Mobilising to NHS Net Zero

Dr Bethan Davies is a trainee in Geriatric Medicine in HEE KSS. She is currently working as Chief Registrar for Medicine and developing the Clinical Workstream of her Trust’s Environmental and Sustainability Steering Group. She tweets at @bethanldavies21

I have developed a secret obsession with walking aids. As an ST6 in Geriatric and Stroke Medicine, at least a passing interest might be expected, but I have spent a disproportionate amount of time of late investigating our Trust’s use of these items – how many are given out, their cost, who gets them and, crucially, what happens to them when the person they were given to no longer needs them.

Why? This year, to put my interest in sustainable healthcare to practical use, I am using my remit as Chief Registrar to establish the Clinical Workstream of our Trust’s Environment and Sustainability Steering Group. Our scope is to measure and reduce our carbon footprint in the areas of medical devices, pharmaceuticals, anaesthetic gases and clinical pathways – no small task! 

Where do walking aids fit into this? Medical equipment and devices account for 13% of the NHS carbon footprint – and a greater proportion in an acute trust¹. Crutches, walking sticks and frames have been identified by the Sustainable Development Unit as being among the top 20 items contributing to the NHS carbon footprint in this category². These items are made out of aluminium, the production of which is energy-intensive and contributes to other chemical pollution³. However, not only is aluminium itself repeatedly recyclable (and cost and energy-efficient to do so), but the walking aids themselves are reusable, potentially for years, if looked after properly.

A sustainable healthcare system meets the needs of today’s population without compromising the health and wellbeing of future generations. Sustainability in this context means taking into account the impact of a given clinical activity on the environment and society as well as finances; the ‘triple bottom line’⁴. At present, the NHS contributes an estimated 4% to the carbon footprint of the UK, as well as contributing to air pollution, water use and plastic waste⁵. 

In October 2020, the NHS made the exciting and ambitious commitment to become the world’s first ‘net zero’ healthcare system⁶. The report ‘Delivering a Net Zero National Health Service’ sets out the interventions that will be needed to achieve this, as well as an ambitious timescale, well ahead of the government’s own net zero target of 2050. Device reuse and refurbishment is one of the key interventions to reduce emissions from the supply chain and the summary of the report makes specific reference to ‘sustainable mobility aids’.

Back to walking aids. After much detective work, two stories emerged at my Trust. First, the good news that items issued to inpatients discharged from hospital are provided under a contract with a mobility aid company that enables return and reuse of equipment. When a patient has finished with an item, the company will collect it and, if in good enough condition, will return it to stock for reissue, with 80% of the cost refunded.  However, at present some items, mainly crutches, issued to patients for rapid discharge are in effect treated as single use items with no option for return and reuse.  In the last year, this amounted to 1452 pairs of crutches or 1.7 tonnes of aluminium (the weight of 2 polar bears) not being reused or recycled with an associated cost of £9K. There are numerous examples of Trusts calling for mobility aid ‘amnesties’ and when Mid Essex Hospital Services NHS Trust launched a return and reuse scheme for mobility aids, 2000 pieces of equipment were reused in the first year (with a resource saving of £25,000 as measured financially)⁷.

Walking aids are just one example among many where there is huge scope to make simple changes that can reduce our environmental impact, as well as saving money which could potentially be channelled into other ‘green’ projects. We all have a part to play in the transition to a net zero NHS. For geriatricians, awareness that older people face specific risks from climate change, being more vulnerable to the impact of extreme temperatures and weather events, make action in this area imperative⁸. Climate change is the greatest long-term threat to human health in the 21^st century⁹, but taking action and minimising the environmental impact of our activities offers potentially enormous health co-benefits – not just for patients, but for ourselves and future generations. The story of walking aids is far from over; incorporating the ‘single use’ crutches into a contract to allow them to be returned and reused will be the next important step on our journey to a greener future.

References

1. Carbon Hotspots Update for the Health and Care Sector in England 2015.  Sustainable Development Unit.  January 2016

2. Identifying High Greenhouse Gas Intensity Procured Items for the NHS in England.  Environmental Resources Management, Sustainable Development Unit.  January 2017

3. Gantau M, Pardey B, Agrawal M. Carbon footprint of aluminium production: emissions and mitigation. Environmental carbon footprint industrial case studies. 2018 197-228

4. Mortimer F, Isherwood J, Wilkinson A, Vaux E.  Sustainability in quality improvement: redefining value. Future Healthcare Journal. 2018. 88-93

5. Public Health England and NHS England.  Reducing the use of natural resources in health and social care. Sustainable Development Unit, 2018

6. NHS England and NHS Improvement. Delivering a ‘net zero’ National Health Service. NHS England and NHS Improvement. 2020

7. Mid Essex Hospital Services NHS Trust Sustainability Report 2018-19. Accessed 5 January 2021 <https://www.meht.nhs.uk/about-us-/sustainability/>

8. HelpAge International. Climate change in an ageing world. 2015.

9. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley et al.  The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises.  Lancet 2021; 397: 129-70.