Amendment 15

Health and Care Bill - Committee (2nd Day) (Continued) – in the House of Lords at 3:34 pm on 13th January 2022.

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Baroness Hayman:

Moved by Baroness Hayman

15: Clause 5, page 3, line 15, at end insert—“(d) how the decision is likely to contribute to—(i) compliance with the duty imposed by section 1 of the Climate Change Act 2008 (UK net zero emissions target),(ii) adaptation to climate change, and(iii) meeting other environmental goals (such as restoration or enhancement of the natural environment).”Member’s explanatory statementThe purpose of this amendment is to include, as part of NHS England’s duties, a requirement that when making a decision about the exercise of its functions, it must have regard to how any decision is likely to contribute to the UK’s climate change and environmental goals.

Photo of Baroness Hayman Baroness Hayman Crossbench

My Lords, in moving Amendment 15 I will speak also to Amendments 43, 101 and 153 in my name. I also support Amendments 201 and 210 in the name of my noble friend Lord Stevens of Birmingham. I am grateful to him, the noble Lord, Lord Prior of Brampton, and the noble Baroness, Lady Young of Old Scone, for adding their names to my amendments. I should declare my interest as co-chair of Peers for the Planet, and my regret that I was not able to be present at Second Reading of the Bill.

I doubt that this debate will mirror the length and enthusiasm of so many participants around the Committee in the outstanding earlier debate. However, I should say that the issues that prompt these amendments are equally serious. The Government spent much of last year in preparation for the COP 26 climate meeting and all year, before and since, they stressed the gravity of the climate crisis that the country and the world face, the importance of making progress internationally and on our own domestic targets, which are statutory, and the importance of taking action across all departments and all sectors of the economy and the country’s activities.

The aim of these amendments is to embed consideration of the UK’s climate change and environmental goals throughout the Bill, in much the same way in which the noble Baroness, Lady Thornton, described how earlier amendments attempted to integrate throughout the Bill the issue of inequalities. I am disturbed, despite the Government’s commitments and despite the experience with other Bills—I look at the noble Earl, Lord Howe, who knows well that we have had similar debates on the Financial Services Bill. Those ended happily, and I hope that we can do the same on this Bill. But it is disturbing that we are still getting legislation through the House as if we were not in the midst of a climate crisis and as if we did not have the most challenging targets on net zero, biodiversity and environmental change.

We turn to the NHS. I suggest to the Committee that the NHS has a vital role to play if the Government are to achieve their key strategic priority of net zero by 2050. The NHS is responsible for approximately 5% of the UK’s carbon emissions and around 40% of all public sector emissions. Recognising that, and with the outstanding leadership of my noble friend Lord Stevens of Birmingham, the NHS has committed to an ambitious net-zero plan. It was the first national health service to make net-zero commitments, and at COP 26 last year 14 other countries followed the NHS’s lead and set net-zero emissions targets for their own health services, illustrating how important domestic action can be on the global stage.

My amendments seek to integrate that overarching NHS plan into the new structures set up in this Bill and to join the dots between high-level policy and the new integrated care boards and care partnerships. They seek to embed climate and environmental considerations into the responsibilities and activities of NHS England, ICBs and ICPs, so that, throughout the NHS, climate action, environmental goals and climate adaptation are taken into account.

I should make clear that contributing to the achievement of net zero is important for the NHS not only in contributing to national targets for reducing the volume of emissions; it is also an important element in improving public and individual health. Rising global temperatures and air pollution, for example, directly contribute to rates of major diseases, including asthma, heart disease and cancer. Again, the link to the earlier debate about inequalities is very clear.

The Government themselves have recognised the link between reducing emissions and improving health, talking in their own net-zero strategy of the

“physical and mental health benefits” of that strategy. The Climate Change Committee, in its progress report to Parliament last year, spoke of

“significant, tangible improvements to public health” from reaching net zero. These views were echoed in the report from the Academy of Medical Sciences and the Royal Society, A Healthy Future: Tackling Climate Change Mitigation and Human Health Together, which was published last year. It is in the interests of the health of the country, as well as of the Government achieving their targets, to ensure that the NHS plays its part.

