Pollution in the health and care system
CO 2 e emissions (t) PM2.5 (Kg)
Nitrous Oxide (NOx) (Kg) Total health and non- health impacts (£)
NHS providers and Ambulance Trusts
(Business mileage, ambulance fleet, patient and visitor travel and staff commuting)
7,231 1,067,713 237 5,232 £646,427,991
Primary care and commissioners (Business mileage, patient and visitor travel and staff commuting)
1,976 426,008 61 1,319 £142,461,818
Total 9,208 1,493,721 299 6,551 £788,889,810
Source created using information from Health Outcomes of Travel Tool; a modelling tool for the harm; air pollution, noise, GHGs and accidents from all travel in the NHS including all business mileage and ambulance fleet, available at
Page 47 of 341 Box 1 Personalised Care for Lung Fibrosis Patients: Reducing
unnecessary travel
Idiopathic Pulmonary Fibrosis (IPF) is a condition that causes progressive scarring of the lungs resulting in shortness of breath, leading to the need for extra oxygen. Treatment is given to relieve symptoms and to try to slow progression. University Hospitals North Midlands (UHNM) University Hospital is a specialised centre for the management of patients with IPF
The issue?
It is only in the past few years that drugs have become available to treat IPF. These can only be prescribed by specialised centres. These drugs have side effects for which patients require close monitoring and regular clinic visits and assessments. As a specialist centre for IPF, UHNM sees patients referred from a large area across the Midlands and Wales. For some patients this means a lot of traveling.
Patients with IPF can also require prompt support, especially as the disease
progresses. This is usually provided in close collaboration with the patients’ carers, local community and hospital-based respiratory services. Thus communication between all parties has to be effective.
Action taken
To address the issues of frequent clinic attendances in person and prompt
intervention to support patients, the team in Stoke have developed a bespoke ‘app’ – accessible by phone, tablet or computer - on a secure hospital website. This allows patients to track and report their symptoms from home instead of attending the hospital in person.
The patient-generated reports are reviewed by the clinical team daily, who can then guide the patient/carer. The app includes the patient’s history and co-morbidities. Functionality is especially useful to enable patients to recognise symptoms and drug side effects. It also supports patient/carer participation in the management of their disease with real–time communication between them and the clinical team avoiding the need to make unnecessary visits to the hospital clinic.
The impact?
There are currently over 250 IPF patients at the trust. Although the app was only recently launched over 50 patients are using it. This can mean a reduction in appointments of up to 50% meaning a saving in carbon costs as well as better outcomes for patients. The trust is hoping the project will enable a reduction to two visits a year for the mild to moderate disease and four visits for severe.
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Lessons learned
• Internal testing was required to ensure patient safety and the suitability of the
application
• A simple user guide was produced;
• Security of the system, data entry and confidentiality were addressed by entry
protection on the Trust website;
• The application can be used on a variety of devices for example smart phone,
tablet, laptop or desk computer according to patient preference; Scaling up
Replication of this application is possible across other specialist centres in the NHS and for other conditions. The trust has received funding to develop a similar self- management system for Chronic Obstructive Pulmonary Disease patients. The clinical team are also currently in talks with commercial parties to roll-out the applications across the wider NHS economy.
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Despite the extraordinary growth of person-held ICT, the miniaturisation of near patient testing, and the potential savings from such developments, there is little evidence that care is being taken to the patient. Consequently, our ability to invest in modern ICT systems, prevention, care in the community, powering public, patients, and primary care is all hindered by the centralisation of healthcare facilities. This results in such a high proportion of road traffic being on NHS business which contributes to air pollution, wasted time, higher risks of road injury and community severance†††, all of which adversely affect health. Figure 2.1 describes how
investment in sustainable transport can affect improved health.
The health service has an important opportunity to be a part of the solution to the pollution challenges we face, not part of the problem. Moreover, health services and health professionals have an important responsibility to visibly show that they take their contribution to air quality (and other issues such as climate change seriously). Some hospital Trusts, Bart’s NHS Trust in East London, and Great Ormond Street Hospital, for example, have specific programmes to reduce the damaging effect their activities have on air quality through reducing their energy use, stopping ambulance idling, other fuel efficient driver training and increasing zero carbon forms of transport in patients.
