Lord Kamall:

Tabled by Lord Kamall

7: After Clause 5, insert the following new Clause—“NHS England: duties in relation to climate change etcAfter section 13NB of the National Health Service Act 2006 (inserted by section 5 of this Act) insert—“13NC Duties as to climate change etc(1) NHS England must, in the exercise of its functions, have regard to the need to—(a) contribute towards compliance with—(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008. (2) In discharging the duty under this section, NHS England must have regard to guidance published by it under section 13ND. 13ND Guidance about discharge of duty under section 13NC etcNHS England may publish guidance about the discharge of—(a) the duty imposed on it by section 13NC;(b) the duty imposed on integrated care boards by section 14Z43A;(c) the duty imposed on NHS trusts by section 26B;(d) the duty imposed on NHS foundation trusts by section 63B.””Member’s explanatory statementThe new Clause would require NHS England, in exercising its functions, to have regard to certain matters relating to the environment, including climate change.

My Lords, in moving Amendment 7 in the name of my noble friend Lord Kamall, I will speak to the other government amendments in his name.

We had a passionate debate on climate change in Committee. There is no doubting the profound relevance of environmental issues to the NHS; indeed, it is already leading the way as a health system in tackling climate change. These amendments will ensure that the NHS can continue in that vital work with the confidence needed to deliver. They place a duty on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. This could mean preparing thousands of NHS buildings to adapt to climate impacts, protecting and enhancing biodiversity across 25 million square metres of trust estate, or decarbonising the millions of kilowatts of energy used by trusts every year. I must emphasise to noble Lords that this includes decisions about the NHS’s procurement of goods and services. The noble Lord, Lord Stevens, was quite right to underline in Committee that, according to NHS England’s data, the NHS supply chain accounts for some 62% of its emissions footprint. It is clear that the NHS will need to take urgent action to decarbonise procurement.

These clauses will give vital legislative grounding and confidence to the Greener NHS programme and further strengthen the commitments made by the UK through the COP26 Health Programme: namely, to develop climate-resilient, low-carbon health systems. Importantly, Amendment 7 includes a power for NHS England to issue statutory guidance on environmental issues to the system. As discussed in Committee, NHS England already has some targeted net-zero guidance in place for current ICSs, but the system currently lacks that critical statutory guidance that sets the direction for the whole NHS. We expect this guidance, in the first instance, to be issued within 12 months of the Bill receiving Royal Assent.

In developing these amendments, we have had to consider the excellent work NHS England has already undertaken on these issues and gain clarity over what value a legislative solution could add. This has included working across government with BEIS and Defra, while also looking closely at the individual amendments proposed by noble Lords in Committee. I believe the amendments tabled in my noble friend’s name achieve these aims, adding the right value in the right way, to the benefit of our natural environment, the NHS and the people who depend on it. I pay tribute to the work of noble Lords in helping us reach this position. I beg to move.

My Lords, I thank the Government for supporting these amendments, which reflect the substance of amendments that my noble friend Lady Hayman, I and others brought forward in Committee. That debate rehearsed the health case for action very clearly, as we have just heard, so I will not detain the House by repeating that.

However, I think the events of the last 24 hours have underlined two other reasons why these amendments are so important. In addition to the health case, there is clearly a financial case and we also now clearly see the security and humanitarian case for action. The financial case was underlined by yesterday’s IPCC report:

“The financial value of health benefits from improved air quality alone is projected to be greater than the costs of meeting the goals of the Paris Agreement.”

In respect of the security and humanitarian consequences, yesterday, the Government welcomed Shell’s decision to sever its relationship with Gazprom, yet Ministers may have seen an important story in the Health Service Journal suggesting that, over the last two years, at least 17 NHS trusts have continued to rely on gas sourced from Gazprom, which has confirmed today that it continues to get its gas supplies through Ukraine. Decarbonising the health sector will take pound notes out of the hands of dictatorial regimes that are engaged in acts of aggression. For all these reasons, the clarity that these government amendments provide, putting on a sound statutory basis the ability to take fundamental action across the NHS, is most welcome.

