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Sustainability in Surgery

SiS imageOur commitment to sustainability.

We have pledged our support to the ten commitments set out by the UK Health Alliance on Climate Change (UKHACC), recognising the need for health organisations to show leadership and take steps to mitigate and adapt to climate change. The commitments will help to guide our continuing sustainability work within the College and the wider surgical community.

Because it's not just our patients who need saving.

We have made a climate emergency declaration, together with the other UK surgical royal colleges. Read the new Intercollegiate Green Theatre Checklist and the supporting compendium of peer-reviewed evidence, guidelines and policies. This compendium will support members of the surgical team to introduce changes in their own operating departments. The recommendations apply the principles of sustainable quality improvement in healthcare, which aim to achieve the 'triple bottom line' of environmental, social and economic impacts.

Climate change is the defining issue of this decade, and it is imperative that the role of individuals and organisations is understood. The NHS contributes significantly to the UK’s CO2 production, including travel, infrastructure and waste management. Operating theatres are responsible for a major part of this.

The Royal College of Surgeons of England is a member of the UK Health Alliance on Climate Change and we will align with relevant national and international initiatives aimed at mitigating further global temperature rise and climate change, such as the UN Sustainable Development Goals

The Academy of Medical Royal Colleges (AoMRC) has provided a definition and framework for our emerging strategy:

Sustainable healthcare involves ensuring the ability to provide good quality care for future generations by balancing the economic, environmental, and social constraints and demands within health care settings. A sustainable healthcare system maintains population health, reduces disease burden and minimises use of healthcare services.

The triple bottom line framework was developed to help organisations to understand their broader impacts and consists of economic, environmental and social domains. To improve sustainability, organisations must ensure that their use of resources does not exceed available supplies, and that their impacts do not negatively affect the wider community, the environment, or future generations.



Our Sustainability in Surgery Strategy, launched in April 2021, outlines how we plan to embed financial, environmental and social sustainability with ethical purchasing into everything we do. We are committed to supporting sustainability work and to help our industry to meet net zero carbon by 2045, in line with the Greener NHS strategy.



Our Good Practice Guide Sustainability in the operating theatre supports you to make improvements in surgical care through small, sustainable practices that maintain patient care and support environmental health. You will learn about:

  • Solid waste reduction
  • Green purchasing
  • Water conservation
  • Care pathways
  • Cultural change and surgical leadership.

Working Groups

Two working groups guide the development and implementation of our sustainability strategy.

Sustainability Staff Group

Our staff are passionate about a greener future for RCS England. This group lead on identifying areas to improve sustainability in day-to-day operational running, maximising opportunities in the College building in London. Details of members of this group and terms of reference are to follow.

The Sustainability in Surgery (SiS) Group 

This group was established in December 2019 to look at issues of sustainability in surgical practice, associated industries and within RCS England itself.

In December 2022, we opened recruitment for 14 roles within our Sustainability in Surgery (SiS) Group, including Co-Chair and Group member posts at varying career grades. Read the application pack for more details on the roles and job description. Applications are now closed. Thank you to all applicants for your interest in joining the SiS group, we will be in touch shortly.

James Lind Alliance 

SiS Group Vice Chair Victoria Pegna, led The Royal College of Surgeons of England in supporting the James Lind Alliance, ‘Greener Operations’. In June 2022, the results identified the top ten research questions that should be addressed to help make operations (including surgery, anaesthesia, and healthcare provided around the time of an operation) more environmentally sustainable.

Take a look at our sustainability collection for relevant articles from all RCS England journals. Learn more about sustainability in surgery with the resources below.

RCS England are proud partners of The Centre for Sustainable Healthcare’s Green Surgery Challenge. The 2021 challenge involved five finalists devising and implementing a quality improvement project to make surgical practice more environmentally, socially and economically sustainable, whilst maintaining or improving standards of clinical care.

Congratulations to the team from Leeds Teaching Hospital NHS Trust for winning the Green Surgery Challenge with their holistic review of a laparoscopic appendicectomy. All five teams presented innovative projects to help make surgery greener, with initiatives ranging from reusable materials to examining preoperative care. If all of the projects were continued for one year they would save a combined 133.3 tonnes of CO2e.

Please email for any queries related to sustainability in surgery.

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