The seemingly unachievable challenge of reducing carbon emissions across the NHS is breeding a culture of denial, with Doomsday scenarios failing to galvanise trusts into action, a new report warns.
Despite evidence that the NHS is the biggest contributor to carbon emissions, and therefore global warming, with a carbon footprint of 21 million tonnes, many organisations are doing little to address the issue, according to a pilot study carried out among 200 UK public health registrars.
A paper reporting on the results of the study claims that, while there are pockets of good practice, many health professionals are yet to engage with the drive to improve sustainability in the NHS.
These findings are in keeping with the Sustainable Development Unit’s wider experience that, while there are some exemplary individuals and pockets of good practice, many in the NHS are yet to engage with this agenda
The review was authored by Dr David Pencheon, director of the NHS Sustainable Development Unit (SDU); and public health researchers, Dr Kate Charlesworth and Dr Fiona Head.
It describes the results of the pilot, which featured a number of day-long workshops aimed at helping to make the UK’s NHS more sustainable and with outcomes measured in areas of awareness, advocacy and actions.
But the findings prove the NHS still has a long way to go to meet tough government targets of an 80% reduction in CO2 emissions by 2050.
The paper suggests four main reasons conspiring against the broader and deeper involvement of health professionals in particular. They are:
- Health professionals naturally apply a critical and balanced approach to all new evidence which may result in them being overly sceptical of new health threats or opportunities
- They are very busy, and focused on the day job, hence they have less time for longer-term issues such as sustainability or climate change
- They are focused on reacting to demand, problems and crises; and not on being pro-active to need, preparation or prevention
- Working in the area of health, they feel they are already making a worthy contribution to society, sometimes termed ‘a moral offset’
The document states: “These findings are in keeping with the Sustainable Development Unit’s wider experience that, while there are some exemplary individuals and pockets of good practice, many in the NHS are yet to engage with this agenda.
The SDU has found that most clinicians and GPs respond best to the health co-benefits argument; that a low-carbon lifestyle is a healthy lifestyle
“Given that climate change is the biggest global health threat of the 21st Century and that implementing the principles of sustainable development are an opportunity, particularly for health and health services, it is perhaps surprising that so many health professionals are yet to be convinced and engaged.”
After attending the sustainability workshops, 26 of the 238 delegates were asked to go back to their organisations and run similar events for their own staff. Of those, just five took up the challenge and another three said they had set a date for the training. Reasons for not pushing ahead with the exercise included a lack of time, lack of confidence, inexperience, being of the view that it’s not part of the role of a health professional, and being cynical about how much influence they will have.
To try and address the issue, the three authors have put together a five-point plan they hope will optimise engagement in the sustainability agenda across the NHS. It advises sustainability champions to:
- Get the facts straight: It is vital to get the climate change story straight, clarifying terms and examining the basic science, including common myths and misconceptions. Participants in the workshops were surprised by the graphical comparison of countries’ per capita carbon footprints; the NHS’s carbon footprint; the multiple ways in which climate change affects health, for example mass migration and food and water shortages; and the fact that climate change is a major global issue of social justice and health inequality
- Tailor your message: Most people respond to messages that address their own interests and concerns. Sustainability is well aligned with many other health objectives, such as the importance of prevention, more cost-effective use of resources, providing care close to or in the home, and the greater use of information and communication technology and is relevant to the practice of many medical specialties and health issues. The SDU has found that most clinicians and GPs respond best to the health co-benefits argument; that a low-carbon lifestyle is a healthy lifestyle. It also found that medical students and public health professionals are often interested in the social justice and health inequalities issues, whereas finance directors and chief executives are often attracted by the financial savings and reputational issues.
If people feel that a challenge is too great or that they are powerless to act, a powerful coping mechanism is denial. Thus, Doomsday scenarios are unlikely to be effective in encouraging engagement with the issues
- Be realistic: Participants wanted to focus on practical, achievable, individualised actions that they could carry out in their workplaces. Some examples of their subsequent achievements were incorporating sustainability in their current work by including carbon reduction in a procurement policy or commissioning contract; raising the issue with colleagues and implementing workplace changes through sustainable meetings, home working and remote access; and by submitting sustainability proposals to the finance director who had asked for cost-cutting suggestions. One regional group of registrars conducted an audit of the business miles travelled and the costs incurred in meeting their training commitments and several groups implemented teleconferencing to reduce the impact these have on carbon emissions
- Be positive: If people feel that a challenge is too great or that they are powerless to act, a powerful coping mechanism is denial. Thus, the report states, Doomsday scenarios are unlikely to be effective in encouraging engagement with the issues. With health professionals, the study found that talking about sustainability rather than climate change can be much more broadly and positively framed as a set of solutions. As noted during the workshops, there are many reasons for the NHS to deliver services sustainably, and climate change is just one of them. Responses from delegates confirmed this, with comments such as: “It is hard to win people over by scaring them.” Instead, several registrars advised reframing the issue as a positive first, emphasising what’s in it for them, especially the financial benefits
- Tell stories: Ensuring you have narrative examples of success that are not too ambitious can be highly motivating. Stories are what people remember and often what inspires them. In the feedback from the pilot, participants frequently asked for more anecdotes and case studies
To read the full study, click here