We ask whether the NHS is doing enough to meet the Government’s target of ‘net zero’ carbon emissions by 2050
Earlier this year the Government extended its commitment to reducing carbon emissions from public-sector organisations, setting a new target of becoming ‘net zero’ by 2050.
Currently the health and social care sector is responsible for 6.3% of England’s carbon footprint, so change is not only needed to protect the environment, but also to help reduce energy spend at a time of stretched budgets.
But, with organisations working on reducing the impact services have on the world’s resources since the Climate Change Act was passed in 2008, are they doing enough?
The answer is undoubtedly ‘no’!
Alexandra Hammond, director of sustainability at ETL, explains: “Generally, the NHS has stepped up action on carbon reduction and a lot of investment has been made.
“However, much of the overall reduction in carbon from the NHS is from the decarbonisation of the National Grid.
“Progress towards rapidly reducing carbon and environmental impact in other areas simply isn’t happening fast enough.”
Change is needed
Of the 227 NHS trusts in England, 115 - or 52%, - had not implemented any energy efficiency schemes in the year ending 31 March 2019, according to data from the Estates Return Information Collection (ERIC).
In addition, in the 2017/18 ERIC data, there were 74 trusts without a sustainable development manager or a carbon reduction plan in place.
Hammond comments: “The NHS is going to have to make fundamental and significant changes to get to net zero.
“It is currently not on track to meet this, but acknowledges this and has committed to accelerating action to reach the target.”
To date, most of the ‘quick wins’ have been through relatively-low-cost interventions such as the installation of LED lighting.
And many trusts are addressing long-term improvements through the creation of energy performance contracts (EPCs) with private energy-saving firms.
These trusts work with their partners to undertake large-scale cost and energy-saving projects, such as the development of energy centres and heating and ventilation upgrades.
In most of these cases, the private company puts up the necessary capital and agrees set energy reduction targets and the trust pays this back over a period, typically, of between 15-25 years.
Finding the capital
There are other funding sources to help trusts, with ETL supporting over 30 NHS trusts to secure £25m in funding through the NHS Improvement Energy Efficiency Fund and Salix in the past 12 months.
In 2018, NHSI also announced a £46m PDC fund - essentially a grant fund - for trusts to invest in LED lighting in 2018.
This is currently underway and investment will be complete over the next two years, bringing many organisations a big step closer to their targets.
Kevin Cox, managing director of Energys Group, one of a handful on the health service’s Essential Framework to deliver LED lighting upgrades to the NHS estate, said: “It’s not true to say that the NHS has done ‘most of the quick wins’ and is therefore able to move on to ‘what comes next’.
“The NHS is a long way from implementing all of the energy-saving quick wins!
“Yes, they might well have identified them; but in terms of doing these projects fully, well, no, this hasn’t happened.”
Moving forward, all the experts agree that collaboration is increasingly going to be key.
Hammond said: “We need to learn from each other, share our experiences, and push the status quo to achieve net zero carbon on - or even before - the 2050 target.”
ETL is supporting several NHS organisations to progress towards net zero carbon through developing sustainable development management plans (SDMPs) that focus on high-impact and achievable action on the five main areas for carbon reduction - buildings and energy, waste, water, procurement and travel.
Hammond said: “There are many ways in which trusts can work collaboratively towards the net zero carbon target.
“We should be sharing our SDMPs and talking critically about how we will implement these plans over the next few years.
“The NHS must take collective action to systematically and fundamentally address energy use and carbon in its services.”
And she advises a three-pronged approach:
· Setting a strategy – Sustainable Development Management Plans are fundamental to making sure opportunities are identified and ensuring senior level buy-in to invest and prioritise interventions. These can also help identify whether services are necessary in the first place. Also, key are sustainable procurement plans to address the impact of what the NHS buys - up to 70% of the NHS’ total carbon impact - and sustainable travel plans
· Thinking big – address energy from a strategic point of view and consider what needs to be done to ensure long-term, low-carbon energy to trust sites. Sustainable procurement strategies are also important here, to show how purchasing decisions can have a big impact
·Getting on with it and securing the easy wins – LED lighting, HVAC, IT upgrades to new and more efficient equipment and switch-off campaigns are some examples of quick wins that can be implemented in short timescales
Hammond: “Right away trusts need a SDMP and they need to work together. Don’t compete against other trusts. Instead, share learning and ways of getting things done quickly.”
This need to be more transparent is echoed by Jay Patel, energy and commercial analyst at Vital Energi, which is also working with trusts across the country to help implement change, including York teaching Hospital NHS Foundation Trust, NHS Tayside, Gloucestershire Royal Hospital, and Scarborough and Bridlington hospitals.
He said: “Historically, there has been a varied approach to sustainability and carbon reduction and there are lots of good examples of projects that have made a positive impact.
“Now, these stellar examples need to be replicated across the entire estate in order to become the standard approach if a real impact is going to be made.”
Also recommending some of the ‘quick wins’ such as lighting and BMS upgrades, he reveals that the ‘silver bullet’ of the last 20 years has been gas-fired combined heat and power (CHP) plants.
But, he warns, these are now being usurped by more-modern technologies.
“This technology has historically delivered significant financial savings and carbon reductions of around 30%,” he said.
“And there may still be a part to play for this technology in the future if utilised as part of an overall solution, but as more and more renewables come onto the grid, the relative carbon savings delivered by gas-fired CHP seems to be diminishing to a point where this technology becomes a carbon generator instead.”
To address the issue moving forward, Vital Energi suggests a ‘fabric first’ approach.
“There is no point installing efficient or renewable generation technologies if the buildings do not maintain these measures, or if they waste all of that energy saved through heat losses or leaving lights switched in vacated rooms,” said Patel.
“There is often a focus on delivering major projects encompassing hydrogen fuel cell or energy storage, but there is no getting away from the fact that physically using less energy will save money and carbon.”
He adds: “The NHS aims to provide world-class healthcare, particularly during a crisis like we are facing with coronavirus, but it doesn’t always have time or resources to be experts in carbon reduction, too.
“Increasingly more and more people are taking action to be carbon neutral but, despite its importance, there is no getting away from how complex it can be. Therefore, it is vital to partner with a company with knowledge and experience in implementing carbon reduction solutions within the NHS.”
Cox concludes: “There is a lot of value in understanding the data in order to have empirical evidence of the actual usage and therefore what areas might respond best to intervention.
“It’s essential to have a good monitoring and verification plan for the projects the NHS is doing. And, it’s essential to exploit the benefits of lighting control technology, for example, to gain significant additional savings.”