What is sustainable healthcare?   

Sustainable healthcare is healthcare that can continue within the resource envelope into the future. 

That means looking after the planet that we're on, but also the people that are on the planet with us.   

People being healthy enough and having a good environment.  We quite often talk about the triple bottom line, with health outcomes on the top as the output, and the inputs, in terms of resources, are not just money but they are environmental and social as well. 

In short, we mean people, planet, profit or social environment and financial.  

The culture around what we do and how we behave is really central to that resource use, but it's also central to us being healthy and continuing into the future. 

What areas in healthcare have the biggest carbon footprint and where do we need to make the most changes from a sustainability perspective? 

We have the principles of sustainable healthcare and they start with prevention.  Then they talk about patient centred care, lean pathways, and then low carbon interventions.  

Suppliers might be more interested in the low carbon interventions but also in the lean pathway. If you're trying to reduce the size of a syringe or change from one kind of glass syringe to a thinner plastic or glass one, you can measure that change quite easily.  That will have impacts right through from primary care to secondary, all through the pathway because you're using those syringes in lots of different places.  Manufacturers of things in the health system, whether they're drugs or equipment, alongside the laundry, the PPE, the masks - makes up a huge percentage of the health system's carbon footprint. 

The carbon footprint of the buildings is roughly around 15/ 20% of the overall total, with another 15/ 20% in travel and so the rest of it is in procurement. 

That is in the supply chain. The pharmaceuticals are a huge part, along with the medical equipment and the devices - whether they're single use or reusable, of the carbon footprint. You can't just change the building and expect to go to net zero. You can't just put really good recycling bins in because that waste is only 1% or 2% of the whole carbon footprint.  So it's really important to get the healthcare professionals on board and to some extent the patients.  

How do you do that?  

15 years ago, people didn't really think about carbon. They didn't understand sustainability.  We had this idea of connecting people to the environment with a very simple symbol of a tree. And we wanted to plant one tree for everybody in the NHS, everybody working in the NHS as a symbolic connection. 

We have run the NHS forest programme for quite a long time now and that's one part of what we do, but it's a small part, and our work on green space and health has grown out of that, which is more complicated than just planting trees. 

We have a strapline, which is inspire, empower, and transform. We want to transform the whole of the system. We need to inspire people. And that comes in different ways. It can be telling positive stories, giving solutions. 

Our programmes have grown into engagement programmes. And that sense of empowering people within the system to make a change.  We realised early on that we were never going be big enough or have enough power to do all the things ourselves. It's a lot about working alongside people within the system to support them, to make changes, to educate them, to understand the benefits of this for patients and for health outcomes.  

So the benefits of sustainability alongside working with people in procurement and estates and so on to, to help them to make the changes with which they were tasked.  

What kind of programmes do you run and what kind of outcomes have you seen?  

We run sustainable speciality programmes.   

Within medicine, the natural communities of practice are the specialties; eye care, kidney care, cardiology. Knowing they were the way that change happened already, the culture within the NHS is that change happens within that community of practice, so we've done a lot to work with those specialties.   

For example, we started in kidney care. We started a network, we sent out a survey, we worked with the Royal College of Physicians at that time. We invited a really broad round table of people, including people from industry, patients, healthcare professionals themselves, technicians, sustainability experts and researchers to really understand what the footprint of that specialty is.   

What is it made up of? Where are the hot spots? Where can we make changes? How does change normally happen in that area? Then we got somebody specifically to work with that community on understanding those changes, researching and begin to work with them on the changes that could be made. 

The you move into conferences, seminars and disseminating the understanding and information, getting a broader input from a wider range of people and really starting a movement. 

Within a year, we had 85%/90% of kidney units in the country signed up to the sustainability network, which can then generate questions and answers and start understanding some of the solutions as well.   

What kind of solutions have they implemented? 

An example would be someone seconded in from kidney care to work with us for two years.  Not only did he calculate the carbon footprint of home dialysis versus dialysis in hospital (because that was a question at the time) but he worked directly with industry. 

He went to their factory and worked with them to try and reduce the size of the bottle that the saline liquid is delivered in because they found that it was too big and that they were throwing lots away and it was a waste. So from quite complex things about machinery and pathways to quite simple changes that could be made, which people on the ground were seeing but didn't know what to do with that information. 

What training do you offer to leaders in the NHS? 

We offer board level training on sustainability and that includes social and environmental.  This receives a huge amount of enthusiasm and buy in. They are tasked with a bit of pre reading and some of them do loads more.  They come along really fired up and everybody is on board.  

That is needed at the top to support things because there's a huge amount of upswell from the ground of people who are fed up with seeing a lot of waste and know how strapped the NHS is and want to do more for the communities around them and be a positive source of change. 

This whole idea of the NHS as an anchor institution, modelling good behaviour, but also being a hub in their community, because they are very visible. Hospitals especially as lots of people work there.   

We run courses, not just for senior leaders. We get them on board, then provide education for as many people as possible within the workforce. We have about 20 courses, running from an introduction to carbon modelling, to getting sustainability into quality improvement.  We also run specialist course such as mental health and child health and so on, so that people from those specialties again can come and talk to groups of people in their own specialty. 

How can you be contacted? 

Via our website: www.sustainablehealthcare.org.uk  

Check out our resources: www.sustainablehealthcare.org.uk https://networks.sustainablehealthcare.org.uk/resources

We're also on social media. I can be emailed direct at rachel@sustainablehealthcare.org.uk  

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