We work in healthcare – of course we care about carbon!
The World Health Organisation has stated that climate change is “the greatest threat to global health in the 21st Century”. The Marmot Review ‘Fair Society, Healthy Lives’ highlighted that the impacts of climate change will be felt disproportionately by vulnerable groups including economically disadvantaged people, and those with mental illness. Those who most need healthcare are already least able or likely to access it, so disadvantaged people stand to suffer most as financial and environmental resources are constrained. The UCL Lancet Commission: Managing the effects of climate change comprehensively categorized the health risks of climate change, and it doesn’t look good.
OK, so the evidence shows that climate change is a healthcare issue, therefore it’s important healthcare professionals should be invested in combatting it. But why focus on sustainability within healthcare?
Naturally, for a transformation to a sustainable society, all sectors need to be involved. However, the health sector in particular can make a vital contribution to sustainable development, because:
- Its goal is the health and wellbeing of the population – which is profoundly impacted by global environmental change. Therefore, what’s good for health is also what’s good for the environment.
- Healthcare itself has a significant environmental impact that urgently needs to be reduced. The NHS is the UK’s biggest public greenhouse gas emitter, responsible for ~5% of all UK environmental emissions with over 20 million tons of carbon from NHS England alone. One in every 20 journeys on UK roads is healthcare-related.
- Health professionals are highly respected and trusted, and are ideally positioned to model and lead sustainable change through their interactions with their patients and with the public. The NHS employs 1.5 million people and, in England alone, over 1 million people have contact with the NHS every 36 hours.
Sustainable healthcare is about much more than decreasing the carbon footprint of healthcare.
Within healthcare, sustainable development has largely been estates-based, focusing on energy use and other measures in buildings. However, this contributes only 20% to the NHS carbon footprint (figures from 2015). The vast majority of greenhouse gas emissions arise from the manufacture and supply of drugs and equipment, and from staff, patient and visitor travel. In other words, their level is determined by clinical decisions and models of care.
Changing clinical practice and models of care is therefore the greatest opportunity we have for reducing healthcare’s carbon emissions. What does this look like?
The good news is that the interventions we take according to our 4 principles do not just reduce carbon emissions: they usually reduce cost and improve patient care too. For this reason, the Lancet has described climate change as “the greatest global health opportunity of the 21st century”. Improving the quality of healthcare is often synonymous with the principles of sustainability. In secondary care, surgical advances such as laparoscopic aortic aneurysm repair have led to safer and more effective outcomes for patients while at the same time dramatically decreasing length of stay and operative costs. Terminal care delivered at home rather than in hospital or even a hospice is likely to have a lower total environmental impact and we know is the preferred choice for a majority of patients.
The NHS is already struggling financially, and increasing demand in the future as a result of the health impacts of climate change and an ageing population will only exacerbate this. In other words, sustainability serves the NHS both now and in the long term. Sustainable healthcare builds on key healthcare priorities: prevention, patient experience, value/cost-effectiveness. For example, CSH’s Green Nephrology programme, which reached 85% of kidney units in the UK, provides evidence for annual savings of 11,000 tonnes of CO2 equivalent and £7 million in kidney care by applying proven sustainable approaches. The NHS could slash its carbon footprint and save £1 billion if these proven examples were replicated in other areas of healthcare. In another report which made the front page of the Guardian in 2014, CSH identified £2 billion worth of savings to be made from reducing waste in the system. With the 2008 Climate Change Act the government has set a legally binding target of 80% carbon reduction by 2050 that the healthcare sector will not be immune from. CSH has determined that the need for an 80% cut in emissions by 2050 means reform of clinical practice is required.
It is healthcare professionals that are best able to help to navigate us towards a patient-centred, high quality service operating within an increasingly decarbonised society.
CSH has focused within clinical specialties to engage with health professionals on the design and delivery of sustainable, preventative, patient-centred, high-quality care. There are two areas to focus on in relation to care pathways. The first is to challenge the accepted way of doing things. Care is often provided for patients in outpatient clinics because that’s the way that it has always been done. The aim should be to focus on the desired outcome first and then design the care around this endpoint by delivering services closer to, or sometimes in, patients’ homes. Diabetic care is a good example. In Bolton the diabetic service has moved into the community and become more integrated with primary care.
The second is to take a care pathway and make it as lean and efficient as possible. A good example of this is the approach taken to minimise waste associated with renal dialysis services in Bristol. The Centre for Sustainable Healthcare has developed a Sustainable Action Planning tool which can help to identify areas where savings both in cost and carbon can be made.
There’s still a lot more to do, but in many cases we already know exactly what we should do because someone has successfully made the change already. We just need to copy it. Clinical specialties are uniquely placed to address the environmental sustainability of services and there are now many resources out there to help people who want to get involved. Over the next 6 months CSH will be collating some of these as part of our Sustainability Series - keep an eye out and spread the word!