The Centre for Sustainable Healthcare’s (CSH) Green Ward Competition is an award-winning, leadership and engagement programme aimed at transforming healthcare by cutting carbon emissions, improving patient care & staff experience and saving money. The Green Ward Competition can be run for individual healthcare organisations (e.g., NHS Trust; NHS Health Board) or at a local, regional, national, or international level.
The NHS is responsible for around 4% of the UK’s carbon emissions. This year, the Northamptonshire Health Charity made it possible for four teams from across Northamptonshire’s health services to engage in the Green Team Competition. The teams were supported by the national Centre for Sustainable Healthcare to develop, run, and measure projects that add sustainable value to their service by considering the "triple bottom line". The triple bottom line includes social factors (People), the environment (Planet) and the financials that any organisations need to consider to be successful (Profit).
Dr Lynn Riddell, Clinical Service Lead for Northamptonshire Integrated Sexual Health and HIV services (NISHH) led the entry from NHFT.
The programme was aimed at a specific group of patients with HIV who were deemed to be ‘very stable’. The aim was to look at changing a clinical pathway that would result in a reduction in the number of face-to-face appointments from twice a year to once a year. The changes had to include safety netting and patient consent, if the patient met the eligibility criteria. The measurements were around the social impact on patients, the environmental impact of reducing consumables and travel, and the financial benefits. Patients were consulted and over 90% supported the concept of a reduction in appointment frequency, with over 95% preferring electronic text-link communication and the removal of paper and letters.
Reducing the appointments from twice a year to once a year resulted in significant environmental saving through reduced physical journeys, the majority of which in this rural county are made in cars. Even with only 70% of the HIV cohort assumed to be eligible for the new pathway, 25,957.8 kgCO2e per year would be saved. This is equivalent to 74,763 miles driven in an average sized car, or put simply, the equivalent of 108.3 return journeys from Northampton to Glasgow every year.
The consumables saved from reducing appointments (blood bottles, needles, gloves etc) equated to a cost saving of approximately £45,000.00 per year. This figure was for consumables only and did not include any cost saving attached to reducing appointments/staffing. If these savings were projected across the UK for all registered HIV patients, the potential savings would increase by a factor of approximately 100.
In addition, 350 hours of Band 6 nurse time and 200 hours of senior doctor time could be saved per year. This time can be redirected to higher value work such as covering existing and increasing pressure points, and for staff to dedicate more time to patients with specific difficulties e.g. with adherence issues.
Preliminary discussions with patients who are currently ineligible for this pathway suggest that annual attendance versus biannual attendance could be a powerful incentive to improve their adherence to medication. Improved adherence has massive public health implications as undetectable viral load levels equate to untransmissible HIV.
At the October 21st Judging and Awards Ceremony, the four teams presented their projects, including the anticipated savings and opportunities to scale and spread within organisations and across the UK. The judging panel consisted of:
- Paul Slater - Clinical Director Anaesthesia, Northamptonshire General Hospital NHS Trust
- Jean Knight - Chief Operating Officer, Northamptonshire Healthcare Foundation Trust
- Stuart Finn - Director of Estates and Facilities University Hospitals of Northamptonshire Group
- Keith Brooks - Director Northamptonshire Health Charity
- Cath Richards - SusQI Programme Lead, Centre for Sustainable Healthcare
The combined projects of the four Green Team Competition teams have projected annual savings of £71,529 and 53,221kgCO2e, with the NHFT project the dominant saving scheme.
Congratulations to the winning team, NHFT’s Integrated Sexual Health and HIV Service team with their project ‘A novel care pathway for Stable HIV patients’. The team kept the patient voice at the heart of their changes, and their resulting impacts are a great exemplification of the triple bottom line of sustainable value in practice (People, Planet and Profit). The NGH Infection Prevention and Control team with their project ‘Be PPE Free!', received the highly commended award.
Dr Lynn Riddell, Clinical Service lead for Northamptonshire Integrated Sexual Health and HIV Services said: “The NHS impacts significantly on the environment. So much of what we do in the NHS involves ‘habits’ and things we have done for many years. We now have better technology, better medication, and a clearer patient voice about the social impact of the NHS on their home and work lives.”