Ken Barker

Dr Ken Barker is a Consultant Anaesthetist, the Clinical Lead for Sustainability NHS Highland and co-founder of the Scottish Environmental Anaesthesia Group. Ken is based at Raigmore Hospital in Inverness.

This interview took place on 31 January 2023.

Timestamps

00:00 Introduction

00:50 When did you become aware of the impact of climate change on health?

03:34 What is the impact of climate change on health in Scotland?

05:34 What changes do you expect to see in Scotland in the future?

07:59 What changes do you expect to see globally in the future?

09:03 What do you think about your government's response?

13:41 On an individual level - what can practitioners do?

16:45 What are the obstacles preventing change?

19:01 How do you deal with the challenge of those who are not engaged?

19:54 Will our actions make a difference?

20:48 What sources of reliable information would you recommend?

22:54 Any final thoughts?

Transcription

Interviewer:

So just to start off with, could you give us a bit of information about yourself? So where you live, where you practice and what your specialty is.

Ken Barker:

Yeah, sure. So my name is Kenneth Barker. I'm a consultant anaesthetist at Raigmore Hospital in Inverness. I have been for over 20 years now. I have two additional roles now. Just in the past few years, I took on the clinical lead for the National Green Theatres Programme, which is a Scottish Government programme hosted by the Centre for Sustainable Delivery at Golden Jubilee and Clydebank. And I'm also Chair of the Environment and Sustainability Committee at the Association of Anaesthetists in London.

Interviewer:

Thank you very much. So when did you first become interested in or aware of the impact of climate change on health?

Ken Barker:

Well, actually, I can fairly clearly pinpoint that to a talk I went to at the Scottish Society of Anaesthetists meeting in Dunkeld in 2017. It was a chap called Tom Pierce, who's a colleague anaesthetist from Southampton. And he had been talking about the subject for many years, the effect of anaesthetic gases on radiative forcing and therefore climate change. And the talk was a real eye opener. I went away from it, determined to change my own practice. A good number of my colleagues from other hospitals around Scotland also went home and changed their practice. And I think all of us together started to spread the word amongst our departments. And that, we got together sometime later. We made some fairly significant change in our department and then decided that the best thing to do was to spread the word. So we formed a grassroots group of anaesthetists called Green Anaesthesia Scotland and put together the…sort of areas that had moved ahead quite quickly and tried to bring in other areas that hadn't heard the message or hadn't managed to move ahead. And within a short space of time, a couple of years, we had made significant changes to the carbon footprint of NHS Scotland. We estimated somewhere between 7 and 9,000,000 kilometres of driving just from simple changes to do with one of our anaesthetic gases. And then the process moved on both locally and within this grassroots national group to looking at other gases and to look at other aspects in theatres. We called it, in Inverness, we called it the Green Theatre Project. And we developed ideas, we thought about what an ideal theatre would look like. The basic question was just to look at any piece of equipment or drug or even just a process and ask the question, could we do it better in terms of environmental implications? And that in fact got picked up, as I say, as part of the Scottish Government's climate emergency strategy and is now the National Green Theatres Programme.

Interviewer:

Thank you very much. That's quite an impressive range of things. So my next question, you've touched on this already, but as you say, you are living and working in Scotland. So are there particular impacts of climate change on health in Scotland?

Ken Barker:

I mean, climate change will impact health worldwide, as I'm sure you know. The specific effects in Scotland are probably, we are behind the curve, probably, and the effects that we will see in terms of air quality, air pollution, for instance, most residencies in Scotland will have good quality air. I know there are some areas in Scotland that have poor quality air, but it's perhaps not quite as bad as other countries of the world. We certainly don't as yet have issues to do with the provision of medical care being affected by weather changes - floodings, storms, instability, that sort of thing, which, a lot of usually low-income countries are having to deal with the effects of the climate change that the high-income countries have been primarily responsible for. So, yeah, I don't know, there's an obligation, a moral obligation, on us as producers of a lot of the change to do what we can to mitigate and reverse that change, even although we ourselves are not necessarily directly affected to a great extent as yet.

Interviewer:

Thank you. So you've touched there on the changes that are currently being witnessed, obviously in the context of Scotland, but as you say, even more so globally. But I was wondering what your thoughts are on the changes we will see in the future. So if we're talking 5, 10, 20 years time, I realise that there's a best case scenario of what we will see and a less good scenario depending on how people respond. But what do you think we will see the impact of climate change on health being in the future?

Ken Barker:

So do you mean for Scotland or worldwide?

Interviewer:

I mean both if you could.

