In his latest Out of the Box column, emergency medicine specialist Dr Simon Judkins introduces readers to some of the people and organisations providing leadership on climate action within health systems – from Victoria to the ACT, England and Wales.
Simon Judkins writes:
As I walk through the hospital carpark, I reflect on a conversation with Tony Walker, the CEO of Ambulance Victoria, who outlined the organisation’s work to reduce its carbon footprint, transitioning their vehicles to electric vehicles (EVs) and hybrids.
We spoke about the strong visual impacts of seeing ambulances attached to charging points in Ambulance Victoria’s stations across the state.
By contrast, I note on my walk that the hospital vehicle fleets, for home visits and patient transport, could be doing the same, but I’m not aware of any plan. All petrol, with no transition plan in place.
As I open a dressing pack in preparation to suture a wound, I am reminded that the implements I am using – the plastics, even the metal forceps – all contribute to waste. I look for what can be recycled, and there are no signs on the walls, no separate bins…no real sense that this is a priority in our hospitals.
I ask another hospital for a copy of a patient’s medical record. Thirty minutes later, our fax machine (yes, remember those?) prints off 30 sheets of paper. It will then be scanned, added into our electronic medical records and thrown out. Occasionally it gets into the recycling bin, but not always.
I’m ordering investigations on paper and faxing them through, printing off discharge letters. I walk past empty offices when I leave work at midnight; lights are on, computers blinking.
Recycling bins are filled with food waste.
These are not an uncommon scene across most Australian hospitals.
In the UK, the NHS is leading in reducing the carbon footprint of hospitals and other health facilities. They have a plan.
Sadly, it seems we don’t. Even Wales is way ahead of us, with the release of their plan to decarbonise their national health system.
Sustainable healthcare has been defined and embedded into the NHS mission and values statements as “a system that provides high quality care and improved public health without exhausting natural resources or causing severe ecological damage”.
Their vision includes: “To deliver the world’s first net zero health service and respond to climate change, improving health now and for the future”. Inspiring.
So, how are we doing in Australia?
Well, it would be fair to say that progress has been slow. We have more renewable potential than the UK, but we don’t have strong policy direction to support our hospitals to really “go green”. No grand statements, no grand vision.
Dr Eugenie Kayak, from Doctors for the Environment Australia (DEA), discusses a report that makes this point:
…responding to climate change has until recently been seen as distant from core business within Australian healthcare, with a profound disconnect existing between healthcare, especially hospitals, and the environment.
There is an absence of a ‘road map’ and consistent benchmarking of emissions to track changes. Important roles, such as electricity and gas purchasing, are often outsourced.”
The Australian healthcare system contributes seven percent of the country’s carbon footprint.
Well, we think it’s seven percent. Apart from this well regarded and often quoted article, there is no systematic measurements of the carbon footprint of our healthcare systems.
“If there is no data to guide improvements,” says Kayak, “it is very hard to know where to focus efforts. The DEA have advocated that one of the first priorities is to establish national and state-based Sustainable Healthcare units. At least then we will be able to get consistent data.”
From the ground up
While we see indications that changes are happening, as is occurring in many other industries, they don’t seem to be coming quick enough. Seemingly, any change is being driven from the ground up, with the common theme emerging that it’s the lack of government policy and leadership that is holding back progress.
Staff who are desperate to see their workplaces be more sustainable and environmentally conscious are advocating for more direction, more policy to support this vital transition.
I met with Fiona Armstrong from the Climate and Health Alliance (CAHA). Armstrong is a force to be reckoned with and is very positive about recent progress.
A week of meetings in Canberra has given her good reason to be positive. Representatives from CAHA, DEA and other advocates met with politicians and policy makers in Canberra that week and were buoyed by the reception. “But the next steps are critical…”
Carol Behne, the Sustainable Healthcare Program Manager for CAHA and an area coordinator for Global Green and Healthy Hospitals (GGHH), joins the conversation.
Behne tells me GGHH is building its membership across the globe, with a large number of Australian hospitals as members. It has 10 goals to see a health sector that is climate resilient, sustainable and responsible in managing its significant carbon footprint. “Healthcare needs to get its house in order and lead by example,” she says.
The GGHH links organisations to share ideas, information and successes. They are building to a global roadmap to lead healthcare to zero emissions by 2050.
I have no doubt that the passion and drive provided, as well as the evidence base, are pushing us in the right direction.
But, in the Australian context, the barriers are clear. There is no ‘roadmap’.
Waste reduction is a core part of the work that all hospitals do. GGHH embraces this, supports and encourages members to reduce waste, recycle, undertake sustainable procurement and other initiatives.
“Over-ordering investigations, unnecessary interventions and treatments contribute to healthcare’s environmental impact and programs such as Choosing Wisely and Evolve, guide a positive change,” I add into the conversation. “Clinicians need to embrace the concepts of resource-stewardship and understand that we are contributing to the waste, the landfill and the carbon footprint.”
However, the key issue for reaching the end goal of carbon neutrality is where hospitals get their power supplies to run such complex systems. Most energy is still not from renewables, hospital infrastructure is aged and inefficient, car fleets use petrol and there are not yet any definitive plans or policies in most states to see this change.
