Article Text
PDF
Abstract
Objectives Environmental sustainability is an important concern within the National Health Service. Compared with other specialties, there has been little research within palliative care. This study aims to calculate the carbon footprint of a specialist palliative care unit.
Methods Resources grouped into medical, non-medical, travel, energy and waste were collected for the year 2021 in a hospice in the South West of England. Following a top-down approach, the activity used for each resource was multiplied by an emissions factor to calculate the carbon footprint. Staff attitudes were also surveyed.
Results The hospice carbon footprint was calculated as 420 tonnes kgCO2e. Travel (35%) was the highest contributor to emissions followed by gas (33%) and non-medical supplies (17%). There were 95 responses to the staff survey (59% response rate) with strong enthusiasm towards sustainable practices.
Conclusion This is the first study to estimate the carbon footprint of a specialist palliative care unit. Compared with other specialties, palliative care has relatively low greenhouse gas emissions. Identifying sources of carbon equivalent production can be a first step into developing interventions to reduce this use. Our carbon footprint study will be used by the Hospice Sustainability Group to reduce our unit’s carbon footprint.
- Hospice care
- Service evaluation
- Education and training
Statistics from Altmetric.com
WHAT IS ALREADY KNOWN ON THIS TOPIC
Environmental sustainability is a priority.
Within palliative care, research regarding environmental sustainability is limited.
WHAT THIS STUDY ADDS
Calculating the carbon footprint within palliative care is feasible.
There is strong staff enthusiasm towards sustainability.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
Improve awareness and encourage others to consider carbon footprint calculations when developing a targeted approach to reduce services’ environmental impacts.
Introduction
Environmental sustainability is a global priority. The United Nations General Assembly’s Sustainable Development Goals include climate action and clean energy as key objectives, to improve both human health and planetary health.1 Nationally, the 2008 UK Climate Change Act echoes this with the initiative to reduce greenhouse gas (GHG) emissions.2
The healthcare sector contributes approximately 4% of total GHG emissions worldwide, and there is a growing movement to develop strategies to reduce carbon emissions.3 National Health Service (NHS) England has pledged to be net zero by 2040—where the GHG emissions produced will be balanced by the GHG emissions taken out of the atmosphere.4 Since April 2020, every organisation within NHS England has been required to create a sustainable management development plan, including carbon reduction measures to achieve a net zero NHS.5 While many specialties have made efforts towards sustainability, there has only been one abstract published regarding sustainability within palliative care.6
The aim of this study was to estimate the carbon footprint for a specialist palliative care unit (hospice) in the southwest of England for 2021, and assess staff and volunteer attitudes to sustainability. The carbon footprint is defined as the total GHG emissions produced by an organisation in carbon dioxide equivalents (CO2e).7 In this project, we chose the top-down approach to calculating the carbon footprint.8
Methodology
The project was conducted in a 16-bedded specialist palliative care unit (hospice) in the southwest of England. To estimate the carbon footprint, different activities were grouped into resource areas: medical and non-medical which included energy, waste and transport. Individual breakdown is listed in online supplemental table 1.
Supplemental material
We surveyed staff and volunteers about travel and attitudes to sustainability. The survey was used to determine the approximate number of miles that staff travel to/from and also during work per week. This was converted to figures for a whole year (removing 6 weeks for holiday). The responses from the 55 staff members and 40 volunteers who completed the survey were multiplied in ratios to estimate travel for all staff and volunteers (109 staff and 52 volunteers) who travel to and from the hospice.
In order to estimate travel by patients and families, a snapshot was taken of the hospice—distances for inpatients through return trips from the hospice to their home. Visitor travel (assuming two visits per week for each patient and living at the same address as the patient) was calculated by multiplying the distance for a return journey from the patient’s postcode to the hospice by two.
Where possible, values were sought for 2021, and it is explicitly stated if a value from another year is used. Emission factors (coefficients of GHG emissions produced for each unit of activity) were provided by the Centre for Sustainable Healthcare measuring environmental impact form (online supplemental table 1).9
In order to help decide where best to direct efforts to reduce emissions, the NHS net zero plan encourages organisations to categorise their scope of emissions: scope 1 (direct emissions), scope 2 (indirect emissions from purchased energy) or scope 3 (all other indirect emissions).10 However, we opted to calculate a total carbon footprint in order to be able to compare this with other specialties and healthcare activities. Dividing up emissions into those which are direct or indirect may suggest that those indirectly produced should not be a focus of reduction efforts.
Results
Carbon footprint
The annual carbon cost (online supplemental table 2) for the hospice was calculated at 420 304 kgCO2e (approximately 420 tonnes CO2e) in 2021. To contextualise this, the annual average carbon footprint (figure 1) of a person in the UK is 10 tonnes CO2e per person11, so this is 42 times as much.
Supplemental material
Total carbon emissions (CO2e). CO2e, carbon dioxide equivalent.
Total medical sources were 7638 kgCO2e (online supplemental table 3). The total non-medical sources totalled 73 079 kgCO2e (online supplemental table 4). Gas use produced 138 965 kgCO2e and electricity 32 977 kgCO2e for 2020 (2020 was used for both forms of energy as a 2021 figure could not be provided for the whole year). Water usage was provided for 9 months but extrapolated to 12 months totalling 566 kgCO2e. General waste, print waste and clinical waste totalled 507 kgCO2e, 635 kgCO2e and 17 648 kgCO2e, respectively. Total travel (including staff/volunteers’ travel to work, staff travel as part of work, patient and family travel) came to 148 288 kgCO2e (online supplemental figure 1 and online supplemental table 5).
