Thanks for talking to me Helena. Can you start by telling me what your climate change related work involves? 

Within the Trust I lead on exploring how we engage with the challenges of our carbon footprint from a clinical perspective. I play a similar role in the whole of the ICS; the integrated care system. That's all of the different parts of the health service that work together to meet the needs of the whole population; it's not just hospitals, it's also general practice and community services. In Nottinghamshire, we work very closely with the council because solutions to good health sit within housing and infrastructure as much as within the health services. So, alongside my work for the Trust there is a Climate Action and Net Zero team for the whole county, which I also lead on. I'm trying to join the dots between the different parts of the health service and everything else; because, we don't exist in a vacuum. I think a lot ways we approach health will also directly help with climate change and our carbon footprint.

It's something that I've been thinking about for more than 25 years, since my husband and I worked overseas in Namibia and we came back full of ideas about sustainability. We joined a zero-carbon housing project at Hockerton which is where I’ve been living for some time now. Although I've been working as an ordinary doctor, I've increasingly understood that where we live and how we live is impacting on the climate and our health. I'm now a senior doctor and have built up contacts and credibility which I’ve been able to start to use, both at Sherwood and across Nottinghamshire.

So, the focus is on both the impact of the of the hospital service and all its integrated services in terms of its carbon footprint, but also on how a changing climate is affecting health. Is that right?

That's a really good summary. The NHS is the largest employer in the country and four to five percent of all of this country's carbon emissions come from the NHS, which is enormous. Five percent of journeys are related to the NHS, about five percent of jobs are in the NHS; we're very significant in creating carbon emissions but we also we have the potential to reduce them. And most of the solutions to improving our carbon footprint should also improve health. Active travel is a really good example of that. If we leave our cars at home and walk or cycle to work and school, we are fitter in ourselves. We make fewer emissions because we're not using our cars and we also stop contributing to air pollution which is causing ill health.

There is a sense that the NHS always seems to be in a semi crisis mode, particularly post COVID. Is this idea of reducing the carbon footprint something that is gathering traction when there are issues around staff and resources?

You’re absolutely right, we are in crisis and struggling for money. We've got increasing ill health, an ageing population and a lot of problems that are caused by lifestyle; at the moment we're overwhelmed. It's really difficult to get people to focus away from that, and the bed pressures, to think about how if we started to work more on public health and well-being we might not need quite so many hospital beds. I talk a lot, and I do a lot of teaching, around this: what's our vision for the future? Should we be thinking more about the preventative arena? Do we want to spend a bit more money on talking about active travel and stopping people getting sick rather than just fixing people who are already sick? And as a paediatrician, it's really important that we invest in having healthy children that will grow up into healthy adults.

If we're thinking about creating more green spaces, about opportunities for active travel then we’re starting to have a vision of a healthy community rather than sorting out an unhealthy community. But it's very hard to get that focus when we're in crisis. The thing about preventative health is that for every pound you spend now you save about eight pounds down the line, fixing sick people. And it's the same with the climate; we need to be taking action now because the cost of not doing it, in the future, will be huge. We’ve got climate change here, we've got flooding at the moment in Nottinghamshire, and the cost of having your house flooded is enormous, but so are the health costs. There are mental health impacts of having your house flooded, there are health impacts of very high temperatures in the summer, and more admissions to hospitals cost more money. It all joins together.

“I use this picture in most of my talks as a vision for a healthy low carbon future. It represents a public health approach to the climate and health crisis where we can breathe clean air, and have access to green spaces for active travel, play and good mental health” - Helena

If we were to grasp this and really strive for a vision of well-being and health we could actually reduce the cost of the NHS, but it's really hard. Today for instance we have no spare beds in our hospital; they’re all full and it's a Monday morning. We have to do something different because we've been doing this for years; throughout my time as a consultant we've been increasingly in crisis. I want us to work for a vision of a healthy future which is also low carbon, and there are many things we can do to help with that, with our emissions. We can do more online appointments so people don't have to come to the hospital. I know that’s something that won’t work for everyone but for many it will. If I ask you to come to an appointment to see me for fifteen minutes you might have to take half a day off work; you've got to travel to the hospital; you've got to park. You might come for one appointment and then need an X-ray and come back again the next week. We're building up a cost to you and a carbon cost of all that travel, and we might be able to do it in a different way.

You mentioned the mental health costs of flooding; is there any way of measuring the correlation between climate change and health and well-being? Is it being tracked? Can it be tracked? What are the ways in which it's judged or evaluated or considered?

There’s lots and lots of data, we measure everything these days; you just have to ask the right questions. What we can do is, for example, measure admissions to hospitals with asthma and correlate those to days when we've got high air pollution levels. Or we can look at what happens with suicidal ideations or domestic violence after a heat wave, because we know that both of those things are correlated to high temperatures. If it's very hot, and you don't sleep and you've got mental health issues, you're more likely to get worked up and that can have consequences. We can certainly measure excess deaths in terms of heat waves.

Are there new forms of correlation being analysed? Are people saying, for instance, let's look at rainfall and illness? 

