A climate to fear: Reflections on “Sustainability: a little less conversation a little more action please” plenary presentation at FMLM international conference 9th November 2022 by Astrid Etherington

For many years my environmental conscience has steered my personal lifestyle choices: I don’t eat meat, I recycle, and I use public transport. However, it is only recently, after attending “Sustainability: a little less conversation a little more action” presented at the Faculty of Medical Leadership and Management conference (2022) that I have started to seriously consider the environmental impact of my professional life. The jarring figures presented by Professor Hugh Montgomery, Professor of Intensive Care at UCL, prompted me to take stock and evaluate what part I could play in delivering more sustainable healthcare, and my role in influencing the organisations I work for. The devastating consequences of our continued carbon emissions will reveal themselves during the span of my career. The time to make meaningful change is now and I feel compelled to take action as an emerging leader.

In the opening minutes of Professor Montgomery’s emotive talk, we heard that in 2019, prior to the COVID-19 pandemic, humanity burned 245, 031kg of coal a second. The massive consumption of greenhouse gases since 1998 has resulted in energy gains to our atmosphere that are the equivalent of 48.8 million Hiroshima bombs. Even if all emissions terminated immediately, the heat trapped will remain for thousands of years. The startling figures emphasise the scale of the issue and the urgent need to reduce our global greenhouse gas emissions now. Radical climate action that healthcare systems need to take I Professor Hugh Montgomery FMedSci – YouTube

The powerful imagery used by Professor Montgomery, reminded listeners of the consequences of rising temperatures on our planet – sea and land ice are melting, and sea levels are on the rise. On one slide, extreme weather events that have occurred over the last year were displayed together. For me, the image of the empty river Po, which supplies 20% of Italian agriculture, particularly struck a chord. Italy’s River Po drought: Rome declares a state of emergency in five northern regions | Euronews

Even if we stopped emissions today, climate change would continue its current trajectory for millennia. Professor Montgomery laid bare the devastating consequences of our carbon consumption such as unliveable heat, species extinction and population displacement, which would ultimately reduce Earth’s capability to sustain human life. Without urgent and significant action, we will see these effects in the next 30 years.

We are compelled to act now both professionally and personally, “to secure a liveable future”. The remainder of the session explored meaningful actions we should consider as leaders within healthcare organisations and shone a spotlight on the good practice already happening to reduce the environmental impact of healthcare.

It was interesting to hear from Dr Dominique Allwood, Chief Medical Officer at UCL, that whilst most healthcare workers agree that we should be working in a way that supports the environment, most of us do not feel this is the reality. If sustainability is a core value to healthcare professionals, achieving greater organisational alignment with these values will move us closer to our Net Zero target (but also improve the engagement and motivation of our workforce. This is something for us to consider as healthcare leaders. https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/)

Healthcare organisations functioning as “anchor” institutions was a particularly thought-provoking concept touched upon during the presentation. NHS organisations are rooted in community, making them well placed to initiate positive societal impact by adopting more sustainable practices and influencing the health and wellbeing of the communities they serve. To highlight the dangers of air pollution, Great Ormond Street Hospital closed the road outside the hospital and in July 2022, the NHS became the first health system to incorporate a net zero target into legislation. To facilitate this, every leader should strategically consider the environmental implications of healthcare policy and service delivery.

How do healthcare leaders work towards this ambitious target? Dr Allwood suggests we need to focus our leadership behaviours on innovation, implementation, and impact. We need collaboration at scale, there is no benefit to competition in this area. We need to engage everyone in this discussion and in implementing changes. An example that immediately came to mind was quality improvement projects. Every doctor in training engages in quality improvement annually to progress. If we consider carbon emissions as well as care and cost when implementing quality improvement this could be a powerful way of making significant changes on an individual level. An example given by Dr Allwood was rationalising cannulation of patients attending ED – a simple intervention leading to significant cost and carbon emission reductions by reducing non-recyclable waste. Care, cost and carbon should be the three pillars to our decision making when planning and transforming service delivery.

It was encouraging to hear that it is not just the public healthcare sector that are committed to reducing carbon emissions, but also private healthcare companies like Bupa. Ian Culligan, Head of Health and Environment Insight outlined the “Mission Accelerate” initiative which intends to drive rapid action in making their healthcare practice more sustainable. They have appointed sustainability champions to reduce the environmental impact in each clinical facility and motivate colleagues to follow suit. He summarised their “quick wins” policy which involves providing toolkits to their organisations that outlines strategy such as reducing PPE consumption. Change can be slow in healthcare, but small-scale modifications implemented rapidly can snowball, while bigger projects involving service redesign take longer.

Bupa is launching a one stop model for cancer care which not only is beneficial for patient outcomes but also reduces travel costs, administration and has a net effect of reducing their carbon footprint. Reducing environmental impact aligns with improving efficiency in terms of both cost and timeliness of interventions and treatments, with an overall net benefit to both service providers and users. A further example was expanding their chemotherapy at home programme – reducing both carbon footprint from travel and delivering more patient centred care.

The session ended by reimagining the principle of “first do no harm” in an environmental context. With the shadow of climate change growing larger, it’s vital that the interests of the patient and the environment are aligned and that a consideration of both is implemented. We need to enter a dialogue with our patients, perhaps facilitating a virtual consultation is more convenient for the service user as well as offsetting the carbon consumption associated with travel. If two interventions have an equivalent chance of benefit, can we choose the lower environmental impact intervention? This might be the conservative approach. This might mean educating patient in the link between health and the planet. By embedding this logic into our everyday practice, we can start to drive the changes needed to save our planet.


Astrid Etherington

Astrid is currently a HEIW Welsh Clinical Leadership Fellow working with the GMC. This year she is focusing on the role of regulator in supporting compassionate leadership within a pressurised system. Astrid is a haematology specialist registrar based in Cardiff with an interest in organisational culture and improving wellbeing amongst the workforce. She is currently working towards a postgraduate certificate in professional practice in healthcare.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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