By any measure, the NHS is a behemoth. Its 1.3 million staff are spread out across 1,200 sites plus a further 7,600 GP practices in England alone. Every year NHS-related travel – including ambulance journeys, staff commutes and patient visits – adds up to 9.5 billion miles, which is further than the distance from Earth to Pluto. In England, nearly 3.5 per cent of all road miles involve the NHS. As of July 2017, the NHS dealt with more than one million patients every 36 hours.
All this adds up to a sizeable environmental impact. Health and social care in England alone is responsible for between four and five per cent of the UK’s entire carbon footprint – but the NHS has a plan to push that figure way down. On January 25, NHS CEO Simon Stevens announced its plan to reach net-zero carbon emissions ahead of 2050. It’s one of the biggest and most complex decarbonisation projects the UK has ever undertaken but can it pull it off?
One thing the NHS has in its favour is that it has a pretty good idea about its current environmental footprint. “One good thing about Brexit, is the NHS has had to do a very detailed audit of where their its chains come from because it was concerned about the impact of Brexit on its supply chains,” says Piers Forster, director of the Priestley International Centre for Climate at the University of Leeds and a member expert panel overseeing the NHS’ net zero efforts.
In 2017, the NHS emitted 27.1 million tonnes of carbon dioxide equivalents into the atmosphere – roughly the same emissions as Jordan. But only 23 per cent of that comes from things the NHS can directly control, like heating and electricity, NHS transport and waste. The biggest slice of its emissions – 15.5 million tonnes of carbon dioxide in 2017 – comes from its vast supply chains. The carbon cost of medical equipment and drugs alone outweighs emissions from electricity, heating and business travel.
One way to chip away at this figure would be to make sure the NHS isn’t buying equipment or drugs that end up being wasted. “The main thing is you have to look at the efficiency of course. You have to ask, do you really have to have all of those supplies,” says Forster.
The carbon footprint of supplies is also tied to the country they were produced in. In 2018, more than two-thirds of China’s electricity generation was powered by coal, for example, although the country is making vast efforts to increase its share of renewables. By turning away from suppliers that are reliant on carbon intensive power, the NHS could encourage other businesses to shift over to renewables.
“The NHS represents close to ten per cent of the UK’s economy, so it has considerable buying power,” says Helen Clarkson, CEO of The Climate Group, a non-profit that helps businesses and governments address climate change. By exercising its influence as a buyer, the NHS could have an impact far beyond the UK.
The health service will also benefit from other parts of the economy decarbonising. In 2010 Great Britain generated three-quarters of its electricity from coal and natural gas, but now these fossil fuels make up around 40 per cent of the energy mix. Over the same period, electric and hybrid car sales jumped to ten per cent of the UK’s total new car sales.
All this has helped the NHS make a sizeable dent in its emissions already. Between 2007 and 2017, its carbon emissions fell by 18.5 per cent, equivalent to the annual emissions from a small country like Mauritius or Cyprus. Other easier fixes could come from switching away from metered dose inhalers which are currently used to treat lung conditions and make up over 3.2 per cent of the NHS’ entire carbon footprint to dry powder inhalers that contain much smaller amounts of greenhouse gases. The NHS also wants to reduce the number of outpatient appointments by 30 million every year – perhaps by shifting to virtual consultations – which will have a knock-on effect on the number of journeys people make to hospitals and GP surgeries.
If it gets things right, these changes could have an impact beyond the NHS’ climate footprint, says Nick Watts, chair of the net zero panel. “If you do this properly [...] there are some enormous health benefits out the other side that result in improved public health, cleaner air, healthier diets, more liveable cities,” he says. Air pollution is linked to heart disease, stroke risk and lung cancer, and increased temperatures are likely to up the rates of Lyme Disease and encephalitis in the UK.
“If you don't address climate change you threaten the viability of health systems around the world,” says Watts. The panel doesn’t currently have a date set for its net zero target, but Watts hopes they’ll have an initial pathway sketched out in time for the 26th UN conference on climate change, being held in Glasgow in November 2020.
But there might be only so low the NHS can push its carbon emissions. Disposable items like catheters and syringes are packaged in single-use plastic and eventually incinerated. Balancing out these lingering carbon costs might mean the NHS will end up turning to carbon capture technology that extracts carbon dioxide from the atmosphere, says Forster. “I absolutely think that if we’re looking at a net zero carbon goal for the NHS that we’ll certainly have to think about things like carbon capture for those very difficult carbon emissions,” he says.
For now, though, the focus will be on squeezing emissions as low as they can go. “What I would say is let’s work on the reduction first,” says Watts. “I don’t want to start there, because I’m worried that by starting there we’ll tend ourselves into complacency.”
Matt Reynolds is WIRED's science editor. He tweets from @mattsreynolds1
This article was originally published by WIRED UK
