Podcast: Green NHS leaders

This podcast is all about the NHS’ commitment to becoming a net-zero health care system.

Listen to a conversation with Nick Watts, the chief sustainability officer of the NHS and Paul O’Neil of the NHS Leadership Academy at this year’s COP26.


The NHS has been under pressure, has responded admirably, but God it’s been under pressure. I think if you have a second to take a look and really think through the kinds of things that we want to see, to deliver, to build a greener NHS, a net zero health service, what you’ll actually find, is it’s not more, we’re not asking for leaders to do more, to take more time out of their day.

I almost reject the dichotomy. I always reject the idea that you can’t respond to and recover from COVID-19 and tackle climate change at the same time. I, I actually think flip it on its head.

I don’t know how you could respond to one challenge without also taking on the next, the synergies are enormous.

hello, I’m I’m Paul O’Neill. I’m from the NHS Leadership Academy, which is part of the People Directorate of NHS England and Improvement. This podcast is all about the NHS’ commitment to becoming a, net zero health care system.

Hi, my name is Nick Watts. I am the chief sustainability officer for the NHS.

You can maybe hear a helicopter somewhere overhead that is president Joe Biden, I think. Coming, going, flying around the conference center. I’m at the UN climate change summit in Glasgow.

President Biden’s there Prime Minister there as well. You’re there. And the NHS is there. Tell us why you’re there in the NHS is there.

So COP 26 the United Nations framework convention on climate change, UNF F triple C, the big acronym. COP 26 actually stands for the 26th Conference of the Parties. That means this group of people, this group of negotiators, all 190 something countries around the world have met 26 times before to talk about in varying degrees of ambition, detail, occasional intention; what it is that we all together can, should, need to be doing to respond to climate change.

The president of the United States is here, the prime minister is here 40, 50, I think, heads of state scattered across the world. Thousands of people working to deliver a healthier and more sustainable future.

What is the NHS doing here? Well the whole point of this conference is to make sure that the future that we all move into, move into together, is healthy, is livable, is sustainable. You know, to the extent that the NHS, we say it every way we go, the point of the NHS is deliver high quality care for everyone now, yes- to the patient in front of you today. But also for future generations. And unless you respond to climate change, unless the NHS does its bit to respond to climate change, you just can’t do that. So that’s why we’re here.

And the idea that the climate crisis is a healthcare crisis. You know, that, that if we don’t take action, now the impact on people’s health and care and wellbeing Is quite significant. Could you say a little bit more about that?

So listen, you’re exactly right. The climate crisis is a health crisis. Why? What does that mean? It’s easy to say. Little harder to explain. Think about it this way; healthcare systems around the world, the NHS the way that we train and think about our health professionals , our staff, doctors, nurses, all of that was done with the assumption that the environment, that the climate, was going to be stable. Everything was going to be kept more or less the same as the environment that we grew up in. Climate change is all about that changing and changing faster than human systems can cope with. So what do we mean by the climate crisis is a health crisis? We mean anything from the extremes of heat and the impacts that has on cardiovascular disease on end-stage renal failure.

We want to talk about flood, an extreme event. What that does direct injury, right? Floods are big, dangerous, scary things. But also some of the more insidious effects of flood; the mental health impacts that you find when you come back and you check in on a community two months, three months, six months after an extreme weather event.

You’re worried about hates you worried about flood, but you’re also worried about the spread of infectious diseases. We are seeing the march of malaria moved down across the east coast of Australia. We know that malaria, dengue fever actually, used to be fairly endemic in Europe. All of those effects combined along with the impact it has on food security, on water security, on mass migration, population displacement.

It’s all of that together that makes the climate crisis a health crisis. It’s all of that together that makes it clear that you simply can’t deliver that high quality care for all now in future generations, unless you respond.

Okay, So, now I’m scared, but thank you for explaining that!

