Creating a planet-friendly health service

Thankfully there are many shining examples of NHS Trusts that are committed to the carbon cause, as this article highlights

The NHS in England is one of the largest employers in the world. It is a major buyer of goods and services from local, national and international economies and is the largest public sector contributor to climate change in Europe. It has a carbon footprint of 21 million tonnes of CO2 equivalent (CO2e), broken down to building energy (24 per cent), travel (17 per cent) and procurement (59 per cent).

The Sustainable Development Unit (SDU), formed in 2008, aims to help the NHS fulfil its potential as a leading sustainable and low carbon healthcare service. It acts as a source of leadership, expertise and guidance concerning sustainable development to all NHS organisations in England. This article highlights the many shining examples of NHS organisations that are showing initiative in embracing more sustainable practice in areas such as leadership, procurement, travel and waste.

Food waste
The NHS in England spends around £500 million on food and serves 300 million meals every year. The food waste can either be sent to landfill, which is expensive, or it can be macerated which involves chopping it up and flushing it down the drain.

Maceration is bad for the environment and is facing increasing regulation because of the high carbon and biological oxygen demand present in the liquefied food. Treating the macerated food is costly since it wastes a large amount of water and causes blockages from the fat.

To help save money, improve sustainability and to meet future legislation Stockport NHS Foundation Trust near Manchester replaced its food macerators with  two food waste digesters.

The Trust’s onsite food waste digester uses a bio-enzymatic formula. It turns food waste into grey water, which then passes through the system’s filter and into the drains, with no harmful effect on the environment. Each unit can digest 180kgs of waste per day, and due to its chemical reaction, eliminates fats, oils and greases which can block drains and be expensive to clear up.

Stockport NHS Foundation Trust carried out an audit and discovered it disposed of 2.6 tonnes of food a week. Each digester can deal with 1.4 tonnes of material per week and the whole process is low odour.

Savings
The cost of running the Trust’s three macerators is around £22,000 a year. The running and maintenance cost for the digesters is expected to be around £2,200.

This means that over five years, the hospital is projected to make savings of more than £96,000 pounds, with payback period on both machines around 12 months.

Buying the digesters will therefore save the Trust money, make a positive environmental commitment, and will comply with legislation should there be a ban on disposing food waste down the drain.

David Moss, deputy director of estates at Stockport NHS Foundation Trust, said: “The national guidance for Healthcare Waste water guidelines issued in April 2011 indicates it may no longer be acceptable to put food waste to drain without consent so the Trust knew action was necessary. Installing the digesters means we avoid blocking drains with fat and food waste and also avoid expensive repairs to macerators caused by cutlery jamming up the motors.”

Moss believes the main challenge was achieving the buy-in of all the kitchen staff: “Prior to the digester, staff scraped all the food off plates and straight into the macerator. They now have to scrape the food into buckets and then carry them over to the digesters, which inevitably means more handling than using the macerator. The challenge was getting the staff to understand the bigger picture and positive environmental and cost benefits from their actions.”

A good corporate citizen
Demonstrating leadership in overall carbon management, Sussex Community NHS Trust (SCT) has undertaken a range of energy-efficiency measures to become one of the best ‘Good Corporate Citizens’ in the NHS.

The Trust was newly formed in 2010 and provides NHS community health services in West Sussex and Brighton and Hove. It employs 4,000 staff across 77 properties, covering an area of 800 square miles. It has a £190 million turnover and delivers 9,500 patient interventions per day.

In 2010 the Trust’s Board approved a five year Sustainable Development Management Plan (SDMP), with the aim of achieving an ‘excellent’ classification in the Good Corporate Citizenship (GCC) assessment tool.

In order to achieve this, by 2015 the Trust has put in place targets to achieve a 25 per cent reduction in carbon footprint, 25 per cent improvement in energy efficiency, sending zero waste to landfill, and achieving average scores of ‘excellent’ in each of the GCC themes.

SCT took systematic steps to measure and improve the sustainability of its activities. A comprehensive carbon footprint and carbon management plan was developed and the GCC framework was used to develop the Trust’s Sustainable Development Management Plan.

A  number of qualitative and quantitative key performance indicators (KPIs) were agreed and progress reports submitted to the Trust’s Board every six months.

A cross-departmental steering group was established and actions were identified to reduce impacts and improve the GCC scores.