Lots of this kind of data is being collected now and people are much more interested in what it's telling us. The Royal College of Paediatricians have just done some research in developing countries asking doctors how they're seeing the impact of climate change. And they're talking about the number of children with psychological distress, the number of children with respiratory problems, the number of children who aren't getting to school, and the number of children who get displaced by all sorts of different weather events. These are things they're describing to us from a number of different countries, so we’re getting much more evidence about the global health impact of the changing climate. We can see the rate of spread of infectious diseases and vector-borne diseases; things that are transmitted by insects, like malaria which is moving north because of the rising temperatures.

All of these things are being monitored right around the world and we're very globalised now; that data can be shared so we don’t keep reinventing the wheel. If the research is being done in America or France or Australia it's probably going to be relevant to us here. We just need to know if someone has a good solution and get on with it. It’s the same within the ICS and within Nottinghamshire; if we've got a good idea in King’s Mill Hospital we need to share that with Queens Medical Centre. We all win when we are reducing that carbon footprint; we haven't got much time and just need to do it as fast as we can.

That’s one of the advantages of working across the system with all of the paediatricians around the country; we can share good practice. But we know that only about twenty percent of our health is related to access to health care. Eighty percent is affected by our education, our housing, our transport, our food, our families and occupation and all of those things. Something like the Green Meadows project will potentially make more difference to the health of your residents than anything I can do as a doctor.

I'm also interested in the idea of climate anxiety and paralysis and of a language that catastrophizes what we know is a difficult situation. Whether or not that makes people feel utterly powerless, which is an unhelpful feeling. Is there more mental anguish that's been caused by climate anxiety? Is that a thing that is noticeable and does that have health impacts that you're aware of?

I think there is absolutely concern about and interest in this, and a friend of mine has just worked on a PhD exploring the question. The Royal College of Paediatrics and Child Health has surveyed thousands of children across the country who are aware of climate change and are worried about it, with varying degrees of anxiety. And we need to hear that because it's their future that we're talking about. But you're right, that sense of powerlessness is really profound. Young people, particularly, feel that they don't have a voice, that they can't vote, that they are dependent on adults, that they don't have financial security. And, and as you say, if you feel powerless you can be paralysed by that.

I’ve spent a long time thinking about this. I know the data about climate change and it would be very easy to be in despair and to be despondent, so I talk a lot about hope. There was an article in The Lancet, one of our big medical journals, talking about the climate crisis being the greatest threat to the NHS. And that's true, but more recently it's been rephrased as the greatest opportunity; because if we grasp that idea of good health made possible through some of the solutions we’ve been talking about, then we can create a more hopeful vision, doing things that will make us healthier both from a mental and physical perspective, whilst addressing the climate crisis. That’s a much more positive way forward; that’s how I stop myself being despondent.

We have a group of climate champions at King’s Mill Hospital and I make sure that we all focus on this, on what we can all achieve together. And projects like yours at the Meadows, which help to get people energised and hopeful, is really important because despair doesn't get us anywhere. If we feel empowered then we become active and have strength and we can tackle these things. That's really important for children and young people who are facing this to know; that hope is absolutely crucial.

Can you tell me a bit more about the climate champions?

At the Sherwood Forest Hospitals Trust we’ve had a climate action team which has been meeting informally for about a couple of years, although it's quite small. So now we’ve launched a climate champions group, made up of people working on our wards and in our clinical departments who have been nominated by their teams. They come to events to talk about climate change and about the small wins that we can amplify if everybody does them within the wards, clinics and operating theatres. In King’s Mill Hospital we've got just over five thousand members of staff, so talking and sharing information and ideas is really important.

It’s also important to recognise that those who work in a hospital aren’t just health providers but users as well; we're all patients, we will all go to our GP. We need our staff to be healthy so that they're at work. All of the things that we want our patients to do, we need to do ourselves; all of those concerns around the environment affect us as well. We’ve discussed all kinds of ideas and strategies, and each of the climate champions has given a pledge that they’re going to take action at the ward level, and in the operating theatres, and in admin, to really start spreading the word and amplifying the message that we can all do something.

What might be an example of something you could do within the working environment?

Some of it is about basic recycling, because sadly we're not very good at it in the hospital. That’s partly because we've got a lot of different kinds of waste; some is messy, some is to do with food, and then some is recyclable waste. But if you don't get it in the right bin then it causes problems and it causes more costs. We just need to get that right. I don't know why it's so difficult, but it is. Most of us recycle at home and sometimes you think, oh, I'm just going to put it in the general waste because it's too difficult; but the simpler we make it, the better it is.

There’s also the less obvious recycling that many of the healthcare staff aren’t aware of, like the plastic bottles that drink supplements are in and other things that we find on the wards. There’s the air conditioning and the heating, really basic things. But when you're in a very big building knowing how to optimise these systems is not always obvious. We spend a fortune on air conditioning in some parts of the hospital, heat the rest of it, and then everybody opens the windows and the heat flies out. There’s the turning off of computers; things that we should do in our homes, but we should do even more in the hospital. Most of it is really basic, but it will make a difference.

