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  • Patient Safety Spotlight Interview with Angela Hayes and Caroline Morris, Palliative Care Nurse Specialists at The Christie NHS Foundation Trust

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    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Angela and Caroline spoke to us about how they are helping healthcare organisations consider sustainability a core part of their work. They reflect on the responsibility of both patients and healthcare professionals to ensure patient safety for future generations.

    About the Author

    Angela and Caroline are Clinical Nurse Specialists (CNS) in Palliative and Supportive care at The Christie NHS Foundation Trust in Manchester. They are both passionate about improving sustainability in healthcare and raising awareness of how climate change affects people's health and healthcare. As part of her role, Angela works on improving sustainability and helping her Trust work towards achieving Net Zero and the greener NHS plan for hospitals.

    Questions & Answers

    Hi Angela and Caroline! Please can you tell us who you are and what you do?

    Angela: My name is Angela Hayes, I’m a Clinical Nurse Specialist (CNS) in Palliative and Supportive care at The Christie NHS Foundation Trust in Manchester. As part of my role, I’m also funded to do some sustainability work toward Net Zero and the greener NHS plan for hospitals.

    Caroline: I’m Caroline Morris, a CNS in the same team and I am also interested in the future of the planet and sustainability. From a healthcare perspective, my question is, “How can we improve people’s lives alongside achieving a sustainable lifestyle?”

    How did you first become interested in patient safety?

    Angela: My interest in climate change meant I dipped my toe in the patient safety world without really realising it, and the more I get involved, the more the link between sustainability and patient safety is apparent. 

    I became interested in the climate crisis a few years ago, when I became more conscious about air pollution related to children’s health. On the school run, I’d see lots of parents dropping children off at school and leaving their car engines running, and because of their size, children more directly breathe in exhaust pollutants. I realised that we need to be thinking about it, because children’s lungs’ are developing and more vulnerable—these children will be our patients in the future. 

    This interest spilled into my work life and it seemed to me that people in healthcare weren’t talking about sustainability; environmental concerns were dropped at the door of the hospital. So I just started asking questions about what we were doing in regard to the environment. The NHS produces tons of waste, so there are many opportunities to try and make improvements, from both a financial and carbon cost perspective. I helped to set up a sustainability committee with a couple of colleagues who were working on greener travel and how we run our estates more sustainably. 

    As time has gone on, more clinical colleagues have become involved and we are seeing and understanding the wider implications of the climate crisis on public health and health inequalities. It’s a sad fact that those who are most vulnerable to the effects of the climate crisis contribute least to climate change. As healthcare professionals, we need to take on this agenda and be advocates for people who can’t always represent themselves.

    Caroline: As healthcare professionals, but also as patients ourselves, we need to ask how we make ourselves safer as well as guiding others. We are all patients at some point, and therefore we should all be aware of how we can help keep ourselves safe, alongside thinking about sustainability issues. My parents were environmental activists so I’ve always been aware of climate change, and I’ve now jumped on the bandwagon, supporting Angela in the work she’s leading.

    Angela, how does your role allow you to spread awareness about sustainability in healthcare?

    Angela: My sustainability role is an add on to my ‘proper job’ as a nurse specialist—I’m lucky to have understanding managers who support me to do this work. It’s the part of my job that really excites me, and within that, presenting to groups is the part I find most rewarding. I’ve given presentations to clinical staff and healthcare suppliers and have spoken at conferences. When you receive feedback that your talk has been inspiring and you know your message has got through, that’s really fulfilling. You almost ‘set a torch’ under someone else to take action. 

    I have attended training to become a carbon literacy trainer, but apart from that, neither of us are qualified in this subject, we just have a passion and drive for it. It shows that anyone can get involved in healthcare, and that’s empowering for people.

    What patient safety challenges do you see at the moment?

    Angela: A key challenge I have come across in my sustainability work is that there are always conflicting priorities that healthcare professionals face. Many people don’t link the climate emergency with health as it’s not part of people’s everyday working life or their job description. 

