Emergency Healthcare (Public Services Committee Report)

Baroness Bennett of Manor Castle Excerpts

Thursday 20th July 2023 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Morris of Yardley, and to join others in thanking the noble Baroness, Lady Armstrong of Hill Top, for this report. I share the reflection that it is a great pity that there is no capacity for people to participate remotely, particularly given that there is a speakers’ list here, so it would be very easy, logistically, to facilitate. This debate does not have the potential difficulties of when there is no speakers’ list. I also join in with the comments about how long it has taken us to get a debate on this.

As others have said, the report came at a point of absolute crisis in emergency services, but there is no real evidence that the crisis has in any way abated. I did not originally plan to, but I will speak from a different perspective that might at first be surprising: the environmental impact of emergency care. The context is that yesterday, my office launched a policy briefing entitled, Eco-directed and Sustainable Prescribing of Pharmaceuticals in the United Kingdom. It was written by my interns, Julze Alejandre and Emily Stevenson, working with Paul-Enguerrand Fady. I acknowledge the financial support of the British Society for Antimicrobial Chemotherapy for that work.

I must admit that, in thinking about the report and the environmental impact of pharmaceuticals and medical devices, I have mostly thought about chronic conditions and treatment in the community and the great deal of discussion about the alternatives of using social and green prescribing—issues that do not apply to emergency care. However, I was absolutely inspired at the launch event yesterday by one of the attendees, a critical care consultant from a foundation trust in the north of England. They said, “Each day, I consider the environmental impact of the treatments that I give my patients in the ICU”. The doctor set out that that meant three steps, or principles: first, choosing the most environmentally friendly route for medical care, which means acknowledging that intravenously administering drugs requires more plastic packaging; secondly, minimising the amount of PPE used by opening only the PPE that is needed; and thirdly, demedicalising by trying to shorten the length of hospital stays where possible, which means less PPE and generally lower consumption of resources in hospital. The consultant told us that these environmental considerations are included in the doctors’ notes and discussed by the healthcare team during the patient handover.

That approach addresses something that we are starting to get some attention and focus on: the fact that, in England, 4% of our total greenhouse gas emissions come from the healthcare sector. There is the impact of plastics, which is increasingly acknowledged, and the pharmaceuticals going into the water supply.

Another of yesterday’s inspiring speakers was Sharon Pfleger from the One Health Breakthrough Partnership in Scotland, a partnership of the NHS Highland, the University of Highlands and Islands, the Environmental Research Institute and the University of Nottingham, which has a £100,000 UKRI Medical Research Council grant. This picks up the point that the noble Baroness, Lady Morris, made about joining up all the issues and all the healthcare bodies, as well as those not immediately related to healthcare, that collectively make up part of our healthcare system. We cannot afford to think, “Here’s the NHS that does healthcare, and everybody else does other things”. This applies in the case of the environment as well as in other things. Looking at the overall aims of the One Health Breakthrough Partnership, I see that it

“seeks to facilitate new knowledge sharing across organisational boundaries, raise awareness of the environmental impact of medicines, and develop novel and robust solutions to complex sustainability issues”.

That joined-up, complexity-systems thinking is an example of what we need to do.

I was reminded of an interview I did recently on LBC. We had been talking for some time about what might be described as the social determinants of health, and how environment helps determine people’s health and whether they will need the emergency care that is now so stretched—meaning everything from mouldy, cold homes to air pollution and all those other issues—when the presenter said to me, “I realised that I invited you on to talk about environmental problems, but you are talking about social problems too. They are all interrelated”. I thought, “Bingo! We have just had a moment of understanding”.

The point I really wanted to make is that, when we talk about healthcare and environment, emergency medicine probably looks like the most distant part—the part where it is hardest to think about the environmental impact. You have an emergency situation in front of you and you have to care for this patient. I think, however, that I have just shared with the Committee a really inspiring example of where individual leadership is really showing a way of operating differently. This is what we need to encourage and evolve. Consultants are, perhaps, seen to have the power to do something like that on their own ward; we need to empower people right across the healthcare system and more broadly to take the steps needed.

To pick up the point made by the noble Baroness, Lady Morris, there are so many good pilots. One of the great institutional problems in the UK is that we have funding for pilots, systems for funding new ideas and people who really clearly see the problem, and who can maybe make a difference in their local trust in their local area, but it does not get rolled out further.

We are the most centralised polity in Europe. Power and resources are concentrated in Westminster and Whitehall. We need to move to a system where the power and resources are held vastly more locally to create circumstances that work for local conditions.