Feature: exploring the future of sustainability within the NHS

Sustainability has been a major talking point in many organisations and across many industries for a long time now, and healthcare is no different – but what is happening to turn that talk into action?

In 2017, the NHS published its Sustainable Development Management Plan for NHS England 2018 – 2020. The plan outlined the NHS commitments and ambitions to meet the diverse needs of people in its existing and future communities, promoting personal wellbeing, social cohesion and inclusion, and creating equal opportunity whilst contributing to the UK’s national and global sustainable efforts.

The NHS was thrust into unprecedented change in March 2020. The pandemic brought with it a host of changes and challenges, forcing swift re-prioritisation not only of resources but also of future plans and ambitions. Despite the strain caused by the pandemic, in October 2020 the NHS became the world’s first health service to commit to reaching carbon net zero, and in October 2021 reported that they had “reduced emissions equivalent to powering 1.1 million homes annually.”

Although the COVID-19 pandemic is ongoing, many trusts are releasing Green Plans to demonstrate their commitment to sustainability.

In the new Green Plan from Barnsley Hospital, the trust notes that “climate change is now considered the greatest environmental threat to global health of the 21st century.” The trust shares their plans to reduce their environmental impact, including continuing to offer alternative working arrangements for staff and investing in appropriate technology for the ongoing provision of virtual appointments.

University Hospitals of Morecambe Bay NHS Foundation Trust has used their Green Plan to outline their aim of achieving an 80% reduction in CO2 emissions by 2028, with targets such as increasing renewable energy purchases until all electricity is provided by non-fossil fuels, and eliminating the use of volatile anaesthetic gas Desflurane.

Camden and Islington NHS Foundation Trust intend to replace their older, inefficient buildings with newer facilities to help them meet and exceed energy efficiency and insulation targets, with their new hospital set to achieve a rating of ‘excellent’ from a sustainability assessment method that sets standards for environmental performance of buildings through design, construction and operation.

East Lancashire NHS Foundation Trust discuss their focus on digital transformation: “Through the ‘eLancs’ Programme the trust is investing in full electronic patient records and digital systems to enhance patient care, improve efficiency and remove waste from the system,” the plan states. “Cloud-based computing, electronic capture of observations and the removal of paper from the trust has significant green benefits.”

To explore approaches to sustainability in more detail, and how the COVID-19 pandemic has impacted those approaches, LH spoke to two NHS organisations: Wirral University Teaching Hospitals (WUTH) and Yorkshire & Humber AHSN (YHAHSN), one of 15 AHSNs set up by NHS England to operate as the key innovation arm of the NHS, and the national lead on environmental sustainability on behalf of the AHSN network.

To begin, what does sustainability mean to these organisations?

“Continuing to prioritise and provide healthcare to our patients without it being at the expense of a healthy environment,” said Janelle Holmes, Chief Executive Officer of Wirral University Teaching Hospitals. “The link between climate change and health is clear, therefore in order to provide the best care that we can to our patients, we also have to protect our environment. This means adapting to the changes that are already happening in addition to reducing our environment impact. We need to consider our contribution to air pollution, waste, energy use and also our scope three emissions from our supply chain.”

Speaking for Yorkshire & Humber AHSN, Deputy CEO Kathy Scott said that prioritising sustainability means “supporting innovators to understand the environmental impact of their innovations and reducing it through the implementation of national adoption and spread programmes, to learning and sharing best practice across the NHS. It’s about supporting the NHS to find ways to change practices, processes and existing services in order for innovations with huge potential to have a positive environmental impact to be introduced into the system quicker.”

Here’s what Janelle and Kathy had to say about WUTH and YHAHSN’s approach.

What are your priorities when it comes to sustainability?

Janelle: Our priorities for 2022/23 are to look at energy reduction, aligning to capital investment, optimising resource and performance, enhancing our food offerings to improve patient experience and nutrition, which will support the reduction in food waste and packaging. We’ll be enhancing our retail offer to ensure that we follow market trends and reducing the environmental impact of the goods we offer in our shops. The trust is also supporting clinical groups with their sustainability ambitions.

Wirral has two main sites, which both provide opportunities to enhance green space which we are looking to develop for the health and wellbeing of our staff and patients. Arrowe Park Hospital is also located next to a large public country park on the Wirral where the local council is creating a memorial wood to commemorate those who have died from COVID-19 across the borough.

Kathy: Our priorities are to find ways of consistently and comparably identifying the environmental impact of innovation so we can select the ones that will make the most difference and give the best outcomes. Within the health sector, we need to be able to bring people together around this incredibly important agenda and make things happen by sharing and collaborating as well as growing the capability for doing things differently in the NHS. This isn’t down to just one organisation; it needs to be and should be a joint effort across all sectors as that is when you will see real impact and real benefits.

How has the COVID-19 pandemic impacted sustainability or your future plans for sustainability?

Janelle: The pandemic has been and still is a top priority for all healthcare organisations, therefore understandably a lot of things have been put on hold over the last couple of years. However, the issue of climate change isn’t going anywhere, and the changes are already happening so it’s important that we continue to drive forward with the sustainability agenda whilst maintaining our core business of caring for our patients. One way that the pandemic has definitely impacted us and the majority of workplaces in terms of sustainability would be the introduction of working from home, which reduces the amount of people commuting to work and therefore reductions in travel emissions and air pollution. This wouldn’t have happened at the scale and speed that it did otherwise.

