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Reducing Emissions across Health Services: a Landmark Commitment

17th Nov, 2021

Climate change: our biggest public health challenge

We know that climate change not only presents a substantial environmental risk, but it could also pose the biggest public health challenge. Increasing global temperatures will result in water scarcity, food insecurity, extreme weather and could lead to more infectious diseases. This means that global health systems will need to adapt and evolve to continue to deliver high quality services and respond to these ever-changing circumstances.  

In tandem, health systems need to transition to reduce their own impact on climate change. With health systems contributing to around 4.6% of global greenhouse gas emissions, they are a sector of our economy which we cannot afford to ignore in the race to net zero. However, decarbonising this complex network of buildings, manufacturing sites, transportation and services will not be simple.  

The more we, at Gemserv, delve into the issue of health sector decarbonisation, the more we realise the interdependencies that exist  and the international action needed to deliver the desired outcomes. Commitments and isolated actions in one country alone will not be enough.  

NHS Net Zero Plan: One year on

We welcomed NHS England’s Net Zero Strategy in October last year. Stated to be the most advanced review of its kind, NHS England committed to become Net Zero by 2045. The report placed greater emphasis on the indirect scope – with a hefty 60% of emissions coming from the supply chain.  

A year on, it is clear that the journey to Net Zero is much more complex than some people initially thought. As a result, the NHS is very much in ‘listening mode’ and initiated a series of forums to work alongside suppliers to fully understand the complexity of decarbonisation pathways. Alongside forums, we have been informed that 7 clinical leads have been appointed to action the holistic perspective of Net Zero with models of care at the centre of change. This is a key time to influence the debate. 

What pledges have been made since then?

It was fantastic to see the four UK nations coming together to pledge the same world-leading commitment to achieve net zero by 2045. But it is not simply about the UK. The past two weeks at COP26 has demonstrated a willingness and a need for international collaboration to deliver the changes required to reduce emissions. So, we were delightedpleased to see a further 47 countries agree to transition their health services to be sustainable and low carbon. Unfortunately, there is very little detail on what this means in reality, but this pledge offers an opportunity for the UK to lead the discussion and help to shape international action plans too. 

What needs to happen next?

Targets and agreements are a great first step but how these commitments come to life is where the challenge lies. There are two key areas where we would like to see action.

 1. Alignment of global and national stakeholders 

To achieve our climate change ambitions, we need to see alignment across the health sector’s international supply chains, so these landmark commitments are a necessary first step in the journey. However, pressure is needed to ensure that concrete action plans are put in place. Here the UK has an important role to play in laying the foundations for others to follow. 

There is a need to better understand the supply chain and the emissions associated within both manufacturing and distribution. Given that the supply chains are international, global misalignment of climate change targets and enforcement is a major issue for NHS suppliers. It is clear that sustainable procurement will be key to ensure these targets permeate throughout the whole network. However, consistency is needed to avoid patchwork implementation and differing outcomes across the sector. 

    2. Upgrading existing building infrastructure 

Delivering upon these ambitions will require upgrades to existing buildings and ensuring that new hospitals are compatible with net zero. In the UK, there are significant opportunities for emissions reduction from energy use in buildings. Many hospitals still rely on fossil fuels with some using oil or coal fired heating systems. Transitioning to low carbon heating solutions will be essential. It is therefore positive to see NHS Scotland-owned buildings committed to using renewable heat by 2038, and 48 new hospitals in England being built to a net zero standard by 2030, similarly new hospitals in Wales will use renewable energy and low carbon heat by 2030.  

To meet net zero, we must deploy technologies like fuel cells, biomass, combined heat and power plants, and heat networks. Campus sites like hospitals lend themselves to the use of heat networks due to their consistent heat demand profiles. As healthcare facilities seek to lessen their carbon footprints, we expect to see energy efficiency also playing an important role to minimise demand and deliver cost savings. 

How can Gemserv help with these next steps?

We are at the heart of the biggest issues facing society today – longer, healthier lives and climate change. Our health and low carbon teams are working closer than ever to drive the transition to a net zero healthcare system. Utilising proven methodologies to understand industry challenges and leveraging established relationships to influence change, we are proud to be working with clients and to be at the forefront of the transition. If you’re not sure what this all means for you, our experts can help you understand what COP26 means for your organisation and help you drive policy outcomes that are ambitious but practical.   

Key commitments in the UK:  

For the NHS in England, this will mean: 

  • Working with stakeholders to establish how best to embed issues like Net Zero, biodiversity and climate resilience in the NHS Constitution for England, with a formal review in 2022. This follows being the first health service in the world to commit to being net zero by 2045. 
  • A zero-emission fleet, with the world’s first zero-emission ambulance capable of travelling 300 miles before being charged, unveiled at COP26. 
  • All NHS suppliers will need to publish a carbon reduction plan. 
  • Over £330m investment in climate-smart healthcare and low-carbon hospitals, improving energy efficiency, cutting carbon emissions and tackling climate change. 
  • A new Net Zero healthcare building standard will be published and be applied to the existing commitment to build 48 new hospitals before 2030. 
  • Ensuring health resilience is at the heart of the low-carbon transition, publishing the 3rd UK Healthcare Adaptation Report and with the UK Health Security Agency publishing its Single Adverse Weather Plan. 

For the NHS in Scotland, this will mean: 

  • Becoming a net zero carbon emissions health service by 2045, with the ambition to bring this forward to 2040 after consultation on our draft NHS Scotland Climate Emergency & Sustainability Strategy. 
  • All NHS Scotland-owned buildings to use renewable heat by 2038. 
  • Working towards zero emissions of medical nitrous oxide by 2027. 
  • All NHS Scotland small and medium vehicles to be net zero by 2025. 
  • Reviewing NHS Scotland supply chains and taking action to reduce their negative impacts while promoting positive effects. 
  • Developing a Climate Emergency and Sustainability Strategy setting out action to achieve sustainability targets. 
  • Preparing net zero route maps for all 22 Scottish Health Boards by the end of 2022 and align these with climate risk assessments and adaptation plans. 
  • All new buildings and major refurbishments to be carbon neutral. 

For the NHS in Wales, this will mean: 

  • NHS Wales and social care is committed to the ambition for the public sector in Wales to be collectively net zero by 2030. 
  • By 2025, all lighting across the NHS Wales estate will be LED. 
  • Reducing emissions will be part of all new procurement contracts for major suppliers to NHS Wales. 
  • By 2030, the Welsh Ambulance Service will aim for all new ambulances to be plug-in electric or low-carbon fuel. 
  • Low-carbon heating will be used in all NHS Wales new builds and renewable energy will be generated on site by 2030. 
  • Delivery of the NHS Wales Decarbonisation Strategic Delivery Plan. 

For Health and Social Care in Northern Ireland, this will mean: 

  • Developing a sustainable and low carbon health system to help meet NI emission targets. 
  • Producing an assessment of greenhouse gas emissions and subsequent action plan for the health and social care system, consistent with the Northern Ireland Executive’s Green Growth strategy. 
  • Influencing supply chains to reduce their carbon emissions in supplying health and social care. 
  • A continual programme of assessing the health system’s vulnerability to climate change and identifying adaptations required for resilience. 



Samantha Shea

Head of Policy Insights and Engagement

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