Ken Barker:

Gosh. So Scotland, I think we'll start there because I think what we will see in Scotland is a combination of the general global warming, climate change issues that we all know about in terms of weather patterns and the sort of resilience of healthcare systems to deal with that. I mean, we did see last summer in England, one of the hospitals in London, I think was their IT systems went down due to heat in their computer terminals. We've had locally issues with flooding and in fact, generators backup generators, being flooded. So we need to be aware of these types of things. But I think the wider picture about environmental harm is more likely to come in Scotland from things such as pharmaceuticals in the environment and effect on biodiversity. I think one of the great worries in modern healthcare is antimicrobial resistance, and that's primarily, perhaps not primarily, but to a large part, a worry in terms of what we put into our water supply. The exits of hospitals and communities, a lot of the work done by the One Health Breakthrough Partnership up in Caithness demonstrated large numbers of drugs and particularly antibiotics in the exit of wastewater treatment plants. So we need to consider what we're putting in our water and what effect that has on creatures around us and bio systems and primarily what effect also that will have ultimately on resistance to those antibiotics in humans. We may be, well I've heard before people saying we're living in golden times in terms of being able to treat infectious diseases. and that might not be the case again in the future. In terms of global, well, I'm certainly not a climate scientist and I'm not totally au fait with the effects that will have on specific, countries around the world. But, like most lay people, I understand that the general global warming and the climate change will affect not just the weather systems, but also food supply and security. And, the likely outcomes of that are things like population shift and, scarcity of things like clean drinking water, etc. So, I'm just like any other person who watches documentaries on the television. I'm certainly not a climate expert on that, but it does give me cause for concern.

Interviewer:

Thank you very much. So we've focused particularly on the impact of climate change on health so far. So I wondered if we could move on now to action or what can be done to improve the situation. So the first thing I wanted to ask was how well do you feel your government or, either the Scottish Government or the UK Government, is responding to the challenge of climate change?

Ken Barker:

Yeah. There's two parts to that really because there's the response in terms of how healthcare can respond to climate change and then there's this kind of general response to climate change and those are probably two different things. I'm a strong believer in the idea that each individual has a responsibility to do what they can. You know I have had responses to things I've said or actions I've put forward where the almost insignificance of one small person or one small group of people doing something in the global picture is put forward and I've always felt that you have a duty to do what you can and of course all these individual small things, all these small actions together, will have an outcome that can be of significance. In terms of support, so the response to healthcare contributions to climate change has dramatically changed in the past few years, just in two or three years. When I started this journey, there was very little government interest or input into climate change issues within healthcare, i.e. our contribution towards global warming. And it was quite frustrating, in fact, to get any sort of answers in the early days. But certainly the past two, three years have seen a complete change in that from the Scottish Government. As I say, there's been quite a lot of focus on the climate emergency. There are now a good number of programmes in place across healthcare, with strong senior support and with now some very important obligations being put on health boards to report back on the changes that they're making and what progress they've made. So I think that's a really forward-looking step. In my role as chairman of the committee in the association, I know that the Greener NHS, which is an arm of NHS England, are also making really good progress. It's a bigger ship that they're having to turn around effectively in England, so it's slightly slower, but there is interesting research and there's good moves to change policy on a number of things to do with acute health care. And I know they have, like Scotland, primary care is also quite involved in that. So those are good things. I'm impressed really with government direction in health care. I'm disappointed in the general change, so the general direction of response to climate change, across the UK, both Scottish government and particularly UK government, in terms of the things that I think they've reversed on, simple things like building regulations and higher standards of insulation and housing to, you know, that would have the multiple benefit of social benefit for those occupants of that house, reducing costs, etc. And also reducing need to heat your homes. And also the way that generation of power and so forth is, there are some answers and I think more emphasis needs to be put on renewable methods of generation of power rather than fossil fuels. So yeah, I mean, as I say, like most people, I think there could be much quicker and more urgent steps made by government in general to deal with climate change.

Interviewer:

Thank you. So obviously, you talked about the kind of the governmental level. I'm interested to know as well on the individual level, which is something you've touched on already, specifically, what can physicians or other medical practitioners do? What are the changes that as individuals you can make?

Ken Barker:

First of all, inform yourself. That's one of the key things. The information is out there and I think most specialties across healthcare and most roles across healthcare, not just talking medical, but nursing, midwifery, pharmaceuticals, or pharmacy, I should say, and estates, the information is there for a lot of actions that need to occur. And I think it's our responsibility first to make ourselves aware of that. There are areas that we need to be more demanding. So the thing that I refer to is the black hole of procurement. I'm sure you know we spend billions of pounds on procuring drugs and equipment and services across the NHS. And it's shocking how badly we prioritise the environment in that. So simple things like asking the suppliers, the companies that produce these products, to give us their life cycle carbon assessments, to give us their data on what effects the drugs for instance have on ecosystems. A lot of the information we know these companies have because they have to submit them to the European Medicines Agency, for instance, to get a license for their drugs. And it just behoves, it's our responsibility, to demand that information as part of their contract in order to make that information available to clinicians. Because ultimately, I think the Centre for Sustainable Delivery, no, so that's my bunch, the Centre for Sustainable Healthcare, showed that about 80% of the carbon footprint of the NHS is due to clinical decisions or models of care. But it's very difficult to make a judgment on a clinical decision or a change in model of care if we don't have the data, the basic data to allow us to compare two different methods or routes. So that's the first thing, educate yourself and find out the information. Once we've got that information, then we can start to balance the triple bottom line of costs and efficacy and social and environmental weightings, I guess, against each other to make those clinical decisions.

