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19th February 2024

An immersive installation to encourage imaginative thinking on getting the NHS to net zero

UKHACC Chair, Richard Smith writes about an immersive installation that aims to present a future vision of the NHS

People running the NHS have to think about the quality, safety, and cost of health care, waiting lists, and much more. One of the things they should be thinking about is the NHS’s legally-binding commitment to get to carbon net zero by 2040/45, but that commitment seems far away and much less pressing than reducing waiting lists and balancing their budgets. Might there be ways better than written reports to encourage their thinking, particularly the imaginative thinking that will be needed to finally get the NHS to net? The Health Foundation has teamed up with creative consultancy The Liminal Space to produce an immersive installation and workshop, which I have now experienced. I’d like to see it made available to staff across the NHS and, indeed, citizens and patients—but also its managers and others with power to change what is ominously called “the system” who will benefit the most.

The installation has three rooms, and in groups of about seven we moved from room to room. In all the rooms there is a scene from a future scenario of one day in June 2036, four years before the NHS should reach net zero on all it directly controls and nine years before net zero on all it consumes.

The first scene is a patient’s living room, and it’s 7.30 in the morning  but already sweltering. A box contains the patient’s drugs which have been delivered by a drone. A pharmacist comes onto a screen in the room and discusses changing the patient’s drugs to ones with a lower carbon footprint. The pharmacist has access to the patient’s records and physiological information. In the room there is information on cool banks and the importance of physical activity and a low-carbon healthy diet. There are recycled books and a newspaper—dated Friday 13th—that says how the government is wanting the NHS to speed up reaching its targets. (It seemed to me that there was little in this room that wasn’t already available except perhaps precise measures of the carbon in particular drugs and drugs being delivered by drone.)

A hybrid hospital trust board meeting happens in the second scene. The meeting chair says how the trust has fallen behind with its targets and the new government is wanting faster cuts in carbon. (When, I wondered, will we have a government that wants more urgent action? My answer to myself was “when there is widespread pain and economic harm from climate change.”) She asks for ideas for further reductions. The chief medical officer says that surgery is the biggest source of carbon but it has already been radically transformed. Single use instruments are no longer used and emissions from greenhouse gases have been cut. It’s hard to see where to go next when there’s so much demand. Another board member says there should be more emphasis on public health and prevention. Does that mean reducing care?, asks the chief medical officer. There is a lack of evidence for the effectiveness of prevention in reducing carbon, says the chair, and it’s not a quick fix. Besides, we should have been doing it decades ago.

The third scene considers public reaction to the NHS reaching net zero. We watch a phone-in, and the host starts by saying how one in five of the population now has a major illness and yet the government is wanting bigger carbon cuts in the NHS. Tony, the first caller, is in poor health and is grateful to the NHS for keeping him alive. He sees that the staff are overstretched and thinks that they should be able to do what they need to do without having to worry about cutting carbon. Seema is all for fighting climate changes as it’s a major crisis, but her daughter has severe asthma and she worries whether any change in her treatment will be safe. Rachel lives in the country and thinks it wonderful that the NHS is aiming to get to net zero but thinks it might do even more. She has a heat pump now, and can call an on-demand electric mini-bus to take her places. Her village had a solar farm and an electric bike hub. Why, she asks, is the NHS not reaching its targets?

After passing through the installation we discussed our reactions, what we liked and disliked, and what the NHS needs to do. We were the third group to go through the installation and workshop, and the Health Foundation will be writing up the common findings. It has also been taking its staff and board of governors through the installation. My group comprised mostly people with some sort of particular interest in getting the NHS to net zero—and most were relatively junior. The Health Foundation is discussing whether to use the installation more, perhaps preparing a travelling version and taking it to conferences and other NHS settings.

My first reaction was that the world is likely to be much more different by 2036 than the installation suggested. The NHS didn’t seem to be that different from now, whereas I think that it is on an unsustainable course and will have to change much more before 2036.

In addition, climate change is accelerating, meaning that heatwaves, floods, and storms will be much more severe, again forcing the pace of change. Supply lines of food, drugs, and other products are likely to be disrupted. Adaptation of the NHS, as is often the case, was largely forgotten.

Remembering, however, that the main function of the installation is to prompt thinking among those thinking little about getting the NHS to net zero, I can see the point of making 2036 not seem too far away or too scary.

The installation brought out clearly for me the importance of involving citizens and patients. They, not health professionals, are the “owners” of the NHS, and, as a Health Foundation survey has shown, less than one in five members of the public is aware of the net-zero plan.

Under four in ten (39%) agree that “the NHS has a responsibility to reduce its impact on climate change,” and 25% disagree (a proportion that increased from 21% in 2021). These questions are asked in the abstract, but it’s easy to see, as the third room in the installation showed, that if direct conflicts arise between what benefits the patient and the planet then people are going to find it hard to forego what will be good for them or their family.

Perhaps for that reason enthusiasts for net zero (and I’m one) like to say “what’s good for the planet is good for the health of people” and that “good healthcare is environmentally friendly care.” The first statement is largely true if we are talking about health as opposed to sickness care—in that driving less and walking and cycling more and eating less and mostly plants is good for the planet and people. But the second statement is less true: there will have to be trade-offs between the care that patients want and carbon-intensive care. The chief medical officer in the second room couldn’t see how further carbon cuts could be made in surgery without doing less surgery when the trust was facing increasing demand, and Tony expressed in the phone-in how the NHS should be focusing on what it was set up to do.

Many other points and tensions were raised by the installation, and I think it a good way to stimulate debate, thinking, and imaginative leaps about getting the NHS to net-zero, particularly among those who haven’t thought about it much. I hope that the Health Foundation can find the resources to take it on the road.