It is scary though, right? Climate change. Some of these big scales, they are actually. They can, they can keep you up at night if you don’t careful. The really exciting thing is that there’s a lot of progress. There’s a lot of things that people all around the country or around the world are already doing to respond to climate change already doing, to reduce emissions.

Is there anything that you’ve seen or heard that’s piqued your interest from a healthcare and a net zero point of view?

Well, two, three meters away from where I’m standing is the world’s first zero emission ambulance. Designed by our friends at LAS; London ambulance service. It’s electric, hydrogen hybrid, no air pollution. Reducing, tackling the air pollution that we know kills over 36,000 people across the country every single year. No carbon emissions tackling all those scary things we’re talking about from climate change and able to go over 300 miles on a single charge, able to cover anything you could possibly want. There are two zero emission ambulances in the world, the NHS, has both of them, one of them fully electric, currently carrying patients in the west Midlands.

And this one up here, a COP being showcased to the world. It’s things like that, that I think take that kind of scary, that terrifying that, oh my God, what are we going to do? And start to pave a way for what actually do you know what there is a future that is possible, positive, potentially even inevitable.

Okay, so now I’m excited. So that is good to hear that really concrete exciting example. I think it’s just over a year or so since the NHS committed to becoming net zero. How are we doing?

So let’s take a step back. The NHS, you’re right, has cared about climate change, has cared about the impact that it has because it understands all of the scientific evidence we’ve already talked about for over 12 years. It has already reduced it to emissions by 30% in the last decade. Well ahead of the rest of the UK economy.

And we should be really proud of that. And I think actually people are really proud of that. Equally, is that enough? Are we moving fast enough? We’re losing far enough. Absolutely not. Do we need to go further? Do we need to go faster? We always can. And so that’s what the report last year was all about. The report came out October, 2020 delivering a net zero national health care system.

The world’s first healthcare system, the world’s first national healthcare system to make a net zero commitment. Net zero is difficult because it’s not saying, Hey, I’ll just do this one little thing and then I’ll take a rest and it’s not saying I might do the top three things and then I’ll take a rest.

It’s saying, what is the entirety of my impact? What is everything I could possibly do to reduce emissions and Hey, I’m going to do all of it. So all through 2020, we gathered together world experts, national experts in health policy. Clinical excellence and climatologists, right, climate change, energy experts.

We looked through all the different things that the NHS could do. We developed a… the two words I like to use to describe it ‘ambitious’ but ‘feasible’. Right? These things have to be ambitious. We are talking about the future of healthcare, but they also have to be deliverable because otherwise what’s the point. So that’s the plan. And we have two dates. In fact they’re a little, they’re a little complex, but let me explain why we have two dates. And if everyone, if ever, anyone is giving you dates about their net zero, and they seem a little too good to be true, or they’re fudging the difference, call them on it because they might be lying to you.

You should always be able to get under the difference underneath the sort of nuance of what people are talking about. So for us, we have been as transparent as we possibly can. Two targets; for the emissions that we control absolutely directly; we call them scope one and scope two emissions, for those emissions, net zero by 2040.

For the emissions that we don’t control directly but, hey, we actually have a pretty significant influence in where they come from. These are the emissions in our supply chain. We have an influence in that because yes, the emissions occur in a factory that is making a drug. But we decide what drug we prescribe and we decided that with our patients, and yes, there may be a farm somewhere that is releasing the emissions for some food, for some meal. But we have chefs scattered throughout the country and our hospitals who are deciding what to put on the table. So those emissions 2045, 5 years later, ‘cos it’s a little more complex. It’s a little more dispersed, but we’re still gonna make that commitment because we’re good health professionals. And we understand that healthcare doesn’t just stop at the four walls of a hospital or the four walls of a clinic.

So those are the two targets, 2040, the emissions we control directly. 2045 for everything else.

