A sustainable NHS needs innovation that is driven by data and without boundariesBMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1902 (Published 29 July 2022) Cite this as: BMJ 2022;378:o1902
- Dominique Allwood, chief medical officer, UCLPartners
- Twitter @DrDominiqueAllw
As we have experienced recently, climate change is not a future problem, it is happening now. It is affecting all our lives, but particularly people from the most vulnerable populations. The effects of climate change, such as air pollution and extreme temperatures, harm our physical and mental health. Every year, air pollution contributes to around 36 000 excess deaths in the UK alone.1
Our NHS feels the strain of these health implications, yet it is also a key contributor to them, responsible for 4-5% of England’s carbon emissions.2 Actions taken to mitigate climate change do not only help the planet, they also help to strengthen the NHS by protecting our nation’s health and reducing demand on services.
There is substantial support across the NHS for greener healthcare.3 Trusts and integrated care systems have their own green plans in place and some great progress has been made, with the NHS in England becoming the first health system in the world to embed its target of net zero emissions into legislation.4 However, despite the “why” being widely accepted and the “what” being mapped out in our plans, the question of “how” to achieve impact at scale and pace is still eluding us, especially in areas where the NHS has less direct control. Shifting focus to the three Is of sustainability—innovation, implementation, and impact—is crucial if the NHS is going to increase momentum and achieve net zero.
We need to get better at assessing, adopting, and repurposing innovations and technologies, working together to influence external supply chains and overcoming our professional boundaries to make the most of expertise across industry, academia, and healthcare. We must improve our use of data that drive improvement, ensuring we focus on the initiatives that will result in the biggest impact. And we should also get to a place where carbon metrics are routinely considered alongside other established measures of performance. We should be mindful that our efforts do not widen inequalities—for example, staff often report that workplace active travel schemes tend to have higher uptake in consultants compared with lower paid staff, who may struggle with any required financial investment, such as purchasing a bike.
Harnessing innovation, including technology, and empowering frontline staff to implement change offer us the best hope of achieving a greener NHS. But the innovation challenge confronting us is threefold: firstly, how do we best support industry and academic partners to develop and test new innovations; secondly, how can we quickly identify existing technologies that would benefit our NHS and adapt them accordingly; and lastly what is the most effective way to scale up existing successful innovations so that they have more widespread impact?
The innovations do not need to be radical or demand considerable investment. In some cases they do not even need to be new. In fact, according to the International Energy Agency, most of our sustainability improvements over the next decade will be achieved through adopting technologies available today.5
An example where we could repurpose and adapt existing innovations for the NHS can be found in airports, for example, Heathrow has recently been refurbished in some areas to use passive Bluetooth sensors. These monitor passenger occupancy in a space and adjust the heating accordingly. This has resulted in a reduction of energy consumption and improvement in indoor air quality.6 This could work in the NHS where large parts of estate are periodically unoccupied, such as outpatient clinics.
We also have examples of innovations that have been taken up by a small number of NHS sites, but not yet reached their full potential by being rolled out across the entire healthcare system. Consider nitrous oxide, which is used widely across the NHS (predominantly in maternity settings) and makes up 2% of our healthcare system’s pollutant emissions.7 We have a national ambition to reduce nitrous oxide emissions by 75%, and Newcastle’s Royal Infirmary has been working towards this with an industry partner.8 They have been using an innovative solution that collects residual nitrous oxide from exhaled air and subsequently destroys the gas.
Other hospitals, such as Imperial College Healthcare NHS Trust, are piloting innovations such as capture technology, which collects and cleans volatile gases to reduce emissions from surgery.9 This has additional “circular economy” benefits as it can potentially reuse the volatile anaesthetic agents in future.
Our NHS will inevitably have a carbon footprint, but more needs to be done to reduce it. By doing this and doing it well we can help to tackle the climate emergency, and strengthen our ambitions to prevent illness and reduce inequalities.
Carbon must become “currency” in healthcare decision making, on par with considerations of cost and clinical care outcomes. It cannot be an afterthought. To put it simply, sustainability must become sustainable. How we embed green thinking into all that we do is critical. Data can help us to ensure we are intentionally focusing on the most vulnerable when we are looking at costs and impact, but to make any of this work, we need effective and compelling senior leadership. Only then can we facilitate, coordinate, empower, and connect staff in ways that allow us to scale up what works.
Organisations working at the interface of the NHS, academia, and industry, such as UCLPartners, the AHSN Network, and Sustainable Healthcare Coalition, are well placed to support the NHS to become a sustainable leader. Indeed, the UCLPartners Climate Collaborative10 aims to complement and accelerate local and regional work to deliver the NHS Green Plan.11
There has never been a more critical time to tap into academic and industry expertise to accelerate the NHS’s efforts to reach net zero. We must facilitate inclusive working, source innovative ideas, and draw on industry insights and expertise from across professional bodies to drive real world change.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: none.
Provenance and peer review: Not commissioned, not peer reviewed.