A quick recap - what does the report say?

• Declares a ‘Health Emergency’: NHS Chief Executive Sir Simon Stevens acknowledges that “the climate emergency is also a health emergency”.
• Acknowledges NHS Contribution to Carbon Footprint: The NHS recognises its own contribution to UK carbon emissions (~4-5% of total emissions) and the role it has to play in reducing these emissions.
• Creates ambitious but deliverable targets: For the emissions the NHS controls directly (the NHS Carbon Footprint), to become ‘Net Zero’ by 2040, and for the emissions the NHS can influence (NHS Carbon Footprint Plus), to be ‘Net Zero’ by 2045.

What do we mean when we talk about Net Zero?

To achieve net zero carbon emissions, the amount of greenhouse gas produced by an organisation or state must be equal to the amount of greenhouse gas they remove from the atmosphere. This combines two approaches:

1. Reducing greenhouse gas emissions: This can be achieved through schemes such as reducing energy consumption or switching to more renewable energy sources or suppliers.
2. Removing more greenhouse gas from the atmosphere: This is typically achieved through ‘carbon offsetting’ schemes, which are designed to make equivalent reductions in carbon dioxide in the atmosphere.

How must NHS organisations change to meet targets and who will lead?

The NHS ‘Net Zero’ report plans “to close the gap to net zero the NHS will need to remove 6.1 MtCO2e from the NHS Carbon Footprint and 24.9 MtCO2e from the NHS Carbon Footprint Plus, roughly equivalent to the emissions profile of Croatia”. 

Achieving change of this scale will involve all NHS organisations as well as the 1.3 million staff the NHS employs.

Organisations will need to adapt their approaches in two key areas:

Strategy:

The NHS ‘Net Zero’ targets are long-term ambitions. Strategically, this is a significant shift in perspective for NHS organisations which historically have been asked to meet short-term targets.

Organisations will need to agree local visions for carbon reduction, engraining environmental considerations into all key decision-making processes including option appraisals.

Transformation:

Environmental considerations should consequently be included in all Capital Programmes and transformation processes, ranging from transforming estates and facilities to designing new innovation clinical models.

Achieving this will require organisations to build staff ownership of the ‘Net Zero’ agenda, engaging both clinical and managerial staff in leading these transformations.

These changes will be most effectively and efficiently directed from a System-level. This is because Systems can simultaneously influence national policy, NHS supply chains, new models of care, travel and transport, and estates and facilities – consequently enabling organisations to act in a coordinated manner towards achieving longer term targets.

What challenges are we likely to come up against?

This is an ambitious target, so it’s unlikely to be a smooth road. To begin on this journey, the NHS will need to address several pressing challenges to support health and care systems:

1. Securing Funding for Net Zero: Over the medium to long-term, central government will need to provide further funds to match the strategic NHS Net Zero ambitions laid out in the Delivering a Net Zero National Health Service report. This will be essential to support Health systems and organisations to deliver the transformation required to meet these ambitions.
2. Creating Space for Net Zero: NHS Systems and organisations will need to take into account the longer-term impacts of interventions in their decision-making processes. This should be supported through updates to the NHS Constitution to make this a clearly stated legal requirement, and updates to the Green Book options appraisal guidance.  
3. Building Support for Net Zero: Healthcare organisations should unite in supporting the NHS to deliver this mission. Royal Colleges and NICE should be engaged, and should help develop guidance for healthcare workers, organisations and Systems on how to deliver these ambitions.

We're fascinated to speak to other people in this area, so please do get in touch with us if you have any thoughts on how the NHS can reach its Net Zero targets at hello@thepsc.co.uk. 

Author: Louis Jamart and Sam Rose