West Yorkshire and Harrogate Climate Change Team: A Year of Sustainable Achievements

After many years of being an anaesthetist with an interest in sustainability, I was appointed to the role of Climate Change Lead for my local ICS (West Yorkshire and Harrogate Health and Care Partnership). Along with a small but committed team, we set about delivering one of the ICS’s Big Ambitions, spelled out in the five year strategy – we aspire to be a global leader in our response to climate change. It is clearly a huge task but we have had a busy year and wanted to share some of the things that we have done. If anyone would like any more detail, please do get in touch by email.

In our first 12 months the Climate Change Team and West Yorkshire and Harrogate Health and Care Partnership have:

1. Written the strategy

These two objectives in the West Yorkshire and Harrogate Health Care Partnership Climate Change Strategy have set the scope and direction of travel for the team and the many further details help steer our thinking when given a new situation to consider: 

• Objective 1: A healthy, equitable and environmentally sustainable society
• Objective 2. A high quality, equitable and environmentally sustainable health and care system

2. Created the website

The West Yorkshire and Harrogate Health and Care Partnership’s Climate Change website is both an explanation of the team and a resource for everyone within West Yorkshire and Harrogate. It hosts the strategy document, information about our work, and what resources and training are available. 

3. Increased the team from two to 9

Our nine staff are part time which allows us to maximise diversity of thought whilst allowing people to enjoy the benefits of portfolio working and ensure that there is increased sustainability thought throughout the wider system. Whilst some are people we have appointed, most are volunteers, people on work experience or people who have approached us to ask if they can be involved.

4. Got desflurane out of Bradford Royal Infirmary and reduced its use in every other hospital in the region

Desflurane is an anaesthetic vapour which is vented out the top of hospitals, into the atmosphere after use. It is an extremely potent greenhouse gas, it costs more money than the alternative and it doesn’t provide any clinically meaningful benefit. There are national targets for reducing desflurane use but we are already ahead of the curve.

5. Awarded £20,050 for respiratory care grants to improve clinical staff and patient management of asthma

Asthma is often poorly controlled in the UK. This leads to a huge waste of environmentally unfriendly inhalers but, more importantly, to lots of poor health. We have funded a training programme to help GP surgeries educate patients about their illness in a more manageable way so that they have better quality of life and don’t need inhalers so much.

6. Hosted a two day summit for approximately 150 delegates

This brought together all the like-minded individuals in the region and many from further afield to hear experts and discuss potential solutions across many dimensions of sustainability. By bringing groups together, we improve “cross pollination” of ideas and help individuals and organisations benefit from one another’s work and thinking.

7. Been involved in the inequalities academy

Climate change is caused disproportionately by the most affluent in society and felt by the most disadvantaged. Inequality is also one of the biggest drivers of poor health so it is key for us to be involved in the Health Inequalities Academy both to highlight the interconnectedness of the problems but also to start to develop ways to move forwards.

8. Engaged with more than 200 people in our staff and citizens workshops

These workshops helped us to understand what health and care staff, and citizens in West Yorkshire and Harrogate think about the relationship between care and climate change. We also gained insight into where people want us to focus our energies, what messaging is likely to be effective and just how much support there is for this work from all quarters.

9. Established a Steering Committee

The steering committee is a group of about ten diverse “critical friends” from West Yorkshire and Harrogate. They are deliberately not all employed in health and social care. We meet with them once a quarter to answer three questions: Are we doing the right stuff? Are we going about it in a reasonable way? And what are we missing? In this way, we get a really high level view of our work and where it sits in the bigger picture of society at large.

10. Established an Operational Leads network of sustainability managers

Operational leads are the people in organisations that do the sustainability work “on the shop floor”. By bringing them together once a quarter to discuss current challenges, opportunities and successes, we can share the work that we’re all doing and pool resources to help overcome difficulties. Enhancing the strength and density of this network is key to ensuring that everyone in the health and care system moves forwards together towards sustainability.

11. Engaged with Greener NHS

In October 2020 Greener NHS launched their Net Carbon Zero ambition paper showing the way that the health system is going to travel towards sustainability. We have been working closely with regional and national teams to ensure that our work complements their ambition but isn’t duplicating effort. We have also fed back to Greener NHS to help them understand the way in which a mature ICS works and thinks about sustainability.

12. Established a Board Level Net Zero leads network

In line with the Greener NHS Net Zero ambition, every board must have a Net Zero Carbon Lead. By connecting these people together across West Yorkshire and Harrogate, it’s been possible to create a group of top level decision makers who can drive change both in their organisations but also in the system as a whole.

