Since the NHS became the “world’s first health service to commit to reaching carbon net zero” in October 2020, we’ve seen integrated care systems and trusts developing their own green plans with three key focuses – supporting the NHS’s net zero ambitions, prioritising interventions to improve patient care whilst tackling climate change, and supporting organisations in planning investments and increasing efficiencies.
NHS England shares a range of case studies, from drones being used to deliver chemotherapy to the Isle of Wight, to a trial of an electric cargo bike courier delivery scheme to make deliveries between two hospital sites in Newcastle, to installing solar panels to generate enough electricity to meet a hospital’s daytime running needs during summer months in Hull.
What else is happening across the NHS? Here, we take a look at some of the practical programmes and projects that are being put in place across the country to support green ambitions.
Six green projects across Coventry and Warwickshire
In Coventry and Warwickshire, six clinical teams from South Warwickshire University NHS Foundation Trust have taken part in the Centre for Sustainable Healthcare’s Green Team competition. The competition sees projects focusing on the use of innovative practices to support environmental, financial and social sustainability.
The projects including reduction of routine blood testing in the frailty and care of the elderly, with the team developing a decision-making tool to help clinicians decide if a blood test was necessarily and if so which tests were necessary for each patient, with figures showing that the intervention led to a 9.8 percent reduction in phlebotomist request forms.
Another project saw a team develop a consensus on a “lean pathway (including adoption of low carbon alternatives) for curette and cautery skin surgery procedures”, including switching from sterile gloves to clean nitrile gloves, removing the need for an alcohol skin wipe, reusing surgical markers and reducing the level of anaesthetic used.
The third project developed reductions in continence products waste in the neuro rehab setting; the team observed participating wards for four weeks to identify how many products such as bed pan holders and wash bowls were being disposed of un-used, observing an average of 25.5 items wasted per day. After presenting findings to the clinical team and encouraging mindfulness, the team “observed an 80 percent reduction in wasted products, saving 20.5 items per day”.
Looking at how to improve the environmental impact of patients with diabetes and on insulin, the next project team sought to switch appropriate patients from single use insulin pens to ‘smart pens’, which last for five years and require smaller cartridges. Following review of clinic caseloads to identify suitable patients, clinicians have started to transfer patients over to smart pens, with the team estimating that if 80 percent of suitable patients moved to reusable prescriptions in the next year, it would save 1,863kg CO2e.
The fifth project looked at reducing physiotherapy referrals from care homes on waiting lists through health promotion, physical activity and falls prevention; here, the team noted the potential to reduce carbon emissions through limiting appointment travel. The team undertook analysis of routine caseload and a literature review and engaged with key stakeholders to set up a home exercise programme to target strength and balance training, with the programme set to be trialled in two care homes before potential roll-out across all care homes in the area.
Finally, the sixth project team examined the potential to reduce wastage through duplicate dispensing in the medicines pathway for the pharmacy team. The team explored the reasons behind the duplicate dispensing, gathering data to identify requests for unnecessary resupply. Across a month, they found 243 re-dispensed items, which accounted for 4 percent of all dispensing undertaken – equating to 12,288kg CO2e. The team is developing a plan to present findings, with initial suggestions including a communications plan to share findings with ward staff and increase awareness; a change to patient transfer procedures to ensure that medicines are not left behind and wasted; and an additional check for porters when handing over medicines in admission areas, to identify whether the patient has moved in the time taken to dispense.
The Centre for Sustainable Healthcare states that potential savings from all six proposed projects combined could amount to £95,963 annually, with a reduction of 7,032 kg CO2e. This is “the same amount as 281 mature trees absorb on average per year and 20,768 miles in an average car”.
Sustainable dentistry in North Central London
In North Central London ICS, a sustainability project in dentistry at the Eastman Dental Hospital is said to have led to a “significant reduction” in carbon emissions.
University College London Hospitals’ dentistry team identified that the longest procedures were the ones with the highest nitrous usage and so trained dentists and dental nurses on the effective delivery of nitrous oxide. By “encouraging the use of minimally invasive dentistry which does not require sedation”, they managed to reduce the carbon footprint from nitrous oxide by over 20 percent “within just a few months”.
The team is now focusing on expanding the project nationally alongside the British Society of Paediatric Dentistry, with the aim of creating practical guidance for dental practices across the UK, including hospitals with a piped supply of nitrous, as well as community and dental practice settings using individual cylinders.
Greener healthcare facilities in Buckinghamshire, Oxfordshire and Berkshire West
In Buckinghamshire, Oxfordshire and Berkshire West, a £1.8 million upgrade for Winslow Health Centre has been completed, to make the facility “greener and more environmentally friendly”.
Thanks to funding from NHS Property Services, Winslow Health Centre now includes six consulting rooms, five treatment rooms and a purpose-built dispensary.
Key features of the upgraded facility which contribute to its “greener” status include new energy-efficient rendering, special window insulation to conserve energy, and integrated air source heat pumps and solar panels.
In related news, we covered Black Country ICS’s green plan here; the ICS highlights nine key areas of focus including supplier procurement, digital transformation, travel and transport, estates and facilities, adaptation, medicines, food and nutrition, sustainable models of care, and education and training.
We also took a look at Leicester, Leicestershire and Rutland ICS’s green plan, which sets out planned actions across NHSE’s targeted areas of improvement for sustainability.