Sustainable Healthcare – an impossible challenge?

Sustainability is a huge topic, and is going to be in the headlines more and more as this century progresses.

There are many facets to the subject, and some are controversial. However, manmade global warming is pretty much accepted as happening by the scientific community, and government policies are being formulated with climate change mitigation and adaptation in mind. Indeed there is even a bit of a land and water grab going on around the world as economies start to realise the growing importance of food and water security.

And what does all this mean for health? And in particular health in the uk?

I was at a meeting this week which was looking at how the NHS in London could plan for the future and how it could build on the good work that has already been done in the capital.

I was asked to give my perspective on how clinicians view climate change, and what impact it has on their day to day practice. Well, for out I think that consideration of the impact of clinical activity on the carbon footprint of a Trust is a non-thought. There are relatively few doctors who have thought about how clinical activity translates into carbon emissions.

There are some, and their numbers are growing… The green nephrology network has done great work to raise awareness of the environmental impact of treatment, especially dialysis and has success stories of how units have made carbon, water and financial savings through innovation in clinical practice.

So why don’t all clinicians take note? I think that we are often too busy in clinical practice to take notice of the wider impacts of the work we do, but in an era where a new model of professionalism which takes into account the value of the treatments we are offering has been proposed, clinicians need to become more aware of the implications of the choices of treatment they make with patients when confronting a disease.

In London, resources have been made available to physicians working with smokers with respiratory disease which highlight the value of different interventions – an approach which will become more common as resources become ever more scarce.

In contrast to this slow uptake of so-called ‘green’ behaviour at work, most people now recycle at least part of their household waste, increasing numbers are seeing the sense in ensuring their homes are well insulated, and with smart meters in the home, energy consumption and preservation is part of the conversation of life outside of work.

What is the disconnect then? Why do people shift from one mindset to another when going to work. There are a wide range of reasons, and each person will have their own.

Moral offset could be a major one – that is, “I work for the NHS, often put in overtime, am constantly caring and giving of myself – climate change and being green is just one step too far”

Another is as I mentioned before, the wider implications of the models of care we use are often not examined, and time at work does not often allow for such theorising.

It is also that sustainability might just be too big a thing for any one team or individual to concentrate on. However, when you list the things that make up a number of quality improvement projects and schemes…

Avoiding hospital admissions for chronic diseases through self management
Reducing hospital stays by using more local and regional anaesthetic techniques
Improving exercise tolerance through community based physio courses
Reducing expenditure on waste in hospital theatres
Reducing outpatient appointments through better use of technology
Improving long term condition management through telemedicine
Improving the prescribing of oxygen, both long term and for inpatients
Saving money through better sourcing of hospital food

…then it is possible to see that a great many of these have direct links to the sustainability movement, and yet all of the above are not seen as dubious on grounds of being a ‘fad’ or ‘green’. Instead they mark innovations in clinical care which are often welcomed by clinician and patient alike.

So what is my take home message from the day? Well, strangely, it is that aiming for a greener future may not be the best way to engage NHS workers in the sustainability agenda. Instead, let’s get better at the day job, but bring in some other factors to the thinking… When a service is being redesigned, or a pathway being developed, use the best evidence to inform the process, but we must start to become better stewards of the limited resources of the health service.

Of course it is right that there is an overall strategy towards sustainable working in the NHS, but on a local, team and service level, we might need to aim for a slightly different outcome to make these targets tangible and relevant. We need to start to think more about value ( Outcome / £ spent ) and include some thinking about the wider cost implications of our service designs. Through concentrating on the efficient use of resources, we will be able to not only make care better for patients, but also save money, and reduce our impact on the world around us.

If you are interested in this subject area, please take a look at these resources, in the next few years they will become more and more important

If you are a respiratory clinician then take a look at this advert, a fantastic opportunity to explore this area in more detail with some fantastic people.


2 thoughts on “Sustainable Healthcare – an impossible challenge?

  1. Hi Toby,
    lots of good thoughts in this piece, thank you.
    For me it is all summed up under the banner of ‘motivation’.

    If the organisation is motivated to carry out its core function with a view to continuous improvement, then in many areas social and environmental sustainability benefits will naturally accrue. In those instances where they don’t, good internal governance or policy direction from above may be required to achieve the wider sustainability objectives. This is the part which remains weak.

    If the individual patients, visitors and staff are motivated to behave in a way which impacts positively on health, as well as the connected social and natural environments, then positive outcomes and innovations are likely to follow. As you point out, this could include things like the avoidance of travel or waste. One thing is clear though, the term ‘sustainability’ feels rather incongruous in this context and ‘value’, as you suggest, much more helpful – at least in the near-term. The narrative also needs to be more clearly about health – the core business. In fact it is by framing sustainability through the lens of health that many environmental practitioners are able to build conversations about sustainability.

    Best wishes,

  2. Thanks Matt, sorry I haven’t got back sooner.

    I think the killer point is that health is the core business of the NHS, and sustainability objectives very often align closely with the public health and prevention agendas within healthcare. There are many win-wins which we need to highlight and prioritise.

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