As I said earlier, the NHS itself has recognised the importance of this issue on both those counts and is committed to taking action, but we need to embed that commitment throughout the structures of the service. If my amendments are agreed to, this Bill can contribute by providing strategic direction and a clear policy framework at all levels of the NHS.

Amendment 15 adds to the list of the wider effects that NHS England has a duty to have regard to when making a decision about the exercise of its functions. Having heard the Minister respond to the earlier debate, I know that this will not necessarily be an attractive proposition to him, but I think it is important. If Amendment 15 is agreed, in addition to the matters set out in Clause 5, NHS England would have a duty to have regard to how its decisions are likely to contribute to the UK’s climate change and environmental targets.

Noble Lords will recognise that the wording is broader than simply the achievement of our statutory net-zero commitments, but it may reassure noble Lords, and Ministers in particular, to know that it mirrors the terms of an amendment the Government introduced after a similar debate on the Skills and Post-16 Education Bill. Importantly, the wording includes the “adaptation to climate change” necessary to build resilience within the healthcare sector and protect the health of our current and future populations. This reflects the recognition in the NHS’s own net-zero strategy and adaptation report that climate breakdown may affect the healthcare system with increasingly adverse environmental conditions. It is sobering to note that, over the last 15 years, at least 15 hospitals have experienced major flooding incidents, causing disruption to patient services or hospital support services. Attention to vulnerability in this area needs to be an important focus for NHS England.

Amendment 101 would impose a similar new duty on integrated care boards to contribute to the same three objectives set out in Amendment 15, ensuring that trickle-down of policy objectives through the system.

Amendment 43 also deals with integrated care boards, mandating that their constitutions must provide for a member to be designated—not appointed, I should make clear, but for an appointed member to be designated—as having responsibility for climate change and the environment. This would reflect the NHS’s net-zero plan, which highlights the importance of

“ensuring that every NHS organisation has a board-level net-zero lead”.

This amendment implements that part of the plan in relation to the new framework of ICBs, created in the Bill, and having a board-level lead is an approach which has proved successful in other sectors.

Amendment 153, the fourth in my name, deals with the preparation of strategies by integrated care partnerships. It seeks to add to the issues already set out in the Bill, to which the ICPs must have regard when setting strategy, the UK’s net-zero target

“adaptation to climate change, and … environmental goals”.

I look forward to the comments of my noble friend Lord Stevens of Birmingham on his Amendments 201 and 210, dealing with procurement and payment issues, to which I have added my name and which I support. Obviously, I look forward to contributions from the Committee and a response from the Minister, which I very much hope will be positive. I beg to move.

Photo of Lord Stevens of Birmingham Lord Stevens of Birmingham Crossbench 3:45 pm, 13th January 2022

My Lords, it is a great privilege to follow the noble Baroness, Lady Hayman, and support all the amendments in this group in her name. I speak particularly to Amendments 201 and 210 which, as she said, refer specifically to using the purchasing power of the NHS to drive this agenda. Given how brilliantly she has set out the case, I shall be extremely concise.

There are two evidence-based reasons why these amendments are important. The first, as the noble Baroness said, is because the health consequences of the environmental crisis are increasingly clear. The Royal Society and the Academy of Medical Sciences laid all of those out. Whether on heat-related deaths, the disruption to care through climate emergencies, the increased risk of vector-borne infectious diseases, or the fact that up to a third of preventable asthma cases may be linked to the consequences of air pollution, the health case for action is clear. The second evidence-based reason, again as we have just heard, is that unfortunately healthcare itself is not blameless. It is part of the problem as well as part of a solution. By one estimate, if all the health systems in the world were their own country, they would be the fifth-largest greenhouse gas emitter on the planet. Therefore, the NHS must get its act together, given that it contributes 4% to 5% of our country’s emissions.

Those are the two evidence-based reasons. The NHS has stepped up in the way that the noble Baroness has set out. An expert panel led by the brilliant Dr Nick Watts made it the first health service in the world to charter a practical blueprint to net zero, but to do that, we must recognise that only about 28% of the carbon footprint of the NHS arises directly from care being provided. Another 10 percentage points are associated with travel on the part of patients, staff and visitors, but 62% of the carbon footprint arises from the supply chain—the medicines, the devices, the anaesthetic gases, the asthma inhalers, that the NHS uses, which it procures from 80,000-plus suppliers.