My Lords, I declare my interest as co-chair of Peers for the Planet and apologise to the House that I did not declare that interest in my enthusiasm to get involved in a Question earlier today. I added my name to Amendments 7, 28, 87 and 94 and obviously welcome the way in which the Government front bench has responded to the debate we had and the amendments we proposed in Committee. As my noble friend Lord Stevens said, there is no point in all of us going through the arguments, although I think he added a new dimension in his remarks today; that interplay between health and climate is an important one that we should not neglect.

The Government have done very well in providing a comprehensive suite of amendments that make sure that the considerations of not just the net-zero targets but the targets in the Environment Act and the needs for adaptation, which will be extremely significant in the healthcare field, will be considered at all the correct levels within the new infrastructure that the Bill brings into place. The assurances that the Minister gave on the guidance that will be published and on making sure that procurement, which is such a large spend by the NHS, will also be governed by these considerations are extremely important.

I welcome these amendments across the board. They weave considerations of climate and the environment throughout the ecology of the NHS, and it is an excellent result. The next challenge is to persuade the Government to take the initiative on these issues and to embed these considerations throughout their policies and legislation, which would save a lot of time in the House. But I do not wish to be churlish, and I end by simply reiterating my thanks for the way in which the Government have responded to these amendments.

My Lords, the noble Baroness may wish not to be churlish, but I would regret it if I could not be a little churlish. I declare an interest as chairman of the Woodland Trust and vice-president of a range of environmental and conservation organisations. I thank the Government and the Minister for the assurances given. I also thank the noble Lord, Lord Stevens of Birmingham, for his shuttle diplomacy between the churlish and the less churlish in achieving these very welcome amendments.

I will press the Minister a little further on what she said, just to make sure that we are completely clear. The guidance will be crucial, and I am glad to see that it will be issued initially within 12 months of Royal Assent. I just want the Minister to clarify that the guidance on procurement will cover the need not just to reduce emissions through the NHS supply chain but to secure the other environmental targets, such as those set by the Environment Act. The preamble says that, but I want to make sure there is clarity in Hansard that the guidance will ask for procurement to do not just the climate change job but the other job.

Although the duties on the trusts, ICBs and NHS England include climate change, adaptation to climate change and improving the natural environment, most of the examples the Minister gave revert back just to climate change. The proposed new section in the Amendment is headed up:

“Duties as to climate change etc”.

It is the “etc” that I am rather interested in. I think we should spell out more clearly what that is.

Can the Minister assure the House that the guidance will include performance in all three areas—climate change, adaptation and the wider environmental objectives set by the Environment Act and in other places? Because of the massive threat that climate change represents, it is very easy—we all fall into this trap—to squeeze out focus on the other, equally vital environmental areas. We have to remember that if we want to defeat climate change, we also have to defeat biodiversity decline and a range of other environmental factors. I hope the Minister can give these assurances to the more churlish among us.

My Lords, my speech follows rather neatly from that of the noble Baroness, Lady Young of Old Scone. I will begin not by being churlish but by turning this around the other way and declaring my position as a member of Peers for the Planet and paying great tribute to the noble Baroness, Lady Hayman, who has so led the Government in the right direction on this Bill—as on the Financial Services Act, to think of a recent one before this. I would like to think that maybe it has got a little easier this time than it was on the Financial Services Act, so maybe we are progressing to the point where a Bill will arrive in your Lordships’ House with climate and environment already there, and we can just focus on trying to strengthen and improve it.

The noble Lord, Lord Stevens, has obviously been hugely important in the progress we have made. He referred to the IPCC report yesterday, which relates to an earlier group we were discussing. The IPCC—I think it is the first time I have seen this—is really explicit about the impact of the climate emergency, and all the events associated with it, on people’s mental health. If we look around the globe at this moment, we see that southern Paraguay is enveloped in a giant ash cloud from fires in Argentina. Queensland and northern New South Wales have record floods, and the city of Brisbane has its second enormous flood in 11 years. That has massive impacts—understandably, through the stress, worry and suffering—on physical and mental health.

