Going green: what do the public think about the NHS and climate change?
NHS England’s plan Delivering a Net Zero National Health Service builds on more than 10 years of environmental sustainability policy initiatives in health and social care. Below we provide a brief overview of key policies and progress related to both sides of the climate change response: mitigation (reducing climate change) and adaptation (responding to climate change’s effects).
Climate change mitigation
Mitigation is the action taken to reduce climate change by minimising and ultimately eliminating carbon emissions. In 2008, the UK became the first country to enshrine mitigation targets into law through the Climate Change Act. That same year, the NHS in England committed to the Climate Change Act timeline, becoming the world’s first health care system to set net zero emissions targets. In 2008, the Sustainable Development Unit (SDU, now Greener NHS) was created as a national unit to support and oversee progress towards meeting the targets. The SDU’s first task was to develop a methodology for measuring the carbon footprint of the whole NHS. This was followed by the first national strategy for reducing NHS emissions.
Around the same time, environmental sustainability practices in social care were emerging (see for example the Social Care Institute for Excellence’s sustainability programme in 2009–2012). In 2013, the SDU expanded its remit to include social care and produced a sustainability strategy for the whole of the NHS, public health and social care system in England.
In 2019, the NHS Long Term Plan restated commitments the Climate Change Act targets, alongside new commitments to improve air quality and reduce single use plastics. In 2020, action on environmental sustainability was, for the first time, stipulated in the NHS standard contract and planning guidance. NHS providers were instructed to produce a ‘green plan’, take ‘all reasonable steps’ to minimise their environmental impact, and report on progress annually. The 2020/21 GP contract also included a target for practices to shift towards prescribing lower-carbon inhalers.
The NHS in England has made some good progress towards reducing its carbon footprint, lowering its emissions by 26% between 1990 and 2019. A year on from the publication of Delivering a net zero NHS, the NHS is on track with its planned trajectory to net zero. Carbon reductions have been reported in areas including carbon-intensive anaesthetic gases (reducing from 23.1% of usage to 10.3% between 2018/19 and 2020/21) and patient and staff travel (137 million virtual GP appointments were delivered between June 2020 and June 2021) – though emissions from travel are expected to rise after the pandemic. Additionally, all NHS trusts have been asked to purchase renewable energy as soon as possible, a prototype zero emission ambulance is in development, and engagement has begun with major suppliers to reduce carbon associated with procurement.
Momentum is also building across the wider health system. Arms-length bodies are starting to develop their roles in supporting sustainable health care. For example, the National Institute for Health and Care Excellence have committed to considering the environmental impact of new technologies, and to working with the Care Quality Commission on an environmental agenda. Royal colleges and individual NHS trusts are declaring climate emergencies and developing plans. There are also increasing numbers of advocacy groups challenging the health system on its environmental commitments.
Climate change adaptation
Adaptation is the action taken to prepare for the effects of a changing climate. Adaptation is necessary (in addition to mitigation) because a certain amount of climate change is already inevitable. This means preparing for the health impacts of climate change, such as changes to patterns of illness, and ensuring that health and care infrastructure is resilient enough to withstand weather extremes and can remain operational during climate-induced disruptions and emergencies. The UK Health Security Agency (formerly Public Health England) leads much of the adaptation planning for health at a national level, such as planning for extreme weather. NHS organisations and local authorities also have responsibilities for adaptation under the Civil Contingencies Act (2004) – the legislative framework for emergency preparations.
Assessments of NHS and social care adaptation planning suggest it needs to be strengthened. The SDU’s Adaptation report for the healthcare system 2015 found that while there were areas of excellent practice, this was not systematic at any level. In 2020, the Environmental Audit Committee concluded that the NHS was not adequately prepared to deal with the effects of climate change. Risks around overheating in NHS and social care facilities were raised by the Climate Change Committee in 2019 and 2021 (for example, it is estimated that 90% of hospital wards are vulnerable to overheating). The extent of overheating risks in social care are unknown, but research has identified barriers to effective heat management in care homes, including building design, inconsistent overheating criteria and lack of staff awareness. Greener NHS is currently producing a report on health and care adaptation to feed into the UK’s national adaptation programme.
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