The National Health Service does an enormous amount of good but it does so whilst consuming a huge amount of energy. Patients may be more concerned about their own condition rather than that of the planet, but there are many enthusiasts within NHS Bristol, who are working to help both.
They are making improvements across the board, with more staff cycling, telephone consultations and most important of all, strenuous efforts will be going in to reducing the environmental cost of procuring the equipment, drugs, and other supplies which make up 60% of the NHS carbon footprint.
Understandably, when people need medical treatment, they are more concerned about the quality and timeliness of their care than the environmental factors behind it.
But there is growing concern within the National Health Service about the impact the organisation's carbon footprint is having and steps are being taken to reduce it.
NHS Bristol, previously known as the Primary Care Trust, commissions health services for the population of Bristol. Big strides have already been made to improve its green credentials, as Dr Angela Raffle, Consultant in Public Health, explained: "A chapter about the greening of the NHS was first put into the Annual Public Health Report as far back as 1989. There was a flurry of work at the time but it gained little leverage and it was not until relatively recently that the subject moved up the agenda."
In NHS Bristol the topic is certainly a high priority now. No fewer than 94% of staff who responded to a well supported survey said they were ‘very' or ‘fairly' concerned about climate change and thought the NHS should do more.
Actions have been taken from literally top to bottom. At a seminar for the Board an expert from the University of Bristol was able to handle technical questions and clarify for Directors the importance of human-induced climate change. Combine this with the implications of Peak Oil and it becomes positively irresponsible not to be planning for an NHS that can manage on less energy. HQ staff have access to pool bikes, which means they can come in by public transport and use the bikes to go to meetings - usually quicker than travelling by car.
Individual waste paper bins have been removed, multi functional central printers are used, the e-mail system has been improved, there's more video conferencing and it's easier to make conference telephone calls. Staff are encouraged to cycle or walk to work, to use public transport, there are plans to increase the number of pool bikes and NHS Bristol has joined a Car Club so staff who commute without a car can make occasional daytime work journeys.
"Whilst the average distance for Bristol patients to their GP is less than a mile, overall the NHS accounts for 5% of all road traffic in England and travel is responsible for 18% of our carbon footprint. We are doing several things to reduce that. We are introducing more flexible working practices which mean people can work from home or perhaps in the future from NHS premises closer to where they live and more hospital follow ups are being carried out on the phone. Patients find it quicker, easier and less stressful, doctors can deal with more cases and there's a big environmental benefit," explained Dr Raffle.
Nationally, the NHS is aiming to reduce carbon usage by 10% by 2015 against the 2007 base line. NHS Bristol is co-ordinating its efforts to achieve that through their own Climate Change Steering Group, made up of representatives from all directorates, chaired by a main board director.
"We've made use of a lot of outside skills and experiences, such as those possessed by the Create Centre, borrowed and adapted the Bristol City Council staff survey, taken advice from the Carbon Trust, the Centre for Sustainable Energy and also benefited from the Low Carbon Cities programme of seminars," said Dr Raffle.
As much as 11 million tons CO2, or 60% of the total 18.6 MtCO2 NHS carbon footprint, is generated, not by travel and heating, but from the procurement of supplies, and 60% of this relates to drugs and equipment.
"Something like £8 billion a year is spent by the NHS in England on prescription medicines within primary care alone, so there's plenty of scope to reduce our carbon consumption without incurring huge extra costs as a result. For example we need to look at ways of extending shelf life, and of reducing the huge amount of waste from medicines that are prescribed but not used," she added.
The NHS is an important customer for the pharmaceutical sector and as such, Dr Raffle believes it could do more to use its considerable clout to bring about changes as clients have done in other areas of business.
"Huge amounts are spent on advertising and marketing drugs, as well as flying representatives and potential customers around the world to make sales. A lot of that could be reduced without affecting the service to patients at all. And things would be very different if we used generic drugs with little packaging rather than branded versions," she said.
There is growing recognition within the NHS that decisions about investment in infrastructure need to consider lifetime costings and all long term consequences. It can be hard to apply that principal when difficult decisions have to be made.
"If you have limited funds and competing demands for them, it is not easy to make a case for the installation of a combined heat and power system over the purchase a new scanner. On the other hand, who is to say which would actually deliver the greatest long term benefit? Our greatest challenge is to persuade people to consider not just the health needs for us now but also the needs for our children in the future. We will be involving patients on a local basis in that process," explained Dr Raffle.