Sustainable Development Unit Research Articles

An exploration of hospital pharmacists' engagement with sustainability policy in the NHS England.

NHS England has set itself a target of net zero emissions by 2050. Therefore, to address this gap in the literature, this study aimed to explore engagement with NHS policy on carbon reduction (including awareness of the Sustainable Development Unit [SDU] and the Coalition for Sustainable Pharmaceuticals and Medical Devices [CSPM]) in NHS hospital pharmacists in England. Semi-structured interviews were conducted with 23 pharmacists working in six NHS England hospitals across all hierarchical levels. Four interview questions elicited Yes/No responses and one generated qualitative data which were analysed by two methods - Leximancer and manual coding. Only five (5/23; 21.74%) had heard of the SDU and none knew its purpose. Those who did not wish to learn more about the SDU could not see its relevance to their clinical practice. Barriers identified to the inclusion of sustainability considerations in clinical decision-making were lack of knowledge of the environmental risk profiles for treatment options, lack of quality environmental evidence incorporated into clinical guidelines and lack of time to research for themselves. Many participants did not believe that environmental considerations were part of their job. For NHS England to successfully deliver on its target of net zero emissions by 2050, immediate action is required from all hospital staff, clinicians included. The challenge for the NHS will be engaging pharmacists and other clinicians with sustainable clinical practice and working with clinicians to reduce identified barriers. As these data were collected in 2016, further research is warranted to determine if pharmacists' attitudes towards sustainable practice are changing.

Climate Change Health Emergency: The Role of Healthcare Professionals

THE IMPACT of climate change is clear, urgent, and formidable, with the effects of climate change on health an immediate threat to patients and populations both now and in the future. The Royal Society of Medicine (RSM) shared a series of 10 expert-led presentations on the ‘Health Emergency of Climate Change’ in 2021, with the closing presentation focusing on the role of healthcare professionals in addressing the health impacts of climate change. Linda Luxon, RSM Council Trustee, hosted a discussion between Cheryl Holder, President of the Florida State Medical Association and Co-chair of the Florida Clinicians for Climate Action, USA; David Pencheon, Founding Director of the National Health Service (NHS) Sustainable Development Unit, UK; and Rita Issa, Clinical Research Fellow in Climate Change, Migration and Health at University College London, UK, and Co-founder of Doctors for Extinction Rebellion. Their discussion highlighted the scope of the issue facing healthcare professionals, identifying strategies that can allow clinicians to be advocates for the health of their patients as well as have an impact on wider policy and systems-level changes to address this health emergency.

The BMJ Awards: director of Sustainable Development Unit wins outstanding contribution to health award 2020.

The BMJ Awards: director of Sustainable Development Unit wins outstanding contribution to health award 2020.

AORN Position Statement on Environmental Responsibility

<scp>AORN</scp> Position Statement on Environmental Responsibility

Climate change is a health issue: what can doctors do?

The visit to Australia by Dr David Pencheon, Founding Director of the National Health Service (NHS) Sustainable Development Unit, in April-May 2018 generated considerable interest and engagement. Dr Pencheon's overarching messages were that climate change is a health issue and that doctors and health systems have an opportunity, and responsibility, to lead climate action. This article distils Dr Pencheon's presentations into three themes: (i) carbon accounting; (ii) transformational change in our systems of healthcare; and (iii) a health system fit for the future. For each theme, we highlight promising initiatives that are already underway in Australia that are starting to transform our health system into one fit for a future environmentally sustainable world. We suggest practical ways in which doctors can lead the transformation through personal action and influence broader systems.

Sustainable achievements and future aspirations in the NHS

Sustainable achievements and future aspirations in the NHS

Green dentistry: the art and science of sustainable practice.