13. Written a board level lead introductory  paper

As part of the Greener NHS Net Zero paper there is an expectation that each organisation has a named Net Zero person on their board. In order to ensure that these people understand what’s expected of them and to highlight to them the work that’s already ongoing, as well as training opportunities which are available, we wrote a briefing paper establishing a common baseline.

14. Established a Green Social Prescribing network

The evidence for Green Social Prescribing continues to grow and we now need to translate the research into behaviour change. Putting together a network of academics, projects and other interested parties allows them to speak with one voice to enhance the ability of the local population to access high quality, safe greenspace and to enjoy the lifelong health benefits that such access enables. 

15. Awarded £84,773 for green social prescribing

Green social prescribing has a host of benefits for both humans and the environment and we are keen to promote it as much as possible so we have funded ten projects in the region and we are working with two universities to demonstrate the benefits so we can build the case to increase the number, size and quality of future projects.

16. Established a Pharmacy network

Pharmaceuticals are responsible for a huge carbon footprint in the UK and pharmacists in both communities and hospitals have a key role in educating citizens and prescribers about alternatives to medicines, such as green social prescribing, and low environmental impact medicines, such as dry powder inhalers. Bringing interested pharmacists together has galvanised action and ensured that individuals don’t feel like they’re doing this work in isolation.

17. Established an ED docs network

ED work is a hotspot in terms of single use, disposable equipment and the use of nitrous oxide which is a potent greenhouse gas. By bringing like-minded ED staff together to share ideas, best practice and frustrations has galvanised action to reduce waste in several of the hospitals in the region.

18. Influenced the Capital and Estates Board of the ICS

By highlighting sustainability issues to the Capital and Estates Board, we were able to get agreement from all of the Finance Directors in the region that climate change is something that we all have a responsibility for. Going forwards they will give consideration to climate change in their decision making process which will mean that we don’t only choose based upon lowest cost going forwards.

19. Influenced the Equality Impact Assessment tool in use by the ICS

This tool is used to assess the impact of any significant change in the system on the rest of the system and the citizens we serve. It currently looks at several dimensions including workload, finance etc. but by including a climate change dimension, we ensure that we are making decisions which take broader climate change elements into consideration as well. We are therefore much less likely to suffer from unanticipated consequences such as increased waste or travel.

20. Funded 100 places for staff on Centre for Sustainable Healthcare courses

The knowledge base around sustainability and sustainable healthcare has increased hugely in the past few years and it’s difficult for staff to keep up to date. We have therefore funded 100 places on the Centre For Sustainable Healthcare courses for anyone who works or volunteers in the health and social care system in West Yorkshire and Harrogate so that our workforce can stay up to date with the latest thinking. Details are available, here. 

21. Held training for our aspiring executives so that they are aware of sustainability issues

In the summer of 2020 the ICS published its BAME review and then created its Aspiring Executive Fellowships as a way to increase cultural diversity amongst the senior decision makers in the system. Highlighting to these fellows that people from ethnic minorities suffer the worst consequences of climate change imprinted on them the need to take climate change very seriously. As they are the next generation of executives in our system, they will be pivotal in ensuring we move towards sustainability quickly enough.

22. Hosted a Podcast

Our podcast (which is one of the most listened to podcasts in the ICS catalogue) introduced the concept of sustainable healthcare and outlined the strategy document (See number 01) in a way that staff and citizens can digest without having to read a lot of text.

23. Hosted Lunch and Learn sessions

Rather than host another Sustainable Healthcare Summit (See number 06) in 2021, we decided to work in collaboration with our colleagues in Humber Coast and Vale ICS and host a series of one hour sessions on a wide variety of topics. Each session involves one or two experts with a lot of time devoted to Q&A in order that the attendees get the most out of the session. Booking and recordings are available, here. 

24. Engaged with MHRA

As the UK has now left the European Union, there is an opportunity to re-write some legislation which impacts on health and social care. We are working with MHRA to share our expertise and help them write regulations which reflect the UK’s mandate to be net carbon zero by 2050.

25. Engaged with NHS Procurement

In order to achieve our net zero commitments, we will need to understand the environmental impact of everything which we buy. We have been working with NHS procurement to highlight good practice regionally and to help them to understand what information we need from manufacturers in order to make informed decisions.

26. Sit on Bradford City Sustainability Board

Bradford City has an ambitious plan to reduce its environmental impact and as a big employer and purchaser in the region, the health and social care industry has an important part to play. We are working with them to not only help the transition but to bring training, jobs and economic prosperity into the region and thus reduce the inequalities which fuel both climate change and poor health.

27. Chair West Yorkshire Combined Authority Health and Transport Board

Transport is key to sustainability from equality, noise, air pollution, CO2 emission and social cohesion viewpoints. It therefore is important that we have a voice at the decision making table when it comes to the future of travel, public transit, active travel and road building schemes.

