Reducing carbon is a central part of being a socially responsible NHS body – but initiatives such as promoting ethical purchasing of supplies show there’s more to it than that. By Jennifer Trueland

Creating sustainable organisations involves much more than reducing carbon footprint – although that’s important too. Becoming truly sustainable means a focus on the social and financial bottom lines, as well as improving the environment.

Sustainable Development Unit

Sustainable Development Unit

These three elements form a thread that runs throughout the Sustainable Development Strategy for the NHS, Public Health and Social Care that was launched in 2014. The document, produced following consultation across the system, and written by the Sustainable Development Unit – which is funded by, and accountable to, NHS England and Public Health England – sets out a vision and goals up to 2020.

Many organisations are making tremendous progress in sustainability, but it is still far from universal, acknowledges SDU head Sonia Roschnik.

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Case studies: Steps to minimise impact on environment

“There are some exemplar set-ups, and if we could roll their good practice out everywhere then that would be great,” she says. “However, it is still not embedded consistently across the NHS, public health and social care.”

’We are seeing more integration, both within organisations and across local systems’

As one of the judges of the annual HSJ award for improving environmental and social sustainability she has, however, been encouraged by examples of excellent practice submitted by organisations across the country.

“Over the years of this award we’ve really seen change happening,” she says. “You still need enthusiastic individuals, but we’re seeing more of a corporate approach.

”We’re also seeing more integration, both within organisations and across local systems. There’s a sense that, with the board behind it, you are really able to make it a movement that involves whole organisations and beyond.”

Enthusing staff

Northampton General Hospital Trust has taken a trust-wide approach to embedding sustainability, encouraging staff and teams to initiate their own projects. Clare Topping, energy and sustainability manager, says that investment in carbon reducing technologies has helped but that engaging clinical and non-clinical staff has also been crucial.

“You need to find out what makes people excited about a subject and then make it happen. It is about going out and having the conversations.”

Jonathan Reid, deputy chief executive and director of finance and estates at Sussex Community Trust, agrees that enthusing staff is important. The trust’s Care Without Carbon initiative, for example, has the long term aspiration of making the trust the first carbon-neutral NHS provider in the UK, and is expected to involve savings of around £4.8m by 2020.

’It is about going out and having the conversations’

“Staff are motivated to get involved and people are excited by sustainability,” says Mr Reid. “I see a real difference in how people think about what they can do to make a difference.”

One of the challenges of judging the HSJ award is the breadth of entries. Ms Roschnik points to this year’s entry from the British Medical Association, which has highlighted the need for ethical or fair trade purchasing in healthcare. The entry is specifically for a campaign for improved procurement around surgical instruments.

The BMA Medical Fair and Ethical Trade Group conducted research that revealed unethical working conditions in the manufacture of a number of supplies routinely used in the operating room. It has pointed out that, while awareness of fair trade of consumer products such as coffee and chocolate is high, the same scrutiny isn’t given to goods used in healthcare.

The organisation has been working with NHS providers to support them to introduce social criteria into procurement and secured commitment to do so from NHS Supply Chain, and Guy’s and St Thomas’ Foundation Trust.

Research in October 2014 by the BMA showed that introduction of social criteria in procurement contracts was having an impact on the ground. For example, the prohibition of child labour is being enforced and wages being paid in accordance with minimum wage. “The healthcare sector, with its huge purchasing power, can improve conditions round the world,” the organisation says.

Ethical procurement

“The BMA’s campaign has relevance for all healthcare organisations because it applies to all kinds of ethical procurement,” says Ms Roschnik. “It also shows that sustainability isn’t just about carbon – it’s about much wider environmental and social impact too.”

This is something that rings true for The Shrewsbury and Telford Hospitals Trust, which has taken action to galvanise improvements both in-house and among the wider community. Steps include improving procurement to make it more socially responsible – for example, choosing a local milk supplier – and encouraging community volunteering to create healing gardens for patients, staff and visitors.

Director of corporate governance Julia Clarke says it is important to work with colleagues in health and social care, and the wider community. “Working in isolation just slows everything down and so we work with partner organisations to learn from each other and pool resources to achieve our mutual goals.

”For example, the appointment of a local travel coordinator in partnership with our local councils has enabled us to look at developing green travel plans in a much more joined-up and cohesive way.”

Making sure that programmes can be easily shared with other organisations is also essential. Carin Charlton, executive director of strategy and corporate services at Mid Essex Hospital Services Trust, says that’s a vital part of its strategy.

’Sustainable development has to be positioned as business as usual’

“Our model is widely replicable, which in our opinion makes it a true example of sustainable development. It relies on three aspects; building wide networks with the community, thinking of innovative ways to resource the sustainability programme, educate and engage the trust board.”

Kevin Thoy, environmental services manager at United Lincolnshire Hospitals Trust, says some of the biggest successes come when the concepts are a routine part of organisations’ work.

“Sustainable development has to be positioned as ‘business as usual’; creating a sustainable, comfortable environment is an important part of the care of patients and colleagues.”

Ms Roschnik agrees: “We’ve got to get to the point where sustainability is just the way we do things – like health and safety, or equality or diversity. We need to be at the stage where we don’t even question it – it’s just what we do. We’re not there yet but we’re seeing real progress.”

While we often hear about the financial sustainability of the NHS and health sector, we hear less of its environmental sustainability. However, we know that our health and our physical environment are intrinsically linked and if we are to ensure the sustainability of health services we need to think more holistically in terms of financial, environmental and social sustainability.

The effects of climate change – such as heatwaves and flooding – have considerable health impacts on people and, with them, costs for services. We also know that emissions have a direct effect on people’s health. Air pollution causes 29,000 early deaths per year and countless unnecessary admissions to hospital.

But, too often, people have perceived a cost to actions that have positive environmental effects (or reduce negative effects). The reality is that most interventions that protect the environment also improve people’s health and save money.

Taking the broader environment seriously helps us to avoid breaking the law, breaking the bank and breaking our contract with current and future generations.  

The health and care sector in England is the largest public sector emissions producer in the country, accounting for 41 per cent of total public sector. We must act to reduce our carbon footprint and prepare for, and mitigate, the effects of climate change because we will soon be facing the problems it causes.

However, we have made good progress and these pages contain just a few examples of the fantastic work already being done across the system. We are the first country to have a sector-wide sustainable development strategy for the health and care system.

Alongside this, the NHS Five Year Forward View and the Public Health England priorities recognise the importance of sustainable development and its principles. Principles such as preventing ill health, empowering people and communities to live healthy lives, and utilising technology to help people take ownership of their treatment and responsibility for their health.

The work is well under way. We have recognised the importance and set a direction; we just need to make sure it doesn’t get lost among the many priorities we face.

It may be a well-worn cliché, but every challenge is an opportunity. The challenges we face in the health and care sector right now – and those of climate change in the present and near future – may provide us with the greatest opportunity yet.

Dr David Pencheon is director of the Sustainable Development Unit