Dentistry is highly energy and resource intensive with significant environmental impact. Factors inherent in the profession such as enormous electricity demands of electronic dental equipment, voluminous water requirements, environmental effects of biomaterials (before, during and after clinical use), the use of radiation and the generation of hazardous waste involving mercury, lead etc have contributed towards this. With rising temperatures across the world due to global warming, efforts are being made worldwide to mitigate the effects of environmental damage by resorting to sustainability concepts and green solutions in a myriad of ways. In such a scenario, a professional obligation and social responsibility of dentists makes it imperative to transform the practice of dentistry from a hazardous to a sustainable one, by adopting environmental-friendly measures or 'green dentistry'. The NHS in the UK has been proactive in implementing sustainability in healthcare by setting targets, developing guidance papers, initiating steering groups to develop measures and implementing actions through its Sustainable Development Unit (SDU). Such sustainable frameworks, specific to dentistry, are not yet available and even the scientific literature is devoid of studies in this field although anecdotal narratives abound. Hence this paper attempts to present a comprehensive evaluation of the existing healthcare sustainability principles, for their parallel application in the field of dentistry and lays out a blueprint for integrating the two main underlying principles of sustainability - resource use efficiency and eliminating or minimising pollution - in the day-to-day practice. The article also highlights the importance of social values, community care, engaging stakeholders, economic benefits, developing policy and providing leadership in converting the concept of green dentistry into a practised reality.

Sustainable development.

The Sustainable Development Unit has produced updated guidance for providers and clinical commissioning groups (CCGs) developing sustainable development management plans (SDMPs). The new version has been brought up to date with the NHS standard contract, and provides detailed guidance on what areas are more or less appropriate for large providers, small providers and CCGs. The aim is to help organisations write SDMPs that identify, prioritise and monitor the actions needed to improve sustainability performance, while reducing the carbon footprint.

Making health care more sustainable: the case of the English NHS

The NHS is the most revered organisation in Britain: ‘the proudest achievement of our modern society’.1 It is certainly the largest, although since its inception in 1948 it has operated in a government-funded environment of restricted resources. Nevertheless, it has also benefitted from a generally effective model of intervention centred on a hospital care system integrating specialist and emergency care and a primary care system which functions as both a source of treatment and a gatekeeper to specialist care. New circumstances, including environmentally-generated risk and a shifting disease reality, challenges the adequacy of this model. This paper argues that these new circumstances, some of which have seen a legislative response by government, mean that the NHS has to apply sustainable development thinking programmatically throughout its management and operations. It is also argued that the organisation needs to refocus towards prevention particularly in order to stem the rising tide of non-communicable disease. This paper sets out the thinking and actions of the Sustainable Development Unit, which has the task of developing and implanting sustainability concepts in the NHS. It is argued that the cause of sustainable development calls for a mix of cultural and technological shifts, new incentives and a rolling programme of innovative change. Some examples of success are presented.

A medium-rise 1970s maternity hospital in the east of England: Resilience and adaptation to climate change

The late 1970s design for the Rosie Maternity Hospital on the Addenbrookes campus in Cambridge is a recurring type across the UK National Health Service, a framed three-storey courtyard configuration in brick masonry. It was selected as a case study project for the ‘Design and Delivery of Robust Hospitals in a Changing Climate’ project, pursuing the methodology developed for that research. Temperature data were collected in representative spaces within the hospital, over a two-year period. These revealed overheating in mild conditions relative to an observed 24℃ threshold for sleep but concealed within the customary 28℃ threshold marking the upper limit of acceptable conditions. The building was modelled using current climate data to predict 2010 conditions. The model was then calibrated against the observed 2010 data and used to predict the likely internal temperatures in current and 2030s. The results indicated an increase in peak temperatures. Four adaptive intervention schemes were subsequently developed: an ‘enlightened’ industry standard ‘Passivhaus’-type option providing superinsulation, sealed glazing and heat recovery; a lower technology-based scheme promoting natural cross-ventilation by providing greater opening glazing area, opening up the plan, sunshading and additional insulation; an enhanced natural ventilation scheme glazing over the courtyards to provide supply air winter gardens, and an advanced natural ventilation option pursuing passive downdraught cooling. All four schemes were modelled using the projected current and 2030s weather data and their performance was compared. The schemes were fully costed to yield relative ‘value for money’ guidance to National Health Service Trusts. Practical application: The Heat wave Plan for England 2014 warns National Health Service (NHS) organisations of the risks to patients, particularly the very young, the elderly and the seriously ill, from extreme summer heat events.1 The Chief Medical Officer in her introduction challenges each NHS locality to plan well in advance of hot spells, as appropriate. This paper describes the likely extent of overheating risk and a series of potential adaptation plans for a recurring NHS hospital building type. As a consequence, estates and facilities decision makers in NHS organisations and Public Health England officers charged with the mitigation of risk resulting from overheating of wards and clinical spaces will benefit directly in their necessary decision making from the findings. Policy makers in the Department of Health and policy advisors in the NHS Sustainable Development Unit and the Climate Change Committee Adaptation Sub-Committee will benefit from the evidence presented in advising the NHS and Department of Health.

