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Dan dare – doctor of the future

Ben Williams from the Centre for Sustainable Healthcare explores what  it really means when we say ‘sustainable healthcare’ with the help of dream doctor Dan Dare…

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Dan is a dream doctor trying to deliver sustainable healthcare...

It’s 2020. Meet Dan. Dan’s a great guy. Intelligent, compassionate, boundlessly committed to his job, his colleagues, and his patients. A young George Clooney might well play Dan in the film of his life. That’s the kind of guy Dan is.

For years now, Dan has been aware of the impact he has on the environment. His Trust has been leading the way in Care Without Carbon, and he’s proud that he now cycles to work in a state-of-the-art zero carbon facility, holds his conferences remotely from his paperless office, and leads the Trust in minimising the use of consumables, and recycling whatever can’t be reduced or reused.

There is no stone Dan’s life left unturned, to drive waste and carbon out of both his work and his personal life.

So he’s a bit miffed when he realises people are looking at him when they ask “why are we still producing so much carbon?”

For a while it’s been preying on Dan’s mind what happens once he signs the prescription, or the treatment referral. Dan knows he’s done everything in his power to reduce his impact, but what about further downstream?

How much embedded carbon is there in that course of Statins? How much water and energy does a dialysis treatment use? These things are still a mystery to Dan and it’s only now that the Trust has nailed down its emissions in every other aspect of its operations that these impacts are coming to life.

Dan knows that supply chain is a huge part of the Trust’s carbon project, and that a vast amount of work is being put into ensuring that outsourced products and services are as ethical and as energy efficient as possible, but he can’t help but wonder to what extent this philosophy has penetrated the clinical supply chain on which he so relies…

From Dan to reality...

Wind the clock back a bit to the present day, and we at the Centre for Sustainable Healthcare have been experiencing a similar existential dilemma to Dan. So much fantastic work is put into reducing the environmental impacts of the wider business of an NHS operation, but when it comes to a patient presenting a given set of symptoms, then a very linear response presents itself, and it is often not the most efficient or highest value use of clinical resources.

“The Sustainable Physician” published by CSH’s Medical Director Dr. Frances Mortimer, articulates the four principles of sustainable clinical practice: Prevention, Patient Empowerment and self-care, Lean Care Pathways, and Low Carbon Alternatives. The further upstream you can make the intervention, the lower the environmental impact. Easily said, harder in practice.

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Green spaces are healing spaces

Towards the preventative end of the spectrum we have initiatives such as the NHS Forest – creating green spaces within and adjacent to NHS properties, that allow patients, staff and visitors to benefit from the well-established health benefits of access to green space.  Combined with the advent of social prescription models and an increasingly independent community health and social care sector, these developments enable a host of conditions to be managed outside the traditional “pill for every ill” context.

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To date, the NHS Forest has created green space assets at over 180 NHS sites, ranging from GP practices to major acute Trusts, and our goal for the future is to work more closely with this network, building skills and capacity within their workforce to bring the business objectives of the Trust more closely together with their green space, directly delivering clinical outcomes through their environmental assets.

Reducing waste, reducing the cost both in terms of cash and carbon

Further downstream, we can find initiatives such as our pilot Green Nephrology network, which directly addresses the environmental and financial costs of kidney treatment through engaging renal physicians directly involved in delivering the treatment, and addressing the specific processes and resource throughputs of the care pathway itself.

In all resource efficiency initiatives such as these, engaging with the front line staff is critical. The Holy Grail of waste minimisation is the guy on the production line in the Swan Vesta factory who said “how about we only put the sandpaper down one side of the box?”  Our approach is to work through clinical specialisms, engaging the clinicians themselves in the process, and it is through this approach that we are beginning to deliver truly sustainable outcomes.

We'll get there - with a little help from each other

The Academy of Medical Royal Colleges has outlined some approaches within clinical care for reducing waste, and well makes the point that environmental and financial savings go hand in hand – this isn’t simply about being good to the planet, but it’s a vital part of delivering a sustainable healthcare system for the future.

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Don’t be afraid to stand out from the crowd with sustainable suggestions…

So Be Like Dan. But more than that, Be Like Swan Vesta Guy and give Dan a helping hand, because it’s as much in the treatment processes themselves, as what goes on around them, that Care Without Carbon is going to be achieved.