Sustainable improvement: growing a greener NHS

The positive influence of anchor institutions 

Anchor institutions are large, public sector organisations that have a significant stake in a geographical area. They have an impact on their local area in many ways, including through the jobs they offer, the buildings and space they occupy, and the supply chains they use. Anchor institutions can consciously use their influence to benefit communities.  

One of the five key areas in our ongoing anchors programme looks at how the NHS can promote environmental sustainability. In practice, environmental sustainability strategies could mean adopting sustainable practices within an organisation’s own operations, and influencing sustainable practices in the community. 

For example, Sussex Community NHS Foundation Trust has embedded sustainability criteria and metrics into its tendering process with targets for suppliers to reduce their vehicle emissions. 

North Bristol NHS Trust changed its approach to the procurement of catering services in order to purchase more food locally. In 2018, 54% of its food spend went towards local produce.  

University Hospitals of North Midlands NHS Trust has installed solar panels on NHS hospital buildings, saving nearly £300,000. The money was invested into a local charity, which tackles cold-related sickness and fuel poverty. Early evaluation suggests the project has reduced the rate of readmissions, particularly among elderly people and other vulnerable groups. 

The Health Anchors Learning Network (HALN), supported by the Health Foundation and NHS England and NHS Improvement, is a UK-wide network for people who are interested in using anchor approaches to share ideas, knowledge and skills. The HALN recently hosted a webinar on environmental sustainability and anchor action. 

Teaching sustainable quality improvement 

We are supporting the Centre for Sustainable Healthcare to embed sustainability into quality improvement education and training for health care professionals. 

Also supported by Health Education England (HEE) and King’s College London, the 3-year programme is working with medical, nursing and allied health professional schools to pioneer the integration of their Sustainability in Quality Improvement framework (SusQI) approach into health education. SusQI provides a practical framework bringing together the well-established principles of quality improvement with a holistic understanding of the social, environmental and financial value that together contribute to sustainable value in health care.  

The Centre for Sustainable Healthcare provides support, training and a wide range of practical resources. These are designed to equip students, trainee health care professionals and educators with the knowledge and skills to address environmental and ethical challenges through service improvement – leading to more preventative, holistic and lean low carbon care.  

Telehealth and virtual consultations 

Before the COVID-19 pandemic, the Health Foundation was supporting projects trialling and adopting innovations such as telehealth and virtual consultations. The intention behind these trials was to improve quality of care and patient experience – but these interventions can also make a positive contribution to reducing carbon emissions. 

For example, the Health Foundation supported Barts Health NHS Trust to explore the use of video consultations for outpatient consultations. Subsequently, the team worked on spreading the model to Oxford University Hospitals NHS Foundation Trust and Northumbria Healthcare NHS Foundation Trust.  

Barts have shown that video outpatient consultations are viable alternatives to in-person appointments and can reduce carbon emissions. Barts estimates that a single virtual oncology consultation can save an average of 5.8kg of carbon dioxide. Across 100 journeys, this equates to a level of carbon dioxide that would take 10 tree seedlings 10 years of growth to capture. 

The Health Foundation also supported Pharmacy Anywhere, a project led by NHS Highland. Pharmacists used telehealth to work across a large, rural and sparsely populated area, accessing medical records and speaking to patients at home with a video conferencing system. The project showed that telehealth was viable in this context and it reduced travel time for patients and staff, reducing waiting times as well as environmental impact. 

Over the last 18 months, telehealth has been rapidly scaled up across the country in response to the COVID-19 pandemic. There will be valuable learning from this experience in terms of practicalities, safety, and clinician and patient experience. Where it is found to be effective, telehealth can be a useful tool in reducing carbon emissions from travel.  

Green space at NHS sites 

The environmental benefits of trees include reducing the risk of surface water flooding and mitigating carbon emissions. And as the experience of COVID-19 has highlighted, spending time in green space can have a positive impact on our wellbeing. 

We funded an evaluation of the Centre for Sustainable Healthcare's NHS Forest project, which investigated the impact of gardens and green spaces at hospital sites on staff wellbeing. The year-long study focused on three sites that had encouraged staff to recharge in green spaces.  

The Space to Breathe research found that staff reported positive effects on mental and physical wellbeing, including feeling relaxed and calm, refreshed and re-energised by spending time in green spaces. A large majority of staff said they would like to spend more time in green space at their site than they currently did, and around half said attractive green spaces were important to them in considering where to work. This study illustrates how pro-environmental approaches can achieve multiple strategic objectives: a win for the environment can be a win for the health and wellbeing of staff and patients, as well as the wider local community.    

Supporting sustainability through the Q community and THIS Institute 

Making progress towards the net zero target will require transformation across the whole NHS – in procurement, prevention, clinical care, travel, technology and more. It will also require collaboration and the sharing of ideas, which is why networks can help to amplify efforts and be catalysts for change. 

Through the Q community’s Connecting Q locally programme we provided funding to the Centre for Sustainable Healthcare to grow a Sustainable Health Care Special Interest Group for the Q community, where there are nearly 4,500 members leading improvement work in health and social care.  

The Sustainable Health Care Special Interest Group brings together people who are passionate about sustainability and are keen to support a shift to low carbon health care in the NHS. The forum enables discussion of the challenges and opportunities for improving sustainability within health care. 

The Centre for Sustainable Healthcare was also successful in obtaining funding through Q Exchange to explore whether the evaluation of environmental and social impacts (in addition to clinical outcomes and quality of care) can help with the spread of good practice. The team is exploring whether sharing information around all the benefits achieved through COVID-19 adaptations will encourage people to take pride in it and nurture commitment to further service improvement. The project is focusing on measuring and communicating the environmental and social benefits of the discharge-to-assess approach in South Warwickshire. 

Finally, The Healthcare Improvement Studies (THIS) Institute, led by the University of Cambridge and funded by the Health Foundation, is also supporting efforts to foster a more sustainable health care system through their new Environmental Sustainability Fellowship, which is now open for applications. THIS Institute is keen to encourage innovative research activity to advance NHS capacity to improve environmental sustainability and will award fellowships to individuals to lead studies on this theme. Applications are open until 15 December 2021.  

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.