The rapid decarbonisation of healthcare

13 October 2021


The rapid decarbonisation of healthcare

Reported by Ryan Francis, CSaP Intern and Jessica Foster, CSaP's Communications Coordinator

Healthcare is one of the largest contributors to the UK’s total carbon footprint. Throughout the COVID-19 pandemic, the NHS experienced a rapid change in the delivery of healthcare. Can this sense of critical urgency be harnessed and applied to the decarbonisation of the National Health Service?

In October 2021, a multidisciplinary group of practitioners and academics met for the first Cambridge Zero Policy Forum discussion of the academic year. It was held to discuss if and how the NHS could reach net zero much more rapidly than the 2040 target currently set by NHS England. The meeting was led by Cambridgeshire GP and public health expert Dr James Smith, as part of his Cambridge Zero Darwin College David MacKay Research Associate project. The secretariat to the Policy Forum is provided by CSaP and the Hughes Hall Centre for Climate Engagement.

Dr Smith highlighted that healthcare contributes to approximately 5% of the global emissions footprint, with major contributors being electricity and heating of the healthcare estate, travel, procurement of goods and services, notably pharmaceuticals and medical devices, and use of anaesthetics and metered dose inhalers. It was revealed the amount of electricity consumed by Addenbrookes Hospital in Cambridge is equivalent to the consumption of three small towns, and participants suggested the NHS needs to equally balance cutting both internal corporate emissions and external indirect emissions.

During the discussion, Dr Smith recommended there are many changes which can be made to rapidly reduce the NHS’s greenhouse emissions. One example is increasing the use of lower carbon inhalers. Currently, metred dose inhalers (MDIs) are the dominant type of inhaler used in the UK. MDIs use hydrofluorocarbons (HFCs) as propellants, which are thousands of times more potent greenhouse gases than CO2. Dry powder inhalers (DPIs) are a low carbon alternative which do not contain propellants. As witnessed in Scandinavia, the high use of DPI is compatible with good respiratory outcomes for patients. This shift to high DPI use could readily be made in the UK, however progress has been delayed due to a lack of awareness among health professionals and patients, a medical focus on the COVID-19 pandemic, and possibly vested corporate interests.

Throughout the policy forum, participants explored other challenges linked to the rapid decarbonisation of healthcare, including how to highlight the urgency of the threat of climate change, as we saw in the COVID-19 pandemic. For example, prior to 2019, nearly all outpatient appointments were face-to-face at Cambridge University Hospitals, and the previous aim was making 30% of them virtual within five years. This was deemed “unachievable”, however the pandemic proved to be “a game changer” as two-thirds (66%) of appointments were taking place virtually during the 2020/2021 lockdowns.

Adopting a “purposeful anarchy” was presented as a possible solution for the rapid decarbonisation of healthcare. This entails breaking away from current bureaucratic structures and instead delegating authority, powers and freedoms to local professionals and front-line staff, to propose creative and ambitious carbon-cutting solutions, alongside expertise from institutions such as universities.

Key questions raised during the discussion included how might we pursue zero carbon initiatives at the same time as handling more immediate clinical care challenges? Where should climate change be ranked as a threat, to help accelerate it as a priority for action? The formation of organisational partnerships was one idea discussed, which could help implement large-scale changes.

While the NHS has the potential to advocate for wider systematic change, balancing the rapid decarbonisation with the potential risks needs further exploration. The potential for collaboration between organisations is fundamental to driving large-scale changes, however it was concluded that decision-makers need to perceive climate change as an urgent emergency, for any real action to happen.

To read the full report of this discussion click here.

Ryan Francis

Centre for Science and Policy, University of Cambridge

Dr James Smith

Department of Public Health and Primary Care, University of Cambridge