Progress in decreasing carbon emissions within the NHS appears to be stalling. The pandemic has required the NHS to prioritise protecting the immediate health of the population and service delivery. However, climate change poses a major threat to health and doctors are already seeing the impact of air pollution and climate change on patients.

Therefore, UK Governments now need to increase their support for NHS organisations, who are major contributors to carbon emissions, to help them achieve sustainability goals and keep up momentum in reducing their carbon footprint.

The story so far

The health service has an important role to play in reducing carbon emissions

• The health service contributes around 4-5% of total UK carbon emissions and the NHS in England alone is responsible for 40% of the public sector’s emissions.
• Given the grave threat that climate change poses to public health, health services have a responsibility to reduce emissions and help to safeguard the health of future generations.

The NHS has set sustainability goals

• In 2020 NHS England set out a road map towards the goal of making the NHS the first net zero health service in the world by 2045 in their report Delivering a Net Zero health service.
• Since then, the health services in Wales and Scotland have also announced targets. For Scotland this target is net zero by 2045, while the health service in Wales has committed to a 34% reduction by 2030 in order to meet a wider goal of a net zero public sector by 2030. The health service in Northern Ireland has not yet set a target.

Progress has been made, but it needs to continue

• The NHS has made good progress towards becoming more sustainable and less carbon-intensive with a number of initiatives being implemented within organisations and nationally, and the NHS carbon footprint reducing. For example, in England, the NHS carbon footprint plus (emissions that the NHS can influence rather than those it is directly responsible for) reduced from 27.3 MtCO2e in 2015 to 25.0 MtCO2e in 2019. However, these decreases in emissions slowed by 2020, with an estimated output of 24.9 MtCO2e.
• BMA analysis of data from NHS organisations also suggests a stall in progress. There is inconsistent measuring of carbon footprints by NHS organisations across the country, and where measurements are made progress in decreasing emissions is slowing.
• Improvements that have been made seem to centre on using fewer petrol/diesel vehicles in NHS fleets and investing in sustainable lighting – so once these initial gains have been made progress in reducing carbon emissions further becomes harder.

Our work on sustainability in the NHS

In December 2021, we surveyed 237 NHS organisations, including NHS Boards, NHS Trusts, and ambulance services on their sustainability practices. 175 of those (74%) responded to our request.

Of these, 159 (91%) were organisations in England, while 6 (3%) were in Wales, 5 (3%) were in Scotland and 5 (3%) were in Northern Ireland.

This follows on from a similar BMA survey of NHS organisations in 2020, which we highlight in our report Climate change and sustainability: The Health Service and Net Zero. Comparing responses for 2020 and 2021 gives us some insight into whether, and how, the NHS is progressing towards a greener future.

What the results of our sustainability survey shows

Not all NHS organisations are measuring their carbon footprint

Of the organisations that responded, the majority (over two thirds) told us they measured their carbon footprint. This includes some organisations that previously did not measure their carbon footprint. 12% of the organisations surveyed that did not measure their footprint in 2020 had started doing so by 2021.

However, a number of organisations have stopped measuring their carbon footprint making it difficult for them to make progress on their journey to zero carbon. It is crucial that the 16% of the organisations surveyed who did not measure their carbon emissions in 2021 despite having previously done so in 2020 again start to do this.

Decreases in emissions are starting to stall

The median level of emissions has fallen from 3.04 tCO2e/WTE (tonnes of CO2 per full-time staff member) in 2016 to 2.29 tCO2e/WTE in 2021. However, this decrease took place mostly between 2016-2019 and seems to have levelled since 2019.

This may be due to the implementation of initial quick win activities, such as the installation of sustainable lighting and a lack of progress on implementing further activities.

Small improvements have been made in reducing energy consumption from fossil fuels

On average, around three quarters (76%) of responding organisations’ energy usage came from fossil fuels. This suggests a small improvement in the use of fossil fuels since the start of 2020 overall.

However wide variation remains between organisations; while around half (52%) of responding organisations reported a decrease in the proportion of energy consumed from fossil fuels, almost two in five (38%) indicated that this had increased since the start of 2020.

