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Innovating a more sustainable health service

By David Lynch - 27th Jan 2025

sustainable health service

A recent IHCA symposium discussed opportunities to champion sustainability in the health service.
David Lynch reports

The crucial role played by consultants and other healthcare workers (HCWs) in improving sustainability in the health service was emphasised at a recent symposium organised by the IHCA.

The well-attended event, held in Dublin on 11 January, focused on the theme of “implementing sustainable healthcare solutions”.

Doctors were advised that the new consultant innovation fund – a provision of the public-only consultant contract – provided a “unique opportunity” to finance projects focused on sustainability and climate action (see panel below).

Mr Jared Gormly, Head of the HSE Spark Innovation Programme, said the total annual (available) funding was up to approximately €20,800,000 (on the basis of 2,600 consultants holding the contract).

Mr Gormly told the Medical Independent (MI) a significant increase in consultant engagement with the fund was anticipated during 2025. While the fund was not specifically for projects relating to climate resilience, many initiatives tended to have a climate action benefit or sustainability element, said Mr Gormly.

IHCA President Prof Gabrielle Colleran described the fund as a “unique opportunity” for consultants to pilot initiatives aimed at “reducing waste and improving effectiveness of care”.

Impact of ‘low value’ care

The symposium heard from international and national health experts who discussed practical measures to improve sustainability across the Irish and global health services.

According to the IHCA, a significant amount of health spending is not considered “high value” care (eg, unnecessary lab testing or inappropriate prescribing).

A number of speakers focused on the impact of “low value” care on carbon emissions, waste, and the climate crisis.

“Much clinical care is unwarranted and costly,” Prof Ian Scott, Consultant General Physician and Professor in Clinical Decision Making, University of Queensland, Australia, told attendees.

Speaking by video-link, Prof Scott said such wasteful practices contributed to the carbon footprint of healthcare. He said the financial and environmental sustainability of healthcare “go hand-in-hand”.

He told doctors and other HCWs that they “are both instigators of care and responsible stewards of the system”.

“Clinicians have a prime responsibility to reduce low value care, as much as we can. Therefore, we need to critically appraise, challenge and reform unjustified habits and practice norms.”

Low value care conferred no benefit or a benefit that was low compared with its cost, or it wasted limited resources, outlined Prof Scott.

He noted that 7-8 per cent of all carbon emissions in Australia arose from the health sector. Low value care contributed to 2.6 per cent of all carbon emissions in that country. Prof Scott said scientific research has proven the numerous environmental benefits of reducing low value care.

According to Prof Scott, a number of factors contributed to low value care, including cognitive biases among clinicians, fear of malpractice, clinicians’ over-optimistic estimates of benefits vs harm, patient pressure and requests, inadequate time spent with patients, and vested commercial interests.

He outlined several countering strategies including those advocated by Choosing Wisely Australia (see www.choosingwisely.org.au/). This organisation promotes a national dialogue on unnecessary tests, treatments, and procedures.

Echoing such themes, Dr Brian O’Connell, Emergency Physician and Sustainable Healthcare/Climate Risk Lead in New South Wales, Australia, outlined a vision of a sustainable emergency department.

He urged clinicians not to be “over-monsters” meaning they should seek to avoid “over-investigation, over-diagnosis, and over-treatment”, with the aim of becoming a “sustainable clinician”.

Dr O’Connell, who is originally from Enniskillen, Co Fermanagh, said that climate solutions needed “systems change”. He believed Ireland could potentially play a leading role. Ireland was relatively small compared to some other countries, but had a “large cultural footprint” that it could leverage to be a leading voice in the area.

Dr O’Connell said even without the threat posed by climate change, healthcare was “not sustainable” because of rising costs. He said measures focusing on building sustainability within the sector were crucial.

“We are a powerful voice; people trust doctors, nurses, and other healthcare professionals.”

