Sustainable lessons in healthcare | Member placement - North Bristol NHS Trust, UK

Andreea Zotinca - Circular Healthcare Project Officer

A blog post by Andreea Zotinca,
Circular Healthcare Project Officer  – HCWH Europe

Last November, I visited Southmead Hospital, one of the healthcare facilities that form the North Bristol NHS Trust – a member of the Global Green & Healthy Hospitals (GGHH) network. I was guided during my visit by Sustainable Development Manager Megan Murphy, who introduced me to some of the most dedicated individuals working towards sustainability in the hospital. I witnessed the inspiring work to reduce the hospital's environmental impact and learned about some of its challenges.

Hospital equipment and furniture reuse and repair

The day began with a visit to the repair workshop, where I met Paul, Equipment Supervising Officer, who started the "Warp-It" initiative in 2016. "Warp-It" facilitates the reuse and repair of old furniture and non-medical equipment and has saved over £156,000 (approx. €178,245) and 236 tonnes of waste to date. It is an excellent way to give a second life to items that would have otherwise been thrown away. Employees use an online platform to list items they no longer need, making them available to others who can use them. If an item needs repair, it goes to Paul's team before becoming available for reuse. 

Despite the platform's popularity, there are still challenges to overcome, such as new employees not being aware of its existence and language barriers. Paul is spreading the initiative through presentations, posters, and team discussions. People are, however, reporting broken items more frequently now, indicating the platform's growing popularity.

Paul stressed the importance of standardising equipment to facilitate repairs using spare parts from other items. He also mentioned the importance of using high-quality, durable materials, such as stainless steel, instead of plastic to help equipment last longer.

Solar panels and LED lighting in healthcare

I then met with Matthew (Carbon and Energy Manager) and Xavier (Energy Officer), who are part of the Strategic Estate Development and Sustainable Health department and are responsible for reducing the energy emissions of the trust. They gave me a tour around the hospital grounds, showing me the site’s solar panels and one of their buildings undergoing insulation improvements. The team works on switching to LED lighting and plans to install more solar panels and improve insulation. These projects were funded by the Public Sector Decarbonisation Fund.

Reducing waste in the emergency department

Emma, a consultant from the emergency department, told me about their efforts to reduce the department's environmental impact. They reduced the unnecessary use of cannulas by over 40%, reduced desflurane anaesthetic gas use by 98% since 2016, and worked on capping off ports to the manifold to reduce anaesthetic gas waste. To reduce the use of Entonox, they are exploring the possibility of transitioning from manifolds to portable cylinders. They have estimated that manifolds may leak up to 94% of nitrous oxide in some of their theatres.

The team plans to start a pilot project for reusable aprons to minimise PPE waste and is working on reducing disposable cup use. Aprons significantly contribute to hospital plastic waste, as we often encounter during our healthcare plastic waste audits. Reducing the use of aprons could substantially decrease the overall plastic waste in hospitals.

Emma expressed her interest in optimising custom packs by eliminating unnecessary items and reintroducing reusable instruments. Disposable custom packs comprise single-use sterile items intended for specific procedures but often contain additional products that are discarded along with the used ones. Please refer to our best practice list for more information on this topic.

To foster sustainability initiatives, the emergency department has established a WhatsApp group and an email address for staff and patients to submit suggestions, which are reviewed and monitored regularly.

Cultivating green spaces in healthcare

During my visit, I explored the green spaces on the grounds with Phoebe, a dedicated nature recovery ranger at the North Bristol NHS Trust. Phoebe is deeply committed to revitalising the existing green spaces and creating new ones that are accessible to both patients and staff. We discussed the green space improvements to new building developments e.g. living roofs, native hedgerows, wildflower meadows, and bulb planting. She stressed the significance of green spaces for the health and well-being of patients and staff alike. 

In 2022, North Bristol Trust received the Space for Nature Bee Bold Awards for supporting pollinators and promoting a connection with nature across their estate. Specifically, the award recognised Phoebe's work in this area, including creating opportunities for staff and patients to enhance their health and well-being by engaging with nature. The Trust's explorer map, which identifies areas where staff and patients can unwind and connect with nature, was also highlighted.

NHS Forest provides trees for the hospital that are planted with the support of the local community, ensuring that everyone has a hand in creating and maintaining these vital green spaces. Phoebe and her team are dedicated to providing every patient room at Southmead with a green view.

One of the tour's highlights was the vegetable garden, where patients and staff could grow their produce, some of which is even used in the hospital's canteen kitchen. It was nice to see how these green spaces serve as a source of fresh produce and a venue for community activities such as yoga and acoustic music sessions.

Despite the cold, grey, and rainy weather, I enjoyed exploring the gardens, including the rooftop garden, where they grow herbs for the kitchen. It was heartening to see how the hospital is committed to integrating green spaces into its care model and how these spaces positively impact the health and well-being of patients and staff.

Reducing the emissions of operating theatres

After lunch at the hospital canteen, which offers delicious plant-based options daily and supports staff to use their reusable containers for takeaway, I spoke with the two anaesthetic consultants, Gemma and John. We discussed the challenges of reducing plastics within theatres, their implementation of a reprocessing scheme for laparoscopic instruments, and their work on reducing emissions from anaesthetic gases.

Theatres have also dramatically decreased the use of Desflurane, with only a few bottles used in exceptional circumstances, and have eliminated nitrous oxide (298 times stronger than CO2).

They hold regular touchpoint meetings between procurement and clinical staff to discuss their needs. They noted, however, that leadership engagement is necessary for significant change and recognition of the successes they have achieved so far.

If you're interested in working on innovation procurement to identify sustainable solutions, learn more about our Procure4Health project here.

Finally, Megan took me to see the new bike park, where staff can borrow bikes as part of the hospital's effort to become a mobility hub, working with the city authorities. Staff can borrow electric bikes for a month to try them out, but city bike infrastructure must also improve to encourage more people to bike to work.

A big thank you to all the people at the North Bristol Trust for welcoming me and taking the time to walk me through their activities, especially to Megan Murphy, who helped me organise this visit!

Andreea’s placement in Bristol is part of HCWH Europe’s Member Placement Programme – helping the team to connect more closely with members.

Learn more about the programme here