Intended for healthcare professionals

Rapid response to:


A more sustainable NHS

BMJ 2019; 366 doi: (Published 02 August 2019) Cite this as: BMJ 2019;366:l4930

Rapid Response:

Re: A more sustainable NHS

Van Hove and Leng, of NICE, are right to call for a more sustainable NHS, but wrong when they say that a system-wide approach is required to move us towards a carbon neutral healthcare system. More than that will be needed.

In fact, it will be impossible to achieve a carbon neutral system until the wider economy is decarbonised. 58% of the system's carbon footprint derives from the supply chain of goods and services, and a substantial part of emissions that are attributed to 'core' activities comes from such things as hospital electricity use, or staff transport. Unless and until the electricity grid is decarbonised, electricity use within the health and social care system will always have an associated carbon footprint.

The continuation of civilisation depends on us reaching net zero carbon emissions as soon as possible. The legal time limit of 2050 is probably too late. So a more important question than whether dry powder inhalers can substitute for metered dose inhalers is what the NHS can do to accelerate the necessary wider decarbonisation, and whether we can reduce the carbon intensity of healthcare fast enough, or whether we need also to cut back on supply of healthcare as well. It is increasingly accepted that in the wider economy we will have to consume less to achieve net zero. This is likely to be the case in health care as well.

That then raises the question as to which interventions are too carbon costly, in relation to the health gains, to be affordable. No one surely would be better placed than NICE to start calculating the carbon cost per QALY of different interventions, and to start the debate as to which of them can, and cannot, be afforded, if we are to keep our planet habitable.

Competing interests: No competing interests

01 September 2019
Jeremy Wight
Retired Public Health Physician
Croft Head