These facts underline the scale of the challenge that NHS England and NHS Improvement are looking to tackle through the release of its NHS Net Zero plan earlier this month.
The plan outlines a desire to be net zero carbon by 2040. It also outlines the same target for emissions from their supply chain and patient and visitor travel by 2045, an initiative they have called Carbon Footprint Plus.
More than 50% of greenhouse gas (GHG) emissions for which the NHS is responsible, in the widest sense, come from the supply chain; the MRI scanners, syringes, food, inhalers, medicines and so on.
This means in total that before 2045 that the NHS needs to remove around 30 MtCO2e, which as the report cites is roughly the same emissions profile as a nation like Croatia (population 4 million).
The plan is to divide the actions into direct actions the NHS can take and enabling actions, which involve others. I have broken down five key areas for focus:
1. The NHS Estate: The NHS estate is both large and varied, reflecting the wide range of services provided by the health system. The Naylor Report in 2017 cited that NHS Trusts occupy 1,200 sites on 6,500 hectares, and that is before factoring in over 7,000 GP sites in primary care. The NHS Zero Report states that the current estate accounts for 15% of the total emissions profile.
The Health Infrastructure plan provides an opportunity to rationalise the estate with renewals providing opportunity for better building fabric, new zero-carbon heating systems, and the disposal of carbon-heavy assets. But the 2040 target will demand that the 40 new hospitals promised by the current UK Government before 2030 be net zero from the start.
Is this realistic? A new Net Zero Carbon Hospital Standard will be available in Spring 2021. The ambition in this standard will set the tone for the new hospitals, some of which will have well-developed designs by Spring.
The standard will provide a good indicator of the ambition targeted for retrofit of the existing estate, which dwarfs the 40 new hospitals in scale, complexity and impact and thus already needs active consideration of decarbonisation in estate strategies.
2. Transport and mobility: 3.5% of road travel in the UK relates to the NHS, accounting for 14% of the NHS’s total emissions. Electrification of the NHS transport fleet by 2032 is key, there are precedents in both the public and private sector to support both fleet upgrades and infrastructure development. This will also reduce operational costs and improve air quality. The NHS can also take comfort from the benefits brought about by a shift to a focus on walking and cycling, something that aligns with the NHS focus on preventive healthcare measures that may prevent patients from travelling to healthcare facilities.
3. Behavioural change: The report refers to the fact that “An upskilled workforce will be needed to drive and implement the interventions outlined in this report”. Interventions include the introduction of a new training package for staff working in estates.
Nudge theory, and behavioural science is cited by the report; and remains a critical enabler across all industries to support GHG Emission reduction.
With NHS Trusts operating on over 26 million sqm of estate, turning things off, checking controls and managing systems better will all have a part to play in reducing emissions, and builds on existing behavioural trials elsewhere in the NHS.
4. Digitisation: Digital presents enormous opportunities, from the impact of telemedicine, turbo-charged this year by the constraints imposed by Covid-19, to mobility trends that redefine health itself. If we can ensure digital interaction is secure and accessible to all users, we can greatly improve the quality of service and use digital to support preventive measures that reduce the demand for treatment and care. Undoubtedly digitisation will enable cheaper, more effective and efficient care – and will reduce its carbon footprint. Smart building technology, which manages and optimises systems like heating, ventilation and lighting is market ready and provides another opportunity for efficiency in new and existing estates.
5. The Supply Chain: The supply chain is responsible for more than half of the NHS GHG emissions. NHS Net Zero commits to direct interventions on procurement and, more broadly to engage with the supply chain to encourage it to be zero carbon as well. This represents hundreds of companies in 4.5m orders per year, from huge pharmaceutical companies to small, niche SMEs. 11,500 companies are required to report GHG emissions in the UK alone, and many will benefit from trends around digitisation, mobility and circular economy, there are signs that 2020 could also prompt a shift in thinking brought about by COVID-19.
How will this be financed?
All this investment requires funding. The report does discuss opportunities to use money from internal carbon funds and using procurement to drive GHG emission reductions.
Construction and backlog project budgets and cost plans will need to consider any additional investment to deliver net zero solutions.
But work that WSP has done indicates that net zero strategies can be optimised based on cost: benefit analysis, and net zero interventions can often be self-funded which could prove significant.
Is it viable?
There is good news. Our experience in healthcare, and across the built environment tells us that there is reason for optimism. Technology around zero emission heating systems and mobility, as well as the growth of renewable energy on the grid makes net zero realistic.
It means net zero makes financial as well as environmental sense, and this points to supporting a more efficient and cost-effective future NHS. An NHS that delivers better health outcomes, is cheaper to run and sets its sights on net zero is a goal we can all get behind.
Andrew Wildgust is Director of Healthcare Advisory Services at WSP.