As the UK is recognising the urgency of undertaking steps to mitigate the impacts of climate change, the NHS, which makes up 4% of the UK’s total carbon footprint, is also getting involved.

Since October 2020, the NHS has been on a mission to reduce the environmental impact of its services and become the world’s first net zero national health service. It has two main targets:

For the emissions we control directly (the NHS Carbon Footprint), we will reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032;
For the emissions we can influence (our NHS Carbon Footprint Plus), we will reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039.’

Planning a route to achieving a net zero NHS is not easy, however, and requires careful planning. Here we discuss ways the NHS is planning to get closer to achieving net zero.

The goals of the NHS differ slightly across the country.

‘In England, the NHS is aiming first to become net zero by the year 2040 for emissions it controls directly, and then to reach net zero by 2045 for emissions it influences but does not directly control.

NHS Scotland is going one step further, bringing forward its target date for achieving net zero emissions from 2045 to 2040. In Wales, the public sector is aiming for net zero carbon by 2030, with the NHS contributing a 34% reduction by the same deadline,’ Pharmaceutical journal reports.

NHS Carbon Footprint

EMA’s Green Plan is designed to deliver environmental, social, and financial value and help the NHS meet its net zero goals and reduce its carbon footprint. Here are sources of carbon emissions in NHS carbon footprint by proportion:

Medicines, medical equipment, and other supply chain	Medicines and chemicals: 20% Medical equipment: 10% Non-medical equipment: 8% Other supply chain: 24%
NHS carbon footprint	Business travel and NHS fleet: 4% Anesthetic gasses and metered dose inhalers: 5% Waste and water: 5% Building energy: 10%
Personal travel	Visitor travel: 1% Staff commute: 4% Patient travel: 5%
Commissioned health services outside NHS	4%

EMA reports that improving performance in some of these areas can take 15 years or more. EMA also believes that addressing certain areas, namely ‘medical gases, travel and transport, which is around 14% of the system’s total emissions, are going to be key to our success, and strategically how we decarbonise our heating in the near future.’

For successful decarbonisation, emissions in all of these areas need to be monitored and their environmental and social consequences need to be considered. Also, all actors that work with the NHS need to be involved. This includes hospitals, pharmacies, manufacturers, and suppliers.

Here is a case study of Kingston Hospital, which as EMA writes is ‘a medium acute site in south-west London, providing emergency, planned and specialist services to a local population of approximately 1m people. We do this from a varied group of 30 buildings aged between 1 and 150 years old, with a team of 3,000 staff and contractors. We generate heat and power on site by burning 46GWh of natural gas per year and we import 3GWh of electricity, the total cost of energy services is approximately £3m per year.’

The hospital has one energy manager who focuses on energy, waste, sustainability compliance and reporting. In 2018, they introduced an intention to reduce their environmental impact in the form of the 2018 Sustainable Development Management Plan (SDMP). However, at this point there were no concrete carbon targets. So, the hospital decided to launch annual action plans to inspire and track positive change in the field of energy efficiency and sustainability. The hospital has also been tracking its carbon emissions for several years now and figured out that it emits around 20,000 tonnes of CO2e per year from its core activities.

Data for the hospital’s energy, waste, and water consumption is mainly captured from billing which is later validated against meter readings. EMA says that this year, for the first time, the hospital’s ‘Pharmacy department has started to track the quantity of anesthetic gas used and inhalers dispensed. Our ‘fleet’ of 3 pool vehicles is not currently tracked and we are working with finance to capture more granular information from recharges made to staff for using their own and public transport.’

At the moment, the hospital is preparing plans focusing on sustainability for the next 10 to 20 years.

The main obstacle to achieving these goals is the fact that ‘The longer-term solutions to get us to net zero by 2040 will require heavy investment to renew buildings and services to net zero standards. This has proved difficult to obtain to date and we look forward to finding out how this will be managed at a national level.’

Strategic path

As EMA reports, there are 6 priorities designed to facilitate delivering the NHS five-year long-term plan:

Partnership in place – focusing on supporting place-based systems to solve structural inequalities and create value for local communities

Working with staff – placing effort on caring for and inspiring staff to improve inclusivity in all kinds of activities

Operational excellence – improving patient safety and altering the strategy to meet the needs of the population and improve building staff capacity

Change programmes – delivering change programmes and working in partnership with other actors

Improved research – improving the experience for students and trainees, using technology to promote innovation

Commitment to environmental sustainability – delivering plans to improve energy efficiency and environmental sustainability.

Difficult road ahead

Sustainability should be at the center of everything the NHS does but the plan for the NHS to achieve net zero is very ambitious and will not be easy to complete. It seems like the NHS is on the right path as since 2010 it managed to reduce its emissions by 30%, owing to steps taken across the workforce. If the NHS can keep the pace up and keep implementing reforms focusing on sustainability, the quality of patient care will improve while carbon emissions will go down. Developing modern technologies and promoting innovation is crucial to ensure the best outcomes for patients and the most efficient NHS.