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Climate change remains the leading threat to global health. The NHS in England produces roughly the same greenhouse gas emissions as Denmark and, rightly, has legally binding targets to reach net zero.  

So far, much of the national and local efforts to decarbonise the health service have understandably focused on the big-ticket short to medium-term wins for reducing emissions, such as changes to the way the NHS uses energy, estates, the vehicle fleet and its supply chains. These kinds of changes tend to be ‘behind the scenes’ for patients. But, as NHS England’s Delivering a ‘Net Zero’ National Health Service report sets out, achieving net zero will also require big changes to how care is delivered. And while promising action is already happening on this front, it will need a much greater focus given the scale, complexity, and urgency of the shifts in care required to meet the NHS’s targets. 

To decarbonise care delivery the NHS will need to build a better understanding of which aspects of care are most carbon-intensive and how transformation and innovation can reduce emissions, alongside improving patient experience, health outcomes and service efficiency. It will also require policy makers and system leaders to put net zero on the same footing as other important system priorities, addressing them simultaneously where possible. 

The good news is that action to decarbonise care delivery can align closely with other priorities, such as improving efficiency and reducing costs, moving care out of hospitals, and preventing disease. The Sentinel Project in Hull and East Yorkshire, which was designed to improve asthma outcomes by optimising inhaler use, illustrates the potential for better disease management to reduce emissions. It has prevented 44,275 polluting ‘reliever’ inhalers being issued, equivalent to a saving of 1,240 tonnes CO2e (or the emissions from around 1,500 flights from London to New York).  

Where appropriate, moving care out of hospitals – which are particularly carbon-intensive due to the resources they require – is also key to decarbonising care pathways. In just a year, an occupational therapy programme that supported earlier discharges at University Hospital of Wales saved an estimated 15,600 bed days, £1m and over 573 tonnes CO2e (equivalent to driving from Land’s End to John O’Groats nearly 2,500 times in an average petrol car). It has also helped patients return to their homes and regain independence.  

These examples are just a snapshot of the ways health care teams are showing how high-quality care and environmental goals can be achieved simultaneously. However, net zero care at scale will not be achieved as a by-product of improvements focused on other priorities. Instead, it requires a strategy that integrates environmental sustainability goals with other core priorities for care, such as transformation, innovation and quality, exploiting the mutual gains that can be achieved in a systematic way.  

How do we achieve this in practice? An important part of this is engaging and enabling healthcare staff and leaders. Surveys commissioned by the Health Foundation suggest that most NHS staff are not aware of the NHS net zero ambition. This is a problem. All staff need to know what more sustainable care delivery looks like and why it matters. Weaving environmental sustainability through all strands of healthcare education is important. And of course, organisations and staff also need the knowledge, capability and capacity to implement the changes to care that deliver lower emissions. For this to happen, effective senior leadership on sustainability in NHS organisations is crucial.  

Progress is still at an early stage, capability and resources are limited and duplication is occurring between providers. So, coordination of activity and sharing of resources and best practice will be critical to implementing and scaling changes to care delivery.  

There is also a question about whether the right incentives are in place to drive the transition to net zero care. Healthcare leaders cannot swim against a tide of expectations, targets and policies if they are pulling in the opposite direction. Much greater effort is needed to understand how national policy and regulation – including in areas such as payment systems, performance targets and clinical guidelines – shape care planning and delivery and how these might be modified to support the transition to net zero care. Research and innovation are also needed to make clear which aspects of care providers and staff should focus on and the best approaches to address emissions alongside improving patient care.   

In our latest Health Foundation analysis, Net zero care: what will it take?, we set out what net zero care is and explore four key areas where further action will be needed to make progress: staff capacity and capability; leadership; national policy; and research and innovation. There are huge opportunities to deliver improvements to care that benefit patients, services and the environment. But seizing these opportunities will require embracing net zero care as a strategic goal alongside other priorities. Delaying efforts to do this will only lead to wasted opportunities and harder decisions later on.  

The NHS is aiming to cut its directly controlled emissions by 80% in less than a decade. As the climate emergency becomes increasingly serious, health care policymakers and leaders must act quickly and decisively. 

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

Tom Hardie is an Improvement Fellow in the improvement team at the Health Foundation.

This content first appeared on the HSJ website.

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