east_midlands_nhs_carbon_reduction_project_-_full_report (1)
TRANSCRIPT
ENERGY
SUSTAINABLE
CARE HOMES
FOOD
East
Mid
land
s N
HS
Sust
aina
ble
Dev
elop
men
t Net
wor
k
June 2015
PROCUREMENT
TRAVEL
NHS FOREST
Social Economic
Environmental
SustainableProcurement
PROJECT REPORT
Achieving a Reductionin Carbon Equivalent Emissions in the NHS
EM NHS COVER final:EMNHS COVER 15/06/2015 12:47 Page 3
1
The project lead was Helen Ross, Senior Public Health Manager - Sustainable Development - Nottingham City PCT on secondment to the Dept of Health in the East Midlands Please note: some websites holding information about this project were removed during the life of the project, due to the reorganisation of the NHS and Public Health. Please contact Helen Ross if you require further information now at: [email protected]. For further information about the pilots see reports hosted on the Sustainable Development Unit website: www.sdu.nhs.uk June 2015 This document has been printed on environmentally friendly paper.
2
“The future is not some place we are going to,
but one we are creating.
The paths are not to be found,
but made,
and the activity of making them,
changes both the maker and the destination.”
John Schaar
3
1 Acknowledgements
The East Midlands NHS Carbon Reduction project required cooperation and input from a wide spectrum of representatives and their organisations. Contact details are listed at Appendix 2. Sincere thanks to all those who have contributed including: Project Chairs Andrew Kenworthy and Dr Ian Campbell Project and East Midlands NHS Sustainable Development lead on secondment to the Dept. of Health from NHS Nottingham City and County: Helen Ross Dept. of Health & NHS East Midlands
Public Health: Professor David Walker, Dr Nick Salfield, Giri Rajaratnam, Anna Morris, Sarah Norrish & Marysia Zipser
The Innovation Fund Team: Bernie Stocks and Catherine Gillam The East Midlands NHS Sustainable Development network for contributing their knowledge and expertise through Action Learning Sets Leeds University and the SHARP Network: Dr Claire Marsh for Action Learning support The Resource Hub: Chris Sparks & NHS Nottingham Supplies: David Bailey for guidance with commissioning The Project Steering group including the Carbon Trust Climate East Midlands - Mike Peverill and Government Office East Midlands - Mike Meech Jenny Griffiths OBE for support with the network and project and especially for inspiring the completion of this report. Phase 1 report & Phase 2 Estates, Procurement and Care Homes pilots: Nottingham Energy Partnership (NEP) main lead Jerome Baddley Phase 2 pilot leads: NHS and action learning set members including:
Estates NHS Midlands and East- Robert Nettleton and NEP pilot lead - Laura Mayhew-Manchon
Procurement NEP pilot lead - Jennifer Strong & Dept. of Health Sustainable Procurement lead - David Wathey
Care Homes the steering group, NEP: Jerome Baddley with support from Louis Mullan – student in MSC in Environmental Governance at University of Manchester - and participating Care Homes: Cherry Trees Resource Centre, Queenswood Care Home, Laura Chambers Lodge Care Home, Wren Hall Nursing Home & Longmoor Lodge Residential Home; Mindy Bassi for advice on medicines management and Nottingham City Council for advice on waste management.
Travel Integrated Transport Planning - Lynsey Harris, NHS Nottinghamshire NHS Nottinghamshire Healthcare Trust: Neil Alcock.
Food Nottingham University Hospitals NHS Trust: John Hughes for inspiring leadership in sustainable hospital catering: the Soil Association for the use of their sustainable catering mark, Sustain for their support, Dept. of Health - Ann Goodwin & the Platform for Health & Well Being: Trish Crowson
NHS Forest Yorkshire NHS Sustainable Development lead: Roger French, Centre for Sustainable Healthcare: Sarah Dandy, Chesterfield Royal Hospital, Andrew Jones Leicestershire Partnership NHS Trust: Mark Evans, Nottingham University Hospital Trust Alberto Rodriguez-Jaume and John Hughes, Masters student taking an MSc in Environmental Management at the University of Nottingham: Ellie Mills
Phase 3 pilot leads Samantha Whiteley Norfolk Community Health & Care NHS Trust, Elmarie Swanepoel Mid Essex Hospital Services NHS Trust Broomfield Hospital, Louise Gaffney West Hertfordshire Hospitals NHS Trust, Hazel Buchanan Nottingham North & East CCG, Clare Topping Northampton General Hospital NHS Trust, Sid Siddiqui Derbyshire Community Health Services NHS Trust, Mark Armstrong-Read Derbyshire Community Health Services NHS Trust and Martin McKay Wye Valley NHS Trust External Verification ARUP: Paul Brockway who provided positive and constructive training and external verification for the project. The Sustainable Development Unit: Imogen Tennison, Lead data analyst for support with data issues, David Pencheon and Sonia Roschnik for the national guidance that provided the policy framework.
