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Can the health service become net zero?

NHS England is aiming to become the world’s first carbon net zero health service. Simon Birch looks at the carbon impacts of surgery, buildings and transport in the UK national health service to see how this might be achieved.

"The evidence that the climate emergency is a health emergency is overwhelming, with health professionals already needing to manage its symptoms,” so states Dr Nick Watts from NHS England.

With the climate crisis inexorably intensifying, NHS England is now responding by making a groundbreaking commitment to become carbon net zero by 2040, the first healthcare service in the world to make such a pledge.

And in another world first, this summer NHS England became the first healthcare service to embed net zero into legislation through the Health and Care Act 2022.

Every NHS Trust in England now has an environmental and carbon-reduction plan in place representing 212 NHS Trusts covering more than 1,000 hospitals and healthcare facilities.

As NHS England’s Chief Sustainability Officer, Dr Watts is now overseeing a pioneering programme of carbon-cutting initiatives involving all NHS staff from clinicians to technicians and cleaners to chefs.

“Everyone who works in healthcare has a responsibility to take action on the health emergency posed by climate change,” says Dr Watts.

The NHS is a massive organisation and the scale of its carbon emissions is huge with estimates suggesting that it contributes around 6% of the UK’s total annual carbon budget.

The carbon footprint of surgery

One of the single biggest contributors to the NHS carbon footprint is surgery. Just 5% of patients in hospital go under the knife but surgery makes up around 25% of the emissions from a typical NHS trust.

To tackle the problem, in spring 2022 a team from University Hospitals Birmingham NHS Foundation Trust carried out what it says is the first net zero operation where carbon emissions were reduced to virtually nothing.

A variety of carbon-cutting measures were used such as using reusable surgical gowns and installing low-energy lighting.

However one of the biggest contributors to the carbon footprint of surgery are the anaesthetic gasses which are routinely used during surgery which have a massive carbon footprint.

By switching from a gas to a liquid anaesthetic which is injected directly into the patient, substantial carbon savings were made.

“Operating theatres are resource intensive environments, contributing to 25% of the Trust’s carbon output,” says Consultant Surgeon and Senior Lecturer at the University of Birmingham Mr Aneel Bhangu.

“We cannot achieve net zero health systems without making surgery more green, so this is a vital proof of concept step.”

West Midlands Ambulance Service launched the first 100% electric emergency ambulance in the UK in 2020. Image (C) WMAS

Electric vehicles and solar panels

Elsewhere initiatives big and small are now being rolled out in hospitals across England from vegan options and meat-free Mondays in canteens, to remote consultations which the NHS estimates last year saved 14 million travel miles as well as vast amounts of carbon.

Earlier this year the London Ambulance Service secured the funding required to buy over 200 new electric vehicles including 40 new electric ambulances as well as 42 electric fast response cars and three electric motorbikes.

The good news of course is that the overwhelming majority of these carbon-cutting measures result in much-needed cost savings too, ensuring a win-win scenario for both the NHS and the planet.

For example 11,000 solar panels have recently been installed on land adjacent to the Castle Hill hospital in Hull. The result is that not only will the hospital slash its carbon footprint, but with rocketing energy prices, it’s estimated that the project will save the hospital around £300,000 a month.

Chemotherapy drugs delivered by drones

New technology is also being used to help drive both carbon reduction and improvements in patient care. Chemotherapy drugs are now being delivered to cancer patients in the Isle of Wight by drone from the nearby Portsmouth Hospital as it’s difficult to transport because some chemotherapy doses have a short shelf life.

Each drone delivery replaces at least two car journeys and one hovercraft or ferry journey per delivery – saving carbon emissions and contributing to improving air quality for patients and the community.

“Delivering chemo by drone is another extraordinary development for cancer patients,” said NHS England chief executive Amanda Pritchard.

“It shows how the NHS will stop at nothing to ensure people get the treatment they need as promptly as possible – while also cutting costs and carbon emissions.”