How and why clinicians should embrace sustainability and Trust green plans
With all NHS Trust green plans now refreshed in line with statutory guidance, Helena Beer speaks to Elliott Westhoff and Lyndsay Muirhead from the sustainability team at University College London Hospitals NHS Foundation Trust about their progress and advice for clinicians on contributing to sustainability success.
Five years ago, NHS England set a target to reach net zero by 2045. This included achieving net zero for direct emissions – those fully within their control – by 2040, with an interim target by 2032 of an 80% reduction against a 1990 baseline.
In September, it was revealed that the NHS is on track to meet this interim target after seeing a 68% reduction in emissions between 1990 and 2024/25, including a 14% reduction since 2020.
Continuing this momentum requires a collective effort by all NHS staff members across the country. And while recently refreshed green plans will go some way to achieving this, individual responsibility is equally as important.
Embracing sustainability principles, implementing impactful solutions within hospital departments and driving positive, climate-conscious change is crucial – no matter how small an action may be.
A green thread throughout clinical practice
For the sustainability team at University College London Hospitals NHS Foundation Trust (UCLH), the notion that the climate crisis is a health crisis is the main motivation for their work and is central to their messaging throughout the Trust.
‘People have got to understand why it’s relevant to their practice,’ says clinical sustainability project lead Lyndsay Muirhead. A radiographer by background, she joined the sustainability team after recognising that climate change impacted every aspect of her practice and required a joined-up approach from a range of stakeholders, including clinicians, to tackle effectively.
‘We have been running courses and doing education sessions on the links between climate change and the health implications,’ she explains. ‘Since we’ve done that, we are seeing more engagement from people.’
This, Lyndsay says, has allowed the Trust to move away from clinicians seeing sustainability as an extra consideration on top of their already very busy workloads – similar to how infection prevention and control used to be seen as an additional duty and is now embedded within the mainstream of care.
‘It’s really about bringing sustainability to the forefront of their minds and running it as a green thread throughout their practice,’ she says. ‘It’s not about asking them to do something else, it’s asking them to adapt the way they practice in order to be more sustainable and protect patients’ health.’
This buy-in is particularly necessary at UCLH as the Trust is working towards ambitious net zero targets of their own. Whereas the NHS target for direct emissions is 2040, UCLH plans to achieve this by 2031 and reach net zero for indirect emissions by 2040 – five years earlier than the NHS as a whole.
Elliott Westhoff, head of the sustainability programme at UCLH, acknowledges that it will be a challenge, but says this level of ambition was a deliberate choice to create a sense of urgency.
‘There are immediate risks happening right now and we don’t just need to be mitigating our emissions, we need to be adapting,’ he says. ‘The 2040 and 2045 NHS targets are really important, but they do seem a bit distant and intangible for people. When I think about where I’m going to be in 20 years’ time, I can’t really think that far ahead. Bringing the targets slightly earlier makes them a little bit more real to me, our patients and staff.’
Making sustainability a priority
To support this, UCLH is updating its governance processes to embed sustainability throughout. Elliott says the ultimate aim is for sustainability to be ‘business as usual, not an add-on’.
As such, sustainability is now incorporated into all staff appraisals, with a recommendation to align one of their individual yearly objectives with the Trust’s net zero strategy. This could be around energy efficiency, waste reduction, transforming their clinical pathway – the options are endless.
And it’s not just existing staff who are being encouraged in this way. ‘It’s already part of job descriptions and job adverts. It features in every Trust induction when staff are onboarded to the organisation,’ Elliott explains. ‘Recently, Lyndsay and Olivia Garrow, our project support officer who is also a registered nurse, have been targeting medical students at University College London (UCL) and resident doctors as they join our organisation. They’re doing 30-minute sessions with this audience, and it’s capturing them right at the start of their career with us, which I think is really important.’
Involving clinicians in all aspects of sustainability efforts is a key part of the team’s approach to understand workflows, identify pressures and priorities and integrate sustainability in a way that offers the greatest impact with minimal disruption. ‘Absolutely everything about our clinical practice has to be altered in some way,’ says Lyndsay.
UCLH sustainability projects
The Trust’s Gloves Off campaign began as a joint sustainability and infection prevention and control project to promote good hand hygiene instead of using single-use plastic gloves, when it is clinically safe.