The pandemic made us embrace different ways of working and adapting, and sharpened our focus on wellbeing, supporting each other- and brought a greater emphasis on the link between the environment and health, especially outdoor space.  We secured sponsorship to improve landscaping and garden areas at Arrowe Park Hospital, providing outdoor areas where staff could relax and be safe.

Kathy: If the pandemic hadn’t happened then sustainability would have been the number one issue for the NHS, but it has happened. While we’ve seen a reduction in travel and so on, we’ve also seen a huge increase in single use plastics going to landfill (PPE, facemasks, lateral flow tests). Work has been done that shows that more than 8 million tonnes of pandemic associated plastic waste was generated globally – that’s just pandemic related plastics and most of that is medical waste generated by hospitals. Globally, it’s estimated that 1.4 billion single-use facemasks/face shields are discarded daily because of the COVID-19 pandemic.  In the UK, there are suggestions that we are discarding 45 million facemasks every day – the equivalent of over 5 million tonnes of plastic waste generated since the start of COVID-19. 

But we’ve also seen a change in the way that the NHS has been doing things – there was much more appetite to try something new and to do it quickly in the pandemic. One example of this is the work several AHSNs have done in collaboration with the Department for Health and Social Care around introducing reusable and recyclable PPE.  The work is really encouraging.  Staff like it, it is kinder to the environment and it’s more cost effective, even with manufacturing and laundering costs.

Another example is digital technology. Digital technologies in healthcare include ways of conducting virtual consultations as part of remote monitoring solutions for long-term health conditions.  As an AHSN, we’ve seen the development and introduction of new apps to monitor conditions remotely as well as bringing together data in repositories for access by NHS staff.  These tools often keep people from attending a clinical setting therefore reducing the amount of carbon generated from travel or from other consumables.  One of our main tasks as an AHSN is to try and maintain that cultural shift by identifying evidenced innovations that supports environmental sustainability and can be spread and adopted at pace and scale.  This is with the proviso that firstly there is an environmental cost to developing and implementing digital tools which we need to take account of and minimise – (we are already working with innovators to do that). Secondly, the NHS is rightly concerned with patient safety, efficacy and effectiveness and all these factors need to be considered to achieve sustainable healthcare.

Can you tell us about a key challenge you’ve faced with regards to sustainability, and how you’ve tackled that?

Janelle: Our buildings and infrastructure are 40-years old this year, so we are definitely due for an update. We have successfully bid for £28m of NHS capital under the Future Hospitals programme and we are about to embark on an upgrade of our Accident and Emergency Department and Urgent Care facilities, which is a major investment in state-of-the-art facilities and the biggest in the hospital’s 40-year history, reflecting the need to modernise our infrastructure and design facilities for living with COVID-19. 

We have a unique opportunity to build a hospital facility that is greener by design, has social value at its core and one where the finishes have been selected to reflect the naturally occurring geological and environmental features of the Wirral, like sandstone. We are also using modern sustainable building techniques for our £10.6m new build operating theatres at our Clatterbridge site, where modular construction will see the units constructed offsite for swift onsite assembly and connection to services, reducing construction site traffic. Our new build plans also offer the opportunity to develop our on-site road infrastructure and to provide electric vehicle charging points for patients and staff.

Kathy: The way the NHS operates is a big challenge. It’s multi-faceted. The first facet is around the culture; the NHS is often rightly risk averse – patients should never be harmed by the delivery of healthcare. However, we are risk averse for areas that have nothing to do with patient safety and this could usefully change. Linking in to this, many ways of working have been in place for a long time and for good reason. But this can often mean that change is very difficult to initiate.

Additionally, we aren’t yet used to asking about outcomes other than when it relates to patients or finances for example. We need to start including ‘environmental impact’ into how we measure successful outcomes – and we are beginning to do that which is hugely encouraging.

We’ve seen this very recently here in Yorkshire and the Humber thanks to our work with Astra Zeneca and Hull Primary Care Networks. This particular project is helping asthma patients to reduce their reliance on blue ‘reliever’ inhalers. It also allows clinicians to swap patients onto a more environmentally-friendly inhaler (where clinically appropriate), reducing the huge carbon footprint they contribute to. Data from the first three Primary Care Networks involved in the programme has shown a reduction in blue inhaler prescribing by nearly 9000 units since starting the programme, equating to an offset of nearly 250,000 kg eCO2 emissions (equivalent to more than three hundred transatlantic flights). This number continues to rise and we are seeing interest in this area from other parts of the country too. So, while the challenge is big so is the appetite for change. 

Any other comments – any key takeaways you want LH readers to leave with?

Janelle: Owing to the focus on the natural environment for wellbeing, and the evidence of the climate emergency and its impact on our local environment as a coastal peninsula, our staff are ready and willing to embrace sustainability initiatives. We are excited to see what the future holds and we know our staff will support our Green Plan and the chance to play their part in a more sustainable future.

Kathy: It’s very easy to see issues around sustainability as an insurmountable problem, however it can be solved if we collaborate – collaboration is vital if we are going to succeed and make a real and long-term impact. I often wonder how our lives would look if we lived as though this was THE most important issue.  What would we do differently?

Many thanks to Janelle and Kathy for sharing their thoughts with us; you can read Wirral University Teaching Hospital’s Green Plan here and keep up with Yorkshire & Humber AHSN here.