I have known Michael Gorton for some time, starting when we were both working with ACEM (the Australasian College for Emergency Medicine). While we would have liked to be able to sit and chat over a coffee, we met recently by yet another Zoom encounter.
We reflected on our previous work lives, with travelling to meetings being a large of what we both used to do. This day we caught up to discuss “greening hospitals” in the context of his role as Chair of the Board at Alfred Health.
As with most hospitals, there is a strong desire to do more and a groundswell of energy coming from staff who want to see change. And the hospital is doing a lot of work, as outlined in their environmental strategy.
But, to really make the big changes, there needs to be more.
“A good Board will have an environmental strategy and the Alfred has one. But there are not effective incentives; we do it because it’s the right thing to do,” says Gorton, “and our staff are demanding it.”
Many hospitals are older and changes in infrastructure require significant investment. Are there policy changes which need to happen to drive changes?
“Logistic supports, policy supports would help,” says Gorton.
“The change for one hospital is significant, but maybe a less ‘hands-off’ approach would help. Whilst the Victorian Government has a greening our hospitals policy framework, real incentives to do more are limited. Centralising and managing an environmental strategy which they [Government infrastructure bodies] can help fund could go a long way.”
Gorton says that, for example, changing hospital car fleets to hybrids or EVs is expensive, but it is a price they would pay if given the directives.
Central procurement of supplies would also help, if backed up by a robust environmental policy. “Some of the centralised procurement has started to happen,” says Gorton.
But a combination of funding to remove barriers, greater funding to incentivise hospitals would support the evolution.
“New builds clearly have an opportunity to really do things differently, but retro-fitting old infrastructure is difficult,” says Gorton.
“Regardless, the solution has to be green energy. There is a will to do more, but when hospitals are stretched to do the work they do, there needs to be a higher level of support.”
I say to him that, from an employee perspective at the coalface, nothing looks different, despite the hospital strategies.
Gorton is also on the board of Ambulance Victoria. He compares that organisation’s ability to better determine its future, citing the plan for a significant reduction in the carbon footprint, including sourcing electricity from 100 percent renewables and transitioning its vehicles.
Big green steps
But big green steps are possible, and Canberra Health Services is leading the way. I had the opportunity to discuss this with someone who is walking the walk.
Colm Mooney is leading the team in the development of the new build at Canberra Health Services – a complex that includes a 60-bed intensive care unit, a 120-space emergency department and 22 new theatres. The electricity to power this state-of-the-art facility is coming from renewable sources. In addition, much of the ageing infrastructure across the health facility’s footprint needs to have a significant upgrade.
“The new building is all renewables, no gas,” says Mooney. “However, across the whole of Canberra Health buildings, we have still had to make some concessions. We’ve rewired and retrofitted many of the older buildings, but it’s not possible, with ageing buildings, to make a complete transition”.
So, while the new build is very much a “green build”, there are still some legacy issues which will be addressed in time.
“Issues like transitioning of the hospital’s vehicle fleet takes some time, due to expense and infrastructure required, but eventually, the car fleet will be moved to EVs,” says Mooney. “We will be using Nissan Leafs and they will be able to feed-in energy in down times.”
I asked about the policy and direction from the ACT Government. Mooney says that this was pivotal in leading the transition and build of the facility: “The policy platform really made the decisions for us.”
The exciting thing is that it’s not only about what the health service needs now, but the planning required thinking about how new technologies will be catered for as they come online.
Currently, the back-up plan for a potential outage in the energy supply has generators for the response, but future build would introduce battery technologies and green energy plants as part of the Canberra Hospital campus master planning.
“Buildings like this drive innovation. We will need to develop new roles who are proactively managing and harnessing the power of building analytics, we have a campus modernisation team who are looking at future opportunities to innovate and we have embraced other aspects of a ‘green’ facility, looking at our waste handling, recycling and procurement,” Mooney explains.
Reflecting on the conversation with Michael Gorton, I asked Mooney whether the hospital would have taken this path without the direction provided by the ACT Government.
“I think that it would have been more difficult without that driver,” he replies. “Hospitals have to prioritise their budgets to deliver healthcare, and the demands are increasing. However, we have shown, with some of the work done in the updating of our electrical infrastructure, changing our heating and cooling, making our buildings more efficient, that, even with the increased demands, our electricity use has decreased.”
I am left with the strong impression that governments need to take a lead to see all future hospitals and health builds are embracing renewable energy, adopting new technologies, and building the infrastructure for EV fleets and better waste management.
All new hospitals, being designed today and built tomorrow, need to follow the lead set by Canberra Health Services.
As Colm Mooney says, hospitals built now will have a 50 to 60-year legacy. “If we really want to be carbon neutral by 2050, we cannot build a hospital now which isn’t built green.”
So, “greening” our hospitals is very achievable. Let’s see if the next big builds can reach these goals and lead by example. We cannot wait any longer.
Read previous Out of the Box columns.
This article is published as part of Croakey’s contribution to the Covering Climate Now initiative, an unprecedented global media collaboration launched last year to put the spotlight on the climate crisis, of which Croakey Health Media is a member.
It is co-founded by The Nation and the Columbia Journalism Review (CJR), in partnership with The Guardian.
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