Meet sustainability fellow Dr James Dalton
Turning off nitrous oxide in theatres, more environmentally friendly use of drugs, and reducing single-use items – these are just some of the improvements currently exciting the Trust’s first anaesthetic sustainability fellow.
Dr James Dalton started in the new role at University Hospitals Sussex last October, bringing with him 10 years of medical experience and a passion for reducing carbon emissions through championing cultural and behavioural change.
“This is a unique opportunity and hugely exciting job to have,” said James. “At University Hospitals Sussex, 80% of my role is dedicated to the sustainability agenda and so I’ve been given the time to make a real difference and introduce change.”
Moving from a full-time clinical role to practising just one day a week is a huge change for James, who was previously working in the Bristol region, where he trained in emergency medicine before transitioning to anaesthesia and intensive care medicine.
It was here, as a member of the South West Network of Sustainability and Environmental Anaesthesia, that his interest in sustainable healthcare grew and he started to meet like-minded doctors and colleagues from across the NHS.
James said: “The only reason I’ve moved to Sussex is because I met the Trust’s clinical lead for sustainability, Professor Mood Bhutta, at a national event where he was enthusing about our commitment to good environmental practice and new opportunities available through the sustainability fellowship programme, so I applied!
“Now I am in post, it feels great to be given agency to make change. It’s a really satisfying field to work in because often we can save money at the same time as reducing carbon emissions, and so we can achieve good results all round, especially in a resource restricted environment like the NHS.”
Reducing N20 is a win/win scenario
One example of an environmental and financial win/win scenario is the programme James leads to reduce anaesthetic usage of nitrous oxide in theatres.
While work has been ongoing for some time to reduce usage, the time James is able to dedicate to the project has seen it gain significant momentum, with plans to turn off piped nitrous oxide altogether in the coming weeks.
James said: “Nitrous oxide is an ozone-depleting gas, it is a potent greenhouse gas that’s almost 300 times more powerful than carbon dioxide, and there’s also better alternatives we can use clinically.
“Elsewhere in the UK, when piped nitrous oxide has already been replaced by bottles in theatres, both usage and costs have tumbled.”
Another example is the use of paracetamol in anaesthesia, which is the subject of another green improvement project James is looking forward to working on.
Intravenous paracetamol is used regularly, but according to James, it is significantly worse for the environment that swallowing a tablet.
He said: “Intravenous paracetamol can be 50 times more carbon intense than an oral dose. It’s also ten times the cost, and while in theory it should be more effective for pain, the evidence shows there’s no benefit for patients compared with taking an oral dose.”
Changing behaviour is a tough nut to crack
Despite the case for change often being strong, it is changing established practice and persuading people to behave differently that poses the biggest challenge.
But this is also an aspect to the sustainability fellow’s role that James genuinely relishes.
“When you’re trying to change cultures and systems, especially with a sustainability agenda, lots of behaviour change is involved,” said James.
“While this can be a tough nut to crack, it’s also a really satisfying challenge with massive potential gains.
“The NHS has a huge carbon footprint – it could be a small country on its own really!
“And we cannot carry on as we are, but if we put the work in, make a positive change for one service or hospital, then introduce this at all our hospitals, then across Sussex and on to national bodies, we can create a massive domino effect.
“So, it’s exciting and the potential to make a difference is incredible. But the challenge is to change people’s behaviour and we need to recognise we cannot always achieve consensus. Instead, we can win as many hearts and minds as possible and then be brave and make the change, as we’re doing with nitrous oxide.”
Other green improvements within James’ sights include introducing washable theatre hats, improving waste segregation, and reducing waste heat treatment rates within the world of anaesthesia.
The sustainability fellow is also a key player in the Trust’s broader Green Plan delivery team, supporting Professor Bhutta and colleagues, as well as Jasmine Abbott, who is the Trust’s first medical sustainability fellow.
To find out more or help James with his sustainability work, get in touch by emailing [email protected].
For more information about the Trust’s commitment to carbon reduction check out the UHSussex Green Plan, first published in February 2021.