Nitrous oxide

Other doctors addressed the symposium on proactive and sustainable practices being implemented at a national and local level.

In recent years, the College of Anaesthesiologists of Ireland (CAI) has established the national nitrous oxide mitigation project. Nitrous oxide has been commonly used as an anaesthetic and analgesic agent for over a century and is a potent greenhouse gas.

In the theatre setting, nitrous oxide is usually supplied via a manifold of cylinders to enable a continuous, uninterrupted supply. According to the CAI, recent work has demonstrated that the majority of nitrous oxide manifolds in the UK and Ireland have a significant leak (with between 83-100 per cent of nitrous oxide leaking out to the atmosphere before reaching point of delivery), placing a significant burden on environmental and atmospheric health, as well as being financially wasteful. The CAI project aims to decommission nitrous oxide manifolds at Irish hospitals.

Addressing the conference, Dr Dónall O’Cróinín, Consultant Anesthesiologist, Mercy University Hospital, Cork, said that progress had been made.

Speaking to MI, Dr O’Cróinín, who is also Chairperson of the CAI’s sustainability committee, said the biggest challenge is developing “enough enthusiasm in each institution to tackle the issue”.

“Because every institution is different,” he said. “I can’t go into any hospital and just say, ‘Do this, this, and this’.  It’s a problem just getting enough people interested in every institution to tackle what needs to be done…. It’s straightforward, but it needs internal buy-in.”

He told MI that the nitrous oxide system has been decommissioned at six hospitals. 

“We just need to keep on going to increase that number,” he said.

Following decommissioning, small cylinders of nitrous oxide are brought into each operating theatre when needed. “That is instead of having a joint system feeding pipes everywhere, so you have a mini system in each room where it is needed and that’s it,” said Dr O’Cróinín. “It hugely cuts down on waste and leaks.”

He said the CAI campaign aims to reduce the carbon footprint for anesthetic gasses in Ireland by 50 per cent by 2030, and becoming net zero by 2050.

In 2024, Cork University Hospital (CUH) decommissioned the nitrous oxide pipe system. This has been one of many sustainable measures undertaken on the CUH campus recently.

Dr Cathy Burke, Consultant Obstetrician/Gynaecologist and Chairperson of the ‘green group’ in Cork University Maternity Hospital (CUMH), spoke of green healthcare projects implemented across both CUMH and CUH.

She noted specific environmental issues in her specialty, including use of single-use materials such as plastics, gowns, and drapes, and also the waste from formula milk.

Dr Burke said that examples of sustainable initiatives undertaken at both CUMH and CUH included a switch to recycled paper for daily printing, greater emphasis on recycling, no plastic bottles allowed at meetings, the use of anesthetic masks with less plastic, and the use of recycled plastic bin bags and composting bins

Describing challenges in supporting sustainable healthcare projects, Dr Burke noted the “urgency and magnitude” of the required change. The “time poverty” of many HCWs was also an issue. She said there needed to be a particular focus on HSE procurement policy in how it impacts carbon emissions and waste. She said change in this area was “too slow”.

According to the IHCA, climate change is inextricably linked to poor public health outcomes. Hospitalisations attributable to air pollution accounted for 63,572 bed days in Ireland between 2016 and 2019.  Likewise, Ireland could see an 18-fold increase in the number of heat-related deaths, and almost a doubling in cold-related deaths in our ageing population, by 2100 due to climate change.

“Hospital consultants are uniquely positioned to lead the charge in integrating sustainable practices across our healthcare system,” said Prof Colleran. “This symposium is a positive, ground-up movement, driven by the expertise and innovation of consultants who are committed to creating a healthier, more sustainable future for patients, the healthcare sector, and society as a whole.”

Unique opportunity for consultants to drive positive change

Last month, this newspaper reported that some 2,729 consultants held the public-only consultant contract (POCC). This represented over 60 per cent of consultants in the public health service.

Each contract holder is entitled to access the consultant innovation fund to support innovation projects and research. 

