Health conference delegates in Edinburgh spent a productive session discussing the problems caused by climate change for NHS staff and patients alike – not to mention the planet.
While there was a sense that many in the NHS are seeking to make the “behemoth” a responsible player in the fight against climate change, there’s still much to be done to avert disaster.
The session was opened by a guest speaker. Neil Cartwright is a net zero programme manager for NHS England, working in the Greener NHS team in the North East and Yorkshire, concerned with how NHS organisations prepare for and respond to climate-related disruption.
He started by establishing the big picture: “The World Health Organisation stated in 2023 that climate change is the single biggest health threat facing humanity,” he said. “It’s quite a big statement. But we’re already seeing impacts on health. It was 26.7 degrees last week. In April. We’re living it. It feels like we are the frog that’s being boiled but isn’t noticing what’s happening.”
While the 11 most recent years have been the 11 warmest on record, Mr Cartwright believes that scientists and others are still having difficulties getting their warnings across. “The language of climate change is absolutely rubbish. People don’t really understand net zero. It’s a phrase that’s been weaponised by obvious bad actors. The challenge that we face is that if I were to ask 100 people what they think about in terms of climate or sustainability, I get hundreds of slightly different answers.”
Nevertheless, there are many who are trying to make progress. In a wide-ranging speech, he spoke about three different sides to the issue for him:
- Mitigation: reducing the NHS’s own carbon emissions
- Adaptation: helping the NHS to weather the changes that are happening as a consequence of the changing climate, diminishing the risk on services, staff and patients
- Just transition.
Greener NHS is about the first of those two, he said, “reducing our NHS emissions and the damage that we’re doing to the climate, at the same time as planning so that we have a resilient healthcare system in five, 10, 15 years time.”
And of the third and, for him, the most important, he said: “Health risks are disproportionately faced by the most vulnerable in our society, and we need to keep that in the forefront of our minds in any work that we do in this area. Yes, we need to reduce emissions. Yes, we need to think about adaptation. Yes, we need to plant trees and improve our biodiversity. But we need to keep people and our communities at the heart of this.”
The green plan
Mr Cartwright told delegates that he was “incredibly proud” that the NHS was the world’s first health service to commit to reaching net zero carbon, an ambition that is embedded in legislation, namely the Health and Care Act 2022. All trusts are mandated to have a green plan, and a board level officer responsible for sustainability. The aim, with 1990 levels as a baseline, is for emissions controlled directly by the NHS to be net zero by 2040, and those only influenced by the service, such as supply chains, by 2045.
“These are bold words in terms of our aspirations as a healthcare system,” he admitted. “But we are a behemoth of an organisation, and as a consequence, we are a behemoth in terms of the damage that we’re doing to the environment.”
Areas of work include estate decarbonisation, travel and transport, medicines, digital transformation and supply chains, among many others. He spoke of the importance of multidisciplinary teams in achieving results. And he directly told the delegates: “I think there’s an opportunity here to become involved in that process – certainly to call our organisations to account.”
There are numerous obstacles. “So in the NHS, we’re used to absolutely everything being a priority. And the challenge that we face is when everything’s urgent, the important just gets kicked down the road. Look, we’re going through a process at the moment in NHS England, where one of seven regions in England retains a Greener NHS team, the other six don’t. The challenge for us is, how do we keep climate change at the forefront.”
He again turned to the delegates, quoting a piece of Ipsos market research that shows that the people the general public generally trusts to tell the truth are nurses – right at the top, with 92%. Politicians are at the bottom of the list.
“There’s a role here, isn’t there, in terms of healthcare, in our conveying the importance of climate change. I think we need to use this superpower.”
Green UNISON
This is, of course, UNISON’s Year of Green Activity. The health conference, like all the union’s conferences this year, has gone paper free. And the conference’s motion on ‘greening the NHS – strengthening climate resilience and accountability in health and safety reporting’, demonstrated how engaged many in the union already are.
The motion noted that extreme weather events, environmental degradation, and carbon-intensive practices directly impact the safety, wellbeing, and sustainability of health services. Staff and patients experience the effects through disrupted services, unsafe environments, and increased workload pressures.
At the same time, current health and safety reporting systems across the UK do not consistently capture data on the impact of climate-related events – such as heatwaves, flooding, or air pollution – nor on the preparedness of the carbon mitigation actions of health boards and trusts. And the implementation of sustainability initiatives across health boards is “uneven”.
