Climate and health, creating a Greener NHS

1. Climate and health,
creating a Greener NHS
Rebecca Waters
Health Improvement and Inclusion Manager
NHS North East London
rebecca.waters@nhs.net

2. Content
Greener NHS overview
Impacts on health
Year one achievements
National resources

3. 3
Every step we take together to reduce our carbon
footprint is a step towards great health and wellbeing.
• Every time we reduce the use of fossil fuels from travel and transport operations, we help
our patients, staff and residents breathe cleaner air and reduce carbon emissions.
• Every time we support locally produced, low-carbon diets through our supply chains, we
improve access to quality and affordable healthy food for people in NEL.
• Every time we nurture green space around health and care facilities, we improve wellbeing
for patients and staff, and strengthen local ecosystems that absorb carbon.
• Every time we provide climate literacy training for staff, we empower our people to act and
help shape our journey.
Our NEL Green Plan embodies collaboration, urgency, support, empowerment and trust - we are
shaping our partnership culture to enable everyone to act.
This is our journey to Net Zero and beyond - we welcome everyone to help shape the path.
“We need ALL
staff across NEL
Integrated Care
System (ICS)
making low-
carbon decisions
every day”
Zina Etheridge

4. The challenge
NHS is 5% of UK carbon footprint.
NHS Carbon Footprint- our direct emissions
• 40% reduction by 2025
• An 80% reduction by 2028-2032
• Net zero by 2040
NHS Carbon Footprint Plus- entire emissions
• An 80% reduction by 2036-2039
• Net zero by 2045
(MtCO2e) November
2021
80% reduction by
2028 would bring
us to
Carbon
Footprint
136,420 27,284
Carbon
Footprint Plus
847,450 169,490

5. The climate crisis is a health emergency

6. Health Co-Benefits – taking action on climate
action addresses many other health issues

7. Wildfires in Dagenham in July 2022
• Several homes across five different residential
Essex streets were completely destroyed after
a huge fire spread out of control
• 15 fire engines and approx, 100 firefighters
were called
• Two people were rushed to hospital suffering
smoke inhalation
• 135 people were evacuated from surrounding
properties
• An area of parkland (approx. eight hectares)
was damaged
• 25 vehicles were destroyed.
Photo source: Essex news

8. Mortality and morbidity- Heatwaves
UKHSA data: over the 5-heat periods in the summer
of 2022, there were 2803 excess deaths in England
in people over the age of 65 (excluding deaths for
covid-19).
In 2022 the day of the highest temperature was
deemed a 1 in a 1000-year event.
NHS pressures- direct effects- admissions for sun
stroke and heat stroke and sunburn
Poor infrastructure in the UK to deal with heatwaves-
improvements in housing/ insulation, awareness
of risks, strengthening of primary care

9. Three of the five top five local authorities with the
most 'at risk' neighbourhoods from extreme
heat are in NEL
Those neighbourhoods that are high-risk neighbourhoods for heat
already exposed to hot weather, will be exposed to very hot weather
under 1.5 degrees, and dangerous hot weather at 3 degrees scenario:
• Newham 154
• Tower Hamlets 117
• Hackney 111
• Waltham Forest 75
• Barking and Dagenham 59
Source:
Heat_vulnerability_England_background_b
riefing_3.pdf (friendsoftheearth.uk)

10. Extreme weather - Flooding
The challenge
The third UK Climate Change Risk Assessment (CCRA) in 2022, identified that in all future climate change scenarios flood risks
are projected to rise over the course of the 21st century, as UK sea levels continue to rise.
At risk populations: children, elderly, pre-existing MH disease including cognitive impairment, pre-existing physical health
problems, homeless, language/ cultural vulnerabilities.
Floods and windstorms cause4
• Direct effects (drowning, injuries, electrocution, fire)
• Infectious diseases (GI infections from contaminated water, rodent borne disease)
• Respiratory disease from mould and damp
• Carbon monoxide poisoning due to inappropriate use of generators
• Long-term mental health problems,
• Indirect effects (temporary limitations on access to health and social care services, prolonged displacement, power outages).
• Other health effects (for example, heart attacks)
Flooding and health: Assessment and management of public mental health (no date) GOV.UK. Available at: https://www.gov.uk/government/publications/flooding-and-public-mental-health-assessment-
and-management/flooding-and-health-assessment-and-management-of-public-mental-health (Accessed: December 11, 2022).

