Some brave souls are arguing that a future petrol blockade could be just the impetus the NHS needs to rethink its attitude to environmental issues. Ann McGauran reports

Fuel protests are very bad indeed for the NHS. That's the message the government hammered home as it went into emergency planning mode in September.

Two months on, the nation teeters on the brink of another confrontation with the protestors.

But a strange twist is emerging - which suggests further chaos could bring some rather more positive aspects for the health service.

As people abandoned cars in favour of trains, bicycles and their own two feet, a report covering North West region found that admissions to accident and emergency units were 'notably lower' than in the previous four years.

Figures released by Lancashire county council showed that fatal and serious road traffic accidents dropped by 58 per cent during the last petrol shortage. Levels of pollution were also down on the same period in 1999.

The review, by senior lecturer in environmental health at Liverpool John Moores University, Helen Casstles, does not claim to be in depth or definitive.

But North West regional public health director Professor John Ashton believes it is a clear reminder that the health service is a crucial part of society as a whole, and needs to wake up and take environmental matters seriously.

'It takes the anarchistic action of militant hauliers and farmers to draw our attention to the benefits of changing the way we travel and move around, ' he said.

'It's an interesting and ironic spin-off that demonstrates that what we are accepting as normal is actually extremely destructive.'

This is the same Professor Ashton who found himself pleading with the protestors at his local fuel depot in September.

Trusts are already working their way through NHS Executive checklists in readiness for another fuel crisis. Matters to be resolved in time for the next emergency include the use of public transport, car-share schemes, the provision of hospital transport to bring people to work and operating in a fuel-efficient way.

But rather than being rolled out for red alerts, Professor Ashton believes these are just some of the approaches hospitals should be adopting daily to deal with global environmental problems.

He doesn't appear to be terribly impressed with the pace of progress so far: 'I'm very impatient about this. My personal view is that these issues are not being treated with a great deal of urgency.

'If you talk to the average chief executive of an acute trust, would they have a green transport plan in place?'

A hospital is not just a place to treat sick people, he says. 'It's an environmental setting that has implications for global warming.

Tens of thousands of people are coming and going from the average acute trust every week, so what are the environmental footprints they leave?'

Maybe it is time for the Department of Health to follow the lead given by prime minister Tony Blair, who gave his very first speech on green issues last month.

He had almost four years to form the conclusion that there were 'at points, real conflict between the immediate interests of consumption and the longer-term interests of the environment'.

Professor Ashton certainly thinks it is time the NHS got moving: 'Mr Blair said in his speech that he wants to kick the environment up the agenda, so let's get back and pick up green issues in the NHS.'

He wants someone on each hospital board appointed to deal with the green agenda, giving a much needed extra impetus.

This is backed by Sian Fisher, waste minimisation officer at Preston Acute Hospitals trust.

Her brief is to improve systems and introduce recycling programmes.

'The whole thing has to have a much higher profile. It would benefit from having an interested party at board level.

'Unless staff get support and commitment right from the start, why should they do it?'

She ensures that waste is disposed of correctly, 'as opposed to going onto land fill sites, and minimising the amount that needs to be disposed of as clinical waste'.

The frightening thing is that some trusts do no recycling at all, she says. Her trust has mini-recycling points on-site provided free by Preston borough council.

And there is a level of success to shout about. The trust has made an initial saving of 35 per cent in the amount of clinical waste generated over the last few years.

The NHS has recently set up controls assurance - a set of risk management standards that includes environmental management as one of 18 topic areas on which trusts are measured. It's certainly a starting point.

'The environment can have a direct effect on our health, ' Ms Fisher adds. 'As healthcare providers we should be setting an example and protecting the environment.'

Although there is little indication of the DoH taking a wellpublicised and proactive approach centrally, there are some encouraging stirrings of life at trust level and the start of a networking approach.

Set up to encourage hospitals to work in a healthy way in the very widest sense of the word, the English National Network of Health Promoting Hospitals and Trusts is part of a World Health Organisation network. It is funded by individual trusts and receives no support from the DoH.

WHO spokeswoman Rabbia Khan says the 30 trusts across England are taking the 'long view', examining a host of issues including their transport policies, where they buy their materials and how to minimise packaging waste.

It is called a 'whole-systems approach' and they share good practice.

Pam Ashton, who works for the Health for All Network UK, has run workshops on green issues attended by 60 trusts in the North West.

She sees a 'huge opportunity for hospitals to use a green village approach to get them to play their part in dealing with a global problem'.

But she is shocked at the poor practice that still goes on, including a new large car park at the Bradford Royal Infirmary.

Lesley McAllister has been healthy travel co-ordinator at South Manchester University Hospitals trust for the past 18 months.

Her job is to develop a green travel plan for her trust, which has two sites located five miles apart.

With the Wythenshawe site set to become the main acute hospital, and car parking spaces 'very tight', staff are being encouraged to take up alternative methods of transport.

But despite a car-share scheme and a bicycle users group, there has been 'varied' success in changing people's habits, she says. 'We need to make the alternatives a lot more attractive.

'The difficulty is we really need to prove that this is actually going to do some good.'

The NHS could probably do more, but it is easier for the private sector, she stresses. 'I'd like to put in more cycle routes, rent out bicycles and subsidise bus services, but the public sector is having to be very careful about how public money is spent.'

There is no loud green message coming through from the top. But Mrs McAllister doesn't want us to think there is no progress. 'Some trusts are taking these things seriously.'