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Vital role of clinicians in reducing the NHS carbon footprint through smarter procurement decisions
  1. Nada Al-Hadithy1,
  2. Katie Knight2,
  3. Anya Gopfert3,
  4. Maria Van Hove3,
  5. Xana Villa Garcia4
  1. 1 Plastic Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Paediatric Emergency, North Middlesex University Hospital, London, UK
  3. 3 Royal Devon and Exeter Hospital, Exeter, UK
  4. 4 3Keel, Oxford, UK
  1. Correspondence to Dr Nada Al-Hadithy, Plastic Surgery Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK; nadaucl{at}


Background The NHS’ impact on the environment is significant, accounting for 5.9% of the national carbon footprint of the UK and 20 million tonnes of carbon dioxide equivalent (Mt CO2e) emissions a year.

The procurement of goods and services is responsible for 72% of the NHS carbon footprint—equivalent to 15.2Mt CO2e. Procurement is, therefore, a priority focus area to consider, if carbon reductions are to be made. The impact of procurement decisions extends over the ‘whole life’—from identification of the need for a product or service through to the provision of the product or service and including the product’s ‘end of life’ process (disposal).

From April this year, any new procurement needs to have a 10% net zero and social value weighting. From April 2023 onward, any new procurement two times per day should incorporate carbon footprint and environmental impact.

This paper aims to introduce clinicians to the concept of green procurement and illustrate the potential greenhouse gases savings possible if procurement decisions were informed by the sustainability credentials such as the carbon footprint of a product or the corporate social responsibility programme of the supplier.

Methods While seconded at the Department of Health and Social Care, the senior author on this paper collaborated with the NHS Supply Chain to pilot carbon footprinting of one clinical item. We chose to focus on the 20-gauge ‘pink’ cannula as a high-volume familiar article; 25 million cannulas are purchased via the NHS Supply Chain each year, of which the most commonly used size is the 20 gauge.

Results Of the seven companies approached, five sent us their CSR strategies. Four companies provided product primary data, and of these four, one provided sufficient data to carry out a carbon footprint analysis. The one set of detailed data provided was for two 20-gauge cannulas, 1 with wings and 1 without. The total carbon footprint for Cannula 1 is 33.92 g CO2e. The total carbon footprint for Cannula 2 is 35.45 g CO2e. This amounts to a 1.54 g CO2e difference between the 2 cannulas.

Conclusion It is both necessary and possible for the NHS to demonstrate leadership in reducing the carbon footprint of healthcare.We have provided an overview of NHS procurement to empower clinicians to get involved with local and national decision-making. We have demonstrated the potential carbon savings that could be made through careful choice of products. We have also highlighted the risks if clinicians do not engage with green procurement.

  • sustainability
  • health policy
  • clinical leadership
  • productivity

Data availability statement

Data may be obtained from a third party and are not publicly available. No applicable.

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Data availability statement

Data may be obtained from a third party and are not publicly available. No applicable.

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  • Contributors NA-H: conceived and developed the paper and liaised with all the pharmaceutical companies, NHS Supply Chain and Department of Health and Social Care. KK, AG and MVH: conceived and co-wrote the paper. XVG: did the carbon footprint calculations. NA-H, Guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NA-H is married to Simon Miller, the Managing Partner of 3Keel, Sustainability Consultancy Firm, who carried out the carbon footprint work pro bono.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.