11. We have the highest number of deaths
related to air pollution in the UK
Source: Mayor of London report removed
due to remodelling

12. Global Action Plan
• Source of expertise
• Assist in communicating our message
• International campaigners.
The Lancet
Children exposed to air pollution
showed significantly smaller lung volume (a loss
of approximately 5% lung capacity)
(Lancet 2018)
CMO report 2023
• National mandate for action.

13. Inhalers achievement – Openprescribing website
easy to access and see progress

14. Celebrating success

15. Nature recovery ranger
The ICB funded Nature Recover Role at Homerton hospital
ran from November 2022 to April 2023.
They were working in conjunction with our GLA Greener
Resilience Spaces funding bid and made a great impact in
addition to the co-production exercises they undertook to
feed into the Homerton Green Corridor Masterplan
designs.
Time and expertise was deftly applied to create a sensory
rest garden, a food growing patch and to set up staff
volunteering and nature based interventions for patients.

16. Greener NHS dashboard
• Secondary care estates
• Volatile anaesthetic gases
• Primary care inhalers
• Nitrous oxide
• Nitrous oxide and oxygen
• Net Zero supplier
performance
• Travel & Transport
• Food & nutrition
• Adaptation

17. Building our knowledge bank
• Expertise of ICB Net Zero Clinical Leads for Primary Care
• Published the ICS Green Plan which includes links to Trust and LA plans
• Green Primary Care Webinars
• 16 RCGP Climate Health Scholarships
• Joined Greener NHS England Step Up a Gear Network (modal shift and active
travel) – 4 projects
• Adult inhaler formulary
• Air pollution toolkit
• Carbon literacy programme 2023
• Hosting NEL-wide subject specific forums to share and innovate

19. Introduction to Sustainable Healthcare
18 October (Wed) 9.00-13.00
21 November (Tues) 13.00-17.00
Sustainable Primary Care
26 September 9.00-13.00
7 December (Thur) 13.00-17.00
Sustainable Child Health
27 September (Wed) 13.00-17.00
Sustainable Dentistry
18 October (Wed) 9.00-13.00
Dates of remaining 2023 sessions
Sustainable Anaesthetics
21 November (Tue) 13.00-17.00 *limited
places*​
Sustainable Kidney Care​
6 December (Wed) 13.00-17.00
Tech: Sustainable Quality Improvement​
19 October (Thur) 9.00- 13.00
Tech: Carbon Footprinting for Healthcare​
16 November (Thur) 15:00-19:00
Green Space and Health​
23 November (Thur) 13.00-17.00

20. SusQI aims to improve healthcare and measure impact in a holistic way, by assessing quality and
value through the lens of a “triple bottom line”.
In SusQI, the health outcomes of a service are measured against its environmental, social and
economic costs and impacts to determine its “sustainable value”.
SusQI embeds the CSH principles of sustainable clinical practice: prevention, patient empowerment
and self-care, lean clinical pathways and low-carbon alternatives.
Click here to learn more about Sustainability in Quality Improvement (SusQI)
Join the Sustainable QI Academy

21. Accessing national materials
• Sustainable Healthcare Module
• Greener NHS Community on NHS Futures
• Follow the campaign on social media: www.twitter.com/GreenerNHS
• National Ebulletin: https://www.england.nhs.uk/email-bulletins/greener-nhs/
• Greener Practice North London Network
• Green Impact for Health Toolkit – for GPs and for Dentists

22. References
Slide 3 NEL ICS Green Plan
Slide 4 Delivering a ‘Net Zero’ National Health Service (scopes on page 12)
Slide 5 Climate Wheel explained Climate Effects on Health | CDC
Slide 6 Essex news coverage, 24 July 2022 Dagenham fire: Photos show destruction after field fire spreads to five Dagenham residential streets -
Essex Live
Slide 7 UK Health Security Agency – mortality and heatwaves Excess mortality during heat-periods - Office for National Statistics (ons.gov.uk)
Slide 8 Fiends of the Earth report Heat_vulnerability_England_background_briefing_3.pdf (friendsoftheearth.uk)
Slide 9 Flooding and health: Assessment and management of public mental health (no date) GOV.UK.
https://www.gov.uk/government/publications/flooding-and-public-mental-health-assessment-and-management/flooding-and-health-
assessment-and-management-of-public-mental-health (Accessed: December 11, 2022)
Slide 10 Mayor of London report removed due to remodelling
Slide 11 Action for clean air by Global Action Plan/ The Lancet / Chief Medical Officer’s annual report 2022: air pollution - GOV.UK (www.gov.uk)
Slide 12 Prescribing measures for NHS NORTH EAST LONDON | OpenPrescribing
Slide 13 Greener NHS dashboard https://nhsi.okta-emea.com/