Sustainability. That word is everywhere you turn these days. Even the Care Quality Commission (CQC) are now looking to incorporate it into their inspections. It is estimated that 5% of worldwide greenhouse gases are produced by healthcare (Smith, 2022, as cited by Hayes, 2023) and in 2020 the NHS committed to achieve Net Zero for emissions by 2040. Lots of work is underway, but this seems to be focused on the hospital sector. It is important to also look at what actions can be taken in care homes to help the environment.

I think all of us would say addressing carbon emissions is a great idea, but how feasible is it?  What degree of investment might it take to swap all lighting over to LEDs? To get the solar panels fitted? How can we find the time to swap from disposable products to reusables? Whichever way you look, there are obstacles to overcome and a million issues to address.

We are lucky to be able to have a sustainability manager in our charitable not-for-profit organization who has responsibility for managing the organisation’s sustainability strategy and programmes. This year we committed to PlanetMark Business Certification as a first step towards putting in place a Net Zero strategy, measuring scope one and two carbon emissions initially until we can measure scope three emissions. This strategy work will become increasingly important to those of us that undertake NHS-contracted work in the very near future. Since April 2023, the NHS has required suppliers with contracts over £5 million per year to publish a Carbon Reduction Plan for their UK scope one and two emissions and a subset of scope three emissions as a minimum. From April 2024, the NHS will require a Carbon Reduction Plan from all suppliers (see references at the end).

What can we do in a Care Home?

In the care home setting, we have all the same problems we have in our own homes, but on a bigger scale! But some key principles we might be able to implement at home may not be quite so feasible in a care home setting. So, where are the big areas of spending? Utilities will be a big cost, with high spend on electrics, gas, and water. We all know about appliances being left on unnecessarily at bedtime, and turning the tap off when we brush our teeth, but are we following the same principles at work?

  • Consider hot weather – how often do you see windows wide open during the hottest of days, instead of keeping the heat of the sun out of the building, while electric fans furiously churn the hot air around. Similarly, some residents and colleagues feel the cold – instead of upping the thermostat or adding extra portable heaters, we can ensure that our residents have appropriate clothing layers on for the season, and that colleagues can wear extra (short-sleeved!) layers under their uniforms. We can also close all the curtains when it gets dark in the winter months to keep the heat in, even in unoccupied rooms.
  • There may be opportunities to reduce water waste depending on your particular care home and working practices. If there are urinals in the male changing facilities, check if they are on a regular automatic flush, even when there are few men in the building. When doing your flushing of infrequently used outlets to manage legionella risks, use a timer to ensure that the flush time is no longer than it needs to be.
  • Kitchens can also generate lots of waste. Check taps are not left running and what is happening with food scraps. A good range of menu choices is so important for our residents, but with that inevitably comes food waste. Unserved vegetables may become tomorrow’s soup, but we also set up “community fridges” in all of our sites so that food not served to residents is chilled, plated up and then placed in the fridges for 24/7 access by colleagues free of charge. Consider what else is disposed of from kitchens that goes into landfill, or even useful stuff that ends up being recycled – big plastic lidded tubs for sorting out the craft supplies or give plastic bags from loaves of bread to dog owners for use as poo bags. You could consider having a meat-free Monday, and try and monitor the food miles on the produce used in your kitchens.
  • We have recently undertaken a review of our cleaning products to minimise the use of hazardous chemicals, to reduce the number of products needed, and to standardise products across the care homes in the group. Having gone out to a small range of possible suppliers to see what solutions they could offer and then trialing the product range from the company we selected, we have saved a staggering amount of money! All products come in concentrated form, which is diluted appropriately into reusable spray bottles. The next exciting steps are to roll out the new products across all the services, convert to using fully launderable mop heads and trial launderable cloths. These will obviously require an initial investment, but the costs will quickly be recouped.
  • Disposable products cost a bomb and then we have to pay for their disposal as well. Consider whether there alternatives such as a launderable product instead of a single-use one. Think beautiful vintage aprons to protect clothes instead of those vile disposable bibs to protect residents’ and colleagues’ clothing at mealtimes, linen napkins, or launderable bed pads instead of disposables for use when doing dressings, or for residents’ beds if their tissue viability is good.
  • Try to reduce glove use for inappropriate tasks like changing unsoiled bedding or brushing a resident’s hair. Royal College of Nursing (RCN) guidance “Tools of the Trade” is available to support the reduction of inappropriate glove use. Net knickers wash and tumble dry really well – we’ve put them through 50 cycles in our laundry – label them up and launder them with the resident’s other clothing instead of binning them after every use. Pad companies are also starting to produce launderable absorbent panties for use instead of the “just in case” pads worn by many. Did you know that sanitary products are 90% plastic?
  • Use face flannels where practicable – they are much nicer to use, more effective, and more homely and recognisable than plastic wipes. A more expensive option is a launderable pillow, which is also more effective for infection prevention.
  • We are just starting to consider how we might be able to tackle medication waste and are currently exploring the feasibility of having certain items held as stock, instead of residents all having their own. Regular medication reviews (as advised by NICE) can ensure that people are not receiving unnecessary medications, which can reduce the risks associated with polypharmacy as well as reducing waste. Consider the types of inhaler in use to see if any residents could switch from an aerosol-type product to a dry powder one, which could save the equivalent in gas emissions of a 175-mile car journey compared to a 4-mile one!
  • Consider the energy (and resources) that go into planning an activity for residents or a training session for the team. If you are a single care home, perhaps you could buddy up with a nearby care home and borrow, share and swap resources. Maybe you could consider challenging colleagues to buy resident gifts from charity shops. Maybe you can have crafting activities with residents to make new Christmas cards from last year or buy in bulk all the ingredients to make Christmas puddings for residents to mix up together over carols and mulled wine to gift to their loved ones.
  • Think about how colleagues get to work – the council may offer a cycle-to-work scheme, or can you use your intranet or noticeboards to encourage car sharing. The important thing is simply to start making small and simple changes. The transition to sustainability is a journey for us all, and making a start will make broaching the next change seem less daunting. Some changes might not work as you had planned – that is OK, being ‘sustainable-ish’ is better than wholly unsustainable.

Let’s all make a start on those small acts and be proud of them. Let us share our ideas on the QNI care home nurses’ forum on Facebook or email me – I would LOVE to hear your ideas. But of course, this is not just about ideas. Ideas are pretty meaningless without action. What action will YOU take first?

Heather Kirton
Clinical Governance Lead, St Monica Trust


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Image courtesy of  The Green Wellbeing Project funded by our NGS Elsie Wagg Innovation Scholarship.




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