Carbon reduction and Net Zero


Chronic diseases causing widespread suffering She next showed a graphic, on the right of which were chronic diseases causing widespread suffering and increasing demands on healthcare, adding that more and more patients were presenting today with multiple conditions to pathways designed to treat single conditions. Dr. Pinto said: “This list covers the six groups of conditions identified in the Government’s Major Conditions Strategy that account for over 60% of mortality and morbidity in England. On the left, you’ll see the things we need to do to tackle climate change.” She pointed out that by rapidly transitioning from burning fossil fuels to renewable energy sources, and reducing our car dependency, we would improve air quality. She said: “We saw the immediate benefits of this with respiratory conditions like asthma during lockdown. Air pollution can exacerbate or cause almost any condition – including many mental health disorders, particularly dementia. By transitioning to active and public transport we also increase physical activity, which is strongly linked to physical and mental health. Currently, half of children and around a third of adults are not active enough for good health. By reducing car-related infrastructure, we free up urban space for nature, and improve access to green space – which has wide-ranging physical and mental health benefits, while reducing flood risk and temperatures during heatwaves.” By reducing meat and dairy intake,


meanwhile, there was the opportunity to reduce cardiovascular disease, some cancers, and – coupled with increased activity levels – ‘the epidemic of obesity and diabetes’. Dr. Pinto told delegates: “Retrofitting homes helps ensure people don’t have to choose between heating and eating, are not living in cold, damp, mouldy conditions, or overheating during heatwaves.” Those to benefit most were the most deprived communities. ‘If done well’, she added, tackling climate change should not be a burden for those already struggling in our society, and has the potential to reduce health and social inequality, and improve everyone’s quality of life. Emphasising that sustainable care was ‘not in conflict with good care’, she said that it was in fact high, and possibly higher quality, care that ‘aligns with, and can help to deliver on, what people might consider competing agendas’ – social value, personalised care, and addressing health inequality. Stripping out waste and reducing demand can ‘help balance budgets’, while ‘almost invariably’, SusQI projects were either cost- neutral, or saved money. She said: “We found, even working with quite burnt-out staff, that this approach motivates and inspires – I think


The Sustainability in Quality Improvement (SusQI) approach.


because so many people are worried about the climate crisis, and are making changes at home. Some then feel those values have to be left at the door when they come to work. Being able to live your values at work energises teams, and supports staff wellbeing.” The Centre for Sustainable Healthcare’s case study library was ‘full of examples’ of successful SusQI projects. Dr. Pinto’s next slide showed an example, titled ‘Eliminating low value appointments from the patient care pathway’, which illustrated how – by eliminating just one routine appointment that had become unnecessary due to improved effectiveness and tolerability of treatment – a clinical team saved emissions equivalent to around 75,000 miles of driving and nearly £45,000 annually, and freed up staff to spend time with those who actually need them. While such successful projects showed what is possible, if they remained as individual projects, ‘they will not move the dial’. With ‘evidence of what works’, and multiple case studies, the need was to develop more effective frameworks to scale them up. Additionally, the speaker added, there


were a wide range of NHS initiatives ongoing with sustainability potential ‘for prevention, empowerment, lean pathways, and low carbon alternatives’, but ‘almost universally’, they were not explicitly incorporating sustainability. This was ‘a huge missed opportunity to maximise the potential of these initiatives’.


Good work going on but you have to ‘hunt for it’ Dr. Pinto said that while there was also ‘a lot of good work’ going on to provide guidance and training across major health institutions, one needed to ‘hunt for it’. She explained: “What I hear from NHS Boards is that they get lists of priorities and targets, but that sustainability is


nowhere to be seen. “If we’re not modelling embedding sustainability at the top, then how can we expect embattled provider Trusts to do so? Working with NHS organisations, we often see sustainability still being a side issue left to solitary sustainability leads and a few passionate individuals trying to fit it in around their day jobs. “This was noted in a Health Foundation


report last year, which described the reliance on volunteerism, and highlighted the need for dedicated time and resources for staff working on this.” From her experience, Dr. Pinto said she would add training to the overall formula. She commented: “Without training on how to identify hotspots, and where the biggest impacts can be achieved, what you get is recycling projects.” While recycling was important, the speaker


stressed that the overwhelming majority of environmental impacts occur before the point of use, adding: “We cannot recycle our way out of this. So, we don’t know everything about how to achieve Net Zero in healthcare, but we do know enough to progress a lot faster. Missing at a national and local level are clear, consistent, visible leadership and prioritisation.” Dr. Pinto said the priority was ‘to communicate more effectively – outlining honestly the risks we face, but also sharing a positive vision of how sustainability can improve our health and quality of life, linking explicitly to the issues people care about’. With the NHS employing around 1.3 million people, it should, she said, be possible to mobilise ideas and expertise, and to ‘make a big difference’. She added: “Secondly, we must embed sustainability in a highly visible way from top to bottom. It should be embedded in our accounting, our decision making performance, and in staff training and appraisal. The Royal Navy is making climate change training


January 2025 I www.clinicalservicesjournal.com 39


Courtesy of the Centre for Sustainable Healthcare


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