That’s a long way away. And if it’s so far away, you know, people are just going to go, okay, well, I can do with forgetting about that for a little while. And so what we’ve also done is we brought some interim targets in. 80% reduction targets. Right. We’re going to go really, really fast early on, and then we’re going to tackle some of the hard stuff and we’ll have a little bit more time for that. So 80% reduction target by 2028 for that first target, and 2036 for the second.

Those, the near term enough that they make me feel uncomfortable and that is precisely what they are designed to do.

That was a really clear, eloquent explanation as to how those metrics work the purpose of having those timelines. This podcast is aimed particularly at leaders in the NHS. Now, who are they? Well, the very dispersed, working in primary care and mental health in hospitals and in various departments that clinical and nonclinical from payroll to the surgery and everything else and leaders at different levels as well.

People who are putting a small team or running a division in a big hospital or running a primary care practice. Or a chief executive or a, or an integrated care system chair. So lots of different people at different levels. Have you got any comment on what different leaders at different levels might do?

So the question is a really good one. The question, what is it that we as individuals, we as leaders at all levels of the NHS… If there’s one thing that was drummed into me again and again, as a medical student, as a junior doctor- everyone, everyone is a leader that healthcare system doesn’t function unless we are acting as leaders.

What is it that all of us can do to respond to climate change?

Let’s, let’s start with some of those senior people. Right, let’s start with some of those chief executives, medical director, chief nurses of of some of the large trusts. I think there’s one or two things.

Number one, this problem is big. It is enormous. It is not just about tinkering around the edges and recycling and paper or turning off the lights. And we need our leaders to start talking that way, to understand when someone comes to you with a problem, with a solution to that problem, you say, fantastic. Multiply it by 10. We need to go bigger. We need to go further. When someone says I can do this by 2025. Well, how about my March? That’s the first thing I think we need to understand embrace the size and the scale of the challenge that we are all facing.

I think the second thing that we need to do is we need to take some responsibility. Every single individual in the NHS, right? Every single individual had some degree of personal responsibility for some piece of. I don’t care what it is. It might be in the anesthetic drug or the inhaler that a doctor prescribed. It might be in the way that an OT or a physio manages their outpatient appointments. It might be in joked about the food that shows up on the plates of patients, staff, visitors, every single day. To the extent that you’re involved in that you have agency over it. We need people to start identifying those little pieces of carbon that they personally hold the keys to and doing something about it.

There are big, big things that the NHS can do to reduce its emissions, to do with large capital investments to do with, procurement policy shifts and those things we’re going to do, we promise we’re going to do. We’ve made it very clear. We’ve actually made some really great.

But it’s not going to be possible to get to net zero. It’s not going to be possible to deliver a net zero healthcare system unless you have 1.4 million leaders making 1.4 million decisions every single day. That’s the only way you get there.

And so I think that’s the other thing, right? Is there’s a lot of talking. There’s a lot of, oh, let’s have another framework. Let’s have another plan. Let’s have another something… Enough of that. Think about one piece of carbon. One thing you can do tomorrow morning, go out and do it.

So it’s kind of thinking and acting both at a small scale and at a large scale, and the pace is really important too. So, yes. Think as big as you can, as ambitiously as you can, as quickly as you can and not just think but act. But also, that personal responsibility of doing even the small things start tomorrow.

Can I add as well? Cause I think you’re right. we don’t have all the answers. We don’t know what a fully net zero healthcare system looks like at 2044 and an 11 and a half months. And so we’re going to have to be okay with that. We’re going to have to be okay with innovating.

We’re going to have to be okay with experimenting. We’re going to have to be okay with failing every now and then. We’ve done a bit of that in the last year, but every time we’ve done that, we have written it up with shared that failure. It’s how clinical medicine progresses. And you learn from it. And so I think embracing some of that being okay with not knowing all the answers, but also knowing you can’t let that paralyze you, you’re gonna have to find a solution to this problem. So we’re going to have to, you know, make some mistakes and get some stuff right. And have fun along the way.