Petrol or diesel is still the main fuel for the NHS fleet

An average of 83% of vehicles in the NHS fleet use petrol or diesel, 8% of vehicles are hybrid, and 9% of vehicles are electric.

The fleet is an area where progress in reducing carbon emissions has been made. Since 2020 over half of responding organisations decreased the proportion of vehicles in their fleet using petrol or diesel. However, just over a quarter reported the same proportion of petrol or diesel vehicles in 2021 as in 2020, and one in five reported a higher proportion of their fleet using petrol or diesel.

Most organisations have not received funding support for sustainability

Over half of the organisations that responded (54%) said they had not received funding for sustainability or to reduce their carbon emissions. Where organisations had received funding, it was mostly from Government departments.

There were very few other sources of funding identified by responding organisations to support them to improve sustainability or to reduce their carbon footprint.

Funding was most commonly spent on LED lighting, followed by auditing and decarbonisation scoping exercises such as energy audits and food waste monitoring.

What we are calling for

It is evident that progress has been made with improving the carbon footprint of the NHS. Many NHS organisations are implementing sustainability practices and plans are in place at regional levels. For example, in England, all Integrated Care Systems should now have a Green Plan in place that outlines ambitions and focuses the delivery of sustainable practices.

However, it appears from our work, that progress on decarbonisation levels has slowed. This may be due to issues such as the Covid-19 pandemic placing additional pressure on the NHS. It is important that the NHS does not lose momentum or there is a risk that future targets will not be met.

Governments will need to provide additional resources and support to NHS organisations

If UK governments are serious about achieving net zero carbon targets, they will need to provide further support for NHS organisations to ensure progress isn’t prevented. Just over half of the responding organisations had not received any funding for sustainability.

Given the huge pressures NHS organisations are under and the increasing energy costs, major improvements to sustainability practices may not happen if specific funding is not made available by UK governments. Funding for dedicated staff to drive sustainability practices within NHS organisations could result in major improvements being made. Any national or local funding initiatives should be widely promoted to NHS organisations with clear information on how to submit applications for funding.

Support and guidance tools will also be crucial to helping NHS organisations to reduce carbon emissions. It is evident that some organisations are much further along in working more sustainably and have more measures in place than others. Practical guidance on how organisations can implement sustainability practices and measure their effectiveness could help those organisations that are struggling.

Consistent measuring and reporting of carbon emissions is needed to assess progress

In order to monitor progress in achieving targets, accurate and consistent carbon monitoring is needed by all NHS organisations. This is not necessarily happening across the UK as one third of our respondents reported not measuring their carbon emissions. Accurate and consistent monitoring across all organisations will enable progress in meeting national targets to be measured, as well as allowing comparisons between organisations to be made; it may also encourage some organisations to prioritise action.

NHS organisations may benefit from national guidance on carbon monitoring or support to train staff in these skills. This could also help carbon monitoring to be consistent across the country, which is important for making comparisons and ensuring we do not compare apples with pears.

Increased awareness

There is a need to raise awareness of sustainability strategies and targets. To increase buy-in to activities, staff, patients and partners need to be engaged on the development and implementation of sustainability plans, such as the Green Plans in England. They need to highlight which current practices have the most impact on the environment and engage the local population on finding solutions. Responsibilities of staff, patients and partners should be set out clearly. Support guides and information should be provided to ensure all stakeholders know how to take action.

Best practice examples can be a very effective way of providing organisations with information and guidance on how to implement sustainability practices. For example, Greener NHS has highlighted some good practice from Trusts in England. It is important that examples such as these are promoted widely across the country to reach as many NHS organisations as possible.

Health professionals are important advocates for change. Examples include championing sustainability practices, encouraging colleagues to follow sustainable responsibilities and speaking to patients about making sustainable choices. Where possible, health professionals can implement sustainable practices in their workplace or encourage their organisations to implement such practices.

For example, the BMA highlighted some activities that can be implemented in general practice. All healthcare workers should be empowered to raise concerns regarding poor practice and supported to make greener choices.