16 Mar, 12 | by BMJ
“The very beginning” has famously been advocated as “a very good place to start,” but when it comes to sustainability, this doesn’t seem to be such an easy mantra to follow. For one thing, it’s not altogether clear where “the very beginning” is, and for a second, we in the NHS are so busy trying to keep up with the here and now, that hunting around to find the ideal starting place seems out of the question.
Well, here is an altogether easier and more accessible approach—let’s start at the NHS sustainability day audit… NHS sustainability day is coming up on the 28 March, and there are a whole host of reasons why this is a good opportunity for anyone who works in the health service to get involved.
I have recently been confronted with the question of how to bring this core health issue into the mainstream in a new work environment. Starting work as an FY2 at a large GP practice in rural North Yorkshire, I was keen take forward the sustainability agenda. While one or two of the 12 or so GPs that I met in my first few weeks showed some interest in the topic, I found that the most tangible way to address and highlight the benefits of sustainability has been to carry out a brief audit of the practice. I’ve learnt a lot through doing this, and I’ll present the results along with calculations that I’ve made about cost and carbon savings that could be made through technological and process improvements at a practice meeting in two weeks.
The NHS sustainability survey is an accessible and easy way to begin because it provides a framework from a reputable source (NHS SDU and UCLH) and a guideline that can be used to audit against. It’s quick to carry out, and could easily be completed by 1 or 2 people in a couple of hours in most GP practices, wards, and health centres. Even if you can’t answer every question clearly, answering and investigating as far as you can gives really useful pointers about where energy and resources are used, and how savings might be made.
Yesterday evening I was tasked with speaking at a rural GP practice in North Yorkshire to a group of healthcare providers, including clinicians, a practice manager, and an information systems manager, about sustainability in the NHS. At the opening of the talk, we heard from a number of the GPs present about what questions they have about NHS sustainability. One issue that recurred was a lack of tools to take action locally.
We all know that health is influenced by far more than access to high-quality health services, and that health cannot be sustained unless we have access to clean air, clean water, space (physical, temporal, and cultural) for physical activity and a healthy environment. Nonetheless, for those of us working in the healthcare system, contributing to protecting these “social determinants of health” can seem like an overwhelming challenge.
As I opened yesterday’s talk touching on issues of resource scarcity (e.g. peak oil), climate change and its inequitable health effects, and the increasing prevalence of chronic diseases (e.g. obesity), I hoped that this would not be paralysing, but motivating. It’s important to remember that future health threats do not exist in all or nothing situations. Every little does count, because, though we cannot prevent all negative health effects, from air pollution and chemical pollution to food price rises and sea level rises, we can reduce the severity of the problems. Just as we don’t give up hope on a patient who is failing to quit smoking or take their medication as prescribed, we have to continue to chip away at these problems, and even achieving a small change (fewer cigarettes per day, increased concordance, or reduced severity of climate change) will provide health benefits.
The second half of our evening on sustainability focused on the question that much of the audience had come with: what can we do? The work of the NHS Sustainable Development Unit highlights the extent of the ecological footprint of the health service and the need to measure it and to manage it. Meanwhile, the Green Nephrology project, provided a very practical example of clinicians and managers identifying ways to modernise care pathways and technologies to provide more sustainable, high quality, cost-effective renal services. For a GP audience, the example of the use of teleconsultations to review patients with chronic diseases, and the principles of sustainable healthcare (including promoting care closer to home, patient empowerment, and preventative medicine) were particularly relevant.
After all this discussion, I wanted to leave the audience with practical steps that they could take. The upcoming NHS Sustainability Day of Action provides an excellent opportunity, and the GP practices are now planning to join the national survey. As well as helping health professionals and managers to identify where savings can be made at a local level, results of the survey from around the UK will be compiled and published by the organisers.
So for anyone who wants to make their contribution to a healthier society and a sustainable healthservice, here’s your first step: http://www.nhssustainabilityday.co.uk. Happy Sustainability Day!
Sarah Walpole works as a clinical teaching fellow in sustainable healthcare at Leeds Medical School and an FY2 doctor at Whitby Group practice in North Yorkshire.