I’m not sure when it first occurred to me that the UK National Health Service (NHS) was obsessed with reducing greenhouse gas emissions. It must be a few years since I noticed an electronic display on a wall as I was leaving a small hospital near where I live, solemnly telling me something about CO2 emissions, but apart from vaguely registering that it was rather odd (there was nothing telling me how many patients they successfully treated, or anything about waiting lists, by contrast) I thought little more about it.
Greener NHS campaign to tackle climate ‘health emergency’
Obsession does seem to be the word, however, as the above title makes clear. It is the title to an online press release/articlei on the NHS website, dated 25th January 2020 which starts like this:
NHS Chief Sir Simon Stevens has today announced the NHS and its staff will step up action to tackle the climate “health emergency” this year, helping prevent illness, reducing pressure on A&Es, and saving tens of thousands of lives. The initiative follows the launch of the Climate Assembly UK this week, which is discussing how the country can best get to ‘net zero’.
There are quite a few things to notice about this. The first is that it is obviously political, timed as it was to coincide with the UK Climate Assembly. The second is the massive irony of it being dated a few weeks before the covid pandemic – a real “health emergency” – hit the country. The third is the conflation of climate change with air pollution.
The causes of air pollution and climate change are often the same, so the ‘For a greener NHS campaign’ will help address both. The health and care system in England is responsible for an estimated 4-5% of the country’s carbon footprint.
Air pollution is linked to killer conditions like heart disease, stroke and lung cancer, contributing to around 36,000 deaths annually.
A recent study by Kings College London looking at nine English cities demonstrated that on high pollution days there are 673 additional out-of-hospital cardiac arrests and hospital admissions for stroke and asthma, with spikes in ambulance 999 call outs.
Last month a group of 175 doctors warned that air pollution is directly adding to current pressures in accident and emergency departments.
The changing climate is leading to more frequent heatwaves and extreme weather events such as flooding, including the potential spread of infectious diseases to the UK. Almost 900 people were killed by last summer’s heatwaves while nearly 18 million patients go to a GP practice in an area that exceeds the World Health Organisation’s air pollution limit.
The link between climate change and air pollution strikes me as a piece of legerdemain. The causes of air pollution and climate change might, arguably, often be the same – road vehicles mostly, I imagine – but to suggest that the NHS’ “estimated 4-5% of the country’s carbon footprint” has much to do with air pollution is a stretch too far. So far as the NHS is concerned, there is precious little connection between the two, but it doesn’t stop them pushing this dubious “link” for all they are worth – e.g. the fatuous claim that “nearly 18 million patients go to a GP practice in an area that exceeds the World Health Organisation’s air pollution limit.” That may be true, but how many of them are being treated for diseases related to air pollution? Nothing like 18 million, that’s for sure, so why mention that number, other than to try to suggest that a crisis exists where it doesn’t, and to make the leap from that alleged crisis into the supposed need to do something about climate change?
As for heat-waves in the UK killing people, the reality is that far more people die every year from cold, both in the UK and around the world, than die from heatii. Whether or not UK floods are driven by AGW (as opposed to being the result simply of bad weather, blocked drains, building on flood plains, concreting over our green and pleasant land, etc.) is very much a moot point, and although any life lost in a flood is a very sad event, we are not here talking about a “health crisis”. As for “the potential spread of infectious diseases to the UK” I simply reiterate the irony of this appearing weeks before (and possibly after – who knows?) the arrival of SARS-COV-2 in the UK.
As for pressure on A&E, I suspect that one of the main drivers of that is the inability of many people to see a GP face-to-face. Unable to see a doctor in the traditional way, by popping round to the GPs’ surgery, in desperation they go to A&E instead.
Anyway, what was the plan?
First, NHS England is establishing an expert panel to chart a practical route map this year to enable the NHS to get to ‘net zero’, becoming the world’s first major health service to do so.
Dr Nick Watts, of University College London, will chair the NHS Net Zero Expert Panel. He is a medical doctor and executive director of Lancet Countdown, the independent international expert group that tracks the links between climate change and health. The NHS in England is the only health-care system in the world that is routinely reporting on greenhouse gas emissions. The Expert Panel will look at changes the NHS can make in its own activities; in its supply chain; and through wider partnerships – thereby also contributing to the government’s overall target for the UK.
