’ approach will be one of the defining characteristics of its time in office. To be successful it will need to build connections between its health mission and climate mission so that they become mutually reinforcing: the health sector can be a significant contributor to the drive for a greener economy just as climate action can help with the goal of improving healthy life expectancy. By placing sustainability at the heart of both the 10-year health plan and the health mission, the NHS can lead the way on climate at the same time as improving care for people using its services.