NHS is aiming to become first‘net zero’health service

Last October, the NHS adopted a multi-year plan to become the world’s first carbon net zero national health system – in terms of both its direct and indirect emissions – by 2045. Having taken soundings from a wide range of stakeholders, receiving almost 650 responses to an initial call to evidence, it published a new report, Delivering a ‘Net Zero’ National Health Service. This not only set out the actions and some of the most notable carbon reduction milestones achieved to date, but also identified the areas of activity – many of them estates and facilities-related – seen as offering the greatest short-to-medium term carbon emission reduction potential as part of the wider drive towards ‘net zero’. HEJ editor, Jonathan Baillie, reports.

In his foreword to the 76-page report, NHS CEO, Sir Simon Stevens, put the new publication into context by explaining that on 1 January 2020 the NHS launched a campaign, For a Greener NHS, to mobilise its more than 1.3 million staff, and ‘set an ambitious, evidence-based route map and date for the NHS to reach net zero’. Published on 1 October last year, Delivering a ‘Net Zero’ National Health Service sets out the initial results of this work, the goals of which are for the NHS to reach net zero emissions for the care it provides (the NHS Carbon Footprint) by 2040, and zero emissions across the

entire scope of its emissions (the so-called ‘NHS Carbon Footprint Plus’) by 2045. The report explains that these dates – and the activities that will help deliver the targets – have been informed by NHS staff, an international call for evidence, and the NHS Net Zero Expert Panel, which met regularly throughout 2020, ‘to provide guidance on the scale of ambition and the scope of change required’. The report says: “Over the last 10 years, the NHS has taken notable steps to reduce its impact on climate change. As the biggest employer in this country, there is more that the NHS can do. Action must

not only cut NHS emissions, currently equivalent to 4% of England’s total carbon footprint, but also build adaptive capacity and resilience into the way care is provided. This action will lead to direct benefit for patients, with research suggesting that up to one-third of new asthma cases might be avoided as a result of efforts to cut emissions. This is because the drivers of climate change are also the drivers of ill health and health inequalities. For example, the combustion of fossil fuels is the primary contributor to deaths in the UK from air pollution, disproportionately affecting deprived and vulnerable communities.”

Progress since 2008 emissions CH4 Major N4 O SF6 CO2 CFCs PFCs HFCs

Scope 1 Direct Scope 2 Indirect

Scope 3 Indirect


Outside GHGP scopes

Medical devices

Fossil fuels

NHS facilities Anaesthetics

NHS fleet and leased vehicles


Energy Well-to-tank

Business travel

Public transport, grey fleet etc

Business services

Waste Water

Metered dose inhalers

NHS Carbon Footprint

38 Health Estate Journal February 2021 Construction

Manufacturing (products, chemicals, gases)

commuting Staff

NHS Carbon Footprint Plus

Figure 1: Greenhouse Gas Protocol scopes in the context of the NHS.

Freight transport

Food and catering


Patient, visitor travel

Commissioned health services outside NHS


Since 2008, the NHS has tracked and reported its carbon footprint, ‘regularly improving its methods and monitoring its progress in meeting the commitments of the Climate Change Act (2008)’. This report provides both an update on the service’s progress in reducing carbon emissions, and an overview of the targets and trajectories for reaching net zero. A number of ‘inputs’ were used to inform these ‘targets and trajectories’. The ‘almost 650’ stakeholder responses elicited via the ‘call to action’ were analysed by NHS England and NHS Improvement, following which a four step-analysis was followed to establish the trajectories: n Baseline: A complete update of the NHS carbon footprint was conducted to provide an estimate of present-day emissions against a 1990 baseline (see Section 2.1). This made use of a hybrid approach, combining ‘top-down’ modelling (drawing on financial activity data and an environmentally extended input–output model) with ‘bottom- up’ validation (drawing on a range of inputs from NHS organisations, including local travel, buildings, and medicines data). n Projections: A number of scenarios


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