were then modelled to understand the emissions from the NHS over the long- term, including a ‘do nothing’ scenario, and a ‘committed policies’ scenario.

n Carbon reductions available across the system: Available reductions for each of the key sources of carbon were then estimated, which informed the system-wide targets for net zero.

n Net zero interventions: Drawing on the call for evidence and external technical input, an extended set of interventions and carbon reductions were modelled, ‘to give confidence in the credibility and ambition of the trajectories’.

Context and perspective Before detailing the level of carbon reductions already achieved in the UK – providing some useful context on how much further the service needs to go – and looking ahead to the areas of NHS activity where NHSE, NHSI, and the NHS NET Zero Expert Panel’s analysis suggests the greatest potential for further impactful emissions reductions lie, the report explains that the 2008 Climate Change Act set national targets for the reduction of carbon emissions in England, against a 1990 baseline. Since then, the NHS has been working to deliver on these targets, most closely approximated by the NHS Carbon Footprint (see Table 1). The report makes clear, however, that these targets do not cover the full scope of emissions from the NHS. It explains: “The Greenhouse Gas Protocol (GHGP) scopes cover a wider set of emissions, and support international comparison and transparency via three ‘scope’ categories, as follows: n GHGP scope 1: Direct emissions from owned or directly controlled sources, on site.

n GHGP scope 2: Indirect emissions from the generation of purchased energy, mostly electricity.

n GHGP scope 3: All other indirect emissions that occur in producing and transporting goods and services, including the full supply chain.”

There are, however, ‘still some emissions that fall outside these scopes’, and the report emphasises that, as agreed with the NHS Net Zero Expert Panel, the NHS will also work towards net zero for a NHS Carbon Footprint Plus – which includes all three of the ‘scopes’ above, plus the emissions from patient and visitor travel to and from NHS services, and medicines used within the home (see Fig 1). (An independent review by the Lancet Countdown has confirmed that the methods used to calculate the NHS Carbon Footprint and NHS Carbon Footprint Plus ‘remain the most comprehensive and sophisticated of any health system to date’). In looking ahead to the greatest

Commissioned Health Services Outside the NHS, Manufacturing of Products, Chemicals, and gases, ICT, and Staff Commuting. Finally, Patient and Visitor Travel are deemed to be outside of the three GHGP scopes, but are identified as an important target area for carbon emission reduction.

Where the NHS currently stands on carbon emissions reduction Section 2 provides data on the extent of progress made by the service and its 1.3 million staff so far in reducing the NHS’s overall carbon footprint against the 1990 baseline year. Carbon budget target reductions for the years 2010, 2015, and 2020 (estimated) were 25%, 31%, and 37% respectively. In the past three decades, the NHS’s overall Carbon Footprint has fallen from 16.2 MtCO2 6.1 MtCO2

e in 1990, to an estimated

Delivering a ‘Net Zero’ National Health Service sets out the NHS’s bold ambition to become the world’s first Net Zero Carbon health service.

potential opportunities for further carbon reduction, one must first understand which activities are deemed part of the NHS Carbon Footprint, and which make up the NHS Carbon Footprint Plus category. NHS Carbon Footprint activities designated as Scope 1 ‘Direct’ contributors to carbon emissions include Fossil fuels, ‘NHS Facilities’, Anaesthetics, and NHS Fleet & Leased Vehicles. Also part of the NHS Carbon Footprint, but designated as a Scope 2 ‘Indirect’ contributor, are emissions from purchased electricity, while Scope 3 ‘Indirect’ contributors to carbon emissions deemed part of the NHS Carbon Footprint are: Metered Dose inhalers, Water, Waste, Business travel (including public transport and the grey fleet etc), and Energy (‘well-to-tank’).

NHS Carbon Footprint Plus activities, meanwhile – all categorised as Scope 3 ‘Indirect’ contributors to carbon emissions – include: Medical devices, Freight transport, Business services, Construction, Medicines, Food & catering,

e last year. In percentage terms, compared with the 1990 baseline, this represents reductions of 46% by 2010, 54% by 2015, and an estimated 62% by this year. Similar data for the NHS Carbon Footprint Plus shows an overall fall in the footprint from 33.8 MtCO2 estimated 24.9 MtCO2

e to an e in 2020, a 26%

reduction on 1990. Warning against complacency, however, the report adds: “Despite this progress, there is still a significant challenge ahead. To close the gap to net zero the NHS will need to remove 6.1 MtCO2

Footprint, and 24.9 MtCO2

Carbon Footprint – roughly equivalent to the emissions profile of Croatia.”

Where the greatest potential lies While the report stresses that ‘every area of the NHS will need to act to achieve net carbon zero’, Figure 2 in section 2.1 (see Fig 2 in this article) shows that ‘the greatest areas of opportunity – or challenge – for change’ are in the supply chain, estates and facilities, pharmaceutical, and medical devices. Figure 3 in the same section (not reproduced here), meanwhile, focuses on sources of carbon emissions by activity type and settings of care. Unsurprisingly, activities in the acute healthcare sector including Building Energy, Waste,

Table 1: NHS emissions from 1990-2020. Carbon footprint scope Climate Change Act –

carbon budget target NHS Carbon Footprint

(MtCO2 e) NHS Carbon Footprint as

a % reduction on 1990 NHS Carbon Footprint Plus

(MtCO2 e)

NHS Carbon Footprint Plus as a % reduction on 1990

17% 19% 26% 26% 33.8 46% 54% 28.1 27.3 62% 25.0 62% 24.9 16.2 8.7

e from the NHS Carbon e from the NHS

1990 2010 2015 2019 2020 (est) 25% 31%

37% 7.4 6.1 6.1

February 2021 Health Estate Journal 39


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68