NHS has scope to cut further emissions

Setting a goal can be straightforward, but achieving it? That is when the hard work begins. And while going for the low-hanging fruit can result in some easy, early wins, it is key that the wider picture is always kept in mind for sustained, long-term results.

In 2020, NHS England became the world’s first national health service in the world to commit to reaching net zero net zero and it has laid out ambitious targets to help achieve its aim (with equally ambitions plans for the NHS in Wales and Scotland).

But the pathway to net zero is not going to be an easy one and will need a rounded approach, looking at all three scopes.

The NHS Carbon Footprint, for the emissions it can control directly, has the aim of reaching net zero by 2040, with an ambition to achieve an 80% reduction by 2028-2032. For emissions over which it has no direct control but can exert influence – the NHS Carbon Footprint Plus – the goal is to reach net zero by 2045, with the aim of making an 80% reduction by 2036-2039.

But it was reported in June 2021 that half of NHS Trusts are already behind schedule on these decarbonisation targets. It was revealed that some positive action had been taken: the vast majority of Trusts had installed electric vehicle charging infrastructure on site or were planning to install it within five years and most Trusts were installing technologies to improve energy efficiency.

With 53% of Trusts reportedly off-track and just 5% ahead of schedule, the task ahead is not one to be taken lightly. A lot of attention has gone into looking at the first set of emissions with the NHS focussing on the traditional areas around building use, energy and heat, all issues related to estates and facilities. In many ways, these are the easy parts to address. But it is the scope 3 emissions that come under the Footprint Plus where concerted efforts now need to be made. (What are scope 3 emissions and how do you calculate them?)

The report from a meeting in June between NHS England and the NHS Improvement provided an update on the work completed over the previous nine months and outlined areas for future action across the Greener NHS National Programme.

The update stated that all NHS Trusts and Integrated Care Systems (ICS) would be required to confirm a Board-level Net Zero Lead by 1st October 2021 and to develop refreshed Green Plans by February 2022. These Green Plans need to set out the ambition and strategy for each NHS Trust and ICS to significantly reduce carbon emissions.

Achieving net zero emissions in healthcare will be possible only with radical and immediate engagement of the clinical community and this includes work around sustainable models of care, procurement, food and catering and medicines.

Sustainable models of care

It is critical that net zero principles are embedded across all clinical services. Consideration needs to be given to how emissions can be reduced in the way care is delivered. Many clinicians are beginning to develop new service models, but often the impact of carbon is not considered. NHS Trusts need to engage with their clinicians and introduce some joined-up thinking. This isn’t a battle that can be won in isolation; all areas of the organisation need to engage in achieving the targets.

The NHS Long Term Plan set out a commitment to deliver a new service model for the 21st century. But if the NHS is to achieve its ambitious goals, any new service model will require a focus on sustainability and reduced emissions. The NHS isn’t alone in this, as all industry sectors are having to revisit their processes and review how they operate.

As part of the new service model for the 21^st century, multiple commitments are in progress, including boosting ‘out-of-hospital’ care, empowering people to have more control over their own health, where appropriate. Progress has been made around digitally enabled care through virtual consultations and clinics in the past 12 months with more than 22 million virtual outpatient appointments being delivered. The Covid-19 pandemic was a big catalyst for the rapid adoption of digital health tools and more work needs to be done in supporting clinicians to understand what technology is available, or could be available, to support improvements in the delivery of clinical interventions, as well as providing investment to support the change.

Whenever changes are being considered, it should be part of the process that a carbon analysis is carried out in the planning stages. It needs to become an automatic consideration as there will be little point implementing changes that ignore the importance of emissions and push the onus on to someone else.

Procurement and supply chain

One of the biggest areas where change needs to be implemented is in procurement and the supply chain, especially given that the NHS is the largest UK buyer of goods and services and has more than 80,000 suppliers.

The NHS can reduce emission from its supply chain in three ways - more efficient use of supplies, low-carbon substitutions and product innovation and by working with suppliers to decarbonise their own processes.

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As evidence of its wholehearted commitment to this mission, NHS England is working with 500 of the NHS’ largest suppliers to disclose their carbon emissions.

The NHS supply chain accounts for approximately 62% of its total carbon emissions. In order to deliver a net zero health service, a net zero supply chain is a must.  All Trusts need to use their individual or collective purchasing power to reduce the carbon embedded in their supply chains. While Trusts cannot directly influence the emissions of a supplier, they do have the option of voting with their feet. And the introduction in April 2022 of a mandatory social value weighting of 10%, which will include carbon reduction among its factors, will force those companies who want to supply goods or services to the NHS to be proactive in improving their green credentials.

In November, NHS England published a Net Zero Supplier Roadmap to help suppliers align with the net zero ambition. After 2030, any supplier not meeting minimum expectations will not be contracted.  It is expected that all suppliers publish a carbon reduction plan from April 2024 but embedding this requirement into contracts will be challenging. If the NHS is to include a requirement on suppliers to reduce their carbon emissions and publish their carbon reduction plans, then NHS Trusts will need support including the introduction of standard contract terms as part of the NHS terms and conditions. This is a very positive step towards tackling scope 3 emissions.

Food, catering and nutrition

 With 6% of total emissions related to the NHS’s food and catering services, it is an area that cannot be ignored. Steps are already being taken by NHS England and NHS Improvement to develop new national standards for healthcare food for patients, staff and visitors. These standards will lead to an improved approach to procuring and producing sustainable and healthy food. This may include, for instance, ensuring suppliers have sustainable production and transportation practices, sourcing local supplies of food, the use of seasonal produce, increased use of sustainably sourced fish and efforts to limit food waste. This will have the added benefit of assisting patient recovery.

Medicines

 Although medicines account for 25% of emissions within the NHS, it is a small number of medicines that account for a large portion of them, and there is already a significant focus on two such groups – anaesthetic gases (2% of emissions) and metered dose inhalers (3%).

Anaesthetic and medical gases have also been announced as specific areas for future action as they “are among the single most carbon intensive medicines available, with desflurane among the most intensive”. As a result, NHS England and the NHS Improvement Board are aiming to reduce “desflurane as a percentage of all volatile gas use by volume, from 20% in 2020/21 to 10% in 2021/22”. This commitment to specific, quantifiable targets is a clear indication that they recognise the threat posed by climate change and are dedicated to delivering on the goals of the NHS Long Term Plan.

NHS Trusts need to look at opportunities to reduce the carbon emissions related to the prescribing and use of medicines and medical products – including medicines optimisation, responsible capture or disposal of waste medicines and considering lower carbon alternative medicines.

There needs to be training with clinicians related to more sustainable prescription and administration and the NHS Trusts need to work with the supply chain to purchase pharmaceutical products that are low-carbon.

While NHS England is to be commended for its ambitious net-zero aims, it is clear that a concerted effort in all areas of the organisation is needed to achieve those goals. It is important to look beyond the obvious and look at direct interventions within supply chain and medicines as well as enabling actions including new ways of working. It could lead to an NHS that follows a different delivery model to what we are used to but big changes will be necessary to achieve those net-zero aims.

Original article written by Jess Twemlow published in the Health Estate Journal April 2022 edition.