Doctors Working Towards a Greener NHS

In an effort to explore innovation by doctors in the UK, Medscape UK spoke to Dr Jonny Groome, co-founder of Green Anaesthesia and Sustainability Project (GASP) about his work to reduce the environmental impact of healthcare and beyond - how he got started and what led to his project winning a BMJ award last year for Environmental Sustainability and Climate Action.

"Over the last few years, climate change and sustainability has shifted from an area of special interest to something that everyone is incredibly enthusiastic about. It's now becoming more of a professional expectation, than an extracurricular activity," says Dr Groome..

He is one of a growing number in the medical community who are looking at their working environment and thinking of ways to make it less wasteful and more sustainable.

It's a big ask. If global healthcare was a country, it would be the fifth most polluting. The NHS itself is responsible for 4-5% of England's annual emission but it's at the forefront of a move to change.

NHS Leading the Mission

In October 2020, the NHS became the first health service in the world to commit to reaching carbon net zero, in response to the growing threat to health posed by climate change. It wants to achieve that by 2040 and to reduce the total carbon footprint, including the international supply chain, to net zero by 2045.

By April 2027 the NHS wants all its suppliers to have a sustainability action plan that aligns with its trajectory to net zero carbon, otherwise they won't get the business.

The NHS's carbon footprint comes from medicines, equipment, the supply chain, energy, water, and waste. It also comes from anaesthetic gases and metered dose inhalers.

The Story Behind GASP

Back in 2018, as an anaesthesia trainee at Bart's Health Trust in London, Jonny Groome was struck by the amount of waste he witnessed.

"I've always been environmentally conscious and was making changes in my personal life but as soon as I came to work all of those changes felt insignificant. In my operating theatre alone, we created so much waste mostly from the huge rise in the procurement of single use equipment, it was absolutely maddening."

Dr Jonny Groome

Groome was on a quality improvement course and needed a project: "I got in contact with the waste and environment lead for trust. He was very surprised as he doesn't usually get approached by clinicians, and said it was the second call he'd had in a week from an anaesthetist wanting to tackle the waste issue."

Groome set up a project recycling oxygen masks, anaesthetic masks, and PVC tubing. "We got a company to take away and reprocess the PVC free or charge and turn it into tree ties for the horticultural industry," explains Groome.

Within 6 months they'd managed to divert about half a ton of PVC from clinical waste. Living the peripatetic life of a young doctor, he was soon onto the next rotation so he set up GASP to carry on his work and attract other people who were interested in a cleaner NHS.

The project has grown since then to encompass four domains, education, improvement, advocacy, and consulting. Its mission statement is to reduce the environmental impact of healthcare in the UK and beyond. It now has more than 70 member volunteers worldwide.

Last year, GASP won a BMJ Award for Environmental Sustainability and Climate Action.

Local Initiatives

Groome says, "Sustainability is now more an expectation we demand from our health system. The Greener NHS movement has been an incredible driver and source of inspiration to many of us, and to many outside the NHS as well."

The national strategy is being supported by many different local short-range initiatives across the country.

"For example, within anaesthesia there are certain anaesthetic agents that we are really trying to reduce their use of significantly, like desflurane, which has an incredible high global warming potential. It's 2540 times more warming that carbon dioxide. Latest figures show that hospitals have now met the target of reducing the proportion of desflurane to volatile gases used in surgery to less than 10%. Many hospitals have got rid of it all together," he says.

"Another example is the use of nitrous oxide, another potent greenhouse gas, as an anaesthetic and analgesic adjunct. An incredible team led by pharmacist Alifia Chakera recently discovered that the NHS is very wasteful when it comes to its use. We are seeing a huge amount of waste coming from poor stock management with cylinders going out of date and through leaks in the pipe network. The solution is trying to shut down the nitrous oxide manifolds or stores and in areas where nitrous oxide needs to be used, relying on local cylinders. These measures are already having a considerable impact on the carbon footprint of the NHS as a whole."

Use Your Voice as a Doctor to Make Changes

"It is clear that the climate crisis is a health crisis and health workers worldwide are our going to find ourselves on the front line dealing with the consequences," warns Groome, "In many countries this is already happening with climate-related health indicators worsening year on year. A major environmental health concern in the UK is air pollution where we see up to 36,000 excess deaths a year as a result."

"While we in healthcare are contributing 4.4% to emissions, we need to be screaming and shouting about the other 95.6%. We should be making much more of our voice as trusted health professionals than we are now," he adds.

Groome's advice is to read up about the issue, look at your own practice at home and at work, talk to your patients about it, and start creating sustainable healthcare groups in your trust.

"If you are seeing practices within your own work setting that are unsatisfactory from a waste or energy waste perspective always use your voice to start making a fuss. We are seeing a rise in local advocacy groups in hospitals starting to be incredibly effective in lobbying their health trusts towards sustainable change and net zero declarations," he says.

Too Daunting a Task?

The climate emergency is potentially the biggest challenge the planet has ever had to deal with. Isn't it all a bit overwhelming?

Says Groome: "No. I get excited by the task ahead. It can be a challenging concept to get your head around, and the overwhelming nebulous nature of the climate crisis make it a potentially difficult issue to talk about, but it is worth noting that from a health perspective there are a lot of co-benefits moving forward. Active transport, which reduces CO2 emissions, also gives positive health benefits in itself. Creating a green community garden, eating less red meat, the list goes on. I think we will end up living a much healthier lives in a much more pleasant society, with a better climate if we start making some of these changes. There are so many positive actions and innovations we can take in tackling the daunting topic that is the climate crisis. This is an exciting time for research and improvement, and the fact of the matter is, as health professionals, we all have a responsibility to do something about this significant health threat."

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