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Establishing a Greener Endoscopy in Northumbria Healthcare NHS Trust

In this blog post, Leigh Donnelly, endoscopy education and development lead at Northumbria Healthcare NHS Trust, explores the preliminary measures their trust has taken to improve sustainability within their work.

At my trust, the amount of physical waste we produced in endoscopy during the COVID-19 pandemic made it clear that the situation was unsustainable. Coupled with the NHS commitment to reach net zero by 2040, it became essential that we assessed our current practice to see what changes could be implemented.

I was aware that managing any change can be difficult, particularly when COVID-19 was at the forefront of our minds. We hoped that making a few simple changes in the first instance would be the key to our success.

The First, and perhaps the most important step, was the introduction of Green Champions:  enthusiastic team members with a keen interest in sustainability. They had the difficult task of imbedding the initial changes in current practice at the department level.

The next challenge was to tackle waste segregation. This was achieved through establishing links with the trust’s Waste Management department, the recycling officer from the local county council and, importantly, with engagement with the Infection Control Team. With the support of these networks, we completely changed the way we discarded our physical waste and made effective use of domestic, clinical and recycling waste streams.

Unfortunately, these changes have been difficult to measure, as the organisation currently has no way of auditing waste for each department. However, by appropriately segregating our waste and making conscious decisions regarding recycling, we can see the visual impact this has made. We feel that the amount of clinical waste has significantly reduced.

We needed to be careful about making too many changes in the first instance, so that we could let the new waste arrangements settle in. In due course we added in further changes, which then didn’t seem like big changes to the team. These included:

  • adding Green Endoscopy to the Endoscopy User Group (EUG) as a standing item, to introduce the concept of sustainability to the whole of EUG. We wanted to make sure that we opened channels of communication to ensure that sustainability was one of our key areas of quality practice. It also gave us an opportunity to introduce and ratify new ways of working with regard to our greener endoscopy practice
  • asking the question ‘How can we make the list more sustainable today?’ at the morning huddle
  • moving to paper bags for patients’ belongings – and then to a reusable version
  • having a green newsletter circulated digitally to engage with teams
  • moving to digital patient information
  • conducting patient surveys and feedback via QR codes
  • reducing the use of dignity shorts by offering only to patients who wanted them, rather than automatically giving them to each patient. While this might seem a small change and, in some ways, can be regarded as insignificant, these disposable dignity shorts increase clinical waste. By offering the patients a choice we reduce the number used and ultimately disposed of, and it also means we need to order less. This is a work in progress so metrics are not available at present. We have also sought alternatives such as reusable garments, but there are difficulties regarding laundering 
  • reducing sterile water use for manual flushing
  • encouraging patients to bring their own dressing gown if they feel comfortable, to reduce the use of double gowning
  • discussing the harmful environmental impact of Entonox, the gas used as a pain relief, with patients. Many of our patients are aware of the impact climate change has on health and are open to discussion. Most patients, we find, are unaware of the harmful environmental effects of Entonox and as a result some patients are happy to explore alternative methods of pain relief for their procedure. However, it could be argued, by ensuring endoscopists are very skilled and perform high-quality procedures and employing techniques such as water immersion colonoscopy, patient procedures can be much more comfortable thus requiring less analgesia.
  • keeping the idea of green endoscopy in the front of everyone’s minds
  • embedding sustainable practices within our policies and protocols.

This is just the tip of the iceberg of our sustainability journey; we have lots of aspirations yet to be realised and a few more in the planning stages. We know this is a long-term commitment, and that it is an evolving process, but as a specialty we’re keen to explore what more we can do. It hasn’t been easy, we have had failures as well as successes, but a journey of 1,000 miles begins with a single step.