Matter for discussion: How can we achieve a greener health care system?

The climate emergency is internationally recognised as a health emergency. The impacts of tackling climate change can also bring health benefits whilst protecting our vulnerable ecological environment.

Climate change brings direct and immediate consequences for our patients, the public and health and care services. Nursing as a profession will be directly impacted. For example, evidence demonstrates how the effects of rising temperatures are already emerging, with global heat-related deaths increasing by 85% in people over 65, a third of which are attributable to anthropogenic [human] changes (Lancet, 2023). Heat has direct consequences for labour productivity and pressures on health systems. The resulting effect on health care workers is a real risk.

Health and care systems globally account for 5% of greenhouse gas (GHG) emissions. In England alone, the NHS is estimated to be responsible for 40% of the public sector carbon footprint. The NHS contribution to climate change is described in two ways and reflects wider health and care impacts – by direct emissions it can control, and emissions it does not control but can influence. Direct emissions include energy use, travel and transport, water usage, waste management, and use of high intensity GHG medicines such as desflurane and pressurised metered dose inhalers (NHS England, 2020).

Addressing emissions offers the greatest challenge and the greatest opportunity to reducing health care’s carbon footprint. It requires scrutiny on the use and procurement across all areas of health care, including medicines, consumables, medical devices, food/catering, buildings, and IT. There is an urgent need to educate and build capacity in sustainable nursing practice.

All UK countries have pledged to achieve a net zero climate impact by 2045 with devolved action to achieve this. In Scotland, the 2022-2026 Climate Emergency and Sustainability Strategy requires health boards to publish an annual report on progress towards the goals and actions outlined in the strategy. Boards are required to establish a climate emergency response team to work with clinicians to make clinical services environmentally friendly. RCN Wales published Promoting Efficiency and Saving Money in Health and Social Care in Wales (2023) (including carbon efficiency) which details case studies of small-scale initiatives which, if rolled out across Wales, could reduce NHS Wales’s estimated carbon footprint of 1 million tonnes CO2 equivalent.

The need to support plans to address these critical challenges at UK and international levels is recognised. Health care needs to move to sustainable models of care, by redirecting its workforce to create, embed and evaluate our impact as the largest global profession delivering care.

The reading list for this debate is available here.

References 

NHS England (2020) Delivering a ‘Net Zero’ National Health Service. Available at: www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service 

Romanello M, Napoli C di, Green C et al. (2023) The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms, The Lancet, 402(10419), pp. 2346–2394. doi.org/10.1016/S0140-6736(23)01859-7 

Royal College of Nursing (2023) Promoting efficiency and saving money in health and social care in Wales. Available at: www.rcn.org.uk/Professional-Development/publications/promoting-efficiency-and-saving-money-english-uk-pub-011-248 

Scottish Government (2022) NHS Scotland climate emergency and sustainability strategy: 2022-2026. Available at: www.gov.scot/publications/nhs-scotland-climate-emergency-sustainability-strategy-2022-2026/documents