Carbon reduction and Net Zero 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? Eighty-eight per cent 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


Recent surveys show that less than half the UK population understand the term ‘Net Zero’, and just a quarter the terms ‘green’ or ‘sustainable’.


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 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 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 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 healthcare activity – ideally through increased focus on prevention, and empowering people to take a greater role in managing their own health, maintaining awareness of their capabilities, and the barriers they may face to making healthy choices’. Dr. Pinto said: “Lean pathways mean stripping out activities that are not only low value, but potentially harmful, such as over-investigation and overprescribing. For the activities we need to continue, we must consider how we do so with the least environmental impact.” Prevention was, she said, ‘the first principle’ – because it had the greatest potential. She added: “Focusing on prevention forces us to break out of our silos; to use the trusted health voice and our status as anchor institutions to work across our communities, advocating for those policy and planning decisions that not only help tackle the climate and nature crisis, but also have enormous potential benefits for population health.”


Sources of carbon emissions by proportion of NHS Carbon Footprint Plus. 38 www.clinicalservicesjournal.com I January 2025


Delivering a ‘Net Zero’ National Health Service, NHSE / NHSI, October 2020


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