A greener NHS and how technology can help

The dictionary definition of ‘Going Green’ is an all-encompassing phrase for environmental protection. The societal push to be eco-friendly happened some years ago, with the aim of avoiding harm to the environment through products and emissions. This is still ongoing work and important work, but now the time has come to encourage sustainability too; ensuring resources aren’t being overused at the risk of harming future generations.

Most people are already doing their part through recycling, but for a greener NHS the goal must be to re-evaluate the procurement of medicines, utilities, products, and the functionality of the care facilities themselves; something we expand upon further in our new Greener NHS guide.

Going green matters because of the risk to human life posed by climate change. This occurs naturally, but humankind has accelerated the process and continues to do so. The Greener NHS National Programme gave a simple message about why we need to take action on global warming now:

"left unabated climate change will disrupt care, with poor environmental health contributing to major diseases, including cardiac problems, asthma and cancer."

Climate change has long been identified as a risk to the human race, but the response from governments and business has been slow. The evidence of humanity’s impact on the environment is ever more obvious by the damage happening to the environment and the impact on the people that live in it.

Four of the five hottest days on record in the UK have come within just the last three years, and data from the Intergovernmental Panel on Climate Change (IPCC) – reported in an article from The Economist - suggests that the target of limiting the global temperature rise to just 1.5c by 2050 is now nigh on impossible, and that even limiting to a 2 degree Celsius rise is unlikely.

A climate shift will dramatically impact health, mortality, and healthcare provision through the following three problems:

• Heatwaves & Drought
• Flash flooding
• Air quality (including pollution)

Earlier this year there was a clash in the UK media over the summer heatwave and temperatures approaching 40C. Some outlets reported this as good news; hot weather in Britain for once, sunshine at the beach with ice creams for all. Others were more cautious, warning of the impact of UV to the skin, the increased chance of heatstroke, and forest fires.

The concern was warranted. The Office for National Statistics (ONS) reported 3,271 excess deaths from 2022’s heatwaves, which tallies with figures from the NHS showing that the 2020 heatwaves caused more than 2,500 excess deaths in the UK.

Drought soon followed. Clean water is vital for the health of any population, for drinking and for sanitation. Failure to meet one or more of these inevitably damages a population, putting pressure on healthcare services. Britain, France and Germany all experienced droughts across their lands in 2022 as a result of the long heatwave that sat over Europe.

These heatwaves may become much more commonplace by 2050 as the global temperature rises, and they also impact air quality. The heat exacerbates air pollution, which is harmful to many but especially infants, the elderly, and those with respiratory problems like asthma. An article in The Independent recently stated: “Air pollution is known to reduce life expectancy by increasing the chances of cardiovascular disease and stunted lung growth in children. It causes thousands of cases of lung cancer in non-smokers each year.”

The media has already highlighted that one in 20 deaths in the UK are attributed to air pollution, with further study being done relating to air pollution and dementia. These issues are even worse in countries like India (with 35 of the world’s 50 worst polluted cities) and China. Nobody would say it’s a surprise that oxygen is vital, but many often are when they see the how the change in air quality hits energy levels, the immune system, and sleep.

The final problem is flooding. Whether after a dry spell, where dry land cannot handle the volume of rainwater, or just an abnormal amount of rain, flooding is incredibly damaging. There were hundreds of deaths in Germany and other parts of central Europe in 2021, but the aftermath is also a serious concern. Torrents of dirty water overloading the land is unsanitary. The World Health Organisation (WHO) cites data around 485,000 diarrhoea deaths each year from contaminated drinking water, with thousands more from cholera, dysentery, typhoid and even polio.

The British Medical Journal reported on the devastating floods in Pakistan this year and echoed these threats, while Rescue.org has recently done a feature piece on the cholera outbreak in Nigeria following their floods. There’s more than just dirty water being unsafe to drink or use though: the BMJ also cites the stagnant water being a breeding ground for mosquitos, which in turn can transmit diseases through bites.

The NHS Standard Contract 2021/22 has made it a requirement that Trusts and Integrated Care Systems must develop a three-year Green Plan to adjust their operating models and account for the overall goal of reducing the NHS’ carbon footprint.

Suppliers to the NHS have also been given a roadmap. This schedule means that from April 2023 suppliers of goods, services or works – over £5 million per annum – are expected to publish a carbon reduction plan for their direct emissions. From April 2024 this expectation will roll out to all suppliers. Beyond that, from April 2027 these plans must account for indirect emissions (those from organisations the suppliers work with). April 2028 will see the NHS push to monitor carbon footprints of individual products, and from 2030 onwards suppliers will only qualify for an NHS contract if they can provide plans and reports about reducing their carbon emissions.

NHS England announced a new strategy in 2020 called "Delivering a Net Zero National Health Service". The goal of this plan is to reduce carbon emissions from the NHS as a whole to be net zero by 2040, with an 80% reduction by 2032 at the latest.

There are many benefits that can be achieved by pursuing sustainability in the NHS: 

• A reduction in paper used
• A reduction in vehicle mileage
• A reduction in electricity used
• Improved data security
• Improved communications
• Greater operational efficiency
• Greater opportunity for eLearning

- Using less paper

By going digital, the NHS can make savings on both postal contact with patients and the production and storage of paper records.

Reducing postal costs via mass emailing or text messaging (SMS) is an easy win for the NHS. The text message alert system for vaccine appointment reminders sent over 7.5 million messages, resulting in a CO2 reduction of 173.3 tons by not printing, posting and transporting letters to remind people.

- Reducing mileage

By reducing paper usage, the NHS is in turn reducing the mileage and pollution that comes from transporting paperwork and appointment letters.

The NHS’ own data reports that NHS vehicles account for 3.5% of road traffic within the UK. This breaks down to 9.5 billion miles of travel or 5.4% of all UK emissions.

Community care has been a big beneficiary of improvements to health and care software, resulting in fewer return trips to a base or head office to report in and log patient records.

- Reducing energy usage

A blog post from Centrica reports findings from Lord Carter of Coles, who stated back in 2018 that if just half of NHS England used energy saving schemes it could save the NHS £130 million per year. The suggestions were for alterations to air conditioning or climate control, as well as building insulation, the actual construction materials used, LED lighting, building ventilation, and even hot water provision – all things that could be improved upon.

- Improved data security

Digital record-keeping means no need for rooms, buildings or even warehouses to store information. This means a reduction in rent and land management, but also a reduction in risk. It’s cheaper to utilise a digital server storage and firewall protection than keep and protect physical records from the elements.

Software also helps data management. It can assign permissions to different users to control who has access to what sensitive data, as well as tracking the usage pathways of employees to see how they operate and how software can be improved to help them work more efficiently. It allows for a unified approach to managing things like patient records for improved accuracy and relevancy to a patient’s care planning, and it enables easier sharing (where appropriate) of records between departments or organisations to ensure a consistent high level of care.

- Improved Communications

Better communication means more opportunities for collaboration, which in turn speeds up the patient care journey but also improves the care given. This is because improved communications can properly inform healthcare professionals of a patient’s status and needs, and more knowledge about the patient means a better treatment plan.

This benefits NHS sustainability because there’s less wasted medication and less inappropriate or irrelevant treatment.

- Greater Operational Efficiency

Communication and collaboration help the NHS become greener by reducing wastage. Fewer unnecessary appointments, fewer mistakes with a care plan, less inappropriate medication being prescribed. We should stress that healthcare professionals aren’t making mistakes due to incompetence but because they are often overloaded with work. People are living for longer and longer with modern medicine and lifestyles. More and more people need help with health and care. There are financial constraints for recruiting more staff, and time constraints for training new staff, which leaves one other option – better communication.

- Improved eLearning

By offering online learning sessions or courses, the providing organisation doesn’t need a tutor, students, or both to travel to a new location. People can simply access the internet and join a group call or meeting.

This also has an added benefit from a learning perspective as often the calls can be recorded, meaning a student can re-visit content on for better information retention and understanding.

Technology is rapidly changing the social and cultural landscape of planet Earth, and healthcare is not exempt from these changes. The push now is how we can utilise technology to encourage sustainable work and life practices across the globe.

This is where healthcare software comes in. It has the opportunity to adapt and make improvements to primary and secondary care, and to also improve staff quality of life in the process. Below we break down all that The Access Group has to offer, and how the NHS – and other organisations – could work towards the greater good by implementing these tools.

- Electronic Patient Record Systems

An EPR is an electronic patient record. It is a digital document that is held on hosted servers (saved online in a virtual hard drive). EPR systems are a type of clinical record software that create one central patient record to which other software(s) can connect and interact. By showing a full patient history it helps improve the accuracy of notes and reduces clinical risk.

A reduction in paperwork for patient notes is the big appeal to an organisation like the NHS. Printing costs come down, transport costs come down, emissions through transport are reduced, electricity and heating costs for physical storage are down, and these funds can be used elsewhere – whether in patient care or sustainability projects like solar panelling to rooftops.

At The Access Group we provide Rio EPR and the cloud-based version Rio Cloud for patient records. Within Rio EPR, we also offer Rio eObservations (nursing charts), Rio Mobilise (community care records), and many other patient record tools to simplify day-to-day note taking.

- EPR on the move

Electronic patient records are crucial for the most up-to-date patient care, but using the software can be inconvenient for community care workers visiting clients at home.

Applications have been designed for smartphones and tablet devices to help with this. They allow health and care workers to operate on-the-move and away from the office; working in the community to provide healthcare and support in a home or community setting. The premise is that these mobile apps work in conjunction with the electronic patient records. Access’ own Rio Mobilise does just this with Rio EPR (electronic patient records).

Mobile software working with the computer programs means healthcare workers don’t have to return to the office as much as previously. Statistics from the Midlands Partnership NHS Foundation Trust show a 15% reduction in staff visits to base, amounting to 165 extra visits per nurse per year.

