Sustainable care
A world renowned institution, NHS Golden Jubilee has provided care through collaboration for patients across Scotland since 2002.
Consisting of the Golden Jubilee University National Hospital, Research Institute, Conference Hotel, Centre for Sustainable Delivery and NHS Scotland Academy, NHS Golden Jubilee works with colleagues around the globe, from industry to academia, to provide the highest quality of person centred care.
As Scotland’s flagship hospital for elective and specialist care, we are home to Scotland’s largest ophthalmology centre, 1 of Europe’s biggest elective orthopaedic centres and a major diagnostic imaging service.
NHS Golden Jubilee also manages all heart and lung surgery for the west of Scotland, as well as
3 national heart and lung services, including the country’s only adult heart transplantation unit.
National Centre for Sustainable Delivery
The national Centre for Sustainable Delivery (CfSD) is a national unit designed to sustainably
improve and transform Scotland’s health care system through innovation, collaboration and clinical
leadership.
Hosted by NHS Golden Jubilee and commissioned by the Scottish Government, CfSD brings together
existing transformation programmes with an innovation team to support the rapid rollout of
new techniques, innovations and clinically safe, fast and efficient pathways for Scotland’s patients.
CfSD will work with experts and patients across Scotland to make our healthcare system the best
in the world and ensure that people receive the right care, from the right people, at the right time.
To achieve this we need to focus on sustainability, value, innovation and listening to our patients.
National Academy
NHS Scotland Academy is an exciting partnership between NHS Golden Jubilee and NHS Education
for Scotland to offer accelerated training for a wide range of health and social care roles and
professions.
The Academy:
- Provides an opportunity for staff to improve their skills in specific areas, using residential, distanceand virtual reality learning.
- Offers attractive training programmes linked to recruitment and career progression.
- Draws on the strengths of both parent organisations using both the state-of-the-art clinical and simulation facilities at NHS Golden Jubilee and the educational expertise and technology-enabledlearning offered by NHS Education for Scotland.
- Supports NHS Scotland to develop additional capacity and new capabilities.
- Adds to existing educational programmes and respond to evolving and emerging workforce needs.
- Helps ensure the health and social care workforce is prepared for future needs in Scotland by addressing recruitment gaps and training needs.
- Commits to the principles of eliminating discrimination and harassment, promoting equality of opportunity for all and recognising and valuing diversity in employment and in the delivery of our services. Our Inclusive Education and Learning Policy sets out our commitment to making education and learning more inclusive.
6.1 Anaesthesia and surgery
Greenhouse gases are used as anaesthetics and for pain relief. These gases are nitrous oxide
(laughing gas), entonox (a mixture of oxygen and nitrous oxide) and the ‘volatile gases’ (desflurane,
sevoflurane, and isoflurane).
Through improvements to anaesthetic technique and the management of medical gas delivery
systems, the NHS can reduce emissions from these sources.
NHS Golden Jubilee’s total emissions from these gases in 2023/2024 were 133.63 tonnes of CO2
equivalent, an increase of 27.78% from the year before. This is entirely due the increase in piped
entonox for the commissioning of the new surgical centre.
More detail on these emissions is set out in the tables below:
| Source | 2018/19 (baseline year) | 2022/23 | 2023/24 | Percentage change 2018/19 to 2023/24 |
|---|---|---|---|---|
| Piped nitrous oxide | 179.69 | 0 | 0 | -100.00% |
| Portable nitrous oxide | 9.90 | 59.89 | 52.14 | +426.67% |
| Piped entonox | 0 | 0 | 27.09 | Not available |
| Portable entonox | 1.94 | 44.69 | 54.40 | +2704.12% |
| Total | 191.53 | 104.58 | 133.63 | -30.23% |
Table 8
| 2018/19 (baseline year) | 2022/23 | 2023/24 | Percentage change 2018/19 to 2023/24 | |
|---|---|---|---|---|
| 5.40 | 1.70 | 0 | -100.00% | |
| Isoflurane | 9.90 | 59.89 | 52.14 | +426.67% |
| Sevoflurane | 0 | 0 | 27.09 | Not available |
| Total | 191.53 | 104.58 | 133.63 | -30.23% |
Table 9
What did we do in 2023/2024 to reduce emissions from anaesthetic gases?
NHS Golden Jubilee has been a leader in the field of Total Intra-Venous Anaesthesia (TIVA) which
contributes to avoiding the use of volatile gases. Work has been continuing over the last year to
further reduce emissions from anaesthetic gases by maximising the opportunities to use TIVA in
our surgical procedures.
The use of piped nitrous oxide as a carrier gas for volatile and aesthetic agents ceased in early
2020 and subsequently the nitrous oxide manifolds were decommissioned.
Graph 2
Heating, Ventilation and Air Conditioning system (HVAC) and Anaesthetic Gas Scavenging System
(AGSS): We are working with the theatres teams and Estates to reduce the electricity and carbon
footprint in a way that is clinically satisfactory. A short life working group has been established and
is progressing this project.
What are we doing in 2024/2025 to reduce emissions from anaesthetic gases?
The NHSScotland National Green Theatres Programme was officially launched in 2023 to help
reduce the carbon footprint of theatres across NHS Scotland and enable more environmentally sustainable care by:
- Working with clinicians and professionals to develop actions that reduce carbon emissions,waste and resource use.
- Supporting Boards to implement, measure and report on these improvements.
