It has been three years since the NHS committed to eliminating carbon emissions, with the aim of becoming the first net zero national health service. At the time, it was recognised the targets were ambitious. But the service’s focus since then has been on recovery following the Covid-19 pandemic and an extremely challenging financial environment.
This has led those working on net zero objectives to look for creative ways to work with what they have. How much progress have systems been able to make on these green ambitions?
The NHS’s Delivering a net zero health service outlines the plan to reduce the service’s total net emissions to zero in response to the climate emergency. The NHS has taken a two-tiered approach, with two specific reduction targets, tackling its direct emissions and the indirect emissions associated with its wider activities:
NHS carbon footprint. This covers emissions over which the NHS has direct control – from its facilities, its use of fossil fuels, its fleet of vehicles and medical equipment such as inhalers. The service aims to reduce these emissions by 80% by 2028-32 and to zero by 2040.
NHS carbon footprint plus. This covers emission sources over which the NHS has influence but no direct control, such as construction, staff and patient commuting and manufacturing. The service aims to reduce these emissions by 80% by 2036-39 and to zero by 2045.
Many investments that would support progress towards net zero make financial sense. Reducing energy consumption or reducing the costs of energy supply, for example, through environmentally friendly self-generation can improve financial as well as environmental sustainability.
But many schemes require some form of pump priming or capital expenditure. And that can be tough in the current climate, where capital allowances are scarce and systems are struggling to deliver financial balance while tackling growing waiting lists.
Net zero and green investment in general can be low priority when it comes to allocating funding for investment. With a maintenance backlog valued at more than £10bn, building repairs and refurbishments are often seen as a more urgent priority than green projects across the service. Repairing damaged roofs, refurbishing wards and replacing old equipment are among the focuses of capital funding considerations.
John Williams, the chief finance officer and deputy chief executive of Sheffield Children’s NHS Foundation Trust and a chair of the HFMA Environmental Sustainability Special Interest Group, acknowledges the obstacles, but says they can be overcome: ‘Lots of reports indicate a critical backlog in infrastructure, billions in backlog maintenance. But if you’ve got a critical backlog problem and capital funding available, you can address a green agenda. There are potentially some mutual wins.’
According to Mr Williams, pursuing these mutual wins requires the adoption of a ‘green lens’ approach. By viewing other capital spending projects in terms of whether and how green objectives can be rolled into them, staff can identify ways to achieve both sets of objectives at once.
A roof repair, for instance, might represent a good opportunity to install solar panels or new insulation with less additional expense and time than you would need if both projects were done separately.
Milton Keynes University Hospital NHS Foundation Trust is a good example of a trust furthering its environmental goals while addressing maintenance needs. The trust employs a refurbishment-first policy, which prioritises improving and repairing existing buildings where possible rather than building entirely new ones. Many of the hospital’s buildings are more than 35 years old. Roofing was nearing the end of its lifespan in 2021, allowing water to seep into parts of the hospital. This required the trust to replace these roofs and refurbish certain areas to repair the damage caused.
The existing hospital buildings have flat roofs, which made it relatively easy and cost-effective to install solar panels during the refurbishment. More than 3,300 panels were installed across the site in two phases. The first phase, installing around 2,500 panels, went online in August 2021, while the second phase wrapped up at the end of 2022. In total, £1.4m was invested in the solar panel project.
The trust’s goal for how much of its electricity needs are met by the solar array is changing as it expands its site and switches to a 100% renewable energy tariff. However, the array currently meets 11% of its total needs and it is looking for other renewable options to improve on this against growing demand.
It has saved the trust £353,000 in utility costs since the first array came online, partially shielding it against recent energy cost rises. This unanticipated saving, alongside good procurement outcomes and use of more efficient panels than planned, has significantly cut the project’s payback time from its original nine years to 4.9 years.
Another approach to encouraging investment of capital funding in green projects is to consider whole life costs and savings. Guy’s and St Thomas’ NHS Foundation Trust’s head of financial operations, Andrew Cavanagh, says: ‘Many opportunities require up-front investment, which is proving increasingly difficult to find – even though the costs may be recovered by net financial savings over the scheme’s lifetime.’
