Item 7, a statement by the Minister for Health and Social Services: an update on the decarbonisation programme for health and social care. I call on the Minister, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. As Members will be aware, the Welsh Government’s Net Zero Wales plan was launched last week, 28 October, and I'd like to take this opportunity to provide an update on health and social care’s crucial role in contributing to the Welsh public sector’s collective ambition to reach net zero by 2030. We know that action is needed, not only because NHS Wales is the largest public sector emitter, contributing up to 40 per cent of public sector carbon emissions, but also because health and social care systems are at the forefront of responding to the impact of the climate emergency on health outcomes.

In response to this challenge, in March this year, the 'NHS Wales Decarbonisation Strategic Delivery Plan' was published; a clear and ambitious mandate for action that sets out key commitments for delivery across our highest emission areas. Health and social care have a collective and critical leadership role in driving and embedding net zero across all that we do, and in bringing the communities of Wales with us because we all have our part to play. We know how tirelessly our health and social care sector have worked throughout the COVID-19 pandemic, and that further winter pressures lie ahead. However, the climate emergency has not and will not go away and must be responded to with the same urgency that the pandemic has required of our sector.

The challenge has already been embraced across the health sector, and I have been really impressed by the dedication shown by groups of doctors, nurses, pharmacists and non-clinical staff across Wales who are already driving this agenda forward and developing their own green groups to help their healthcare settings to run more sustainably. The team at Ysbyty Gwynedd, for example, have initiated trials of reusable PPE; they've switched to less polluting anaesthetic gases and planted trees and wildflowers, acknowledging that reducing emissions and increasing green spaces not only helps prevent disease but has significant well-being benefits. The change of medical gas in just this one hospital has saved around the equivalent of driving 27,500 miles a month. Such work is not isolated, with excellent progress being made across our health sector. All-Wales data demonstrates that there's been a 67 per cent reduction in the carbon footprint of anaesthetic gases across Wales since June 2019, and the Welsh environmental anaesthesia network committee has aims now of reaching 80 per cent.

Further activity is also under way to strengthen Wales's approach to sustainable healthcare and to support decarbonisation in wider primary care. Our policy of prudent healthcare, with the aim of patients getting the right care in the right place at the right time, will reduce unnecessary multiple patient contacts and travel.

Our blended model of care, based around clinical triage, delivers appointments by telephone or video as well as face to face where clinically appropriate. This blended model is more convenient for patients; it helps prevent the risks of spread of disease and reduces unnecessary patient journeys. This has been made possible by investment in digital infrastructure and software, giving patients a choice of more appropriate and greener ways to access care and advice, and has already resulted in a reduction of over 7 million miles travelled and over 1.7 million kg of carbon emissions. That is is the equivalent of 289 journeys around the world.

Another important aspect of the effort to help Wales to reach net zero will be reducing emissions from public sector transport and its fleet. To that end, EV charging points have been introduced across the NHS estate and they will be considered for all future projects. The NHS buildings are due to undergo energy efficiency upgrades, with large-scale renewable electricity schemes deployed and low-emission or electric ambulances procured. 

Public sector organisations have collectively committed to be more efficient in how public sector buildings and locations are used. The NHS is leading the way on this, with groundbreaking work happening in Swansea Bay University Health Board, where the land has been secured to develop a 4 MW solar farm. The solar farm comprises 10,000 panels on 14 hectares of land, and it provides power to Morriston Hospital via a private wire connection. Morriston Hospital is the first hospital in Wales to do this, and indeed it's believed to be the first in the UK to develop its own full-scale solar farm. It will cut electricity demand by about £0.5 million per year, significantly reducing carbon emissions and at peak times it could also meet the electricity demands for the entire hospital.

While progress has been made, the 'NHS Wales Decarbonisation Strategic Delivery Plan' is just the beginning. The social care sector has also embarked on its decarbonisation journey, with work well under way to determine its own carbon footprint and to deliver a decarbonisation plan for the sector by March 2022. Good practice is already being identified across social care, with many social services departments moving to cluster-based domiciliary calls to reduce emissions, and carbon footprint is a key factor of the procurement process. 

Wrexham has adopted a fabric-first approach to make its social care buildings more environmentally friendly and energy efficient. Other local authorities, such as Newport and Flintshire, have enhanced energy efficiency at their care homes through the installation of solar electricity panels. The social care sector is well represented and is working hard as the work progresses, and it's committed to its collective efforts within the public sector's 2030 net-zero ambition. 

The pandemic has reminded us that we need our services to be flexible and resilient for future challenges. We are also committed to preparing Wales for hotter and wetter weather in the future. Work has been commissioned to update public health advice and guidance on climate change risks based on the latest evidence of public health impacts from extreme heat, cold, flooding and vector-borne pathogens. In addition, processes for issuing public health advice for acute episodes of extreme weather conditions will be updated to factor in new Met Office alert services to keep the public better informed. Thank you very much, Dirprwy Lywydd. 

The Llywydd took the Chair.

Minister, can I thank you for your statement this afternoon? Of course, as the world focuses on our climate emergency—and that's what it is—I think it's right that we discuss this in the context of health and social care. So, in that regard, I welcome the statement today.

