Good to see the NHS leading the climate change cause as the UK’s biggest area of care limbers up to do its bit for the future.

An initiative of the Campaign for Greener Healthcare, a charity run by Dr Frances Mortimer, Rachael Stancliffe and Muir Gray amongst others, started with the reasoning that:

“Because fossil fuels are finite, and because of carbon capping to minimise climate change, it follows that this component of cost is set to rise. Indeed, it has been predicted that at some point in the not-too-distant future that the carbon expenditure associated with healthcare delivery may well be the principal determinant of rationing, either directly or as a result of the costs that result.

Cancer care in most cases conforms to a chronic disease model of care that is characterised by periods of activity that are interspersed by long periods of remission or stable disease. It has been estimated that the life-time risk of receiving a cancer diagnosis is about 1 in 3. If an ageing population wish to be looked after as well as they can be on receipt of a cancer diagnosis at a time when there are increasing pressures on the healthcare expenditure it follows that cancer care needs to be designed and configured in a manner that is as sustainable as possible. This one-day workshop is about finding out ways in which this might be possible.”

It's important because the NHS alone is responsible for 3% of the UK’s CO₂ output, and 25% of the public sector carbon footprint. As cancer becomes more prevalent, the number of patients will increase and the amount of CO₂ produced could follow suit unless action is taken.

Sir Robert Naylor, Chief Executive at UCLH since November 2000, kicked off proceedings, hoping that the “landmark meeting” would bring a cultural change in attitude to cancer care provision in the UK, setting a national and even global example.

But he pointed out that it was not just a case of switching off the lights, given that 60% of CO₂ expenditure was from procurement, 22% from energy (electricity, heating) and 18% from travel, and highlighted some of the new buildings recently opened by UCLH that were set to increase energy efficiency and reduce patient movements.

A no holds barred summary of why we should cut carbon emissions followed from Professor Hugh Montgomery, intensive care consultant at UCLH and director of the Institute of Human Health and Performance, including some worrying predictions about species extinction.

Director of UCLH estates Trevor Payne highlighted some of the steps already taken within UCLH to reduce emissions, including designated ‘Energy Champions’, e.g. porters, nurses, who dedicate a set amount of time per day to cutting down the energy costs of their working environment, as well as the usual savings in better use of electricity and heating. UCLH have ensured that new buildings are energy efficient, and carried out thermographic surveys of old buildings to assess where energy can be saved, As well as consolidating the supply network across London and using electric vehicles for hospital supplies.

Dr Frances Mortimer, director of the campaign for Greener Healthcare, gave a round up of what had already been achieved in Renal care, such as conserving water used by haemodialysis machines and suggested 5 points to help cancer care do the same:

            1.) Prevention
            2.) Greater engagement of patients in managing their own care
            3.) Leaner systems
            4.) New Technology
            5.) If two treatments have the same outcome, the lower carbon option should be used

              And perhaps controversially even,

             6.) Reducing the size of the NHS

Dr Adam Glasser, speaking as a practicing clinician, pointed out that savings could be made by reducing unnecessary retesting after therapy as well as automated surveillance, and seamless information exchange between the levels of care and also the patient, and supporting patients in their own home.

He showed how the internet could be used as a low carbon resource for secure communication through all aspects of care, for example automated texts to patients and emails rather than letters.

Other examples came from Amanda Saunders, cancer manager at Bristol NHS, who had overseen a successful pilot study to provide chemotherapy at home, which had greatly reduced the carbon footprint of the chemotherapy service as a whole.

Prostate specialist, UCLH’s Clinical Director for Cancer and meeting coordinator, Dr Mark Emberton called for MRI upfront for all potential prostate patients, pointing out that the initial extra energy used by MRI scanning would be dwarfed by the huge reduction in CO₂ associated with unnecessary surgery and continuing treatment, not to mention the difference in lifestyle for those men who have had their prostates removed unnecessarily due to PSA screening.

A brave attempt to woo the crowd from two advocates of proton beam therapy was met with some scepticism due to the 1.7MW energy needed to run the equipment. Suggested energy savings came from recycled materials used in construction, reduction of patients flying to the US and Europe for similar treatment, and reduction in unnecessary treatment. Carbon issues aside, it looks like UCHL could lead the way with proton therapy within a few years.

National Cancer Director Mike Richards suggested a calculation on the amount of CO₂ released that would kill one person world wide, to be compared to how many lives could be saved producing the same CO₂ by cancer care.

“High-carbon lifestyles are a cause of cancer and chronic disease and, indeed, many preventative measures for cancer encourage low-carbon lifestyles. Moreover, lower carbon cancer care can, in itself, contribute to prevention,” Frances Mortimer, medical director of the Campaign for Greener Healthcare, said. “Reducing carbon in cancer services presents an opportunity to improve quality and cost efficiency, through moving from high carbon institutions to flexible, low carbon systems of care.”

The meeting noted that the overall incidence of cancer in the UK was rising despite efforts at prevention. On a positive note, however, there were many changes already under way in cancer services which were likely to reduce the carbon footprint. Examples included supporting patients to take a greater role in managing their own health, reducing unnecessary follow-up appointments, and bringing care closer to home. There were also calls for calculating the carbon footprint of an entire cancer patient journey and reducing wasted procurement, for example nail clippers only being used once on the off chance they could transmit CJD.

A final statement was agreed upon by all attendees, as follows:

This meeting notes that:

1. Climate change is an urgent global health threat. Lives will be lost as a result of greenhouse gas emissions that result from delivering healthcare. Clinicians, therefore, have a duty to lead on initiatives that reduce CO₂ generation.

2. NHS England is responsible for 21 million tonnes of CO₂ equivalents per year, amounting to one quarter of all public sector carbon emissions. The NHS is committed to reducing its carbon footprint by 80% by 2050, and cancer services will be required to play their part in this.

3. High carbon lifestyles are a cause of cancer and chronic disease; many preventative measures for cancer encourage low carbon lifestyles and lower carbon cancer care can in itself contribute to prevention.

4. Reducing carbon in cancer services presents an opportunity to improve quality and cost efficiency, through moving from high carbon institutions to flexible, low carbon systems of care.

This meeting further notes that, despite efforts at prevention, the overall incidence of cancer in the UK is rising. However, there are many changes already underway in cancer services which are likely to reduce the carbon footprint – examples include supporting patients to take a greater role in managing their own health, reducing unnecessary follow up appointments, and bringing care closer to home.

Building on this foundation, this meeting proposes that cancer services take a lead in the transformation to sustainable, low carbon healthcare.

To that end, we pledge:

1. To improve the sustainability and reduce carbon emissions of our own organisations, for example by:

         • Developing a carbon reduction strategy

         • Signing up to the 10:10 climate change campaign

2. Through our organisations, to support the research, dialogue and action necessary to create environmentally sustainable cancer services, for example through:

       • Sustainability mapping of our organisational strategies

        • Specific initiatives to support research, dialogue and action for carbon reduction in cancer care





Read the news story from the meeting here