As well as helping to reduce the rate of hospital acquired infections, the 2024/25 Gloves Off campaign saw 2.75 million fewer gloves being purchased, saving £150,000 and avoiding 27 tonnes of CO2 equivalent emissions.
A move from using single-use theatre hats to personalised, reusable fabric hats displaying staff members’ names and job titles has also been game-changing. Identification within the theatre is now easier, and patient safety and experience have improved.
Joe Burton, the team’s sustainability transformation project lead, has been focusing on testing various reusable products and has plans to roll out reusable gowns this year. This aligns with the new Greener NHS target to reduce single-use gowns and gloves by 25% by 2030.
Other projects have had positive benefits for sustainability, whether initially intentional or not. For example, as part of UCLH’s efforts to expand digital healthcare, the Trust has established one of the highest rates of virtual appointments in England, largely driven by a desire for efficiency and accessibility.
‘We know patients like it because it’s very convenient for them. They don’t have to travel into hospital or take a morning off work, they save money if they’re not having to come in just to get a result or to get a follow-up check-in from a clinician,’ says Lyndsay. ‘Obviously it reduces the carbon footprint because they’re not traveling to us, and it means that clinicians can see more patients as well. So, this is a really nice win-win-win situation.’
Elliott echoes the financial benefit, adding: ‘Typically, if you are more sustainable, you’ll often see a financial saving as well, which can be reinvested in patient care.’
As such, sustainability isn’t distracting from patient care, it’s improving it.
Rationalising practice
Knowing where to start can be half the battle, and Lyndsay recommends that all healthcare professionals begin by rationalising their practice from a sustainability perspective.
Highlighting the Centre for Sustainable Healthcare’s four principles of sustainable healthcare, she notes Lean Service Delivery as key.
‘Are you doing something in your clinical practice because it’s the right thing for the patient, or are you doing it just because? Are you doing it because it’s the way that it’s always been done?’ she asks. Legacy approaches may well need to change and taking a step back to assess this can be useful to ensure ‘you’re getting it right first time for patients’ and for the planet.
Rationalising practices at UCLH was made easier by the fact that they record and assess carbon emissions as standard, Elliott explains, adding that pharmacy was one of the stand-out areas identified for action and investment.
‘We’ve managed to get a grant to hire a sustainability pharmacist who’s going to work on a range of projects, including switching intravenous medicines to oral medicines as there’s a big carbon difference there,’ he explains. ‘A big part is reducing medicines wastage and there’s lots of different ways we can do that, from stock rotation to changing some of our protocols in how certain medicine is used.’
Engaging staff to support green targets
While much of a Trust’s green plan requires a top-down approach through adequate investment and dedicated leadership, progress towards sustainability goals is also reliant on grassroots support from healthcare professionals and other Trust staff.
At UCLH, this is achieved via a two-pronged engagement strategy after realising that some people were keen to help and others simply interested in learning more about sustainability.
A sustainability network is available to staff as a ‘discussion-based information sharing platform with no commitment, no obligation and no action required from the members’, Lyndsay explains.
Alongside this, a more formal sustainability lead role was created for people interested in taking action, or who were already leading initiatives without formal recognition. ‘This role was to give them a little bit more authority, being the go-to person for sustainability in their area,’ she says.
The sustainability team successfully negotiated with management to ensure protected time every month for the leads to carry out their role and embed it as a fundamental part of practice moving forwards.
So far, their projects have included moving from paper-based patient information to QR codes, carrying out waste audits and optimising bin placement, and setting up contrast recycling in radiology. The key has been focusing on projects that are of personal interest to these individuals to optimise engagement.
The team has certainly seen the benefits of a supportive and collaborative approach, with sustainability leads bringing enthusiasm and passion to their roles. But with that comes a risk that Lyndsay is keen to help mitigate.
‘They tend to do a lot of things at the same time, and we don’t want them to burn out, and we really emphasise this point,’ she says. ‘That’s one thing that UCLH is really good for, is supporting people’s wellbeing.’
Providing manageable sustainability education
Supporting staff to engage while avoiding burnout is a priority that Elliott says extends to the more formal sustainability education at the Trust. In a busy hospital, time barriers are challenging to navigate and so ongoing education focuses on short, snappy activities.
