King’s College Hospital Foundation Trust announced last week that it had published its first Clean Air Plan, in partnership with Guy’s and St Thomas’ NHS Foundation Trust. Fittingly, the plan was launched on the 15th of June, which has been named as Clean Air Day in the UK’s largest air pollution campaign.
The plan’s five areas of focus are transport, procurement, buildings and sites, monitoring, and engagement and communications.
Need for the plan is demonstrated by the fact that “every single hospital, medical centre and care home in London is located in an area that exceeds the World Health Organisation’s guidelines for the concentration of air pollutants”.
The plan recognises the importance of air quality, and the responsibility of trust’s to take action to protect population health.
“Local air quality and illness are closely interlinked. We recognise that our own operations contribute to air pollution. And that, as healthcare providers, we treat the people whose health is affected by air pollution.”
Guy’s and St Thomas’ Foundation has already launched its Impact on Urban Health ten-year programme to address the effects of poor air quality on the most vulnerable. A partnership between Impact on Urban Health and the trust has also enabled an “increased focus on air quality work at the trust”.
The plan refers to statistics which show that up to 4,000 Londoners die prematurely each year as a result of air pollution, and to London’s status as the city with the highest proportion of particulate air pollution-related deaths in the whole of England. It also outlines the devastating health consequences of air pollution on populations, and particularly pregnant women, children, adults and the elderly.
“Air pollution has devastating effects on everyone’s health, but it disproportionately affects children, older people, and people with health conditions. Communities with higher levels of deprivation, or a higher proportion of people from minoritised communities, are also more likely to be exposed to higher levels of air pollution in cities like London. At the same time, these communities are less likely to contribute to local pollution levels. For example, those most affected by air pollution from traffic are often the same people who can’t afford to drive. Air pollution and its health effects is therefore not only an environmental health issue but also a social justice issue.”
Outlook on the Clean Air Plan 2023-2026
The overall approach of the plan to reducing local air pollution is two-fold:
- raising awareness of the issue, as well as its effects on human health, while “empowering staff and patients to take action”
- reducing Trust’s contributions to local air pollution
The plan moves on to focus on each of the five focus areas (buildings & sites, monitoring, transport, procurement and engagement & communications) in more detail, looking at commitments to 2026, as well as short-term priorities to get there.
Under the focus area of monitoring, the plan looks at how the trusts can implement air quality monitoring to measure air pollution levels across their sites.
“The data gathered contributes to building up a London-wide picture of air pollution levels around hospitals and other healthcare settings; helps us identify and address specific areas of our own contribution to the problem; and allows us to track progress over time.”
The plan identifies areas in which progress has already been made, including the early adoption of ambient air quality monitoring and indoor air quality monitoring. It also sets out objectives to continue with this monitoring to 2026, along with the installation of new sensors across Trusts and a focus on areas like loading bays which are known to be “hotspots” of air pollution.
Under the focus area of transport, the plan considers the impact of the “fleet” across the Trusts, including staff cars, patient transport, community teams and supplier deliveries.
“Guy’s and St Thomas’ and King’s College Hospital trusts operate just under 300 vehicles as part of their core fleet, enable the leasing of 500 vehicles through salary sacrifice schemes, and reimburse staff members for grey fleet vehicle miles where private vehicles are used for work purposes.”
With this in mind, progress has been made to identify potential for behavioural shifts, as well as areas where improvements could be made, with two electric bikes being piloted for nurses at Guy’s and St Thomas’ in 2022. Looking to the future, the trusts commit to introducing e-bikes at six additional locations and reducing the number of low mileage vehicles in use across the trusts by 10%; as well as finalising electrification and charging infrastructure plans.
Under the focus area of procurement, the plan looks at air quality criteria for tenders and contract performance management.
“The most effective way of addressing air pollution from our supplier fleets is through procurement and, more specifically, tender criteria and contract management. For both, the focus will be on criteria and clauses that are complementary to those relating to carbon emissions.”
Guy’s and St Thomas’ opened an off-site consolidation centre in Dartford in August of 2019, and King’s have managed a consolidation centre in Croydon since 2020. This has reduced the number of direct truck deliveries to site, but has not eliminated them completely. Moving forward, the Trusts are committed to “including separate air quality criteria” in tender documentation for supplier contracts with “significant transport elements”, and to “integrating air quality considerations in supplier contract clauses”.
Buildings & sites
Under this focus area, the plan looks at existing buildings, along with future construction projects.
“The sites and buildings we operate from need to be heated, cooled and ventilated, cleaned and serviced – all activities that cause indoor and outdoor pollution. The buildings also need to be periodically refurbished to bring the existing estate up to standard and new facilities need to be invested in and built.”
Both trusts have committed to “integrating air quality considerations in all energy and decarbonisation planning”, as well as to integrate these considerations into major construction projects and ongoing improvements, leading two air quality and emissions workshops to improve knowledge and understanding between capital projects and estate planning teams.
Engagement & communications
Under this focus area, the plan considers staff engagement, air pollution alerts and patient engagement.
“People do not have much control over the air pollution they are exposed to. However, it is important that people are informed about air pollution. With more than 37,000 staff members and four million patient contacts per year between the two trusts, the opportunity to raise awareness of air pollution and its health effects among these direct stakeholder groups is significant.”
Both trusts run their own staff engagement groups: the Clean Air Network at Guy’s and St Thomas’, and the Air Quality Action Group at King’s. These look at raising staff awareness and creating ideas for behavioural change amongst staff members. Both have committed to working with clinicians and stakeholders to improve awareness and understanding of air pollution which can then be passed on to patients and the wider community. Air pollution alert systems will be installed, which will alert staff on days with high or very high levels of air pollution.
To read the Clean Air Plan for yourself, please click here.