While there were few applicants in the first year of the contract (2023), numbers have since increased, Mr Jared Gormly, Head of the HSE Spark Innovation Programme, told the Medical Independent at the IHCA conference.

A POCC contract holder can apply for up to €8,000 under the fund per calendar year.

There is also provision for an additional €12,000, bringing the total amount claimable to a maximum of €20,000 per calendar year. This additional funding can be provided by using the consultant’s unspent continuing medical education funding.

Furthermore, up to €50,000 is available if the project is pooled with other applicants.

The innovation fund is not ‘competitive’ in that applicants who fulfil the requirements are eligible to be awarded the funding.

According to Mr Gormly, the number of applicants in 2023 was small as the POCC was only introduced in March of that year.

“However, in 2024 there was an increase in uptake, with over 400 people engaged with it,” he added.

Mr Gormly noted there are now over 2,600 consultants on the contract. “So we would expect that there would be a big increase this year.”

He said that HSE Spark anticipated “something like double the engagement” in 2025.

“We are optimistic because for the consultants who have engaged with it so far, it has worked well for them. So we think it will become almost a routine [that consultants will apply for it annually].”

A number of initiatives that have received funding had a sustainability and climate action aspect.

Mr Gormly said the HSE is working on further developing an evaluation framework, which will include an appraisal of the sustainability component of projects.

Addressing the symposium, IHCA President Prof Gabrielle Colleran said it was her aspiration that new projects would emerge from the consultant fund and that many could be scaled-up to national implementation.

“I believe we have a unique opportunity thanks to the generous innovation funding available under the new consultant contract.”

Prof Colleran said that healthcare is responsible for about 5 per cent of Ireland’s carbon emissions and the HSE is the largest employer in the country. “So we can act as the demonstration model for other industries and we can show what can be achieved when innovation and sustainability combine.”

“Incremental changes are no longer enough; we need bold transformative actions…. Together we can help turn the tide on climate change. It is not our intentions, but our actions, that will make the difference.”


*The application form for the consultant innovation fund is available here https://healthservice.hse.ie/staff/spark-innovation-programme/consultant-innovation-fund/

Building climate action in the regions

Six regional sustainability leads are in place across the new health regions, Dr Philip Crowley, National Director of HSE Wellbeing, Equality, Climate, and Global Health, told the IHCA symposium.

In summer of 2023, the HSE launched its Climate Action Strategy 2023-2050. This strategy aims to reduce the negative climate impacts of the health service, achieve net-zero emissions for the HSE by 2050, and deliver healthcare that is environmentally and socially sustainable.

Dr Crowley told attendees that progress had been made. He said a guidance document had been issued for ‘green teams’ in each of the health regions. There will be a focus on supporting the formation of the regional green teams during 2025.

Quoting the World Health Organisation, Dr Crowley warned that climate change is “the single biggest health threat facing humanity”.

He believed there had been an increase in awareness regarding the specific impact of climate change on patient health.

Healthcare had what he termed a “bi-directional” problem. On the one hand it is a “major emitter” of between 4 and 8.5 per cent of the national carbon burden. At the same time, healthcare is on the frontlines dealing with climate change.

Dr Crowley said recent years had seen the emergence of some positive trends, including the rise in telehealth, which lessened patients’ reliance on transport.

He emphasised that lifestyle medicine could be a key driver in positive climate action.

“Global disease burden could be reduced by about 40 per cent over the next two decades through behavioural modifications.”

He noted that every one euro invested in prevention could yield two-to-four times the economic benefit. “Up to 80 per cent of cases of coronary heart disease, 90 per cent of type 2 diabetes cases and one-third of cancers can be avoided by changing to a healthier diet, increasing physical activity, and stopping smoking,” outlined Dr Crowley, who is a GP.

He said there was growing interest in climate action among HSE staff and over 800 staff members signed-up for sustainability training last year.

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