Conference, there is a growing area of harm that we are not properly measuring, and that is the impact of climate change
Proposing the motion, Tamzyn MacFarlane of Lothian Health branch, said: “I stand before you today not just as a member, but as a research nurse working within the NHS, a system built on evidence, safety and accountability. Every day we collect data, understand harm, we investigate incidents, we change practice based on what the evidence tells us. That is what makes our health service safe. But conference, there is a growing area of harm that we are not properly measuring, and that is the impact of climate change.
“We already see it in our workplaces. We see it in overheated wards, where patients and staff struggle in unsafe temperatures. We see it in disrupted services during extreme weather. We see it in rising emissions during heatwaves and poor air quality. But we are not consistently recording these events. We are not capturing them in our safety systems, and because of that, we are not learning from them or adapting. In healthcare, if we don’t measure something, it doesn’t exist in the system. If it doesn’t exist, we don’t fix it.”
Ms MacFarlane said that numerous climate-related solutions were available, for example the lower carbon anaesthetic gases being adopted in Scotland, and the adapting of buildings and services to cope with extreme weather.
“But progress is inconsistent. And without data, there is no accountability. This motion is not asking for something radical. It’s asking us to do what the NHS already does best – measure risk, learn from it, act on it. By introducing a dedicated climate and sustainability category into our safety and reporting systems, we can identify risk to patients and staff, plan services more effectively and protect our workforce and accelerate the adaptation of proven solutions.
“It is about turning climate change from an abstract concept into reporting evidence-based harm, and once we have the evidence, we can no longer ignore it.”
Overheating
Yasmin Morgan, from Fife Health branch, is a sustainability officer for NHS Scotland. She wanted to speak to the delegates about the issue of overheating.
“My board has conducted what we believe is the first multidisciplinary overheating in wards investigation in NHS Scotland,” she said. “Even though we are in Scotland, we recorded temperatures of 34 degrees in the dementia ward last August, when it was only 22 degrees outside. This goes to show that it does not need to be a heatwave to cause overheating, and I am sure that many of our colleagues in England and Wales are experiencing the same thing many months of the year.
“This is just fundamentally unacceptable. The reason given by estates teams for not taking action is that there is no legal maximum operating temperature. However, healthcare systems are required to provide safe temperatures for patients and staff comfort. It just seems hypocritical to not provide a safe space for patients to be cared for, and then they are sicker because of the environment that they’re in.
“When high temperatures increase ill health, anxiety and mortality risk, we should be absolutely paying attention, recording incidents and preventing future overheating. Lack of action is currently causing and will cause preventable deaths in NHS buildings.
“I will say sustainability in NHS is improving slowly,” she added, “but there are key barriers that are limiting progress, similar to other issues in society. We need financial and organisational commitment now.”
Planning ahead
A delegate from UNISON’s national young members forum also referred to the heatwaves that are becoming common in the UK.
“During the heatwaves last summer, we surveyed and monitored the temperatures in my hospital’s canteen prep kitchens, and across two weeks there wasn’t a single day where the temperature was below 20 degrees. There were even examples of temperatures being 36 to 38 degrees.
“It’s kind of unacceptable that we let health and safety get this unregulated and uncontrolled. It’s dangerous to our staff who are looking after patients. A lack of health and safety inspectors across trusts, deteriorating equipment and a lack of funds to improve NHS infrastructure are all contributing to this. We need to collect the data on climate-related health and safety issues, locally report them and nationally raise the issue.
“Climate resilience planning should be a priority for staff side negotiations, and we should use the health and safety legislation for support.”
Conference called on the service group executive to:
- Lobby all UK health departments (across the four nations) to include a dedicated climate and sustainability category in national safety reporting systems, to record:
- The impact of climate-related events on service delivery, staff, and resources
- The mitigation and adaptation measures in place or lacking
- Lessons learned for future resilience.
- Ensure that this data is used to support resource planning, staff protection, and climate resilience strategies across all health services.
- Develop mechanisms that enable staff to hold health boards accountable for inaction on carbon reduction, resilience, and sustainability commitments.
- Promote this as part of UNISON’s campaign for a safe, sustainable and climate-resilient NHS that protects both people and the planet.
As part of the Year of Green Activity, this August UNISON will be encouraging members to join the union in demanding the government set legally binding maximum workplace temperatures.
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