Dr Nick Watts is the director of the Centre for Sustainable Medicine at the National University of Singapore.
Why does the NHS rarely feature in discussions about net zero?
Clinicians have been slow to this fight. Though, as the NHS is showing, once healthcare professionals show up, they can move mountains. The NHS is running well ahead of its commitments under the Climate Change Act. Healthcare is about 5.5 per cent of emissions in the UK. That’s bigger than shipping and aviation. It’s not a small piece of what the country does.
Are you confident the NHS will achieve its 2045 net zero target?
The NHS ran its big net zero strategy between 2019 and 2020 to really understand, deep down, where all the emissions were. 2045 was selected, frankly, to be right on the cusp of what we thought was feasible but ambitious. I often get asked, can you hit it, and the answer is often 50:50. The target was designed to be hard. The costs associated with decarbonisation, for the most part, are pretty minimal for a few of our fixed assets. There’s a question of where do you treat your patient? Are you siting them correctly? Do they really need to come in for the fifth time to an appointment in the hospital? I view this challenge almost entirely as a change management process. The cost of intervention is low, but the cost savings are high. You want to go after some things that could bring serious benefit to the health system itself like energy efficiency or on-site renewable generation. In healthcare we don’t have any silver bullets. We’ve learned over the past five years that this challenge is primarily not a financial one. The return on investment is actually pretty excellent for a lot of the things that we want to do.
How do you measure success?
You’ve got three metrics you should be chasing. First is carbon. You know it’s working, because there is a team that runs a monitoring and reporting system that checks and reports to the sustainability board regularly. The next thing is can you demonstrate that this is good value for taxpayer’s money? Can you take the money spent and reinvest it back into patient care? The third metric is are you getting serious buy-in from your most important asset, the 1.4 million staff across the country? We would monitor and run public opinion polling every now and then – 92 per cent of health professionals want to work in an NHS that is living up to their own values.
How do you make sure the patients’ experience isn’t harmed in the process?
What doctor do you honestly think would pick carbon over a patient? But you do have to be really thoughtful about it. You have to make sure that every time you’re asking yourself, “Is there anything we’re doing that could harm patient care?” If the answer is maybe, then you can’t do it. More often than not, we find our interventions end up improving patient care. I would flip it and ask: how do we use this as an intervention? We’re going to revolutionise the NHS. We’re going to decarbonise the entire health system in a way that improves health and saves money.
You were the first person to occupy this role. What kind of difference can it make?
You need someone who is senior enough in an organisation of that size to be visible, to be proud, loud, and angry. You need someone who cares deeply about this, day after day. It’s a pretty specialist thing and the job is really difficult. But without a central team, it’s not possible. I have seen attempts in other countries where healthcare organisations try and say, our chief nurse or chief medical officer is doing sustainability work part time. I’ve yet to see that be properly successful, frankly, because they’ve got another very important and serious job as well.
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