The Palliative Care Sustainability Network ran a pilot scheme where teams worked through the GPCA framework towards either Bronze, Silver or Gold award. 

Applicants were supported to work towards achievable standards, set out for each level, and were supported with resources and examples linking the teams with national work by bodies such as Greener NHS and the Centre for Sustainable Healthcare. 

Teams worked on key organisational changes, such as developing and delivering on Green Plans, together with actions that all staff (and volunteers) could work on. From cutting carbon emissions and reducing waste, to adopting sustainable procurement practices and promoting greener travel, the awardees demonstrated that quality care and environmental responsibility go hand in hand.

If you are interested in reducing your own team’s environmental impact, want to meet the Care Quality Commission's (CQC) standard on environmental sustainability, or you just want to improve team working and job satisfaction in your workforce, why not get started on the Bronze GPCA? Open to all palliative care organisations free of charge, the Bronze award focuses on getting together, education, raising awareness and identifying the first areas to tackle in improving environmental sustainability.

Sign up to our Palliative Care Sustainability Network page or email pallcaresusnet@gmail.com and join the growing movement of climate conscious healthcare workers!

More information can be found here: https://apmonline.org/greener-palliative-care-award/

The Award team have been working with the support of the following organisations: The Centre for Sustainable Healthcare, Hospice UK, Sue Ryder, UK Health Alliance on Climate Change and the Association of Palliative Care Medicine.

The Centre for Sustainable Healthcare supported the Bladder, Bowel and Pelvic Health community team in Lewisham by undertaking a sustainable quality improvement project: a ‘Trial without catheter (TWOC) using a structured approach’. The team (consisting of the clinical lead, catheter lead nurse and a graduate management trainee) worked with the district nursing teams and urgent care service as part of the Green Nursing Challenge to improve care for patients, whilst saving money and carbon emissions.

The challenge

Indwelling urinary catheters are among the most used invasive medical devices in the UK, and an estimated 90,000 people in community settings require long-term catheter use. Evidence suggests that the longer a catheter remains in place, the higher the risk of infection, and around 2,100 deaths per year are directly attributed to catheter-related infections. The financial burden of catheter-associated urinary tract infections (CaUTIs) is approximately £2,000 per episode and the total annual cost of Foley catheter use estimated between £1 billion and £2.5 billion.

A TWOC is conducted when a catheter, which is a tube inserted into the bladder to drain urine, is removed to determine if the patient can urinate normally without it. This procedure is essential for evaluating bladder function and ensuring that the patient can manage without ongoing catheterisation

The team found that there was a lack of knowledge around standardised TWOC protocol, and a lack of clear evidence on how to manage the process. They identified problems with repeated catheter use, unnecessary district nurse visits, ambulance callouts and avoidable hospital stays. These inefficiencies not only compromise patient care, comfort and quality of life, but also generate considerable plastic waste from catheters, gloves, aprons and maintenance solutions.

Removing catheters as soon as possible has many advantages, but it is vital that removals are planned and effective to prevent adverse events, unnecessary emergency call outs or attendances to the emergency department. Avoiding the cycle of failed TWOC and repeated catheter insertion is key.

The Green Nursing Challenge helped the team in the successful implementation and evaluation of a project to develop a structured TWOC process, and measure the impact from a social, financial and environmental perspective. They implemented a classification system for TWOC suitability, together with corresponding TWOC strategies.  The project saw the team training staff and evaluating their results across the community of Lewisham and the wider Trust.

Results

Monthly figures were collected before and after the project and showed clear improvements in the following: 

Reductions in:

• Catheter-related ambulance call outs by 25%, suggesting more timely community interventions. 
• Catheter-related hospital stays (bed days) by 32%.
• Catheter-related hospital admissions by 12.5%, indicating fewer acute deterioration events. 

No catheter associated urinary tract infections were reported.

Environmental sustainability 

• The projected annual saving is 42,156.40 CO2e, equivalent to driving 124,026 miles in an average car.

