Towards a greener NHS?

Earth Day this week reminds us that time is running out to address climate change. We now have just a decade left to cut carbon dioxide emissions significantly if we are to limit global warming to within 1.5 degrees above pre-industrial levels and prevent potentially irreversible damage to our planet.

While COVID-19 is clearly the more immediate global threat today, the uncomfortable truth is that the climate change clock cannot be paused. So even if progress may slow in the short term, our efforts to limit global warming cannot be abandoned.

Health implications of climate change

Climate change has serious implications for our health, including in the UK. This is already playing out in real time.

Floods have become more severe over the past 50 years in some regions of Europe, with parts of the UK among the worst affected. But flooding can also cause mental health problems that persist long after the floodwater has subsided. Air pollution, generated by similar sources to climate change, already causes an estimated 40,000 premature deaths in the UK annually.

If carbon emissions continue to rise, we could see an increase in the severity and frequency of extreme weather events such as heat waves, droughts and floods, and a rise in vector borne diseases – all of which bring health risks.

The NHS: part cause, part cure?

Not only will our health service need to respond to these risks, but as a significant consumer of natural resources and contributor to carbon emissions, it will need to change the way it operates. While the carbon footprint of health and social care services has reduced by 18.5% since 2007, there is much more to be done to meet the Climate Change Act target of net zero carbon emissions by 2050 at the latest.

The hope is that the recently launched For a Greener NHS campaign will chart a path for the NHS in England to achieve this goal. But what would a net zero NHS look like and how might we get there? At the Health Foundation, we are supporting work that could help achieve the NHS’s target, while improving the quality of health care.

Promising ideas

To mount a serious effort to achieve net zero, environmental sustainability needs to be a golden thread that runs through every aspect of how the NHS operates: from how it delivers clinical services, to the energy it consumes and the way it uses its estates.

Recently, remote clinical service delivery, such as video consultations, has received close attention as a means of reducing the NHS’s carbon footprint. Barts Health NHS Trust, for example, has shown that video outpatient consultations are viable alternatives to in-person appointments and can reduce carbon emissions. Barts estimates that a single virtual oncology consultation can save an average of 5.8kg of carbon dioxide. Across 100 journeys, this equates to a level of carbon dioxide that would take 10 tree seedlings 10 years of growth to capture.

Remote clinical service delivery is now being scaled up in the response to COVID-19. If, where appropriate and effective, this can be sustained long-term, it could play an important role in supporting the NHS to reduce carbon emissions.

Another promising example is a framework developed by the Centre for Sustainable Healthcare to integrate sustainability into quality improvement work, which we are supporting to pilot in undergraduate and professional education. The ‘SusQI’ framework provides practical guidance on how sustainability can be considered in the quality improvement process so that projects can reduce their environmental impact at the same time as improving health outcomes.

Our research on the NHS as an ‘anchor’ shows how NHS organisations can go beyond their role as providers of health care, and improve the social, economic and environmental conditions of the populations they serve. The research demonstrates how NHS services can promote public transport or walking and cycling to work, monitor waste generation and recycling rates, and install more energy efficient heat and power sources. Providers and commissioners can use national tools such as the Green Plan guidance to help plan their sustainability work.

Analysing how NHS organisations use their estates, a study of the NHS Forest initiative, which works with the NHS to plant trees and make green spaces available for health purposes, is showing that that green space can have a positive impact on the health and wellbeing of NHS staff and patients. The environmental benefits of trees include reducing the risk of surface water flooding and mitigating carbon emissions.

The anchors research and NHS Forest’s work illustrate how pro-environmental approaches can achieve multiple strategic objectives: a win for the environment can be a win for the health and wellbeing of staff and patients, as well as the wider local community.   

Scaling sustainability through systems and networks

The challenge for reaching net zero will be to learn from what works and determine how this action can be scaled up. Sustainability and Transformation Partnerships and Integrated Care Systems will need to spearhead action in their local areas. This will require leaders to put sustainability firmly on the agenda, ensuring there are ambitious environmental targets in their 5-year plans.

Networks will also be helpful enablers for sharing learning and supporting the scale of successful interventions, which we know from running Q, a community of over 3,500 people leading improvement work in health and social care. With a sense of more people than ever wanting to do something positive, Sustainable Health and Care Networks are a good place to start. Networks like this and Q can amplify efforts and be important catalysts for change.

Earth Day: an important reminder

The herculean response to COVID-19 shows how large-scale action can be mobilised quickly.  While emerging from a tragic situation, some of the resulting action, such as the shift to remote service delivery, could be used to accelerate progress towards a greener NHS. There is also a host of other ideas, like those set out in our anchors research, that can be tested and scaled once the virus has abated. Climate change will still be here when it has. Earth Day is a reminder that we shouldn’t lose sight of the importance of sustainability, even in the midst of other serious challenges.

Read the Health Foundation’s response to the Net Zero NHS Expert Panel call for evidence, which provides insights from our portfolio.

Tom Hardie is Improvement Fellow at the Health Foundation.