A sustainable NHS

In the fight against climate change, the NHS aims to reduce its direct greenhouse emissions to net zero by 2040. For emissions produced by its supply chain, the aim is to reach net zero by 2045. Dr Nick Watts, the NHS’s first chief sustainability officer, and Professor Linda Luxon, who recently organised a Royal Society of Medicine series exploring the intersection between healthcare and climate change, talk about why the task goes far beyond electrifying the ambulance fleet. 

Dr Nick Watts: As chief sustainability officer, anything that falls under the umbrella of sustainability arrives on my desk – single-use plastics, vehicle air pollution, sustainable supply chains, the list goes on. At the moment, we’re focused on how all that comes together in the NHS net zero commitments. With 1.3 million employees, the NHS is the largest employer in Europe and the fifth largest in the world. Our emissions are roughly 5% of the UK total, so while tackling that may seem daunting, the scale is what makes it exciting. Get this right and we can make a real difference. 

Prof Linda Luxon: We have known the need for something like this for decades. In the 1970s and 80s, scientific evidence was beginning to accumulate about the health impacts of climate change. We had known for years about the health impacts of air pollution, but we were beginning to understand how this huge thing called ‘climate change’ was impacting on our health at a very local level. When I worked at the Royal College of Physicians, the academic vice-president, Tim Evans, asked me to lead a project called The Future Hospital Initiative. The aim was to identify ways to make healthcare more effective and one of the areas we looked at was climate change. That’s when I really began to research the area properly. I appointed two clinical research fellows and we produced a report in which we highlighted not only the health impacts of climate change, but also that the practice and provision of healthcare needed to change as it was a major contaminator of the environment. 

Dr Nick Watts: We knew we had a problem, so the first priority was to find out where we’re generating emissions. My team spent most of 2020 building a full footprint of the system. We worked with several independent analysts to ensure the data we were gathering was robust enough for us to have real confidence in it. I can tell you how our emissions break down by medicines, by buildings, by region and by other metrics, but at the level of a specific ward in a specific hospital, the data is not quite good enough yet. But we have good enough sense of where we are to start making effective recommendations. We’re not yet in a position to empower every individual to know their own carbon emissions – that’s what we’re working on over the next two years. 

Prof Linda Luxon: I think focusing on what people can do in the here and now is incredibly important. Most people are aware of climate change, but I get a sense that they still see it as something that is only going to impact upon us in the UK at some unspecified future point, that the present urgency lies elsewhere. But the urgency is here and now. Most people in the wider community accept the connection between air pollution and lung disease. But what they may not realise is that a quarter of cardiovascular diseases are initiated or made worse by air pollution. Strokes are the same: approximately a quarter are initiated or exacerbated by the increased air pollution. The data is also showing a correlation between climate change-driven environmental changes and increasing levels of gastrointestinal disorders, skin disease and infectious diseases. There isn’t a medical discipline that isn’t affected in some way, and this is a message we really have to get across. 

Dr Nick Watts: The danger is that the problem seems so enormous that it’s disempowering. People think, what can an individual do? In truth, individuals can make all the difference. An organisation is a collection of people making individual decisions. The key is communication. We act as a central point for identifying issues and co-ordinating responses. Take ambulances, for example. By 2030 we need to have a zero-emission ambulance infrastructure in place, as buying fossil fuel replacements will be banned. So, I talk to the teams in charge of our ambulance fleet and together we devise a strategy to help hit that target. It is the same for our commercial directors. We’ve been very clear that within a decade the NHS will no longer purchase from any supplier that does not meet or exceed our standards on net zero. But it’s not just a case of chucking a new rulebook at them. We are currently working with manufacturers on the development of zero emission ambulance prototypes, which is a very complex task. 

Prof Linda Luxon: The great thing is that this is part of a growing international consensus on the direction healthcare needs to take in its approach to climate change – one in which both treatment delivery and disease prevention play a key role. Here at the Royal Society of Medicine, we recently ran a 10-part series on the intersection between climate change and health that was introduced by HRH The Prince of Wales. The series attracted a wonderful range of international speakers, real high-fliers from a wide range of specialties, all talking about climate change from their perspective and suggesting possible solutions. The series left me in no doubt that the medical field is really beginning to understand the problem across the globe. The key is translating that into government action. This is why the NHS net-zero project is so important; it is about the health sector taking a significant and highly visible role in tackling the problem here and now. 

Dr Nick Watts: This is about making sure that everyone across the whole system understands that a lot of what we want to do is perfectly aligned with improving public health. People get on board very quickly when they realise this. Maybe they can’t achieve the end result tomorrow, but given time, they will. I think my job is 50% operational, 50% engagement and managing cultural change. Do people understand the direction we’re heading in, what is going to be the hardest part, where are the success stories? I believe a lot of what we need to do will sell itself if we can get those messages across. 

Prof Linda Luxon: For this to work, the NHS is also going to need help from other sectors in getting the message across. Professor Chris Rapley, a professor of climate science at University College London, recently gave a lecture about society’s approach to cause and effect. The COVID pandemic has raised serious questions about the balance between health and the economy. For centuries, our leaders have had the approach that if you improve the economy, better public health will automatically follow. He showed this isn’t quite correct – while the two are intertwined it’s not a bi-directional phenomenon. There are many other factors at play. The NHS has a part to play, but it has to be part of a wider coordinated approach. 

Dr Nick Watts: There’s not a single doubt in my mind we can do this.  It’s going to mean a lot of sleepless nights. But what an exciting thing for the NHS to achieve. We were the world’s first universal health care system, we rolled out the world’s first national vaccine programme, the first heart and lung transplant, the first COVID vaccine. The NHS has so many impressive firsts, if any health system in the world can be the first to achieve net zero, it’s us. 

This article was first published in the February 2022 issue of Prognosis Magazine.