Economic sustainability

• On average, the initiative contributed to projected net annual savings of £441,708.

Social sustainability

• The reduction in bed days meant that patients spent less time in hospital and more time at home which linked to improved emotional wellbeing.
• Reduction in staff pressures due to TWOC attempts and urgent visits for catheter-related complications.
• Increased staff confidence in catheter management contributing to a working environment that was less reactive and more focused on delivering high quality, consistent care.
• Improved integration, communication and patient pathways helped to ensure accurate referrals, faster and more effective communication.

Next steps

The team are continuing to develop their project hoping to see further improvements in emergency attendance, hospital stays, CaUTI rates, use of catheter materials and speed of catheter removals. They hope developing more comprehensive guidelines will lead to faster assessment and TWOC, or referral elsewhere, with the net result being a significant reduction in catheter usage overall.

For more information please see Green Nursing Challenge Trial without catheter - a structured approach.

Do you have a project you would like to share on the hub? We'd love to hear from you. Please email contact@pslhub.org.

Social due diligence helps pharmaceutical companies identify, assess and manage social risks related to people, communities and ethical practices. It ensures that business operations respect human rights, employee welfare, patient safety and community well-being.

Understanding social due diligence

Social due diligence is a structured process used to evaluate how a company’s activities affect people. It focuses on social risks such as unsafe working conditions, unfair labour practices, community health impacts, and ethical issues in clinical trials and supply chains.

In the pharmaceutical industry, where trust is critical, social due diligence is essential to maintain transparency, compliance and long-term sustainability.

Why social due diligence is critical in the pharmaceutical industry

1. Protecting human rights and worker safety

Pharmaceutical manufacturing involves chemical handling, laboratory work and high-risk processes. Social due diligence ensures:

• Safe working conditions.
• Fair wages and working hours.
• Protection from workplace hazards.

This helps prevent accidents and promotes employee well-being.

2. Ethical clinical trials and ersearch

Clinical trials involve human participants. Social due diligence ensures:

• Informed consent is properly taken.
• Participants are treated ethically.
• Vulnerable groups are protected.

Ethical research practices build public trust and meet international standards.

3. Responsible supply chain management

Pharmaceutical companies rely on global suppliers for raw materials and active ingredients. Social due diligence helps identify risks such as:

• Child or forced labour.
• Poor working conditions.
• Human rights violations.

Monitoring suppliers ensures ethical sourcing and compliance.

4. Community health and social impact

Manufacturing plants and research facilities affect nearby communities. Social due diligence evaluates:

• Community health risks.
• Access to healthcare.
• Social disruptions caused by operations.

This helps companies reduce negative impacts and support local development.

Key elements of social due diligence in pharmaceutical companies

Employee welfare assessment

This includes reviewing labour policies, safety standards, training programmes and grievance mechanisms to ensure employees are treated fairly and respectfully.

Stakeholder engagement

Engaging with employees, patients, regulators and local communities helps identify concerns early and improves decision-making.

Risk identification and mitigation

Social risks can be identified through audits, assessments and surveys. Companies can then create action plans to reduce or eliminate these risks.

Compliance with regulations and standards

Social due diligence ensures compliance with:

• National labour laws.
• International human rights standards.
• Industry-specific guidelines.

Benefits of social due diligence for pharmaceutical companies

• Builds trust with patients and regulators.
• Reduces legal and reputational risks.
• Improves employee morale and productivity.
• Supports sustainable and ethical growth.
• Enhances brand credibility in global markets.

Companies that invest in social due diligence are better prepared to face regulatory challenges and social expectations.

Conclusion

Social due diligence in the pharmaceutical industry is not just a regulatory requirement—it is a moral responsibility. By focusing on people, ethics and transparency, pharmaceutical companies can ensure safe operations, protect human rights and contribute positively to society.

In an industry where human lives are at stake, responsible practices create long-term value and sustainable success. Social due diligence helps pharmaceutical companies move forward with integrity, accountability and trust.

