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NHS Chief Sir Simon Stevens has today announced the NHS and its staff will step up action to tackle the climate “health emergency” this year, helping prevent illness, reducing pressure on A&Es, and saving tens of thousands of lives. The initiative follows the launch of the Climate Assembly UK this week, which is discussing how the country can best get to ‘net zero’.
The causes of air pollution and climate change are often the same, so the ‘For a greener NHS’ campaign will help address both. The health and care system in England is responsible for an estimated 4-5% of the country’s carbon footprint.
Air pollution is linked to killer conditions like heart disease, stroke and lung cancer, contributing to around 36,000 deaths annually.
A recent study by Kings College London looking at nine English cities demonstrated that on high pollution days there are 673 additional out-of-hospital cardiac arrests and hospital admissions for stroke and asthma, with spikes in ambulance 999 call outs.
Last month a group of 175 doctors warned that air pollution is directly adding to current pressures in accident and emergency departments.
The changing climate is leading to more frequent heatwaves and extreme weather events such as flooding, including the potential spread of infectious diseases to the UK. Almost 900 people were killed by last summer’s heatwaves while nearly 18 million patients go to a GP practice in an area that exceeds the World Health Organisation’s air pollution limit.
Scientists believe perhaps a third of new asthma cases might be avoided by cutting emissions while Lyme Disease and encephalitis are among conditions expected to become more common as temperatures rise.
Health chief Sir Simon Stevens has today announced three steps the NHS will take during 2020 to tackle this problem.
First, NHS England is establishing an expert panel to chart a practical route map this year to enable the NHS to get to ‘net zero’, becoming the world’s first major health service to do so.
Dr Nick Watts, of University College London, will chair the NHS Net Zero Expert Panel. He is a medical doctor and executive director of Lancet Countdown, the independent international expert group that tracks the links between climate change and health. The NHS in England is the only health-care system in the world that is routinely reporting on greenhouse gas emissions. The Expert Panel will look at changes the NHS can make in its own activities; in its supply chain; and through wider partnerships – thereby also contributing to the government’s overall target for the UK.
These include the Long Term Plan commitment to better use technology to make up to 30 million outpatient appointments redundant, sparing patients thousands of unnecessary trips to and from hospital. It is estimated that 6.7 billion road miles each year are from patients and their visitors travelling to the NHS.
It will also look at changes that can be made in the NHS’s medical devices, consumables and pharmaceutical supply, and areas the NHS can influence such as the energy sector as the health service moves to using more renewable energy.
The Panel will submit an interim report to NHS England in the summer with the final report expected in the Autumn, ahead of the COP26 International Meeting in Glasgow.
NHS chief executive Sir Simon Stevens said: “With almost 700 people dying potentially avoidable deaths due to air pollution every week we are facing a health emergency as well as a climate emergency.
“Patients and the public rightly want the NHS to deliver for them today, and to help safeguard the future health of our children and grandchildren.
“While the NHS is already a world leader in sustainability, as the biggest employer in this country comprising nearly a tenth of the UK economy, we’re both part of the problem and part of the solution.
“Indeed if health services across the world were their own country, they’d be the fifth-largest emitter on the planet.
“That’s why today we are mobilising our 1.3million staff to take action for a greener NHS, and it’s why we’ll be working with the world’s leading experts to help set a practical, evidence-based and ambitious date for the NHS to reach net zero.”
Sir Simon will also act as an adviser to Climate Assembly UK.
Dr Nick Watts, chair of the new NHS Expert Panel, said: “The impact of climate change on our health is there for all to see and at the Lancet Countdown, we have amassed the evidence to encourage health systems across the world to take action.
“The NHS in England leads the world in taking action on climate change and improving public health along the way, so I am delighted to have been asked by Sir Simon Stevens to help chart a route to a net zero health service.
“Everyone who works in healthcare has a responsibility to take action on the health emergency posed by climate change, and I encourage all NHS staff to join the campaign to feed in their ideas and help drive this forward.”
In addition to the expert panel, Sir Simon announced two other measures the NHS would now be taking.
The NHS will be taking immediate action in 2020, with a proposed new NHS Standard Contract calling on hospitals to reduce carbon from buildings and estates, whilst switching to less polluting anaesthetic gases, better asthma inhalers, and encouraging more active travel for staff.
