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Reducing carbon emissions in orthopaedic services

3 January 2024 | Catherine Borra and Rebecca Wood
Hear from research associates Catherine Borra and Rebecca Wood at Barts Health NHS Trust about their project which aims to embed carbon costing within a randomised clinical trial that is focused on orthopaedics.

UCLPartners’ Connecting for Change programme, part of our climate collaborative, is funding four new research projects we believe can accelerate progress towards reducing the carbon footprint of NHS estates.  

These proposal ideas were facilitated through an innovative ‘sandpit’ methodology. This methodology involved bringing together doctors, nurses, estates staff, and IT teams to work collectively together to reduce CO2 emissions.  

Hear from research associates Catherine Borra and Rebecca Wood at Barts Health NHS Trust about their project which aims to embed carbon costing within a randomised clinical trial that is focused on orthopaedics. As a result, the project team hopes to create a strong framework that allows for carbon costing measures to be embedded within future orthopaedic studies. 

Identifying areas of waste and inefficiency to help the NHS reach net-zero by 2040 

We have a clinical background in orthopaedics and the service we provide to patients often involves surgeries, medication, and lots of equipment. We have identified that there are various areas of waste and inefficiencies that unnecessarily cause carbon emissions. In our roles as researchers, we saw an opportunity to reduce carbon emissions in Orthopaedic pathways. 

A lot of the sustainability projects in the NHS focus on reducing emissions of existing services. This involves changes to existing processes which requires resources and behaviour change.  Our starting point, however, is the design stage of new interventions.

The framework that we create looks at proposed interventions for our service area and generates data on the carbon costing of these interventions. Service commissioners can then take this data into account when they decide which interventions to introduce. Undertaking this work at the design stage rather than retrospectively reduces the need for changes to processes at a later stage.

Getting everyone on board

It is very important for us to work with stakeholders at all stages of the pathway. These include patients, clinicians, management and academics. All of these play an important role in the process, starting from the design to the implementation and use of the interventions.  

One of the key findings of our public and stakeholder engagement activities has been that people have very different points of view and those involved in and affected by our innovation want to be listened to. They want to be engaged at every step of the way. For example, a clinical manager might have a very good birds eye view of the service, including pathways of devices from purchase to disposal. Others might have a better understanding of the day-to-day services provided in a clinic and therefore the operational use of devices and resources. It is important that their specialist knowledge of the service is considered. That is key to building trust and to keep stakeholders onboard. 

Our stakeholders include patients, clinicians, management and academics. It is important that everyone’s specialist knowledge is considered. That’s key to building trust.

Early successes and long-term goals

We are positively surprised about how keen people are to be involved. When it comes to climate and sustainability, people’s opinions vary. But people are very keen to implement improvements if they are consulted and involved. It is important that they feel they are part of the process. And that applies to people across the board, including those in the NHS and the members of the public we engage with. Being able to build these relationships and the willingness of people to get involved really surprised us positively. 

By the end of the project, we hope to have a strong framework for embedding carbon costing measures within orthopaedic studies. We see this as a set of guidelines that our immediate orthopaedic academic group can use when developing interventions that will be trialled in research studies.  

The long-term goal is for this framework to be of interest to other orthopaedic groups outside of our Trust. We also liaise with other disciplines who are looking at greener trial methodologies. This is exciting and we hope to be able to highlight which ones of our engagement methods and data collection frameworks could be applied to these disciplines. Ultimately, the goal is to deploy our framework as widely as possible to reduce the carbon footprint of the NHS to get us a step closer to reaching net zero by 2040. 

The role of UCLPartners 

The support was essential to take our idea and to expand it. The support and tools, but also the network we have been introduced to is very valuable and formed the first building block of the project. The contacts we have made will be valuable for our future ambitions as well. The benefits of UCLPartners’ support go beyond the timeframe of the current project.

The support provided by UCLPartners is essential. The tools and the network we have been introduced to is very valuable and form the first building block of the project. 

How can anyone who is interested in your work get in touch if they would like to hear more? 

We are very happy to speak to anyone interested in our work or for them to tell us more about their ideas. You can contact us here by emailing Bartshealth.orthopaedic-research@nhs.net 

This work is part of the UCLPartners’ Connecting for Change programme which is funding four new research projects we believe can accelerate progress towards reducing the carbon footprint of NHS estates.