Supplemental material
Supplemental material
Supplemental material
Supplemental material
Survey of attitudes
There were 95 responses (59% response rate), comprising 40 out of 53 volunteers, and 55 out of 109 staff members for the survey. Seventy-eight (83%) respondents used a car as the main form of transport. Sixty-nine (73%) respondents travelled to the hospice more than once a week. For travelling to work in a 46-week year (after removing holidays), volunteers and staff respondents travelled 14 491 km and 267 701 km, respectively (extrapolated to 19 202 km and 530 535 km to consider all volunteer and staff). As part of work, in a 46-week year, volunteer and staff respondents travelled 16 213 km and 30 981 km, respectively (extrapolated to 22 032 km and 63 717 km to consider all volunteer and staff).
There were 10 patients in the hospice for the week chosen which amounted to 49 258 km for patient and family travel when extrapolated for the whole year. Only 6.5% of respondents drove a hybrid vehicle. Thirty-two per cent would consider owning a hybrid. When asked about attitudes to environmental sustainability, on a scale of 1 (of little importance) to 10 (of highest importance), 48% of respondents scored sustainability 10. A total of 86% of respondents scored 7+ to the importance of sustainability (online supplemental figure 2). From 95 responses, 90% supported or were open to the suggestion of ‘meat-free Mondays’ as an alternative to reduce meat consumption.
Supplemental material
Discussion
This study provides the first estimated carbon footprint of a specialist palliative care unit, and offers an opportunity to contextualise the contributions of the carbon emissions within this discipline alongside other specialties. For example, the estimated annual carbon footprint for cataract surgery in Cardiff has been estimated as 405 tonnes CO2e.12 This is a similar carbon footprint generated for a single surgical procedure compared with a hospice’s footprint for the delivery of all its clinical services.
The highest carbon emission contributors of the 420 tonnes CO2e produced were from travel (35%), gas (33%) and non-medical supplies (17%). When comparing with NHS England’s 2019 carbon emissions, travel, the supply chain (including medical and non-medical resources), and delivery of care (including energy and waste) contributed to 10%, 62% and 24%, respectively.13 In our study, travel was the highest contributor which differs from NHS England’s carbon footprint. Furthermore, repairs and maintenance were the highest non-medical resource emitters. In this regard, it is notable that the original hospice building was built in the early 14th century, which accounts for the high maintenance and heating costs.
It is important to consider the impact of the COVID-19 pandemic where strategies to reduce infections, such as increased ventilation by opening windows, will have increased the energy costs for 2021. Furthermore, increased clinical waste from personal protective equipment alongside staff point-of-care testing will have impacted the footprint.14 To support staff working from home, computers and telecommunications were required. It is debatable if these will be ‘one off’ costs or potential long-term additions for future emission calculations. However, post-pandemic, some staff continue to work remotely, which may reduce travel contributions.
There was overwhelming enthusiasm among the staff and volunteers towards environmental sustainability. Many supported the recent implementation of ‘meat-free Mondays’, as well as fund raising a garden for homegrown vegetables. Using the survey, a myriad of ideas was suggested from car-sharing to energy-saving measures including secondary glazing and eco-friendly lighting. Respondents also suggested using a renewable energy provider. Currently, 44% of the electricity provided by the hospice is from renewable energy sources.15 Providing 100% renewable energy could reduce the carbon footprint by 33 tonnes CO2e (equivalent to 8% of total emissions).
As with any carbon footprint calculation, estimations are needed. Staff travel was extrapolated for a whole year removing 6 weeks for periods of holiday. Together, patient and visitor travel approximated to three return trips each week. In reality, some patients may see a greater number of visitors compared with other patients, and likely from different locations. However, as patient and visitor travel formed only a small component of the footprint, this estimation is unlikely to have a significant impact on the overall results. Electricity and gas costs were taken for the year 2020 as values for the whole year could be provided for that year, but not 2021.
In summary, this is the first report on the estimated carbon footprint of a specialist palliative care unit. It demonstrates enthusiasm among staff and volunteers for sustainable practices. Since the start of this study, a sustainability group has been established at the hospice, committed to reducing the carbon footprint.
Ethics statements
Patient consent for publication
Ethics approval
Use of the Health Research Authority Decision Tool determined that NHS Research Ethics Committee review was not needed for this study.
Acknowledgments
The authors are grateful to staff and volunteers from Sue Ryder Leckhampton Court Hospice who assisted with this study and responded to the sustainability questionnaire. We would particularly like to thank the following: Rob Saunders, Joan Smith, Patricia Fleming, Ben Daley, Mari Pittman, Graham Stubbs, Laura Grainger, Andrea Sharam, Alice Levett (Bioregional), Sian Cooke (Bioregional), the Centre for Sustainable Healthcare (CSH), Martin Hill-Tout, Mmabotsha Motswaledi, Mary Goodenough, Ann Cuthbert, David Trennery and Tabitha Winnifrith.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors KD, MM and PP collected the data. KD wrote the first draft. All authors aided with data interpretation and critically revising drafts. They also read and approved the final version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.