Frances Mortimer: Going green saves money in kidney care

Frances MortimerThe quest for financial savings was a recurring theme at the British Renal Society/Renal Association (BRS/RA) annual conference last month, and the green nephrology programme had plenty to offer.

At last year’s BRS conference, deputy ward manager Libby Critchley was one of the first people to sign up at our green nephrology stall. At that stage, the programme mainly comprised an email list and a promise of more activity in the future, as we waited for the arrival of Dr Andy Connor, the first “green nephrology fellow,” in September.

This year, Libby was back, presenting on the Chester kidney unit’s waste reduction project to an audience that included the “renal tsar” (Dr Donal O’Donoghue) among other eminent figures.  The project has reduced paper consumption on the unit by 75%, and has led to the trust stopping sending out paper lab reports (which were already available online) – saving many thousands in staff costs.  In the unit, reducing the patient care plan from 14 to 6 pages has been a particularly popular move with nursing staff, releasing more time for direct care. 

With the green nephrology fellow now 9 months in the post, Libby is now one of many green nephrology local representatives covering 79% of kidney units in the UK so far (see  As well as participating in the national sustainability survey, the local representatives have been feeding into case studies on water recycling, waste management, heat exchangers for dialysis machines, telephone clinics for renal transplant follow up, and more.

Back at the green nephrology reception (hosted by the programme sponsors, NHS Kidney Care), another local rep, Simeon Edwards described how the Cornwall team’s green action plan has saved £32,000 in the last year on food, laundry, transport, and procurement. Leicester nephrologist Rachel Westacott reported the successful introduction of waste segregation in their procedures room, with plans to extend this across the dialysis unit. This saves both carbon and money by reducing the amount of waste entering the clinical waste stream and therefore being incinerated (at a cost of approx £400/tonne), instead diverting it to landfill (£90/tonne).  Waste reduction and recycling carry even greater benefits, and staff nurse Mary Thomson from Fife had many good examples to share.

The CKD Electronic Advisory Service, presented by Dr John Stoves from Bradford, supports a rich online interaction between GPs and hospital kidney doctors, who are able to give advice on the management of individual patients in primary care.  This effectively reshapes the patient pathway, avoiding the need for many referrals, with their attendant travel, inconvenience and duplications.  Potential cost (and environmental) savings are considerable, but depend on local tariff negotiations with the PCT.

When asked whether cost saving or greening was a more powerful message when engaging with colleagues, the green nephrology representatives were clear: cost saving can be viewed negatively by staff, while greening is seen as a positive agenda.  But all agreed that quantifying the cost savings is also very important, particularly when management support is required.

I couldn’t help noticing the enthusiasm of our renal tsar, who managed to plug green nephrology in pretty much every speech he made at the conference.  Pressed for a quote, he was happy to oblige:

“Thanks to Green Nephrology, sustainability is now regarded as an integral part of quality, the work over the past year has caught the imagination of the whole kidney community and has launched a social movement to provide better, greener and leaner kidney care. Waste in the NHS diverts resources from healthcare. Everyone has a part to play, patients as well, in achieving affordable and sustainable high quality care for all. green nephrology is leading the way.”  Dr Donal O’Donoghue, national clinical director for kidney services, Department of Health.

Green Nephrology background:

Kidney care has this year become the first clinical specialty to address its environmental impact, with the creation of a “green nephrology” programme.  The aim of the programme is to support the transformation to sustainable kidney care, harnessing the many benefits to clinician engagement, care quality and cost efficiency. It is delivered through a partnership between the Renal Association, the British Renal Society, NHS Kidney Care, the NHS Sustainable Development Unit, the National Kidney Federation, the Association of Renal Industries and Baxter Healthcare, led and supported by the Campaign for Greener Healthcare. In September 2009, renal trainee Dr Andrew Connor took up post as the first “Green Nephrology Fellow”, funded by NHS Kidney Care.

Dr Frances Mortimer is medical director of the Campaign for Greener Healthcare (CGH), where she is the driving force behind the Sustainable Specialties programmes, and has led the development of the CGH Principles of Sustainable Clinical Practice.  She continues part time clinical work in the Oxford Kidney Unit, having left specialist training in renal medicine in 2008 to work in sustainable healthcare.