Making critical care more sustainable in the NHS 

The challenge

Healthcare’s environmental footprint is a global problem. Many organizations are recognizing that they need to take urgent steps to reduce their impact, while planning how to provide holistic care in the future.

In the UK, it’s reported that the National Health Service (NHS) accounts for 4% of the UK’s carbon dioxide (CO₂) emissions and is responsible for around 20 million tons of CO₂ emissions annually [1,2]. It is undergoing a journey to be the world’s first net zero health service, with a target of reaching net zero by 2040 for emissions it controls directly and 2045 for emissions it can influence.

But the NHS can’t do this alone, especially as 62% of emissions are identified as ‘Scope 3’ (indirect). To succeed, there must be significant collaboration across the public and private sectors, including suppliers and partners. CDDFT understands that a sustainable future for the Trust and the wider NHS will be one that embraces partnerships and innovation, and identifies ways of driving the highest quality clinical care through environmental improvements.

Philips was the first private-sector organization to approach CDDFT, offer a collaborative hand, and support its aims to become an exemplary Trust for environmental sustainability in human healthcare.

We share a common purpose: to enable sustainable high-quality healthcare that improves, maintains, or restores health, is affordable to all now and in the future, while minimizing negative impacts on the environment.

Sustainable healthcare challenges in the UK

• £1,621 per bed, per day: UK critical care is expensive [3]
• 125kg CO₂ emissions per bed, per day: UK acute care CO₂ footprint makes up 56% of the NHS footprint, with critical care being a part of this [4]
• +9% demand for critical care: unlike most other categories of hospital beds in the NHS, the total number of critical care beds has increased [5]

The solution

Trust ambitions

County Durham and Darlington NHS Foundation Trust is one of the largest integrated care providers in England, employing over 7,000 members of staff and serving a population of over 650,000 people. The Trust recognizes that it has a key role to play in reducing its carbon emissions and, as an anchor institution, supporting the local community in adapting to climate change. Today, it’s still in the early stages of its sustainability journey.

“Working with Philips, who also has a strong interest and footing in sustainability, has complemented our efforts and opened our eyes to other key focus areas,” said Sue Jacques, Chief Executive, County Durham and Darlington NHS Foundation Trust. “The team that we worked with are a credit to the business – amazing individuals, who were focused, hard-working and engaging, with unbounded enthusiasm.”

The solution

‘Greening critical care’ is a joint response between the Trust and Philips. Through the Trust’s existing Managed Service strategic partnership in radiology, Philips suggested a holistic analysis of the existing care environment with a focus on material and waste management. The aim of the program was to identify critical opportunities to reduce carbon footprint and material waste across patient care pathways and staff workflows.

Critical care was strategically chosen as a focus area as per patient, it is a high consumer of electricity and single use items and is one of the most expensive types of care. The program fosters sustainable optimization across all aspects of critical care: clinical process, supply chain, technology, and healthcare environments.

The team then produced a detailed report, highlighting key sustainability opportunity areas and recommendations for targeted improvements, which will now serve as a blueprint for further change. These were showcased at a joint workshop event, with a particular focus on medical equipment, estates and facilities, clinical operations, and supply chain. The following areas were outlined, alongside specific key performance indicators (KPIs) to measure:

• ICU discharge optimization: including resolving bottlenecks, optimizing staff capacity planning, reducing resources that patients do not require when getting ready for discharge, and reuse of consumables. Example KPIs: patient outcomes realized per CO₂ emissions produced, total CO₂ emissions produced per year.
• Reducing waste in the supply chain: including reducing the CO₂ and waste volume impact associated with single use items; saving costs by using less and moving to reusable equipment where possible. Example KPIs: number of projects / improvement cycles conducted, percentage of consumables re-used in ICU and total volume of consumables used.
• Staff experience: driving cultural change by training staff on the latest sustainability requirements, identifying sustainability ambassadors, enabling staff to share ideas, measuring success, and recognizing staff for their efforts. Example KPIs: number of staff trained on sustainability, number of sustainability projects initiated by staff.
• Medical technology: reducing excessive noise in the ICU from patient alarms, as well as power reduction and effective management of assets. Example KPIs: reduction in measurable power waste.
• Strategic refurbishment masterplan: reducing CO₂ emissions by appraising the existing building stock and exploring ways to retain and adapt. Example KPIs: extending lifespan of existing buildings, reduction of costs and CO₂ emissions.

Taking action

During the workshop, stakeholders from Philips and CDDFT discussed the importance of the findings and demonstrated a commitment to driving them forward. The Trust is already implementing some of the recommended initiatives, including:

• Sustainability reminders in the daily ICU huddle
• Environmental impact assessment line in daily reviews led by Dr Richard Hixson
• Pharmaceutical reviews – ensuring drugs prescribed are still required and when they are, assessing whether they can be given via the enteral rather than the intravenous route to reduce waste
• Only opening equipment when needed to prevent unnecessary waste
• Ensuring PPE use is appropriate to each patient, not a blanket policy
• Actively de-medicalizing patients as their health improves, reducing frequency of monitoring and removing monitoring when clinically indicated
• Sustainability included in rolling Quality Improvement projects

In addition, CDDFT has achieved over 95% compliance with the National Health Service’s net zero education module. The team is now planning to measure the impact of the interventions made.