This is delivering huge fuel savings by cutting out arduous back-and-forth journeys to provide small, regular updates to patient records and client notes, with data showing an 8% cost reduction through mileage claims. It also cuts the need for paper records and the couriering around of these documents as and when needed, and this in turn showed in the Midlands Partnership NHS Foundation Trust data a 35% reduction in printing costs.

Fuel usage is down meaning pollution is reduced. Paper needs are down which means less need for ink, less cost for expensive paper styles, and also the obvious benefit to trees. Electricity usage is down for storage, lighting and cameras to monitor the physical documents, as well as the data input requirement. Doing the input once is more efficient than re-doing it back at the office onto the main system.

- Care Commissioning

Care Commissioning is software for healthcare, social care, housing and transport. It works to support strategy and long-term goals, aiming to grow provider markets, streamline behind-the-scene processes around organising contracts and commissioning, and to save time and money as a result of making things more efficient.

The healthcare angle is obviously the relevant part for an organisation such as the NHS, and benefits a greener NHS is the digitisation of the commissioning process. Digital documents, online communication, and virtual meetings all help mitigate the typical paperwork and transport impacts upon the environment. For more information, please read Access Adam Care Commissioning.

- Social Prescribing

Social prescribing software can empower organisations so they can establish, scale and better measure the uptake and impact of social prescribing. These digital systems can link to GP software and connect doctors with commissioners, referrers, link workers and community providers of programmes and services; all while providing reporting and analysis of tasks.

Access Elemental Social Prescribing is one available digital tool. It helps reduce GP appointments where other care can provide the support or answers quicker and easier than GP, and it reduces unscheduled care visits or appointment clashes from care and social work. Fewer unplanned visits reduces vehicle emissions by not wasting journeys, and the same applies to GP appointments and the travel often needed to attend.

- Virtual Assistants

Many healthcare organisations are beginning to use virtual assistants like The Access Group’s Rio Virtual Assistant. These computer programs emulate human conversation to have a two-way chat with patients to discover their needs, offer automatic responses, and escalate to a support team as necessary.

The big environmental benefit of this software is the reduction in paperwork surrounding things like appointments and questionnaires; easily programmable scripted conversation points that the virtual assistant can engage with to ascertain patient information and concerns without needing to physically jot it all down.

Less paper used, fewer envelopes, a reduction in printing and mailing costs, and the transport impacts of all the above. Lots of wins for the NHS.

- ePMA

Electronic Prescribing and medicines administration (EPMA) is software designed for electronic prescribing and medicine administration. The module enables trusts to manage prescriptions and medications digitally and ensure that patients receive the correct medication at the right time. It gives clear information on missed doses, and issues can be escalated automatically.

ePMA is again reducing paper usage (prescription sheets, medication charts), fuel usage, and electricity usage, but the big benefit is the reduction in pharmaceutical waste. By making prescription history and patient notes easier to see, pharmacists can spot allergies and other issues that might cause a problem.

University College London reported back in 2010 that around £300 million is lost as pharmaceutical waste. This hurts the environment in terms of resource management, but it also hurts the NHS in terms of its capacity of care provision. £300 million could be used for a hospital refurbishment, the hiring of additional staff, new equipment, new research… or it could even be allocated towards supporting sustainability. Upgrades to heating systems, improved building insulation, energy efficient lighting, solar panels... nobody can complain about the costs if they are funded by savings made elsewhere.

- eLearning

Digital learning or eLearning was mentioned in part 5 so we won’t dwell on it too much. eLearning removes the need for attendees and trainers to travel to a single place as a venue. This is cutting emissions generated from travel, electricity used for the venue itself, and from a logistics point there is no real limit to how many can be part of a session or seminar – as opposed to physical venues. Factor in no venue hiring costs and a reduction in printouts and eLearning sells itself.

- Patient Flow Management

Patient flow management software is designed to be used in hospital and care settings by a bed manager or similar. The purpose is to follow a patient or client’s journey through the care system and to best accommodate them around their needs but also the organisation’s own priorities.

All of the software up to this point has helped reduce the need for paper records, but patient flow management tools like Rio Patient Flow Management also help reduce any wasted or repeat journeys for patient transfers. Better planning means fewer changes once a person has been moved.

On top of that there’s a reduction in electricity and food usage from a patient with the length of stays being cut to more appropriate times based on their treatment, and the same goes for the usage of non-sustainable products like whiteboard pens. Digital is cleaner and more consistent.

Going green requires a change of working practices and attitudes, but these changes take time and need time. Clinicians and administrative staff both need support as they adjust their working practices to the new best standards.

Healthcare technology is the solution. By streamlining or automating different parts of care provision, computer software is reducing the burden on healthcare professionals. This means more time for the patients most importantly, but also more time to learn new things and adapt to these new approaches to day-to-day operations.

The world needs to make collective changes to safeguard future generations, but healthcare providers like the NHS need to lead by example. Good intent and a willingness to adapt is important, but change cannot be achieved by this alone. Modern problems need modern solutions, but thankfully these solutions are on hand right now and ready to implement.