In her 2017 annual report, Chief Medical Officer, Professor Dame Sally Davies calls on the NHS to extend its duty of care to patients to cover the health impact of its pollution footprint.
The NHS is a source of pollution, which is harmful to human health. As in other areas of public health, for example healthy eating and wellbeing, the NHS is being urged to take a lead and demonstrate exemplary behaviour in not causing avoidable harm to health. Particular areas for attention include traffic pollution, greenhouse gas emissions, waste – including drugs - and taking responsibility for the pollution footprint of its supply chain.
“I would like to see all forms of pollution at the forefront of professional and public attention,” says Professor Dame Sally Davies.
Furthermore, financial sustainability and environmental sustainability are linked. The report says: “Much pollution caused by the health system is due to wasteful practices that generate harm to the environment (and in turn to the public and patients), waste money (and other finite resources), and jeopardise safety. Understanding the scale of the problem and the opportunity for improvement brings significant, multiple benefits for the health of both current and future generations, as well as preserving those resources now.”
The NHS is now reported to be responsible for 5% of all road traffic at any one time – a combination of patients travelling for care, staff movements and the NHS’s own fleet of vehicles. Business mileage and the movement of ambulances alone in 2016 by NHS providers equates to around 680 million miles per year.
The £540 million spent on energy equates to the release of 3.7 million tonnes of CO2 and it is reported that there are still providers burning coal and oil at healthcare sites, both of which are very carbon and pollutant intensive fuels.
The NHS also generates significant volumes of general waste. In 2016/17 NHS providers in England alone generated over 590,000 tonnes of waste, including office materials, clinical waste, food, drugs, medical devices, packaging and single use devices/products, such as PVC masks.
There is a legal requirement for Trusts to consider the waste hierarchy and move away from disposal and towards re-use, recovery, recycling and ultimately reduction or elimination of waste. Some Trusts are already ‘zero waste to landfill’, but in others more needs to be done. “Dealing with waste in a less polluting way is important (for example replacing landfill with mixed dry recycling, energy to waste recovery), but absolute reduction in waste (starting with procurement) and circular approaches to resource management should be the priority.”
The report makes several suggestions for improvements:
• All hospitals could have travel plans as part of their Sustainable Development
Management Plans (SDMPs) including plentiful active and low carbon travel opportunities to and from health facilities (walking, cycling, public transport)
• Energy strategies in the NHS could consider non-combustible renewable heat and co-generation (for example fuel cell combined heat and power), the use of renewable source electricity (either by generation on site or through energy contracts) and District/Community Heating Schemes: this should include restricting use of energy resilience equipment. It should be used for energy resilience, where necessary, but not for short term financial gain through incentivised combustion of heavy polluting fuels to support the national grid
• The NHS could adopt innovative models of prevention and care that allow patients and staff to travel much less whilst receiving high quality care (telecare, long term condition monitoring, virtual clinics, specialists in primary care settings)
• All action to reduce pollution in the NHS could be elevated from “expectations” to “must do”: This requires complete buy-in and adoption from the regulatory agencies such as Care Quality Commission, NHS England, NHS Improvement, Department of Health and Social Care and National Institute for Health and Care Excellence
• Waste reduction, notably through efficient procurement, must be at the centre of all efforts to reduce pollution and harm caused by healthcare
• NHS bodies should use incentives to comply with the waste hierarchy, for instance, built into waste management/recycling contracts
• Healthcare waste management operations at local, regional and national levels should be well organised and well planned.
The specific chapter on pollution from the health and care system was authored by David Pencheon, (Honorary Professor, Health and Sustainable Development, University of Exeter Medical School) and Andrew R H Dalton, (Public Health Specialty Registrar, West Midlands Deanery).
* Click here to download the full report
