It is widely accepted that the world needs to stop emitting greenhouse gases (GHG) into the atmosphere within the next few decades, that is, achieve Net Zero by 2050, to avoid a climate disaster. This will require significant changes to life as we know it because much of modern life involves greenhouse gas emissions-generating activity. This affects every major sector of the economy and every country in the world. Furthermore, the change to emissions levels will need to be sustained for at least 30 years. It will affect and require consensus and co-operation across all tiers of Government, both nationally and internationally, to achieve the far harder emission reductions over the next 30 years than those already achieved. Many outstanding challenges remain, including electricity storage; cement, iron and steel production; plastics and chemical manufacturing including fertiliser; residential heating; aviation and shipping; methane from farm animals; carbon capture and storage; decarbonising heavy goods vehicles and land transport; and emissions pricing. The challenge is huge and very complex, and made more so by the international dimension without any mechanisms or levers to tackle sources (including countries) of high emissions.
The UK is a minnow in terms of global emissions, being responsible for 0.79% of GHG emissions in 2022 (Crippa et al, 2023), which represents a consistent reduction in total emissions since 1990, as well as a reduction in CO2 per capita emissions. In 2022, China, the US, India, the 27 European Union countries, as well as Russia and Brazil were the largest GHG emitters. Just over half of the world's population (50.1%) live in these countries. They generate 61.2% of the global Gross Domestic Product (GDP), consume 63.4% of global fossil fuels and generate 61.6% of global GHG emissions (Crippa et al, 2023). While China, the US and India increased their emissions in 2022 compared to 2021, India had the largest increase (by 5%) in emissions. Although population growth receives little attention, it directly increases emissions and it is worth noting that the world's population has grown more than seven-fold since 1820 (mainly in Asia and Africa).
The 28th meeting of the Conference of the Parties to the UN Framework Convention on Climate Change (COP28) (United Nations Climate Change, 2023) took place in the United Arab Emirates from 30 November–12 December 2023. A global stocktake of efforts to address climate change under the Paris Agreement concluded that climate action progress has been too slow to limit the global temperature rise of 1.5°C. Negotiators from nearly 200 countries agreed that action needed to be accelerated, including transition away from fossil fuels to renewable energy sources as part of their climate commitments for 2030. Funding arrangements were agreed to help countries and communities which experience loss and damage due to climate change. Targets were agreed for the Global Goal on Adaptation (GGA) (and its framework) which focuses on what needs to be done to increase resilience to the changing climate and how countries' progress would be assessed. The GGA framework covers water, food, health, ecosystems, infrastructure, poverty eradication and cultural heritage.
The COP28 explicitly recognised the link between climate change, ecosystems and biodiversity and the need to ‘conserve, protect and restore’ nature and ecosystems. Practical climate solutions were displayed in the COP28 Global Climate Action space, offering ideas regarding food production, reduced emissions and other challenges. Globally, health systems are one of the largest emitters at approximately 5% of global emissions, largely due to the fossil fuel combustion (84%). There was a dedicated Health Day within the conference with Health Care without Harm leading a week-long Climate Health programme focusing on the health impacts of climate change, their mitigation and sustainable healthcare. Lastly, negotiations were begun regarding an ‘enhanced transparency framework’ including the reporting and review tools for measuring the implementation of the Paris Agreement with a deadline of June 2024 for the final tools so that target implementation can be measured by early 2025 prior to COP29, which will be held in Azerbaijan.