So far so political. Then there was this:
These include the Long Term Plan commitment to better use technology to make up to 30 million outpatient appointments redundant, sparing patients thousands of unnecessary trips to and from hospital. It is estimated that 6.7 billion road miles each year are from patients and their visitors travelling to the NHS.
I’m all in favour of saving patients from making unnecessary journeys, but to suggest that up to 30 million such journeys (presumably every year, given that the claim is that they will save 6.7 billion road miles each year) are unnecessary is, frankly, a staggering assertion. Either the NHS has been quite extraordinarily incompetent in demanding tens of millions of people people attend face-to-face appointments they didn’t need, or else the figure claimed is a gross exaggeration. And it all seems more than a little ridiculous at this stage of 2021, given the ongoing furore about GPs refusing to see patients face-to-face. Finally:
It will also look at changes that can be made in the NHS’s medical devices, consumables and pharmaceutical supply, and areas the NHS can influence such as the energy sector as the health service moves to using more renewable energy.
If money can be saved and waste (both financial and clinical) can be avoided, then all well and good. But relying on renewables, without appropriate back-up, seems more than a little unwise in the context of critical health care where reliable electricity might literally be the difference between life and death. I suspect – but do not know – that if appropriate plans are in place, then for every renewable energy plan, there will also be lots of diesel generators.
And finally, back to politics, as the real reason for all this becomes clear:
The Panel will submit an interim report to NHS England in the summer with the final report expected in the Autumn, ahead of the COP26 International Meeting in Glasgow.
Of course, this has all been delayed by a very real health emergency in the form of covid.
Oh yes, I almost forgot:
Sir Simon will also act as an adviser to Climate Assembly UK.
Blog: One year on from a world-first ambition – let’s stay impatient on the NHS reaching net zero
This is the title to an articleiii which appeared on the NHS website on 15th October 2021. One might have thought that the advent of covid, and the consequent 12 months’ delay to their plans, would have given the climate worriers at the NHS pause for thought, but it appears not, their update beginning as they left off pre-covid:
The climate crisis is a health crisis. So agreed the NHS Assembly at our pre COP26 meeting where Dr Nick Watts, who has been appointed to lead the NHS’s charge on net zero, laid out how the health problems caused by climate change are very real and very immediate.
Despite making that bold claim, the article nowhere offers any evidence in support of it. Instead, it offers us a massive mea culpa:
The health service emits energy at a staggering rate, with almost 5% of the country’s emissions health related, and around 40% of all public sector emissions. Carbon is everywhere in the NHS – the buildings we work in, the energy we use, the equipment we need, the treatments we prescribe.
And it then tells us all about the steps the NHS is taking to purge its climate guilt, and guilt it is:
It is beholden on the NHS and its’ users to fully engage with the carbon reduction agenda.
And again, we have this strange mixture of quasi-religious pride and delight in providing a poorer service to patients:
The Assembly heard about many other great examples across the country, not least those led by NHS Assembly member Dame Jackie Daniel at Newcastle Hospitals NHS Foundation Trust, the first health organisation in the world to declare a climate emergency. And these efforts are in addition to the environmental benefits of more care being delivered through remote consultations and monitoring, reducing patient and staff travel to physical healthcare locations.
Perhaps the NHS should take heed of websites like thisiv:
Coroner highlights five cases in which remote appointments a factor in deaths
Alison Mutch, the Senior Coroner for Greater Manchester South, recently highlighted five cases where, she believed, remote appointments were a factor in the deaths. In each case, the use of remote appointments, whether by telephone or video, meant that opportunities to spot problems were missed.
Alison Mutch wrote five prevention of future deaths reports highlighting concerns that doctors were missing details in telephone appointments which may have been spotted, had the patient been seen in person. Prevention of future death reports are created by coroners and are then sent to people or organisations that are in a position to reduce the risk of a person dying under the same circumstances in the future. Ms Mutch sent five reports to health authorities – including local trusts, Health Secretary Sajid Javid and NHS England – asking them to take action to deal with the risks associated with remote appointments.