I am grateful to the noble Lord, Lord Prior of Brampton, and the noble Baronesses, Lady Young of Old Scone and Lady Hayman, for their support of my Amendments 201 and 210. Their purpose is simply to harness the £150 billion of purchasing power that will flow through either the new NHS payment system or the procurement rules to achieve the two evidence-based rationales that we have been discussing.

Photo of Baroness Northover Baroness Northover Liberal Democrat

My Lords, this is my first foray into this Bill. I have a sense of déjà vu, having deputised for the noble Earl, Lord Howe, on the 2012 Bill. Despite our absolute confidence at the time, it seems that some things need to be tweaked and rectified, though I now find myself on this side and the noble Earl on the other.

From these Benches, I support these amendments. The noble Baroness, Lady Hayman, put it very effectively. Climate change needs to run through to the very foundations of the Bill, as does addressing the health inequalities which were the subject of the previous debate. We have had such a long-standing debate about them over the years.

As the noble Baroness has said, at the moment, the UK is taking the lead internationally on combatting climate change through COP 26 and in the year after. We have been urging the world to take urgent, deep-rooted action if the enormously damaging effects of climate change are to be tackled and reversed. We know that the poorest will be hardest hit and can already see that effect, but no part of the globe will be spared. We can already see this as well.

As the noble Lord, Lord Stevens, said, we also know the effects on human health worldwide. We can see them already in developed countries: we saw the effect of that heat dome in Canada and the deaths that resulted from it. We know that climate change might have played a part in seeding the pandemic from which we have suffered during the last two years. We know all that. We also know that we cannot lead internationally without addressing climate change nationally. I pay tribute to the staff supporting Peers for the Planet, a group of which I am a member, for making sure that we address climate change at every stage, in every Bill.

We are rightly proud of the NHS. It is the major employer in the United Kingdom. The health and social care of our ageing population will play an ever more important role in our lives. It is therefore right that, in the Bill, as in every other area of life, tackling climate change must run as a thread through all we do. The Climate Change Committee makes this clear. It is not something for only Defra or the COP team. It requires fundamental change in everything we do and the scrutiny of every area of life.

The NHS has already made strides forward. Here, I pay tribute to the noble Lord, Lord Stevens, in making sure that that was the case. At COP 26, the NHS made a commitment to net zero. As we have heard, 14 other countries followed the NHS’s lead. More than 50 countries, representing more than a third of global healthcare emissions, have committed to developing sustainable, low-carbon health systems. This is incredibly encouraging. It is also encouraging that, at COP 26, a new international platform was set up—to be hosted in partnership with NHS England and the WHO—to bring together those in the healthcare systems, so that people can learn from each other.

Why does this matter? As the noble Baroness, Lady Hayman, has said, the healthcare sector is responsible for almost 5% of global emissions. Of course, public health is assisted by tackling climate change. Although we pay tribute to what the NHS has managed to do so far—and it is ahead of its requirements under the Climate Change Act—we need to make sure that this is built in and sustained for the future. This is what these amendments are about. Progress is being made, but we need to ensure that it is locked in and does not necessarily depend simply on who is leading these organisations at any particular time.

The noble Baroness, Lady Hayman, has explained how her first amendment affects the overarching structure within NHS England. The other amendments put in place the necessary pragmatic steps to make sure that this is addressed. Thus, we have identified individuals for these particular responsibilities. This is obviously of key importance.

It is fundamental that, in addressing climate change, we do not just see this as hosting a major meeting or siloed in one department—whether Defra or BEIS. I am a member of the Select Committee on the Environment and Climate Change. When our committee asked the different departments to report on what they were doing in advance of COP what came back to us, in many regards, was a kind of surprise that they were relevant to it. They felt that it was something for Defra, for BEIS in particular, or for the COP unit. They did not see it as their responsibility. Some of the responses were superficial in the extreme. That is why it is important to make sure that we mainstream this issue, and this is another opportunity to do so. I strongly support the amendments that the noble Baroness, Lady Hayman, and others have tabled.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

My Lords, it may not surprise your Lordships’ House that as a Green Peer, I rise to offer my full support to all these amendments. I also declare my involvement with Peers for the Planet.

