BMJ Supports Sustainable Healthcare Frances Mortimer: Sustainable Clinical Practice

Monday, 15 July, 2013

Welcome to the second in a series of BMJ blogs on sustainable healthcare that will look at health, sustainability, and the interplay between the two. In the second in a series of BMJ blogs on sustainable healthcare, Frances Mortimer, medical director of the Centre for Sustainable Healthcare, explains why clinicians are central to improving sustainability, and introduces the four guiding principles of sustainable clinical practice.The blog will share ideas from experts across the healthcare field, some of whom are speaking at a major European conference looking at Pathways to Sustainable Healthcare in September 2013. More about the conference can be seen at

Sustainability in the NHS has traditionally been an extra hat for the estates and facilities manager who has been tasked with finding energy savings across hospital buildings. More recently, it has become a cross-organisational endeavour in many trusts, following good work by the NHS Sustainable Development Unit to introduce the “sustainable development management plan.” This has brought a new reach into areas such as trust procurement policies. However, there is a need to move sustainability further towards the heart of healthcare—to create sustainable clinical practice.

Sustainability should be considered as a missing component of “quality” in patient care—to go alongside clinical effectiveness, safety, equity, etc. It is also closely related to value in healthcare, since sustainable healthcare must deliver the best possible outcomes for patients from a radically reduced resource input.

The scale and urgency of carbon cuts needed to protect from climate change dwarf the financial challenge currently faced by the NHS. To meet the UK’s carbon reduction targets, the health sector will need to go well beyond simple efficiencies to strip out redundant process and create whole systems change. We have an opportunity to re-imagine a more preventative, flexible, smaller health service, organised around the true needs of patients.

In 2009, the Centre for Sustainable Healthcare published four guiding principles of sustainable clinical practice:

  1. Disease prevention and health promotion—to minimise the need for healthcare. 
  2. Patient education and empowerment—reducing disease progression, pre-empting complications and improving coordination of care by giving patients a greater role in managing their own condition. 
  3. Lean service delivery—targeted, evidence-based use of investigations, referral and interventions, supported by better use of IT to reduce duplication and unnecessary travel.
  4. Low carbon—preferential use of modes of treatment and medical technologies with lower environmental impact (e.g. dry powder inhalers).

Clinicians can contribute to improving sustainability through their individual clinical practice, as well as through designing and implementing new models of care. And of course, increasingly, through commissioning.

In fact, I would go further and say that clinicians are absolutely central to improving sustainability. Only by clinicians working collaboratively with patients and commissioners, can care systems be transformed to meet the needs of patients today, while preserving resources that are essential to the health and healthcare of tomorrow.

The original blog was published by the BMJ on 8th July 2013. To view the original blog go to: