Road to recovery

28th September 2023

Chris Seekings investigates what IEMA members are doing to reduce the impact of medical services on the climate and to provide sustainable healthcare for all

It’s undeniable that climate change is having an increasingly negative impact on our health. Heat-related illnesses such as heat stroke and chronic kidney disease are on the rise, air quality is worsening, food security and water quality are deteriorating, diseases are emerging in new parts of the world, and climate-related weather disasters are destroying lives.

Indeed, between 2030 and 2050, climate change is expected to cause around 250,000 additional deaths per year from malnutrition, malaria, diarrhoea and heat stress, while the direct financial costs are estimated to be up to $4bn (£3.2bn) annually by the end of this decade.

But while climate change affects health, our healthcare systems are also having an impact on the climate. The sector is responsible for almost 5% of the world’s greenhouse gas emissions, and if global healthcare were a country, it would be the fifth-largest polluter on Earth.

To try to combat this in the UK, in January 2020, the ‘Greener NHS’ campaign was launched to mobilise the service’s 1.3 million staff to work towards becoming “the world’s first net-zero-carbon health service” by 2045. And as of May this year, 22 countries had committed to delivering net-zero health systems.

Turning to technology

Significant progress has been made, and IEMA partners have been instrumental in devising schemes to ensure sustainable healthcare for all.

One of which is the Association of British HealthTech Industries (ABHI), which supports health technology firms in providing products and services that help people live healthier lives. The sector covers medical devices, diagnostic technologies and digital health solutions, and is improving the sustainability of the healthcare system in several ways.

“Although potentially a difficult task, changing the way we are delivering healthcare can have a positive impact on the planet, as was shown throughout the pandemic,” explains Addie MacGregor, sustainability executive at ABHI.

“By moving to a system of remote monitoring, remote triage for assessing the need to visit a healthcare facility, and apps to reduce risks and cases of Covid, we did things differently, while maintaining patient safety and, crucially, reducing our emissions in the process.”

Wearable medical devices enable patients to be monitored remotely, reducing the need for as many physical hospital or GP surgery appointments, which cuts emissions from travel and the resources needed for physical visits.

From shrinking PCR machines from the size of a room to being able to sit on a table, to the use of robotics in surgical procedures, the healthtech industry is enabling a more efficient healthcare system and cutting waste, MacGregor says, “moving in the direction of what is best for patient, population and planet”.

Sustainable supply chains

Some of the most crucial work being carried out by sustainability professionals in the NHS is focused on cutting its carbon emissions. These account for 4-5% of the UK’s total emissions, the majority of which fall within scope 3 of the NHS’ carbon footprint.

NHS Supply Chain manages the sourcing, delivery and supply of healthcare products, services and food for NHS trusts and healthcare organisations across England and Wales, influencing emission levels across the value chain. “For us, whose role it is to procure for the NHS, this means we have a significant part to play,” says the organisation’s head of sustainability, Heidi Barnard PIEMA. “We’re looking at how we can influence and work with both our suppliers and NHS trust customers to change their behaviours to deliver net zero.”

To this end, the NHS Net Zero Supplier roadmap was approved by the NHS England board in September 2021, setting out clear milestones for anyone wanting to supply the NHS. These include a requirement for up-to-date carbon reduction plans, and for all procurements to have a 10% net zero and social value weighting. From June, suppliers have been asked to complete an Evergreen Sustainable Supplier Assessment, while they must also undertake an appraisal using a Modern Slavery Assessment Tool.

“We are also looking across our portfolio and identifying the areas that need work, from our logistics contract to each of the frameworks we provide, to how we present and give our customers information and data to be able to make informed choices,” Barnard says. “Collaboration is key, as we all need each other to reach our net-zero ambitions.”

Innovative models of care

Looking beyond supply chains, anaesthetic gases currently account for 5% of NHS carbon emissions within its direct control. The largest proportion of these come from nitrous oxide – a greenhouse gas 300 times more potent than carbon dioxide.

Newcastle upon Tyne Hospitals NHS Foundation Trust has led the way in trialling innovative new-to-UK equipment to capture and destroy this gas, which is used in many clinical settings, including in maternity, endoscopy and dentistry.

“The UK’s first ‘climate-friendly’ baby was born at the Royal Victoria Infirmary in September 2021 using this N2O capture and destruction technology, previously only available in Scandinavia,” says Laura Middlemass MIEMA CEnv, assistant sustainability manager at the trust.

“The technology converts up to 99% of exhaled N2O into harmless nitrogen and oxygen, and also reduces staff exposure to exhaled nitrous oxide, so contributes to a healthier working environment for staff.”

As the largest employer in Europe, the more NHS staff that are familiar with sustainability issues, the better. The trust has around 400 ‘Green Champions’ and a growing network of ‘Green Champions Plus’ workers who have undertaken sustainability training so that “whether you are a data analyst or a laboratory manager, you will understand how your role impacts on sustainability, and what sort of changes you can make,” says Middlemass. “A number of these Green Champions Plus have been pivotal in implementing a ‘model for sustainability’ in their departments – a framework developed to embed sustainability into departmental strategies and culture.”

Work on wellbeing

As part of ensuring the wellbeing of its staff – and boosting biodiversity – the Newcastle trust has established a baseline biodiversity metric score and developed action plans for improvement, starting work on hedge and tree planting, bird and bat boxes, and wildflower and bulb planting.

Meanwhile, Nottinghamshire Healthcare NHS Foundation Trust – one of the largest community and mental health trusts in the country – has formed an in-house health and wellbeing service, which combines staff health and wellbeing, occupational health and staff counselling.

Available to all its workers, the package is “preventative, proactive and responsive”, says Lynn Walker, MIEMA, CEnv, head of sustainability at the trust. “We know that an organisation is nothing without its people, which is why we are committed to creating a great culture and environment for our colleagues, and one where their health and wellbeing is fully supported,” she continues. “Projects have a focus on maximising the use of our green space for therapeutic benefit, but also as a space for staff, carers and visitors to the trust to access.”

The trust’s occupational health service has enabled it to provide colleagues with timely access to a multi-professional team, staff counselling via self-referral or manager referral, a fast-track musculoskeletal physiotherapy service, as well as various additional benefits.


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