SUSTAINABILITY Visitor travel Staff commute Patient travel

Business travel and NHS fleet


Anaesthetic gases and metered dose inhalers

Water and waste

5% NHS 5%

Carbon Footprint


Building energy

24% Other supply chain Figure 2: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus.

Medicines & Chemicals, Medical and Non- Medical Equipment, Business Services, Construction and Freight, Food & Catering, and Patient and Visitor Travel, are among the biggest contributors to carbon emissions, with the Primary Care sector the next largest contributor, with Medicines and Chemicals by far the largest constituent here.

Two ‘ambitious, but realistic’ targets Basing these targets on analysis of current and planned activities for the NHS, and national and international best practice scalable across the NHS in England (plus assumptions about future innovation, and the pace at which government, other sectors, and the international community will drive change), the report says the NHS Net Zero Panel agreed on two ‘ambitious, but realistic’ net zero carbon targets, ‘supported by immediate action, and a commitment to continuous monitoring, evaluation, and innovation’. The timelines for reaching net zero are: n by 2040 for the NHS Carbon Footprint, with an ambition for an 80% reduction (compared with the 1990 baseline) by 2028 to 2032 (Figure 4 in the report).

n by 2045 for the NHS Carbon Footprint Plus, with an ambition for an 80% reduction (compared with the 1990 baseline) by 2036 to 2039 (Figure 5 in the report).

Alongside concerted action on reducing carbon emissions generated by estates and facilities activities, travel and transport, and the supply chain/ procurement and medicines, the report says achieving the two net zero carbon targets will require ‘enabling actions –

40 Health Estate Journal February 2021

including sustainable models of care, workforce, network and leadership, and funding and finance mechanisms’.

Key actions identified, looking forward

With Section 2 having set the background to the need for further concerted work by all NHS staff and suppliers to reach the targets, Section 3, ‘Direct interventions to decarbonise the NHS’, identifies both the ‘immediate actions’ the NHS will take to reduce emissions, and ‘actions that could be delivered with additional investment and support’. In each instance, ‘waterfall charts’ provide a high-level overview of where emissions can be achieved, and, ‘where practicable’, all savings are expressed in kilotonnes of carbon dioxide equivalent.

Estates and facilities

The report identifies that ‘the NHS estate and its supporting facilities services’ – including primary care, Trust estates, and

Present day emissions In-year actions

Hospital Improvement Programme Upgrading our buildings Optimising building usage

On-site generation of renewable energy and heat National electricity decarbonisation Research, innovation, and offsetting

580 342 147 0 500 CO2 1000

n Present-day emissions n Emissions reduction n Emissions increase n Residual

1500 emissions (ktCO2 e)

Figure 3: Interventions to reduce emissions in the secondary care estate, and estimated carbon savings, compared with 2019 baseline.

2000 2500 5%

Personal travel

Medicines, medical

equipment, and other supply chain


Non-medical equipment


Medical equipment

4% 4% 20% 1%

Commissioned health services outside NHS

Medicines and chemicals

private finance initiatives – comprise 15% of the total carbon emissions profile. Figure 6 and Figure 7 in section 3.1.1 (see Figs 3&4 in this article) highlight the opportunities for emissions reductions in the secondary and primary care estates respectively, ‘with significant opportunities seen in energy use in buildings, waste and water, and new sources of heating and power generation’. The commentary says: “Delivering a net zero health service will require work to ensure that new hospitals and buildings are net zero compatible, as well as improvements to the existing estate. To support this, a new Net Zero Carbon Hospital Standard will be available from spring 2021, and applied across the 40 new hospitals to be built as part of the government’s Health Infrastructure Plan. This will involve both the use of innovative, low-carbon materials, as well as new design that allows for flexibility, and shifts in how care will be delivered in the future.”

Secondary care ‘interventions’ While these new hospitals will need to meet the Net Zero Carbon Hospital Standard, the report acknowledges that as they form less than a fifth of the secondary care estate, ‘significant interventions will also be required in the retained estate’.

In the secondary care estate, among key interventions to reduce carbon emissions highlighted are: n The Hospital Improvement Programme (‘HIP’).

n ‘Upgrading our buildings’. n Optimising building usage. n On-site generation of renewable energy and heat.

n National electricity decarbonisation. n Research, innovation, and offsetting.

Of these, ‘interventions’ identified as among the most vital are: ‘On-site generation of renewable energy and heat’ (a 580 MtCO2

e reduction), ‘Optimising

building usage’ (572 MtCO2 our buildings’ (473 MtCO2

e), ‘Upgrading e), ‘National

electricity decarbonisation’ (342 MtCO2 and the ‘HIP’ (205 MtCO2

e). Healthcare 2351 32 205 473 572 e),



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