Correspondence

COP26 and the NHS: Sajid Javid's open letter to all NHS trusts in England

Published 10 November 2021

Applies to England

Introduction

From: the Rt Hon Sajid Javid MP, Secretary of State for Health and Social Care

To: All NHS trust CEOs

Dear colleague,

With COP26 underway, I am writing to all NHS trusts to underline the vital role that the NHS must play in achieving our shared ambitions on climate change and the environment.

Tackling climate change while protecting and enhancing our natural assets, and the biodiversity that underpins them, is crucial to achieving a sustainable, resilient economy. It is also crucial to maintaining a sustainable and resilient NHS.

I know these ambitions bring both significant challenges and unique opportunities for trusts. As such, I am also taking this opportunity to highlight how this government is supporting you to deliver, including through £1.425 billion in new funding available under the Department for Business, Energy and Industrial Strategy’s (BEIS) Public Sector Decarbonisation Scheme^{[footnote 1]}.

Our shared challenges

In 2019, the government made a world-leading legal commitment to achieve net zero emissions by 2050. On 19 October 2021, we took another major step by publishing our Net Zero Strategy. The strategy outlines measures to transition to a green and sustainable future, helping businesses and consumers to move to clean power, supporting hundreds of thousands of well-paid jobs.

Our work on net zero is supported by a broad range of action on wider environmental policy, including the forthcoming Environment Bill. The Bill will set a legally binding target to halt the decline in species abundance by 2030, putting the environment at the centre of all government policymaking. This will require all public bodies, including NHS England, to report publicly on their impact on key environmental outcomes.

I am strongly in favour of this, and biodiversity is something to which I have always been personally committed. The challenge here should not be understated. Nature is in decline globally and in the UK. Between 1932 and 1984, we lost 97% of our species-rich grassland, 5 species of butterfly have disappeared from England in the last 150 years, and indicators showing the state of birds dependent on farmland stand at less than half their value compared with 1970. This must be addressed.

That’s why this government has committed to leaving the environment in a better state than we found it for future generations. I want to see every part of the NHS playing a leading role in delivering that aim.

Indeed, achieving all these aims will be critical for NHS services. The climate crisis is a health crisis, and the risks to health and social care from extreme weather, and the increased risk of vector-borne diseases and flooding are well known, while the health benefits of biodiversity, which itself plays a role in both climate change adaptation and mitigation, are clear.

The NHS’s responsibility

The NHS has a key part to play in meeting these challenges.

NHS organisations in England occupy some 25 million m² of land in acute care alone, bringing direct responsibilities on major issues like biodiversity, air quality, waste reduction and water quality. On climate change, NHS emissions are around 4t o 5% England’s total carbon footprint, and over a third of public sector emissions. The unique brand and status of our NHS means we have a huge opportunity to lead the way on this agenda – setting the standard for other sectors, with NHS organisations leveraging their roles as anchor institutions to encourage and galvanize action at the local level.

Not only is this right thing to do, but there are significant business benefits on offer. As I am sure many of you have identified, capital investment in net zero can bring a range of significant benefits, including in driving down backlog maintenance bills. Equally, many of the measures required are simply about improving building efficiency – and reducing energy bills.

For all these reasons, I am proud that the NHS has publicly committed itself to becoming net zero.

Great progress has already been made and, since 2010, the NHS has reduced its emissions by 30%. I would like to pay tribute to the work of all of those in the NHS who continue to work so hard on this agenda.

Action and support

There is, however, a significant challenge ahead. The NHS’s Delivering a Net Zero Health Service report (2020) has set out a clear roadmap for meeting that challenge. This has been supported by a range of excellent guidance and support on environmental issues.

NHS England and Improvement has clearly set out the requirement for all trusts and integrated care systems (ICSs) to produce a 3-year Green Plan^{[footnote 2]}, agreed by your board or governing body. I am fully behind this requirement; it is critical that NHS organisations set clear, unified local visions on climate change and agree a range of concrete actions on areas like system leadership, digital transformation, procurement, adaptation to climate impacts, sustainable models of care, and estates and facilities.

I understand that some trusts are also developing biodiversity plans as part of this work. I strongly welcome this and hope that all parts of the NHS will think carefully about how they can best manage and enhance their green spaces for the benefit of people and wildlife, and undertake clear actions to deliver this.

