Caring for the environment and caring in health often go hand in hand, as many trusts have shown, writes Alison Moore

Caring for the environment and caring in health often go hand in hand, as many trusts have shown, writes Alison Moore

Climate change is a frightening prospect. Many people see it as too big to tackle, either in their personal lives or at work.

But a new report from the NHS Confederation Taking the Temperature: towards an NHS response to global warming has highlighted how relatively small changes can have big benefits.

The NHS in England is currently committed to reducing primary energy consumption by 15 per cent from 2000 levels by 2010. Without a major push, it is unlikely to achieve this. The government's 2003 energy white paper set a UK-wide target of reducing carbon dioxide emissions to 80 per cent of 1990 levels by 2010 and 40 per cent by 2050.

'The latest research suggests that the NHS is a long way from reducing its energy consumption quickly enough to meet these targets,' the report concludes. 'There is a need for detailed strategy to address climate change in an integrated way across the NHS.'

The report looks at how NHS organisations are doing this in six areas - energy, planning and building, procurement, transport, waste management and employment policy.

The NHS is responsible for one million tonnes of carbon emissions a year and NHS-related journeys account for 5 per cent of UK transport emissions. So the potential impact of reducing emissions is significant. But there are other reasons for change. Energy-saving measures often make financial sense. If the NHS reduced its energy consumption by 15 per cent, it would save£50m a year.

Some trusts have already started down this path. In Scotland, support has been available from the Central Energy Efficiency Fund. A number of trusts have invested in energy-saving changes that have paid for themselves very quickly.

Big savings

For example, Queen Margaret Hospital in Dunfermline installed variable speed drivers to its heating, ventilation and air conditioning plant. The initial cost - less than£12,000 - should be recouped in six months, with projected savings of more than£25,000 a year. Lifetime savings of around 1,272 tonnes of carbon are expected - equivalent to taking 500 cars off the road.

'When we worked out what the cost of the staff was and what the potential benefit was, it was very attractive,' says Jim Leiper, director of estates and facilities at NHS Fife. 'It offsets some of the big rises we have had in energy costs.'

Other Scottish trusts have also made 'invest to save' decisions based on energy-saving equipment. Glasgow Royal Infirmary also got money from the fund to install a boiler economiser.

These projects have all contributed to the NHS in Scotland reducing emissions by 30 per cent in the 19 years to 2004-05. The energy efficiency fund has certainly made a difference and eased some trusts into energy-saving investments. The Department of Health has now announced it has£100m to help support switching to renewable energy. Because of the long payback times, these have previously been hard to justify investing in.

Making other changes can be harder, however. Addenbrooke's Hospital in Cambridge, for example, has engineered a major shift away from staff driving to work towards using buses and cycling.

Associate director of private finance initiatives Wyn Hughes says that in 1994, 74 per cent of staff came to the site on the edge of Cambridge by car. This has now fallen to 38 per cent, with 25 per cent using buses and 25 per cent bicycles.

This has been achieved using carrots as well as sticks - introducing car parking charges; working with the county council and bus operators to provide better services to the site; setting up a special service to a local park-and-ride; reducing the number of car parking spaces; introducing more bicycle parks; and linking to the national cycle network so staff from one village can use a cycle path on a disused railway to get to work.

Mr Hughes says such changes - especially car parking charges - may not be popular at first. 'You get two weeks of noise as people complain - and then they adapt,' he says. 'You have to be brave to instigate an unpopular change.'

The move has been largely cost-neutral, with the charges from car parking being re-invested in facilities such as an extra 600 secure cycle spaces. The charges also subsidise a bus service to a park-and-ride site. Where previously 20 buses an hour visited the site, there are now 50.

Cutting food miles

But the NHS is also the biggest purchaser of food in Britain. By sourcing food locally, it can reduce the 'food miles' covered as food is taken to hospitals.

However, its power to do so can be hindered by EU fair competition rules, and contracts entered into through the NHS Purchasing and Supply Authority, which exploit economies of scale.

When trusts manage to break through these barriers, they can have a massive effect. The Royal Cornwall Hospitals trust has worked with the Soil Association to purchase more food locally - 40 per cent of it is now produced in Cornwall and 83 per cent (£910,000) was bought through Cornish companies last year. The food miles used to deliver it have dropped by two-thirds.

When the trust began working with the Soil Association, alternative suppliers quickly emerged. For example, locally caught fish is now used for fishcakes. Serving Cornish dairy ice cream has also meant fewer elderly patients need supplements to keep up their calorie intake.

Feedback from patients has been positive - 92 per cent said the food was excellent or very good. This has been achieved within the trust's budget of£2.50 per patient per day.

In the future, climate change is likely to put more stress on the NHS - with a forecast 10,000 extra food poisoning cases and 5,000 extra skin cancer cases, for example - and it is in the NHS's own interests to mitigate it as far as possible.

The report, which includes a tool for trusts to assess their progress towards reducing emissions, was launched at the NHS Confederation conference last week. Eco-campaigner Jonathan Porritt will make a keynote speech and discuss the report in a session on 22 June.