Angela Hayes

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?

This year’s Lancet Countdown report, 2022 on Health and Climate Change (a collaboration of over 120 leading experts from UN countries and academic institutions) warns that ‘the health of people around the world is at the mercy of a persistent fossil fuel addiction’. The report makes it “clearer than ever that we are at a critical point” says Rachel Stancliffe, Director of The Centre for Sustainable Healthcare, and that “if we continue as we are, including subsidising fossil fuels, we will be locked into a devastating future for the children of today”. The report states how alarming things have become – with a 68% increase in heat-related deaths amongst the most vulnerable population groups (infants and those over 65years) in the last four years. It claims that governments and companies continue to prioritise the fossil fuels above, and to the detriment of peoples’ health, jeopardising a liveable future. The Lancet Countdown report’s key message is that we face a critical juncture and states that a health-centred, aligned response to the crisis, can deliver a future where people can not only survive, but thrive. We owe it to future generations to heed this and act now!

The impact of climate change on public health is extensive (see diagram from the Centre for Sustainable Healthcare below) and has been declared an ‘emergency’. The climate crisis threatens to undo the gains we made to public health over the last 50 years and threatens the lives of millions. It impacts on the most vulnerable members of society – those who contribute to global warming the least and who are least resilient to its effects. Avoidable deaths are happening now – we’ve seen the devastation caused by the recent floods in Pakistan, and the ongoing famine in Somalia means thousands face starvation. Both these are directly attributable to global warming. The climate emergency is literally on our doorstep and we have to act now – not in the future. We have to act in response to an emergency. As healthcare professionals we have a duty to care, to protect and promote public health. Our nursing unions agree and, as the most trusted profession for the 20th consecutive year, nurses are ideally placed to deliver this vital climate emergency health message. Working in a greener way should be an integral part of every nurse’s role – not just a job for some bloke in the Estates Team who’s changing a few old light bulbs and installing recycling bins! Sustainable ways of working clinically comes in many forms – from prescribing to reduce unnecessary pharmacological waste, to general dietary health advice to our patients (cutting down on meat and dairy is the most effective way an individual can reduce their own carbon footprint – by up to 70% and is great for the pocket and the waistline). Metered dose inhalers have a terrible carbon footprint, as do some anaesthetic gases. In my department, we’re exploring the use of a light-source treatment for cancer patients having chemo and radiotherapy – which maintains the mucosal lining and prevents the need for complex pain management, prolonged feeding regimes and, ultimately, hospital admissions. Living and working greener is just generally better all round – for our health and that of our planet. And if by looking after our planet our own health improves, then it’s win-win! What can you identify in your clinical practice to reduce waste and cost and help meet the Net Zero targets? Because it’s only by working together, that we’ve a chance of meeting them! We would love to hear what you and your trust are doing about sustainability and climate change. Is this something you've discussed at work? Share your good practice and ideas in the comment field below. Further blogs from Angela Climate change: why it needs to be on every Trust's agenda

