Carbon Copy: The high price of high emissions

Unlike its many performance and financial targets, the NHS has 20 years to hit its carbon neutral ambition.

It has a legal aim to reach net zero by 2040 for direct emissions, such as estates, energy and water, and 2045 for all others, including its supply chain five years later.

The NHS was always going to need a good amount of time for this transition. It is a huge feat; the health service accounts for up to 5 per cent of the UK’s overall carbon footprint, after all.

It needs to start laying the groundwork now to reach this goal. But with a target so far away, it can be a struggle to demand focus now.

Financial savings will be a key argument. And some trusts are already starting to pay the price – quite literally – of not keeping their emissions down.

Fines

NHS trusts can be fined by the Environment Agency if they do not meet government-issued targets on their emissions.

The UK has a scheme which caps emissions from energy-intensive industries and hands out allowances to organisations, which may be traded on a market.

But hospitals are given the choice to opt-out of this and join a simpler scheme instead. This involves annual targets, with trusts fined by the Environment Agency if these are exceeded.

Carbon Copy can reveal £10m in penalties have been issued to NHS trusts for not meeting emissions targets over the last three years.

Around 40 trusts have been fined in total under the UK, and previously EU, emissions trading scheme since 2020.

These fines went up sharply last year. Around £7.8m in penalties were handed out – although some related to infractions from previous years – compared to £1m the year before.

Trusts could obviously do without these added costs in the current financial environment, and this looks likely to become a growing problem as the government scheme to control emissions further turns the screws.

Each year, allowances become smaller to stay on path towards net zero. And the price of carbon – which the penalties are based on – is rising annually.

The scale of these penalties was previously unknown, but the Environment Agency released the data to Carbon Copy via a freedom of information request.

Worst-hit trusts

Trusts with the largest fines mostly pointed towards their size and energy demands, as well as the poor condition of their estate and a lack of capital investment to address this. One suggested their allowance was based on old metrics and did not take into account growing estate.

University Hospitals Coventry and Warwickshire Trust received the largest fines over the three years, with more than £800,000 since 2020. The trust said it was engaged in a “long-term process” to replace gas as its primary heating source.

They were followed by Guy’s and St Thomas’ Foundation Trust and University Hospital Southampton FT – who said they were disappointed by the penalties – with more than £780,000 each.

Imperial College Healthcare paid £683,000 in fines, and said its efforts to reduce emissions were “significantly constrained by our ageing estate, long-term lack of capital investment in our infrastructure and our maintenance backlog”.

This points to a major issue: the NHS needs to upgrade its existing estate, much of which is in poor condition, to reduce its emissions.

This would not only reduce fines, but bring about much larger financial savings from improved energy efficiency.

To date, it is having to rely on its own constrained capital budgets or public sector grants for decarbonising estates. But only the lucky few get this extra funding, which is oversubscribed and described by local sources as “like trying to get tickets for Glastonbury”.

Even so, it was this grant system that NHS England pointed to, saying £800m had been invested to decarbonise estates since 2020.

A spokesman said the NHS was “building on this progress to mitigate future carbon emission penalties” but did not give further details.

Heating up

Separately, new data suggests the estate is heating up fast.

Global warming is making heatwaves more intense and frequent, and trusts will need to make sure they are prepared for this. If buildings become too hot in these events, they may become unsuitable for patient care, especially for treating the most vulnerable patients.

The latest estates returns information collection data showed the number of overheating incidents – where the temperature of clinical spaces surpasses 26C and triggers a risk assessment – is continuing to rise.

The number of incidents annually had previously doubled over the last five years to reach 5,500, and increased again in 2022-23, to 6,800.