We talk a lot about food. One of the most important things we can do is move towards a plant-based diet. We’re considering how we can change the menu so that the plant-based foods are the first thing you see on the menu, rather than the meat-based options. We call that nudging. It doesn't mean that we all have to be vegan, but we can reduce our dairy and meat intake significantly. And when you think we have over five thousand staff and patients that could start to make a difference.

And then you start to get onto the clinical things. Because of COVID people started using a lot more gloves. Every time you dealt with a patient you had a pair of gloves on, and it's quite difficult to unwind that. So, we're doing a project called Gloves Smart in our Intensive Care Unit, which is about not wearing gloves when we're only, for instance, taking a pulse. You don't need to put gloves on to take somebody's pulse. The average patient in an intensive care bed will have one hundred pairs of gloves used on them in a day. Every pair of gloves that you don't use means you're saving money; you're not creating waste, and you're saving carbon. Then there is all of that single use stuff that we use in hospitals; not needles and syringes because those have to be single use, but quite a lot of operating instruments that we use once and throw away. We can go back to sterilising and reusing some of those. And everything is wrapped in about six layers of packaging!

Beyond that we’re starting to look at inhalers, because propellant gases aren’t good for the environment. Of course, it’s more important that your asthma is well controlled than not using your inhaler. But we now know of better preventative regimes for asthma, which means you don't need your old blue inhaler as much. If we can make inroads into this it means that the patient’s asthma is improved, they’ll come into hospital less which eases the strain on the service, and it’s beneficial to the environment.

There’s so much that we can do; all of us. Because medicines are actually a very expensive item in terms of money and carbon. If we were all healthier, we would use fewer drugs. Working on mental health and well-being, through ideas like green prescribing, can help us use fewer drugs which would be a very good outcome for both patients and the environment. We don’t want to cut down access to medications, our patients needs must always come first; but we want to reduce the carbon footprint in the ways that we do this. Nationally, there are a lot of different kinds of health professionals working together to get these messages out and learn from each other so that we can amplify and accelerate this learning as fast as we can.

The other thing is that health professionals are increasingly keen to speak out; for example, I've talked to our local council about air pollution. We all care about our health and our family's health and people generally trust doctors to be on the right side when it comes to thinking about what is good for us. That's our job.

What is green prescribing? Is this becoming more common?

There's definitely a growing interest in this and in GPs making referrals which are mostly around issues of mental health, although it can be used for other things such as someone who has type 2 diabetes and needs support in keeping active. It’s about finding ways to help people to get outdoors, do more exercise, engage in social activity to help with issues of isolation; all of which is proven to reduce the need for medication. 

There are various practitioners who run group groups in the community which might be a walking group, a cycling group, a gardening group, or maybe running individual activities. Some are allied to the NHS but often there's a crossover with local councils and their provision. There’s a lot of different things happening in the third sector as well. All of this means that there is a whole menu of green prescribing options that patients could be offered, and by prescribing we mean that they are recommended to the patient. We don't usually do it from secondary care within hospitals but I wish we did, because it's cheaper and much better than just giving a prescription for a drug. It’s particularly useful for older people and for those facing mental health challenges.

Is it ultimately the financial benefits of interventions such as these that will accelerate their use?

When you're thinking about an innovation you need to think about the benefit for the patient, the financial cost, and the cost to the planet. It has to be affordable because we are in a cash strapped system, but we also have to be aware of the environmental impact. If it's causing harm then we've really got to think ‘is there a better way of doing this?’ That's what our work is about and we're trying to get our finance and procurement teams to increasingly think about this. We're calculating the carbon footprint of everything we get, and the thing about carbon footprinting is that it looks along the whole timeline of an intervention. We can’t just say that we’re saving money or carbon now if there's a consequence down the line; which might be the impacts of a very high carbon content, or a financial consequence on somebody else's budget. We're not very good at thinking like that. We have to make sure that we are always considering the patient, the money, and the planet.

Finally, is there any advice you could give us?

As I mentioned earlier, the healthier we are the less carbon we use and the less of the NHS we use; which is better for all of us. So, keeping up to date with your immunisations, looking after your dental health, which I know is really difficult at the moment, all those preventative things are really important.

Active travel is always good for you and the environment. Air pollution is a real challenge at the moment and has major health impacts; so walking and cycling, or using public transport is really helpful. Food is also really important and has the biggest potential to improve our health and I’d recommend moving to a plant-based diet as much as possible. You may not have that much control over your housing situation but getting energy advice, insulation, and all of those things is important; and if you spend less money on energy you've got more money to spend on healthy food. Allotments are obviously a great source of growing food, but are also good for exercise and social collaboration. Supporting people who can't manage their own gardens is a really positive thing.

I don’t think things are going to get any easier with the weather, look at all the flooding that’s been happening, and so this building of resilience - of learning to deal with excess heat in the summer; of making connections with each other, of looking after your elderly neighbours - is really important. It’s a social resilience and projects such as this one in the Meadows, where you are trying to work collaboratively as a community, are key. Ultimately what I’m talking about is a social vision as much as a health vision.

The Lancet has some free to access articles considering the links between health and climate change which you can find here.