CARBON REDUCTION AND NET ZERO
need to develop frameworks, networks, and perhaps even national targets, to scale and spread what we know works to accelerate progress. We’ve done this with desflurane, but people ask me why we can still prescribe the most damaging metered dose inhalers when there are simple sustainable switches? For larger scale capital projects, we need to unlock funding, but much can be done towards clinical transformation by embedding approaches like SusQI that can save money. And finally,” she said, “we need to raise the health voice to advocate at national and local levels for measures that tackle the climate crisis and also improve health at a population level.” Session Chair, Dr Mullan here thanked the speaker, who he said had ‘really framed the crisis from a broader perspective’. He then invited questions, beginning with one of his own, by asking Dr Pinto – given the scale of the actions that need to be taken across the NHS – how she approaches meetings on sustainability with NHS teams, and how she encourages staff either to ‘start with that bigger picture, or think about breaking it down?’ Dr Pinto replied: “As a doctor I work within the framework of informed consent, and am honest with people about the risks we’re facing, but it’s also so important to paint that picture of sustainability’s benefits. I think that’s been a missed opportunity – we don’t talk enough about what sustainability looks like, but instead focus on what we need people to not do, and not the opportunities this offers.” The speaker feels ‘people need something to work towards’. One key action she would take – given a longer time period – would be to ‘acknowledge the reality of eco distress, how this affects us, and what we can do about that’. She said: “One of the most effective ways to manage this is to take action, but also to recognise that as one individual, you can’t fix the whole thing; this is a planetary- sized problem. What you can do is tackle a piece of the jigsaw that’s in front of you, and engage others to do the same. It’s about breaking it down to work within your sphere of influence.”
Examples of successful projects Asked about other examples of relatively straightforward measures – such as eliminating a single routine appointment that had become unnecessary due to improved effectiveness and tolerability of treatment that she had earlier mentioned, Dr Pinto said there were ‘hundreds of examples of excellent SusQI studies’. A key priority seen in many studies had been the importance of engaging with allied healthcare professionals, and ‘how they can make a difference’. She said: “There’s a great study on mobilising people early on CICU units, which reduces their time there, and their time being ventilated. They get home quicker, with better outcomes, and
‘What’s needed’, in the view of the Centre for Sustainable Healthcare.
over the first year it saved over a million pounds, due to how expensive those beds are.” There was also ‘lots of work ongoing
around inhalers in primary care’, and on looking at pathways and stripping out some elements. She said: “We still use process mapping in the same way you would with a QI project, but it’s about stripping out the unnecessary steps – things that look small that are repeated many times – such as dropping one blood test or appointment; switching to more virtual delivery of medicine, and being aware of some of the issues around digital exclusion and how to address them.” Dr Pinto explained here that the Centre
for Sustainable Healthcare is a charity set up 15 years ago, which has since been working on this. She encouraged attendees and others to visit its website, and link to its free-to-join networks. She explained: “The Sustainable Healthcare Networks Platform hosts our resource and case study library, so you can search for pretty much anything there and hopefully find a similar project. Let’s not ‘re-invent the wheel’, but rather look for case studies that people have already done in your area, and see if you can replicate them”. Another attendee asked Dr Pinto if she had seen Board leads or senior NHS Trust personnel going through the work being done and trying to find sustainability opportunities. She said: “Yes, definitely. We are just about to do our Net Zero leadership training for Boards. For instance, one organisation we have worked with in London has very demonstrably been pulling out case studies and seeing how they can replicate them. You need a team in charge of this, which focuses on what’s happening nationally and internationally, and then prioritises which actions to implement.” Another delegate asked how the NHS can best strike a balance between cost-effectiveness and maintaining high standards of patient care. Dr Pinto said: “With clinical transformation, you are
almost invariably saving money, because you’re genuinely streamlining pathways. Much of what we do around sustainability is actions we need to take anyway – around streamlining, reducing costs, managing capacity, personalisation of care, and making it more effective. Prevention isn’t just out there in the community; there’s quaternary prevention as well – which is about not harming people through what we do.” The speaker said this revolved around aspects such as over-investigation, overprescribing, and overdiagnosis. An attendee from Roche Diagnostics
acknowledged Dr Pinto’s point about ‘overinvestigation’ of medical conditions, but said there were also many cases of under-investigating patients, which he feels have a negative impact on climate. He elaborated: “There are cases in particular of heart failure where a lack of investigation at the early stages is leading to heavy reliance on secondary care services, and picking up disease at a very late stage, by which time it’s actually more carbon-intensive to treat the patient.” He added: “I think we need to look more at how diagnostic pathway innovation can help meet sustainability targets.”
Looking at specific pathways Dr Pinto agreed. She said: “Our courses cover that; there’s real potential for accurate diagnosis. When we discuss prevention, we talk about different levels, so indeed secondary prevention, and early identification. It’s about getting it right, which is a bit more nuanced. It takes looking at specific pathways. One example we use is a new diagnostic test that identifies pre-eclampsia in pregnancy. This has significantly reduced the number of people being admitted and outpatient appointments, because it’s more accurate. So there are many examples. I definitely agree with you. We need to be taking a ‘getting it right first time approach’, and that is why we need to make it explicit that this is actually a sustainability agenda.”
April 2024 Health Estate Journal 47
Courtesy of the Centre for Sustainable Healthcare
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