The Daily Telegraphv has that story too.
There are other equally sad tales, including “The Tragic Story of How Remote GP Consultations Couldn’t Save One Man’s Life”vi about the death of a 26 year old student who, between 14th October and 4th November 2020 contacted his GP on four separate occasions, but was unable to obtain an in-person GP appointment. As the family solicitor commented:
The tragic death of David Nash has highlighted the inadequacy of remote GP consultations and the lack of face to face appointments when they are so desperately needed.
David’s death could have been prevented with appropriate GP care and attention, which he fundamentally did not receive.
Admittedly many of the problems associated with lack of in-person appointments on a face-to-face basis have occurred due to measures taken during the covid pandemic, rather than as a direct result of the NHS crusade to save the planet, but these awful tales should give pause for thought. Sadly, I fear they won’t. What does it matter when you’re saving the planet?
Delivering a ‘Net Zero’ National Health Service
This is the title of a 76 page report available onlinevii which contains a foreword by Sir Simon Stevens, in which the legerdemain is carried on, indeed intensified, despite it being dated October 2020 (the very time when the late David Nash was trying and failing to obtain face-to-face in-person GP appointments), and well after the covid pandemic had caused chaos in the NHS:
The burden of coronavirus has been exacerbated and amplified by wider, deep-seated social, economic and health concerns. The right response is therefore not to duck or defer action on these longer-term challenges even as we continue to respond to immediate pressures. It is to confront them head on. One of the most significant is the climate emergency, which is also a health emergency. Unabated it will disrupt care, and affect patients and the public at every stage of our lives. With poor environmental health contributing to major diseases, including cardiac problems, asthma and cancer, our efforts must be accelerated. We therefore make no apologies for pushing for progress in this area while still continuing to confront coronavirus.
The claim that “the climate emergency” is one of the most serious challenges to dealing with the covid emergency is supported by a single footnote, which takes us to a paper, Salas RN, Shultz JM, Solomon CG. The Climate Crisis and Covid-19 – A Major Threat to the Pandemic Response. N Engl J Med 2020; 383(110: e70.viii It contains all the usual tropes – hurricanes, extreme heat, wildfire smoke, etc. – but unfortunately doesn’t really provide the necessary support for the highly political claim made by Sir Simon since it is a paper addressed to climate-related problems said to be facing the USA, and nowhere deals with climate and the UK. And in any event, it is a highly political paper, concluding as it does with this paragraph:
Until the development and mass deployment of a safe and effective vaccine enables the United States to move past the Covid-19 pandemic, the climate crisis will challenge our pandemic responses; beyond the pandemic, the climate crisis will continue to pose existential risks. It is past time to implement robust and equitable responses to both.
And the political nature of the NHS campaign continues to be clear (page 4 of the NHS report):
With the UK government hosting the UN climate change negotiations in 2021, we will launch an engagement process with patients, our staff and the public over the coming months, to identify further opportunities and resource to help decarbonise our health service.
And then there’s this on page 7:
Our values and our governance: By supporting an update to the NHS Constitution to include the response to climate change, launching a new national programme For a greener NHS, and ensuring that every NHS organisation has a board-level net zero lead, making it clear that this is a key responsibility for all our staff. Meeting this commitment will only be achievable if every part of the NHS – more than 1.3 million of us – are working together. Whether it is a physiotherapist keeping their patients active with sustainable mobility aids, a mental health nurse providing high quality care via telemedicine or a hospital chef sourcing their ingredients from the local community, we all have a role in delivering a net zero NHS, providing health and high quality care for all, now and for future generations.
Personally, I would like physiotherapists, mental health nurses and hospital chefs focussed on their jobs, not on what they can do to reduce greenhouse gas emissions.
The Report carries on in similar vein for many, many pages, and it is too long to summarise here. I content myself with noting that an NHS Net Zero Panel has been set up, comprising 22 members of the great and the good (pages 53-54). It’s worth a read, if you have time and are interested.
Not everyone shares my wish that NHS staff should focus on the day job more than on greenhouse gas emissions, it seems.
