Healthcare as a service creates a huge amount of waste and greenhouse gases, from medicine production, to disposing of gloves for hygiene, to building care centres. The NHS believe they can change this. This article explores their plan and discusses the changes that need to be made.
What’s the problem?
This month, the NHS committed to becoming “carbon net zero” by 2040[i], making them the first nationwide health service to announce a net zero goal. Although “climate change” and “the NHS” are normally mentioned in different news articles about “the crisis we have reached”, the healthcare sector is a huge contributor to the carbon emissions of the UK (in 2017 alone, 27,119 kilotons of CO2 were emitted by the health and social care system[ii]) and more than this; is responsible for consumption of a volume of water similar to that of the country Estonia and around 2% of commercial and industrial waste in the UK. A huge change is needed; but, like everything; the barriers are huge. The NHS is not a normal business model; they cannot compromise on their outcomes temporarily in order to become “green” in the longer term; nor can they adopt a trial and error approach when these errors may quite literally cost lives. Although the amount of waste produced is enormous, when justifications for this are “the plastic was needed so the scalpel used to cut someone open was clean”, it becomes pretty difficult to argue. So what- give up until some genius finds a way to solve the problem? In reality this is what a lot of hospitals have ended up doing- when you know that x tons of plastic are created by y; does it really matter if you recycle that piece of paper and cycle to work? This article is about the shift in healthcare delivery that some claim is needed; and how those smaller changes that seem almost like common sense might just matter after all.
What are the big plans?
The NHS’s “net zero” plan focuses on 5 main areas where change can be rolled out on a national level, as well as discussing a broader “shift in mentality” that must occur. These areas are the physical buildings used, the travel and transport needed, the supply chain emissions, the food consumed; and the medicines used. Some of the ideas in the plan have enormously high initial investment costs; for example it would cost an estimated £492 million to replace lights to achieve 100% LED lighting (although this is expected to save over £3billion in energy during the next 30 years). On the other hand, some proposals would cost little but require a vast amount of change and pressure. The biggest example of this is the idea of reducing transport and travel (aimed to make up around 10% of the NHS’s carbon footprint) by delivering care remotely wherever possible. This is perhaps the only long term plan that has been helped by coronavirus- it has shown patients and professionals that in many cases, this is possible. Perhaps just as importantly, within the next few years we will know whether this remote care has been effective or if patient care has been compromised. This is not a trial that would easily pass an ethics review board in normal circumstances, the risk is far from zero. Other “big” changes recommended are putting pressure on
suppliers to make their supply chain more sustainable and using renewable energy- the ambitious goal that has been set is to purchase 100% renewable energy from April 2021.
What smaller changes might work?
Other changes that are recommended may seem small, until you remember the 1.5 million employees who would have to follow this. This comes under the general shift in mindset; training and teaching to ensure that “sustainability” does not become a vague idea that never becomes anyone’s responsibility. These changes and this mindset need to be everyone’s responsibility, everyone’s role. Examples of these changes include using supplies more efficiently (eg. reusing walking aids), encouraging a low carbon footprint diet or shifting to use of low carbon inhalers for asthma patients. Indeed the current asthma inhalers, containing a propellent and releasing emissions at point of use, are estimated to make up 2% of the NHS’s total emissions. There are wonderful sources of information such as the centre for sustainable healthcare here in oxford and resource sharing networks across healthcare trusts; whereby information about changes that have been implemented and worked can be shared. There are some brilliant examples of effective changes that have been made or planned. Mercury, a toxic metal was used until recently in measurements of blood pressure and temperature, which not only can damage the brain of patients, but is also very difficult to dispose of in a sustainable fashion. The Royal Melbourne hospital had an estimated reduction of 187 tons of clinical waste between 2013 and 2017, simply by installing specific recycling bins (1 at a time to maximise engagement), re-education of professionals about the different bins and ways to save energy (such as turning off lights) and replacing polystyrene cups with paper ones.[iii] In New Zealand, staff were trained about the impact of anaesthetics which are inhaled during surgery in releasing greenhouse gases.[iv] This led them to implement changes, mainly using lower impact gases where possible and this is estimated to have reduced CO2 emissions by 600 metric tons/ year (the equivalent of nearly 1.5 million miles driven).[v]
Change is possible; and the majority of healthcare workers would love to help bring it about. The NHS is on the right track- making a plan for sustainability and encouraging submissions for concrete steps that can be taken is bound to help. The incoming generations of healthcare professionals are being educated about healthcare as something that impacts the environment, but while this remains abstract it is difficult to see how effective it could be. Healthcare professionals are working harder than ever; clear direction about how they can change their practice is needed so that sustainability in their practice is not another overwhelming worry. The plan is a start; and attempts have been made to feature changes from specific hospitals in it, but it shies away from suggesting copying various healthcare centres across the world. Collaboration in research is a well-documented challenge, but perhaps the future of our planet is a topic where everyone will manage to come together?
Author; Helen Clay, Medicine, St.Annes
References
i NHS, F., 2020. For A Greener NHS » A Net Zero NHS. [online] England.nhs.uk. Available at: <https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/> [Accessed 19 October 2020].
ii Greenhospitals.net. 2020. Case Studies Waste | Global Green And Healthy Hospitals. [online] Available at: <https://www.greenhospitals.net/case-studies-waste/> [Accessed 19 October 2020].
iii Greenhospitals.net. 2020. Case Studies Waste | Global Green And Healthy Hospitals. [online] Available at: <https://www.greenhospitals.net/case-studies-waste/> [Accessed 19 October 2020], case study
iv Greenhospitals.net. 2020. Case Studies Climate Change | Global Green And Healthy Hospitals. [online] Available at: <https://www.greenhospitals.net/case-studies-climate/> [Accessed 19 October 2020].
v https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator