Giving it 10%
Nigel Hawkes, freelance journalist
You can see a full colour pdf copy of the article here or read the text below.
Low carbon dinners, hand driers, and ditching old fridges are just some of the tactics health bodies are using to cut their carbon emissions by 10% in 2010, finds Nigel Hawkes
On 10 October a group of sumo wrestlers in Tokyo plan to cycle to their training, an exploit as demanding for the bicycles as for the wrestlers. In the Maldives, the president will install solar panels on the roof of a house, and in Auckland, New Zealand, mechanics will attempt to make thousands of neglected bikes roadworthy again.
The tenth day of the tenth month of 2010 will be the cue for a worldwide series of events, some of which will involve health care. A growing number of organisations in the NHS and the private health sector in the UK are signing up to the 10:10 commitment to reduce their carbon emissions by 10% in 2010 (www.1010global.org/uk). By the beginning of October, 10:10 had signed up 27 acute trusts in England, 11 mental health trusts, 35 primary care trusts, 29 general practices, one strategic health authority (NHS South West), and a couple of dozen other organisations.
From saving electricity in general practices to designing an entire “low carbon” menu for patients and staff at University College Hospital in London, the 10:10 movement is mobilising enthusiasm among many who are disillusioned by the international failure to do more to halt climate change. It is seeking to achieve, through bottom-up initiatives, what diplomacy has so far failed to achieve by top down regulation.
10:10 was founded by the documentary film maker Franny Armstrong, best known for her film about climate change, The Age of Stupid. Launched a year ago, 10:10 has grown fast. It seems to have hit exactly the right note for many people anxious about climate change but uncertain how to help. Networking, mutual support, and localism are the keys to its success.
In health care, the 10:10 banner is carried by the Campaign for Greener Healthcare, part of the charity Knowledge into Action, launched by Sir Muir Gray. The campaign’s project manager, Tim Nicholson, explains: “We had already bought the rights to show The Age of Stupid to NHS audiences, so Franny asked us if we wanted to run the healthcare stream of 10:10.
“We cover health care as a whole, not just the NHS. We include some royal colleges, and some in the private sector—the General Healthcare Group has just signed up. The BMJ Group is also a member.”
The 10:10 commitment, he says, does not literally mean that organisations undertake to cut their emissions by 10% during the calendar year 2010. Each has a baseline year immediately preceding its starting date, and aims to achieve the cut in the following 12 months. Many organisations choose the financial year, because the data they need will be more readily available.
Targets are kept simple by aiming at four key areas: grid electricity, fuel use on site, road transport, and air travel. “The data are either already captured or are easy to capture,” says Mr Nicholson. “It would be easy to make it too ambitious—there are many different ways to measure an organisation’s carbon footprint. But these areas are meaningful to individuals and simple to administer.
“We’re looking for a 10% cut, but that’s an aspiration. If organisations achieve 7%, 8%, or 9%, that’s still fantastic. The expectation is a minimum of 3%—we want to avoid people signing up without any intention of doing anything.”
It is up to the organisations themselves to certify what they have achieved, but Mr Nicholson believes they are careful enough of their reputations not to make claims that can’t be substantiated. “If one or two do, and the vast majority are embracing the target, so what?”
Role models
Good examplars of the 10:10 approach are two neighbouring general practices in Sussex, Portslade Health Centre and Mile Oak Medical Centre. Sally Barnard, a general practitioner at Mile Oak, says: “Brighton and Hove decided to set up a city-wide 10:10 effort, and Rachel Cottam from Portslade and I were keen to get involved.
“They were looking for pioneers in health and we volunteered, not knowing how it would turn out. On your own you can feel very downtrodden, and it was hugely helpful to find somebody else—the genius of the thing is that everyone’s trying together.”
She explains that the start was really simple. “We made sure we turned off the lights when we went to lunch, and also turned off computer screens. We bought a smart plug for appliances that tells you how many kilowatt-hours they’re using. By switching it around, we found that one of our fridges was old and was using three times as much electricity as the new ones. Just eliminating that and reorganising the contents to the other four fridges saved us 0.4% of our electricity consumption.”
The thermostat in the practice has been lowered to 19ºC from 21ºC, and energy surveys undertaken. Christine Hapgood, one of the GPs, has started cycling to work rather than driving, at least when the weather is not too bad. The practice’s cleaner, Karen White, is strongly committed and makes sure that lights are turned off when they are not needed and computers are not left running overnight. Replacing paper towels with Dyson hand driers is set to save £1200 (€1400; $1900) a year, as well as cutting carbon. A video has been made as an inspiration to others.1
Dr Barnard hopes some of this “chipping away,” as she calls it, is getting through to patients as well. “We want to make them sit up and take notice so we put up posters in reception and leave out cards with the ‘top ten tips’ that they can take away.” She welcomes the fact that David Cameron signed government departments up to 10:10 two days after taking office as prime minister and that Ed Miliband, the new Labour leader, is also a supporter. “One of the main outcomes I hope for will be to get the message up to those in power,” she says.
At NHS Stockport, public health researcher Jilla Burgess-Allen was motivated to try to do something by the NHS’s huge carbon footprint: 21 million tonnes of carbon dioxide a year, a quarter of all carbon emitted by the UK public sector. “Not only will climate change have effects on health, but we’re also contributing to it,” she says. “That’s two reasons to act. We need to be seen to be taking the issue seriously—it’s like when doctors stopped smoking and showed they really did believe it was harmful.”