I want to particularly pick up the point from the noble Baroness, Lady Young of Old Scone. I noticed, like her, that the Minister said climate and then added environment as an afterthought. Anyone who looks at the Hansard from Committee will see that I very much majored on environment and a couple of aspects of it. Biodiversity is obviously huge, but there is also the issue of antibiotic resistance. The debates between the Minister and me on the Government’s inadequate approach to antibiotic resistance go back to the passage of the Medicines and Medical Devices Act. I also raised in Committee the issue of PFAS—the forever chemicals —and these are huge issues for the NHS.

One final area I raised in Committee was plastics. Before the pandemic I chaired an excellent event seeing some really good progress in the NHS on seeking to reduce the use of single-use plastics. Understandably, that has stalled in the light of the Covid pandemic—for reasons we can all understand. It is really important that that goes back as a focus. There is so much plastic use in the NHS that is easily avoidable, and I would like to ask a very simple question: why is anyone anywhere in the NHS having drinks in plastic bottles? It is the kind of thing that is very easy to get rid of.

I focus on that because I spoke a little in Committee about microplastics. I am going to cite three studies that have come out since then. Microplastics have been found in the placenta and the bodies of newborn babies. Chemicals from microplastics have been linked to obesity; there are studies with mouse fat cells where chemicals from microplastics are promoting the growth of fat cells. Some studies out of China show relative gut health being very closely related to the level of microplastic in people’s bodies. These are studies in the last month.

We have a world choked with plastic. We have a world wildly overheating. We have a world—as the noble Baroness, Lady Young of Old Scone, said—where biodiversity is in collapse. I think the NHS is starting to focus on these things, but we need to see, as the IPCC said, that health and environment are not two separate issues. We live in the environment, and we have to look after it in every part of our activities.

My Lords, I rise for the first time on Report and declare my interests as laid out in the register, particularly as a non-executive director of Chesterfield Royal Hospital NHS Trust and as a vice-president of the Local Government Association. We on these Benches welcome this suite of amendments, with a caveat of clarification that the noble Baroness, Lady Young of Old Scone, raised, to do with not just the climate but the implications for the environment.

The reason we welcome this suite of amendments is that it is vital that there is mandatory guidance from the centre to all parts of the system in the NHS. The only thing I seek to push the Minister on is that she said the guidance would be out within 12 months. I ask that, as we are in a crisis and this is important, it is done as soon as possible. The reason for this—I have experience of it from Chesterfield—is that some of the procurement or building decisions made today will not come around for maybe three or four years, but the design and implications that start today have life cycle implications for both the climate and environment over a long period. So, I strongly push the Minister to ask that the guidance is out as fast as possible, and we do not wait for the whole 12 months.

My Lords, I, too, am a member of Peers for the Planet and I congratulate the noble Baroness, Lady Hayman, and the noble Lord, Lord Stevens, on their engagement with the Government and thank them for taking their concerns on board.

I have previously raised the fact that a big way in which the NHS can reduce its emissions is by having energy-efficient buildings, and I should like reassurance that any new buildings and refurbishment of the NHS estate will involve highly insulated and low-energy buildings. There are so many things that the NHS can do by using low-energy lighting, reducing microplastics, using compostable single-use plastic or not using plastic at all and using microwaves to deal with clinical waste, because they are much more energy efficient. How will all this be reviewed after the Bill has passed? Will there be any reporting back on how well the NHS has been able to respond to this challenge?

My Lords, I thank the Minister and welcome these government amendments in response to the key concerns raised in Committee about the crucial importance of including the NHS’s duties on climate change and working towards net-zero emissions in the Bill, and the excellent supportive speeches today.

