Sustainable Models of Care

The majority of carbon emissions from the NHS are related to the care of patients. The Greener NHS pathway to net zero shows that a large proportion of the emissions reductions will be as a result of changes in care pathways, innovation and clinical leadership. In order to have a more sustainable and resilient hospital it is essential to embed net zero across all clinical services.

Where we are now:

NGH has undertaken projects in most clinical settings, particularly, but not exclusively through the Green Team Competition run in conjunction with the Centre for Sustainable Healthcare. There have been three iterations of the competition which uses Sustainable Quality Improvement principles to aid the measurement of environmental, social and financial projects carried out in a three month period. Over the three competitions the total projected annual ealHeal

savings have been over £425,000 and 120 tonnes CO2e.

Projects from the Green Team Competition have twice been Highly Commended in the HSJ Awards, and have been included as examples of good practice in the 2024 Design For Life report issued by the Department for Health (move to reusable instruments), Critical Care Sustainability Recipe Book (reduction in the prescribing of PPIs) and HIV Good Practice guide (change to the care pathway).

The 2023 project from IPC that was aimed at reducing the use of continence products resulted in the employment of a specialist continence nurse. A second project was completed in 2024 that highlighted the link between caffeinated drinks, continence, falls and violence and aggression which has resulted in the removal of caffeinated drinks across both NGH and KGH and has been shared across primary care and with other Trusts.

The NGH Associate Director of Infection Prevention has started a GoGreener Nursing and AHP group to implement changes to single use items across both NGH and KGH using the Design for Life high priority items as a starting point.

We work closely with suppliers to implement innovative solutions and reduce the use of single use items. From 2023 NGH has worked with Mackwell Health to investigate the use of UV for decontamination of items. Mackwell received SBRI (Small Business Research Initiative) funding to use UV decontamination for anaesthetic masks allowing the Trust to trial and refine the process and move to a reusable rather than a single use mask. The next phase will see the use of the UV cabinet in place of the Tristel three stage wipes for Video Rhino-Laryngoscopes. NGH is also a partner organisation alongside Addenbrookes Hospital for the University of Exeter research project into Digital Enabled Healthcare Innovation (DECHI) and sit on the project’s advisory board.

The Trust has a Sustainable Surgery group looking at options for more reusable items that is also attended by Sterile Services, Procurement and Infection Prevention. In addition to the reusable masks this has also resulted in the introduction of Vanguard reusable harmonic shears which in a full year will reduce Scope 3 emissions and save money.

Our Phlebotomy Team has also started to undertake blood taking clinics at Danetre Hospital, 15 miles from NGH. This is an improvement for patients on the west of the county, and reduces car journeys to NGH by approximately 40 per week. Positive feedback has been gathered from patients and the environmental benefits will be calculated.

Our aims are to:

Continue to reduce wasted resources within models of care

Understand the carbon hotspots within care pathways

Adopt lower models of care and undertake projects focussed on:

Critical and perioperative care

Urgent and emergency care

Diagnostic tests and procedures

Medical pathways with a focus on acute or long term conditions e.g. renal, diabetes, cardiovascular

Sustainable Models of Care Action Plan
Action	Financial Investment	When	Responsible Department
Introduce reusable holloware to reduce single use plastics	Medium	2027	Theatres / Sustainability
Calculate the carbon footprint of the maternity models of care using the Centre for Sustainable Healthcare calculator	Low	2027	Maternity
Run the Green Team competition	Medium	2025	Sustainability
Introduce hybrid instruments into surgery	Medium	2026	Procurement / Theatres
Create a Green Assessment Framework for Wards	Low	2027	Nursing / Sustainability
Include Sustainability in Quality Improvement training	Low	2026	Quality Improvement
Undertake a minimum of six nursing and Allied Health Professionals led projects a year	Low	2028	Nursing / Sustainability
Introduce all applicable items from the Green Theatre Checklist	Low	2027	Theatres / Sustainability
Achieve Bronze level on the Green Emergency Department Framework	Low	2026	Medicine and Urgent Care
Use examples from Centre for Sustainable Healthcare and Get It Right First Time within both Quality Improvement projects and clinical audits	Low	2027	Quality Improvement/ Audit / Sustainability
Create a library of case studies for reference and teaching	Low	2026	Sustainability