In this blog, Dr David Ross, consultant chest physician at NHS Western Isles, discusses how videoconference appointments have helped to reduce carbon emissions in the Outer Hebrides.
I’m fortunate to work in the Outer Hebrides. Like other island groups and remote areas, the population doesn’t warrant full-time secondary care posts, so providing urgent care between monthly visits is a challenge. Within the islands, travel can be a significant obstacle, particularly for the infirm and disabled; for instance, one island group is two ferry trips and a hundred miles distant with no direct flights. Both modes of travel can be unreliable, and such travel has a high carbon footprint. Travel from the mainland to the islands for healthcare professionals like me also has a significant environmental cost.
The technology for videoconference (VC) appointments was available in 2015, and although underutilised, it allowed for a reorganisation of our service. Instead of bringing all patients to the main hospital in Lewis to see visiting consultants, we established hospital-based VC clinics in two GP–led hospitals on southern islands, making appointments with spirometry and X-rays accessible without flights or ferries. We also began to offer home VC appointments These appointments could be delivered from anywhere in the UK, or occasionally from holiday or conference destinations.
In the first year, we calculated that the reduction in carbon emissions for 44 patients from the southern isles (a population of 2,500 who would have previously have to have flown) to be just over 10 tonnes, but this excluded a greater number who had to fly to the mainland for other tests and treatments.
Are these results applicable to the wider NHS? Avoidable emissions related to road transport are greater, due to the sheer numbers in other parts of the UK, but retail franchises within hospitals, parking income and a lack of responsibility for travel costs and impacts are strong financial disincentives.
Had I delivered all consultations over home VC, the theoretical annual carbon saving would have been around 60 tonnes (for a total population of 25,000).
Beside reducing infection risks, there are clinical advantages in being able to speed patients’ investigations and treatment by seeing them within a day or so, giving the opportunity to arrange investigations and clinical reviews with minimal travel – and not only in the context of cancer.
A specific example shows where the NHS could make significant savings. I assessed a remote dyspnoeic asthmatic patient urgently over VC and – seeing his swollen calf – arranged prompt local treatment followed by an outpatient scan the following day. A few days later, after lengthy discussions with a nurse and then doctor at NHS 111, a close friend in the same situation in the south was told to go to A&E and join the back of the queue (during the COVID pandemic).
VC appointments can not only reduce the carbon footprint of healthcare directly by reducing transport for both patients and healthcare professionals, but also indirectly by allowing new, more efficient ways of working such as utilising it as part of enhanced community triage in out-of-hours care.
