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How the NHS net-zero ambitions force us to invest time and financial resources into our health system for the benefit of the environment.

Promises have been made from all sides when it comes to the environment, and for the most part, little has been done to achieve the dramatic change that needs to happen. The environmental crisis is officially a health crisis, with asthma, cardiac problems, and cancer all on the rise due to environmental factors, and access to healthcare becoming increasingly limited in some areas due to severe weather. The NHS net-zero pledge is bold, but is it a viable reality or just another pipe dream? And can we achieve the change we need to see in the proposed time frame?

By investing time and financial resources into the digitisation of health and achieving the NHS net-zero ambitions, we will benefit nationally, businesses will benefit financially and individuals will benefit in terms of their health. The pressure and urgency we face to achieve these goals will be instrumental in inspiring a green revolution when it comes to healthcare, as well as the industries that serve it.

Nested model of sustainability

Previously, people thought sustainability was the intersection between the three pillars of society, the environment, and the economy. This view has been superseded by the nested model of sustainability (Fig 1). This highlights that without a functioning living world, there will not be the opportunity to have a functional society. Without a society, there cannot be an economy for the latter is unequivocally dependent on the former. The traditional approach that the economy is somehow more essential than the other two pillars is demonstrably false.
Furthermore, the initial investment of time and resources into achieving net-zero will eventually pay off. Climate change is a real problem, recognised across all business sectors and all countries across the globe, but there is still hope. There is a window of opportunity but is it closing fast. Through a combined global effort, the progression towards a runaway climate with soaring temperatures, passing the irreversible tipping points of ice cap loss and rising sea levels, can be avoided.

By understanding what a carbon footprint is, recognising the sources of greenhouse gas emissions through our personal and professional lives, positive action to reduce the harm being caused to the natural world is possible, many would even say essential.

Current emissions and breakdown

The NHS contributes to around 4.4% of global emissions and can be broken down into various sectors. The NHS carbon footprint is around 24% and consists of building energy, water and waste, anaesthetic gases and metered-dose inhalers, business travel, and NHS fleet. Travel makes up around 10% and consists of patient travel, visitor travel, and staff commute, but the most substantial contribution is that of the supply chain (62%). For the NHS to reach net zero, the supplier alignment to the Net Zero commitments is essential, and this includes low carbon alternatives to current equipment.

Net zero ambitions

“As part of the NHS net-zero plan, all suppliers must have a carbon reduction plan and net-zero targets. Suddenly, you’ve got the influence of one organisation or one sector that is spreading out its ripples to 10,000 other businesses. If they then have to instruct the same to their suppliers in order to be compliant, then actually that ripple spreads even further.”

Dr. Matthew Sawyer, Latus Health Advisory Board member and Director of SEE Sustainability.

There is a Net Zero Supplier Roadmap which is due to be fully available this year. Within it, there are various milestones for suppliers including:

· From April 2023: the NHS will adopt the Government’s ‘Taking Account of Carbon Reduction Plans‘ (PPN 06/21), requiring all suppliers with new contracts for goods, services, and/or works with an anticipated contract value above £5 million per annum, to publish a carbon reduction plan for their direct emissions.

· From April 2024, the NHS will expand this requirement for all new contracts, irrespective of the value.

· From April 2027: all suppliers with contracts for goods, services, and/or works for any value, will be expected to publish a carbon reduction plan that takes into account the suppliers’ direct and indirect emissions.

Is remote health part of the solution?

Digital technologies provide many opportunities to reduce the carbon impact of health and care services. In the 12 months to June 2021 virtual appointments are estimated to have saved carbon equivalent to taking 40,000 cars off the road for a year. Remote monitoring technologies are estimated, over the next 3 years, to reduce patient travel by 28 million miles. That’s almost 6,000 tonnes of carbon and is equivalent to taking 1,283 cars off the road for a whole year. Between June 2020 and 2021, 247,000 GP appointments were managed, and 365,000 online consultations were completed through the NHS App, resulting in a reduction of approximately 386 tonnes of carbon dioxide.
Whilst virtual appointments can be instrumental in reducing the emissions associated with travel to in-person appointments and the emissions under the direct control of the NHS, it is also an essential tool for facilitating access to healthcare during the environmental disasters that we’re seeing more often. Dr. Sawyer pointed out that the increasing severity of the climate crisis has contributed to a significant amount of natural disasters, highlighting flooding as being one of those that have caused problems. He spoke of the 2019 flooding which affected the village of Reeth, North Yorkshire, so severely that accessing the village became impossible for healthcare professionals.

Remote access to health will be critical in preventative medicine and maintaining good health, whilst also eradicating certain barriers to accessing healthcare. Access to healthcare for all at a time and place which is convenient to them is essential – especially for those currently marginalised or unable to access traditional forms of healthcare. For example, in Hull, the results from the people’s panel survey in July 2021 showed about a third of people didn’t feel they could access their GP without a car. Digital healthcare could – when provided correctly – help overcome some of the traditional barriers to access.

Pipe dream or viable reality?

With the correct amount of pressure on the supply chain, NHS net zero is a viable reality. Suppliers have to conform with the new guidelines or risk not being able to provide at all, effectively by removing the factor of choice, there’s a sense of increased urgency for the supply chain to prioritise sustainability. The increase in remote health and virtual appointments also has the potential to drastically reduce the emissions produced by NHS buildings and transport, whilst also improving patient and employee experience. The real question is, is the pledge too little too late? And how can other sectors be motivated to act in order to achieve the dramatic reduction required?