Make it green

Forget the new budget; climate change will be the greatest global threat to health this century. Some of the direct effects – vector diseases, heatwaves and flooding – are already appearing, and indirect effects such as crop failures, droughts and mass migration will create much greater health risks. The government has responded with the Carbon Reduction Commitment and, more specifically for healthcare, the NHS Carbon Reduction Strategy, aiming for a 90% reduction in emissions on today's levels by 2050. But the NHS, with a carbon footprint of 21m tonnes, has a lot of carbon to cut. How are we going to achieve this? To begin we need to understand where carbon emissions are coming from: roughly 20% from buildings and energy use, 20% from travel and 60% from procurement. A lot of attention has been paid to the management of buildings, but clinical systems, travel and the use of material resources, particularly drugs, also need to be addressed. We should be able to cut a good deal of the 20% in travel by using e-health/m-health and simple technology like the telephone and teleconferencing. These could also be used to reduce the percentage in for the buildings component. Perhaps the simplest use of technology is telephone consultations in place of patients attending clinics in person. An example of this can already be found in some renal clinics, although there is a need to scale up and to revise the incentive system which favours face-to-face meetings. (At present the clinician does not get paid unless they see the patient in person – although this is beginning to change). M-Health, the use of mobile devices for self-monitoring and treatment, provides another range of possibilities. It can save patients from making journeys to and from treatment centres, save resources inside NHS organisations and give the patient more involvement in their own care. More common online resources, such as internet shopping, and social networking, can also be used for healthcare, saving on journeys for carers, saving NHS resources and increasing patient involvement. Similarly, electronic games can be put to some innovative uses: Tetrus has been used to reduce post-traumatic stress disorder. We can begin to see a trend towards the multi-channel delivery of healthcare. These provide carbon benefits in reducing the need to travel, cutting the number of cancelled appointments, minimising disruption and helping patients to feel more in control of their care. They also bring financial benefits through the efficient delivery of care. But since 60% of the emissions are in procurement – most of which is linked to clinical care through the purchase of systems and drugs - we also need to consider reductions in this area. So there are many widely available technologies already here that can help us to improve the patient experience, the use of resources and sustainability. We need to work more cleverly and consistently to share existing best practice, as well as continuing to develop new technology. Even if climate change were a hoax, many of these changes can help us to save money now, and wouldn't we want to use our existing resources for the best health outcomes? The Campaign for Greener Healthcare is a charity committed to supporting the transformation of healthcare, highlighting the links between climate and health, and between financial, patient and sustainability benefits. www.greenerhealthcare.org