Climate Change & HealthCare – It’s a Global Health Emergency

Climate Change & Healthcare are closely linked. Recognising that it’s also a Global Health Emergency, the UK’s “For a Greener NHS” campaign is committed to reaching net zero in healthcare by 2040.

Like us, many people feel that the NHS is the best thing about Britain, and we cherish dearly the 6 vital Cs which are at the heart of its philosophy:

• Care
• Compassion
• Competence
• Communication
• Courage

However, in our all-consuming dedication to delivering these values, 2 other C’s have been sorely overlooked: Climate Change.

• The NHS is the most significant public sector contributor to climate change.
• It is the largest user of single-use plastics in Europe.
• NHS England spends £50 million per year on carbon permits.
• The NHS disposes of 133,000 tonnes of plastic each year.
• Only 5% of this plastic waste is recycled.

The Covid Pandemic and resulting requirement for PPE have done nothing to reduce this burden. The UK used 19 billion single use face masks, and NHS England went through 5.5 billion pairs of non-sterile gloves in a year. But even prior to that, routine care was dependent upon single-use plastics.

For example, even taking a temperature requires disposable plastic probe covers to be changed at every reading. An average hospital uses 2-3 million of these per year. The carbon footprint of 1 year of kidney dialysis is equivalent to 7 return flights between London and New York.

The following case studies illustrate some of the good work which is already being done, and will hopefully encourage others to pursue similar strategies.

One theme they share is that these measures not only reduce plastic waste and our carbon footprint, but also result in significant financial savings.

Chemotherapy drugs used to be transported via a 4-hour road and sea journey between Portsmouth and the Isle of Wight. However, thanks to ground-breaking technology, medication can now be delivered to patients by drone.

The flight takes only 30 minutes, minimising treatment delays and reducing carbon emissions. Further drone routes for pathology specimen transportation are planned, dependent upon the development of UAV flight corridors.

Further examples of low carbon transport options being used across the NHS include:

• Electric vehicles are now transporting blood samples between communities and hospitals in many NHS Trusts.
• The first EV ambulances are being used by 8 trusts in Northwest England to carry non-emergency patients.
• Electric cargo bikes have been trialled in Newcastle for deliveries between NHS sites.
• A cycle service for transporting chemotherapy in Oxford has saved 10 tonnes of carbon emissions per year and proven faster and more efficient than car or van. The Trust hopes to extend plans to e-motorbikes to deliver medication to more distant sites.
• Health Visitors in Sussex Community NHS Foundation Trust now do their home visits on e-bikes. As well as sending a positive message to their community, they have been delighted with the reduction in time spent in traffic jams and looking for parking.
• Many staff can contribute to lowering the carbon footprint of the NHS by walking, jogging, or cycling to work.

Of course, the most effective way to lower your travel carbon footprint is not to travel at all. Forced into remote consultations by the Covid Pandemic, many of us now realise that these, (much maligned by the media), strategies are often far more efficient for healthcare workers and patients.

Where used appropriately, they save time, reduce discomfort, eliminate the stress of travelling, and cost the patient less. Remote consultations save millions of car miles and thousands of tonnes of carbon dioxide per year.

Similarly, the “Scale Up BP” telemonitoring blood pressure service, launched in collaboration with NHS Lothian and the University of Edinburgh, saves thousands of GP and Practice Nurse consultations every year, as well as thousands of patient miles.

Thermometer Probe Covers
So, what can be done about the millions of thermometer probe covers that are discarded every year? Surely, they are necessary to reduce infection risk? Actually, non-contact thermometers such as TRITEMP™ are now available as sustainable alternatives which save time, waste, and money.

Unnecessary Cannulation
St Mary’s and Charing Cross Hospitals launched a “Contemplate before you cannulate” campaign after observing that 86% of A&E patients were cannulated upon attendance, but over 40% of the cannulas were not used. This message led to a 25% reduction in cannulation during attendance in the emergency department which, in real terms, translated to a reduction of 40 unnecessary cannulations per day, saving £95,000 per year.

Non-sterile Gloves
The Royal college of Nursing’s Glove Awareness Week encourages staff to safely reduce their use of non-sterile gloves in favour of good hand hygiene. Studies have shown that overuse of plastic gloves can cause complacency about hand washing, thus inadvertently increasing infection risk. Great Ormond Street set out on a mission to relay this guidance to all its staff and instil long-term practice changing habits. Over a 10-month period they reduced their consumption of non-sterile plastic gloves by 3.7 million, (21 tonnes), and in doing so, saved the Trust £90,000.

Desflurane
The anaesthetic gas, desflurane, is 2,500 times more potent as a greenhouse gas than carbon dioxide. Sevoflurane and total intravenous anaesthesia (TIVA) are lower carbon alternatives. The NHS has reduced its use of desflurane from 20% (all anaesthetic agents) in 2018 to 3% in 2022.