28. Awarded £29315 for active travel funding

This money was awarded as grants to encourage active travel amongst staff and the public.

29. Engaged with the regional Travel Plan Network

One way to reduce single occupancy vehicles is to promote active travel and public transport. The Travel Plan Network makes it easy for employers to allow their staff to benefit from discounts and special offers as well as helping them to establish what the barriers are to more sustainable transport options. We have introduced the Travel Plan Network to the Operational Leads Network (see number 10) to enhance collaboration.

30. Worked with Y&H AHSN to fund mentoring for green med-tech innovation

Providing support to entrepreneurs and start-ups to help them get their green med tech solutions to market is a great way to boost system change for the better.

31. Worked with the WY Anchor Institutions network

As we feel the effects of climate change more and more, we will look more and more to our Anchor Organisations for support, leadership and employment. It is therefore critical that those organisations understand what is happening and what role they can play in keeping local communities resilient. By discussing climate change with them and ensuring that they think about the wider role they can play as leaders in society, we are maximising their utility as change agents.

32. Creating a Risk and Resilience framework for the region

As well as reducing our environmental impact going forwards, we understand that we need to support communities through the changes that are already “locked in” such as a 1-3m sea level rise before 2100. By modelling expected changes and working through scenarios, we can utilise the available resource to best effect.

33. Engaged in work to reduce single use PPE

At the height of the pandemic, some hospitals were using 100,000 single use, plastic, disposable, surgical facemasks a day. The environmental impact of creating, transporting and disposing of them is huge and when added to the impact of gloves and gowns and visors etc. etc. the numbers become unfathomable so we have worked hard to explore the possibility of using re-usable PPE wherever possible and made sure that we are following best infection prevention practice at all times.

34. Worked with local housing associations to promote low carbon retrofitting

In order to achieve the UK’s mandate to be net zero carbon by 2050, we will have to retrofit and insulate many hundreds of thousands of homes. This is not simply a cost though – warm, dry homes directly contribute to health so by improving housing stock, we can reduce the demand on health and social care, reduce the environmental impact and improve people’s lives.

35. Contribute to the local Economic Recovery Board

As we recover from COVID-19 it is vital that we don’t “get back to normal” but rather make the most of this opportunity to do things more equitably, more healthily and more environmentally friendly going forwards. By promoting green jobs and green recovery, we will enhance the economic prospects of our local population, build resilient communities and improve overall health.

36. Included climate change in the vision statement for paediatrics in the region

Climate Change is the third biggest threat to the health of our children according to the Royal College of Paediatrics and Child Health. Numbers one and two are obesity and mental health – both closely linked to sustainability. With this in mind, we have been actively involved in the creation of the vision for paediatrics in the region for the next 20 years. Climate change must be central to this policy because our young people will suffer the effects of climate change in a way which is much more pervasive than the effects that we will see.

37. Engaged with Health and Wellbeing Boards

Health and Wellbeing Boards have huge influence over the direction of travel for health and social care in the region and we have done what we can to meet them and discuss why climate change is so important for them to think about going forwards. In conjunction with sustainability teams in Public Health and Local Authorities, we are really helping to move the conversation towards a system wide understanding of our responsibilities.

38. Started regional conversations about charging infrastructure for electric emergency vehicles

Emergency vehicles have a mandate to use only zero emission and ultra-low emission vehicles by 2028 and there are currently no dedicated charging points in West Yorkshire for them. Hydrogen is a possibility but the technology is not currently sufficiently mature. We are working with Fire, Police and Ambulance services to explore ways in which they can access rapid charging in a timely fashion, charge the electricity to their organisation and still perform the critical functions which we rely on them for. Conversations are progressing and there is an agreement that a system wide solution is preferable.

39. Influenced the ICS Future Commissioning Work

As the ICS transitions to become a statutory body, there is a lot of change in the system and a lot of opportunity to improve the environmental sustainability of the work that we do. We have incorporated climate change considerations into a document describing how well the ICS is performing so that we don’t forget how important it is going forwards.

40. Engaged and discussed with the other programme directors in the ICS

In order to truly transition towards sustainability, this isn’t something which we can deliver in isolation. We need every team in every department in every organisation thinking about it and changing the way they function in order to reduce their impact. By discussing with other teams and highlighting the problems but also some of the solutions, we have created new conversations and understanding that are helping us to move forwards together towards a world leading ICS.

Author:

Frank Swinton

Frank is a Consultant Anaesthetist at Airedale Hospital and the climate change lead for the West Yorkshire and Harrogate Health and Care Partnership.