Measuring the distance towards a Net Zero NHS

The NHS has made an impressive start towards net zero, but with less than ten years left to achieve an 80 per cent emissions reduction against 1990 baselines, tools that are sophisticated enough to assist in understanding your current and future emissions will increasingly become a necessity, says Stephen Lowndes of the Carbon & Energy fund


On the face of it net zero carbon should be a relatively straight forward definition, in so much that it means avoiding carbon emissions associated with all your organisation’s activities, resources and assets included in your ‘carbon footprint’.


In practice it is more nuanced and potentially open to misunderstanding or even used to misrepresent the real situation, or to justify actions or activity that is not really helping carbon emission mitigations at all.
People can also become confused as they see big corporates making big claims that they are net zero or ‘carbon neutral’ already. What does this mean and how can they be so far ahead of the game than the rest of us?

Ahead of the game
Fortunately, the NHS is ahead of the game, at least in its aspiration and in identifying its responsibilities with regards to delivering net zero. In October 2020, the NHS declared its aspiration to become the world’s first net zero health service by 2040. To this end it has targeted the reduction of emissions produced by its services, buildings, and vehicles by 80 per cent compared to a 1990 baseline by the end of this decade and by 2032 at the latest.

So, we have now less than 10 years to deliver one of the most fundamental and far-reaching changes to the way we procure, manage, operate and deliver services within the NHS to achieve this goal. These aspirations also recognise that it will take a further five years, until 2045, to reach net zero for all the emissions over which the NHS has widest influence relating to its full supply chain.

To truly grasp the extent of impact and to try and see how best to manage a way forward, we need to understand our carbon footprint to appreciate what aspects of our footprint have the biggest influence, so that we can start to plan and budget for the adjustments and changes we are going to have to make.

The NHS carbon footprint
Our footprint relates to the impact we have on carbon emissions that we have control or influence over. The NHS Delivering a ‘Net Zero’ National Health Service report identifies a core carbon footprint as well as a ‘NHS Carbon Footprint Plus’. The core footprint considers emissions from NHS facilities including fuel used for heating as well as electricity use, water consumption, waste management and treatment, medical gases and fuel used in fleet vehicles.

These emission sources are categorised as either Scope 1, Scope 2 or Scope 3 to align with the Greenhouse Gas Protocol which is the internationally recognised greenhouse gas management reporting standard. Generally speaking, Scope 1 covers fuels and refrigerants and Scope 2 electricity, with Scope 3 everything else.

All organisations need to establish a boundary around what they have influence and control over and while the NHS core footprint is by no means minimal, the NHS ultimate aim is to cover the ‘NHS Carbon Footprint Plus’. This plus size footprint covers much more of the supply chain including medical devices, food and catering, commissioned health services outside of the NHS, business services, manufacturing, and construction too.

To this end the NHS is looking at a net zero supplier road map, which from April next year, requires all contracts above £5 million to ensure suppliers publish a carbon reduction plan for their UK Scope 1 and 2 emissions, and this will apply to all procurements from April 2024. From 2027 all suppliers will be required to publicly report carbon reduction plans for global emissions aligned to the NHS net zero target, for all of their Scope 1, 2 and 3 emissions and from 2030 suppliers will only be able to qualify for NHS contracts if they can demonstrate their progress through published progress reports and continued carbon emissions reporting.   

Top-down verses bottom up
Knowing the full extent of emissions therefore will become key to managing the journey to 2040 net zero and beyond. It is essential that there is an ability to count emissions from each area within the NHS footprint as you cannot manage the unknown.

Key influences associated with energy use in buildings, even at a basic utility supply point level, can be readily assessed as long as the kilowatt hours are recorded. This could be as simple as recording meter readings on a spreadsheet and then calculating the carbon emissions from this information.

Other emissions from medical gas usage or waste treatment can be calculated in a similar way, by recording quantity and calculating emissions using carbon emission factors published by the UK government.

These are bottom-up calculations, whereas in order to calculate emissions from medicines, medical devices, or business services we need a top-down approach, generally based upon parameters assigned at the level of monitory expenditure, as realistically they cannot be calculated in a more detailed way.  

Both the bottom-up or the top-down emission assessments for each area of the carbon footprint will need to be ‘back-cast’ to assess the equivalent baseline aligned with the NHS 1990 baseline which defines the 80 per cent reduction pathway to be achieved by 2032 and therefore also forecastable into the future, to see if the footprint is on track, or what intervening measures might be needed to get to 2040 net zero.

Pathway influences on 2040
Having the emissions calculated for each element in your carbon footprint immediately paints the picture of where your key areas of influence lie. If it's energy that has the lions share, then clearly these are aspects of the footprint which will need to be seriously addressed and improvements budgeted for. Other areas related to Scope 3 activities that may include business services or commissioned health services outside of the NHS may need a more strategic approach.
The pathway to 2040 is of course not fixed. Your carbon footprint does not stay static and is heavily influenced by factors inside and outside of your organisation. The net zero reduction pathway therefore needs to be strategically linked to general and medical policies, which will influence decisions made at organisational levels and at individual site and estate planning levels going forward into the future. The ability to see what might happen to your future emissions pathway to net zero by 2040 if certain strategic decisions are made now, or in a few years’ time, will be as vital as understanding the impact to your organisation’s expenditures and revenues.

Having tools that are sophisticated enough to assist in understanding your current emissions and future emissions with the ability to see the impacts of future plans to your 2040 net zero goals is therefore going to become increasingly useful and a necessity if organisations are not to lose their way, or if they are to plan strategically with carbon emission reductions an intrinsic part of their decision making.

About the Author
Stephen Lowndes BEng (Hons), MSc, CEng, MCIBSE, MEI, has many years’ experience of energy project design, as well as supporting operational management, including carbon and energy management within the public sector that started with NHS projects in the 1980s.

A Chartered Engineer and Certified Measurement and Verification Professional, he leads the Carbon & Energy Fund technical delivery team, working on all aspects of project feasibility, through to construction and operational delivery.