Dr Robin Clarke
In 2021, the World Health Organization declared climate change the biggest health threat to humanity. Dr Robin Clark, medical director for Bupa Global and UK, explains how, as a leading healthcare company, Bupa is determined to be at the forefront of the sector in addressing this.
Bupa is committed to helping people live longer, healthier, happier lives and making a better world. Making a better world means playing our full part in addressing the climate emergency.
We know that people’s health is inextricably linked to the health of the planet. That’s why we have made a commitment to get to net zero by 2040, including across our supply chain and across all the countries we operate in – one of the most ambitious targets any healthcare organisation has set, underpinned by rigorous science-based targets.
Climate change represents a devastating threat to human health, with the acute and chronic impacts also carrying a significant financial cost. Mitigating the health and economic impacts of climate change requires action from government, businesses, charities and all parts of society.
In the course of treating patients, the healthcare sector is itself a cause of pollution from greenhouse gases and other pollutants.
According to NHS Carbon Footprint Plus figures, the health and social care system in England alone accounts for approximately 5% of the country’s national greenhouse gas emissions. The true figure will be higher when emissions from the private sector are factored in too.
The biggest impacts on the NHS carbon footprint come from its supply chain; for example, pharmaceuticals and medical equipment, followed by building energy, anaesthetic gases and travel of staff, patients and visitors.1
Tackling emissions related to energy will deliver significant gains. However, there are other steps we can take now to move the dial in the right direction; for example, by reconsidering our procurement choices.
While single-use disposable devices have become popular in an effort to reduce hospital-acquired infections, their environmental impact is longer than their lifecycle.
Bupa is investing in and delivering innovation that helps make healthcare more sustainable through our eco-Disruptive programme to find and support sustainable, scalable start-ups and innovative solutions that will improve people’s health and the health of the planet.
And we are putting this into action at the Cromwell Hospital, in London. Here are some of the ways we are doing that.
Recycling anaesthetic gases
About 95% of the anaesthetic used during surgery is exhaled by patients and released into the atmosphere as waste. This equates to 97,000 tonnes of carbon dioxide equivalent (CO2e) each year in the UK alone.2
Cromwell Hospital has become the first private hospital in the UK to trial an innovative medical device which captures and recycles waste anaesthetic gases, preventing them from polluting the atmosphere.
The trial was made possible through Bupa’s eco-Disruptive programme, which sees employees partner with sustainability start-ups to tackle environmental challenges.
The SID-Dock, developed by SageTech Medical, can capture 99.9% of waste anaesthetic agents (sevoflurane, isoflurane, desflurane) through actively controlled adsorption onto a re-usable capture canister. The captured waste is then recovered and recycled for future reuse.
It fits easily and safely into hospital operating theatres, without having to make changes to any existing equipment.
When the cannisters are full, SageTech Medical collects them from the hospital and takes them to their processing facility where the captured anaesthetic is purified and recycled back into pharmaceuticals, ready to be used again by hospitals.
This unique circular economy solution not only reduces direct emissions but means the volume of virgin drug that needs to be manufactured is also significantly reduced, conserving natural resources and reducing the associated emissions.
Cromwell Hospital has been trialling the SID-Dock for over six weeks now, as I write, and the team say that one of its biggest attributes is how effortlessly it fits into the hospital’s systems in theatre. Space is a commodity and they were initially concerned about how it would integrate with the equipment already there.
However, the footprint of the SID-Dock is very small; it fits in next to the anaesthetic machines without causing any disruption.
Another surprise was how quiet the machine is. This is very important, as loud machinery noises can disrupt surgeons. The SID-Dock makes minimal noise when in use. It does need a power source, but it has low energy consumption.
As my colleague Mehnuhlik Lynch, anaesthetic team leader at Cromwell Hospital, said: ‘Clinicians are becoming more and more aware about the impact their clinical practice is having on the environment.
‘Using SageTech’s solution, we can help reduce the carbon footprint of anaesthesia and give patients a greener choice for their healthcare. We’re really excited to be trialling this ground-breaking technology at Cromwell Hospital.’
Scrubs made from recycled plastic waste
Each year, 14m tonnes of plastic waste is dumped in our oceans. It destroys marine life by causing physical suffocation as well as constantly leaching chemicals and colouring agents.
And when it breaks down into microplastics, it causes devastating effects on reefs, water temperatures and lifecycles of aquatic animals.
Instead of using crude oil to make new plastic, Upcycled Medical turns existing marine litter (waste plastic) into upcycled clothing, including the scrubs that healthcare professionals at Cromwell Hospital have been wearing in theatres since the end of 2021 and in ITU since autumn 2022.
This helps to bring down the amount of plastic that goes into our oceans and ensures that there is no need to create new plastics in future, saving our fuel sources too.
Upcycled Medical, which was another participant in Bupa’s eco-Disruptive programme, treats waste salvaged from the oceans – including PET plastic, glass, metal and rubber – then turns it into pellets which are then bound into yarn.
This yarn is used to create medical clothing which is comfortable, durable and can be worn over long periods of time. Approximately seven to nine bottles that would have gone to landfill go into the making of every piece of medical clothing.
Re-usable anaesthetic equipment trays
It is important to realise the impact of using plastics in healthcare. Most single-use plastic items are considered as clinical waste post-use, so they can’t be recycled. Instead they must go into clinical waste, which is ultimately incinerated.
The team at Cromwell Hospital felt strongly that we should all be considering switching to smarter ways of using plastics to reduce carbon impact. That is why they began looking into trays that can be re-used and decontaminated safely so as not to pose an infection control risk.
The re-usable plastic trays from Henley Medical Supplies are very durable and have received positive feedback from the teams using them.
They use different colour trays to reduce cross contamination and as an additional safety measure when handling medications, with emergency drugs placed on a yellow tray.
This makes them easy for clinicians to spot them when needed. Other general anaesthetic drugs are put on green trays.
After use, the trays can be disinfected with cleaning wipes or put through an autoclave for sterilisation if needed.
By switching to re-usable trays, Cromwell Hospital has not only saved over 9,000 single-use trays from being incinerated each year, it has also reduced its costs by £4,000 per year.
Previously, Cromwell Hospital used metal single-use laryngoscope handles that contain lithium iron batteries. These handles were used once in line with the manufacturer’s instructions, which meant that they had to be discarded in clinical waste for incineration.
In February 2023, the team switched to metal re-usable laryngoscope handles from Timesco, which can be cleaned with disinfectant wipes or sterilised in an autoclave.
The handles, which are covered by a five-year guarantee, are compatible with rechargeable batteries instead of single-use ones and can be autoclaved up to 4,000 times.
This cuts our environmental impact by saving 1,900 single-use handles with lithium batteries from being incinerated every year. And it has also saved the hospital a projected £6,000 per year that can be re-invested into patient care.
As Cromwell has shown, it is easy to take simple steps and make careful procurement choices to positively impact the environment. We want to be a catalyst for change, sharing best practice and working with our partners across the healthcare sector to accelerate reaching Net Zero.
1. Delivering a ‘Net Zero’ National Health Service, NHS, July 2022
2. The carbon footprint of general anaesthetics: A case study in the UK. Hu, X, et al. Resources, Conservation and Recycling 2021; Volume 167