This study has explored a bottom-up modelling framework to aid in the decision-making for both greenhouse gas emissions and cost in healthcare.

Increasing greenhouse gas emissions constitute a potentially serious threat to human health and the environment, chiefly through their effects on global climate.

The NHS was responsible for 30% of all public sector carbon emissions and 3% of total CO2 emissions in England in 2010. In order to decrease its carbon footprint, the NHS has pledged to reduce its emissions by 80% by 2050, with an interim target of 20% by 2020.

This research has developed a complex model for assessing the carbon and cost implications of different secondary healthcare scenarios. The model specifically considers outpatient clinics, theatre lists, beds, and, diagnostic facilities.

Using data from the Royal Cornwall Hospital Trust, UK, five scenarios have been tested that consider the following variations in service configuration:

1. Business-as-usual
2. Service expansion
3. Site closure
4. Water temperature reduction
5. Theatre optimisation

The model analysis has shown that site closure, reducing hot water temperatures and maximising theatre usage would lead to varying reductions in emissions. However, carbon savings due to site closure would be offset by increases in those due to patient travel – underlining the importance of a holistic approach to emissions reductions.

This research demonstrates that for the carbon reduction targets of the healthcare sector to be met, the use of bottom-up models of this nature in decision making and forward planning is pivotal.

Currently the model considers direct GHG emissions (those produced from sources that are owned or controlled by the reporting entity) and indirect emissions (emissions that are a consequence of the activities of the reporting entity, but occur at sources owned or controlled by another entity) from electricity and patient transport. It is hoped that in the future embodied emissions such as those from medicines and equipment – and those arising from waste – will also be considered.

This research is published in the journal Environmental Science & Technology.