While the UK Government had begun initiatives to address emissions levels with the Climate Change Act 2008, the enactment of the June 2019 Climate Act 2008 (2050 Target Amendment) Order (UK Government, 2019) committed the UK Government to reducing GHG emissions by at least 100% of 1990 levels (Net Zero) by 2050. That is, the amount of GHG emissions produced by the UK would be equal to or less than the emissions removed from the environment and may include offset schemes such as tree planting or technological innovations including carbon capture and storage so that Net Zero is attained. There are a number of policies which underpin the plan to attain the Net Zero target, namely, Net Zero Strategy: Build Back Greener (UK Government, 2021a) setting out proposals for decarbonising all sectors of the UK economy to meet the 2050 Net Zero target drawing upon the Ten Point Plan for a Green Industrial Revolution (UK Government, 2020a); more recent policy documents include Powering Up Britain (UK Government, 2023a) and Powering Up Britain: the Net Zero Growth Plan (UK Government, 2023b). Other important policy documents include: Energy White Paper: Powering our Net Zero Future (UK Government, 2020a); Heat and Buildings Strategy (UK Government, 2022a); UK Hydrogen Strategy (UK Government, 2021b; updated December 2023); Industrial Decarbonisation Strategy (UK Government, 2021c); Decarbonising Transport: a Better Greener Britain (UK Government, 2021d); British Energy Security Strategy (UK Government, 2022b); Green Finance Strategy: Mobilising Green Investment (UK Government, 2023c); and Carbon Budget Delivery Plan (UK Government, 2023d). Several Acts of Parliament and other legislation have also been enacted: the Environment Act 2021 (requires air quality, biodiversity, water and waste targets to deliver improvements and stop all avoidable waste) (UK Government, 2021e), the Climate Act 2008 (Credit Limit) Order 2021 (supports the UK's commitment to international action to address climate change) (UK Government, 2021f), and the Energy Act 2023 (sets out arrangements for energy production and its security, and the regulation of the UK energy market) (UK Government, 2023e).
‘The NHS, like other sectors, is a source of GHG emissions with the NHS emissions representing 4% of England's total carbon footprint and 40% of public sector emissions.’
As part of the Climate Change Act 2008 an independent statutory body, the Climate Change Committee (CCC) was established to advise the UK Government and devolved administrations (Scotland, Wales and Northern Ireland; where the devolved governments have their own policies for simplicity only the English government policies including NHSE are cited) on emissions targets. It reports directly to Parliament on progress towards reducing GHG emissions, and preparation for/adaptation to the impacts of climate change. Their latest reports are: CCC Adaptation Monitoring Framework: assessing the effectiveness of adaptation action across the UK (March 2023) (UK Government, 2023f); CCC Progress in Adapting to Climate Change – 2023 Report to Parliament (March 2023) (UK Government, 2023g); and CCC Progress in Reducing Emissions – 2023 Report to Parliament (June 2023) (UK Government, 2023h)).
The NHS, like other sectors, is a source of GHG emissions with the NHS emissions representing 4% of England's total carbon footprint and 40% of public sector emissions (McGeoch et al, 2023). In 2020 NHS England launched its campaign ‘For a Greener NHS’ (NHS England, 2020a) which culminated in publication of the strategy ‘Delivering a Net Zero National Health Service’ (NHS England, 2021b) setting two clear targets for achieving a Net Zero health service for direct emissions by 2040 (target of an 80% reduction by 2028–2032) and indirect emissions by 2045 (target of an 80% reduction by 2036–2039). The strategy is now statutory guidance which, along with the Health and Care Act 2022 (UK Government, 2022b), requires NHS England and its constituent parts such as NHS Trusts and integrated care boards to meet statutory emissions and environmental targets.
The contributions of NHS buildings, their heating and electricity consumption and waste, together with anaesthetics and ventilators to GHG emissions are obvious; perhaps less obvious are personal protective equipment, cleaning products, single-use plastics and equipment, medications and wound care products (NHS England, 2021a). Transport emissions are also significant and are derived from freight/delivery transport, leased vehicles, business travel, staff commuting in addition to patient and visitor travel (NHS England, 2021a). There is huge potential to reduce waste and develop a more sustainable and circular economy.
While community nurses may feel that their contributions will have little impact, as individuals, we can make a difference both within our personal and professional lives. All NHSTrusts have Net Zero plans, which should be accessible to all staff, and a sustainability lead/Green Champion to whom staff may turn with their queries and suggestions. Everyone will need to develop their skills and knowledge to implement the necessary changes to care delivery. Importantly, the best way for the NHS to reduce GHG emissions is to deliver the existing priorities of ‘preventing disease, improving the management of disease and health, moving care out of hospitals, eliminating avoidable waste, avoiding unnecessary interventions and using lower-carbon alternatives’ (McGeoch et al, 2023).
As a first step you may wish to explore the resources available on the Queen's Nursing Institute's website: https://qni.org.uk/sustainability/ or those to support sustainable quality improvement initiatives at the Centre for Sustainable Healthcare https://www.susqi.org/.
In 2023, we saw the hottest year ever with unprecedented global temperatures from June onwards. Surface air temperatures broke records and surface sea temperatures were unusually high between April and December, and concentrations of GHG continued to increase (Copernicus Climate Change Service, 2023). We must all take sustainability seriously.