In introducing this group so comprehensively and, I would say, brilliantly, the noble Baroness, Lady Hayman, said it was just important as the group that we were discussing previously, which addressed inequalities in issues such as smoking and alcohol and their impacts on health. I would actually go further and say that the two groups are intimately related, in that when someone arrives at the NHS needing treatment for an illness or a disease, at a point where their environment and society, often, has failed and has created or amplified that disease, the NHS then has to deal with the problems created by society and that environment. We need a systems-thinking approach to health—not just “Here’s a disease” or “Here’s a limb or an organ with a problem” —that considers the whole person. I say in passing that I regret that I was not able to take part in that earlier group due to my being unable to be here at the start.

I am not going to run through all the amendments, which have been very well covered, but they go all the way from the duty of the NHS to have regard to climate and the environment, right down to the detail of procurement. I particularly commend the noble Lord, Lord Stevens. We would like to see the Government take control of procurement more broadly to improve our society. The Preston model comes to mind here.

I want to address the climate side of this issue, and then I am mostly going to talk about the environmental side, which has not been discussed much yet; I want to add something different rather than repeat. However, I have to highlight the fact that we are talking about 5% of UK climate emissions and 40% of public service emissions.

We really have to think about the interrelationship of environment and health. We know that heatwaves have huge impacts, particularly on the health of older people. They can be a significant cause of death among older people, and as long as the NHS contributes to climate change, there is a disastrous cycle there. Also, some 10% of London hospitals are at risk of river flooding. I have not been able to find figures for the country as a whole, but I am sure that will be true for many other hospitals too.

While preparing for today’s debate, I looked at the Medicines and Medical Devices Act, which we debated last year. It is a little unfortunate that, as I look around the Chamber today, practically no one is present who attended those debates. That Act was a huge missed opportunity. It requires that when the appropriate authorities are approving veterinary medicines, they must have regard to their environmental impacts. I moved an amendment—but lost the vote—that would have applied the same judgment to human medicines. This point applies particularly to antibiotic resistance. I am not going to repeat everything I said in Committee on 26 October, but it is all there. The management of antibiotic resistance is a huge issue that the NHS needs to do a great deal more on, as do all global health systems.

I want to focus on some other aspects of the environmental impacts of the NHS today, particularly in light of the report by the Environmental Audit Committee in the other place on the state of our rivers. The Bloomberg Green newsletter going around the world today has the following headline:

“English Rivers Join Europe’s Most Noxious with Chemical Cocktail”.

That report notes, as have many others, that:

“No river … received a clean bill of health for chemical contamination.”

Discussion of this issue often focuses on the behaviour of water companies, and untreated sewage. But even if we tackle that problem and get the sewage treated, sewage treatment will be unable to deal with some of the medical products that impact water quality. There are also impacts on air pollution and soil contamination, as I will set out.

We have to look at this in the context of Covid. The UK healthcare sector alone has seen the demand for face masks rise by 4,700% to 85 million to 90 million per month. The use of single-use aprons and gloves has grown by 550% and 200% respectively. The vast majority of these are made from plastics coming from fossil fuels. This has other huge impacts. If they are incinerated after their single use, there are more carbon emissions and toxic gases such as dioxins and furans, and toxic ashes. If they go into landfill they will persist for hundreds of years, potentially leaching toxic chemicals into the soil.

Commendably, the NHS has a pilot project to introduce reusable IIR-certified face masks, showing that it is possible to do things differently. But this is a pilot project and not something happening at scale. Surgical masks were reusable until the 1960s, and there were no issues of infection prevention and control. At the time they were shown to be of equal or even better quality than the single-use alternatives. However, large scale production has now stopped, so it is hard to make a comparison in the current situation. Many hospitals have closed their on-site cleaning and sterilisation facilities, which has pushed them further towards single-use products. This is not just an environmental issue. In the United States, UCLA Health has saved an average of $450,000 a year just by switching to reusable gowns. As a rule of thumb, reusable gowns and other such materials have a 200% to 300% lower carbon footprint and reduce energy, water and other resource consumption.