To further reduce emissions from anaesthetic gases we are maintaining staff awareness and working to keep usage low as well as promoting the use of TIVA.
In conjunction with the Green Theatres Programme, we will progress the following in 2024/2025:
- HVAC (Heating, Ventilation and Air Conditioning system) and AGSS (Anaesthetic Gas Scavenging System): A short life working group has been established and is progressing this project.
What are we doing in 2024/2025 to make surgery more sustainable?
Patient warming: a clinical audit will be conducted to manage patient’s temperature peri and post
operatively. This will inform a further piece of work to identify how we can improve clinical practice
with regard to patient thermoregulation, and how we can achieve this using more in using more
sustainable products.
• Reusable theatre caps: A risk assessment will be carried out to inform a standard operating
procedure (SOP) for the safe introduction of reusable theatre caps.
14
• Reusable theatre gowns: Will be trialled with clinical teams to assess usability and logistics
around laundry.
• Lean theatre Trays: Will be rolled out to hip operations and to other specialities. In our first trial
period of 120 MAKO robotic knee procedures, we achieved savings of £3.5K / 183,720g CO2.
• Rubbing not Scrubbing: This is being extended beyond the Orthopaedic theatres to Thoracic
Surgery and Cardiac Catheterisation Laboratories.
6.2. Respiratory medicine
Greenhouse gases are used as a propellant in metered dose inhalers used to treat asthma and Chronic Obstructive Pulmonary Disease (COPD). Most of the emissions from inhalers are from the use of reliever inhalers – Short Acting Beta Agonists (SABAs). By helping people to manage their condition more effectively, we can improve patient care and reduce emissions.
There are also more environmentally friendly inhalers such as dry powder inhalers which can be used where clinically appropriate.
We estimate that emissions from inhalers in NHS Golden Jubilee were 38.50 tonnes of CO2
equivalent in 2023/2024.
| Source | 2019/19 (baseline year) | 2022/23 | 2023/24 | Percentage change 2018/19 to 2022/23 |
|---|---|---|---|---|
| Primary care | 0 | 0 | 0 | N/A |
| Secondary Care | 41.57 | 42.07 | 38.50 | -7.39% |
| Total | 41.57 | 42.07 | 38.50 | -7.39% |
Table 10
What did we do in 2023/2024 to reduce emissions from inhalers?
This year to improve patient care and reduce emissions from inhalers we will encourage patients to bring their own prescription medicines, including inhalers, so we are not adding to the carbon burden by prescribing something they have at home. We have encouraged ward staff to utilise patients own medication where possible and ensure patients own drugs are sent on transfer.
Due to the nature of our services we rarely initiate inhaler therapy and only supply inhalers when patients have forgotten to bring them in, medication has expired or is not transferred with the patient. In addition, we will encourage staff to use the type that are not pre-metered dose inhalers, which is better for the environment and interchangeable in the majority of patients.
In general we will raise awareness when dispensing inhalers and not to order duplicate inhalers when they get home, and encourage patients to recycle them at their local pharmacy where available.
What are we doing in 2024/2025 to improve patient care and reduce emissions from inhalers?
As a Board that infrequently initiates inhaler therapies, we are auditing the supply of inhalers to investigate the reasons behind supply of routine therapy during short stay admissions. We will then review and target initiatives to ensure supply is appropriate. In addition, we are planning a change to wording on admission letters to encourage patients to bring in their own medicines. We have also aimed to reduce wastage by using a multidisciplinary approach to reduce the need for inhalers to accompany patients to the theatres suite.
What are we doing to raise awareness with staff and patients?
This year we are continuing to encourage patients to bring their own prescription medicines, including inhalers, so we do not add to the carbon burden by prescribing something they have at home.
Our admission letters will be updated to stress the importance of bringing all medicines into hospital, due to the nature of our services we rarely commence inhaler therapy and normally only supply them when someone has forgotten to bring them for their stay. This will be emphasised to all wards and departments to ensure staff have full awareness of this issue.
In addition we will encourage staff to use the type that are not pre-metered dose inhalers, which is better for the environment and interchangeable in the majority of patients. In general, we will raise awareness when dispensing for discharge, only supplying when definitely required. We will continue to discuss with patients regarding not over ordering when they get home, and recycling them at their local pharmacy where available.
6.3. Other sustainable care action
What else did we do in 2023/2024 to make care more sustainable?
In 2023/2024, NHS Golden Jubilee did the following to make operating theatres more sustainable:
- Oral paracetamol: Use of oral paracetamol has been rolled out with a significant reduction in the use of IV paracetamol. This is now being regularly monitored to ensure that this change in practice is sustained. The Pharmacy team is actively is looking at further medications where a switch from IV to oral administration would be clinically appropriate.
- Rubbing Not Scrubbing: Orthopaedic Theatres have embedded using sterillium rub in place of scrubbing for all cases with the exception of the first case of the day. This has been introduced safely with no impact on infection rates, significantly reducing water use; and
- Lean Surgical Trays: This has been introduced in Orthopaedics and Ophthalmology. Currently saving 1 tray per procedure for Mako knee procedures which significant financial and carbon savings. What else are we doing in 2024/2025 to make care more sustainable? Waste segregation: at the moment we are using orange waste bags in all clinical areas, and recycling collections only at the storage room level. This issue has been discussed previously, and will be reviewed again this year to determine whether recycling collections can be expanded.
