Sunday 31 October marks the start of the United Nations COP26 climate change conference which will dominate the news, as global leaders come together, we hope to lead our world towards a sustainable future. The NHS has a big part to play in efforts to reduce emissions, as the country's biggest employer and due to the scale of services it provides. We can do better than a "ghastly future" – we know that we need to face the full range of climate change impacts and not only mitigate greenhouse gases but adapt how we live and how we work to the world as it will be in 2050. The NHS has a plan and integrated care systems (ICSs) need to follow suit in recognising climate change as the public health challenge of our century.
NHS England's most recent board meeting was notable for the salience of a positive progress report on carbon reduction from healthcare organisations demonstrating the NHS' unequivocal commitment to reducing its climate impact. Last year, the NHS published its report, Delivering a 'Net Zero' National Health Service, where it set out its commitment to become a net zero-carbon health service by 2040 and 2045. All trusts and ICSs are expected to develop plans by April 2022 to reduce carbon emissions within their locality.
Trusts are building on progress made to date against the 1990 carbon emissions baseline, and embedding sustainability into every part of how they work. New build hospitals represent an opportunity to reframe sustainable design and adapting ambulance fleets is a key priority for the years ahead. Every transport contact, each procurement decision, and using technology to deliver care safely and remotely, represents a contribution. The Greener NHS team are clear that primary care estate now needs a particular focus. An appropriate multi-year capital settlement in the comprehensive spending review must support the NHS to go further, faster.
But the task at hand is huge and time is the enemy. Current inter-governmental targets to cut carbon emissions may keep average temperature increases to below 1.5/2 degrees Celsius. But the wider impacts of climate change mean that the benefit of that will only be felt in the next century. Sea level rises, biodiversity loss and population change mean we need a much broader set of adaptive changes now for the coming decades. The mitigation of the net zero ambition is only the first half of a plan. NHS adaptation is needed.
Climate change and public health: What are we adapting for?
By 2050, it is estimated that nearly 10 billion people will inhabit our planet not today's 7.6 billion. Shifts in migration patterns from countries on the equator to the south and north, will see major changes in who lives where, as temperatures in these countries become too extreme to live and work in. Insects will continue to relocate – with the shifts in infectious disease patterns that this implies. In sum, in thirty years' time we can expect our planet and our politics to seem very different to now.
At a national level, England has seen nine of its 10 hottest years on record within the last decade, with heatwaves expected to become more frequent and severe. Air quality is one of the major challenges we face, with cities across the country adopting clean air zones as London and Birmingham have. The NHS has embraced the immediate carbon challenge as a starting point for a wider plan to adapt to the risks of climate change – alter its ways of working, the services it offers, and the relationship it has with the resources it consumes.
A system wide effort is needed
In our latest NHS Providers survey, 78% of trust leaders insisted/confirmed that tackling climate change is a key priority in the coming 12 months, in spite of the unprecedented operational pressures created by the pandemic and forthcoming winter. Half of respondents told us that they have already made major changes to energy suppliers, procurement plans, transport or the use of plastics in their organisations as part of delivering this agenda.
But the need for expert support from industry to refine plans for change and pick up the pace is also clear. 60% express concern about their bandwidth and ability to deliver in 2022. 75% of leaders want to know more about outstanding approaches to sustainability as we face up to this enormous challenge. Working together is going to be essential. Innovation has to spread fast.
The Newcastle upon Tyne Hospitals NHS Foundation Trust was the first trust to declare a climate emergency over two years ago and is among about a fifth of trusts who have done so. If your ICS has not yet declared a climate emergency, what is holding you back?
We haven't produced a 45-point action plan…instead we have decided to be brave and take a leap of faith, knowing that it was the right thing to do for both population and planetary health.
August 2019Chief Executive, The Newcastle upon Tyne Hospitals NHS Foundation Trust
Tackling climate change and its health effects will be a key matter of board governance and leadership. The work of trust leaders in driving further action on environmental sustainability is an engagement activity which brings the enthusiasm of their teams to the fore, with 98% of front-line NHS employees regarding climate change as a priority. This connects organisations to core purpose and the biggest of big pictures, and those choosing careers can now expect action not words from their future employer. Changes at work will help promote changes at home.
Whether it is de-carbonising and wilding our estate, reducing single-use instruments in theatres, cutting back meat consumption in hospital food, or altering our energy use and supply chain transport, the whole health and care system has a massive part to play in shaping the future.
There is no reason a contribution to the green economy cannot be central to the social value duty each ICS will need to demonstrate when the Health and Care Bill is passed. If the NHS has to manage today while shaping tomorrow, climate change is the real test of our ability to deliver. It cannot wait.
This blog was first published by HSJ.