The health service will also now launch its own grassroots campaign ‘For a Greener NHS’ to encourage staff and hospitals to cut their impact on people’s health and the environment.
The ‘For A Greener NHS’ campaign will be supported by the UK Health Alliance on Climate Change – which includes representative bodies covering over 650,000 NHS staff. The campaign will build on the work already underway to help trusts and staff to cut emissions, energy use and waste, including phasing out oil and coal boilers and increased use of LED lighting and electric vehicles.
Staff and local NHS organisations are being encouraged to feed in ideas to the Expert Panel, and evidence of steps they may have already taken within their own hospital. A new website https://www.england.nhs.uk/greenernhs/ will help local NHS bodies to share ideas and ramp up initiatives that are already working across the health service.
Collectively the NHS’ 1.3million staff could make a huge impact on the campaign. For example, each person switching to refillable water bottles instead of plastic bottles could save 65kgCO2 per year. One London trust showed that just by turning off printers, computers and other equipment overnight and managing heat loss each staff member was able to reduce CO2 emissions by an average of 70kg a year.
Professor Carrie MacEwen, Chair of the Academy of Medical Royal Colleges said: “We know our own health and the health of our planet are inextricably linked, so it’s great that the NHS is taking this lead and it’s certainly something everyone who works in the NHS or uses it should get fully behind.”
Professor Andrew Goddard, Royal College of Physicians President, said: “The climate emergency is a health emergency, with doctors and other clinicians already seeing the impacts associated with air pollution, rising temperatures and extreme weather events on the patients they treat. Climate change isn’t something we can afford to delay acting on so it’s positive to see the NHS showing leadership on the issue.
“The NHS as an employer can support staff to do small things which can all make a difference. However, it’s clear that we must also focus on the impacts of the system as a whole, and how the NHS can move towards net-zero as quickly as possible. It must use all the levers available to it, particularly those which encourage suppliers to move towards net-zero.
“Hospitals also have an opportunity to use their influence as key anchor institutions in local communities to drive positive change beyond their walls. Together staff and hospitals can make a big impact relatively quickly, by reducing wastage and promoting active transport. I know our members stand ready to help.”
Dr Katherine Henderson, president of the Royal College of Emergency Medicine, said: “This is an important initiative for the NHS, and we would encourage all staff to sign up.
“The air pollution and increased frequency of adverse heat events caused by the burning of fossil fuels lead to higher rates of respiratory and cardiovascular diseases and mental health crises, all of which will increasingly impact on the already stretched emergency care system.
“The Royal College of Emergency Medicine has declared a climate emergency and is exploring ways in which we can help tackle the problems, both as an organisation and a specialty. We encourage every organisation and specialty in the healthcare sector to look at what they can do to be ‘greener’ and supporting the ‘For a Greener NHS’ campaign is a great place to start.”
Dr Nick Scriven, immediate past President of the Society for Acute Medicine, said: “We have all seen the results of extremes of hot and cold weather impacting on the front line of the NHS with people suffering from illness requiring hospitalisation more frequently during these extremes. Coupled with the figures confirming the impact of pollution and poor air quality it is time for the NHS and its staff to play their part whenever possible.
“This initiative is a step in the right direction and I look forward to working with colleagues in doing what we can to help.”
Kay Boycott, joint chief executive of Asthma UK and the British Lung Foundation, said: “Breathing in toxic air is particularly dangerous for the 12m people living in the UK with lung conditions, sometimes with fatal and devastating consequences. High pollution can trigger asthma attacks and COPD exacerbations, and worsen symptoms for people already struggling to breathe.
“It’s in all our interests for healthcare to be as environmentally friendly as possible, whilst ensuring patient care is not compromised. There is so much the NHS can do, from cleaning up the vehicle fleet to advising respiratory patients on the risks of air pollution. We are pleased to see this commitment by the NHS and look forward to seeing action very shortly.”
