The PSC news-insights: entry

13/12/2023
Strategy, News, Insights

Reaching net zero in the NHS need not compromise patient care - in fact, it should enhance it

Discover how the NHS's net-zero initiatives combat climate change while improving patient care. Explore three key areas: energy-efficient hospitals, community care, and streamlined patient journeys.

Climate change has never felt as unambiguously urgent as it does now. According to NASA, the summer of 2023 was the hottest worldwide since global records began in 1880, prompting a spate of extreme weather events such as wildfires, flooding, tropical storms and drought across every continent.

Reaching net zero in the NHS need not compromise patient care - in fact, it should enhance it

The World Health Organisation has therefore declared climate change the ‘biggest global health threat of the 21st century’. Although this is felt most acutely in the Global South, climate change is punishing our health in the UK as well, through increased heat-related illness and death, more regular flooding, poor air quality, or the emergence of new diseases

However, the very systems we rely on to protect and improve our health – most notably our National Health Service – are perpetuating the damage to our health caused by climate change. While the contributions of energy, transport and food industries to climate change are well documented, it is less well-known that the health and care sector contributes to 4.4% of global emissions: more than the total carbon footprint of economic powerhouses such as Brazil or Japan. Our NHS is no different, accounting for 4% of England’s total carbon footprint, and pumping as many emissions into the atmosphere each year as the entirety of Croatia.  

The UK Government has committed to delivering a net zero economy by 2050; decarbonising our NHS will be essential to reaching these challenging targets. The NHS therefore became the first health system in the world to put net zero aims into legislation in 2022, committing to reaching net zero by 2045. 

In conversations with net zero leaders across the NHS, we have found that progress towards net zero commitments is mixed. Despite ambitious plans and great progress in some areas, the challenges to delivering on net zero plans are all too familiar for those working in the NHS: extreme operational pressures, long waiting lists, and difficulties retaining staff.  

The end result is that, in 2021, only 27% of NHS staff were aware of the NHS’s net zero ambitions, and some worry about how the net zero agenda may affect patient care. This reflects sentiments amongst healthcare staff in comparable countries such as Germany, Sweden and Australia. For example, tensions between sustainability and patient care were exposed when the use of single-use PPE rose during the Covid-19 pandemic. These fears mirror the language of trade-offs and sacrifices which is ubiquitous in the climate change debate.  

However, when it comes to health and care, this logic often doesn’t hold: the net zero agenda and quality patient care are not adversaries in a zero-sum game. Rather, the key changes the NHS must make to improve care for patients in the coming years will also support the journey to net zero.  

We’ve identified three key areas where the NHS – and healthcare systems around the world - can dramatically cut emissions while also improving the experience and outcomes of patients: 

  1. Building modern, energy-efficient hospitals 

The government’s New Hospital Programme is expected to invest over £20 billion into new and refurbished hospital infrastructure over the next decade to provide a safer and more pleasant environment for patients – but building net zero considerations into these plans will also benefit patients.  

As of this autumn, all new developments or upgrades to NHS hospitals need to comply with the NHS’s Net Zero Building Standards. These standards promote better energy efficiency through measures which also improve patient experience and outcomes. For example, automated doors and lights stop doors being left open and lights being left on – reducing energy use for heating, cooling, and lighting. However, they also reduce the risk of infections spreading through door handles and light switches, and can improve patient sleep and privacy. This was found by a pilot project at Barts Health NHS Trust, in East London, where a campaign to turn off lights and close doors delivered patient benefits alongside reducing as many carbon emissions as 180 flights between London and Sydney. 

High efficiency lighting and natural light also reduce energy use and have proven benefits for patient comfort. Patients exposed to daylight are likely to recover more quickly, with one study finding that these patients used 22% less pain medication. Meanwhile, LED lighting  avoids the headaches and eye straining associated with other artificial lighting sources. Therefore, building modern energy-efficient hospital does not only reduce our carbon footprint; it improves the safety, outcomes, and experiences of patients across the country today.  

  1. Helping people stay healthy in the community 

A healthier population has fewer health and care needs – so helping people stay healthy and out of hospital is the best way to reduce demand for health and care, thereby reducing the carbon emissions associated with the NHS’s buildings and operations. 