Reducing carbon and controlling energy costs

British Journal of Healthcare ManagementVol. 20, No. 11 Energy EfficiencyReducing carbon and controlling energy costsJohn CareyJohn CareySearch for more papers by this authorJohn CareyPublished Online:12 Nov 2014https://doi.org/10.12968/bjhc.2014.20.11.517AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Pencheon D, Nicholson D, McKay N, Cointet S (2010) Saving Carbon, Improving Lives. NHS Sustainable Development Unit, London Google Scholar FiguresReferencesRelatedDetails 2 November 2014Volume 20Issue 11ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 12 November 2014 Published in print 2 November 2014 Information© MA Healthcare LimitedPDF download

Assessment of Water Supply Service Provision in Gaza Strip - Report to the World Bank - Middle East and North Africa Sustainable Development Unit

The assignment focussed on four municipalities, mainly: Rafah, Khanyounis, Dar-el-Balah and Jabaliya in Gaza Strip. The main thrust was in assessing the quality of water service provision based on access, production and consumption, cost recovery, and efficiency of municipalilty's service delivery.

Occupancy analytics: a new basis for low-energy–low-carbon hospital design and operation in the UK

This paper introduces an innovative approach to low-energy–low-carbon design for a new hospital in the UK. This innovation is achieved through an analysis of hospital operational policies and the impact of them on this performance. The analysis leads to new information and data, and it will be explained how this has a significant impact on the engineering design for the hospital's environmental systems. The work is a significant point of departure from conventional design practice, which largely focuses on the asset specification of the facility as a means for the achievement of this performance. There is now clear evidence that demonstrates that UK hospitals are failing to achieve the performance required by the UK Government's Carbon Reduction Commitment and this calls in to question how improved performance can be achieved by improved asset specifications alone. The primary source of this evidence emanates from the National Health Service (NHS) Sustainability Development Unit (2009. Executive summary. In D. Pencheon (Ed.), Saving carbon, improving health (pp. 8–9). Cambridge: NHS Sustainable Development Unit), which reports that actual carbon emissions from hospital buildings are increasing not falling, and that the rate of increase is diametrically opposite to that which is required (subsequent reports confirm this trend). The innovation presented in this paper concerns the development of a new building science called as ‘Occupancy Analytics’, the objective of which is to address this situation by providing new knowledge about how hospitals are used and then to use this knowledge to transform the engineering design process (and in the future: hospital operational management). The background to Occupancy Analytics is based on the assertion that as it is people that consume energy and not hospital facilities, then we should seek to understand how they are used and in particular how the working practices and processes (operational policies) of use impact energy consumption and carbon emissions. The importance of understanding occupancy is of fundamental importance to building science and has long been recognised as such within the building engineering profession. For example, it is the one major factor that determines the sizing and control of the engineering systems. In this paper, the author sets out the arguments for developing a new understanding of occupancy rather then reliance on formulaic principles (which largely characterises conventional design engineering design practice) that lead to poorly informed engineering solutions, which then lead to poor energy and carbon performance in UK hospitals. Occupancy Analytics has been implemented on a major new acute hospital in the UK. The objective of the implementation has been to establish a new benchmark in hospital energy and carbon performance. It will demonstrate how the development of new knowledge concerning occupancy should lead to a radical improvement in hospital performance. The results of the work undertaken so far have been substantial in their impact. A major finding was that conventional design practice grossly over-estimates occupancy leading to the poor energy and carbon performance described earlier. However, using Occupancy Analytics the author forecasts a reduction in carbon emissions for the new hospital of 34% and a forecast energy performance of 28 GJ/100 m3 or 280 kWh/m2, which is comparable to the best performing hospitals in Scandinavia.

The role of public health in climate change and sustainability: is the UK public health community’s response adequate?