Winning team

Winner: Norfolk and Norwich University Hospitals NHS Foundation Trust recognised for their close collaboration between professionals across both maternity and inflammatory bowel disease (IBD) services, working together to deliver more efficient, person-centred and environmentally sustainable care.

Highly commended: Oxfordshire Health NHS Foundation Trust for their joint District Nurse & Diabetic Nurse Specialist reviews, optimising care for patients in the community, reducing harms and the need for hospital admissions.

Showcase outcomes and learning 

The Green Nursing Showcase celebrated the inspiring work of the six project teams who took part in the Green Nursing Challenge 2025. Together, these teams are helping to shape more sustainable and equitable nursing care.

During the event, each clinical team presented their Sustainable Quality Improvement (SusQI) projects, focussing on priority areas identified through collaboration with challenge partners, carbon footprinting analysis, and discussions with patient and staff groups.

The event’s keynote speaker was Charlotte McCardle, Global nurse consultant and former CNO for Northern Ireland and DCNO at NHS England, who spoke of nurses and midwives being the “…holders of hope, the voice of the vulnerable, and the champions of change. I believe you are very well placed to lead. Don’t undersell in any way your work… You can use what you’ve created in your projects to break down barriers for others.”

The Challenge demonstrates how nurses and midwives can play a crucial role in achieving the NHS’ Net-Zero targets. By making changes in working practices, nurses can lead action to minimise the environmental harm created from healthcare services, and can help address health inequalities, improve outcomes and experiences, and contribute to a more sustainable healthcare system.

 To hear more about the individual projects follow the link: Green Nursing Showcase 2025 — Sustainable Healthcare

A global response to a global challenge

The training recognises that climate change is one of the most urgent threats to health and is part of a ground breaking pilot to expand sustainability education for the nursing and midwifery professions. Nurses and midwives are uniquely positioned to shape care that addresses not only the environmental challenges, but reduces health inequalities, improves outcomes, and promotes climate and social justice.

Tailored for different levels

Introduction to sustainability in health and care

This foundation-level course explores the key links between health, environment and sustainability. Designed for frontline nurses and midwives, it provides practical guidance on planning and delivering a small sustainable quality improvement (SusQI) project, with step-by-step support for turning knowledge into action.

Sustainability analysis and quality improvement in nursing and midwifery

Tailored for service leads and managers, this course offers a deeper exploration into SusQI methods and introduces the basics of carbon footprinting in healthcare settings. Participants learn how to assess and improve the environmental, social and financial sustainability of their services—while enhancing quality of care

Sustainable innovation in nursing and midwifery leadership training

Designed for senior nurse and midwifery leaders, this interactive course develops the leadership and communication skills needed to embed sustainability in daily practice, engage teams, and align sustainability with organisational and policy priorities. Participants will explore how to lead adaptation and mitigation strategies and accelerate climate-smart change at scale.

This course is free to access, but spaces are limited.

All three courses are being offered free of charge for registered nurses and midwives, thanks to the support of the Burdett Trust for Nursing. This reflects a growing recognition of the vital role that nurses and midwives play in delivering sustainable, equitable, and resilient healthcare systems.

Booking is now open, and spaces are limited. Nurses and midwives across the UK, and around the world, are encouraged to register early to secure their places: Free global sustainability training for nurses and midwives

The checklist is divided into four sections, the first dedicated to anaesthetic care, and the subsequent three looking at preparation for surgery, intra-operative practice and post-operative measures.

It is suggested the checklist is initially used at the daily brief at the start of an operating list, as an aide-memoire for the team of the modifications that could be applied there and then. Once these practices become embedded into practice, then the checklist may be used less frequently. At present, some theatres will lack the infrastructure required to enact all the suggested interventions and so the checklist can serve as a roadmap for discussion with management, or at departmental meetings, to guide required changes. Finally, if completed regularly, the checklist could also be used as a scorecard to monitor progress.

