Anthony Hassall, chief accountable officer of Salford Clinical Commissioning Group, and Sarah Price, director of population health for Greater Manchester Health and Social Care Partnership, joint chairs of the group leading this work, explain why the climate emergency is a health issue and how the city region is leading national policy to provide solutions.
When Greater Manchester declared a climate emergency earlier this year the city centre was full of Extinction Rebellion protestors who had set up camp for four days. The timing was purely coincidental but it felt somehow appropriate that the NHS and social care should demonstrate leadership in tackling the greatest threat to our health. The contribution of the NHS in causing climate change and environmental degradation should give us pause for thought. It is estimated that five per cent of all UK environmental emissions and five per cent of all journeys on UK roads are healthcare related.
This is a product of the scale and disparate nature of health and social care – covering everything from large hospitals, clinics and GP practices through to home care visits in every community. In Greater Manchester we consume £6 billion of resources annually through the services our staff provide, the supplies we use and the wages we pay. Everything we do has an impact.
There is a number of areas where healthcare processes are particularly damaging to the environment. For example, the propellant used in a large proportion of asthma inhalers and some anaesthetic gases produce high levels of greenhouse gases, while large quantities of single-use plastics are used as standard in preparing the equipment used in routine surgical procedures and health appointments. If we do not tackle each area of carbon emissions in our work we will fail to meet the goals of the NHS Long Term Plan, the Climate Change Act and our own Greater Manchester Five Year Plan for the Environment.
This plan, championed by the Mayor of Greater Manchester Andy Burnham, aims that the city region is carbon neutral by 2038. We fear that simply won’t happen unless the NHS and social care meet the commitments they have made to the city region. Even more importantly we risk the greatest threat to health we can imagine – from extreme weather events and all the anxiety and stress they cause, to air pollution and the harm that does to our health, particularly those who are most vulnerable.
These are the reasons Greater Manchester declared a climate emergency, the first integrated care system – health and care organisations working together – in England to do so. It was not a publicity stunt or a political statement.
An emergency demands a response from everyone. It demands comprehensive action and it demands that we make radical change in the way we do things.
Shortly after our declaration Andy Burnham and the NHS chief executive Simon Stevens announced a collaboration under which Greater Manchester will work together with NHS England and Public Health England to inform policy for tackling climate change. It will explore options for providing discounted public transport for NHS and social care staff, to make it easier to walk and cycle to healthcare locations, to car share and to use low emission vehicles.
Greater Manchester’s status as a devolved health and care system, working together with the mayor, the councils and the passenger transport authority, provides a unique opportunity in England to make radical and wide-ranging change. Issues such as the asthma inhaler propellant and anaesthetic gases can be tackled by Greater Manchester together, instead of asking each acute trust or clinical commissioning group to develop their own solutions. We have a remit to innovate and redefine some of the national guidance that currently requires us to use products or methods that we know are environmentally damaging.
We are now working up our detailed sustainable development management plan, which will be our blueprint for action over the coming five years. This will be grouped under broad headings, such as plastics, air quality, estates and energy use. We will identify the top areas where we can make a difference quickly – for example in single use plastics in catering. We also need to build on the areas where the NHS is expert already – such as behaviour change. If we can help people to stop smoking, to manage a health condition or to adopt regular physical exercise then we can also use those skills to support people to change their personal or organisational behaviours.
The great opportunity of the climate emergency that the NHS must embrace is to adopt behaviours that are good both for personal health and good for the planet. Swapping car journeys for walking and cycling has an obvious dual benefit. Green infrastructure – parks, allotments, canals, rivers – also helps both the environment and our mental health. Better insulated homes will improve both personal comfort and air quality through reduced emissions from energy production.
As part of our work with NHS England we will look to build expertise in tackling climate change, making Greater Manchester a centre of excellence for the skills the whole country will need as it steps up to this challenge.
It is a challenge we are uniquely placed to lead on and one which we will willingly accept.