Environmental Sustainability and Surgery

The NHS currently emits over 1/3 of the UK’s public sector emissions and produces 590,000 tonnes of waste. This makes it the largest public sector contributor to climate change in Europe, contributing equal municipal waste to the whole of Luxembourg. 

Surgery is the most resource intensive aspect of healthcare, responsible for a large portion of these emissions. A study published by the Lancet estimates that theatres are between three and six times more energy intensive than equivalently sized other areas of the hospital due to their heating, ventilation, and air conditioning requirements. Furthermore, one operating theatre suite in a UK teaching hospital had a comparable annual carbon footprint to over 2,000 homes.

Sustainability Champions

In recognition of the clear and present danger that the climate emergency poses, the Royal College of Surgeons of Edinburgh has put together a working group of “Sustainability Champions” to devise practical solutions,  helping the surgical profession to understand and reduce its environmental impact.

The Group comprises:

  • Katie Hurst (Chair) - General Surgery SpR within Thames Valley, currently undertaking a DPhil with the University of Oxford. ​Past member of RCSEd trainees committee
  • Professor Michael Griffin OBE – Immediate Past President of the Royal College of Surgeons of Edinburgh.
  • Nathan Stephens - Consultant Oesophagogastric Surgeon at the Royal Liverpool University Hospital and current Chair of the RCSEd Younger Fellows’ Committee.
  • Jasmine Winter Beatty - Surgical Registrar in the North-West London deanery and Clinical Research Fellow at ICHNT, pursuing a PhD on the application of digital technologies and AI in surgery and the essential role of sustainability in surgical innovation.
  • James Chu - ICAL medical student in urgent and emergency care at Treliske Emergency Department. Affiliate and sustainability champion of RCSEd.
  • Haroon Rehman – Chair of the RCSEd’s Trainees Committee and a Specialty Registrar (ST8) in Trauma & Orthopaedic Surgery based at Wrightington Hospital

For more information, please contact sustainability@rcsed.ac.uk or Chris Sanderson on 0121 647 1562

Green Theatre Checklist

The UK and Ireland surgical colleges have recognised that it is imperative for us to act collectively and urgently to address this issue. Here we present a compendium of peer-reviewed evidence, guidelines and policies that inform the interventions included in the Intercollegiate Green Theatre Checklist. This compendium should support members of the surgical team to introduce changes in their own operating departments. Our recommendations apply the principles of sustainable quality improvement in healthcare, which aim to achieve the “triple bottom line” of environmental, social and economic impacts. 

This is an emerging field, and therefore this is an iterative document that will evolve with new evidence. 

Find out more about the Checklist here.

Upcoming Webinar

NetZero: Theatre Departments - Implementation of the Green Theatre Checklist
22nd November 2023, 19:00 to 20:00 GMT


RCSEd launched the Green Theatre Checklist in November 2022 as part of an intercollegiate approach to improve surgical sustainability. On its one year anniversary we discuss its successes, its pitfalls and how you can get involved.


This Intercollegiate webinar, run in partnership with RCSEng, is part of a series of NetZero webinars on sustainable surgery. Following release of the Green Theatre Checklist we plan to highlight its successful implementation in trusts, look at ways in which it can be adapted for use, and engage members and fellows in ways they can make sustainable changes to their day to day practice.

Learning Objectives

By the end of the webinar participants will understand more about sustainability, be able to make a difference from tomorrow, and have the tools to lead significant change in their departments.

Register here >

Steps That Can Improve Your Environmental Impact

Steps to improve your carbon footprint


NetZero Surgery Webinar Series

Our new Intercollegiate webinar series, run in collaboration with the Royal College of Surgeons of England, ‘NetZero Surgery’ follows on from previous sessions which introduced the issue of sustainability in healthcare and highlighted the significant contributions of the NHS, and particularly of Surgical practice, to the destruction of our environment. This series aims to present evidence-based solutions to improve the sustainability of healthcare that our audience can apply to their daily surgical practice, patient pathways, anaesthetic selection and operating theatre departments.

The webinar series will include:

  • NetZero Operating Theatre
  • NetZero Anaesthesia
  • NetZero Patient pathways
  • NetZero Theatre departments (TBC)
  • NetZero Surgical Training and future of surgery

Session one: The NetZero Operating Theatre

Session two: NetZero Anaesthesia 

Session Three: NetZero: Theatre Departments - Implementation of the Green Theatre Checklist | 

Surgeons' News:

Read our article in Surgeons' News June Edition on pages 26-27 covering the '12 Steps of NetZero Surgery' here.

Previous Webinar Sessions:

Implementing Change:

Join the discussion:

Starting the Conversation and Raising Awareness

The destruction of the only life system known to support human life poses significant dangers to our health with consequent added burdens for the NHS. Heat-related mortality in those over 65-years-old has increased by 53.7%, over the past 20 years. 

Air Pollution is now the biggest killer worldwide causing >7m deaths/yr.

The NHS is the largest public sector contributor: its carbon footprint is 5% of whole of UK! Of the whole NHS footprint 5% is caused by volatile anaesthetic gases, 10% energy, 10% instruments & equipment.

Did you know the average carbon footprint of a UK operation is equivalent to driving 435 miles? That’s more than driving from London to the COP26 in Glasgow! Surgery is 3-6 times more energy intense than any other hospital department. Good news: you can enact change in your department to mitigate this! 

Where to start: within surgery anaesthetic gases account for 42% of emissions; of the remaining carbon footprint, energy accounts for 58% and consumables for 32%. Here are some tips for QUICK ACTIONS that you can take in your department and at home!

What can you do? Find out about your trust's Green Plan. Ask if your Trust has declared a Climate emergency? Does your Trust have a Sustainability team, and can you get involved? Get the conversation started and don’t be afraid to implement small changes! Keep an eye on our page for more information and resources!

Contact us: 

For more information, please contact sustainability@rcsed.ac.uk or Chris Sanderson on 0121 647 1562

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