Alice Joy: Sustainability is good for patients

Sitting down to write this piece, I found myself almost overwhelmed by the vastness of the subject.  The fact is that nothing stands alone in this world and sustainability is linked to everyone and everything.  It is fantastically complex and yet of such critical importance that we must, all of us, be prepared to move forward in positive ways, even if we think that those ways are small and fail to take in the full complexity of the situation.

With that in mind, my approach will be to look at certain aspects of sustainability from a fairly broad perspective in the hope that it might spark some creative thinking among my colleagues, both professional and lay.

The health care climate footprint report report found that if the global health care sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet.  The NHS and Public Health are just part of the world-wide need for sustainability.

There is a worrying gap in people’s knowledge of the health care sector’s impact on the environment and the plans in place to mitigate it. The Health Foundation carried out a survey to understand the public perception of NHS and climate change - Going green: what do the public think about the NHS and climate change?. Almost half believe that climate change poses a real threat to human health right now, yet only 9.4% listed minimising the NHS's impact on climate change and the environment as a top priority.

The report also stated that although the public are largely unaware of NHS net zero ambitions with 13% indicating awareness, this does not represent a barrier to support of the ambitions. Once explained, 70% support the net zero ambition, with just 6% in opposition.

Clearly, Information for patients is crucial if we are to achieve the aim of net zero emissions by 2040.  The survey supports the need for better, more accessible information.  The NHS must be an organisation that encompasses patients as partners if we are to be successful in reducing emissions.

Sustainability is good for patients

It shouldn’t take headlines of the death from air pollution of a nine-year-old child to alert us to the fact that we need to clean up our act.  We know that environment has a critical effect on health and health inequity.  We know, too, that more patients mean more pressure on staff and resources.  Greener NHS has launched the “Healthier Planet, Healthier People” campaign for staff.  Reading their report, I was struck by the fact that there was no mention of the role patients themselves play in reducing the impact of health care on the environment. 

Air pollution and associated respiratory conditions adversely affect people, particularly the less well off.  Support for smoking cessation is vital, and other means of promoting healthy living can also benefit the environment.  Many patients - including myself - would very much like to live healthier lives, but the flesh is weak and professional support can make all the difference.

Patients and the wider public must be part of the campaign and be respected, fully engaged partners.

Patience is not always a virtue

Waiting in a clinic for two or three hours is not only miserable, it is wasteful.  It is wasteful of patients’ time – and if you are a postie or a gardener you won’t take your laptop to the clinic – which adversely affects the economy.  The NHS does not exist in a vacuum and so achieving net zero is only part of the solution.

The Covid pandemic pushed us towards remote and virtual consultations.  They are not always appropriate and many patients dislike them, but they are more environmentally friendly and, for many patients, more convenient, time-respectful and comfortable.  Some resistance to change is inevitable, but time and practice bring understanding and acceptance.  From a patient’s perspective, if such a consultation runs smoothly, the technology works, the experience is as pleasant as possible and the outcome satisfactory, then acceptance will come more readily.

We are in this together

We are in a ‘chicken and egg’ situation.  Improving the environment will help people stay well and reduce pressure on health services.  Reducing the number of patients will help the environment recover and improve the health of the population.  Sustainability, from a patient’s viewpoint, is having a productive, healthy life while spending as short a time in ill-health as possible and a good death.

Emphasis on health rather than cure needs to inform government funding.  We need to think and act more collaboratively with others to make aspirations reality.