Laura Jane Brown (14 January 2023) - talks about her recent work exploring NHS staff's attitudes to Net Zero.

Dr Cliff Shelton, a leader, teacher and researcher in Healthcare Sustainability at Manchester Foundation Trust (1 December 2022) - discusses sustainable anaesthesia, peri-operative medicine and nitrous oxide manifolds.

Professor Marion Lynch, Global Health Consultant and Research (24 November 2022) - talks about health and well-being to promote resilience, and empower nurses to create a modern and sustainable workforce.

Rob Chuter, Christie Foundation Trust, Manchester, Radiotherapy Physicist (19 November 2022) - the Founder and Chair of the Institute of Physics and Engineering in Medicine (IPEM) Environmental Sustainability Group (ESG) chats about his passion for preserving our planet.

Dr Fin Craig, Consultant in Paediatric Palliative Care, Great Ormond Street Hospital (1 November 2022) - shares his passion for all things green.

The Green Team Competition is a quality improvement initiative at the Christie NHS Foundation Trust run with support from The Centre for Sustainable Healthcare, which encourages more sustainable ways of delivering healthcare. Teams were asked for ideas to cut carbon, but also help patient care and save money. Competitors, from endocrinology, palliative/supportive care, outreach, surgical theatre, radiotherapy and anaesthesia did just this – in bucket loads!

The projects were varied and ranged from streamlining resuscitation equipment and preventing theatres delays/cancellations, to removing, literally, tonnes of carbon through leaky nitrous oxide pipework.  The judges were bowled over with all the results, but awarded the palliative/supportive care team as winners with their photobiomodulation therapy for treating/ preventing oral mucositis. Photobiomodulation therapy is the application of light (usually a low power laser or LED) to promote tissue repair, reduce inflammation or induce analgesia.

The ‘highly commended’ award went to the Endocrine/Ward 11 team (who looked at introducing screening tools to prevent hip fractures.

The results of the projects were wonderful, predicting savings of over £550,000 a year. The environmental benefits were really impressive – with carbon reductions equivalent to doing 734 return journeys from Manchester to Kings Cross!

But the real overall winners are our patients. As an example, In the Palliative/Supportive Care project, Alex Langstaff (the Clinical Nurse Specialist who led the project) was able to show not only massive cost and environmental benefits of photobiomodulation, but the huge impact on patients – which the judging panel were particularly impressed with. She demonstrated significant reduction in hospital admissions and clear improvements to patient’s quality of life. Alex is now working to buy six machines to embed photobiomodulation into future treatment regimens.

The Green Team Competition has inspired green thinking amongst the competitors, why not think about your own ideas?

Data were included from 23 unique quality improvement initiatives that described 28 interventions. Eleven (39.3%), eight (28.6%), three (10.7%), and six (21.4%) interventions, respectively, were categorised as refuse, reduce, reuse and recycle. The researchers found that the potential annual cost savings varied from $2,233 (intervention: transition to a waterless surgical scrub; environmental impact: 2.7 million litre of water saved annually) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste), although the methods of measuring environmental impact and cost savings varied considerably among studies.

"The opportunity to reduce our carbon footprint falls squarely on us, and I see surgeons taking a prominent role in leading efforts, not just locally with their green implementation teams, but in setting national standards and policies that will move this effort forward for an overall sustainable way of approaching health care delivery," a coauthor said in a statement.

• using reusable gowns, drapes, and scrub caps
• giving medications through the veins for general anaesthesia rather than anaesthetic gases, which have a strong greenhouse effect
• implementing a plan for minimising electricity use, including heating and lighting
• recycling of single-use equipment used in surgery, working with industry partners
• recycling of “clean” paper and plastic waste
• using individually packed equipment, and only opening items as they were required
• one consultant surgeon jogged to hospital, and the other cycled.

Safety and efficiency were maintained for the patient throughout, carried out within a full, day-long operating list, including surgery for three other patients.