Cancer specialists pledge to reduce carbon emissions

Wednesday, 17 March, 2010

Senior NHS cancer clinicians and managers have pledged to reduce carbon emissions and work towards sustainable cancer services.

The pledge came in a statement agreed at the end of a one-day national summit held at University College London Hospitals NHS Foundation Trust (UCLH) last week to explore the carbon consequences of modern cancer care. The summit was organised jointly by UCLH and the Campaign for Greener Healthcare.

The high-level group agreed to lead the transformation of cancer services into sustainable, low carbon care systems by persuading their organisations to adopt a number of measures (if they have not already done so), such as

  • developing a carbon reduction strategy,
  • signing up to the 10:10 climate change campaign, and
  • supporting the research, dialogue and action necessary to create environmentally sustainable cancer services.

Explaining the impetus for the summit, the clinical director for cancer services at UCLH, Mark Emberton, said: “In healthcare, we are currently not accounting for the cost of carbon, a finite energy resource which is set to become more costly since it is being capped to minimise climate change. The cost of carbon emissions associated with healthcare delivery may well be a key factor in determining funding in the not-too-distant future.

“If an ageing population wishes to be looked after as well as they possibly can, at a time when there are increasing pressures on the healthcare expenditure, then cancer care needs to be designed and configured in a manner that is as sustainable as possible,” Mr Emberton said.

Setting the challenge

The summit was opened by UCLH chief executive Sir Robert Naylor (one of the first NHS chief executives to sign up to the 10:10 campaign), and was attended by the National Clinical Director for Cancer Services, Sir Mike Richards. A sober tone was set by intensive care physician, Professor Hugh Montgomery, who reviewed the science of climate change, setting out the enormous threat it poses to global health through crop failures, forced migration and conflict. Lives will be lost as a result of carbon emissions – including those from healthcare.

The NHS in England is currently responsible for 21 million tonnes of CO2 equivalents per year, amounting to a quarter of all public sector carbon emissions, but it is committed to reducing its carbon footprint by 80% by 2050. The summit considered how cancer services could take a lead in carbon reduction through transformation to low carbon models of care.


Dr Adam Glaser, clinical director of the National Cancer Survivor Initiative, described how cancer patients make a median number of 53 separate trips for their treatment, while many follow up appointments are “empty” encounters – failing to address their concerns. There is huge scope to improve care and reduce carbon through supporting patients to take a greater role in their own care: helping them to understand their condition, recognise warning signs and access help quickly when needed.

Amanda Saunders reported on the carbon footprint analysis of a chemotherapy service commissioned by NHS Bristol. The study had shown that providing the chemotherapy in patients’ homes had only a small impact on the carbon footprint, but that if the model were adopted more widely, efficiencies of scale could provide significant carbon savings (through geographical grouping of patient visits, and reduced need for central facilities).

The overall incidence of cancer is rising, and the greenest approach of all is prevention. The summit discussed how preventive measures can be better integrated into clinical encounters across the NHS. It was noted that rates of many cancers (including cancers of the breast and prostate), are significantly reduced by exercise – so supporting a shift from car use to walking and cycling would benefit both cancer prevention and the environment. Similarly, a more sustainable diet containing less meat and dairy produce would reduce rates of bowel cancer.

Next Steps

Many changes needed in the transformation to low carbon cancer services present opportunities to improve both quality and cost efficiency of care – in fact, many of these changes are already under way. However, the group identified an urgent need to measure the carbon impact of cancer pathways, both to inform future service planning and to raise awareness across the specialty.

The position statement agreed on 5th March sends a powerful message that cancer services will be at the forefront of transformation to sustainable, low carbon models of care. Following on from the summit, UCLH is working with the Campaign for Greener Healthcare to develop a green action plan for the specialty.

Counting the Carbon Cost of Cancer Care was held on 5 March 2010. Among the organisations represented at the meeting were: Oxford Radcliffe Hospitals NHS Trust, ARUP, the National Cancer Survivor Initiative, Newcastle upon Tyne Hospitals NHS Foundation Trust, the NHS Sustainable Development Unit, Macmillan Cancer Support, the UCL Institute for Human Health & Performance, The NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), UCL Partners, NHS Bristol, Papworth Hospital NHS Foundation Trust, Map of Medicine, BUPA and Hopkins Architects.