The second in GIRFT’s series of ‘greener’ pathways highlights the high-impact steps trusts can take to decarbonise the elective hip replacement pathway, helping to reduce the environmental impact of the NHS while improving patient care.
The new green pathway has been developed in conjunction with Greener NHS, the British Orthopaedic Association, the British Association of Day Surgery, the British Orthopaedic Trainee Association, the British Hip Society, the Royal College of Anaesthetists, the Royal College of Surgeons of England (RCS), the National Joint Registry and the Sustainable Health Systems Hub.
The guide lists 13 high impact and practical clinical recommendations for decarbonising elective hip replacement surgery, covering every step of the patient pathway from community care and referral through to pre-, peri- and post-operative processes. For each recommendation, the potential annual emissions reduction across England if the recommendations are carried out is also given.
For example, maximising theatre efficiency for planned hip surgery – by following GIRFT guidance to maximise cases per list, taking steps to minimise short notice cancellations and introducing a standby list to backfill lists – has the potential to reduce carbon emissions by 915 tonnes CO2e across England annually, as well as ensuring fewer patients have their surgery cancelled at the last minute and helping to reduce waiting lists for the NHS.
Each of the high impact recommendations is supported with key actions to achieve the carbon saving (eg: rationalising equipment in surgical tray sets and using absorbable sutures instead of staples) as well as a rationale for the changes and the benefits for patients and the NHS.
The guidance has been shaped by input from leading clinical experts spanning primary to tertiary care and representing different national organisations. It has also benefited from the involvement of patients.
NHS England is committed to reaching net zero carbon emissions by 2045. Developing environmentally sustainable models of clinical care is one of the key priorities to help achieve this ambition, ensuring the health of patients is improved both now and for generations to come. The GIRFT programme is ideally placed to design sustainable models of care given its national reach and clinically led approach to identifying and supporting best practices.
The greener hip replacement guide follows the GIRFT guide to decarbonising the bladder cancer care pathway, which was shared in 2024. They are among a series of greener pathways GIRFT is developing, in areas where there is the most potential for the NHS to improve or maintain the quality of patient care while mitigating its environmental impact, delivering cost savings and efficiencies.
These pathways are developed using the cross-specialty, clinically led GIRFT Environmental Lessons Learned and Applied (ELLA) approach, which uses the clinical pathway as its starting point. The work is supported by UKRI and NIHR funding through the Sustainable Health Systems Hub based at the University of Exeter.
Dr Joseph John, GIRFT’s lead for sustainable care pathway development and an academic registrar at the University of Exeter and Royal Devon University Healthcare NHS Foundation Trust, said: “Delivering environmentally sustainable models of clinical care is an essential priority to complement wider efforts by Greener NHS to decarbonise the NHS.
“For this guide, we have used a data-driven approach to understand where the most impactful changes can be made. This analytical approach to common conditions that use substantial healthcare resource has highlighted a significant opportunity to reduce our environmental footprint.
“The GIRFT programme is continuing to develop guidance that advances knowledge about delivering environmentally sustainable healthcare which maintains and improves on the broader fundamentals of high-quality healthcare.”
Source: GIRFT
Image: Canva
