SUSTAINABILITY
to atmosphere, and breaks it down into harmless nitrogen and oxygen. Such schemes are likely to be watched closely by others.”
Access to open space has been shown to really benefit mental health. “There’s also insufficient thought given
to accessibility to when it comes outdoor space, with a lack of understanding of its ‘power’ – for instance for growing food, and the benefits for people in learning how to grow their own food or herbs. We found instances where there were fruit trees on a hospital site, and the fruit was just being thrown away.”
Accessibility of green space Back on access to outdoor space, and Inenco’s experience was that there was ‘a huge split’ between acute and community Trusts – because a number of acute Trusts had ‘limited space, and not very much green space’, and could therefore struggle with ‘delivering’ biodiversity-wise. Beth Goodwin said: “They’re going to be looking at roof space – already in high demand, window boxes, or really limited areas. In contrast, many community sites have sprawling estates, including some green space not yet re- purposed. Access to green space can be so beneficial; studies show a reduction in cortisol levels from people spending time in nature. One element we discussed with an acute Trust looking at buying a new hospital site was identifying a larger plot of land than they actually needed, and then encouraging the designer to incorporate open space.”
Anaesthetic gases I asked about other interesting findings in Inenco’s liaison with Trusts on their Green Plans. “The Global Warming Potential (GWP) of anaesthetic gases has assumed ever greater importance,” Beth Goodwin explained. “Such gases have been an explicit target in the NHS Standard Contract for some years, with particular pressure to reduce the proportion of desflurane to sevoflurane. The latest Standard Contract also enables
Trusts to report on their isoflurane consumption; indeed there are a number using large quantities of isoflurane that were previously looking worse in their data than they needed to. Desflurane is the anaesthetic gas with the highest GWP.” Beth Goodwin stressed that anaesthetic gases could account for 6-8 per cent of some acute Trusts’ carbon footprint, with the impact likely to increase – because healthcare providers were now starting to record their use of Entonox, which is less damaging, but used in significantly higher quantities, particularly in Maternity units.
Potential solutions being explored I asked how Trusts could reduce anaesthetic gas-related carbon emissions. She said: “Starting with desflurane and sevoflurane, we have a really broad view of who’s doing what. Some Trusts mandate that they will no longer purchase desflurane, but others are nervous about losing their established anaesthetists, or imposing rules around what they can do clinically. Most, however, are now looking at the evidence critically, and discussing with their lead anaesthetists the fact that some of the established views – for example that desflurane might be better clinically – are not necessarily correct. Many are now actively encouraging a reduction in desflurane’s use, and within the next couple of years I believe most Trusts will ban it.” The situation with Entonox was ‘rather
different’. Beth Goodwin said: “Its use is really well established – people expect to have gas and air when they’re delivering, and it’s something you can’t really remove from a clinical standpoint. However, Newcastle upon Tyne University Hospitals NHS Foundation Trust has been piloting a Medclair Mobile Destruction Unit which essentially takes in the emitted gas and air, so the Entonox isn’t being released
Harnessing technology What about other notable areas where NHS Trusts were enjoying particular success, in line with their Green Plan targets? Beth Goodwin said: “As with the Newcastle example, it’s about what people can do innovatively using technology. Where people have engaged with technology solutions, there have been some really positive impacts. Modernising the digital side of the NHS will be crucial. Clearly the pandemic has seen a significant reduction in carbon footprint with the move to working from home. One challenge is continuing with this, and ensuring that the impact is not lost, although changing work patterns must not negatively affect patients or service-users.
Earlier intervention “We also need to be thinking about earlier intervention in a way that doesn’t require patients to travel to sites. This is partly about health education, but needs to be done nationally. What Trusts are doing though – with the ICSs now in place – is forming closer links with others. We’re seeing now that when someone sees a doctor, the clinician is considering other things. So, if someone has a mental health appointment, the doctor or nurse also discusses their physical health. “We’re also seeing more people going
into the community on vans to undertake blood or diagnostic testing. Where I live, people have been having lung health tests at the local supermarket. I’m expecting community healthcare sites to start seeing this kind of remote treatment van coming from their local acute hospital to do sessions, or potentially sharing some of their space with consultants from the acute hospital, so people can see them closer to home. We’ve also seen a move towards follow-up visits in the community, while Trusts have been looking at whether they can release particular patients earlier, and safely manage some of their recovery at home. I think that has really pushed some of the boundaries.”
Telehealth
Beth Goodwin said that against this backdrop, Inenco envisaged greater opportunities for telehealth. She said: “We’ve already seen its effectiveness – even in some unexpected areas – for example physiotherapy, where you might think you would absolutely need the physiotherapist with you.” She pointed out that, in many areas of work life, with less travel, employees were saving considerable time, and working more efficiently. She said: “Many of the lessons from the ‘corporate world’ could
May 2022 Health Estate Journal 39
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76