Yeah. Great approach to innovation and it’s kind of what makes it exciting as well. Isn’t it? We’ve been bothered about this for 12 years or more, the last year or so has been pretty atypical. Nobody saw the global pandemic coming. How has that affected progress towards.

Yeah. So, so the question of, “Okay. Okay. You have a big plan, a net zero national health care system, but how are we doing? How has the last year been?” Comes up quite a lot. And so it should. We made a big commitment that was 12 months ago. What have you done? Well, a few things have happened, so number one, you’re entirely right, there’s a pandemic and the NHS has done no one here will be surprised to hear me say here, everyone they’ve done an impressive job of the response to that pandemic. Something that we should all be incredibly proud of. What we should be just as proud of is that while that’s happened, we’ve managed to reduce our emissions. Well in line of the target that we were aiming for. So we were aiming for about 1,260. kilo tons of carbon reduced within a 12 month period, we hit that just a week or two ago, in fact, 1,260 kilo tons of carbon is almost meaningless. So let me try to put that in context. Roughly the equivalent of 1.7 million flights from London to New York, roughly the equivalent of 1.1 million homes powered for an entire year.

The NHS is big. And so when we do things, we do things at heroic levels. That has happened in part because there has been new investment flowing into the system, decarbonizing our estate, improving, heating, lighting, sometimes boring, the really important stuff, that just has such a fantastic return on investment. It pays itself back in two and a half, three years.

We have worked with clinicians with the need to just with our primary care friends and GPS. To design new incentives, new schemes, to reduce emissions from some of the most polluting gases. I’m talking about the anesthetic desflurane, I’m talking about particular kinds of inhalers. All of this co-designed with our patients, co-designed with clinicians to make sure that we’re doing two things together; we are improving patient care, and we are also tackling climate change. It’s been those sorts of things. Being the estate investments. I’ve talked about it. We’ve just finished announcing new innovations, 10, I think 11 new innovation projects that the NHS is going to fund low carbon healthcare with our friends at FBRI.

In fact, the ambulance, i’m standing right next to it, was an innovation from just a year or two ago, just a year or two ago. It wasn’t really possible. The idea of something so big, so heavy or complex, being able to be zero emission people laughed. Now here it is. At COP being shown off to the entire world. So we are incredibly proud that we’ve managed to reduce emissions in line that we’ve managed to hit our first year target, but we are cautiously optimistic because it’s going to get harder from here. Year one, you get some low hanging fruit. Year two, that’s still a few more, but year three, that’s where we really need to have some proper momentum so we can tackle some of the tough stuff.

Encouraging though Nick. That’s fantastic to hear the progress to date and how it’s been done in a very sort of atypical year, which there were some pros and cons to that. I I’m Sure. in terms of the impact of less travel, but more PPA and that kind of thing all eventually, even despite that we still achieve d that first year target.

So congratulations to you, the team and the NHS for doing that. Nick, I just want to get a bit more personal if I may. And I just, you know, tell me, tell us a little bit about, you know, what brought you to this work, what’s led you to being so interested and passionate, and also having such an important role in the NHS? What’s your own story here?

My accident I hope reveals I’m Australian. I’m a doctor, exactly my accent and maybe even my approach to life. I’m a, I’m a doctor. I trained down in Perth, in Western Australia. But you know, Very very early on. I realized something that I think every doctor knows deep in their heart healthcare doesn’t start, doesn’t stop in the four walls of a hospital, right?

So much of what determines the health of our patients, the health of the people that we care for. It extends out into the broader social determinants with, we spend a lot of time talking about and understanding and acting on, but also those environmental determinants of health. And there I’m talking about clean air.

