CARBON REDUCTION AND NET ZERO
The Centre for Sustainable Healthcare’s ‘Green Team’ competition: “Depending on what consultants are in that meeting, they’ll just skip it and say, ‘Oh yeah, we all love the dolphins and skip it.’ ” Dr Pinto said: “The fact that a highly trained NHS healthcare professional still doesn’t get this epitomises the catastrophic failure of communication that surrounds the defining issue of our time.” Moving to ‘briefly outline where we
Sources of carbon emissions by proportion of NHS Carbon Footprint Plus.
and was a senior honorary lecturer at the University of East Anglia. She has a Psychology degree, and early in her career completed general practice training before pursuing a psychiatry career. She has been involved in climate education, outreach, and activism for many years.
Climate change and the ‘collapse of nature’ Dr Pinto explained that she had been asked to speak on progress on sustainable healthcare delivery, and priorities for meeting the Net Zero targets. She said: “We know from a wealth of evidence that climate change and the collapse of nature are the biggest threats to human health. The Lancet Countdown reports demonstrate that this is not just a problem for the future; already, extreme heat, drought, wildfires, air pollution, floods, storms, the spread of vector and waterborne diseases, increased pandemic risk, and threats to water and food security, are damaging the health and wellbeing of millions of people in every region of the globe. We know there is injustice in the distribution of these impacts, and that those least responsible are bearing the brunt. Even here in the UK,” she continued, “it’s our most deprived communities that are most exposed to air pollution, heat, flooding, and rising food prices, due to climate-related impacts on crop yields. We also face challenges in maintaining safe delivery of healthcare. Our infrastructure is vulnerable; the 2022 heatwaves saw over 5000 reported incidents of overheating in clinical areas, affecting both patients and staff.” Working at high temperatures can – it is acknowledged – impact cognitive functioning – ‘not ideal when making life and death decisions’. Dr Pinto added: “Hospitals struggled with overheating of scanners and IT systems, and safe medication storage temperatures. Between April 2021 and March 2022, there were 176 flooding incidents at NHS sites, with 10% of our hospitals at risk of
44 Health Estate Journal April 2024
flooding. Additionally, the complex global supply chains on which our systems depend are highly vulnerable to incidents elsewhere. The IPCC’s 1.5 degrees report demonstrated that these impacts increase significantly as we move from 1.5 towards 2 °C – which is why the national 2050 Net Zero targets are based on the IPCC pathway to remain below 1.5 °C. This pathway offers only a 50/50 chance of achieving that – not odds we’d consider acceptable for safety and clinical practice.” Against this backdrop, Dr Pinto said the UK could be proud that the NHS has set more ambitious targets of 2040 for our direct emissions, and 2045 for those we can influence. “However,” she warned, “even 2045 can seem a long way off, which can mean us taking our foot off the pedal when there are competing priorities.” “So,” she asked, “how can we maintain
focus? Firstly, to remain on this pathway and not spend our carbon budget in the next few years, we need to halve our emissions by 2030. The NHS pathway calls for an 80% reduction in that time period – and that’s only six years away. Last year global temperatures leapt up 1.45 °C, and we’re much closer than we thought to breaching the crucial 1.5 °C threshold, so we must accelerate our efforts.” Adding that in 2014, the planet was 0.8 °C degree warmer than pre-industrial levels, but that this had nearly doubled in 10 years, she asked what this meant for the future of our children; 88% of the health impacts of climate change are apparently falling on children under five. Dr Pinto said: “We could consider that our collective failure to tackle climate change is a safeguarding issue for an entire generation.” Despite a recent rise in public awareness of climate change, she said most people still didn’t really properly grasp the issue. She told attendees: “Recent surveys show that less than half the UK population understand the term ‘Net Zero’, and just a quarter the terms ‘green’ or ‘sustainable’.” She cited a quote from a clinician from a recent evaluation of
are now, and what we need to do next’, she said: “The latest NHS Annual Report shows that – against all odds – we are on track with emissions reductions, which is encouraging news, but we must keep in mind that the first steps are often the easier ones, and progress is starting to stall.” Showing a pie chart, Sources of carbon emissions by proportion of NHS Carbon Footprint Plus, taken from page 14 of the October 2020 report, Delivering a ‘Net Zero’ National Health Service, she said many providers had to date been quite focused on building and energy projects. She said: “If we are to continue making progress on this, cash-strapped provider Trusts must be able to access funding for the ‘invest to save’ projects which bring down emissions and reduce bills.”
Pharmaceuticals and medical supplies She pointed out, however, that 35% of the emissions in the NHS Carbon Footprint Plus originate from pharmaceuticals and medical supplies, before even considering that clinical pathways determine ‘how much we travel, use buildings, consume water, and produce waste’. She said: “In primary care, where most patient contact occurs, 65% of admissions are due to clinical activity. The bottom line is we cannot achieve Net Zero without clinical transformation.” How we do this had been the focus of the work of the Centre for Sustainable Healthcare over the past 15 years. She explained: “One of the tools we’ve developed is Sustainability in Quality Improvement (SusQi). This embeds sustainability into clinical innovation using existing quality improvement teams and frameworks.” This ‘holistic approach’ ‘assesses outcomes using the concept of sustainable value, which broadens the focus beyond simply cost effectiveness to measure and value both environmental and social impacts, while also considering the impact of our activities on the health of the population, being mindful that patients are members of the population, not a competing group’. Dr Pinto said: “This is not intended to be a mathematical equation to be solved, but an approach to decision making at any level – from individual care to care pathway design, to business case and funding allocations.” The Centre also bases its work around the principles of sustainable healthcare – ‘the most effective way to reduce healthcare’s impact being to reduce
Delivering a ‘Net Zero’ National Health Service, NHSE / NHSI, October 2020
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