Speaking at a Health Foundation webinar last week (December 8), Dr Nick Watts, Chief Sustainability Officer for NHS England & NHS Improvement and Lead of the Greener NHS Team, outlined a number of initiatives planned for introduction over the next couple of months to take the NHS on the next stage of the net zero journey.
The webinar, ‘After COP26 – what will it take to get the NHS to net zero?’ took the form of a panel discussion, chaired by Jennifer Dixon, Chief Executive of the Health Foundation, and also featuring Professor Mahmood Bhutta, Co-Founder Sustainable Healthcare Group at Brighton & Sussex Medical School, Sonia Roschnik, International Climate Policy Director at Health Care Without Harm and Adam Vaughan, Chief Reporter at the New Scientist.
During a brief summary of activity and achievements on net zero targets in the last 12 months, Dr Nick Watts said the NHS is cautiously proud to say it believes it has achieved its year one target. This includes removing 1,260 kt (kilotonnes) of carbon – roughly 352 kt of this has been removed from the estate. Nick was quick to add that year one is easy - it will get harder in each subsequent year from now.
Coming in the next two months
A new and lengthy net zero hospital standard will be released to be applied to every new build over £15m and every new site. "It is challenging and it will change how we think about healthcare,” Nick stated. He added: “It's not perfect yet. You can’t build a net zero hospital today and anyone who tells you that they have, I promise you, is lying. We can get there in about five/six years, when the technology catches up."
On January 1, 2022, 10% weighting in every single NHS tender will come into effect. This will be another challenging programme, since procurement across the NHS is controlled by thousands of individuals. This will require an education process, to start to embed low carbon thinking into the way the NHS procures. It will be aligned with a new sustainable procurement framework.
Nick and his team will work with every Trust and Integrated Care System (ICS) to ensure each has a board-level lead for the organisation’s net zero commitments and a net zero strategy. As of December 8, 81% had a net zero board lead - up from 6% just 12 months ago - and 82% either already have, or are only one month away from completing their net zero strategy - up from 17% 12 months ago. This is progress at an enormously fast pace, but, as Nick pointed out, it means that 19% and 18% respectively still don't. “Everyone has to get there, and that’s what we will be focusing on over the next two months.”
Where net zero fits within the new Health and Social Care Bill was discussed properly during the second reading of the Bill in the House of Lords recently. This was encouraging, and indicates high level support to helping the NHS to meet the net zero commitment.
Primary care will also be a focus. A new innovation competition is being launched for low carbon primary care which will aim to support and scale-up the good ideas from across the country. ICS green plans will be essential, providing the link between the 42 ICSs and the primary care community. Investment in a new partnership with the Royal College of GPs with a view to developing practical guidance for GP practices outlining positive action they can take now towards this agenda.
More investment is to come into the ambulance fleet of the future. A fully electric ambulance is already in use carrying patients and trials will start soon of an electric-hydrogen hybrid model. “Two is not enough – we need five,” Nick said, confirming more investment in innovation around how to run a zero emission ambulance, including trials with ambulance Trusts. In two and a half years there will be a new national specification to prevent the NHS from purchasing out-dated ambulances. “Zero-emission ambulances are the future.”
When questioned over what else NHSE/I has in its power to nudge the net zero agenda forward at a system level, Nick replied quite simply, capital. In the capital guidance coming out in the next few weeks it will no longer be a question of just where capital is spent but what is being spent on net zero, together with starting to report back on how that capital is contributing to the net zero journey of the NHS.
Whose responsibility is it?
There was a very clear view that whereas originally the net zero target was viewed as an Estates & Facilities task/responsibility, there is now greater awareness that it is more than that. It is understood that clinical engagement and input is essential, closely linked with the transformation of how healthcare services are delivered, as well as the behaviour - and expectations - of patients themselves, including how they travel to appointment, whether those appointments have to be face-to-face and where they receive care.
Nick made the point that NHSE/I cannot deliver on this agenda alone because it cannot directly control all of the influencing factors. It therefore needs all 1.4 million healthcare professionals who are making daily decisions to engage and create that movement towards net zero, with guidance from organisations like the Health Foundation.
Professor Mahmood Bhutta took the point further with a simple example around the practice concerning single-use gloves, which is inconsistent from Trust-to-Trust, often as a result of differing infection prevention and control policies. There is a tendency for single-use gloves to be a substitute for more – and more frequent - hand washing. The approach is disjointed and central guidance on this practice, which also considers the impact on the environment, would be beneficial. There is also, he said, a misconception in operating theatres that single-use is better, but with our advanced sterilisation systems this may not be the case. "We just need to change the system," he insisted.
Changing the system involves suppliers making suitable products available that are designed to last; to be sterilised and re-used.
There is much talk of offsetting. The advice was to focus on decarbonisation first and foremost because it is not possible to offset all healthcare emissions. Tree-planting, for example, will enable around 0.8 - 1.2% of emissions to be offset. "We can't buy our way out of this," was the stark warning from Sonia Roschnik.
Dr Nick Watts advised tackling the agenda in small chunks. Keep focusing on reducing emissions where that is possible and eventually what is left will be a bucket of carbon that cannot be reduced any further. That is the point at which we need to start to look at offsetting, but we are not there yet. When we get to that point, Nick added, we have to hope that innovation will bring us new ideas.
In addition, don't get fixated on recycling. The focus should be on reduce and reuse. "We will never be able to recycle enough to make the difference," said Mahmood. "We need equipment that is made to re-use and to last."
At COP26, 14 other healthcare systems around the world also committed to reach net zero carbon – some on a shorter timeframe than the NHS and not all with a strategy for how this will be achieved. The NHS is investing into a new partnership with the World Health Organization to help and work with those countries and others, to share the expertise and what it has learned so far (including what it has done wrong), and to develop, lead, and move together to a net zero healthcare system with all 196 global healthcare systems.