It is not just a question of the plastics in the protective materials, but what else is in them. Consider PFAS, a large family of organic synthetic chemicals which are linked by the carbon fluoride bond. These are often known—you will see the headlines—as “forever” chemicals because they never break down. They have been found in penguin eggs in Antarctica and polar bears in the Arctic. Recently, a study by Stockholm University published in the Environmental Science & Technology journal showed that although it had been thought that we could dump them in the oceans and that would get rid of them, waves bring them back into the air and on to land; they are circulating everywhere. They are typically impregnated into a liquid-repellent finish on single-use surgical gowns and drapes, and they are also found in ambulance jackets. This demonstrates the seriousness—we still do not know how serious—of the problem. There are definitely huge impacts.

While I am on gowns, I point out that there has been a huge trend towards treating surfaces with biocides. But we then come back to the problem of antibiotic resistance that I referred to earlier. Experts say—I note Health Care Without Harm’s work on this issue—that there is no evidence that they have any positive impacts on reducing infection.

So, what does this mean in terms of scale? On average, about 20% of the active pharmaceutical ingredients in wastewater come from healthcare facilities. That is a far from negligible amount. Of course, a lot of them also come from household use of medicines. In November, Health Care Without Harm published a really useful report on this. It contains five case studies, demonstrating how some European hospitals are dealing with these issues. Examples include the use in Germany of

“urine bags to keep iodinated contrast media out of the water cycle”, and “thermal plasma” research in the Netherlands. There are things that can be done, and much more that needs to be done.

I am aware that I have been quite technical, but these are really important issues that we want to get on the record. I gave the Minister prior notice of a question that I planned to ask, which refers again to a Health Care Without Harm Europe report. It produced a list of chemicals of concern that it says we should seek to phase out from the entire healthcare system. Quite a number of regional health groups, hospitals and medical groups across Europe have signed up to seek to ensure that the chemicals on this list, which has a very detailed and serious eight-point set of criteria, are phased out. Are the Government ensuring that NHS England takes account of and acts on this list, and takes the kind of steps that we are seeing taken in Europe to eliminate these chemicals of concern from our healthcare system?

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers 4:00 pm, 13th January 2022

I support these amendments and in particular the words of my noble friend Lady Northover. I too am a member of Peers for the Planet and, as a biologist, I have been devoted to trying to address climate change ever since I knew anything at all about it. I particularly support the noble Baroness, Lady Hayman, in her determination to mainstream the issue. It is not the responsibility of just Defra but every department of government and every single individual in this country.

From my work on the Science and Technology Committee, I was aware of the health service’s 5% contribution to our emissions, but also of what the NHS has already done and pledged to do under the leadership of the noble Lord, Lord Stevens. I confess I was a little surprised when I saw these amendments; I thought, given all that, “Why does the noble Lord think more needs to be done?” The noble Lord, Lord Stevens, knows more than I or any of us do about the health service, so if he thinks more needs to be done, I am with him. We absolutely should support these amendments.

I would like to ask the Minister one particular question. The NHS has a very large portfolio of property and the Prime Minister has promised 40 new hospitals in a certain period of time. Leaving aside the fact that some of the buildings promised are not hospitals and are not new, if we are building new buildings, I would like to be assured that all of them will be zero-carbon. That can be done and there is no excuse not to do it.

Photo of Baroness Wheeler Baroness Wheeler Shadow Spokesperson (Health and Social Care), Opposition Deputy Chief Whip (Lords)

My Lords, I congratulate the four noble Lords who have produced this excellent suite of amendments across the Bill to ensure that ICBs procuring or commissioning goods and services on behalf of the NHS are firmly focused on their responsibility for NHS England’s commitment to reaching net zero by 2040. It has been an excellent and informed debate, and one with much enthusiasm to reassure the noble Baroness, Lady Hayman.

We fully support the amendments and have little to add from these Benches following the expert contributions of those proposing the amendments and the other noble Lords who have spoken. I am sorry my noble friend Lady Young, who put her name to the amendments, cannot be here. She was a key member of our team during the recent passage of the Environment Bill, and her expertise and wisdom always guides and reflects our approach. The House is clearly interested in this vital matter, as we saw this week in an important Oral Question on the Prime Minister’s promise for a new, overarching net-zero test for new policies. Assuming the Government fully support the key commitment from NHS England, I hope that, in his response, the Minister will accept the need for the amendments and will not argue that the proposed new clause is unnecessary as NHS England already has a commitment that will percolate down to ICBs.