The NHS leads the world in green healthcare. But it faces a political roadblock
This was the heading to an articleix in the Guardian by Polly Toynbee on 21st October 2021. In it, as well as telling us to be grateful to Extinction Rebellion and Insulate Britain activists, she extols the virtues of remote consultations:
Remote consultations – oddly under attack by the health secretary, Sajid Javid – are a huge contributor to cutting journeys: the NHS saved 14m miles by using remote consultations last year, Dr Nick Watts, NHS England chief sustainability officer, tells me. These helped cut Newcastle’s travel emissions by 43%, along with walking, cycling and electric buses for staff while at work.
Well Polly might think it’s odd to attack those “carbon”-saving remote consultations, but the families of those who died because they couldn’t see a health professional other than remotely might not agree.
Then there’s this:
Anaesthetics turn out to be climate killers: one vial of desflurane has a carbon footprint equal to the emissions from 350 kilos of coal. Switching to sevoflurane is as effective and less destructive, according to Watts.
I’m not a medical expert, and I take on trust the claim that sevoflurane is as effective as desflurane (the limited online research I have conducted seems to support that view). However, I note that cost isn’t mentioned. I haven’t been able to find a direct cost comparison between the two types of anaesthetic, but I have found materialx that suggests that sevoflurane is expensive, and it seems to be almost four times as expensive as another common anaesthetic, isoflurane. I do hope that cost and value for money is also being taken into account when these “climate-saving” changes are being made, given the never-ending shortage of funds that is always being claimed for the NHS.
The Guardian article also repeats the stale claim seeking to equate greenhouse gases with real air pollution, which of course isn’t a valid conflation and doesn’t justify the claims being made:
The climate crisis is a health crisis, he says, sometimes in very direct ways: air pollution kills up to 36,000 Britons a year, and hospitalises many more. He aims to cut 3% of NHS emissions this year – which he says is the equivalent of 1.7m flights London to New York. But, in a wicked spiral, the asthma inhalers necessitated by the UK’s pollution, using hydrofluoroalkane as a propellant, themselves release 4% of NHS emissions. Switching just 10% of them to dry powder inhalers has so far cut CO2 emissions equal to taking 120,000 cars off the road. Meanwhile, 18m patients attend GP clinics in streets exceeding World Heath Organization air pollution limits.
Thus the Guardian repeats the rather irrelevant claim contained in one of the first NHS papers we studied above, and confirms the political, rather than medical, basis on which it was included. Brief online research suggests that switching inhaler types might be neutral in terms of efficacy, but I struggle with the claim that inhalers alone represent 4% of NHS emissions. I would have liked to see evidence to back that claim up.
And the truth will out – this net zero NHS programme is, it seems, massively expensive, as the final paragraphs of Polly’s article confirm:
But here is the sobering truth that reflects every aspect of the climate catastrophe confronted at Cop26: good though this progress is, the health service still has vast, as yet unfunded capital costs to reach net zero. Newcastle hospitals can’t make much more progress while aged and leaky estates need massive investment to rebuild, to insulate and replace gas boilers with heat pumps and solar panels – that’s where 90% of the remaining emissions are….
…At next week’s budget, there is no sign yet that the chancellor plans the kind of enormous capital spending it would take to green the NHS estate – let alone the whole country.
Just as I would like health professionals to focus on the health of patients ahead of greenhouse gas emissions, I would also like scarce funds in the cash-hungry NHS to be directed to clinical care ahead of greenhouse gas emissions.
Instead, what do we see?
NHS Climate Emergency Response Lead
Job adverts like the onexi with the above heading are what we see. The job overview reads like this:
Climate change has been described as the biggest global health threat and tackling it as potentially the greatest global health opportunity of the 21st century. As Scotland’s largest employer, the NHS has a significant role to play in our efforts to reach net-zero by 2045 and many of the actions that need to be taken to mitigate climate change have both environmental and health benefits. As the Scottish Government’s lead for the NHS Climate Emergency Response, you will be responsible for providing leadership and direction to efforts to decarbonise NHS Scotland and create an environmentally sustainable health service. This will involve close engagement with Health Boards and with colleagues across government. You will support national level governance for the NHS climate emergency response, working with senior colleagues both in government and the NHS. You will provide strategic advice to Ministers on the options and opportunities for prioritising, financing and delivering investment in support of the NHS’s climate emergency response.
