Sustainable speech and language therapy – a reflection of practice in a neonatal unit.

Rachel McLean's picture

As a speech and language therapist working in hospitals, it was the amount of single use plastic used every day that first got me thinking about the impact of our healthcare system on the environment. This has only worsened through the Covid-19 pandemic. But, when I started to do more research, I was shocked to learn that clinical waste actually accounts for a very small percentage of the NHS carbon emissions (only 0.1% - though, this may be underestimated). With the NHS goal to be carbon net zero by 2040, this led me to wonder where I as a therapist could perhaps be making a bigger impact. The four principles of sustainable healthcare, helped me to broaden my perspective.

These key principles are intended to guide professionals to look more closely at their service and identify where they could have the biggest impact – it may be in one or all of these areas. What this highlighted to me was as speech and language therapists, we are fortunate to be ahead of the game in many ways, as the first two principles - prevention and patient self-care - are embedded into a lot of our everyday practice. Reflecting on my role in a neonatal unit, I realised several of our therapy goals and service quality improvement projects inherently promote a move to more sustainable practice, I just wasn’t consciously aware this was the case.

For example, for premature infants, we promote use of oral cares with breastmilk. This has several therapeutic and medical benefits including positive oral experiences and improved feeding outcomes for the infant, increased parental confidence in carrying out cares and reading their baby's cues (which in turn supports longer term communication development), and reducing incidence of infections and complications such as ventilator associated pneumonia and necrotising enterocolitis. Reduced complications has potential to reduce number of medications required and shorten overall length of admission (both big contributors to NHS carbon emissions). This intervention is therefore targeting both principle 1 - prevention and 2 - patient self-care (in the form of parental education and empowerment).

While our explicit aim is to enhance patient outcomes for feeding and communication  – through a sustainability lens we can also see potential social, financial, and environmental benefits – this is known as the ‘triple bottom line’ for sustainable value.  Mouthcare is just one intervention we promote, and the triple bottom line could be considered more centrally within many of our other therapy goals and services, from promoting reusable baby bottles over single use (principle 4 - a lower carbon alternative), to advocating consideration of an earlier discharge pathway for infants who are medically well but still require nasogastric tube feeds (principle 3 – lean service delivery). The move to virtual services / telemedicine can also be considered a lean pathway.

It is empowering to me that in our roles as speech therapists, taking a holistic approach to incorporate social, environmental, and financial outcomes (the triple bottom line), does not necessarily change the types of interventions we use. Our knowledge and use of early intervention, evidence-based practice, and education are powerful tools not only for our patients, but for our healthcare systems, environment and communities moving forward.

So with this in mind, where could we start? I really feel the next step for us as therapists is to talk more explicitly about where our profession fits within the sustainability of health and healthcare, and as speech therapists, talking is something we are very good at! By opening these conversations with our fellow therapists and wider MDTs, we can increase awareness, find like-minded colleagues, take a deeper look at our services and importantly - take action.

There is a lot of information available to support us in initiating these conversations - COP26 (The United Nations Climate Change Conference) is currently wrapping up its second week, drawing a lot of media attention to the complexity of sustainability issues, including many discussions on the interrelationship between climate change and health. The Centre for Sustainable Healthcare (CSH) are providing daily recaps here. The recently launched NHS Greener AHP’s Hub can also support in guiding us to broaden our perspective, generate ideas, and look at what AHP’s are already doing - as discussed in previous SLTSusnet blog by SLT Iona Sinclair.

Please comment below to share your opinions and ideas on sustainable SLT practice, and help us get these conversations started!

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