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.”
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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?