Climate change: a health emergency The NHS has a huge carbon footprint, producing around 25 million tonnes of carbon a year – equivalent to all the emissions from Sri Lanka! Carbon dioxide emissions attributable to the NHS in England are greater than the annual emissions of all the aircraft leaving Heathrow, and if healthcare was a country, it would be the fifth largest polluter! The NHS declared climate change, ‘a health emergency’ – it undermines the foundations of good health, deepens health inequalities and threatens to undermine the gains made in public health over the last 50 years. As trusted messengers, healthcare professionals have a moral duty to act, to protect and improve public health, and should be demanding stronger action to tackle the problem. The human cost of climate change is enormous – resulting in poor air quality, extreme weather events, scarcity of resources (safe drinking water/cultivatable land), conflict and war, displacement of people and exploitation of the most vulnerable members of society. Climate change will result in increased disease, cancers, malnutrition, mental disorders, and threatens the lives of millions. We‘re likely to experience frequent pandemics that spread more easily. Covid-19 and its impact will seem like the ‘warm-up act', dwarfed by the devasting effects of climate change. Those who contribute to the problem the least, are likely to be the most affected by the impact of climate change. Those whose carbon footprint is the lowest, are those who are far less resilient to its effects. Termed ‘climate injustice’ – the most susceptible groups are children, the elderly, minority groups, women, the poor and the sick. Global temperatures are rising. We are seeing the effects of this already. We see forest fires, floods, trees torn up by their roots and wheely bins flying round in storms! We’ve experienced unprecedented temperatures this summer. These events are happening here and now, and are literally on our doorsteps. They are almost not news worthy, they happen so often these days. My own hospital is in an area that has flooded twice in the last 2 years. If the area is flooded, supplies can’t get in, staff can’t get in and patients can’t be treated. We are trying to limit global temperature increases to 1.5 degree. If temperatures rise beyond this, we can expect irreversible damage to our planet which will be catastrophic in terms of health. If we see global temperatures rise by 2–3 degrees, three-quarters of Spain will be ‘desert-like’. Ninety-nine percent of Cyprus will turn to dust. We are on course to reach a 1.5 degree warming in less than 8 years! My children will be 22 and 25 years old. Climate change will affect our own lives and is certain to have a huge impact on our children and grandchildren's health. The NHS has declared climate change a health emergency – but many healthcare professionals have not even talked about ‘sustainability’ in their working lives, let alone are acting in response to an emergency. We have a moral duty to act, to protect lives and promote social justice. We need to act as Greta Thunberg says, ‘like our house is on fire!’ What can we do? There are things we can do in our home and working lives to reduce our carbon footprint. Reducing meat and dairy consumption is the most effective way an individual can reduce their carbon footprint (by up to 70%!). Eating less meat is better health wise and lighter on the pocket. Taking more exercise and not using our cars as often, is better for the environment and brings health benefits too. There are movements in healthcare to reduce our carbon footprint, but we could see significant improvements if healthcare professionals were aware of the problem and considered the carbon costs of their clinical decision just as much as we think about what we spend. Some of these actions are easy wins that staff probably do in their own homes but don’t even think about at work – turning off lights, computers, fans and air conditioning when not in use are all simple things we can do. When sending emails, we can consider our electronic carbon footprint, when sending large files, attachments, or even just whether ‘replying to all’ is necessary. Working on a laptop uses a third of the energy of a computer – could this switch be made? As prescribers we can consider alternatives with lower carbon footprints. Dry-powder combination inhalers are a great example of how to effectively reduce our carbon footprint; not only are they much kinder to the planet, but they bring about health benefits with better asthma control and, therefore, less need for healthcare services. The benefits of ‘social prescribing’ should be considered – prescribing ‘exercise regimes’ rather than more medications, which may positively influence our patient’s lives as they benefit from being generally in better shape. We can share these messages with our patients too – as greener ways of living are just generally better for the environment and good for our health. As healthcare professionals, we can influence not only our patients, but our friends, colleagues, managers, suppliers and politicians to act and bring about positive changes. Sustainability needs to be on the agenda – literally! We need to be acting like we’re facing an emergency. Initiatives at Christie's I got myself involved with sustainability by just asking questions about what we were doing in my Trust. Since first approaching my CEO, things have taken off massively and I’ve got involved in a number of initiatives around green projects, and I now get funding to work on sustainability each week. I’ve worked with local school children to create ‘No Idling’ signs around the Trust to improve air quality around the site and hospital nursery (I even asked a policeman to turn off his engine when idling outside the Trust!). I’ve used the hospital nursery children to create green Christmas decorations, help with 'Clean Air Day', and have even enlisted their singing talents – performing a song I wrote: A Note from Greta - starring the Christie's Nursery kids. We’ve now secured funding to run the Green Ward competition, which encourages sustainable ways of working in both the clinical and non-clinical areas with prize money and support provided by The Centre for Sustainable Health Care. We have plans to join the Royal College of Nursing's 'Gloves Off Campaign' to reduce the PPE wastage; we have sustainability training in place for all new staff and plan to introduce Board level training too. I’ve lectured about climate change in and out of my hospital, we have a well-attended and passionate Sustainability Committee and have plans to include sustainability our Trust’s corporate objectives. I’d urge you to think and talk about sustainability and climate change in everything you do. I’d encourage you to do one green think today and start your own green journey. Who knows where it might lead you… We would love to hear what you and your trust are doing about sustainability and climate change. Is this something you've discussed at work? Share your good practice and ideas in the comment field below. Further blogs from Angela The climate crisis: Are we bothered? A blog from Angela Hayes