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Paper outlines GIRFT’s ‘unique position’ in supporting the NHS drive for net zero carbon emissions

A review outlining how the GIRFT programme is well-placed to support the NHS in reducing carbon emissions to net zero by 2045 has been published in a respected journal.

Research by a group of 10 GIRFT clinicians, many of them Fellows working with the programme, is available to read now in the March edition of Anaesthesia, the journal of the Association of Anaesthetists.

The paper – titled Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint – concludes that GIRFT’s drive to reducing unwarranted variation in care and improve efficiency across the NHS puts the programme in a unique position to identify exemplary practice which can be scaled nationally, as well as areas for improvement in sustainable healthcare. Embedding sustainability and carbon reduction into GIRFT processes has the potential to link up clinical improvement work with the NHS’s efforts to reach net zero carbon emissions.

Healthcare is a major contributor to global carbon emissions; in the UK, it is responsible for 4.6% of all carbon emissions. In 2020, NHS England committed to reduce direct carbon emissions to net zero by 2040 and indirect carbon emissions by 2045.

The research team identified several areas of GIRFT’s focus where there is the potential to contribute to a reduction in NHS carbon emissions:

  • Elective surgical hubs: The lower complexity of procedures commonly conducted in elective surgical hubs, and the standardisation of patient pathways, make hubs ideal for trialling low carbon models of care and implementing sustainable methods. Any improvements in the sustainability profile of an operation may be rapidly scalable across the national network of hubs.
  • Day case surgery: Improving rates of day case surgery can make a significant impact on the carbon footprint. For example, recent modelling by GIRFT and Greener NHS found that increases in the rates of day surgery for transurethral resection of bladder tumour (TURBT) surgery has saved 20.9 million kgCO2e over 9 years (2013/2014 to 2021/2022), due to fewer inpatient hospital admissions. This can also apply to other suitable procedures. In addition, identifying and reducing procedures with limited benefit to patients (eg; knee arthroscopy before total knee replacement) can not only increase efficiency and reduce costs but reduce carbon emissions.
  • Delivering a patient-centred service: Changes in service organisation following the COVID-19 pandemic offer an opportunity to modify operating theatre practices in line with best sustainable practice, and to consider surgical pathways as a whole. Eg; face-to-face outpatient appointments are being now minimised through one-stop-shop care models and virtual appointments. GIRFT’s work on pathways across many specialties means the programme can advocate for any recognised sustainability improvements at scale.
  • Anaesthesia and peri-operative medicine (APOM): Studies have attributed 42% of the carbon footprint of surgical care to anaesthetic gases. The GIRFT national report for APOM (2021) highlighted a number of areas where the carbon footprint for the specialty might be reduced, including:
    • reducing and recycling waste and clinician education on waste management;
    • use of low-flow inhalational anaesthesia wherever possible;
    • use of total intravenous anaesthesia;
    • increased use of regional anaesthesia techniques; and
    • increased use of augmented volatile anaesthetic gas capture.

In addition, reducing operating theatre downtime can help to increase throughput and reduce the per-patient carbon emissions associated with running an operating theatre, such as lighting, heating, extraction systems and staff travel. In the longer term, once waiting lists have been reduced, operating theatre facilities and services could be turned off earlier in the day.

Assessing what a minimal surgery and anaesthetic procedure kit should contain for each procedure to eliminate unnecessary equipment would also help to avoid disposal or re-sterilisation of unused items.

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