Sustainability & Net Zero - British and Irish Orthoptic Society

Net Zero NHS

The impact of climate change represents a huge public health challenge and one that the health sector can make a significant contribution to tackling.

This is reflected in the recent commitment of all four UK health services have to achieve net zero carbon emissions. Net Zero means that the output of carbon emissions produced by the NHS is neutralised by the amount the NHS will remove from the environment.

Both NHS Scotland and NHS England have pledged to become Net Zero on their carbon emissions by 2040, with NHS England setting a target of an 80% reduction in place between 2028-2032 and Scotland setting out their plans for the next four years in their Climate Emergency & Sustainability Strategy. NHS Wales has detailed 46 initiatives in the NHS Wales Decarbonisation Strategic Delivery Plan to contribute to a net zero public sector.

The NHS is responsible for 50% of public sector emissions, which is a shocking amount. However, the NHS is able to reduce this but they need our help.

There are two parts to the CO2 production, indirect and direct.

Direct causes are those we have direct responsibility for eg: reducing single-use plastic use and recycling within our departments and homes.
Indirect are causes that we are not directly responsible for but are there because of the NHS requirements. eg: emissions from vehicles delivering supplies, supply chain emissions during factory production and packaging of deliveries.

UK health services aim to reduce these direct and indirect emissions by working closely with staff in their hospitals and working with supply chains that are using sustainable production methods.

More information about delivering a Net Zero health service:

Centre for Sustainable Healthcare – Resources for Wales and England
NHS Confederation – Sustainability in the NHS – what’s the theory and what’s the practice?

What can we do?

Orthoptists are part of a much larger AHP care group, made up of 14 distinct professions, working across the NHS. Amending the way we work and our actions at home, even in small ways, will help build towards the target of being Net Zero.

Why not try;

Addressing the use of single-use plastics within your department? When are they necessary and where/how could this be reduced?
Are the products we use recyclable, if not are there alternatives out there?
Are the suppliers we’re ordering from using sustainable production and packaging methods? What is their carbon footprint?
Is recyclable packaging being used when we post out supplies?
Ensuring staff are using reusable mugs, bottles and cutlery.
Reducing food packaging waste, could you buy fresh meals from the canteen instead of shop-bought packaged meals? Or bring meals from home?
Consider how you travel to work? Could you walk/cycle, car share or use public transport?
Ensuring electrical equipment and lighting is switched off when not in use?
Where able, could telephone/virtual clinics be held to reduce patients need to travel into the hospital?
Change your department lighting to LED bulbs.
Asking patients to return aids to reuse when no longer needed. eg: planos, typoscopes or magnifiers.
Can you apply this at home too?

These are small things that we can try and change within our own Orthoptic/Ophthalmology departments, but will overall help change the bigger picture for our NHS.

Hospitals across Britain are already beginning to make changes to the way they work. For example in Milton Keynes they have installed solar panels upon their new roof, already making savings of £18,000 off their electricity bill and reducing their CO2 emissions by 181tCO2e.

In Imperial College Healthcare NHS Trust A&E departments they have reduced the amount of single wastes plastics, especially in unnecessary cannulations. Usually, the majority of people attending A&E would be cannulated- just in case- but they found that 40% of cannulations were not needed. By reducing the number of cannulations, and introducing a process to prove cannulation is required they have managed to reduce their use by approximately 40 cannulations a day, with an estimated annual saving of £95,000 and removing 19,000 kgCO2e of waste.

You can read more examples of current case studies from NHS England here.

As AHPs are the third-largest clinical workforce in the NHS. We have the power to implement changes. If you have an idea, go with it! Talk to your line manager, your colleagues and set the ball rolling. It may influence other departments around your Hospital to do the same and even across other trusts.

Let us all work together towards achieving a Net Zero NHS.

