The pressure to tackle the climate emergency continues to mount and the healthcare sector has more of a motivation than most to ensure reducing emissions is an absolute priority for their own operations, governments and businesses across all industries. Increasing global temperatures will result in water scarcity, food insecurity, extreme weather and more infectious diseases. Global health systems will need to adapt to continue to deliver high quality services and respond to these ever-changing circumstances.  

Two years ago this month the NHS pledged to reach net zero by 2045 – aiming for its direct emissions to be eliminated by 2040 and its indirect emissions through the goods and services bought from partners and suppliers by 2045. This was an ambitious goal, but what has been achieved since? 

NHS net zero: the progress

In October 2021 the NHS reported that it expected to cut total emissions in 2021-22 by 1260 kilotonnes of carbon dioxide equivalent (ktCO2e), putting it on track to meet its target to become a carbon net zero health service by 2045, one year after it announced its intention. These expected reductions were primarily related to changes and investments secured in its own operations and practices, including energy efficiency and lower carbon heating system upgrades, reductions in and electrification of travel and switch away from high carbon anaesthetics. 

By January 2022, all Trusts had Green Plans in place and on 1st July, the NHS became the first health system to embed net zero into legislation, through the Health and Care Act 2022. This brings the targets and guidance in the ‘Delivering a net zero National Health Service’ report into statute, with implications for all Integrated Care Systems, NHS providers and suppliers. 

The NHS is also launching an Evergreen sustainable supplier assessment to its 80,000 suppliers in early 2023. While the assessment is not yet mandatory, it is designed to evaluate where suppliers are in their sustainability and net zero and sustainability journey, and rate them between 0 (meeting minimum statutory compliance) and 3 (leaders in sustainability). Over 50 suppliers are currently piloting the assessment ‘on-system’. 

Challenges for healthcare in reaching net zero

Getting onto and staying on the required trajectory to achieve net zero is challenging for a number of reasons. Despite many advances in embedding sustainable healthcare activity, many hospitals have not yet reduced their carbon footprint sufficiently. Newcastle Hospitals, for example, highlights this in its Annual Sustainability Report for 2021- 22. The report demonstrates the challenge to reduce total emissions in the face of increased activity, driven by increased demand for healthcare and catching up on the backlog that was exacerbated by the pandemic. It calls for action beyond the Trust and reviews the need for more support to address systemic barriers to change, without which it will be impossible for Newcastle, and the wider NHS, to reach net zero. 

Meeting the short-term net zero roadmap timeline and requirements is a challenge on the supplier side too. By April 2023 the 500+ suppliers that bid for contracts of £5m+ will need to report ‘direct’ emissions (scope 1 and 2) as well as some subsets of indirect (scope 3) emissions. 

What needs to happen to reach net zero?

In 2021, a year after the strategy was published, NHS England approved a roadmap, outlining its delivery of net zero for suppliers between now and 2030. The roadmap includes steps such as suppliers having to publish a carbon reduction plan, and publicly report all targets. While targets are a great first step, the challenge lies in how these commitments will come to life. 

1. Alignment of global and national stakeholders 

Alignment across the healthcare industry’s international supply chains will be an essential move for the NHS in achieving its climate goals. However, pressure is needed to ensure that concrete actions are put in place. Suppliers will need to first estimate then start to accurately capture the emissions of their own suppliers (scope 3), and will need expert guidance on strategies to do this. 

Stakeholder engagement and participation will greatly support adaption actions. It’s therefore important to understand who the key stakeholders are and what their interests, responsibilities and positions are, to develop an appropriate stakeholder management strategy.

2. Upgrading existing building infrastructure 

The health and social care system is currently associated with significant use of resources and carbon emissions, comprising around 4–5% of England’s total carbon footprint. Therefore, delivering on the targets will require significant upgrades to existing buildings and infrastructure, as well as ensuring that new hospitals are compatible with the plans for net zero. 

It will be important to deploy technologies such as heat pumps, fuel cells, biomass and heat networks, but to do so, existing funding streams will need to be maintained and increased in order to deliver these upgrades to existing buildings and infrastructure. Replacing boilers with heat pumps is a significant investment and, alongside the move to electrified fleets, may well require sites to increase their electrical capacity.  

Climate change is one of the biggest issues facing society today, and the solution isn’t going to be easy. To be in with a chance of achieving net zero targets, the government must engage with healthcare innovators to make the NHS’s vision a reality. The time to effect change is now, and we must grasp the opportunity before it’s too late.

By David Newell, Director of Health at Gemserv