The amendments take on particular significance in the light of the stark warning in today’s UN report that climate breakdown is accelerating rapidly and there is only a brief and closing window of opportunity to minimise its catastrophic impacts. The duties rightly go across the roles of NHS England, integrated care boards, NHS trusts and NHS foundation trusts in relation to the Climate Change Act 2008 and the Environment Act 2021, and address the need for those bodies to have regard to the need to contribute towards compliance with government climate change and environment targets. Of particular importance is the duty of each body to adapt to current or predicted impacts of climate change and, in Amendment 7, recognition of the importance of NHS England guidance on how the climate change responsibilities are to be discharged within the promised 12 months of Royal Assent.

My noble friend Lady Young sought reassurance that the guidance on procurement will cover not just the need for the NHS supply chain to reduce emissions but also include the key environmental targets. I hope the Minister will be able to reassure her on that.

Strengthening the law to integrate an active response to climate change through every layer of the NHS has been welcomed by the UK Health Alliance on Climate Change, representing more than 900,000 healthcare professionals. Noble Lords made clear in Committee that omitting sustainability requirements from the Bill would have been a missed opportunity to enshrine and enforce the NHS’s historic commitment to reaching net-zero targets by 2040, and we are pleased the Government have recognised that.

As we heard from all speakers, the NHS has made huge progress, but this is just the start and there is much more to do. The amendments reinforce the importance of action in those areas, particularly for the new bodies and processes the Bill creates, and that progress will need to be managed, delivered, tracked and reported at every level.

My noble friend Lady Young’s point, reinforcing that guidance on duties across NHS bodies must include not just climate change but also the improvement of the natural environment, is well made. I look forward to the Minister’s response on that.

In relation to reporting, raised by the noble Baroness, Lady Walmsley, I understand from the contributions of the noble Lord, Lord Kamall, in Committee that progress is being made. He referred to NHS England’s green plans, and we are told that every NHS trust and interim care system is expected to have prepared a green plan and had it endorsed by its governing body. For trusts, the deadline for submission to ICSs was 14 January, so it would be good to know how they have done so far and how many trusts have submitted such plans. The next stage is for ICSs to develop “consolidated system-wide plans” by the end of the month, which will be

“peer reviewed regionally and published”.

Are we confident that ICSs will meet that deadline, and what is the expected assessment and timescale for ICSs to report back to NHS England and, subsequently, more widely on this vital issue?

My Lords, I thank all noble Lords for their welcome for the government amendments, and for setting the challenge for the Government that there is always more to do.

I agree with the noble Lord, Lord Stevens, on the additional points that he set out about the importance of decarbonisation, not just for the climate but for health, security and humanitarian reasons. I reassure the noble Baroness, Lady Young, and others, that I did not say that decarbonisation was there to exclude other issues; it is just that that particular point related to that.

I say to the noble Baroness, Lady Hayman, that it is a pleasure to work with her on these issues when we look at Bills, including the Financial Services Bill as it went through, but I have noted her and other Peers’ points about the reactive or proactive nature of the Government’s approach to these issues in legislation.

I can provide the noble Baroness, Lady Young, and others, with the reassurance that they seek that the NHS will have to have regard to wider environmental objectives in developing the guidance, and this includes, for example, biodiversity. That applies to procurement and any other guidance NHS England issues to the system using the new power. In my examples, I mentioned enhancing biodiversity and adapting to climate impacts, so I hope I was not inadvertently too narrow in how I spoke to the amendments.

The noble Lord, Lord Scriven, is right that decisions are being made all the time that will have a longer-term impact, so although I cannot go further than the 12-month commitment, I am sure that the NHS will want to work as fast as it can to bring out the guidance within that.

The noble Baronesses, Lady Walmsley and Lady Wheeler, asked about reporting, both on how the NHS will fulfil its obligations under these duties, and specifically under the green plan. NHS England will report on carbon emissions and progress against its wider objectives. The noble Baroness, Lady Wheeler, asked me a number of more specific questions; if I have not addressed them, and those asked by other noble Lords, I will seek to write after today.

Amendment 7 agreed.