Jacob West, executive director of healthcare innovation at the British Heart Foundation said: “As one of the country’s largest employers, the NHS has a critical role to play in curbing air pollution – and this commitment today shows they intend to take the lead in protecting the nation’s health. A net carbon zero NHS will help reduce levels of fine particulate pollution, as many of the sources of CO2 and fine particulate matter are the same. These tiny particles enter our bloodstream, and can get stuck in organs such as our heart, increasing the risk of a heart attack or stroke.
“By encouraging NHS workers to share car journeys and take public transport, the health service will play a valuable role in the much needed reduction of air pollution levels. Cutting levels of toxic air will in turn mean fewer cases of disease in the years to come – we hope other organisations will now follow NHS England’s lead.”
Chris Hopson, chief executive of NHS Providers, said: “Given the size of our carbon footprint, the NHS has both a moral obligation and a unique opportunity to lead national action to address our current global climate emergency.
“Given that global warming is inexorably leading to significant increases in a range of physical and mental health conditions including cancer, heart attacks, anxiety disorders, strokes and severe asthma attacks, it also makes complete sense in terms of trying to manage future health demand.”
UNISON general secretary Dave Prentis said: “Involving staff is crucial if the NHS is to help the UK meet its emissions targets in good time. They know more than anyone how the health service ticks and so are best placed to make practical green suggestions to get the NHS to where it needs to be.
“But the implications for the NHS building stock are huge. Everyone must now work together to understand how environment-harming heating and lighting systems can be replaced without redirecting funds from patient care.”
Niall Dickson, chief executive of the NHS Confederation, said: “Britain will not achieve its green ambition unless we transform the way the NHS operates. The health service represents more than 10 per cent of the economy, it is the biggest employer in the country and it produces vast amounts of carbon. But the challenge is also a great opportunity – working with local government, its thousands of suppliers and its million plus staff, the NHS can be a major force in building a green future. Our members are already making progress but they are committed to doing much more as we aim to create a carbon-free NHS.”
BMA representative body chair Dr Helena McKeown said: “As doctors, we are becoming increasingly concerned about the damaging impact that air pollution is having on the public’s health, young and old, from lung conditions to heart disease, diabetes and dementia.
“On a wider level, the world is beginning to wake up to the reality of the lifelong health consequences that those born today will be subject to if urgent action is not taken to combat rising temperatures.
“As those tasked with looking after the health of the nation, it is positive to see that our health service is already leading by example by providing environmentally friendly healthcare for patients.
“Going this step further demonstrates the kind of ambitious action that we need to see from other organisations, and importantly from the Government and corporations, if we are to accelerate the point at which we can achieve carbon neutrality and ultimately protect the health of future generations.”
Will Clark, executive director – Health Care Without Harm (HCWH) Europe, said: “The health sector is on the frontline when it comes to dealing with the ever-increasing effects of climate change, and yet the sector is contributing to the problem through greenhouse gas emissions from its activities, undermining the health of the very communities it serves – globally, the healthcare sector’s climate footprint is equivalent to 4.4% of global net greenhouse gas emissions and in the UK healthcare is responsible for 5.4% of the country’s net emissions.
“As the health and environmental impacts of climate change become ever clearer, the healthcare sector needs to recognise the opportunity it has to lead the way in tackling this global crisis and take immediate action to reduce its own carbon footprint.
“The healthcare sector is a large-scale procurer of food, energy, pharmaceuticals, and chemicals – considering the products they choose and how they purchase and use them can have a huge positive impact on patient wellbeing and healthcare costs, as well as reducing environmental harm.
“This announcement provides a shining example of how a national health system can respond to the goals of the Paris Agreement and the UN’s sustainable development agenda (SDGs). By committing to net-zero and demonstrating that this can be done, the NHS will provide a model for other health systems in Europe to emulate, leading the way for the rest of the world to follow.”
Professor Martin Marshall, Chair of the Royal College of GPs, said: “The effects of climate change can have a severe impact on the health of patients – and in the UK, we are already seeing the emergence of a second seasonal peak in demand for NHS services right across the system due to heat-related conditions over the summer.
“As a College we accept our responsibility to provide leadership in tackling climate change and already have a strong track record on environmental sustainability as the first medical Royal College to divest from fossil fuel companies.
“The aspiration for the NHS to become net-zero on carbon emissions ahead of the national target of 2050 is both good and necessary. We look forward to seeing robust policy recommendations come from this review as to how we can make this happen, and that these are implemented and backed by appropriate funding.”
