Last reviewed 5 March 2014

NHS Sustainability Day, held on 27 March 2014, will encourage the efforts of staff and managers to create an environmentally sustainable health service and to celebrate successes so far. However, what is the NHS doing about sustainability and how do the unique issues that characterise the NHS make its task, in this regard, more or less difficult? Martin Hodgson takes a snapshot.

What is sustainability?

Environmental sustainability refers to the need for modern organisations to behave in a responsible and far-sighted way — the aim being to preserve and maintain the quality of the environment, both now and for generations to come.

Recent years have seen increasing concern about environmental or “green” issues — specifically in areas such as procurement, pollution, waste reduction, energy and water conservation, transport issues, and the use of resources. In this respect, healthcare organisations and the NHS in general are, along with other industries and sectors, obliged to improve their environmental performance by complying with relevant guidance and regulation, and adopting modern sustainability practices.

Many believe that sustainability is a necessity, not a choice. The world cannot continue to use its natural resources in the way that it currently does, and all modern organisations must recognise that failing to take on board this message is not an option in the long term.

Sustainability strategy in the NHS

One of the largest employers in the world, the NHS, taken as a whole, consumes a huge amount of energy and other resources and is therefore a major carbon producer, responsible for more than 21 million tonnes of carbon dioxide equivalent per annum. It is also a significant procurer of goods and services from local, national and international economies.

For these reasons, the Department of Health has stated its ambition for the NHS to be an example of public sector best practice in sustainable development in general, and carbon reduction in particular. To do this, and led by the NHS Sustainable Development Unit (SDU), the NHS needs to be conscious of its core role in delivering safe and cost-effective healthcare, while simultaneously operating economically and ethically, recognising its broader obligations to the health of the population and the planet.

To reach this goal, in 2009 the NHS published its own Carbon Reduction Strategy, which set out a series of targets to limit the projected increase in its carbon emissions. This was updated in March 2010 to include:

  • a reduction in carbon emissions of 10% by 2015

  • a reduction in carbon emissions of 80% by 2050.

A further update is expected in 2014, along with a new strategy that will embrace all aspects of sustainability, not only carbon reduction, and will apply across the entire health, public health and social care system.

Barriers to sustainability

The NHS has many unique factors that may affect its performance in this area. Probably the biggest barrier is financial short-termism. Sustainability requires a long-term change strategy, but modern cost pressures in the public sector do not always support such approaches, and issues such as sustainability are seen by some as an expensive distraction in the current financial climate.

This barrier is offset by the fact that organisations with a long-term sustainability strategy can hope to make significant cost savings in the future, linked to effective business models. This awareness of the business case for sustainability needs to be spread throughout the NHS, especially with many competing pressures impacting on NHS boards, clinicians and leadership teams.

Size is also a factor. It has been said that the sheer size of the NHS is a barrier to change in itself. Large organisations often find change slower and harder than smaller businesses. However, others believe that larger organisations are uniquely positioned to lead in this area, as long as they have clear policies, systems and strategies in place, effective leadership and sufficient “buy-in” from staff who are motivated towards successful change.

The development of an NHS Sustainability Day to raise awareness of environmental and sustainable practice is a statement of intent from NHS policymakers, and organisations such as NHS Trusts and Clinical Commissioning Groups are being encouraged to get involved.

Sustainable procurement

Procurement is a key issue in sustainability. To implement sustainable policies, organisations must ensure that resources are bought from providers who themselves have sustainable use or production policies. In this way, a “chain reaction” can be created of market forces driving sustainability.

Procurement in the NHS is a large-scale and complex activity that has the potential to deliver on a number of sustainability targets, but it must be firmly linked with efforts throughout the supply chain to reduce waste and increase the recycling and reuse of materials. For example, one aspect of procurement that is a developing theme is that of excess packaging. The general public is becoming increasingly aware of the negative environmental impact of wasteful packaging and this needs to be reflected in NHS purchasing and procurement contracts.

There is commitment to such elements within the NHS at various levels, but there is still much to do. The Government can help by reforming public sector procurement processes and encouraging a “total cost of ownership” approach whereby the true costs of products are considered throughout their life cycle. This is being done through official specifications that all government buyers must follow, and by the use of increasingly sophisticated Procuring for Carbon Reduction (P4CR) guides.

Social value

The SDU was created to help the health service become a leading, low-carbon, sustainable organisation. It encourages every NHS organisation to have its own Sustainable Development Management Plan and provides a range of supporting resources, including leadership programmes, staff development programmes and case studies.

The SDU model views sustainability as about striking an effective balance between the key areas of:

  • economic sustainability

  • social sustainability

  • environmental sustainability.

The unit views environmental sustainability for the NHS as having a broad focus, and has enabled the NHS sustainability agenda to move on in recent years, from an approach focused on reducing energy use and saving money, to a wider dialogue about the ethics of how large, modern organisations such as the NHS should operate in the 21st century.

It is this wider argument that is being increasingly developed by NHS employers, unions and policymakers. Here, the issue of sustainability is increasingly seen as a model of social responsibility, which is essential if the NHS is to be truly ethical and seek to improve health and well-being in the future.

In this view, sustainable actions, such as cutting carbon emissions, are one way of safeguarding the health of future generations. For instance, a recent report on Health Effects of Climate Change in the UK, published by the Department of Health and written by the Expert Group on Climate Change and Health, concluded that climate change caused by global warming will have a significant effect on health in the UK in the future, if society does not act in a more responsible manner toward the environment. This will include an increase in heat-related summer deaths, more water-borne diseases, the risk of major disasters caused by severe winter gales, and an increase in cases of skin cancer and cataracts.

In this context, sustainability in the NHS, in its widest sense, is actually a social contract about how we create a healthier and happier population, and how we can afford to continue to deliver care in the future.

NHS sustainability in practice

There are many examples of good sustainability practice in the NHS. The second article in this series will explore some of them and see how NHS sustainability is looking forward to the future with respect to key areas such as energy consumption and waste reduction.