Do you have any successes in sustainability? Please share your success and ask questions in the discussion section or send us an e-mail at: [email protected]

Further Resources

The NHS England Greener AHP Hub is now being used to support and provide information to help AHPs consider their impact and implement changes across their practice. Please follow the link to find out more.

https://www.england.nhs.uk/ahp/greener-ahp-hub/

The NHS Health Education England, e-learning for Healthcare, run a course “The Environmentally Sustainable Healthcare (ESH) Programme” to raise awareness of the Net Zero pledge and its importance. It looks into providing information for healthcare workers to be able to deliver care with financial, social and environmental sustainability. Please follow the link below to register/log in and complete the free course.

https://www.e-lfh.org.uk/programmes/environmentally-sustainable-healthcare/

Case studies

Low Vision Case Study

In Sheffield Teachings Hospitals, Royal Hallamshire Hospital, it is the responsibility of our Orthoptists to provide an efficient Low Vision service. We provide LVA services to all ages, with a majority of patients finding a good improvement in their abilities when using magnification. However, could we be doing better for our environment as well as our patients?

The NHS Net Zero campaign has encouraged me to look at our service and see where we could make changes that would reduce our carbon emissions. As with any Hospital environment, there is going to be waste but we need to see where we can prevent this.

When we issue aids to patients we need to be aware of their effect on the environment and also which is best and beneficial for the patient. What tends to occur in low vision assessments is the patient is issued with a handheld pocket magnifier and a stand magnifier. These are two plastic aids that eventually will both need replacing. However, now we stock handheld magnifiers that can come with a stand to adapt the magnifier itself, therefore reducing the number of aids a patient requires, which is cost-saving along with the added benefit of reducing the amount of non-recyclable plastic we are giving out. Patients also benefit as they are not needing to switch between two magnifiers. The handhelds with detachable basses are also lightweight and easy to use. Providing patient satisfaction.

If patients require it, we will provide them with a carrier bag to take their magnifying aids home. These bags have come from our own homes so are already being reused which is better for the environment however we could still improve upon this. As a service, we need to consider all aspects and by simply changing to using paper carrier bags we could avoid yet more plastic going into landfill. This is something we shall seek to change as soon as possible.

Lighting is very important in low vision and we always advise the use of daylight bulbs and white LEDs. We encourage our patients to use LED as they are more environmentally friendly, requiring less energy to run and reducing carbon emissions, but they are also best at producing bright and clear light. We also advise patients to change the lighting around their homes to LED bulbs.

Throughout Ophthalmology we could also change our lighting to LED light fittings and also ensure we switch off any lighting and electrical equipment we are not using, this would take steps towards reducing our energy consumption and emissions as a whole department.

In low vision we heavily rely on external stock being ordered in. We need to ensure that our suppliers are aware of their effect on the environment and produce products and packaging that is sustainable to the environment. This would lower our indirect effect on the environment and raise awareness with other companies.

During the COVID-19 pandemic we used telephone consultations as a way of assessing and keeping in touch with our low vision patients. In most cases a low vision face to face assessment is required to find out which is the most appropriate magnifier for the patient. However, where suitable, it would help our indirect carbon foot print to bring less people into the hospital setting and continue with telephone consults and reviews.

In the best interest of our patients and public health it is important to see patients as early as possible in low vision. Appropriate referrals and earlier intervention enables patients to get used to using magnifiers while their level of vision is at a better stage in their condition. Especially those who will deteriorate over time. Patients then get better use from their magnifiers and find they do not need to return to swap and change their magnifiers as often, which creates more plastic waste where magnifiers cannot be reused or recycled. Early intervention in younger patients can also help to keep them in work providing a better quality of life for our patients. Appropriate referrals also mean that patients do not travel to appointments that are not necessary, increasing theirs and the NHS carbon footprint. Working together with Orthoptist and consultants, we aim to promote effective low vision referrals within our Ophthalmology department and wider public such as high-street Optometrists.

As a team we are keen to change what we can to ensure that our Low Vision Service runs in the most effective, efficient and sustainable way. Our small steps will help the NHS become Net Zero.