Delivering sustainable healthcare: position statement

This position statement by the Welsh Government’s heads of profession describes the level of commitment and practice expected of all healthcare staff providing care, to promote environmental sustainability.

It provides a benchmark for patients, carers, healthcare practitioners, managers, employers, commissioners and other stakeholders to use to make informed judgements regarding reuse, reduce and recycle initiatives.

This position statement is informed by the excellent nurse sustainability project undertaken by the Office of the Chief Nursing Officer with input from health boards, trusts and other organisations progressing work to deliver the NHS Wales decarbonisation strategic delivery plan.

This work has been considered by focus groups comprising expert practitioners who have agreed the recommendations contained within this paper.

In 2019, Wales became the first nation to declare a national climate emergency in order to generate greater focus and action to meet the challenges presented by climate change. NHS Wales is one of the leading public sector carbon emitters, contributing approximately 2.6% of Wales’ total emissions. To ensure the NHS in Wales plays its part in improving environmental sustainability, the NHS Wales decarbonisation strategic delivery plan published in March 2021 set out a number of initiatives to reduce emissions to support the ambition for a net-zero public sector in Wales.

In line with key priorities identified, the initial efforts of the health and social care climate emergency national programme have been focused on decarbonising the NHS estate through an emphasis on reducing the environmental impact of its buildings, travel and procurement. Whilst this has produced positive results, more can be achieved through greener clinical practice and healthcare delivery. Our collective ambition is to continue to deliver high quality, safe, efficient and effective care in ways which benefit the environment.

Health and social care staff are the heartbeat of our NHS Wales family. The unique skillsets and qualities of clinical staff can enhance the climate emergency response across NHS Wales. The ability to rationalise complex issues, resolve multifaceted problems, manage complex health care pathways, and to design better processes and policies can all be harnessed to positively affect climate action.

The health and social care climate emergency national programme has made positive steps towards the delivery of sustainable healthcare practices across Wales, including reduced use of environmentally damaging medical gases and pressurised metered dose inhalers. These are tangible examples of how we can achieve our ambition for low-impact healthcare.

Tackling climate change cannot be achieved by any group in isolation and requires a focus on widespread clinical action. Health staff across sectors and specialities must join forces to identify, lobby for, and co-design greener healthcare practices and develop new and innovative ways to reduce our carbon footprint. This includes practices such as:

• adopting a preventative health approach in all we do
• empowering individuals to manage their own health conditions whenever possible
• making sure our health and care pathways are as efficient and seamless as possible
• maintaining a prudent health and care approach
• prudently procuring health supplies
• exploring ways to reduce the clinical waste we produce
• maximising the repurposing or recycling of clinical surplus and/or waste where it is safe to do so

These principles of sustainable healthcare must be embedded at the centre of clinical practice. By putting environmental sustainability at the forefront of clinical conversations, we can enact powerful change.

To support this, there is an emerging range of developing toolkits, resources and advice papers from a variety of professional groups and organisations that all offer practical and achievable actions that guide every health professional to practice sustainably. Examples of this are the Wales Allied Health Professions sustainability toolkit, the aforementioned nurse sustainability project and the resources for sustainable health toolkit.

Every health practitioner can support climate action in their organisation and setting by:

• advocating for sustainable practice at all levels of care delivery
• supporting colleagues to be aware of the climate impact of their work
• linking with their local health board decarbonisation lead or local sustainability champion
• ensuring representation of their profession at a local health board, trust or primary care cluster green group
• accessing sustainable healthcare learning through their local health board, trust or primary care cluster
• exploring with clinical teams or colleagues how their collective care can be more environmentally friendly
• utilising relevant resources to assist delivery of sustainable healthcare that will influence change in practice
• building and facilitating environmentally sustainable healthcare initiatives into their own and others’ practice objectives
• developing a visible sustainability philosophy as an exemplar for patients and the public

By prioritising environmental sustainability, healthcare staff can create a healthier future for both patients and the planet, aligning our mission with public sector efforts to collectively address climate change. Now more than ever, we need a prudent and collaborative response to address the local, national and global challenges our health and care systems are facing.

This statement is endorsed by:

• Sue Tranka, Chief Nursing Officer
• David O’Sullivan, Chief Optometric Adviser
• Ruth Crowder, Chief Allied Health Professions Adviser
• Andrew Dickenson, Chief Dental Officer
• Andrew Evans, Chief Pharmaceutical Officer
• Frank Atherton, Chief Medical Officer
• Delia Ripley, Deputy Chief Scientific Adviser
• Alex Slade, Director of Primary Care and Mental Health