4
2 Contents
1 Acknowledgements ………………………………………….……………………… 3
2 Contents…………………………………………….…………………………………… 4
3 Executive Summary …………………………………………………………………… 6
1 Purpose and Aims ……………………………………………………………... 6
2 Three Project Phases ………………………………………………………….. 6
3 The Need for the Project: Guidance ………………………………………….. 7
4 Methods and Approaches …………………………………………………… 8
5 Outcomes ……………………………….…………………………………….. 9
6 Conclusions ……………………………………………………………………… 14
Recommendations ……………………..……………………………………… 16
4 Introduction ………………………………………………………………………………. 17
4.1 Purpose & Aims ………………………………………………………………… 17
4.2 The need for the project: Guidance …………………………………………... 17
5 Methods and Approaches ………………………………………………………………. 22
6 What was done? ……………………………………………………………………….. 24
6.1 Phase 1 ……………………………………………………………………….. 24
Outcomes ……..………………………………………………….. 25
6.2 Phase 2 ………………………………………………………………………… 26
Pilot 1 - Energy in NHS Estates ……………………………………… 27
Pilot 2 Sustainable Procurement Training …………………………….. 33
Pilot 3 Sustainable Healthy Care Homes ……………………………… 34
Pilot 4 Travel ……………………………………………………………….... 36
Pilot 5: Food ………………………………………………………………… 39
Pilots 6a and 6b - NHS Forest ……………………………………..……… 40
6.3 Phase 3: Development and Replication in Midlands & East ………….… 43
7 Summary of Outcomes ……………………….……………………………………. 47
7.1 Influence on Strategy …………………………………………………… 47
7.2 Outcomes of the three Phases of the Project ……………………..………. 47
8 Conclusions ………………………………………………………………………………….. 50
8.1 Towards a sustainable health service …………………………………..….. 50
8.2 The Challenges ………………………............................................................ 51
8.3 What made the project a success? …………………………..……………….. 51
8.4 The Pilots ………………………………………………………………………… 53
9 Recommendations …………………………………………………………………….. 55
5
Appendix 1- References ……………………………………………………………… 58
Appendix 2: Contacts list …………………………………………………………….. 60
Appendix 3: Glossary …………………………………………………………………….. 62
Appendix 4: Carbon Footprint Calculations …………………………………………….. 64
Appendix 5: Care Homes Project ……………………………………………………… 66
Appendix 6: Financial Account ……………………………………………………… 69
Appendix 7: External Verification ………………………………………………………. 72
Appendix 8: Project Logical Framework ………………………………………………. 89
Appendix 9: Midlands & East Phase 3 NHS Carbon Reduction Project log frame ……. 98
Feed Back Form ………………………………………………………………………… 103
6
3 Executive Summary
“… the World Meteorological Organisation has reported a surge in carbon dioxide in the atmosphere, which reached a new record high of 396 ppm in 2013. Furthermore, according to the 2014 Low Carbon Economy Index, for the sixth year running the global economy has missed the decarbonisation target needed to limit global warming to 2°C. If this current trajectory continues, the carbon budget for the entire century would be depleted within the next 20 years, with grave consequences for the environment and human health.” The Lancet September 2014
The East Midlands NHS Carbon Reduction Project (EM NHS CRP) developed at a time when carbon reduction in the NHS was not a mainstream concept. It took energy and imagination to get it off the ground. This report summarises the project with the aim of inspiring others to lead the NHS towards commissioning and delivering sustainable health and care services.
