Building on what we already do
Although the challenges of achieving a more environmentally sustainable NHS and a net zero carbon output can seem daunting, it is important to remember that many of the changes already planned or underway will help us deliver.
Sustainable New Models of Care
The New Models of Care being taken forward by AHPs as part of the NHS Long Term Plan look not only at improving quality of care but also at being more environmentally sustainable. This is articulated within the Delivering a Net Zero NHS report; describing a new, more sustainable model of care that is focused on self-care, “living well” and reducing the need for acute and hospital care throughout the patient’s life. This approach is familiar to AHPs, who already deliver services that avoid the need for hospital admissions, prompting faster recovery across all healthcare settings. All AHPs will be able to see how they already fit within such a model.
Example: Enhanced Health in Care Homes
New Models of Care are initiatives being taken forward as part of the NHS Long Term Plan by vanguards and new systems such as Integrated Care Systems.
An example is Enhanced Health in Care Homes (EHCH). It aims to move from reactive to practice models of care, which are more focused on individual needs and bring together a whole-system, multidisciplinary team to support care homes.
While it’s clear how this could improve care for care home residents, it will also have a potentially significant impact on environmental sustainability. This model can reduce food waste, prescribed medicines and packaging waste, hospital admissions and accompanying transport costs. It could also prevent the need for energy intensive treatment by preventing illness.
Within an NHS context, improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable. To that, we should certainly add sustainable. It can be argued that it should not be possible to make healthcare safe or equitable if it does not consider environmental sustainability. Environmental harm also harms health, and that impact is felt disproportionately by those already most affected by health inequalities.
AHPs have an important role to play as participants and leaders in quality improvement across health and care. As with new models of care, the positive thing is that in seeking to achieve one form of quality improvement, we will often achieve others, including environmental sustainability. A more effective or patient-centred service will be less wasteful and energy intensive.
The Sustainability in Quality Improvement framework (SusQI) offers a relatively simple way of assessing quality and value in services using a “triple bottom line”, which considers environmental, social and financial impacts for an all-encompassing definition of “sustainability”.
Example: Ward intensity environmental impact
For example, the average carbon impact of a stay on a low-intensity ward is 37.9kgCO2e per bed day. This rises to 89.5 kgCO2e per bed day in a high intensity ward. Anything that AHPs do to reduce a patient’s length of stay will therefore have a clear environmental impact, even if that is not the main reason we are implementing it; e.g. improving nutritional status pre and post operatively, rehabilitation, adaptations. It should become standard for AHPs considering service improvement to consider sustainability in their business cases and evaluation.
The next section considers some of the specific ways in which AHPs might deliver improved sustainability, but it is by no means an exhaustive list. Everything we do to improve services and patient outcomes will likely have a sustainability impact, and we should all be more aware of that.