At the beginning of your statement, Minister, you referred to NHS Wales as the largest public sector emitter, contributing up to about 40 per cent of public sector carbon emissions. I was looking at some recent research by Ipsos MORI, and what that research found was that, largely—and this is taken across the UK, not just in terms of the Welsh NHS—the net-zero ambition for the NHS is welcomed across the UK, but there's a lack of awareness from the public. So, once explained to them what the NHS's ambitions are, then it's got a great deal of public support and little opposition. What was particularly, I suppose, relevant to this research was that addressing climate change was low down on the public's priorities for the NHS. So, it's not in other areas, but it is in this particular area. So, I wonder, Minister, what you can do and what the Welsh Government can do to highlight and emphasise the sustainability agenda in the context of the Welsh NHS.

Minister, so often I see statements and discussions in this Chamber around these areas are very much focused on new buildings, and I'm very conscious of existing NHS stock and buildings as well. I can see there was a consultant in Ysbyty Gwynedd recently talking about temperatures reaching 30 degrees in some parts of the hospital. He referred to old single-glazed windows that lacked insulation that were installed in the 1980s. So, yes, the point he's making is those high temperatures and I suppose it's the cost, isn't it, of the air conditioning systems, and then in the colder winter months, it's the cost of that loss of energy out of inappropriate windows. I think of hospitals in my own constituency like Newtown. That building was built before the NHS was even created, so I wonder in that regard if you could perhaps just widen your thoughts in terms of responding to the need to update existing NHS buildings and stock in the context of what I've just said.

And then, the final issue I'd raise as well is in regard to the travelling for appointments. You talked in your statement about digital appointments or telephone appointments. All good, of course; that's very appropriate, especially for rural areas of Wales, but then you also go on to say, 'where appropriate', because sometimes people need to have that face-to-face appointment. But, of course, in the rural parts of Wales then people might have to take a three-hour round trip. Actually, if you're travelling from the middle of Wales, you might have to travel to Telford for an appointment; it can't be done face to face. But that appointment could be done locally if it's for a specialist treatment and, of course, you can't—you have to travel for specialist treatment—but so often, many of my constituents, for example, take a three-hour round trip, have to do it in a car because there isn't public transport available for an appointment that actually could be done locally because it's not a specialist type of treatment. So often in Government's thinking, rural-proofing comes later down the agenda. It's that, 'Come forward with a policy and then let's now see how we can rural-proof this', but I would suggest that rural-proofing needs to be right at the centre of Government thinking at the very outset. So, perhaps you could just give us your thoughts on that particular thought as well, Minister.

Thanks very much, Russell, and I'm glad to see that you agree with our net-zero ambition. I think that one of the benefits of today is that, actually, we are raising public awareness, we are telling people that this is something that has to happen in all sectors of our policy areas. Although in relation to the NHS, it may not be the thing that people think of as the first most important issue for them, it is clearly something that we need to take seriously in every aspect of our lives, and the NHS will be central to that as well. And the fact is that the NHS emits about 1 million tonnes of carbon dioxide—certainly, in 2018-19 that was the case—so we've got a long journey to go on. You talk about the existing stock, and you're quite right—there are some old buildings in the NHS, and there are some new buildings, and, of course any new building will have to be procured and will have to comply with our net-zero ambitions. But, by 2026, we've made it clear in our decarbonisation strategic delivery plan that every building between 2026 and 2030 will have undergone an energy-efficient upgrade, and low-carbon heating will be utilised and renewable energy will be generated on site. So, we're absolutely clear about where we're heading on this.

Like you, I represent a very rural area. I'm very aware of the sensitivities around rurality and access to public health. But what I've found, actually, is that it's been quite transformative, the whole experience of the pandemic, and that we've all learnt to use technology in a way that we weren't aware that we could do before, and it has been embraced by the NHS. It's been wonderful to speak to patients who previously had to trek miles and miles and miles to go and see a specialist, and now they can have a remote consultation. So, I think that's been a huge benefit, not just in terms of climate change, but also for the patients themselves, of course. But of course there will be times when people have to physically go and meet the specialist, particularly if there's an operation to be had. So, this is all about balance, and we've got to get the balance right, but certainly when it comes to rural-proofing, I think you're absolutely right. We need to think about this at the beginning of the process. One of the things I've been talking about today is the issue about the kind of support that is given by so many people who voluntarily take patients to hospital and the need for us to appreciate them a bit more. So, that's something that is very much on my agenda as well.

Thank you for the statement, Minister. The climate emergency, as we heard from the Minister, is a health emergency too, of course. Doctors are seeing the impact of air pollution. Extreme weather can be a threat to health and a threat to life. These problems will get worse unless there is action, and all our eyes are on COP26 in the hope of seeing signs that that is about to happen. The truth of the matter is that the health and care service itself is a heavy emitter and a contributor to other problems leading to climate change, and we need to address that.