Areas of action
To reduce the carbon impact of its building, a ‘spend-to-save’ programme was established, focusing on investing in low-carbon technologies, such as boiler plant, LED lighting, and voltage optimisation. An in-house cost model and Marginal Abatement Cost Curve MACC tool was developed to help construct the business case.

For greener facilities, SCT worked in partnership with waste contractor Biffa to implement a mixed recycling scheme, installing high efficiency hand dryers to cut paper towel costs and waste.

A new brand and communications and awareness programme called ‘Do your bit for our CO2mmunity’ was created to get the workforce on-board with the Trust’s objectives, as well as a network of Carbon Champions recruited to bring about change.

To improve procurement, SCT established an Ethical Procurement Policy and a collaborative Supply Chain Emissions Project to quantify and reduce impacts with key suppliers.

The Trust also developed a robust Green Travel Plan and worked with Civitas to embed a healthy workforce agenda within the Trust.

Challenges
The fact that the Trust was newly formed and undergoing structural change, made the implementation of a new programme challenging.

The nature of the Trust being a diverse and dispersed organisation with a complex estate portfolio added a further hurdle. What’s more, making a case for investment in low-carbon technology during a time of increasingly restricted resources proved challenging.

The Trust felt it was important that its outputs and processes were robust and stood up to scrutiny, so took the step of asking climate change consultancy AEA Technology plc to provide external verification of these outputs. This was completed in September 2011. In recognition of its successes the Trust won the Health Service Journal Good Corporate Citizenship Award 2011.

Carbon and Financial Savings
In the first 18 months the programme has already reduced its carbon footprint by more than a 1,000 tonnes CO2 and improved its energy efficiency by over 30 per cent. The measures have also boosted the recycling rate to 60 per cent and and reduced fleet vehicle emissions by 23 per cent. Overall, this has saved the Trust £135,000.

A number of additional key factors made the programme a success. These included having a credible and robust plan and a senior officer to deliver it, getting genuine buy-in and commitment from the Trust Board, and being able to demonstrate the value of the programme quickly.

Nigel Burchett, director of estates and facilities, Sussex Community NHS Trust, said: “Our aim is to deliver the best possible patient care in ways that contribute to the sustainability of the communities and places that we serve. We have a responsibility to use our resources and influence to support the health and wellbeing of our local communities, whilst minimising the financial and environmental costs.”

REDUCING THE NEED TO TRAVEL
With many Trusts spread over different areas, travelling to and from different sites to visit patients and attend meetings is often necessary, resulting in high transport carbon emissions.

One example of a widespread NHS organisation that is cutting down its need to travel is NHS Derbyshire Community Health Services NHS Trust. It employs more than 5,000 staff and is one of the largest provider organisations in the country running more than 10 community hospitals and offering a range of services including health visiting and treatment centres.

As the Trust covers a large area, including the Dales, staff have to travel long distances when visiting patients in their homes as well as going to regular meetings in different parts of the organisation.

Collectively they travel around five million miles a year. This costs a significant amount of money in expenses and also wastes employee travel time and associated carbon emissions.

To combat this problem, the Trust adopted teleconferencing as an alternative to face-to-face meetings.

During the first year staff organised 1,200 teleconference calls with 4,700 people taking part. The Trust calculated that this saved more than 3,000 hours of staff travel time and around 20 tonnes of carbon. It also saved the Trust more than £100,000.

The Trust’s audio conferencing service only requires a fixed or mobile phone line and up to 40 people can take part. No prior booking is needed and the service is available 24-7. The Trust has also found that teleconferences last around 35 minutes on average, meaning they are often shorter and more focused than face-to-face meetings.   

Alvaro Pancisi, head of information management and technology strategy, NHS Derbyshire, says the new way of working improves productivity, saves money, helps provide better patient care and is better for the environment. It is also helping the Trust become financially, socially and environmentally sustainable for the future.

He said: “There was no financial outlay, we only pay when we use the service, and the benefits in terms of efficiency and travel savings are well evidenced. It also demonstrated its flexibility during the heavy snowfalls in December 2010 when travel was made especially difficult.”

These examples reveal how NHS Trusts are taking climate change seriously and implementing measures which not only cut emissions, but also save money on associated energy costs.

For further evidence of the health service’s work to improve its sustainability, visit the Sustainable Development Unit’s website for case studies and information.

For more information
www.sdu.nhs.uk