Dr Jennifer Dixon, Chief Executive of the Health Foundation said: “This campaign is good for the planet, good for our health, and a good initiative from Britain’s largest organisation.”
Professor Derek Alderson, President of the Royal College of Surgeons of England, said: “The latest research shows that climate change is already harming human health around the world. Flooding enables contagious diseases to spread, bush fires lead to loss of life and affect air quality for millions, while pollution in cities around the world is damaging lung health.
“We know climate change is bad for our health, so it is vital the NHS, and all health organisations, play our part. In the world of surgery, we are looking at how to make operating theatres ‘greener’, and promoting active travel. Cycling or walking has the double benefit of reducing carbon emissions and being good for your health. It is vital, both for the planet and human health, that we work together to reduce our environmental footprint.”
Dr Richard Smith, Chair of the UK Health Alliance on Climate Change, said: “The World Health Organisation has described climate change as ‘the defining health challenge of our time’, and through heatwaves, flooding, and air pollution, it is already shortening the lives of people in the UK and around the world.
“But we know that actions that are good for the planet are also good for our health. By reducing our emissions, for example by cycling or walking instead of driving, we can simultaneously improve our health and the health of the planet.
“Health professionals have a duty to protect the health of the public so it’s fantastic that the NHS is leading by example and taking action to end its contribution to this climate and emergency. The UK Health Alliance on Climate Change, which represents over 650,000 health professionals working across the NHS, fully supports this campaign.”
Dr Lucy Williams, Royal College of Anaesthetists Council Lead for Sustainability, said: “The NHS Long Term Plan commits the health service to reducing its carbon footprint, and has challenged the specialty of anaesthesia to deliver 2% of this reduction by transforming anaesthetic practices. The NHS produces higher emissions than the global average for healthcare with 5% of the carbon footprint from acute organisations coming from anaesthetic gases. Just one hour’s use of desflurane gas is the equivalent of driving 230 miles.
“Meeting targets will require a fundamental shift in clinical practices – NHS hospitals and their anaesthetic departments and teams must recognise the need for change and take appropriate actions. The College is committed to collaborating with the Association of Anaesthetists and other stakeholders to promote sustainability and work towards increasing the use of less harmful anaesthetic agents, amongst other actions. Together we can help tackle the climate ‘health emergency’ and deliver a more environmentally sustainable future.”
Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing, said: “As the largest profession delivering healthcare, nursing is uniquely placed to advocate, educate and lead action to mitigate the risks associated with global temperature increases.
“RCN members recognise the importance of healthcare providers acting on climate change now for the benefit of patients and population health. As a profession, we can influence in driving changes to help us practice, work and live in more sustainable ways.
“The RCN is already taking steps to help nursing staff and their employers reduce avoidable waste through initiatives such as our Glove Awareness Week, which aims to educate nursing staff about appropriate glove use. We also support members to get involved in decisions about procurement, and contribute ideas to making care more sustainable, through our ‘Small Changes, Big Difference’ campaign.
“There is already great work happening with members changing practices to help reduce their workplace’s carbon footprint, while improving care. We’re committed to extending that to help all those involved in healthcare to reduce the impact on the environment on delivering such care.”
Rachel Stancliffe, Director of The Centre For Sustainable Healthcare, said: “We are very excited about the Green NHS plan – we will all work together this year to develop a detailed plan to support managers, clinicians and all staff to be part of a sustainable health system.
“This is a critical time for our health, our future, and we all have a huge responsibility to develop a detailed plan for how we are going to get to net zero carbon.
“The Centre for Sustainable healthcare has been developing models of sustainable healthcare for 12 years and we are very excited to be part of a properly supported and resourced plan to embed these in the mainstream.”
ACEVO CEO Vicky Browning said: “Tackling climate change should be on the agenda of every workplace across the globe, and I am pleased that NHS England is taking action through this new campaign.
“Climate change isn’t someone else’s responsibility, it is all our responsibility and we should work collectively across the public, private and not for profit sectors in order to halt the climate crisis. ACEVO looks forward to working with and supporting NHS England on this important initiative.”