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The NHS and climate change: a decade of distraction


Ten years ago, the NHS published its first carbon reduction strategy. In doing so it became the first major health system anywhere in the world to develop a strategic vision outlining how health care needs to evolve as part of the transition to a low carbon economy and to commit to progressively reducing its own carbon emissions.

In the years since then there has been some important progress. The carbon footprint of the NHS in England has fallen and national organisations have pledged to take further action. Much of this has been underpinned and co-ordinated by the pioneering work of the Sustainable Development Unit, funded jointly by NHS England and Public Health England.

Despite this, it is hard to argue that climate change has become the strategic priority for the NHS that it needs to be. It received a mention in the appendix of the NHS long-term plan (on page 120) but has not been integrated within core strategic thinking. We have argued previously that financial sustainability and environmental sustainability need to be thought about in tandem and that some of the steps needed to achieve a carbon neutral NHS are aligned with broader strategic objectives in health policy. When the NHS talks about sustainability, however, it is almost always in reference to money alone. In terms of the emissions reductions that have been achieved to date, Camille Oung observed in a recent blog for the Nuffield Trust that, although welcome, these represent a fraction of the change that will be needed over the coming years.

There are several reasons why mitigating and adapting to climate change should be a strategic priority for the NHS, including direct health risks in the UK and elsewhere, opportunities to improve population health through tackling climate change and the fact that the carbon footprint attributable to health care in the UK is dauntingly large. While climate protests (such as those organised recently in London and elsewhere by the Extinction Rebellion group) tend to focus their ire on prominent targets, such as the fossil fuels industry, we should not forget that public services, too, have a substantial impact on the environment and need to be thinking about their role in creating a sustainable society.

Regrettably, what we have seen over the past decade is a series of distractions that have prevented the NHS from taking the longer-term perspective that is needed.

Distraction number one: the 2012 Health and Social Care Act. The enormous top-down reorganisation unleashed by this legislation meant that for three years (or more) the focus of NHS leaders was on reinventing the institutional architecture of the health and care system and figuring out how the new arrangements could be made to work in practice. Despite their efforts, further legislative change will be needed sooner or later to remove the impediments created by the Act.

Distraction number two: austerity. Rising costs combined with vanishingly small annual budget increases have meant that since 2013/14, NHS organisations have been in overall financial deficit. As a consequence of this, meeting key national targets has become the exception rather than the norm. This has led to those in charge of local NHS organisations being put under intense pressure from national bodies and politicians to quickly find ways of balancing their books. In the middle of this hand-to-mouth financial struggle, talking about longer-term challenges, such as global warming, has felt almost wilfully eccentric.

Distraction number three: Brexit. Like other public bodies, parts of the NHS have been plunged into a planning vortex by the uncertainties created by the United Kingdom’s planned departure from the European Union. This has included stepping up recruitment from outside the European Union to balance the reduction in nurses and midwives coming from EU countries and making contingency plans to safeguard access to medicines and other vital supplies in the event of a ‘no deal’ Brexit.

Reflecting on this series of events, it seems that there is never a good time for the NHS to focus on the single biggest challenge facing humanity. The same could be said of other long-term objectives, such as reorienting the health system towards prevention and population health. Progress is being made but generally at the margins – there is always something else that needs doing first.

The point I want to make in this blog is not that the NHS has taken no action on climate change. It has, and the Sustainable Development Unit continues to be a leading authority on sustainable health care despite its meagre resources. My point is more that the example of climate change serves as a case study of how the ‘tyranny of now’ repeatedly prevents the NHS from prioritising the kind of longer-term transformations that are needed to make it more sustainable in all senses of the word.

The biggest concern has to be that the NHS serves as a microcosm for what has happened in the country as a whole over the last decade, with action on climate change being crowded out by more immediate preoccupations. We need to find a way to break out of this pattern and allow the NHS to use its prominent position in the public eye to lead by example on climate change. Doing so will allow today’s health leaders to say to future generations ‘we did our part’.