“Sustainability” is at the heart of the NHS Long Term Plan. Yet when it comes to sustainability in an environmental sense, its content is scarce. Only a few paragraphs connect NHS action to the environment. The link between sustainability and climate change is made only once – in the appendix.
The health service has both a duty and a vested interest in acting on emissions and pollution
Given the size and reach of the NHS, it’s not surprising that its activities are responsible for 6.3% of England’s total carbon emissions, and 5% of total air pollution. This has direct consequences for health and spending. Increased temperature due to global warming will lead to heat-related morbidity and mortality, an extra burden for which we are unprepared. The air pollution from particulate matter and NO2, both products of combustion and fuel burning, is a proven risk factor for a long and expanding list of diseases.
At current levels, the cumulative cost to the NHS over the next 16 years will be £9.4 billion for particulate matter, and £9.2 billion for NO2. It will be grimly ironic if the NHS creates an environment which leads to ill-health, while simultaneously trying to cure it.
Some of the moves towards prevention and personalisation laid out in the plan could be environmentally beneficial too: telehealth and digital GP access could reduce unnecessary travel and therefore unnecessary carbon emissions.
So how is the NHS faring on environmental sustainability?
There are a number of achievements in the Long Term Plan to be celebrated. With support from its Sustainable Development Unit (SDU), which is grounded in Constitution pledges to use finite resources sustainably, the NHS has monitored the four key areas of carbon footprint, air pollution, water use and waste management. It has acted in areas which have not received much attention in the global health and care sector, across its entire pathway of influence from government, to suppliers, to buildings, and people. A smarter and more effective use of resources has, for instance, enabled a 19% reduction in carbon footprint over the last 12 years, despite a 27% increase in activity. Locally empowered actions have been successful too, like platforms to re-use equipment which have saved £1.6 million a year.
However, much more now needs to be done, for both our health and the sake of our environment. There are worrying reports that a quarter of England’s hospitals and a third of its GP practices are above the World Health Organisation’s limit for particulate matter pollution. This limit is itself well above WHO recommended amounts. If health concerns are not enough, the Climate Change Act of 2008 mandates government institutions to reduce greenhouse gas emissions by 80% from the 1990 baseline by 2050. Current action would have us producing over 25 megatons of CO2e in the NHS compared with a desired 17 – this would stagnate at 25 megatons by 2050, compared with a desired 7.
What needs to happen next
Alongside commitments to continue reductions in key environmental areas, the Long Term Plan also outlines specific actions that improve economic efficiency and mitigate environmental impacts. Ambulances will be replaced with more carbon-neutral vehicles; LEDs will become the preferred source of lighting. Other wider cross-government initiatives, such as the Clean Air Strategy and the 25 Year Environment Plan, will bring further change to the NHS. It will not suffice to act on climate change in the way that is reflected in the Long Term Plan: as an add-on, once everything else is already set.
In his launch of the Clean Air Strategy, Matt Hancock reminds us that “we all have a part to play”. SDU reports show some of the hardest opportunities to realise in reducing NHS emissions come from changing patient and staff behaviour, for example by reducing use of cars compared to other transport. Research has highlighted the concern for short-term climate risks among health care professionals: the NHS Sustainability Day campaign is a testament to this. But changes in behaviour are not easy for many people – for example, alternative transport may not be at hand – and they will require support. The key here is to achieve a collaborative balance between top-down guidance and local empowerment that holds the NHS accountable against its climate performance.
The NHS also needs to act not just to reduce the severity of climate change, but to protect its activities against the inevitable impacts it entails in the long term. As well as temperature increases, health service leaders should consider the impact of a higher risk of flooding and increased air pollution. How, for example, can emergency departments continue to function if their energy supply is cut off by a flood? Central to this must be a concern for equality. Those who are most disadvantaged suffer most from the effects of climate change, yet it is also they who are most exposed.
The Sustainable Development Unit claims that the NHS is “prepared for [the] challenge” that is climate change. We need a lot of foresight, energy and honesty at every level in the service for that to hold true, and it can’t come too soon: it is time for us to accept that the critical moment is now.
Oung C (2019) “The environment needs to be higher up the NHS agenda”, Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/the-environment-needs-to-be-higher-up-the-nhs-agenda