‘We’ve focused on bite-sized videos and podcasts on a platform called Stickerbook where we, as the sustainability team, have filmed videos talking about our strategy and we’ve filmed videos with our staff as well about how they embed sustainability in their workplace,’ Elliott explains.
For Lyndsay, taking the education to staff members is much more effective way to engage them than relying on their proactivity to seek it out and she says this has been one of the most productive ways they’ve seen progress.
‘Olivia has been doing ‘Sustainabili-tea’ parties where she goes to departments, and the staff rotate into a session,’ she says. ‘It’s a chance for us to talk to staff in their workplace about the health impacts of climate change, what sustainability actually looks like, and what’s important to them. We ask them what they care about and what they think is impacting their work.’
Another failsafe approach has been keeping the messaging very simple, only including the essentials and limiting the amount of time they need to engage with it. ‘I think having mine and Olivia’s clinical experience has helped because we have a really good understanding of the daily pressures they’re facing, and we can embed that into our communication strategies because we have an idea of what will land and what won’t,’ Lyndsay adds. ‘We are also lucky to have Julia Elmer as our part-time sustainability communications manager who can help us spread messages via multiple internal and external channels.’
Collaboration and sharing learnings
On a broader level, learning from other institutions is a priority. Great Ormond Street Hospital is one such example and Elliott says they’re leading some interesting work on the topic of air quality and air pollution, which UCLH is taking note of.
University College London, UCL Partners and the Health Innovation Network are also close collaborators, with Elliott and colleagues working with their architect and engineering teams in particular. This has led to the development of a research project on theatre ventilation and energy usage, which involves putting theatres into a setback mode when they’re not in use. The ultimate aim is to move to a switch-off mode to completely save energy while maintaining safety.
‘For a project like this, changing processes in a clinical area comes with a potential clinical risk,’ Lyndsay says. ‘And I think for us to be able to win over the estates team and the clinical teams involved in the project, having that research to back it was really important.’
The UCLH team is also keen to share their own learnings with others. ‘We share within North Central London, working closely with our partner hospitals in this patch,’ says Elliott. ‘We also work with our Shelford Group hospitals. They’re the 10 leading research hospitals, and I’d say that group especially, are all leaders in the sustainability space. We’ve got a lot to offer in England.’
Supporting suppliers and indirect emissions
Collaboration is also key when it comes to the supply chain and working with suppliers to make progress towards the hospital’s indirect carbon emission targets. Lyndsay says the number one piece of feedback they receive from suppliers is uncertainty over what is required and expected of them. As such, the UCLH team is striving to lead those conversations and represent clinicians.
‘We can get that feedback directly and take it to suppliers in a way that clinicians themselves might not be able to because of constraints on time and so on,’ she explains. ‘We have a very collaborative approach, and we do seek the expert opinion of the clinicians as much as we possibly can. We try and bring them together with suppliers as well.’
The benefit are wide reaching, with Lyndsay concluding that ‘it’s not just for us, it’s for our local area and nationally as well.’
Your net zero prescription
Elliott and Lyndsay share their six top tips for clinicians to champion sustainability and make progress towards their Trust’s green plans and NHS net zero targets:
- Work with your sustainability team: speaking to your executive lead for sustainability – or wider sustainability team, if you’ve got one – is a good starting point as they can give you the methodology you need to make a change
- Look for hotspots: use data to determine the carbon footprint hotspots and then assess options to reduce waste, switch to lower carbon medicines, reduce energy consumption and implement reusable products. How can you replace some commonly used, single-use items to reusables?
- Remember, nothing is insignificant: it might just be you doing something small, like reducing glove use, but doing it regularly can have a massive impact. You can influence your colleagues, and other people’s way of thinking. No one can do everything, but everyone can do something
- Rationalise practice: just because you’ve always done something doesn’t mean you should continue to do it. Take a step back, look at the bigger picture and discuss in your team what you can do to optimise your practice and align green benefits with patient care
- Use resources: the Royal Colleges for your field will almost certainly have a sustainability toolkit or information on their website to get ideas and guidance on where to start. The Greener NHS website and NHS Futures platform are also useful
- Collaborate: speak to your peers and networks and share your learnings to broaden your impact.
link