Climate change is the greatest public health disaster facing us today. Sucharita Yarlagadda, Premila Webster and Elizabeth Haworth from the University of Oxford suggest that only with firm and decisive action now can we hope to avert or mitigate an impending public health catastrophe1 While there is a scientific consensus that the global climate is changing, with increasing climate variability and extremes, rising temperatures and sea levels and increased frequency of natural disasters which impact on human health,2,3,4 against a backdrop of persistent world economic pressures, the role of the specialty of public health in responding to environmental and climate change is not clear and needs to be defined. Many governments, including those of the UK have committed to tackling climate change through adaptation and mitigation and carbon abatement measures. The Climate Change Act 2008 sets a legally binding target for reducing UK greenhouse gas emissions by at least 34% by 2020 and by 80% by 2050, using the 1990 baseline.5 The NHS has shown leadership in this area through the Good Corporate Citizenship model,6 the NHS carbon reduction strategy7 and the NHS Sustainable Development Unit's route map for sustainable health.8 These aim to, at least, meet government targets and demonstrate early success with a 10% reduction of the 2007 NHS carbon footprint by 2015. Since April 2010, a new mandatory emissions trading scheme has come into force, requiring increased efforts by NHS organizations to meet government carbon targets.9 Alongside this is growing evidence of substantial financial and health benefits of low carbon business models in response to climate change and sustainability.6,10 As recommended by the Lancet and University College London a new Public Health movement is needed.4 The time to act is now. However, there still seems to be a huge gap between knowledge/ evidence and coordinated public health action. To clarify the public health role, a UK-wide internet based survey of public health departments (service public health, academic public health and the health protection units) was conducted in April 2010. It sought to allow an assessment of climate change as a public health problem, identify actions and innovations already taken, and to promote a coordinated public health response. The preliminary results were presented at the 2010 Faculty of Public Health Conference. The response rate of 32% overall was disappointing, despite a reminder. Over 90% of this considerable UK public health workforce who responded agreed that climate change is an important health problem requiring public health action. Many respondents highlighted the need for a stronger NHS mandate and prioritisation, such as through the NHS operational framework. Most believed that further training and development is essential for effective action, but the urgency is sidelined by current restriction of financial resources to deal with this problem. Although the public health workforce believes that action is needed and there is a public health strategy11 and encouraging response by primary care trusts12 neither an overarching plan nor effective coordination exists. What is good for the planet is also good for health and policies and structural drivers to mitigate and adapt to climate change would have a large positive effect on population health, for example the health co-benefits of walking or cycling to work that both reduce emissions and improve health and wellbeing.13 Emergency plans must be improved, kept up to date and include an effective service response to unpredictable weather patterns because of climate associated disasters and problems. These include floods and related water contamination incidents, droughts, heat waves, food shortages, as well as the problem of emerging diseases such as arthropod-borne infections and other environmentally linked diseases such as skin cancers and cataracts due to reduction/loss of the ozone layer. …

Delivering a more sustainable NHS: key strategies and policies

David Pencheon is the director of the NHS Sustainable Development Unit. Here he gives an overview of the strategies and policies this national unit, based in Cambridge, developed to help the NHS lessen its impact on climate change, promoting a sustainable and low-carbon quality health care service.