†††
‘Community severance’ (also known as ‘the barrier effect’) is a term to
describe transport system interference with people’s mobility and ability to access goods and services e.g. heavy road traffic impeding local people’s ability to navigate their neighbourhood by foot.
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Figure 2.1 Virtuous cycle of investing in sustainable health and sustainable transport
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Author’s suggestions for improvements
• All hospitals could have travel plans as part of their Sustainable Development
Management Plans (SDMPs) including:
o Plentiful active and low carbon travel opportunities to and from health
facilities (walking, cycling, public transport etc.);
• Energy strategies in the NHS could consider non-combustible renewable heat
and co-generation (for example fuel cell combined heat and power), the use of renewable source electricity (either by generation on site or through energy contracts) and District/Community Heating Schemes:
o This should include restricting use of energy resilience equipment. It
should be used for energy resilience, where necessary, but not for short term financial gain through incentivised combustion of heavy polluting fuels to support the national grid.
• The NHS could adopt innovative models of prevention and care that allow
patients and staff to travel much less whilst receiving high quality care (telecare, long term condition monitoring, virtual clinics, specialists in primary care settings);
• All action to reduce pollution in the NHS could be elevated from “expectations” to
“must dos”. This requires complete buy-in and adoption from the regulatory agencies such as Care Quality Commission, NHS England, NHS Improvement, Department of Health and Social Care and National Institute for Health and Care Excellence.
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Box 2 Reducing our emissions for sustainable healthcare is Care
Without Carbon
Hayley Carmichael and Will Clark, Sussex Community NHS Foundation Trust
Sussex Community NHS Foundation Trust spans 1,000 square miles, employing almost 5,000 people. Delivering care in homes and across over 70 sites will always involve travel. However, we believe that minimising that travel is essential for the delivery of sustainable healthcare. For us, sustainable healthcare is about more than saving money, it is about reducing our impact on the environment, improving
wellbeing for our staff, and ultimately our patients. To achieve this we created our Care Without Carbon (CWC) strategy.
Tackling local air pollution, through the reduction of our vehicle emissions is one way that CWC is making a difference. The aim is to reduce travel to its lowest possible level, while also encouraging take up of low/ zero emission, low carbon and active travel alternatives.
Firstly, we set up a travel bureau to support our staff in making fewer, cleaner, journeys. The travel bureau offers local public transport guidance, season ticket loans, a cycle to work scheme and route planning for drivers. Secondly, in tandem with the travel bureau we introduced a low emission pool car and lease scheme for staff, and even electric bikes.
A practical and effective solution
When Gina Cooper took on a new role at the Trust as a Patient Advice and Liaison Service (PALS) support worker, it required her to travel many more miles for work than before. Without a vehicle, the long public transport journeys would have been an excessive time burden and impractical.
“I don’t own my own car, but the new role demanded one. With pool cars, I didn’t have to buy a car. Instead I’m now travelling up to 120 miles a week, often to several locations a day from the base. The pool cars are hybrid, so very efficient to run, and at least twice a week I car-share with colleagues to different locations – a requirement of using the scheme is that we share travel wherever possible, I’ve saved over 700 car miles through car sharing so far.”
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An approach that works
We have increased our low emission pool fleet (vehicles available for staff use from key sites) from 13 to 21 vehicles - available at six sites. This has: cut our grey fleet mileage (staff using their own cars for Trust work) by 826,000 miles, helped us to reduce local air pollution, our carbon footprint, and given a healthy return on investment on each vehicle.
Since 2010 we have reduced our overall travel carbon footprint by 24% - on track to meet our 2020 target of 34%. Although the quantity has not been modelled, this will also reduce other air pollutants. As part of this, we have cut the engine emissions from our owned and leased fleet by 26.4% down to 111.1 gCO2/km.
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