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21/577 HSDR Supporting the delivery of net zero health and social care system - supporting information



Health services in the UK contribute around 4-5% of total UK carbon emissions. Data from the Greener NHS Programme (formerly the Sustainable Development Unit (SDU)) suggests that the NHS has reduced its emissions by around 18.5% since 2007, despite an increase in overall NHS activity. Although these efforts are encouraging, there is an indication that the UK may still fall short of its legal target for carbon emissions.

The Net Zero report (NHSEI, 2020) has set trajectories to achieve net zero emissions within the NHS in England. Similar plans for achieving net zero emissions are either set out or are being drafted by the NHS in Wales, Scotland, and Northern Ireland. Delivering these trajectories will require action from the NHS as well as its partners by delivering direct interventions within estate and facilities, travel and transport, supply chain and medicine and enabling actions, including sustainable models of care, workforce, networks, and leadership.

The environmental impact of health care is influenced by the setting in which it is delivered. Secondary care is associated with an inherently higher carbon footprint than primary care, for example each elective inpatient stay is estimated at 708 CO2e (excluding patient, visitor, and staff travel) compared with an average GP appointment at 6 kg CO2e (18 kg CO2e with prescribing).  Therefore, some service delivery related areas that will benefit from new research include digital care pathway redesign, low carbon models of care, preventative medicine, and reduced health inequalities, zero emission emergency and non-emergency vehicles and on-site energy renewables.

There are plans to develop new clinical waste and energy management strategies for the NHS and a net zero carbon capital planning tool is currently being tested by 15 NHS trusts. There is a focus on shifting away from fossil fuel cars and other vehicles and to attain this, all NHS trusts are required to have a green travel plan. Targeted interventions may include encouraging staff and patients to reduce their vehicle use by promoting active travel (walking and cycling), provision of electric bikes and digital platforms.

Such practices are already being implemented in several trusts such as the Manchester University NHS Foundation Trust’s sustainable travel plan providing personal travel advice for staff. Staff should also be offered flexible working patterns and supported to choose sustainable methods of transport to commute. Another example is the Newcastle upon Tyne Hospital’s NHS Foundation Trust, aiming for a zero-emissions courier service by trialling an electric cargo bike for transporting medical specimens, laundry, and other sundries between NHS services across Newcastle city centre. This initiative has already achieved an estimated carbon savings of 212 kgs, financial savings of £6,250 over a three month period and benefited by occupying little parking space.

The UK Climate Change Risk Assessment has identified climate change as one of the greatest risks to public health in the UK, one which will impact vulnerable people disproportionately. With an increasingly ageing population and increase in younger people with social care needs, climate change will increase the risk of disruption to an already stretched social care system. Social care services may be delivered from a building, either owned by the council or outsourced, or they could be delivered in the individual’s home. Local Partnerships was commissioned by the Local Government Association (LGA) to develop guidance for social care carbon emissions and covers residential care, day care, supported housing, respite care, temporary accommodation, community-based services, and transport for patients to specialist services. Understanding carbon emissions in social care is more complex due to the range and scale of service delivery.

There is limited evidence on environmental impacts associated with specific organisations, service types or patient groups. For example, less is known about the environmental impact of social care and the carbon emissions from this sector and how they are likely to differ from those in the NHS.  It is, therefore, important, and timely to think about how the health and social care sector in the UK can become more resilient and sustainable to environmental impacts in the future . The COVID-19 pandemic has also highlighted the disconnect between health and social care, although there are positive examples of joined-up working. Recent examples of health and social care partnership include “Be Birmingham”, a climate change risk mapping tool with information on health inequalities and a scheme around Bristol to encourage some community-based health teams to reduce the number of miles travelled and switch to electric bikes and low-emission cars.

Relevant on-going and published studies

During the development of the brief the following completed and ongoing NIHR studies were reviewed that applicants may find useful.  (Please note that the studies identified in no way represent a full literature review and applicants should ensure that they review the completed and ongoing research in this area and explain how their proposal addresses a research gap).