The first BMJ Net Zero Clinical Care conference took place on 10th October 2023. After a year of escalating climate consequences, there has been a strong sense of urgency amongst healthcare professionals engaged in the climate movement, for something such as this. An event that enables us to come together and discuss what a Net Zero NHS really looks like, and what we can all do, collectively, to bring it about. Most importantly, amid rising anxiety and negativity about our future, an event that creates space, time and a positive vision of what the sustainable future of healthcare could be. In that respect, this was a long-awaited conference, but even more so, having been (rightly) postponed a few months previously due to industrial action.

Over 1000 healthcare colleagues joined online from 50 countries, whilst I was one of the lucky ones who had made it off the waiting list to be able to attend in person. The fact that there was even a waiting list speaks to just how much interest and engagement there was behind this event.

In the build-up to the event, I wasn’t sure what to expect:

Would it feel impactful?
Can we make a difference?
Or would it feel trivial in the face of what is required?

But I spent the entire day excited by the energy, the sense of collective purpose, and the inventiveness with which healthcare professionals are approaching the problem of healthcare sustainability. I left with many ideas to take forward both in my own centre and as a member of the recently formed Royal College of Radiologists’ ‘Sustainability in Radiotherapy’ Working Group (a multidisciplinary group of healthcare professionals representing the different constituents of a radiotherapy department, formed with the purposes of raising the profile of environmental sustainability  and supporting radiotherapy teams to adopt more sustainable ways of working).

The ‘12 Cs of sustainable healthcare were described by Dr Richard Smith of UK Health Alliance on Climate Change and former editor of the BMJ, in the closing remarks of the day, and, in the days that followed I reflected deeply on which of these resonated most with me.

The event itself was an important platform for many of the C’s Smith describes but the ones that spoke most obviously to me were ‘Collaboration’ – defined as the action of working with someone to produce something – and ‘Contagious’ – spread from one person or organism to another, typically by direct contact.

Effective collaboration between disciplines, specialties, with industry, patients and the public are crucial to the success of our efforts to achieve a low-emission healthcare system. The importance of collaborating with patients, was a key reference point in this conference, as evidenced by the central patient involvement in the Northamptonshire Integrated Sexual Health and HIV service’s report on their streamlined pathway reducing face-to-face appointments for stable patients with HIV. The key reflection from this was that we may underestimate or neglect patient preferences, unless we specifically ask them what they are. And we may patronise  patients by assuming they aren’t also interested in the climate emergency. Collaborating, and in fact co-producing with our patients is valuable for success in this space.

Moreover, events such as this also facilitate connections between healthcare colleagues in the sustainability sphere. For example, as a result of the conference, I am now in touch with one of the co-leads of the Centre for Sustainable Healthcare Palliative Care network, and I’m sure there are many areas in which we could fruitfully collaborate going forward.

However, it is not always easy to collaborate when the ethos of sustainability is not yet fully embedded in our healthcare system. For example, the ‘Sustainability in Radiotherapy’ group mentioned above only has half of the activity of an oncology department under its remit with oncologists also delivering systemic anticancer treatment. Yet medical oncologists, who specialise in this, come under another Royal College, and do not have an analogous group with which we can collaborate. And yet there are so many other elements to consider: oncology nursing, oncology pharmacy, cancer surgery, imaging and more. As patient care benefits from stepping out of our departmental silos and working in an interconnected way, so too does this push towards a sustainable, greener system.

This is where contagion comes in: we must bring all institutions and professional bodies along with us in making sustainability a core consideration if we are to decarbonise the NHS by 2040. We need to find a way to reach the ‘tipping point’ of momentum building – it seems, and I hope, that this conference was part of that work.

Contagion also applies to approaches within healthcare sustainability. As the ‘Sustainability in Radiotherapy’ group considers how we can be most impactful within our field, the other specialties ‘spreading’ their experience can help direct our thinking, which is a key take away from the conference

As an example, I found the Royal College of Emergency Medicine’s GreenED and the Greener Kidney Care initiatives that were presented during the conference inspiring in the scale of their ambition: both approaching the environmental impact of their specialties holistically and providing a framework to empower members of their communities to act locally. Greener Kidney Care is the result of an alliance between the UK Kidney Association, the Centre for Sustainable Healthcare, and the Sustainable Healthcare Coalition; their work has included many stakeholders, including a liaison with industry on the environmental impact of procurement, illustrating the value of collaboration. All great food for thought and highlights that we lead stronger when we lead together! Moreover, hearing about the model of primary care embodied by Frome, Somerset:  a ‘wellness’ service that is an integral part of a community working together towards sustainability, was also truly uplifting. The ‘co-benefits’ of this model in creating a more cohesive community remind us that this is not about sacrifice, we can become sustainable whilst also living happier and more fulfilled lives. Whilst it was less obviously applicable to the secondary care setting in which I work, an important part of leadership is recognising how different parts of the system are working towards our shared goal – and the understanding that allows us to support each other, across boundaries, in this work.

Underlying this all is the consideration of ‘Capacity’, another one of Smith’s core ‘C’s, and the one that seems both pressing and challenging. Many I spoke to at the event were working on healthcare sustainability unpaid and in their free time; the extent of clinical involvement and whether there is funded protected time specifically designated for sustainability varies across trusts and regions. But as we all know, the NHS workforce is overstretched and healthcare professionals are vulnerable to burnout: we cannot continue to rely on goodwill as the need for this work grows. Scaling up capacity for sustainability initiatives is not only an ethical responsibility but also a strategic imperative: our hospitals are as vulnerable to the threats posed by climate change as anywhere else and mitigating this will give rise to more resilient healthcare systems, and cost savings in the long run.

The NHS Net Zero commitments, the initiatives from practices and professional bodies described above, the BMJ’s initiatives including this conference: all these point to a good start and an important aspect of generating energy and momentum in this long road ahead.

But if we are truly serious about sustainability (and we should be) and about meeting the health needs of the present without compromising future generations, building the capacity to embed sustainability throughout our health system must be seen as a leadership priority.

The climate crisis is a health crisis: patients and our systems will suffer as the consequences of climate change escalate, even as the healthcare system’s carbon emissions continue to contribute to the problem.

Organisations and system leads cannot pay lip service to the urgent action of building a Net Zero NHS – our people need time, resources, and support to build on the important work that has already begun and was rightly celebrated during this event.

Author

Dr. Sara Lightowlers

Sara  is a specialty registrar in Clinical Oncology and is currently undertaking a clinical research fellowship at the University of Cambridge. She is chair of the ‘Climate Safe Oncology’ working group at Cambridge University Hospitals NHS Trust and a member of the Royal College of Radiologist’s Radiotherapy Board ‘Sustainability in Radiotherapy’ working group. Outside of medicine, she runs a campaign group as part of the Mothers Climate Action Network, and is a member of Cambridgeshire Parents for Sustainable Travel.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: My PhD fellowship is funded by Cancer Research UK and I also have grant funding from Breast Cancer Now.