England’s National Health Service (NHS) is the world’s first health system to commit to becoming ‘net zero’ [i]. This means cutting emissions of the gases driving climate change to as close to zero as possible and offsetting the rest, for example by planting forests and investing in emission-removing technologies.
The NHS aims to achieve this goal by 2040 for emissions under its direct control, reducing emissions by 80% by 2028. And, by 2045, it aims to be net zero for all NHS-related emissions, including emissions linked to energy use and to goods and services provided by outside suppliers. These indirect emissions make up around half (52%) of the NHS’ total carbon footprint. The NHS has 80,000 suppliers, providing everything from medicines and equipment to catering and business services – all with their embedded emissions.
The Net Zero report charts a route to net zero, spelling out the essential changes required to get there. These changes map closely onto CAST’s research areas: material consumption, food, transport and energy use in buildings[ii].
In each area, the report includes details to surprise. For example, under material consumption, it singles out medicines and medical equipment. Together, they account for 30% of NHS emissions. This includes anaesthetic gases used in surgery; one bottle of the widely-used gas, desflurane, is equivalent to burning 440kg of coal.
Transport is another example. The NHS accounts for 14% of England’s emissions from road travel: by the NHS fleet, patients, staff, suppliers and visitors. A shift to low and ultra-low emission vehicles – for both ambulances and its non-emergency fleet – is built into the plan as is infrastructure investment in active travel and electric vehicle charging points. Within the area of energy use, delivery of the net zero targets will rely on wider decarbonisation of the national electricity supply and improving the energy efficiency of its buildings.
The report maps onto CAST’s agenda in a deeper way – but one where the report has much less to say. CAST makes clear that people must be at the heart of the changes needed to address climate change. Changes at the scale and speed required to achieve a net zero NHS – and a net zero society – depend on people’s participation and support.
The NHS is uniquely placed to mobilise such widescale public engagement.
Firstly, the NHS is a people-based organisation. It is publicly funded – and has been through its 70-year history. A larger proportion of public spending (around 25%) goes on health care, principally the NHS, than any other area[iii]. And the NHS harnesses this spending to serve and employ more people than any other organisation in the UK. Over 60m people are NHS patients and it handles over 25 million calls a year from the public seeking advice and emergency care. Over 1.5m people work for the NHS, making it the largest UK employer and one of the largest in the world. Along with other healthcare systems, it is therefore central to holding back the relentless rise in global temperatures. Globally, the healthcare sector accounts for 4.4% of emissions. If the sector was a country, ‘it would be the fifth-largest emitter on the planet’[iv].
The NHS is important, secondly, because it is a values-based organisation. It is often described as a national religion, enshrining the values of service ‘from cradle to grave’[v]. Health professionals are united by a duty of care, regulated by the Councils that govern doctors, nurses and other health practitioners[vi]. Health professionals are consistently rated above other occupational groups for their honesty and ethical standards, a public view confirmed by the outpouring of support for health workers during the COVID-19 pandemic. Nurses – a largely female workforce – are the UK’s most trusted profession, with a trust score of 96%. In contrast, politicians languish at the bottom of the league table of public trust, with a trust score of 14%[vii].
The NHS is therefore unique as an institution that has people at its heart. It touches everyone’s lives and – as evident in people’s responses to COVID-19 – affirms values and a sense of collective identity that many people share.
The Net Zero NHS report lays out the technical details of how to reduce emissions. But delivery will require it to be the standard-bearer for climate action inspired and supported by people. Only by the NHS community – providers, users and supporters – working together will the NHS succeed in minimising its carbon footprint. Only as a collaborative undertaking will it become a health system that protects – rather than inadvertently damages – the health of current and future generations.
Hilary Graham was a member of the Expert Panel that helped guide the report. She writes here in a personal capacity.
[i] NHS England (2020) Delivering a ‘Net Zero’ National Health Service. https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf
[ii] https://cast.ac.uk/areas-of-focus/
[iii] HM Treasury (2020) HMT Public Expenditure Statistical Analyses 2020 (PESA) https://www.gov.uk/government/statistics/public-expenditure-statistical-analyses-2020
[iv] Health Care Without Harm and ARUP (2019). Health Care’s Climate Footprint https://noharm-uscanada.org/ ClimateFootprintReport
[v] UK Parliament (1942) Social Insurance and Allied Services (Beveridge Report). https://www.parliament.uk/about/living-heritage/transformingsociety/livinglearning/coll-9-health1/coll-9-health/
[vi] Hilary Graham (2020) Climate action: no time to waste, The British Student Doctor, 2020:4(1)5-6 doi: 10.18573/bsdj.143
[vii] Ipsos MORI (2020) Ipsos MORI Veracity Index https://www.ipsos.com/ipsos-mori/en-uk/trust-politicians-falls-sending-them-spiralling-back-bottom-ipsos-mori-veracity-index