Interviewer:

Thank you. So when you're talking about government and you're talking about individual practitioners, you know, you've talked about what could be done or perhaps should be done, but perhaps isn't being done necessarily at the moment. So I'm curious what you think the obstacles are. You know, what are the things that are stopping us from already putting these things into practice?

Ken Barker:

I think it's If we talk about procurement, there are some moves to introduce environmental weighting into decisions. I mean, there's a discretionary weighting of 5 to 8% in the Scottish procurement decisions, but it's very rarely used. And NHS England are introducing a 10% weighting in procurement decisions, sort of partly environmental, partly social. So that's a sign of progress. Many countries in Europe, particularly Scandi countries, etc., have had a 5% weighting for some years, but Norway has moved ahead a wee bit and they've got a 30% weighting for environmental considerations in their procurement decisions. So what's preventing us from doing that? The usual things, I guess, it's not something we've done. The industry itself is probably resistant to the idea. because it's yet another factor that they have to take into account. There are arguments against it, such as in, this is a way for companies to promote a green washing sort of picture. They'll tell you how many solar panels is on their factory, but not how bad their drugs are for the fish, for instance. So we have to be quite specific about what we're asking for. And then I suppose the final barrier is how do we judge different products against each other? We have to be quite robust in our methods and that in itself is a big task. It's a big job and it requires funding and expertise to put that into place.

Interviewer:

Thank you very much. So following on from that, you've touched on already that part of all of our responsibilities should be to inform ourselves, to make sure we're aware. And I wanted to talk a bit more about information and sources of information around climate change. So my first question is, have you interacted with anybody who literally doesn't believe in climate change? Or perhaps you're more likely to interact with people who are just not engaged with the topic, don't see why it's important or relevant. And I was just curious about those sorts of interactions. How do you deal with those sorts of challenges of persuading people, I suppose.

Ken Barker:

Yeah, well, frankly, I haven't really had the situation where I've been faced with somebody who denies climate change. I haven't seen that personally. It may still be out there, but certainly hasn't been put in front of me. I think the most common barrier when dealing with people that aren't interested in changing is more to do with - will what we do really make a difference? the smallness of effect of many of our actions because we are a small part of the overall picture. I think it's very easy to blame industry and commerce and fossil fuel industry, et cetera, and point the finger and tell these sort of groups or companies to clean up their act. But then it comes back to then the figure of 4 to 5% of the UK's carbon footprint being attributable to healthcare. That's a significant amount. I think it equates to the airline industry in terms of size. So I think it's a little bit short sighted just to be pointing the finger at other groups and not to look at ourselves.

Interviewer:

So sticking with specifically climate change in the context of health rather than climate change more broadly, there's lots of sources of information out there, but I'm curious as to where you go for what you view as reliable or reputable information, because obviously you can get lost on the internet and go down some very unreputable or partial routes.

Ken Barker:

Yeah, that's really quite a difficult one because as you probably recognise, there's not vast amounts of data or educational information out there. And of course, with all scientific evidence, there's arguments for and against the validity of it. I read a lot around the topic. I try to speak to people that have greater expertise than myself. For instance, I was on a call with a lady called Jody Sherman, who's an anaesthetist in Boston and has been a leading light in environmental issues within healthcare for many years. And, you know, she was able to correct me on the workings of a particular paper that I had read recently. So It's discussion with colleagues that have a greater degree of expertise, I think is important, and general reading around this topic. And again, it's I suppose one of the things I do with the Green Theatre programme is we, as a group of individuals, come up with ideas. We bat these ideas back and forth. We propose them and we write [unclear word] or proposals for action that then need to have evidence alongside them. So if we can't find the evidence or it's not of a sufficient standard, then we can't really ask people to change their practice without having that good evidence in front of us.

Interviewer:

Thank you. So I've come to the end of my questions, but before we wrap up, I just wanted to ask, Is there anything which I haven't asked you which you would have liked to have been asked or anything else that you would like to say on this topic?

Ken Barker:

Not particularly, but I always come back to this idea that Jody Sherman, that I just mentioned, talks about. It's all, at this point, it's all about trying to embed the idea of sustainability into clinical practice. She talks about putting patient care first but makes the point that it's not just about the patient in front of you, it's about the patient's family and their friends and their community and the wider society. So I think that idea of embedding sustainability in healthcare does put the patient first. It's just that we have to open our eyes to something a little wider than just that individual in front of us.