The must-read stories and debate in health policy and leadership.

The health service is a major polluter, producing more waste than some European countries, according to a 2017 government report.

In 2018, it bought at least 16 million pieces of plastic cutlery, 15 million straws and 2 million stirrers. In October, chief executive Simon Stevens asked hospital trusts to commit to a single-use plastic squeeze.

One integrated care system — the Greater Manchester Health and Social Care Partnership — is planning to make a hefty dent in those figures.

The ICS wants to save some 2 million pieces of cutlery and 800,000 straws and stirrers by switching to sustainable alternatives. It was one of a handful of NHS bodies – and the first ICS — to declare a climate emergency last year.

The move mirrored that of the local combined authority, which is aiming to be carbon neutral by 2038 — 12 years ahead of the UK government’s 2050 target.

Greater Manchester isn’t the only part of the NHS looking to improve its environmental credentials, but its plans are some of the most ambitious.

On a smaller scale, a south western trust has announced a new sustainability project of its own. Gloucestershire Hospitals Foundation Trust will save a million sheets of paper, turn catering oil into biofuel, and melt old plastic trays into blocks to be used in furniture.

Group dynamics

The Queen Victoria Hospital FT, a tiny trust in the south east with a turnover of just £70m, is much loved by its local community. It has a proud history of pioneering reconstructive surgery carried out on burnt airmen from the Second World War.

The trust’s work today — much of which is still around burns and plastic surgery — is applauded by many and its staff were judged “outstanding” for caring by the Care Quality Commission last year.

However, it has increasingly looked unsustainable, both financially and clinically. QVH is predicting a deficit of 10 per cent of turnover for the next few years unless support is forthcoming.

With just 65 beds and fewer than 1,000 staff, the trust also struggles to provide all the care necessary for complex patients, which has led to much closer working with tertiary provider, Brighton and Sussex University Hospitals Trust, over the last few years. Within a few years, its adult burns patients who need an inpatient stay are likely to be treated at Brighton, albeit with QVH clinicians involved in their care.

This trend is likely to continue but may not be enough to secure the trust a future. So it has now taken the step of entering into discussions with the embryonic hospital group BSUH and Western Sussex Hospitals FT plan to form from April.

Joining a group could offer some economies of scale and opportunities for sharing resources — if not, at least, share its deficit with its neighbours — but the sticking point might be structural. BSUH and Western Sussex plan to have a joint senior executive team — a move eased by the fact they already share a chair and a chief executive, and several other executives. QVH has its own chair, chief executive and board.

The crucial question in the months to come may be whether QVH’s top team will be prepared to step aside to allow for a shared leadership, or whether the trust will look for a looser association with the Sussex group.