Authors:
Dr Daniel Hattam – Junior clinical fellow at Marie Curie Hospice, Cardiff and the Vale
Dr Tiffany D’Silva – Junior clinical fellow at Marie Curie Hospice, Cardiff and the Vale
Dr Siwan Seaman – Consultant in Palliative medicine and medical director at Marie Curie Hospice, Cardiff and the Vale
Dr Kate Crossland – Speciality Doctor in Palliative medicine (Guys’ and St Thomas’ trust) and co-lead of the Palliative Care Sustainability Network
Under the NHS Net Zero goals (which aims to have net zero direct and indirect emissions by 2045), we as healthcare professionals and organisations are increasingly being asked to confront our work-based environmental impact [1]. In a specialty focused on compassion, dignity and holistic care, we believe this is intrinsically part of our responsibility, both to our current, but also our future patients, to ensure we are taking care of our planet. This is ever more urgent with climate change being increasingly linked with adverse health outcomes both on morbidity and mortality [2].
At Marie Curie Hospice, Cardiff and The Vale, we had the opportunity to explore how we could raise awareness and drive organisational change to become more environmentally friendly.
Photo 1: The lovely view from the Marie Curie Hospice in Penarth
Photo 2: Some of our Green Group members who worked towards the Bronze Award. From the left: Dr Tiffany D’Silva, Dr Siwan Seaman (medical director at the hospice) and Dr Daniel Hattam.
Why sustainability in Palliative Care?
Palliative Care is uniquely placed on the matter of sustainability. As with any medical specialty we rely on energy-intensive buildings, single-use plastics, pharmaceuticals and medical devices. However, our ethos is inherently values-driven: proportionality, reflection, and avoiding interventions that do not confer benefit.
Sustainability, as we came to realise, aligns naturally with these principles—especially when organisations are given a clear and realistic framework to engage with it.
The PallCareSusNet Greener Palliative Care Awards
In 2025, Marie Curie Hospice, Cardiff and The Vale was accepted as one of ten UK pilot sites (and the only site in Wales) to undertake the Palliative Care Sustainability Network (PallCare SusNet) Greener Palliative Care Awards [3]. PallCare Susnet is a collaborative group of healthcare professionals who are passionate about developing and inspiring sustainable practice across both NHS and hospice sites in the UK.
The Bronze Award deliberately centres on increasing awareness at an organisational level with the silver and gold awards moving further to embedding organisational change and specific target-set improvements across multiple domains.
The call to action – founding our “Green Group”
Our first step in tackling the Bronze Award was to form a multidisciplinary sustainability task force, dubbed the ‘Green Group’. It was very encouraging to see how many people within our organisation across the MDT were keen to engage and already thinking of ideas to improve our practice prior to our acceptance onto the award.
Our group included colleagues from:
- Medicine and nursing
- Physiotherapy and occupational therapy
- Estates and maintenance
- Catering
- Volunteers
- Fundraising
This breadth was transformative giving us ‘Green Champions’ in all departments across the hospice. Sustainability issues surfaced that would never have emerged from a single professional lens, and practical solutions often came with them.
Small projects, real impact
Although the Bronze Award does not require major change, awareness quickly translated into action. Three quality improvement initiatives in particular gained traction:
- “Gloves Off” campaign
Based on the Royal College of Nursing’s Gloves Off campaign this quality improvement project highlighting over usage of clinical glove use led to a significant reduction in unnecessary plastic glove consumption. Alongside environmental benefits, the project prompted wider reflection on infection control practices and professional habits.
- Syringe driver battery policy
By reviewing and updating our policy on battery use in syringe drivers, we were able to safely increase battery utilisation and reduce waste—an example of how sustainability and patient safety can coexist rather than compete.
- Donating out-of-date stock
Out-of-date (but usable) clinical stock was donated to Ukraine, reframing “waste” as a resource and reinforcing a culture of stewardship and responsibility beyond our own organisation.
Photo 3: Examples of out-of-date stock, which is collected on the wards and then sent to Ukraine thanks to our hard-working nursing staff.
What we learned
Firstly, the power of shared ownership which enabled meaningful change at the hospice. Involving colleagues from clinical, therapy and estates teams meant sustainability was considered across the whole hospice (eco)system, from bedside care to building infrastructure. This breadth not only generated more practical solutions, but also fostered organisational buy-in and legitimacy, with sustainability becoming increasingly embedded into our way of working at Marie Curie Hospice, Cardiff and The Vale.
Secondly demonstrating that sustainability goes hand-in-hand with holistic palliative care. Staff engaged more readily when sustainability was discussed as part of caring responsibly for patients, communities and future service users—not as a competing priority.
Lastly, seemingly small and often simple things make the best place to start. Even small individual actions, like using fewer plastic gloves, when multiplied across an organisation can create seismic changes which benefit our wider world, and by extension our patients.
So what next?
The Greener Palliative Care Award bronze level is open to all palliative care organisations to work towards [3]. Joining the Palliative Care Sustainability Network helps connect to others working towards similar goals [4].
Once achieved, an organisation keeps its Greener Palliative Care Award for 3 years. After this, it will need to demonstrate it is continuing to work at that level, or hopefully it has progressed to the next award level.
Ultimately the goal is that environmental sustainability is ‘business as usual’ across our organisation. We’re delighted to have been part of the pilot work, and are keen to share our journey with others to grow progress across both palliative care and healthcare more widely.
If you are interested in learning more about the Greener Palliative Care Awards, please visit the websites listed below or alternatively you can email pallcaresusnet@gmail.com if you are interested in joining the awards scheme. If you want to hear more about our specific experiences as a pilot site at Marie Curie Hospice (Cardiff and the Vale) you can email siwan.seaman@mariecurie.org.uk.
References:
- NHS England. Delivering a net zero NHS [Internet]. www.england.nhs.uk. 2022. Available from: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/
- Gasparrini A, Guo Y, Sera F, Vicedo-Cabrera AM, Huber V, Tong S, et al. Projections of temperature-related excess mortality under climate change scenarios. The Lancet Planetary Health. 2017 Dec;1(9):e360–7.
- Sustainability | APM [Internet]. APM. 2025. Available from: https://apmonline.org/greener-palliative-care-award/
- About Palliative Care Sustainability Network | Sustainable Healthcare Networks Hub [Internet]. networks.sustainablehealthcare.org.uk. Available from: https://networks.sustainablehealthcare.org.uk/palliative-care-sustainability-network/about
Declarations of Interest
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Non declared.