Nitrous Oxide
Entonox (nitrous oxide + oxygen) has been used to provide pain relief for women in labour for over 100 years. However, nitrous oxide is a powerful greenhouse gas – 300 times worse for the environment than carbon dioxide. Newcastle became the first NHS Trust to use a “Medclair” device to breakdown the exhaled analgesic (after the patient has benefitted), to harmless nitrogen and oxygen. https://www.bprmedical.com/news-and-awards/tag/%23sustainability/ Not only does this method reduce harmful emissions, but also minimises occupational exposure of midwives to a gas which is associated with reduced fertility, congenital abnormalities, and miscarriage.

Inhalers
Multi-dose inhalers (MDIs) used to use CFCs (chlorofluorocarbons) as propellants. After CFCs were banned, hydrofluoroalkane (HFA) propellants were substituted. However, it turns out that HFAs are also potent greenhouse gases. – more than 1000 x more potent than CO2.

Dry powder inhalers offer a lower carbon solution, and most patients welcome the consideration of the environmental impact of their therapy. Although many prescribers know this, realists understand that changing prescriptions during a frantically time-pressured clinic requires super-hero-like determination and resolve to save the planet. In Worcestershire, a group of GP Practices, CCG Pharmacists and Secondary Care Consultants formed a collaboration to revise asthma prescribing templates in favour of eco-friendly alternatives. They eliminated the top 2 most carbon-intensive inhalers from the formulary, and co-ordinated their actions with the IT department who were able to write “pop-ups” into electronic records, highlighting suitable alternative options to MDIs for patients over 12 years of age.

In May 2022 a team at Solihull Hospital performed the world’s first net zero carbon operation. Operating with minimum safe standards of heating and lighting, the team wore reusable gowns and scrub caps. The surgical field was surrounded by reusable sterile drapes, and intravenous anaesthesia rather than anaesthetic gas was administered to the patient.

Individually packed instruments were opened and used only as required. To further offset their carbon footprint one surgeon jogged to work, the other cycled, and they also had to plant some trees in the hospital grounds.

Plastic Recycling
The TCG – Thermal Compaction Group, based in Cardiff, is working with 7 hospital trusts across the UK to use thermal heating devices to recycle PPE. They heat face masks, gowns, and curtains to 300 degrees C, sterilising all pathogens. The melted plastic is then turned into 1m long blocks that are 99.6 polypropylene. This can then be made into products such as plastic chairs, buckets, toolboxes, and bins.

The RecoMed scheme, running in 5 trusts throughout the UK, collects single use PVC products such as oxygen face masks and tubing to reduce waste that would otherwise be incinerated or sent to landfill. Barts Health NHS Trust diverted 450 kg of used PVC devices from clinical waste in their first year of partnership with RecoMed. The equivalent of 15,000 oxygen masks were recycled and the Trust made substantial savings on clinical waste disposal costs.

Food Recycling
More than 9 million tonnes of all food produced is spoiled or wasted in the UK every year. St George’s Hospital, London, has introduced a novel recycled food waste scheme. Food that is not consumed by patients is collected and converted off-site to electricity, bio-gas, and nutrient rich fertiliser.

With the aim of becoming net zero by 2040 all new NHS hospitals will use innovative low carbon materials and aim to be built to Passivhaus standards – a globally recognised standard for energy efficiency. Solar panels, building sensors, triple glazed windows, LED lighting and heat recovery systems will contribute to lower energy consumption and cost. Facilities should ideally include electric car charging points and bike storage.

Hull University Teaching Hospitals NHS Trust has already invested seriously in green technology. A Public Sector Decarbonisation grant was used to install a field of solar panels which can generate enough electricity to meet Castle Hill Hospital’s entire daytime running needs during summer months.

In keeping with their eco-friendly vision, a flock of sheep graze the grass in the solar panel field, negating the need for mechanical cutting. The Trust are replacing gas boilers with air source heat pumps as part of the move away from fossil fuels and have also invested in cycle storage and shower facilities for staff.

In other parts of England, Milton Keynes University Hospital has replaced its old roof with solar panels and installed LED lighting.

Manchester University NHS Foundation Trust has provided over 200 additional cycle parking spaces, two cycle hubs for staff (including storage lockers and showers), an extra 11 EV charging points, monthly cycle maintenance sessions, and monthly cyclist breakfasts to boost morale.

Having identified that 206,440 pieces of single-use plastic were being used annually in their canteen, The Yorkshire Ambulance Service committed to make some meaningful changes. By substituting the items on the left side of the table with eco-friendly alternatives, they managed to save 200,000 pieces of plastic, (4 tonnes per year), from the waste stream. In doing so, they also saved £5000.

These NHS Trusts are shining examples to others, demonstrating that much can be done with co-ordinated effort to realise the vision of a sustainable future and net zero NHS. I am certain there will be even more hopeful eco-friendly NHS initiatives to write about very soon.

It will take action on a global scale to combat climate change, but we can each play our part.

At IYASU we care about the environment too. That’s why our bags are made from vegan and recycled materials.