NHS organisations with sustainability policies may be helping to save the planet but closer to home they are also driving performance, says Jennifer Taylor

Trusts that take sustainability seriously are reaping wider benefits of cost savings, increased quality of care and improved reputation, while reducing their carbon footprint. Those with a narrow view of sustainability are missing out.

It is not just about the money. Being publicly named and shamed or rewarded makes it a reputational issue as much a regulatory issue

Over the next five weeks HSJ will look at various aspects of sustainability, starting with regulation.

It is the job of regulators to codify the best practice of trusts that are leading on sustainability and bring everyone up to the same minimum standard, says NHS Sustainable Development Unit director David Pencheon. Regulating on sustainability should help everyone understand that it is not a trade- off - high quality care or sustainability - but that they are part and parcel of the same package. Some trusts will not be aware of the wider benefits until regulation stimulates them to improve their performance on sustainability.

“Regulation is a way of accelerating best practice,” says Dr Pencheon. “It’s not about getting people to stop doing one thing and start doing another.”

The NHS Confederation’s report Leading the Field points out that in the acute sector foundation trusts rank the highest in clinical and sustainability performance.

Monitor has been consulting on adding sustainability to the annual reporting requirements for foundation trusts. It proposes that reports should include the overall sustainability strategy of the trust, waste minimisation and management, use of finite resources such as water, electricity and gas, and a discussion of the trust’s future plans for sustainability.

The Carbon Reduction Commitment Energy Efficiency Scheme, announced in the 2007 energy white paper, kicks off in April. It will affect around 180 NHS organisations, as well as the private sector, rewarding the greenest with cash.

Qualification for the scheme depends on trusts’ energy use. Those that qualify will need to report their carbon emissions to the Environment Agency and will have to buy carbon allowances.

Performance on the scheme will be published in a league table comparing them with other public and private sector organisations. Those at the top of the league table will receive a bonus payment and those at the bottom will be penalised.

But it is not just about the money. Being publicly named and shamed or rewarded makes it a reputational issue as much a regulatory issue.

Dr Pencheon says: “A lot of senior people in NHS trusts are just as concerned about their reputation as they are about their money being lost or gained.”

SHA questions

What strategic health authorities want to know about sustainability

  • Is there a board approved sustainable development management plan?
  • Is the trust registered with the Good Corporate Citizenship Assessment Model?
  • What elements of sustainability is the trust measuring internally?
  • How is the trust raising staff awareness about sustainability?

Case study: London

The best trusts have been tackling sustainability without the need for regulation, but regulation would help bring others up to a common standard.

University College London Hospitals Foundation Trust has six hospitals and is a big carbon emitter. Over the last few years it has been trying to understand the scale of the problem.

“Our first approach was to map it so that we could start to manage it,” says director of estates and facilities Trevor Payne.

Calculating the foundation’s carbon footprint for energy, utilities and buildings was easy. More difficult was calculating the supply chain and procurement carbon miles.

About 76 per cent of the trust’s total carbon footprint is procurement. But Mr Payne points out that he doesn’t know if that is a good benchmark because other trusts have not quantified their carbon footprint for supply chain.

“Regulation would probably help because we would have a system where we were able to do those comparisons,” he says.

Once they had a handle on the size of the problem, the foundation put a series of initiatives in place to manage it.

As a way of self regulation, it signed up to the 10:10 carbon reduction commitment to reduce its carbon footprint by 10 per cent in 2010, for which it has a work plan.

The trust has a board approved sustainability strategy, which maps the direction of travel from now until 2015. The five year plan sets out what the must do to reduce its overall carbon footprint by 15 per cent.

Sustainability underpins all the trust’s objectives and is part of how it does business. It will feed into the way it designs and upgrades buildings, buys and procures products, provides services, and delivers travel and logistics.

But for some trusts, sustainability is only about switching the lights off or recycling. Mr Payne says that if trusts were scrutinised it would get the topic onto trust boards’ agendas.

He adds that it would be useful to have sustainability in annual reports, as suggested by Monitor, which would also be a stimulus to achieving progress.


Sustainable Development Unit

www.sdu.nhs.uk or email karl.heidel@sdu.nhs.uk

Leading the Field, NHS Confederation


Monitor sustainability consultation


Carbon Reduction Commitment Energy Efficiency Scheme


Good Corporate Citizenship Assessment Model


10:10 carbon reduction commitment