As we have heard, the power of public sector procurement is a massive issue and there is no bigger part of the public sector than the NHS. The NHS has such an important impact on other environment issues, such as waste, pollution and resource consumption, especially for plastics, paper and water. We should ensure we are on the front foot in using that impact to deliver the net-zero commitment.

The NHS has made a start, but there is much more to do. These amendments would reinforce the importance of action in these areas for the new bodies and processes that the Bill creates. The NHS is a big player and, as noble Lords have stressed, it can play a big role in tackling all of these climate change and environmental challenges. Procurement is a strong lever that the NHS can utilise in key markets, particularly in those areas where it is the sole purchaser. The noble Lord, Lord Stevens, was very eloquent on this issue and I look forward to the Minister’s response in the light of his contribution.

Like other speakers today, my noble friend Lady Young wanted to stress that action so far is only the beginning. In the light of the importance of climate change and other environmental challenges, we strongly support such a duty being in place for all the public and private bodies with significant impacts when future legislation comes through Parliament. We did that when inserting a sustainable development duty into the remit of every possible public body from the late 1990s onwards, but this time it has to be not only enacted but managed, delivered, tracked and reported.

As the Minister, the noble Lord, Lord Callanan, told the House this week, every sector of government needs to do its bit, and we need to hold them to that. These amendments are vital, since every public body will have to take further action this decade if we are to restrain temperature rises to two degrees—far less, 1.5 degrees.

Finally, I too thank Peers for the Planet both for its work and, especially for me, its excellent briefing. As noble Lords have stressed, the NHS has committed to net zero and aims to be the world’s first net-zero national health service. It is responsible for around 5% of the UK’s carbon emissions. That is why the NHS’s role and contribution to net-zero targets should be fully integrated into the Bill. I look forward to the Minister’s response and his detailing of how the NHS is to achieve its ambitions. I hope that he will acknowledge that its commitment must be in the Bill. These amendments present a vital opportunity to enshrine in law a commitment that I think most, if not all, would want to see delivered.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank the noble Lord, Lord Stevens, for the amendments and the noble Baroness, Lady Hayman, for her opening remarks. I also thank the noble Baroness for her suggestion yesterday that it might make my life a lot easier if I just accepted amendments. I understand that advice, having just gone through a two-hour debate on the previous group.

A number of noble Lords referred to how these amendments relate to our previous debate on inequalities. I point out that that is sometimes not quite in the way that we would expect. We might think there is a direct connection, but sometimes the green agenda can be seen to be for those who can afford it—as I explained before, for the white, middle-class, patronising people who tell immigrant working-class communities what to do and push up their costs. Anti-car policies push up costs for those in rural areas, and there are higher fuel costs as we replace gas boilers with potentially more expensive heat pumps. We have to be aware of those issues. In the long term, I am optimistic. I look forward to the day when we have solar power and wind power, with storage capacity, which will reduce costs.

Photo of Baroness Northover Baroness Northover Liberal Democrat

Will the Minister look at this globally and recognise that the poorest are affected the worst? When he talks about those in poverty, he should think globally.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I accept that point, but I also accept that, sometimes, one can be patronised, and I do not accept being patronised as I was in the earlier debate. One day, there will be cheaper fuel, and we can look forward to it, but we have to make sure that the transition along the way is not seen to push up costs for working people, because we all feel passionately about this green agenda.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

The Minister was talking about the impact of policies on the poor. Does he agree that many of the products—the fabrics, the chemicals—are manufactured in the poorest areas of the world, producing pollution that has disastrous impacts on some of the poorest people?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I was going to come to the noble Baroness’s points, and I am grateful to her for raising these issues directly with me previously.

Turning to the amendments, I thank the noble Baronesses, Lady Hayman and Lady Young of Old Scone, and the noble Lords, Lord Stevens and Lord Prior, for bringing this debate before the Committee. There is no doubt that the NHS has a significant carbon footprint. There is no doubt that a poor environment has direct and immediate consequence for our patients, the public and the NHS. There is no doubt that it has an impact on the health of the nation. As the noble Baroness, Lady Hayman, pointed out, the NHS accounts for around 4% to 5% of UK emissions. If we go further, as the noble Baroness, Lady Bennett, said, that is 40% of public service emissions. Noble Lords are right to highlight the critical role that the NHS has to play in achieving net zero.