Greener Pharmaceuticals

Future Medicinal ChemistryVol. 1, No. 3 CommentaryGreener pharmaceuticalsJames H Clark, Simon W Breeden & Louise SummertonJames H Clark† Author for correspondenceGreen Chemistry Centre of Excellence, Department of Chemistry, University of York, UK. Search for more papers by this authorEmail the corresponding author at jhc1@york.ac.uk, Simon W BreedenGreen Chemistry Centre of Excellence, Department of Chemistry, University of York, UK. Search for more papers by this authorEmail the corresponding author at jhc1@york.ac.uk & Louise SummertonGreen Chemistry Centre of Excellence, Department of Chemistry, University of York, UK. Search for more papers by this authorEmail the corresponding author at jhc1@york.ac.ukPublished Online:29 Jun 2009https://doi.org/10.4155/fmc.09.46AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail View articlePapers of special note have been highlighted as: ▪ of interestBibliography1 Sheldon RA. The E factor 15 years on. Green Chem.9,1273–1283 (2007).▪ A large number of other metrics are available; an attempt to unify green metrics has been made by Andraos [12].Crossref, CAS, Google Scholar2 NHS SDU. NHS England carbon emissions: carbon footprinting emissions projections to 2020 – January. NHS Sustainable Development Unit, Cambridge, UK (2009).Google Scholar3 Dunn PJ, Galvin S, Hettenbach K. The development of an environmentally benign synthesis of sildenafil citrate (Viagra) and its assessment by green chemistry metrics. Green Chem.6,43–48 (2004).Crossref, CAS, Google Scholar4 Kuzemko MA, Van Arnum SD, Niemczyk HJ. A green chemistry comparative analysis of the syntheses of (E)-4-cyclobutyl-2-[2-(3-nitrophenyl)ethenyl] thiazole, Ro 24–5904. Org. Process Res. Dev.11(3),470–476 (2007).▪ First paper to refer to the sildenafil synthesis as the industry ‘gold standard’.Crossref, CAS, Google Scholar5 Constable DJC, Dunn PJ, Hayler JD et al. Key green chemistry research areas – a perspective from pharmaceutical manufacturers. Green Chem.9,411–420 (2007).Crossref, CAS, Google Scholar6 Comerford JW, Clark JH, Macquarrie DJ, Breeden SW. Clean, reusable and low cost heterogeneous catalyst for amide synthesis. Chem. Commun. (Camb.) DOI: 10.1039/B901581G (Epub ahead of print).Google Scholar7 Polshettiwar V, Varma RS. Nanoparticle-supported and magnetically recoverable ruthenium hydroxide catalyst: efficient hydration of nitriles to amides in aqueous medium. Chemistry15,1582–1586 (2009).Crossref, Medline, CAS, Google Scholar8 Polshettiwar V, Baruwati B, Varma RS. Magnetic nanoparticle-supported glutathione: a conceptually sustainable organocatalyst. Chem. Commun. (Camb.)1837–1839 (2009).Crossref, Medline, Google Scholar9 Anastas P, Warner J. Green Chemistry: Theory and Practice. Oxford University Press, NY, USA (1998).Google Scholar10 Lipinski CA, Lombardo F, Dominy BW, Feeney PJ. Experimental and computational approaches to estimate solubility and permeability in drug discovery and development settings. Adv. Drug Del. Rev.46,3–26 (2001).Crossref, Medline, CAS, Google Scholar11 NHS SDU. (2009) NHS carbon reduction Strategy for England: key actions. NHS Sustainable Development Unit, Cambridge, UK (2009).Google Scholar12 Andraos J. Unification of reaction metrics for green chemistry II: evaluation of named organic reactions and application to reaction discovery. Org. Process Res. Dev.9,404–431 (2005).▪ A large number of metrics are available, with Andraos providing an attempt to unify green metrics.Crossref, CAS, Google Scholar101 Janusinfo: environment and pharmaceuticals. www.janusinfo.se/imcms/GetDoc?meta_id=7241Google ScholarFiguresReferencesRelatedDetailsCited ByThe role of solvent selection at exploratory and production stages in the pharmaceutical industryDaniel R Nicponski & P Veeraraghavan Ramachandran1 September 2011 | Future Medicinal Chemistry, Vol. 3, No. 12 Vol. 1, No. 3 Follow us on social media for the latest updates Metrics Downloaded 114 times History Published online 29 June 2009 Published in print June 2009 Information© Future Science LtdFinancial & competing interests disclosureThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.No writing assistance was utilized in the production of this manuscript.PDF download

Health sector leadership in mitigating climate change: experience from the UK and NSW

The threat to human health from climate change means that all levels of government and private and public agencies will need to change their current practices to reduce carbon emissions. The health sector will also need to respond and change practice. The National Health Service in the United Kingdom is developing a systematic and strategic approach to reduce its carbon footprint, as described in the recently released NHS Carbon Reduction Strategy for England. The work is being led by the Service's new Sustainable Development Unit. While the Australian health care system has not yet embraced a shared vision for carbon reduction, there are examples emerging of how the sector is contributing to reduce greenhouse gas production. Examples from two NSW area health services to reduce energy use and promote active transport are presented. In both countries, these changes are supported by new legislation and policy.