A primary care trust like NHS Stockport is largely office based, so the initiatives taken have included changes such as printing on both sides of the paper, switching appliances and lights off when not needed, trying to focus procurement on green suppliers, and spreading the word through monthly bulletins and regular meeting of the 20 “green champions” across the trust—“small incremental steps,” says Ms Burgess-Allen.
A survey shows that staff are changing their behaviour, or claiming to. “Half say they are switching off computers more often, two thirds are doing the same with lights, a quarter are planning meetings with less car use, and a quarter are using buses or walking more,” she says.
The events expected on 10 October show that the 10:10 message has caught the fancy of many people outside the UK; 45 countries now have 10:10 organisations. The events will be jointly coordinated with another group, 350.org, whose website promises 5162 events in 162 countries. Its founder, US author Bill McKibben, says: “People will be doing very practical things, but they will also be sending a pointed political message.” (The organisations name refers to 350 ppm carbon dioxide in the atmosphere, the level claimed to be the safe limit for humanity.)
Franny Armstrong has high ambitions for the day. “10:10:10 will be remembered as the day the world put aside its differences and came together to prevent runaway climate change”, she says.
Low carbon apple crumble to go please
University College Hospital in London is one of the most energetic NHS bodies to embrace 10:10. Sir Robert Naylor, the chief executive, has pointed out that for hospitals the issue goes far beyond turning out the lights, since energy (electricity and heating) accounts for only 22% of carbon, with 18% from travel and by far the largest share, 60%, from procurement.
Trevor Payne, director of estates, is responsible for a modern energy efficient building but has also implemented thermographic surveys of older buildings in the estate to see where energy can be saved and uses electric vehicles for hospital supplies.
His most original contribution to carbon saving is the creation, together with Farhad Khan, retail catering manager at the service provider Interserve, of a low carbon menu, first for hospital staff and visitors and, from 1 October, for patients as well. The menu includes the options of carrot and coriander soup, free range chicken, and tomatoes served with pasta and basil, with apple crumble and custard to follow. Most of the ingredients come from the area within the M25 motorway that circles London.
“When we trialled the menu for staff and patient visitors over the summer, sales increased and the low carbon options actually sold out,” Mr Khan says. “Over the two-week initiative, footfall increased dramatically.” As well as local sourcing, the food is cooked in a less energy intensive way, with the vegetables for the soup and the apples for the crumble steamed as the pasta is boiled.
Mr Payne says that UCLH is probably one of the hospitals where it is hardest to implement a low carbon menu; so if they can do it, anybody can. “I will be challenging the NHS hospital catering association to mainstream this initiative into the NHS.”
Notes
Cite this as: BMJ 2010;341:c5448
Footnotes
· Competing interests: The author has completed the unified competing interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.
· Provenance and peer review: Commissioned; not externally peer reviewed.
Let’s cut some carbon out of health care
Fiona Godlee, editor, BMJ
If you haven’t yet joined the worldwide carbon reduction initiative 10:10, there is still time. All you have to do is establish your organisation’s use of electricity, fuel, and road and air travel by the end of this year and commit to cutting it by 10% within 12 months. As Nigel Hawkes describes (doi:10.1136/bmj.c5448), well over 100 healthcare organisations in the UK have signed up, ranging from hospital and primary care trusts to individual general practices. Forty five other countries now have 10:10 organisations.
Health care faces an enormous challenge. At an individual level, high carbon lifestyles are bad for health. At a global level, climate change has been called the greatest public health challenge of the 21st century. And at the moment health care is part of the problem. The NHS emits 18 million tonnes of carbon a year, a quarter of all emissions from the UK’s public sector. Becoming part of the solution is what 10:10 is all about.
The NHS in England is aiming for a 10% cut in emissions between 2007 and 2015 (www.sdu.nhs.uk/). Some people think that this is unambitious, but it has to be seen against the escalating demand for health care and the numerous barriers to progress at a time of economic constraint. What’s good about 10:10 is its simplicity and practicality.
Don’t let me pretend that it’s an easy option. The BMJ Group was among the first UK based organisations to join 10:10 when it launched last year. Probably our main achievement since then has been to get ourselves “carbon literate.” We now have a carbon footprint covering not only the four factors required by 10:10 but also commuting, waste, food, and procurement. We also know how much carbon comes from producing our journals and websites.
While doing the accounting we’ve not been idle. An energy audit of the beautiful but environmentally challenged building we share with the BMA shows us when and where the main problems are. Lights in some meeting rooms now turn off if you stop moving for too long—good for the bills and the blood flow. We do more videoconferencing for meetings and talks, and as part of our commitment to distance learning, we now have a thriving “remote participation” programme for our own conferences.
As for our products, the BMJ is printed on recycled paper and the plastic wrapper is recyclable. We are working to keep the physical size of the print BMJ down—our research summaries in print have helped. And we’re about to launch the BMJ on the iPad, Kindle, and Sony eBook Reader, which may reduce demand for print. I look forward to the rapid responses about the environmental impact of these devices compared with paper.
It is hard to know how much carbon we and other 10:10ers will cut. But as one doctor interviewed by Hawkes makes clear, a key motivation is to get a message to those in power. As countries prepare for the next round of climate talks in Mexico in December, our leaders need pressure and permission to act.
Notes
Cite this as: BMJ 2010;341:c5553
Footnotes
Follow BMJ Editor Fiona Godlee on Twitter at twitter.com/fgodlee and the BMJ at twitter.com/bmj_latest
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