To support that work, NHS England—thanks in part to work already started by the noble Lord, Lord Stevens, who I know has had conversations with my right honourable friend the Secretary of State for Health and Social Care—is leading the way through a dedicated programme of work, as many noble Lords acknowledged. This includes ambitious targets for achieving net zero for the NHS carbon footprint by 2045 and for its direct emissions by 2040. This is ahead of the target set by Section 1 of the Climate Change Act 2008; we welcome that ambition and will continue to support the NHS in that.

In response to the question from the noble Baroness, Lady Northover, on what the NHS and Department of Health and Social Care are doing, as part of this programme of work, under the 2021-22 NHS standard contract, every trust is expected to have a green plan. As NHS England has already made clear in its guidance on green plans, published in June 2021:

“Every trust and every ICS is expected to have a Green Plan approved by that organisation’s board or governing body. For trusts, these should be finalised and submitted to ICSs by 14 January 2022. Each ICS is then asked to develop a consolidated system-wide Green Plan by 31 March 2022, to be peer reviewed regionally and subsequently published.”

I hope the noble Baroness will accept that as some real action.

We would then expect the current ICSs regularly to review and consider progress against their green plan, and in the future for the boards of both the ICB and the ICP to regularly consider where they can go further, faster. If they can meet targets faster, so much the better. If ICBs and ICPs can learn from each other and from best practice, so much the better. As we alluded to in the previous debate, sometimes the solutions are to be found at local level and not necessarily from the top down. If we can learn from the best social enterprises and others, I think we can go a long way.

On the specific question of procurement, the NHS is already publicly committed to purchasing only from suppliers who are aligned with its net-zero ambitions by 2030. Last year, NHS England set its road map, giving further details on the expectations of suppliers to 2030. Once again, I hope noble Lords will accept that as real progress.

Photo of Lord Mawson Lord Mawson Crossbench 4:15 pm, 13th January 2022

I thank the Minister. Can I just give an illustration about the local on this issue? I am certainly not an expert on climate change, but I am a practical person who worries a lot about granularity and the gap between a lot of talk I have heard over many years on all sides of this Chamber—with very large amounts of money cited, et cetera—and the realities in this building.

I am trying to buy an electric car at the moment, as a responsible citizen. When I went to have a look at the multi-storey car park below this building—the local—and wondered where I am going to plug it in when it arrives here, I ended up talking to one of the facilities managers, who was a very nice man. I asked him how many plug-in points there were underneath this building—again, the local. He said, “I don’t know, Lord Mawson, but I will look into this”.

He was diligent and came back to me. We started to have a conversation about it, and he began to suggest that I need to carry a cable in my car with a three-pin plug. I pointed out that my office is across St Margaret Street, in Old Palace Yard, on the third floor, so maybe I should run it across there with a carpet over it and up to the third floor to plug it in there. We had this amusing conversation. I said, “Well, go on then, tell me: how many are there in this building, where all this chatter and talk is taking place?” His answer was that there are two. I suggest that the gap between reality and rhetoric is very large indeed. If we are really going to deal with these issues—as we must—we must now become intensely interested in the NHS and in all the systems of government about practicality and the procurement machinery, which I suggest is not working.

I talked to one of the facilities people yesterday about my office, which has a light switch with a notice over the top of it telling you how to use it. It is completely ludicrous. She told me that that system is going to be different to all the systems here in the Palace of Westminster; none of it is joined up.

I think the Minister is right. The clue is in the local, but all our systems and our civil servants must now become interested in practicality and the local if we are really going to get serious about these matters. It is absolutely crucial to get procurement right, because without that, we will never deliver this.

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I thank the noble Lord, Lord Mawson, for that intervention, and I completely agree. There are some incredibly inspirational projects going on in our local communities, tackling and addressing the green agenda, and sometimes, top-down, we may feel good about it in this place, but it really affects working people and those who face higher costs and we have to be very careful.

