What’s physiotherapy’s role in reaching NHS net zero?

Limb reconstruction – the management of complex fractures with external fixation – is a process which affects people’s lives and requires significant resources. Because of the surgical complexity of limb reconstruction, physiotherapy can take second place. Poor rehabilitation delays recovery which affects patient outcomes and puts financial strain on healthcare services. Care pathway inefficiencies also have a significant effect on the environment. All resources come with a carbon footprint: additional follow ups, surgery or imaging contribute to the high carbon emissions in orthopaedics – which must be addressed to meet the NHS Net Zero 2040 deadline.

To reduce inefficiencies in limb reconstruction care, our team at Barts Health NHS Trust embedded a specialist physiotherapist within its limb reconstruction service followed by an evaluation of its environmental impact, with support from the Centre for Sustainable Healthcare. We found that by upskilling the physiotherapist in external fixator adjustments, a specialist physiotherapist-nurse duo were able to re-route the majority of frame removals from theatres into clinic. This pathway change was responsible for an annual carbon footprint reduction of 19.66 per cent (1,282.924 KgCO2e), as well as annual economic savings of £54,622.05 and over 70 per cent positive functional outcomes. 

The project was awarded an innovation grant from the Centre for Sustainable Healthcare/NHS Northeast London. Our findings show that decarbonising care pathways needn’t come at a disadvantage to financial sustainability and patient outcomes, and that physiotherapy as a versatile and resource-light profession can play a pivotal role in sustainable healthcare. While we expected the more obvious functional outcomes, it was physiotherapy’s inherent flexibility, the capacity to learn new specialist skills and work collaboratively that had the biggest environmental impact – a lesson about unexpected gains to keep in mind when planning future NHS Net Zero initiatives.

Thanks to the extended project team: Rebecca Wood, Catherine Hilton and Jade O’Brien.