Doubts over NHS strategy to cut carbon

The NHS has set an ambitious goal to cut its carbon dioxide emissions by 10% by 2015. However, the Department of Health has not disclosed how it will ensure the target is achieved.

The National Health Service has set an interim target to cut its carbon dioxide emissions by 10% by 2015 from a 2007 baseline, according to a strategy launched by its Sustainable Development Unit (SDU) in January. By 2050, the NHS aims to match the government’s legally binding target to cut the UK’s emissions by 80% compared with 1990.1 A draft of the strategy published for consultation last summer said the NHS had a carbon footprint of 18.6 million tonnes of CO2 in 2004 - about 3% of England’s total emissions, making the NHS the largest public-sector source (ENDS Report 401, p 9 ).

Procurement is the largest source of emissions at 60%. Energy used to heat and power buildings makes up 22% and travel accounts for 18%. The plan proposes action to cut emissions in each area. An updated footprint assessment is due to be published later this year.

The NHS says meeting the targets is a "huge challenge". Despite efficiency improvements, its absolute CO2 emissions have risen by 40% since 1990 and are forecast to reach 22.8Mt CO2 by 2020 - a 55% increase since 1990 - if nothing is done (see figure). The increasing energy intensity of healthcare from the use of new technology, the growing size of the NHS estate from new hospitals and an ageing population are driving emissions upwards.

However, the strategy only offers general advice on practical measures to cut emissions in five areas: water, waste, transport, procurement and food, and energy and carbon management.

For instance, all NHS organisations should draw up plans to develop sources of renewable energy. They should also work with suppliers to reduce emissions such as those from procurement of pharmaceuticals and hospital food. Further guidance is to be published specifically on procurement. Car mileage allowances should provide an incentive to use low-carbon vehicles.

Nor does the strategy set a timetable with measurable objectives over the period to 2015. Each NHS organisation will need to determine what measures to take and whether to set its own targets, raising concerns that many will not take sufficient action.

David Pencheon, director of the SDU, said the unit does not have the authority to set targets; its role is to make the case for change. The strategy shows NHS bodies and the Department of Health (DoH) that reducing carbon emissions and cutting costs makes good business sense, he continued. "It’s impossible for any one organisation to implement it - we’re all going to have to work together."

Nevertheless, Dr Pencheon said the DoH is ultimately responsible for ensuring that the NHS helps meet the legally binding targets in the Climate Change Act. It should help implement the strategy by incorporating it into the performance management and regulatory framework for NHS Trusts, he said. Monitor, the regulatory body for independent NHS Foundation Trusts, has a similar function.

ENDS asked the DoH and Monitor to say how they will ensure implementation of the carbon reduction strategy across the NHS. The DoH refused to comment, saying it was an issue for the SDU.

A spokesman for Monitor said: "We will be looking in detail at the report to consider what elements of the strategy sit within our regulatory control and how NHS Foundation Trusts can be appropriately encouraged to address carbon usage.

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