UCLH’s 10-point climate action plan commits us to cutting energy emissions by 80 per cent by 2025, moving faster than even the ambitious target of the NHS as a whole. As well as reducing our environmental impact, this will lead to direct benefit for patients. Research suggests that, nationally, up to one third of new asthma cases might be avoided as a result of efforts to cut emissions. In a city like London, which suffers from high levels of traffic-related pollution, the potential benefits are clear.
UCLH is reducing its environmental footprint by switching to cleaner energy, eliminating harmful anaesthetic gases, promoting active travel and reducing waste.
The COVID pandemic has shown that virtual appointments work well in many situations, and patient feedback has been positive. Video and telephone clinics have halved patient travel rates, saving more than 14 million miles of travel in 2021. UCLH is actively looking at continuing its video clinics and our ambition is to maintain a level of 50 per cent of appointments taking place virtually.
“Being able to cut down the number of face-to-face appointments can be really helpful for our patients, who appreciate being able to take far less time out of their day. It's a valuable tool to be able to offer, so patients can choose what's right for them.”
Dr Toby Hillman, Consultant in Respiratory Medicine
UCLH has declared a climate emergency and is committed to cutting carbon emissions by 80 per cent by 2025. With anaesthetic gases contributing around five per cent of the carbon footprint across all acute NHS organisations, and well over two per cent across the whole of the NHS, a natural place to focus has been on our operating theatres. A cohort of theatre staff has come together to create the UCLH Green Theatre Group to tackle this problem, among others which can support UCLH’s climate action plan.
The team have outlined a local action plan to reduce carbon emissions in our hospitals, including a review of our use of anaesthesia, minimising our reliance on single use materials, improving waste management, reducing electricity and an education programme to encourage personal responsibility for action on climate change. While climate action is the driver for the work, improvements to patient and staff experience remain central to any activity.
“The climate crisis means we all have to reduce our carbon emissions to zero. Every action counts and the time to act is now”, said consultant anaesthetist and Green Theatre Team member, Damon Kamming.
The team’s starting point was to reduce reliance on the anaesthetic gas desflurane, which has the highest carbon emissions of all anaesthetic gases This has historically been a commonly used anaesthetic gas, but it releases a lot of greenhouse gases and is actually one of the most environmentally harmful. One hour’s use of Desflurane emits the same carbon emissions as travelling 230 miles in a petrol car and is 2,500 times more damaging to the environment than carbon dioxide. If everyone in our hospitals stopped using Desflurane, its carbon emission contribution from anaesthesia would decrease from five per cent of the total to just 0.5 per cent.
UCLH is now committed to eliminating the use of desflurane across its sites by the end of 2021. The team have made some relatively simple changes in the meantime, such as removing desflurane from our theatres and storing them in pharmacy cupboards instead. Staff are then prompted to use sevoflurane, a less environmentally damaging gas, instead.
The team is also promoting the use of Propofol Total Intravenous Anaesthesia (TIVA), which has a greenhouse gas impact of 10,000 times lower than desflurane. They have already purchased 138 new pumps to allow anaesthesia to be administered this way more often. The benefits of TIVA are far-reaching: patients also report a better experience, since intravenous anaesthesia reportedly leads to less nausea and vomiting.
“The key is to make it easy for staff to do the right thing and harder to make choices that are bad for the planet”, said Damon. “This small change is 'win-win', because we also have the chance to make things better for patients as well as the environment.”
Reducing single-use plastics in theatres
This project is looking at installation of a kit that changes the way UCLH disposes of surgical fluid. It both cuts out the need for single-use plastics for storage, and reduces the amount of manual handling required of staff for disposal.
Additional changes are smaller, but no less valuable. Currently UCLH is incinerating over 1,000 tons of clinical waste a year at a cost of £1 million. A focus on the correct disposal of clinical waste across the department has the potential to dramatically increase the amount of waste that can recycled, which offers the potential to reduce both costs and carbon emissions.
“The climate crisis is here and this is a once in a lifetime opportunity to innovate and collaborate with a shared purpose to make it easy to do the right thing for patients, staff and the planet”, said Damon. “There are so many ways we can make a difference.”
Having been inspired by the visible focus on sustainability in the workplace in his home country of the Philippines, Robert Vincente, deputy charge nurse on ward T8, recognised that his team could make a big impact on reducing the use of disposable items with a little effort and forward planning.
The NHS uses 1.4 billion disposable gloves every year, and although the majority of these are essential for safe patient care, there are still plenty of opportunities to safely reduce their use. “Unless a patient is infectious, there are a number of nursing activities that really don’t need to be done while wearing gloves” explained Robert. “For example, changing the beds or helping to feed someone who is not contagious.”
Robert identified a number of instances where staff were reaching for gloves where they were not required for infection control. In response, he implemented a “Gloves Off” campaign on the ward. In fact, research shows that good hand hygiene is much safer for patients than routinely wearing gloves, which can result in cross-contamination and healthcare-acquired infections.
With the support of UCLH’s infection control team, Robert identified when it was better for staff members to avoid using gloves all together. The team then actively promoted excellent hand hygiene instead of wearing unnecessary gloves.
