Hitting Net Zero without harming patient safety

One thing that’s often forgotten in the constant public discussion around the NHS is the service’s sheer size. Our health service is the biggest single employer in Europe – comprising more than 1.7 million highly skilled professionals up and down the UK. When it comes to sustainability concerns, this of course doesn’t exclude it from the need to decarbonise, but it’s crucial context when looking at the scale of the challenge of achieving an 80% emissions reduction between 2028 and 2032. 

However, the same thinking applies when celebrating the progress made so far – for an organisation that now makes up 4% of the UK’s total carbon emissions, cutting its carbon footprint by 62% between 1990 and 2020 is huge achievement. The NHS’s Net Zero goal in 2040 for the emissions it directly controls is fast approaching, and this affects everything from the fuel that goes into NHS vehicles, to how it uses water. 

Meeting a stricter set of rules

While the drive to a sustainable health service is a top priority for NHS leaders, it isn’t the only focus, and its efforts to reduce emissions in healthcare must meet a far stricter set of rules to ensure that they don’t undermine safeguards on hygiene and patient safety. When it comes to water, the challenge is particularly acute. A huge proportion of the NHS’s emissions come from heating and hot water, making it a prime target for sustainability initiatives, but the health service consumes millions of litres of hot water for a reason: it’s vital for keeping vulnerable patients safe from infection. 

The NHS isn’t just big – it’s also broad and complex, which means the collaboration needed to hit emissions targets goes far beyond clinicians and facilities staff. It starts at the very beginning of value chains for medications and PPE, before ground is broken on construction projects, and continues long after a product or facility’s use life. At every stage, and with every stakeholder, there needs to be a competence-based approach where everyone has an instinctive understanding of how their role contributes to sustainability, patient safety, and how they interact with one another. 

Ultimately, the challenge is a compromise of no compromise – the NHS must reach Net Zero, but it needs to do so without harming patient safety. The NHS still has significant challenges to overcome to meet its 2040 goal, and, as mentioned, water is one of its biggest. Heating water to high temperatures, and flushing systems, are vital parts of infection control plans across healthcare settings; processes which naturally consume huge amounts of energy and water.  

It is for this reason that Water Safety Groups must take an active role in the decarbonisation process, both as a resource in finding solutions, and as a constant guardian of infection control. Work on this problem has already begun, but, as detailed in a previous issue of Looking Deeper, the journal published by Armitage Shanks, many of the potential answers discussed so far are largely imperfect. 

Heat pump ‘challenges’ 

Heat pumps are a prime example of this unique challenge. The heat pumps that are set to ‘transform’ the domestic heating market have a Coefficient of Performance (CoP) of 3-3.5. However, to meet the required flow temperature of 60 °C, and a return temperature of 55 °C, increasing to 70 °C if sampling has indicated an increased microbial risk, means they have huge electricity demands in healthcare settings. It’s a similar story for solar power and point-of-use water heating too, both of which could play and important part in the solution, but raise questions around the implementation of the technology, and whether they can meet the standards the health service needs. 

A possible solution involves augmenting, rather than replacing, existing systems – i.e. gaining heat recovery from wastewater – drastically reducing energy expenditure. Heat recovery has been shown to work on an industrial scale, albeit at a high cost, but its application in healthcare must also come with the assurance that flow temperatures won’t be affected. Application of heat recovery would have to come with a guarantee of a consistent heat supply, which would likely undermine the sustainability value – bringing the NHS back to square one. 

NHS water safety guidelines 

In the face of these, and other imperfect solutions, attention must at some point turn to the immovable object of NHS water safety guidelines, but these are firmly focused on patient safety, unlikely to change, and will be slow to do so. Chemical water treatments have been raised as an alternative, but the potential for harmful by-products, and the need for a suite of additional monitoring parameters, are two of a host of questions posed by this possibility. In reality, the answer is likely to be a combination of technological and procedural solutions, and it’ll be reached with input of water safety teams at every stage. 

Reducing emissions spent on water isn’t the only place where water safety teams can contribute to the NHS’s sustainability mission. In the years leading up to the 2040 target and in the decades beyond, emission reductions will have to become second nature for everyone in the NHS – they’ll have to understand what that means in their role, be able to advocate and implement best practice, and become fluent in recording and reporting on the impact of their work. 

This level of active, consistent knowledge is officially referred to as ‘competence’ by water safety teams, and should be a useful benchmark for the always-on attitude to sustainability that will be needed to get the organisation to Net Zero and, importantly, keep it there. For water safety teams, this competence means constantly assessing the potential risk of contamination at each stage of a project and, for every team member, understanding how their role impacts that risk. 

If sustainability teams could establish a similar level of this competence across their multidisciplinary groups, it would help break a huge task into a manageable part of people’s workloads. It would also help eliminate the scale of the task as a barrier to action, but it does need collaboration and input from across the organisation. The phrase ‘no job too small’ is particularly apt when it comes to considering water safety, but it’s valuable for sustainability as well.

Proper progress 

Luckily, the NHS is powered by some of the best minds in the business, and Trusts across the UK have been working diligently to make their operations as carbon-efficient as possible, with some initiatives requiring more than a little outside-of-the-box thinking. An impressive example comes from the South Coast, where vital chemotherapy treatment drugs are being delivered to patients on the Isle of Wight from mainland providers by uncrewed aerial vehicles, or drones to you and I. Previously, chemotherapy drugs had to be delivered by a courier from Portsmouth by ferry or hovercraft to the island, then driven to St Mary’s hospital in Newport. 

Now, with purpose-built medical drones, this journey, which did take four hours, has been cut to just 30 minutes, and the emissions from at least two car journeys and one ferry/hovercraft saved. This ingenious, technology-driven success story is just one of a thousand small changes that are not just making the NHS greener, but also delivering better care for patients. 

‘More sci-fi than most’

This green initiative is more sci-fi than most, and it’s true that the majority of change will be in the NHS’s core operations, and involve more difficult questions than drones. Much of this work includes making the most of what the organisation already has – for example, plans for intelligent, AI-driven, real-time energy monitoring of NHS buildings is set to contribute up to 2.3% of the total required reduction in carbon emissions alone. 

There has also been work to identify how roofs and adjacent ground space in the NHS estate can support a shift to on-site renewable energy and heat generation, bringing huge emissions savings. This is already happening at Royal Manchester’s Children’s Hospital, which has invested in an on-site renewable energy project, saving 380 tonnes of carbon and thousands of pounds in energy costs. 

A significant upfront cost

Implementing similar schemes in Trusts across the UK will come with a significant upfront cost, but the return on investment can be counted in more than carbon. The energy crisis stemming from Russia’s invasion of Ukraine saw bills skyrocket for the healthcare sector, as well as consumers, in 2023, and if the NHS supported more of its own energy needs with renewable energy generation, it would be much better insulated from similar future geopolitical and market shocks. 

The message from the progress made so far in decarbonising the NHS is that there are opportunities everywhere, and no stone should be left unturned in the process, but also that the solutions, both technological and organisational, can often be found and made to work on a large scale. 

A greener future 

There is a path to a carbon-neutral NHS, and it’s one on which the organisation has already made significant progress. The change that has already been implemented is an incredible achievement, and one that shows the emissions savings that can be found within existing operations. Of course, the scale of work needed to meet the ambitious targets will mean fundamental change, as well as finding hidden efficiencies in many siloed ways of working, of which water management is one. 

Above all though, the process must be collaborative, and every role in the NHS must be informed and empowered to be a driver of the change. If there’s anyone who can rise to this challenge – it’s our NHS.