When I spoke with Helena Clements on the podcast, one of the many fascinating points she raised was her dual identities. At work, she was Dr Helena Clements, a paediatrician helping sick children. Outside of work, she was Helen Tilley, wife, mother, and householder, with sustainability at the heart of home life. She held these identities separate until she recognised she could incorporate her environmental values within her NHS trust through her power as a senior manager. Climate action is now the most important thing she does, as she realised good health is not possible on a sick planet.
Emissions and the NHS
The health sector contributes 4-5% of global greenhouse gas emissions. In 2019, the NHS’s carbon footprint was 25 megatonnes of CO2 equivalent, consisting of:
- 62% – supply chain (pharmaceuticals, medical equipment, business services, other procurement, food and catering, and non-medical equipment).
- 24% – delivery of care (building energy, water and waste, anaesthetic gases and MDIs, and fleet and business travel).
- 10% – travel by patients, visitors and staff.
The positive news is emissions have fallen in recent years from energy system decarbonisation. However, there is still much to be done, and emissions need to be on everyone’s radar.
A climate action team
Within Helena’s trust, a climate action team consists of members across diverse disciplines, such as nurses, therapists, administration, general managers, estates, catering, waste, and communications. This spread of people is crucial to ensure all teams consider their activities through a climate lens and interconnections with other teams. Helena cited the story of a procurement lead who went out with a district nurse for the day. They learned purchasing cheaper dressings led to higher costs and carbon emissions, as the nurse needed to visit the patient more frequently to change the less-effective dressing.
Spreading climate messaging through the NHS
The NHS is the biggest employer in Europe, and one in 20 people in the UK works within it (in one form or another). This figure is a staggering proportion of the population, making NHS staff potentially hugely influential in spreading climate-related messaging through their connection with friends, family, work colleagues, and the community and social groups to which they belong.
Plus, there is an enormous number of interactions between patients and health professionals, and hospitals can advertise their actions to curb emissions.
Carbon emissions and health
Protecting the planet benefits health. For example, investing in good public transport and switching to electric vehicles will ultimately improve air quality, inevitably reducing the risk to people’s health, particularly those with respiratory issues such as asthma. Making homes warm and energy efficient (and economical to run) will lower carbon emissions, and similarly benefit health.
Conversely, healthy people also lower emissions as health-related visits drop. Conversations about patient lifestyles, including what they eat (more plants, less ultra-processed foods) and how they move (replacing a car journey with walking), can be prosperous for health outcomes and the planet.
A net zero NHS
The NHS has set two net zero targets (when carbon emissions are no greater than those removed).
- Net zero by 2040 – for the emissions they control directly.
- Net zero by 2045 – for the emissions they can influence.
In July 2022, the NHS was the first health system to embed net zero into legislation through the Health and Care Act 2022, and each NHS trust has a green plan.
The government has made £635 million available to support public sector decarbonisation, enabling them to invest in low-carbon heating and energy innovations like heat pumps, LED lighting, building fabric improvements, and renewable energy sources.
Some activities to reduce emissions are relatively easy and quick to implement, such as the green prescribing of inhalers for asthma patients (estimated to be 5.4m people in the UK). Metered dose inhalers (MDI) contain hydrofluorocarbon propellants that are powerful greenhouse gases and terrible for the environment. Switching inhalers (an option for many patients) to dry powder inhaler alternatives benefits emissions as they produce an estimated 20g CO2eq per dose, compared to 500g CO2eq per dose for MDI.
Other changes will be more challenging, such as retrofitting buildings to become more energy efficient and no longer reliant on fossil fuels. Medicine waste is another – it is hard to reduce the associated emissions with developing, manufacturing, transporting, packaging and prescribing patient medicines that don’t get used; by law, they cannot be used by anyone else.
Helena’s vision of the NHS
Much of the NHS is geared towards fixing ill health, but redirecting emphasis (money) to public health and wellbeing, as advocated by Helena (and others, I imagine), would reduce demand, costs in the long run and emissions. Preventing sickness perhaps seems obvious, and Covid surely demonstrates the benefits, but it does require upfront costs. If nothing else, a crisis provides opportunities to do things differently, so maybe the way we manage health can do too.