On the specific question of procurement, the NHS is already publicly committed to purchasing only from suppliers which are aligned with its net-zero ambitions by 2030, and last year, NHS England set out its roadmap giving further details to suppliers to 2030. This is supported by a broad range of further action on NHS net zero and we hope that by pushing this through at NHS England level, but also with ICSs, we can see some of that local innovation as local trusts and local care systems and even health and well-being boards respond to those local challenges—others could learn nationally. To respond to the question of the noble Baroness, Lady Walmsley, NHS England will publish the world’s first net-zero healthcare building standard; this will apply to all projects being taken forward through the Government’s new hospital programme, which will see 48 new hospital facilities built across England by 2030.

There is political consensus on green issues. and we should pay tribute to the noble Baroness, Lady Bennett, and the Green Party for making sure, over the years, that the green agenda has been put at the centre of British politics. We find green policies in all the election manifestos of the mainstream parties: that is in no small part due to the noble Baroness’s party and to the noble Baroness herself. So, even while we may disagree on how to achieve some of these things, there is no doubt that we are not going to reverse on our commitment. Whatever Governments are elected in future, all are committed to a carbon net-zero strategy and a cleaner environment. So, I must gently disagree with her that these amendments are necessary.

I would like to have further conversations with the noble Lord, Lord Stevens, given his experience, on why he feels that, despite all the great work that the NHS has been doing, these amendments are still necessary. I would like to have further conversations with him and others, but at this stage, I ask the noble Baroness to withdraw the amendment. Across the political spectrum, we must make sure that we are pushing the NHS to deliver, not only at the national level but at the ICS level and even lower, at the place level that the noble Lord, Lord Mawson, speaks so eloquently about.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

Before the noble Lord sits down, will he respond to the question, of which I gave him prior notice, about the document?

Photo of Lord Kamall Lord Kamall The Parliamentary Under-Secretary for Health and Social Care

I apologise to the noble Baroness—I am so sorry, but I am trying to juggle 300 devices. That is a slight exaggeration, if I am honest. We recognise the importance of ensuring that all chemicals in the NHS supply chain are appropriate and properly managed as part of the net-zero strategy. I think the noble Lord, Lord Stevens, even touched upon some of the chemicals that were used and some of the issues he looked at during his time at the NHS when it comes to chemicals. The NHS must also comply fully with the Control of Substances Hazardous to Health Regulations, the CoSHH regulations.

More broadly, although Defra is the lead department for harmful chemicals, the UK Health Security Agency feeds in its expertise in relation to restricting and banning chemicals, and we are grateful to it for that work. The UKHSA is also looking at each of those chemicals, which we hope in future can be replaced by less harmful materials and chemicals. I undertake to write to the noble Baroness in more detail than the short answer I have given her at this stage.

Photo of Baroness Hayman Baroness Hayman Crossbench

My Lords, I am extremely grateful to all Members who contributed to this debate, which got slightly more feisty than I expected it to do in some areas. I am sure that the Committee will be grateful if I do not respond on the issue of electric charging points in your Lordships’ House, which has concerned me for four years, but there are one or two important things to be said here. There are two dangers. One danger—I fear the Minister nearly got there—is to suggest that those who are concerned about climate are not concerned about fairness or inequality and do not realise the dangers, on everything from heating to electric vehicles or whatever. However, there is not that layer of people who are concerned only with the climate in theory. Most of us who are active in this area are extremely concerned about a fair transition and the implications of individual policies.

The other false dichotomy is that either you work on the absolutely granular local stuff or you make highfalutin legislation that is not relevant to anyone. We need both. We need to go throughout the system. We are legislators. Legislation matters and words matter. Sometimes legislation matters because Governments and policies change but legislation is there in statute—the words are on the page.

Of course I will seek to withdraw my amendment and of course I will have conversations with the Minister, but it is essential that we tackle this, the most serious of issues facing the world. Covid is the crisis of our time but the climate is the crisis of our age and we absolutely need to address it at all the levels that we can—and there are many. As I say, we are legislators and we can start some of that trickle-down. We have a responsibility to monitor and ensure that we end up with exactly the level of granularity that we need—and that we learn from the local. I am happy to delay conversations with the Minister for a later date. I beg leave to withdraw my amendment.

Amendment 15 withdrawn.

Amendment 16 not moved.

Clause 5 agreed.