I’m talking about nutritious food, drinkable water. I’m talking about a safe stable planet. So that’s how I made that transition. Right? It’s a natural shift going from an emergency department in Western Australia. Slowly exploring out thinking, how can I help in a broader context? What else is it, that we as health professionals, have a responsibility to tackle? What bigger problem. Right. I, I sometimes get asked, why do you work on climate change? And I sort of look a little puzzled and I go, why do you not, what bigger problem is there than something like this? It’s planetary in nature. We’re not talking about, you know, small shifts, we’re talking about giga Jules the energy added to the atmosphere. We’re talking about six atomic bombs worth of energy, every single second released into the atmosphere every single second hour, day, week, month, year for decades. That, that’s why I’m here.

Why the NHS though? So the NHS number one, we are a part of this problem. 4.5, 5% of national emissions. And so we have a responsibility to do something about that. First do not harm again, something drilled into you day after day medical school, junior doctor. And so we’re going to act on that, but, but there is something very, very important about the way that a health professional engages with this problem.

Number one, we do. So in a way that prioritizes health, the health of our patients to help you.

Number two, we do so in an apolitical way, right? We’re doing this because we concerned about public health.

Number three, we’re trusted messengers, we have trusted messages and people I think wake up because it’s very difficult for me to explain to you what a part per million of carbon dioxide equivalent molecules up in the atmosphere is, and what that could possibly mean that we’ve gone from 350 to 402 parts per million, just in the last couple of decades. But God, everyone knows what a child with silent asthma looks like in an emergency department.

People understand that tangible health impact. And so I think that’s something really powerful, really important about the health profession putting it’s hand up and saying, “Hey, this is a health problem. And I’m going to do something about that.” Because we have seen that when the health profession engages it can move mountains.

So you might have some sleepless nights, but you know why you get out of bed in the morning to work on a cause like that.

Clearly, you’re a passionate person. You’re a doctor, you’re a healthcare professional. You’re working in the NHS. You’re a COP 26. But in your private life, this most crossover, you can’t just stop being passionate when you get home in the evening. So what was the last thing you did to make your own life a little bit greener and almost the next thing you’re gonna do? might be helpful for our listeners to hear as an example, perhaps the kind of thing that they might do as well.

I really liked the question. Hey, important that we are thinking about, “Hey, what can I do? On this issue? Yes. In my role as professional, but also what can I do tomorrow and what can I do personally?” Because I think this is just as much a professional challenge as it is a personal challenge for everyone.

So number one I’m up in COP, it wasn’t easy. There were train delays. There were all sorts of trouble. A lot of people flew up, from London, but we persisted. We caught the train the whole way up. It took a little while. Plenty of trains back and forth. But there’s no good reason to be flying domestically within the United Kingdom from England to Scotland. No good reason at all.

Um, but that’s my, that’s my first thing. What am I going to do next? Good question. I love it. Hm, um. I am going to the next time I sit down at a pub at a coffee shop with a friend, with a family member who doesn’t work in this space, I’m going to talk to them about the work that I do, and I’m going to talk to them about what is it and how is it that they could embed some of this work into their own world.

I don’t do enough of that. And I think we should all be doing just a little bit more of talking about it, of normalizing, socializing, the idea if it’s something that Hey, it’s just ok to ask those questions, it’s okay to care about that stuff. You wouldn’t believe the power of advocacy when it comes from a passionate nurse when it comes from even a vagabond Australian doctor!

So let me say that, that’s my, that’s my next thing. I’m going to go and find, probably not up at this conference here ‘cos I suspect everyone at the UN climate change conference already agrees me, I’m going to go and find something that doesn’t. I’m going to have a conversation.

Fantastic. ” Leadership happens one conversation at a time” and no change has ever happened without a group of people, committed, having a conversation and then take an action. And you’ve been doing that consistently and relentlessly for years, you’re doing it this week at COP, so we’re really, really pleased that you’re doing that for us and in partnership with us. So Thank you, Nick, for what’s been a fascinating discussion and really appreciate your taking the time out of an incredibly busy week. And so once again, thanks ever so much for making the time. And we’ll see, when you get back off the train and the walk home afterwards. No doubt. Okay. Take care, Nick.

Thank you. Thanks so much.

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