It's a shame that we didn't have an opportunity to discuss in full the delivery programme that was published a day or so before the last Senedd was dissolved. But it's good that we've had this update now, and it's very appropriate that that does happen during COP26. It's encouraging to hear many of the elements of what the Minister had to say today—that things are starting to move in the right direction, that the NHS is showing signs of becoming more sustainable, but there is such a long way to go, from the use of anaesthetic gases, as we heard the Minister refer to, to the overuse of plastics in pharmaceuticals. Asthma pumps have been a major problem, for example, and the way the health estate has been designed and planned. We know that there has been criticism in terms of public transport links to the Grange hospital, the newest general hospital in Wales. I was reading a report from around a year ago in the Caerphilly Observer, which said,

'While concerns have been raised over public transport access...the health board claims most patients will be taken to the hospital by ambulance.'

Well, what we have there is an example of ignoring entirely the environmental problem in failing to think environmentally in planning services. Yes, patients who are very ill will be taken to the hospital in an ambulance, but what about the staff? What about visitors? What about suppliers and all the out-patients who need to be encouraged to leave the car at home and not see barriers put in their place because of a lack of planning? I hope that that doesn't happen with future developments.

There are so many questions that I could pursue, but I'll raise just three or four at this point. What's the Minister going to do to build capacity to generate momentum for green initiatives? We heard specific mention of Ysbyty Gwynedd and the good work done there. Indeed, there is very good work happening on green plans there. But, staff very often have had to work on those on a voluntary basis at the end of their shifts during the pandemic. So, are there plans afoot to create that capacity, to create specialist positions to promote sustainability within health boards and so on? And what discussions have taken place with the finance Minister to help health and care services to try and go even further than is outlined in the strategic delivery plan?

And finally, we don't have to act alone here. It's not Wales operating in a vacuum; we are part of an international effort to seek to address the problem of inappropriate environmental habits, shall we say, and the need to change ways of working within health services. I've been looking today at the Race to Zero programme of the United Nations, and particularly into the 'Health Care Without Harm' heading. There are health boards and health institutions across the globe there who are committed to supporting that particular programme. In a way, you are supporting the principle underpinning Race to Zero, so can I ask whether the Welsh Government will ensure that the Welsh NHS and our care services are also added to that list of organisations who want to be a central part of the race to net zero?

Thank you very much, Rhun. Could I agree with you that there are a lot of things we need to consider in this area? One of those, of course, is something that you mentioned, which is the impact of air pollution on health. We know that there is a link between air pollution and cardiac arrest, and stroke, heart disease, lung cancer, obesity, cardiovascular disease, asthma, dementia—all of those all linked to air pollution. So, evidently, we need to take this seriously. It's not something that is a separate issue.

You're quite right to say that, when we develop ideas for new hospitals or new developments, we need to consider public transport. I want to praise Hefin David for the work that he's done with bus companies to try and achieve better links to the Grange hospital. So, that has been a great help.

In terms of increasing capacity, there is a new group that's been formed, the climate change group, and there is a decarbonisation board, and all health boards have to develop action plans. What's important is that they understand, when it comes to procurement, that that is where a lot of the problems stem from in terms of carbon.

So, there are four areas that we need to focus on: one is the buildings; the second is energy; the third is procurement; and the fourth is transport. So, of all of those, I think it's procurement where we have the greatest scope to make a difference.

I'd like to thank you for drawing my attention to the UN Race to Zero. I haven't seen that yet, but I will look into that to see whether that is something that we can sign up to as well. What I do know is that the WHO has said that climate change will lead to 250,000 additional deaths by 2030. So, we all have a responsibility. Our children are watching us, and we need to respond. 

And finally, Gareth Davies. 

Diolch yn fawr iawn, Llywydd, and thank you for the statement this evening, Minister. I just want to declare an interest as I'm a Denbighshire county councillor and I'm going to mention local authorities. So, currently social care is run and operated by our 22 local authorities in Wales. What is the impetus for decarbonising the social care sector when not every council has declared a climate emergency? My own local authority, Denbighshire County Council, was one of the first to declare, but what about the likes of Flintshire, Rhondda Cynon Taf, Merthyr Tydfil or Neath Port Talbot? Minister, are you sure these councils will take the necessary steps to limit emissions from the care sector? And it's a sector that relies upon transport, whether that's getting carers to people's homes, delivering hot meals or moving care home residents to health appointments. The majority of those reliant on social care are dependent on the motor car. Active travel isn't an option for those with reduced mobility. So, Minister, how does the Welsh Government plan to support the sector to move away from petrol and diesel vehicles, and entice local authorities into choosing the electric vehicle or greener methods of transport? Diolch yn fawr iawn. 

Thanks very much, Gareth, and you'll be aware from the statement that I have just announced that we are absolutely focused on social care. In that statement, I drew attention to a lot of the work that's being done in care, in particular in north Wales, and I talked about Wrexham and the way that they are using new fabrics to make sure that they improve the efficiency of their buildings, but also that places like Flintshire are making sure that they improve the efficiency of their care homes through putting up solar panels. So, I think it's fair to say that many of these councils are taking these steps really seriously. I am pleased that you drew attention to this because we are very aware that this is an area that does need some focus, but I am assured that this sector is very much enthusiastic about being a part of this revolution that we all need to undertake

Thank you, Minister.