A global threat

What role can UK doctors play in the fight against climate change?

THE price of ignoring the issue of climate change was spelled out in dramatic detail at a recent UK meeting of healthcare professionals. If the problem is not tackled then it will not only bring a “global health catastrophe” but has the potential to “threaten global stability and security”.

That is the view of some of the most prominent names in healthcare, including former president of the Royal College of Physicians Professor Sir Ian Gilmore, Professor Anthony Costello (Director of the UCL Institute for Global Health), BMJ editor-in-chief Dr Fiona Godlee and Lord Michael Jay, chair of international health charity Merlin.

The group signed a statement at the high-level London meeting in October 2011 calling for action. It stated in no uncertain terms that complacency “will be paid in human lives” and that tackling climate change could “significantly cut rates of premature death and disability for hundreds of millions of people around the world.”

The statement makes some tough demands, including calling on the EU to reduce greenhouse gases by 30 per cent by 2020 and for an end to the building of new coal-fired power stations.

At first glance, climate change may not seem like an urgent health issue but the statement outlines how rising temperatures and weather instability will lead to more frequent and extreme weather events, loss of habitat and habitation, water and food shortages, spread of diseases, ecosystem collapse and threats to livelihood, potentially triggering mass migration and conflict within and between countries.

This is echoed by a report published in The New Scientist in 2003 that says more than 1,500 people died prematurely during the heatwave in England that year.

NHS impact

In the UK, one look at the scale of NHS emissions shows its considerable environmental impact. NHS England’s carbon footprint is estimated at 21 million tonnes of CO2 equivalent (roughly the same as that of Croatia), while the figure for NHS Scotland (estimated in 2004) is around 2.6 million tonnes – about the same as the small Caribbean island of Martinique. By comparison, greenhouse gas emissions for the UK as a whole are 520 million tonnes.

In January 2009, the NHS in England pledged to become one of the country’s leading sustainable and low carbon organisations. It set itself the ambitious goal of meeting the government target of an 80 per cent reduction in carbon emissions by 2050.

The pledge coincided with the launch of a new carbon reduction strategy, Saving carbon, Improving health which calls on the NHS to “set an example” for the rest of the UK. Dr David Pencheon, Director of the NHS Sustainable Development Unit, said: “Carbon reduction is something that needs to extend to every part of the organisation. Everyone who works for the NHS should be thinking about reducing their carbon footprint as part of their day job.”

Taking action

The 2011 report acknowledged that meeting carbon targets would be a “huge challenge” for the NHS in England but goes on to identify how organisations can make changes in three main areas of energy, travel and procurement.

Action points include encouraging every NHS staff member to take responsibility for carbon reduction; asking NHS organisations to create a strategic plan to develop more renewable energy sources; minimising waste through efficient procurement; and minimising staff, patient and visitor travel.

Similarly, in October 2009 Scottish health secretary Nicola Sturgeon launched the report Carbon Footprint of NHS Scotland (1990-2004), just two months after the Climate Change Act (Scotland) 2009 came into force with the aim of cutting emissions by 80 per cent by 2050.

The report recommends researching ways of identifying and tackling key “carbon hotspots” such as patient travel and pharmaceuticals and improving ways of measuring carbon emissions within the NHS and its suppliers.

In 2008, NHS Lothian was among the first Scottish health boards to sign up to the Carbon Management programme and receive a £700,000 grant from the Central Energy Efficiency Fund. The programme provides tools for analysing energy consumption and workshops to show staff and managers how to effectively use carbon management in their day-to-day work.

The board was subsequently awarded the Carbon Trust Standard in March 2011 for having cut its emissions by 5.3 per cent in the previous two years. New energy-saving measures included using recycled rainwater in the laundry at one hospital and installing solar panels to preheat domestic hot water at a new health centre. The board also started an energy saving drive in 2011 to encourage staff to be more energy efficient. The board hopes to reduce its carbon footprint by four per cent in each of the next five years which would unlock funding of more than £600,000 that could be reinvested in clinical services.

Practical steps

Practical guidance is available for NHS decisionmakers in the 2009 guide Sustaining a Healthy Future – Taking action on climate change [Special Focus on the NHS] which offers “action checklists” on how they can reduce their organisation’s carbon footprint. It offers tips on how to become a “Good Corporate Citizen organisation” through measures such as “increasing green spaces and plants within the care environment”; encouraging health visitors to promote the benefits of walking and cycling; “redesigning patient care and treatment pathways” to make them more environmentally friendly; and holding a “carbon audit” to involve friends and family in the fight against climate change.

Various committees, schemes and strategies have been devised by the NHS in recent years to cut carbon emissions. The NHS Sustainable Development Unit, established in 2008, was one of the first official bodies set up to monitor the health service’s carbon footprint and contributed to the creation of the NHS Carbon Reduction Strategy. The 2008 Carbon Reduction Commitment is a mandatory energy efficiency scheme that will affect the majority of NHS hospitals. Compliance is rewarded with a top spot in annual performance league tables while penalties may be handed out for failure to comply.

Elsewhere, the NHS Reuse Programme was set up by University College London Hospitals NHS FT to reuse old office furniture and equipment across the NHS instead of it being thrown away or put into storage.

Technology also has a role to play in reducing carbon emissions. Over the next five years, the Department of Health (DoH) in England says it will work to bring telehealth and telecare to millions of people with long-term conditions. The telehealth initiative involves patients using electronic equipment at home to monitor vital health signs such as pulse, weight and blood oxygen levels which can be read remotely by health professionals. Telecare involves installing electronic equipment in patients’ homes to support independent living. Examples include personal pendant alarms worn around the neck, door alarms and bed sensors to detect unexpected movements.

Both programmes can help minimise travel to and from practices and hospitals as well as easing pressure on other resources. The DoH admits take-up so far has been slow in England with only around 5,000 telehealth users signed up and 1.5million pieces of telecare in use. But hi-tech healthcare is also increasingly being used in other parts of the UK and it’s hoped it will bring financial, environmental and patient care benefits for the NHS.

Joanne Curran is associate editor of FYi