THE HSE HAS no climate action plan in place at the moment, but an infrastructure report set to be released in March will pave the way for a wider climate strategy.

The health service has the highest greenhouse gas emissions of any public body. Under the 2021 Climate Action Plan, large public sector organisations must create climate action roadmaps by the end of this year. 

The HSE had a sustainability strategy in place from 2017-2019 but this was never replaced. A wide-ranging HSE climate action plan will be released later this year. 

Reducing emissions from infrastructure is one of the key priorities for the HSE’s decarbonisation plans at the moment, according to the health service’s national lead for capital and estates on climate action and sustainability Peter Smyth.

The HSE previously had a National Health Sustainability Office, but this was merged into a wider ranging Climate Action and Sustainability Unit last year. This has not yet been outlined on the heath service’s website.

“Our approach is that the first thing we have to do is deal with the obligations we have and the infrastructural obligations we have,” Smyth told The Journal. 

“If you look at the NHS, their initial approach kind of was very similar to this and there’s an awful lot of international organisations that say that what you do first is you deal with your buildings.”

The UK’s health service the NHS has pledged to reach net-zero on its direct emissions by 2040. 

Around 130 buildings out of 2,594 in total account for roughly three-quarters of the HSE’s energy and emissions. The most emitting buildings include larger acute hospitals and residential care facilities. 

Smyth said a HSE infrastructure decarbonisation strategy and implementation plan has been drafted and will be published in March this year. 

This will form “part of a broader HSE climate action plan which will be developed” later in 2022.

“And that broader plan will include the approach to supply chain and medicines and pharmaceuticals. That’s not developed yet, but that’s the process that’s being initiated,” Smyth said.  

A programme is currently underway to figure out how to make existing HSE infrastructure more energy efficient. 

For this, the HSE chose ten representative sites to examine around the country – four acute hospital settings, four older person units, one primary care and one office building. 

A design team will assess the performance of these ten sites and decide how they can reduce emissions in line with targets while being “cost optimal”. 

“In some cases, some of these very old buildings, it wouldn’t make sense to spend an amount of money on them to make them compliant whereas it would be cheaper to actually go and build new,” Smyth said. 

“We can only really make big decisions then about the future once we have the facts, because up until that it’s peoples’ best guesses and there’s too many variables in it really to make good decisions without that really good information.”

The findings of this exercise will then be applied to the rest of the HSE’s buildings.

“There’s a new way of thinking from the point of view of construction. That is, carbon is so valuable you can never afford to throw anything away or discard something that you’ve expended carbon in constructing in the first place,” Smyth added. 

He said the HSE’s “energy efficient design approach” for new projects, first introduced a few years ago, means that “when you’re designing the building, you’re designing it with energy efficiency and now carbon emissions as one of the key drivers”. 

“We have confidence that when we’ve actually challenged the design at the very earliest stage that we’re going to get a building that’s going to perform without having to add a load of mechanical electric ventilation,” Smyth said.

However, issues remain with the HSE buildings already in use. 

“We spent close to €8 million last year, and we’ll spend at least that in 2022, on the works that are being progressed in the likes of improved insulation, replacing glazing, replacing oil or gas boilers with heat pumps, PV installations [solar panels],” he said. 

‘We need a comprehensive strategy’ 

Dr Ana Rakovac, Consultant Chemical Pathologist at Tallaght University Hospital, said she is “delighted” there is a HSE climate plan in the works. 

Dr Rakovac is the chair of the sustainable healthcare group in the Irish Doctors for the Environment, an NGO of healthcare workers focused on the health impacts of climate change.

“We would like to see clearer targets, clearer actions and clearer ways of measuring the outcome of those actions,” she told The Journal. 

“We need a comprehensive strategy – a comprehensive, system-wide umbrella document and a commitment.”

She criticised that there is currently “not that much” focus on waste and recycling measures and said there needs to be a “consistent sustainability effort” in all aspects of the health service. 

“The system approach is not there,” she said, despite some individual facilities having green groups and committees.  

The World Health Organization recently warned that the vast amount of waste produced in tackling the Covid-19 pandemic posed a threat to human and environmental health.

The tens of thousands of tonnes of extra medical waste had put a huge strain on healthcare waste management systems, the WHO said in a report.

“The main thing healthcare needs to realise, both in Ireland and globally, is that we are part of the problem,” Dr Rakovac said, adding that “everybody needs to start thinking about it” 

“We are doing this as activists in our free time. This should be somebody’s job.

“The last two years showed us that when the politicians understand the urgency of something, a lot of things can be done. Vaccine production can be prioritised. Money can be put where our mouths are – and that’s what needs to happen with this.

We need a concerted effort to see this at the emergency that it is.

Meeting climate targets 

Smyth said the HSE knows “what we’re going to have to do to meet” climate targets and this will be set out in greater detail in the climate action plan later this year. 

The government’s Climate Action Plan sets out that the public sector will have to reduce emissions by 51% by 2030, in line with the overall requirement for emissions reductions in Ireland. 

Public sector buildings accounted for 1.4% of Ireland’s overall greenhouse gas emissions in 2018. 

Emissions from public sector buildings reduced by 12.4% between 2005 and 2011 but increased again by around the same amount between 2011 and 2018.

A new system to monitor and report emissions from the public sector is set to be completed by the end of this year. 

The 2021 Climate Action Plan also said that a review will be carried out to assess the “potential” to widen the scope of emissions captured in the public sector target to include indirect Scope 3 emissions.

These refer to emissions from activities such as business travel and commuting. Most organisations do not systematically record this information.