The mission to make the NHS greener

IF healthcare was a country it would be the fifth largest carbon emitter in the world.

It’s a startling fact that lays bare the important role of global health leaders in the fight against climate change.

In 2020, the NHS became the world’s first health service to commit to reaching carbon net zero – but reports show that it still accounts for 5.4 per cent of the UK’s greenhouse gas emissions.

And it’s not hard to see why. According to the King’s Fund, just one year of kidney dialysis is equivalent to seven return flights between London and New York.

While the task ahead may seem daunting, there are a number of innovative programmes across the UK that give cause for optimism.

Benefits of going green

Advocates for a “greener NHS” are quick to emphasise that tackling climate change can have a direct positive impact on our health, not to mention saving the NHS money.

The Greener NHS campaign in England refers to a “climate health emergency” and cites examples of climate change health consequences, including:

• Air pollution (whose causes are often the same as climate change) is linked to conditions like heart disease, stroke and lung cancer, contributing to around 36,000 deaths annually.
• The impact of extreme weather events (which are becoming more frequent due to climate change). Flooding is connected to the spread of infectious disease in the UK, while heatwaves are also believed to be a factor in hundreds of excess deaths.
• The prediction that rising temperatures and emissions could lead to an increase in physical and mental conditions such as asthma, Lyme Disease, encephalitis and anxiety disorders.

Latest innovations

Net zero surgery

Despite the fact only five per cent of hospital patients go under the knife, figures show surgery is responsible for as much as a quarter of the emissions from a typical health trust.

In May 2022, an innovative team from University Hospitals Birmingham NHS Foundation Trust carried out the first “net zero” operation in the NHS. The Solihull Hospital medics were able to reduce emissions to almost zero, with any remaining carbon offset by other verified means, including planting trees in the hospital grounds.

Eco-friendly changes included switching to reusable gowns, drapes and scrubs; finding energy-efficient lighting solutions; and using liquid anaesthesia (rather than more harmful gas). One surgeon even opted to run from home to the hospital, while another cycled.

UHB consultant surgeon Mr Aneel Bhangu said: “We cannot achieve net zero health systems without making surgery more green, so this is a vital proof of concept step.”

He now hopes to share the approach across the UK.

Greener gas

BBC news reported in March that Scotland has become the first country in the world to stop its hospitals using the anaesthetic desflurane because of the threat it poses to the environment.

NHS data suggests the gas, used to keep people unconscious during surgery, has a global warming potential 2,500 times greater than carbon dioxide.

Banning it in Scotland - from its peak use in 2017 - would cut emissions equal to powering 1,700 homes a year. Hospitals in other parts of the UK have already cut down, with NHS England due to introduce a similar ban in 2024.

Dr Helgi Johannsson, vice president of the Royal College of Anaesthetists, told the BBC: "More and more anaesthetists across the UK have become aware of the sheer extent of the damage the gas can cause to the environment and have chosen to stop using it - and I am proud of that."

But he warns it is only the start and just "a drop in the ocean of the NHS carbon footprint".

These initiatives tie in with work being carried out by grassroots group Green Anaesthesia Scotland as well as the Green Theatre Initiative from the surgical Royal Colleges in England and Scotland. The Royal College of Surgeons of England has also published a guide, Sustainability in the operating theatre.

Going electric

Electric vehicles are also playing a key role. The first fully-electric ambulance is currently in service in the West Midlands, with the unveiling in 2021 of a higher tech model whose hydrogen fuel cell gives it a range of up to 300 miles. Decarbonising the ambulance fleet, NHS England said, could potentially reduce annual emissions by the equivalent of 730,000 car journeys from Cornwall to Glasgow.

In Greater Manchester, the Northern Care Alliance (NCA) became the first NHS organisation to trial the first fully electric heavy goods vehicle (HGV). It now uses two of the lorries to deliver laundry and other essential supplies and equipment.

Dr Owen Williams, Chief Executive of the NCA NHS Foundation Trust, said: “It’s not just the environmental impact that matters, these plans, technologies and trials work to deliver improved patient care, save lives, improve lives, and reduce costs and waste.”

In Sussex Community NHS Foundation Trust, pedal power is the order of the day as a new scheme gives staff access to a fleet of e-bikes – organised by a new Travel Bureau – in a bid to make commutes greener.

Balancing demands

As the health service faces unprecedented pressures and many teams battle exhaustion and burnout, the mission to make the NHS greener seems tougher than ever.

A report by the BBC highlighted the determination of healthcare staff in Wales to go above and beyond to fight climate change. It told how concerned NHS staff at hospitals across Wales are setting up green groups and working extra hours without pay in a bid to reduce emissions.

Doctors, nurses, pharmacists and non-clinical staff at Ysbyty Gwynedd have been working together since 2019 in a bid to make the hospital run more sustainably. The team has planted trees and wildflowers, switched to less polluting anaesthetic gases, and initiated trials of reusable personal protective equipment (PPE).

Junior doctor Tom Downs - who founded the Ysbyty Gwynedd Green Group – told the BBC it had been "something really positive to focus on" during the pandemic. But he said for staff, who may already be working a 70-hour week, finding time to volunteer was "a real challenge".

The British Medical Association (BMA) has called on UK governments to provide NHS organisations with more support to help them achieve sustainability goals.

“Progress in decreasing carbon emissions within the NHS appears to be stalling,” the BMA said. “The pandemic has required the NHS to prioritise protecting the immediate health of the population and service delivery. However, climate change poses a major threat to health and doctors are already seeing the impact of air pollution and climate change on patients.”

It called on governments to increase awareness of sustainability strategies and targets, to work to improve staff engagement and to ensure relevant funding is made available to NHS organisations.

And with the right support and resources, there is hope health leaders could make great strides in their mission to make the NHS greener.