Giving it 10%BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5448 (Published 06 October 2010) Cite this as: BMJ 2010;341:c5448
All rapid responses
The 10:10 campaign highlighted by Nigel Hawkes has succeeded in
translating individual carbon emission reductions into a powerful message
for communities and governments alike, and has seen a significant
commitment from the healthcare sector (1). The medical profession has a
duty of care to lead by example and address sustainability; not only do
low carbon lifestyles improve health, but 25% of all UK public sector
emissions are generated by the NHS, contributing to climate change and its
attendant public health problems (2).
Going beyond the first 10% will put carbon reduction well into the
domain of clinical care - something we believe can be to the benefit of
high quality service provision. Government and NHS carbon reduction
targets (of 34% by 2020, and 80% by 2050, from 1990 baseline levels) will
be challenging to meet and will require re-shaping service delivery (3).
The current financial climate, together with carbon tax and trading
proposals, will also favour efficiency improvements if we are to avoid
reducing quality of care (4). Founded on principles of disease prevention,
patient partnership and lean service design, sustainable healthcare offers
a vehicle to align carbon reduction with quality improvement and cost
Nephrology is the first specialty to commit to providing lower carbon
care via its "green nephrology" programme. The 10:10 philosophy has been
echoed in a renal 10:10 checklist aimed at improving staff awareness, but
it also seeks to transform clinical systems. Coordinated by the Campaign
for Greener Healthcare and supported by influential partner organisations,
79% of renal units now have local representatives. Case studies in
telemedicine, waste management systems and recycling heat and water from
dialysis machines have been developed together with more generic "how to"
guides (http://greenerhealthcare.org/nephrology-resources). The carbon
footprinting of a renal service has allowed comparative analysis with the
NHS as a whole and prioritisation of the key areas for carbon reduction
Patient engagement (as well as patient-centred care) is at the heart
of sustainable healthcare. Young dialysis patients at Great Ormond Street
Hospital were among the supporters of 10:10:10 last week, when they worked
with artist Darcy Turner to create a life-size polar bear from dialysis
packaging as a challenge to medical equipment manufacturers to reduce
By combining sustainable healthcare policies with grass roots
initiatives, the rapid behaviour change needed to reduce healthcare sector
emissions in line with government targets is more likely to be achieved in
time to reduce the deleterious effects of climate change on health.
Tara Collidge, specialist registrar in renal medicine.
Andrew Connor, specialist registrar in renal medicine.
Frances Mortimer, medical director for the Campaign For Greener
Donal O'Donoghue, consultant in renal medicine and National Clinical
Director for Kidney Care, Department of Health.
David Pencheon, Director, NHS Sustainable Development Unit
1. Hawkes N. Giving it 10%. BMJ.341:c5448.
2. Costello A, Abbas M, Allen A, Ball S, Bell S, Bellamy R, et al.
Managing the health effects of climate change: Lancet and University
College London Institute for Global Health Commission. Lancet. 2009 May
3. NHS Carbon Reduction Strategy For England. 2009.
4. Brown S, Ward S. Carbon reduction in the NHS: a role for finance. 2009.
5. Mortimer F. The Sustainable Physician. Clinical Medicine 2010, Vol 10,
No 2: 110-11
6. Connor A, Lillywhite R, Cooke M. The carbon footprint of a renal
service in the United Kingdom. Quarterly Journal of Medicine. Aug 18,
2010. [epub ahead of print].
7. Hospital polar bear highlights need for environmental change.
Press release, Great Ormond Street Hospital NHS Trust. Date: 8.10.2010.
Available from: http://www.gosh.nhs.uk/pressoffice/pressrelease_00867
Competing interests: TC is the Green Nephrology Fellow for 2010-11. AC was the Green Nephrology Fellow for 2009-10 and member of the Campaign for Greener Healthcare. FM is the medical director of the Campaign for Greener Healthcare, which organises the UK healthcare arm of the 10:10 campaign and the green nephrology programme.