    Healthcare professionals have conflicting priorities and pressures and there are many things that might trump spending time considering sustainability issues. But it’s a critical issue; in every decision we make, we need to be considering the carbon cost as well as the financial cost. We need to weigh the benefits against the risks that our actions might pose to our patients, either now, or in the future. We need a huge shift in the way we think about life, including our working lives. 

    Caroline: These are quite difficult subjects for people to talk honestly about, but ultimately the goals that we are striving to achieve are all about improving the lives of our current patients, and those we will be expected to look after in the future.

    What do you think the next few years hold for sustainability issues?  

    Angela: I would really like to see greater appreciation of the clinical impact of sustainability issues. Nurses were recently voted the most trusted healthcare professional, and as such, we are in a privileged position to share messages about green healthcare to the people we come into contact with. 

    I would love to see Clinical Sustainability Nurse posts in every healthcare organisation, rather than sustainability being an add-on role. It would be a really sensible investment for the NHS to make—these clinical specialists could work alongside estates and buildings teams to create a more sustainable way of caring for our patients in the future.

    If you could change one thing in the healthcare system right now to improve patient safety, what would it be?

    Caroline: I would want every healthcare professional and every patient to be empowered to challenge the routine things we do in healthcare. It’s all about getting people talking about it—sustainability needs to be on everyone’s agenda.

    Angela: I agree, we need to see an appreciation that working sustainability is everyone’s role. I think it needs to be part of the teaching curriculum for doctors and nursing staff. Everyone doing something is going to have a far greater impact than a few people doing everything.

    There’s a wider societal culture change that needs to happen so that we appreciate what we have. Our whole culture is driven by growth and things being available that you then just throw away. If we can’t change, our children face a very different future.

    Caroline: One thing we can do is become really good at nagging! If you don’t go on and on about it, the message won’t get through. Even when I hear people joking about climate change in the office, I’m pleased because I know the message has penetrated. Giving up isn’t an option.

    Are there things that you do outside of your role which have made you think differently about patient safety?

    Angela: I never take my sustainability goggles off—they’re my contact lenses. I am always turning off computers and lights on the ward. I once turned a toilet light off because I thought it was empty and plunged a patient into darkness!

    I try to use my hobbies and interests to promote the sustainability agenda and I’ve learned to be quite sneaky about it. I frequently tap on the windows of cars that are idling and ask the driver to turn the engine off. I’ve now started telling them that I am a nurse working in a local cancer hospital and we’re trying to improve patient safety. I tell the driver that sitting in your car with your engine running is really bad for your breathing. People see that as a kindness, rather than seeing me as annoying and interfering!

    I sing in a band with my sisters and wrote a climate change song, ‘A note from Greta’—it’s quite upbeat but with a serious message. I got children from the hospital nursery to sing the chorus—it was so lovely! Having the children involved means it comes across as less preachy, and makes people think about the fact that these children will be the ones living with the effects of climate change.

    Caroline: I’m always thinking about the issues too, and try to take action wherever I can. For example, every year, I help run a bar at a fete, and instead of letting the plastic cups be thrown away, I collect them up and wash them so they can be used again. Taking this viewpoint into the hospital enables me to help make changes for the better at work as well.

    Tell us one thing about yourself that might surprise us!

    Angela: I once tapped on the window of a police car that was idling outside the hospital and asked him to turn his engine off. The person the police officer had arrested was watching from the back seat and found it very entertaining! The officer said he couldn’t turn his engine off because he needed it on for his radio. Afterwards, I contacted his superintendent and highlighted the issue of police cars all idling—we have to ask these questions to see if there is a more climate-friendly solution to these activities that have to happen.

    Caroline: Once we asked a van driver to turn his engine off outside the hospital. We hadn’t realised it was carrying chemotherapy drugs so it needed to be left on. We decided to let him off!

    Related reading

    The climate crisis: Are we bothered? A blog from Angela Hayes
    Climate change: why it needs to be on every Trust's agenda

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