Indeed, there are many great examples of work on biodiversity across the NHS, and I would like to highlight some of the great practice I have seen up and down the country. The NHS Forest initiative has led to over 77,000 trees already being planted across 200 different NHS organisation estates. Equally, there are fantastic examples of good practice at trust level, from the 1 hectare of wildflowers planted by University of Birmingham NHS Foundation Trust to Manchester Foundation Trust’s Honey Project, with its rooftop beehives kept by trained staff beekeepers. I am keen to see more of this sort of action across the NHS.

On net zero, I recognise that estates and facilities work can bring capital pressures. As already set out, investing in net zero makes great business sense, and I want to see all trusts making the best use of their operational capital to drive efficiency savings and mitigate emissions. In addition to this, I know trusts are benefitting from over £280 million under phases 1 and 2 of BEIS’s Public Sector Decarbonisation Scheme. I can confirm that BEIS will be making a further £1.425 billion available to all public sector bodies, including NHS trusts, for heat decarbonisation and energy efficiency projects through to 2025.

Another key area is procurement, with medicines and the NHS supply chain accounting for approximately 62% of total carbon emissions – driving this down must be a key priority for every part of the NHS. I am pleased that, from 2030, the NHS will no longer purchase from suppliers that are not aligned with its net zero ambitions.

Next steps

In government, we will continue to champion this agenda.

At COP26 we will be launching the COP26 Health Programme, one of 3 science programmes that the UK Presidency is leading, with a key focus on climate resilient and sustainable health systems. I am committed to working to encourage other countries to follow the NHS’s lead and sign up to the programme, including setting clear net zero targets for their health systems.

After the conference, the world’s first ever net zero health building standard will be launched and will be applied as part of this government’s commitment to build 48 new hospitals before 2030.

More broadly, we know that the NHS and many other large organisations can’t achieve net zero in isolation from energy supply. That’s why I am pleased to confirm that the government has just unveiled a landmark commitment to decarbonise the UK’s electricity system by 2035.

I want to emphasise how proud I am that our NHS is leading the way in ending this country’s contribution to climate change, and in protecting and enhancing the natural environment. It is the right thing to do, and is critical in protecting and enhancing the health of our nation. There are also significant economic benefits on offer through increasing the efficiency of our NHS.

For all these reasons, I am committed to working with NHS England and Improvement to ensure that sustainability is as fully embedded as possible in all NHS processes, especially those relating to finance and estates. We can’t do this without your support and input, and I would invite all trust CEOs to feed in their ideas about how we can all work more sustainably, and better embed issues like net zero and biodiversity across key processes and systems, especially those relating to the allocation of capital. Ideas and input can be sent to greener.nhs@nhs.net.

I also want to work with all NHS stakeholders to ensure that net zero and biodiversity are part of the very values and principles that underpin our NHS. As part of my statutory duties, I am required to conduct a review of the NHS Constitution. This will be launched next year, and I have asked my officials to ensure that climate issues are a key consideration in this work.

This government is committed to building back better from the pandemic, and that means building back greener. I recognise that this continues to be an incredibly challenging time for the NHS, and that further challenges await as we approach the winter. I am inspired every day by the commitment and dedication of all those on the frontlines of health and social care, and I have no doubt that you all will continue to rise to these many challenges – and to seize the opportunities ahead.

COP26 presents a unique chance for this country to show global leadership on protecting and enhancing our most precious asset – nature.

I look forward to working with you all to ensure that the NHS continues to lead the way in seizing that opportunity: driving down carbon emissions and supporting the drive to reverse the loss of habitats and species that we have seen over the last century.

Thank you for all the work you do.

Yours ever,

Sajid Javid

1. Phase 3 of the Public Sector Decarbonisation Scheme supports the government’s net zero and clean growth goals and continues to have a strong focus on heat decarbonisation to deliver carbon emission reductions. It supports the public sector in taking a ‘whole building’ approach when decarbonising their estates. ↩

2. Every trust and every ICS are expected to have a Green Plan approved by that organisation’s board or governing body. For trusts, these should be finalised and submitted to ICSs by 14 January 2022. Each ICS is then asked to develop a consolidated system-wide Green Plan by 31 March 2022, to be peer reviewed regionally and subsequently published. See full guidance on NHS England’s website. ↩