I wonder if we held a referendum on it, would the public support their money being spent on jobs like that at many levels of the NHS?
While the NHS has spent many months at the height of the covid crisis putting in place an expert panel, writing a very long report, and generally spending goodness knows how much money and many thousands of hours on going net zero, things have not being going well within the organisation. Taking the eye off the ball might seem to be the phrase. The Guardian is aware of the problems. On 22nd October 2021 an articlexii appeared with the headline “Cancer patients face ‘perfect storm’ as Covid piles pressure on NHS” and the subsidiary heading “Macmillan analysis of NHS England data finds overstretched hospitals struggling to cope with backlog”. The whole article makes for sorry reading.
And on 1st September 2021 another articlexiii in the Guardian pointed to a “postcode lottery” regarding waiting times within the NHS, and an addendum to the article confirmed that “[I]n June there were 5.45 million people waiting for hospital treatment in England”. Very many of those people had been waiting for more than a year.
Only this week, Lothian NHS tweetedxiv “Services across #Lothian are under extreme and sustained pressure. DO NOT come to the emergency department unless it is life threatening.“
The casual (or indeed the serious) reader might well wonder whether the NHS, with its Net Zero programme, has its priorities wrong.
In the midst of all this chaos within the NHS, which seems to have its eye more on the climate change ball than the ill patient one, we introduce another climate change element, one that is going to cause further problems for the long-suffering British public in the name of saving the planet.
There seems little doubt that COP26 is going to have a negative effect on the health and welfare of UK residents, and most particularly of course, those who live in and around Glasgow. A BBC articlexv two days ago included this:
Scotland’s health secretary says there is “absolutely a risk” of Covid cases rising after the COP26 summit in Glasgow.
Humza Yousaf said he expects to see a spike in cases after 25,000 delegates descend on the city in a week’s time.
Mr Yousaf said the Scottish government was not currently considering imposing more restrictions.
And only today, another articlexvi appeared on the BBC website, which includes this:
The spread of Covid by activists around the COP26 climate change summit in Glasgow are a “concern”, according to a public health expert.
Prof Linda Bauld said safety measures were in place at the summit itself, but other gatherings posed a greater risk.
An estimated 100,000 people may take part in protests or other activist events during the UN conference.
Infection rates are currently “stable”, she said, but a small change could see a return to exponential growth.
Not that it will stop activists protesting, of course.
And it isn’t simply rising covid cases that could be an adverse health consequence of COP26. According to an articlexvii in the Glasgow Times yesterday:
Outpatient appointments at a Glasgow hospital have been cancelled due to expected travel disruption at the start of COP26.
NHS Greater Glasgow and Clyde confirmed that a “small number” of patients due to attend the West of Scotland Ambulatory Care Hospital on Monday November 1 have had appointments rescheduled or relocated to alternative sites.
It is understood that the number of appointments booked for November 1 had already been drastically scaled back in anticipation of gridlock around the city.
Gridlock? What was that about air pollution?
It’s interesting to note that as well as the cancellation of long-delayed appointments, other appointments have been “relocated to alternative sites.” So much for minimising patient journeys in order to avoid unnecessary greenhouse gas emissions. Then again, if they were concerned about unnecessary greenhouse gas emissions, they wouldn’t be jetting 25,000 in to Glasgow, with many of them being accommodated significant distances from the city and having to make long round trips every day that the event lasts.
I’m all in favour of an holistic NHS, thinking “outside the box” and taking measures that help to improve the health of the nation as a whole, especially if that gives us the added benefits of saving costs and taking pressure off an already over-stretched system which was struggling before covid and now seems to be on its knees.
However, the NHS Net Zero Plan seems to be politically – even ideologically – driven, and the conflating of air pollution with climate change as a key justification for an enormous exercise distracting staff from their day job seems to me to be very much a political rather than a clinical decision.
What with COP26 and NHS Net Zero, I fear that yet again the health, wealth and happiness of the long-suffering British people is being thrown overboard, while the establishment ploughs ahead with an agenda whose tentacles are adversely affecting every area of our lives.