Education for healthcare sustainability

It is predicted that we have less than 10 years to dramatically reduce our greenhouse gas emissions to limit global warming to 1.5ºC. For those of us practicing modern medicine, this requires seismic shifts in our everyday practice.

Lack of knowledge about causes, impacts, and solutions to climate change has been identified as a barrier to engagement in climate action. However, it is reported that 98% of NHS staff support the targets of the 2020 Net Zero NHS plan [1]. Education about sustainable healthcare is essential, and must provide clinicians with the skills and motivation to act swiftly and with maximum impact.

To increase awareness about sustainable healthcare, Health Education England have commissioned the Centre for Sustainable Healthcare (CSH) to produce an introductory e-learning module aimed at all healthcare workers. It will introduce the plan for Net Zero and the important role of health professionals in achieving this. We hope that this will be made available on e-Learning for Healthcare in spring 2021. More tailored educational resources are also available, with the RCoA leading the way [2].

CSH is working hard to develop the concept of ‘Sustainability in quality improvement’ (SusQI), and introduce this into healthcare education. The SusQI approach equips clinicians with knowledge of carbon hotspots in their own specialities, and links this to a recognised method for change. For practising clinicians, time is precious, and therefore it is important to maximise the ratio of carbon reduction to time spent.

In my role as a Quality Improvement Education Fellow at CSH, I am working with others to demonstrate and refine the integration of SusQI into general quality improvement education programmes, evaluate the impact on learning and motivation, and accelerate its widespread adoption. To further this final objective we have produced a dedicated website, and we are providing one-day courses on how to teach SusQI. Despite the pandemic disrupting elements of my fellowship, thus far my experience has been that clinicians at all levels are motivated and engaged in learning and implementing SusQI methodology.

When starting a quality improvement project aimed at reducing healthcare carbon emissions, the first step is to map the current situation in order to explore carbon hotspots. Two such projects in anaesthesia on inhalational anaesthetics and waste have been described by Cathy Lawson in the RCoA quality improvement recipe book [3]. If these projects are scaled up across the whole NHS, huge reductions in anaesthesia-related greenhouse gas emissions could be achieved in a relatively short space of time.

If we are serious about achieving the NHS Net Zero target, we will need to demand greenhouse gas emission disclosure of all products and services, and use this information in procurement and commissioning.

Outwith anaesthesia, a target area for SusQI projects is reducing prescriptions of metered dose inhalers (MDIs). MDI contain hydroflurocarbons, potent greenhouse gases, and an average MDI contains 20 kg of CO ₂e, equivalent to driving approximately 125 miles. MDIs make up 70% of all inhalers in the UK, < 50% in every other country in Europe, and around 13% in Sweden [4]. The UK has some of the worst death rates in Europe for asthma and COPD, making it hard to argue that MDIs are essential for patient care. Encouraging the switch from MDI to the alternative dry power inhalers has parallels with the work on volatile anaesthetic use in anaesthesia.

To maximise the effectiveness of SusQI projects in all clinical areas, a greater understanding of carbon emissions across healthcare-related activities is required. Some of these are listed by the Greener NHS website. However, many remain unknown. This hampers the ability to select medical supplies and equipment with lower carbon footprints. If we are serious about achieving the NHS Net Zero target, we will need to demand greenhouse gas emission disclosure of all products and services, and use this information in procurement and commissioning.

Together, through education, advocacy and sustainable quality improvement, we can make a huge impact to the sustainability of healthcare. I commend you to get involved and do as much as you can.

Rosie Spooner
Quality Improvement Education Fellow at the Centre for Sustainable Healthcare,
Paediatric Registrar,
Gloucester Hospital NHS Foundation Trust

Twitter: @spooner_rosie

References 

1. NHS England and NHS Improvement. A Net Zero NHS, 2020. www.england.nhs.uk/greenernhs/a-net-zero-nhs/ (accessed 15/1/2021). 
2. e-Learning for Healthcare. Environmentally sustainable anaesthetic practice, 2020. https://portal.e-lfh.org.uk/Component/Details/669676 (accessed 15/1/2021). 
3. Royal College of Anaesthetists. Raising the standards: RCoA quality improvement compendium, 2020. https://www.rcoa.ac.uk/media/15646 (accessed 15/1/2021). 
4. Wilkinson AJK, Braggins R, Steinbach I, Smith J. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open 2019; 9: e028763.

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