emission vehicles by 2028. The report says that while ambulances ‘pose a particular challenge, and require targeted interventions’, ‘for the rest of the fleet, rapidly exploring options for a complete transition to zero-emission vehicles by 2032 will be a key focus in engagement’. A ‘significant shift’ away from cars, towards cycling, walking, and public transport, should not only decrease air pollution, improve physical activity, and increase access to care, but also represents potential annual savings of some 461 ktCO2e. All Trusts will be required to have ‘green travel plans’ as part of their annual planning and reporting.

Supply chain activities

Section 3.3, ‘Supply chain’, explains that the NHS Carbon Footprint Plus considers an expanded scope of emissions, covering products procured from some 80,000 suppliers. It adds: “While the NHS does not control these emissions directly, it can use its considerable purchasing power to influence change. Among the key ‘interventions’ highlighted in this field are reducing emissions from medical and non-medical equipment (18%), food and catering (6%), ‘other procurement’ (18%), commissioned healthcare services outside the NHS (4%), and medicines and pharmaceuticals (20%).

Section 3.3.1., ‘Decarbonising the supply chain’, states that ‘the NHS can reduce emissions from its supply chain in three ways’ – via more efficient use of supplies; low-carbon substitutions, and product innovation, and by ensuring that its suppliers are decarbonising their own processes. It says: “Good progress has already been made in using resources more efficiently. Over 1.4% of supply chain emissions are due to single-use devices, some of which could be refurbished and reused, saving the NHS both carbon and money.”

Reducing reliance on disposable products

Action to reduce reliance on disposable products to date includes: n Continued commitment to the NHS Plastics Reduction Pledge. To date over 145 Trusts have signed up, with one – Yorkshire Ambulance Service – removing 200,000 single-use plastic items from its waste stream in 2019/20; saving four tonnes of waste, and over £12,000 a year in packaging, delivery, and disposal costs.

n A 10% reduction in clinical single-use plastics in the short term, eventually saving 224 ktCO2


n Expanding existing walking aid refurbishment schemes, with 40% of all walking aids refurbished in the next five years.

n Reducing reliance on office paper by 42 Health Estate Journal February 2021

More efficient use of supplies


substitutions and product innovation

Present day emissions Forecasted change in activity Reduced single-use plastics Metal instrument reprocessing Device reuse and refurbishment Reduced use of paper Reduced food waste

Supplier alignment to NHS Net Zero commitments

Process and product innovation Switch to bio-based polymers Switch to plant-forward diets Decarbonised construction Electrified freight transport

Commissioned services meet NHS commitments Non-pharmaceutical suppliers meet NHS commitments Pharmaceuticals suppliers meet NHS commitments Research, innovation, and offsetting

4458 4203 865 emissions (ktCO2 498

220 525

533 785

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

0 2 4 6 8 10 12 14 16 18 CO2

e) (000s)

Figure 6: Interventions to reduce supply chain emissions, and estimated carbon savings, compared with 2019 baseline.

50% across secondary care through increased digitisation, with a switch to 100% recycled content paper for all office-based functions.

Specifying low carbon alternatives The report says the NHS ‘will also work to substitute for low-carbon alternatives where they are available’. For example, the authors anticipate that bio-based polymers will produce significant savings of 498 ktCO2

e in the future. It adds:

“In response to COVID-19, the NHS has demonstrated an ability to respond to novel challenges at pace and scale.” It continues: “Finally, the NHS will work to ensure that suppliers are decarbonising their own processes and provide clear and long-term signals about the direction of travel. This process has started through the NHS supplier engagement programme aimed at driving significant reductions in carbon emissions through carbon transparency reporting. An early pilot has seen 27 suppliers voluntarily share their plans on carbon reduction. In 2021, engagement will be expanded to 500 significant NHS suppliers.” Before the end of the decade, the new publication adds, ‘the NHS will no longer purchase from suppliers that do not meet or exceed our commitment to net zero’, adding: ‘This will be an essential component of any net zero strategy, delivering reductions of 9,446 ktCO2 when fully realised.’

e per year

Anaesthetics Section 3.4.2 of Delivering a ‘Net Zero’ National Health Service explains that the NHS Long Term Plan committed to lowering the 2% of the NHS’ carbon footprint from anaesthetic gases by 40%, ‘by transforming anaesthetic practice’ – a goal which it says ‘requires efforts to shift from desflurane to lower carbon alternatives such as sevoflurane; effective capture, destruction, or reuse of these

gases, and reduction in the atmospheric release from leftover nitrous gas canisters’. Anaesthetic gases used in surgery, such as desflurane, have a particularly high carbon footprint, with the emissions from one bottle equivalent to those from burning 440 kg of coal. However, low carbon alternatives exist, ‘and are clinically appropriate in a wide variety of settings’. The report adds: “Engagement with anaesthetists has seen a significant cut in some anaesthetic gas use since 2018, with monthly volumes of some volatiles falling by nearly 50%, saving 17 ktCO2

e per

year. With further clinical engagement, it could be feasible to reduce the use of desflurane to as little as 5% by volume, saving a further 23 ktCO2

e annually.”

The capture and destruction of nitrous oxide could, meanwhile, cut over one- third of NHS anaesthetic emissions. This sub-section concludes: “This technology has been readily deployed in Sweden for some 16 years, and could save an estimated 90 ktCO2

e emissions if

implemented across 132 high-impact Trusts in the NHS. Scaled across the entire health service, this could deliver up to a 75% reduction in nitrous emissions. Similar technologies for anaesthetic gases went to market in 2020, following successful trials in UK hospitals, with funding from Innovate UK.” Significant carbon savings should also be available by decreasing nitrous oxide wastage, with the College of Paramedics estimating that 30% of nitrous oxide is left in canisters after use. However, the report acknowledges that ‘recycling or reusing this is technically difficult, with new methods required to address the residual nitrous oxide’.

n To view and download a copy of Delivering a ‘Net Zero’ National Health Service, visit greenernhs/wp-content/uploads/sites/ 51/2020/10/delivering-a-net-zero- national-health-service.pdf

16,531 1865 224 157 202 417

92 1488



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