A shift in perspective can help. ‘More consideration of project lifetime costs, rather than just initial investment, helps to change the focus,’
he says. ‘My trust set up an environmental sustainability group a few years ago. They bring a very clear and progressive approach and provide a strong voice.’
Solar ‘field of dreams’
Another solar panel project at Hull University Teaching Hospitals NHS Trust demonstrates the potentially major benefits of green investment and the value of advocating for it. The trust began installing solar panels on land around its Castle Hill Hospital site in September 2021, completing the installation of 11,000 panels – referred to as the ‘field of dreams’ – in February 2022. The installation cost around £4.1m and was fully funded by a grant from the Department for Business Energy and Industrial Strategy as part of its public decarbonisation scheme.
The solar array now typically produces enough electricity to meet the hospital’s entire daytime needs between mid-March and October and it sells excess electricity to the grid during periods of especially high production. In addition, running and maintenance costs are minimal – the trust was able to mount the panels on the ground, the cheapest installation option. Total savings from the power generated by the array is put at £1.6m – much higher than the original projections of around £450,000, due to the solar array shielding the trust significantly from rising energy costs.
Asked whether this project would have been possible without the decarbonisation grant, Marc Beaumont, head of sustainability at the trust, says: ‘It is unlikely, given the significant capital investment required and lower costs of energy at the time of concept. However, due to the increase in energy costs over the same period, the payback is now much closer to the acceptable return on investment, so it is certainly something we would look at for the future.
‘This requires available land many organisations do not have. But other options [such as roof mounting] still offer a good payback over a longer time frame, together with removing some of the risk exposure to fluctuating prices in the energy market,’ he adds.
Net zero extends beyond estates planning, as NHS staff at all levels can make a difference. Most health professionals say they understand the importance of tackling climate change and are keen to work on it, but face a range of barriers, especially a lack of time.
Debbie Paterson, senior technical manager at the HFMA, notes: ‘I think there’s a little bit of paralysis. We got through the pandemic and did lots of things differently, and now we’re going back to business as usual. At the ward level, I suspect making change is really difficult.’
Some trusts are taking steps to overcome this. According to The Christie NHS Foundation Trust, there has been a big effort to get more people involved in the net zero work. A spokesperson said: ‘When it first came on the agenda, it was seen as something for just estates to grapple with, but it was never going to be enough for it to be purely an estates team operation. That’s why the focus shifted a couple of years ago.’
Angela Hayes, a clinical nurse specialist in supportive and palliative care at The Christie, has been leading sustainability efforts there, aiming to link clinical models to the green aims.
She organised a green team competition, in which teams of staff across the organisation were invited to submit ideas to improve sustainability. Each entry was required to meet three central pillars, also called the triple bottom line: cutting carbon; improving patient care; saving money. Five of the teams whose ideas best met these goals were shortlisted to turn their proposals into projects, which were submitted to a panel of judges to choose a winner.
The shortlisted ideas included streamlining crash trolleys (removing unnecessary items and medications) and replacing unnecessary and leaky nitrous oxide pipes with cannisters, both of which predicted thousands of pounds of savings and significant reductions in carbon footprints.
Efforts at The Christie haven’t stopped there. Alexandra Langstaff, a clinical nurse specialist who works with Ms Hayes, says efforts are being made to collaborate with other trusts. ‘I have been contacted by a number of trusts, quite a lot of people, about the things we’ve trialled,’ she says. ‘I’ve been in touch with other trusts about [them] compiling data for a later date for projects they haven’t started trialling yet.’
Despite significant obstacles, staff and leadership at trusts across the UK are showing resilience and creativity around the net zero challenge. Efforts to achieve the NHS’s net zero goals continue to be held back by low capital spending and competition for funding for backlog maintenance and investment. But by highlighting the long-term advantages of green investment, looking for mutual wins and engaging staff effectively, progress can still be made across the health service.
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