By Dr Kristine Damberg
Man-made climate change and global environmental breakdown has been recognised as the biggest threat to global health by WHO since 2009. It is becoming apparent that this will have direct and immediate consequences for our patients and will impact on the way we deliver healthcare. Healthcare in the UK is responsible for 4.4% of total greenhouse gas emissions. The NHS was the first health service in the world to commit to an ambitious Net Zero by 2040 plan, reducing our carbon footprint and minimising the environmental impact of our services. [01]
It is now well-recognised that education for sustainable healthcare is a professional and ethical requirement for healthcare professionals.[02] [03] In addition, Association for Simulated Practice in Healthcare (ASPiH) has included sustainability as a core value in its draft standards for 2023: “Simulation practice should include sustainability considerations regarding inclusion in learning objectives and outcomes when relevant, as well as in relation to efficient use, safe reuse, procurements, sharing and appropriate disposal and recycling of resources.”
This has led us to consider what we can do in our simulation centre and our training to support the NHS Net Zero commitment and become a more environmentally sustainable department.
Reduce use of consumables and equipment
Part of the Epsom and St Helier Green Plan towards Net Zero includes the reduced use of consumables (non-recyclable plastics, equipment etc). Through regular messages in the staff newsletter, we encourage the clinical areas to donate all out-of-date equipment to the simulation centre: airway devices, cannulas, catheters, blood gas syringes etc. We receive far more than we can use, but the surplus gets donated to a collection for the war in Ukraine.
We ensure our centre manikins are well maintained to make them last, and we have been able to donate two old but still functioning manikins to other clinical areas in the trust to support their training.
Additionally, when catering for our courses, we use a water urn for hot water and have big jugs for tap water to reduce use of bottled water and single use cups.
Finally, old scrap paper gets a second life when turned into notepads.
These measures have not only reduced waste and saved money, but they have also raised the profile of the simulation department and helped build networks within the hospital.
Encourage active travel
Our courses are mostly face to face and attended by staff from both hospital sites and community, which necessitates travel to our centre. We have given careful thought to the start and finish time of our courses to correlate with the staff bus timetable to encourage staff to use the bus instead of cars. In our pre-course email, we include links to the shuttle bus timetable and other public transport to make this is an easier option and we are planning to provide a map of bike parking facilities at Epsom Hospital, reducing travel anxiety and allowing staff more choice in their transportation means.
Sustainability in teaching
With approximately 700 health professionals attending courses in our simulation centre every year we have a unique opportunity to start a conversation and create awareness of the significant health threat the climate crisis poses. Our debriefing model and style also allow us to explore participants feelings around environmental change, as well as think about solutions and actions. As our courses are leaner led it has been essential to incorporate sustainability as part of our existing course structure and not as an add-on.
During our standard SEIPS human factors the impact of the climate crisis often comes up in the group discussion. Themes identified have included:
- Person – Anxiety and stress about the climate crisis. Worry about relatives in other parts of the world impacted by natural disasters.
- Tasks – The challenges of managing different disease presentations brought on by the climate crisis
- Internal environment – The temperature on wards during a heatwave and how it impacts staff wellbeing and patient safety.
- Tools and technology – IT breakdown during heatwave. Change of inhalers to more sustainable options.
- Organisation – How the Trust Green plan and the implementation of it impacts our work
- External environment – The overall impact of climate crisis on NHS and public health.
In our simulation scenarios, we aim to include sustainability by expanding the back story to include social determinants of health. For example, a COPD exacerbation triggered by environmental pollutants (air pollution and mould), an asthma patient concerned about the climate impact of his inhaler, a cardiac event during a heatwave in a patient living in a top floor flat, and a young person presenting following suicide attempt triggered by climate anxiety. As our debriefs are leaner-led the climate crisis may not be a central part of the discussion, but we find it is often something participants want to talk about as they experience these situations in their clinical environments.
The climate crisis is a complex issue and not all faculty feel they have sufficient knowledge to make this part of our training. To address this, we have had a team presentation on why the climate crisis is a health crisis and signposted faculty to relevant eLearning and webinars.
Making sustainability part of everything we do is still very much a work in progress, and we are keen to collaborate with other centres and share experiences. If you are interested, please contact our sustainability lead Dr Kristine Damberg k.damberg@nhs.net
[01] Greener NHS (england.nhs.uk)
[02] Nayna Schwerdtle P, Horton G, Kent F, Walker L, McLean M. Education for sustainable healthcare: a transdisciplinary approach to transversal environmental threats. Medical Teacher. 2020 Oct 2;42(10):1102-6.
[03] Climate and health: applying All Our Health – GOV.UK (www.gov.uk)