“We did have some concerns in the team to begin with, especially as COVID became an issue”, said Robert. “The key is in identifying where patients are likely to be infectious, Of course, in those instances it is sensible to retain the use of disposable gloves, but with some planning we were able to recognise where there was a genuine risk to staff and patients, and where it was a safe option to work without gloves.
“We also appointed a nursing assistant in charge to take overall responsibility for managing any stock we had on the ward, which really helped as we had oversight of the items that were being used and where they were stored. This stopped accidental reordering.”
The trial was incredibly successful, with the ward reducing usage by 36,500 gloves over a four-month period, compared to the previous year. To give that some context, over a year the weight of the unused gloves would be more than the weight of a highland cow!
As well as seeing this impressive reduction in glove usage, the team started to see other benefits. Approximately one in five nurses are known to develop hand dermatitis – a painful, debilitating condition that may require nursing staff to be moved out of clinical areas due to the risk of infection from damaged skin. Gloves are known to be a contributing factor with this problem. During the course of the trial the team reported a drop in the number of cases of hand dermatitis in the nursing team.
The ward is now looking at other ways they can reduce their carbon footprint, including eliminating plastic cups and assessing the use of patient transport more effectively. “Good housekeeping is the precursor to sustainability”, said Robert. “It just takes focus.”
In January 2021, UCLH began its COVID-19 vaccination programme. Naturally the initial focus was on getting the programme up and running as speedily as possible; but now it is in full flow, the team have been looking at ways to reduce their carbon footprint while they continue to safely deliver vaccines to Londoners.
“When we first started the vaccination programme it all happened so fast. We were sent mountains of leaflets to hand out to patients – more than we could possibly use. We were also less certain about how high the risks were with spreading COVID-19 via surfaces like clothing, so we were using the same personal protective equipment (PPE) as other staff in our hospitals at the time. We were using up to 2,000 plastic aprons a day.” said operational lead for the vaccination centre, Carlo Cavalli.
With the support of UCLH’s infection prevention and control team, it was agreed that there was minimal risk to patients and staff if the team stopped using the aprons all together. With over 400 vaccinations taking place a day, that adds up to saving almost 150,000 aprons a year from disposal. The team also reviewed how often they were handing out sticking plasters to patients and now only use cotton wool after the initial injection unless there is a need for a plaster.
The next thing to tackle was the leaflet mountain. The centre is now looking into having these offered to patients via a QR code to encourage patients to download information leaflets on smart phones wherever possible. This will not only reduce the amount of paper that is being used, but also means that any information updates are instantaneous, rather than waiting for another round of printing to occur. It also makes it easier to provide patient information in a wide range of languages and easy-read formats.
The team has also considered the impact of waste management. “As our yellow sharps bins are full of needles they clearly need to be disposed of safely, so each night the domestic team were replacing the bins and sending the used ones to be incinerated,” said Carlo. “In many cases those bins might have been less than a quarter full, so we were incinerating far more plastic than we needed to. Now we are only disposing of the physical bin when it is more than three quarters full. It still means everyone remains safe; although there is currently no other alternative than to burn them, we are still reducing our carbon emissions from incineration.”
The amount of disposable water cups being used was also an issue. Although cups are still available in patient areas, staff have been encouraged to bring their own water bottles or mugs to work.
Even though this marks a great start, there is recognition that there is still more to be done. At the Bidborough House vaccination centre, Deenesh Dabydoyal, one of the deputy operations managers, has been enlisted as the on-site sustainability champion, with responsibility for looking for opportunities to make the site even more environmentally friendly going forwards.
“We will only make changes where it is clinically safe for us to do so, but we are mindful that we can still make a difference.” says Carlo.
Professor Sanjay Sisodiya, consultant neurologist at the National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology Deputy Director with responsibility for sustainability and climate change, is concerned about the impact of climate change on people with neurological conditions.
Aware of anecdotal evidence of difficulties experienced during heatwaves by people with some of the more severe forms of epilepsy, he consulted colleagues to see if they had come across similar issues. Everyone he spoke to shared his concerns about the environment, and acknowledged that they needed to think more seriously about the issue with regard to their patients. Other diseases of the brain and nervous system, including stroke, may also be sensitive to temperature changes.
Professor Sisodiya said: “We do think that climate change is going to be an important challenge for people with neurological diseases. In the case of some people with epilepsy, their families have noted over the past few years that during the heatwaves their condition has become worse.”
To address these issues, Professor Sisodiya established a consortium of neurologists, scientists, epilepsy nurses, representatives from industry and charities supporting people with epilepsy, called Epilepsy Climate Change (EpiCC). It is a global initiative to foster research and share knowledge in this area. He has also been awarded a grant from The National Brain Appeal’s Innovation Fund, to investigate the harmful effects of global heating on people with neurological conditions.
He continued: “We need to gather the fundamental data on how temperature affects the workings of the brain. Currently there is very little out there.
“The world’s climate is changing now. Global heating and its consequences will greatly affect our lives and work in the years ahead. For people with neurological diseases, and for research into those diseases, climate change is likely to pose significant challenges. We will do what we can to meet these challenges, to reduce our contributions to climate change, and to promote sustainability.”
He continued: “As clinicians and researchers, we need to be more thoughtful about travel. It’s about asking if every meeting we want to go to is useful, or if the learning we get from it could be done remotely.” With our patients, we can learn from what we had to do in the pandemic and – where it is appropriate – make more of our consultations remote.”