COP27 is a reminder of the NHS’s vital role in addressing climate change

As world leaders gather for the COP27 climate talks in Egypt, recent reports paint a sobering picture. The UN has warned that there is ‘no credible pathway’ to prevent average global temperatures from rising more than 1.5°C above pre-industrial levels. The implications for health are serious: as the Lancet countdown’s annual tracker of health and climate change reveals, climate-induced risks from heatwaves, wildfires, drought, disease transmission and food insecurity are rising. COP27 represents another opportunity for leaders to commit to the collective actions needed to avert climate disaster.

What does COP27 have to do with the NHS?

With 7 million people waiting for NHS treatment, extreme pressures on emergency services and severe workforce shortages, COP27 may seem far removed from the NHS’s immediate challenges. But health care’s role in addressing climate change is essential – and action can’t wait.

The NHS accounts for 4% of England’s total carbon emissions and 40% of public sector emissions. All four UK health systems are committed to reaching net zero by 2045.

Achieving net zero requires change across the health care system, including in buildings and estates, medicines and products, models of care and the behaviours of patients and staff. If the NHS gets these changes right – and demonstrates to other health care systems what is possible – the global impact could be significant. Since COP26, 50 countries have committed to developing low carbon health care systems.

What progress has the NHS made on climate change since COP26?

In the last year, the NHS net zero aim has gained awareness among the public. Our polling found that awareness of the NHS net zero goal almost doubled between July 2021 and May 2022, from 13% to 23%. The majority of the public (64%) support the NHS net zero aim.

A combination of new strategies, guidance and legislation introduced this year should help to keep the NHS in England and its suppliers on course. For example, all NHS trusts and integrated care systems (ICSs) were tasked with developing 3-year strategies towards net zero (called green plans) by March 2022. A new requirement came into force from April 2022 for NHS organisations to take social value – including decarbonisation – into account when buying goods and services. In July 2022, the NHS net zero aim was given a new statutory footing through the Health and Care Act 2022.

A growing number of initiatives inside and outside the NHS are also supporting progress towards net zero. This includes funding for technological innovations, grants to decarbonise NHS health care facilities, a sustainability clinical fellowship scheme, and funding for academic research to help the health and care system work towards net zero.

Where next for NHS net zero?

Over the last few months we have spoken to a wide range of people working on sustainability in the NHS, including those working in national bodies, ICSs, NHS trusts, primary care and academia, to better understand the challenges and opportunities ahead. There were three major areas for focus highlighted to us by stakeholders.

First, we heard that getting the leadership and resources in place for work on net zero is critical. In hospitals, sustainability teams can face challenges in reaching into clinical care pathways and securing investment for large-scale projects. In primary care, relatively few GPs have dedicated capacity to work on environmental sustainability. There are also significant variations in how ICSs are approaching net zero. Across the NHS, there is a reliance on volunteers to drive this work forward. They often lack the time and authority to make the changes required. There is a need for engaged leaders to open the door to discussions on sustainability and drive crucial system-level change.

Second, achieving NHS net zero requires culture and behaviour change across the NHS’s 1.3 million staff. Our polling found that almost half (48%) of those working in the NHS are now aware of NHS net zero, up from 27% in July 2021, but clearly there is more to do to raise awareness and help people understand their role. Net zero considerations must be integrated into all decisions on funding, estates and operations, digital, clinical care and quality improvement if ambitions are to be met. In particular, work must be done to understand the changes in care needed to help meet sustainability goals. This extends to social care, where there is a knowledge gap in understanding the overall carbon footprint and potential solutions.

Third, we need to capitalise on the many areas in which existing priorities can be tied with environmental sustainability. For example, action on the wider determinants of health and the leading risk factors for ill health can prevent illness and reduce the need for carbon-intensive and expensive health care. Scaling up virtual consultations and other innovations can benefit patients and the environment. We must ensure that actions benefit those who are most vulnerable to the health consequences of climate change and pollution and do not inadvertently widen inequalities.

The Health Foundation’s role

We are committed to supporting the NHS to meet its sustainability goals. Our work so far includes supporting the Centre for Sustainable Healthcare to embed sustainability into quality improvement education and training, supporting sustainability fellowships through THIS Institute and the UK Health Alliance on Climate Change, and forming a Sustainable Healthcare Special Interest Group within our Q Community. We are using the insights from our recent conversations with stakeholders to inform our future plans and we thank everyone who has given their time to speak to us on this important topic.

Luke McGeoch is the National Medical Director's Clinical Fellow in the improvement team at the Health Foundation.

Genevieve Cameron is Programme and Research Manager in the policy team at the Health Foundation.

Chuma Gondwe is a Research Officer in the research team at the Health Foundation.