A focus on preventing ill health – as opposed to simply treating ill health – will therefore be essential in the NHS’s journey to net zero. This includes both encouraging healthy behaviours – such as exercise and avoiding smoking – and empowering patients to better understand and manage their own conditions. For example, one NHS TrustSouth Warwickshire University NHS Foundation Trust South Warwickshire University NHS Foundation Trust has been working to  has been working to reduce physiotherapy referrals from care homes through empowering care home staff and patients to engage in a home exercise programme to minimise the risk of falls through improving strength and balance. Through this programme, they hope to achieve a 35% reduction in referrals from care homes, delivering an estimated saving of over a tonne of carbon emissions each year – equivalent to driving from London to Jerusalem in a standard petrol car. 

Delivering care closer to people’s homes – or actually in their homes – will also be essential in reaching net zero. By relocating care away from energy intensive hospitals and reducing the need for patient travel, providing more care in the community will put a sizeable dent in the NHS’s energy and transport emissions.  

But, once again, it is good for patients too. Being in hospital can expose patients to new risks, especially for older patients, such as dangerous infections, deconditioning of muscles, disorientation and an increased risk of falls. Meanwhile, patients treated in the community overwhelmingly report better wellbeing and are more likely to proactively manage their own health: both factors known to improve patient outcomes.  

The move away from hospital care is epitomised by the rise of so-called ‘virtual wards’: hospital-level care from the comfort of a patient’s own home, combining in-person visits with use of video chats, apps and wearable devices.  

In Liverpool, virtual wards for 5,500 patients with conditions such as heart failure and diabetes have reduced the use of health services by 40% among those patients, while 80% feel more confident managing their condition. However, the carbon savings are also substantial. By saving nights spent in hospital and reducing patient travel, one virtual ward for 310 COVID-19 patients in Leicestershire is estimated to have saved 140 tonnes of carbon emissions annually – that's the equivalent of driving from London to Beijing a hundred times in a standard car. The same ward is estimated to have saved £1,709 per patient. It’s no wonder NHS leaders are enthusiastic about virtual wards and looking to roll them out more widely. 

  1. Streamlining patient journeys through care 

NHS patients do not always get the care they need first time, often undergoing any number of less appropriate procedures or duplication before receiving the right care. These additional procedures can be harmful to patients as every procedure carries some risk, even if very small. They can also be harmful for the environment, using more energy and more resources, including single-use plastics, than required to deliver the best care for patients. 

In South Warwickshire in 2022, a team working with elderly patients recognised this issue, identifying the overuse of blood testing on their wards. They therefore developed a new tool to support staff in deciding if a blood test was appropriate. This reduced requests for blood tests by 10%, saving lab staff nearly 5000 hours per year and improving patient experience by avoiding bruising and skin damage, minimising distress for those with cognitive impairments, and limiting the risk of infection. However, blood testing also uses lots of single-use products and is an energy-intensive process: the project therefore saved nearly a ton of carbon dioxide in a year. 

This is a small example of the great work taking place across the NHS to reduce the number of additional and less appropriate procedures and cash in on the associated benefits for patient care, the climate and the NHS’s balance sheet. In fact, the national Getting It Right First Time programme is estimated to have avoided 49,000 less appropriate procedures across the NHS from 2014-2019, saving over 26,000 tons of carbon dioxide and gifting countless patients a more comfortable and safer journey through care.  

However, there is much more to do. If the NHS is serious about meeting its goal of net zero by 2045 it needs to accelerate and amplify these initiatives which cut carbon emissions while improving patient care. Much of this will rely on increased capital investment to support new infrastructure and models of care. But we also need to change the narrative. We cannot pit patient care and net zero against one another. Instead, we need NHS leaders, staff and politicians to be unambiguously clear: in most instances, working towards a net zero NHS is beneficial to patients when they’re unwell today, and keeps the rest of us and future generations healthy as well. 

The PSC is a management consultancy dedicated to making public services brilliant. We work with leaders in health and care across the UK on their most difficult challenges, including delivering on the net zero agenda. If you are interested in knowing more, please get in touch at hello@thepsc.co.uk.  

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