Southmead Hospital’s Neurosurgery team cut emissions by over 40% in Green Operating Day trial

A photo of the theatre teams lined up on each side of a corridor in their scrubs.

Theatre staff in North Bristol NHS Trust’s (NBT) Neurosurgery team at Southmead Hospital delivered a Green Operating Day to reduce carbon emissions, in what is believed to be a sustainability first for the NHS. 

The NHS accounts for 4% of the UK's total carbon footprint and 50-70% of total hospital waste comes from operating theatres. With climate change being such a vitally important issue, and with the NHS nationally focused on delivering net zero carbon emissions, the team devised a one-day trial, run simultaneously across all neurosurgical theatres to see how sustainably they could run their operating list. 

One the day, staff made a range of operational and behavioural changes designed to reduce waste and energy use across the department, including staff travel and diet choices. The changes resulted in emissions connected with operations on the day being reduced by at least 44%

The team achieved this through the following measures: 

  • Reducing staff emissions - those working were encouraged to use sustainable travel and maintain a plant-based diet whilst at work 
  • Liaising with suppliers on the logistics of transporting equipment in a carbon-neutral way, including transporting a piece of equipment 100 -miles by bicycle from Maidenhead to Bristol   
  • Minimising single-use equipment 
  • Switching to reusable equipment and personal protective equipment (PPE) wherever possible 
  • Minimising unnecessary energy use within theatres (turning lights off when unoccupied, not leaving taps running) 
  • Exploring alternative lower-carbon surgical anaesthesia options  
  • Using technology to support remote follow-up and programming of devices to minimise patient travel. 

The project was the culmination of months of planning and collaboration between NBT’s Neurosurgery team and Pain Clinic, with the Sustainability team guiding on green operating best practices, as well as collating and analysing data on total emissions reductions. 

Staff involved hope that their findings can inspire other NHS trusts to undertake similar net zero projects and be part of a wider conversation around sustainability in healthcare. The project builds on the work done by Solihull Hospital in Birmingham in May 2022, whose operating team performed the world’s first net zero carbon operation. 

In addition to the NHS’s existing sustainability goals, NBT has committed to becoming net zero by 2030.  

The idea for a Green Operating Day came from Consultant Neurosurgeon Adam Williams. Reflecting on the day, Adam said: “I had the idea of performing a green operation at Southmead, but going a step further and working with suppliers to transport equipment in a carbon-neutral way. I then thought if we were doing it for one theatre, we should think bigger and do a whole day of green neurosurgery. 

“We liaised with the team in Solihull who were involved in their green operation, and with our sustainability team to understand factors that impacted our carbon footprint. 

“My advice to other NHS trusts who want to try similar projects would be to pick your team well. Making these many changes at once is hard, and it can feel quite uncomfortable.  Having a team who are prepared for that discomfort and open to new ways of working is critical. My feeling is that a good nucleus of people demonstrating what can be achieved will then help perpetuate that change into the wider department.” 

NBT’s Sustainability Manager Megan Murphy said: “For us, this project is about making the case for behavioural changes - because people have always done things a certain way. 

“It’s about encouraging a shift towards the way of thinking that the staff working on this project have demonstrated – that enthusiasm and openness to change is exactly what we're looking for, and that's exactly the way that we are going to reach net zero, if everybody thought that way and took these kinds of actions. They don't necessarily need to be big ones! “ 

Chief Medical Officer Tim Whittlestone said: “At NBT we are committed to reducing our impact on the environment in line with our objectives as a Trust to be constantly innovating and improving our healthcare services and delivering the best possible patient experience. In order to achieve this, we need to experiment with new technologies and ways of working. It’s been great to see the level of enthusiasm amongst staff involved in this project, and I am proud of what we have achieved so far.” 

You can read more about our sustainability goals in the Integrated Care System (ICS) Green Plan. 


Case studies

We asked staff from each of the teams involved in this Green Operating Day to share their perspectives on how the day went, and what changes they intend to make going forward.  

Neurosurgery staff 

Prior to the day, staff involved in the project made preparations to ensure they were comfortable with the new processes and routines. Some of these preparations included renting electric bicycles, practicing changing into reusable PPE and preparing plant-based meals. 

Feedback gathered on the day indicates the majority of staff felt the changes were implemented smoothly and increased efficiency in the theatres. Here are some of the responses received: 

“It was a real 'feel good' day. We were definitely more efficient, not just greener. It was lean and green operating, whilst still being safe for our patients.” - Adam Williams, Consultant Neurosurgeon

“It’s a slightly different mindset, paying attention to the little things that cumulatively make a big difference. We could gradually make a substantial difference if we’re all paying a little bit more attention.” - Crispin Wigfield, Consultant Neurosurgeon

“I think it's gone really well. It actually made the whole theatre day run even more smoothly than normal. It's highlighted just how much smoother things run when you simplify stuff. The advice I'd give to another theatre team doing the same thing would be to definitely have a dry run with all the different people, theatre staff and with the anaesthetists.” - Naomi Slator, Consultant Neurosurgeon 

“As far as we’re aware, this is the first time an NHS trust has rolled out a project like this – a day of green operations performed across several neurosurgical theatres. This project will not only support our Trust’s sustainability goals, it also helps us provide better care to our patients. We know that there are health risks associated with climate change, and we want to be part of the solution, not the problem.” - Rebecca Hodnett, Neurosurgery Registrar 


Operating theatre staff worked with global healthcare company Abbott to supply a key piece of kit on the day a remotely programmed spinal cord stimulator which is inserted into a patient’s spine. Not only does this reduce the need for trips to the hospital, it also provides patients with a better quality of life. 

Abbott staff transported the equipment on bicycles from their Maidenhead office to Southmead Hospital, a journey of over 100 miles. There were several logistical considerations involved in preparing for the day, including route planning and health and safety.  

The patients who had stimulators inserted on the day were all informed by staff of the green operating project. All of them reported positive experiences post-surgery, and were supportive of the team’s efforts to reduce their carbon footprint. Here are some of the comments they shared with us: 

“It's a real game changer.” 

“I'm really pleased with how things have gone  couldn't wish for better treatment. And we definitely need to do something for climate change. Many changes need to happen.” 

NBT Sustainability team 

Our Sustainability team played a key role in defining the scope of the project, providing role-specific guidance to staff around sustainable practices and calculating the carbon footprints of each operation. 

Key activities included in the calculations were the energy and water used in theatres, reusable alternatives to single-use items, waste disposal and sterilisation of equipment. The final calculation also included emissions reduced by Abbott transporting their devices to Southmead on bicycles. 

Activities not included in the calculations were staff’s travel and diet choices on the day due to limited visibility over this data.  

Sustainability Manager Megan Murphy worked with theatre staff to align their objectives with industry best practices, using the Royal College of Surgeons Green Theatre checklist as a point of reference. Megan said: 

“People's environmental impact is a lot more wide-reaching than they initially think. It’s about getting people to change the way that they've always done things, but making it easy for them to do that.” 

Updated on 23/05/2024 to reflect revised emissions calculations.