1 Purpose and Aims
The purpose of the East Midlands NHS Carbon Reduction Project was “to equip NHS organisations to reduce their carbon footprint whilst improving the quality, productivity and effectiveness of their services”. It engaged 26 NHS Trusts, 16 of whom implemented pilot projects, and 4 Care Homes. The project aims were to:
accelerate the move of the NHS in the East Midlands to a low carbon economy
measure and reduce carbon equivalent emissions 1 by piloting a variety of methods including developing the use of commercially viable low carbon technologies in the NHS.
The project sought to bring together public and private funding and encourage cross-sector partnerships. Project development was led by Public Health in the Department of Health East Midlands and Nottingham City Primary Care Trust (PCT) and supported by the East Midlands NHS Sustainable Development Network. Nottingham City PCT made a successful application on behalf of the network in 2009 to the NHS East Midlands Regional Innovation Fund and the project was established in January 2010. This was the first health project to use Regional Innovation Funding to help change the culture of carbon equivalent intensive services towards more sustainable health and healthcare services.
2 Three Project Phases
The three phases of the project included Phase 1:- the development phase, Phase 2:- the pilot phase and Phase 3:- the pilot roll out phase. The aims and outcomes of each phase are summarised below, followed by a separate methods section to describe in more depth, the approaches utilised to develop the project and overcome obstacles to progress.
Aims
Phase 1 To develop and establish the project and calculate the accurate carbon equivalent footprint of the NHS in the East Midlands.
1 An abbreviation from carbon dioxide equivalent emissions, a metric measure used to compare the emissions from various greenhouse gases (e.g. methane) based upon their global warming potential.
7
Phase 2 To develop six pilots to reduce carbon equivalent emissions within NHS organisations in the East Midlands, including the use of commercially viable low carbon technologies in the NHS. Secondary aims included making financial savings and improving well-being. Phase 3 The roll out phase: Following the success of Phase 2, an additional Phase 3 was established that aimed to enable successful pilots to be trialled in other parts of the care system and in the wider NHS Midlands and East area to see if they were replicable.
3 The Need for the Project: Guidance
The United Nations’ Convention on Climate Change set an overall framework in 1992 for intergovernmental efforts to tackle the challenges posed by climate change. It recognised that the climate system is a shared resource whose stability can be affected by industrial and other emissions of carbon dioxide and other greenhouse gases. The key objective of the convention was to achieve:
“stabilisation of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system. Such a level should be achieved within a time-frame sufficient to allow ecosystems to adapt naturally to climate change, to ensure that food production is not threatened and to enable economic development to proceed in a sustainable manner.” United Nations (1992)
The NHS commissions and provides carbon equivalent intensive services that have a significant impact on climate change which, in turn, has negative health impacts on society. We attempted through this project to show that change is possible and that carbon equivalent emission reduction can further benefit the NHS by saving money and improving health and well-being. The case made for the project was strengthened by a wide range of international and national guidance, some of which developed in tandem with it: Nationally, the NHS Carbon Reduction Strategy for England developed specific guidance:
“Climate change is one of the greatest threats to our health and wellbeing. It is already affecting health across the globe. The NHS, as one of the largest employers in the world, has an important role to play in reducing carbon emissions, a key cause of climate change.” Sustainable Development Unit (2009 - p63)
Progress
It is important to see the outcome of this project in the national context. The total carbon footprint of
the UK includes the six main Greenhouse Gases comprising: CO2, methane (CH4), nitrous oxide
(N2O) and fluorinated compounds (Hydrofluorocarbons, perfluorocarbons and sulphur hexafluoride).
The Carbon footprint is calculated in different ways in the UK (see Appendix 4 for the explanation).
The Office for National Statistics (ONS) estimates of greenhouse gas emissions are based on a UK
residency basis which focuses attention on responsibility for emissions and includes production
for the whole economy including public and private sectors and households. These were estimated
to be 643.1 million tonnes of carbon dioxide equivalent (Mt CO2e) in 2013, which were 2.0% lower
than 2012 (656.5 Mt CO2e), and 23.6% lower than 1990 (842.0 Mt CO2e). Between 1990 and
2013, carbon dioxide emissions decreased by 14.1%, methane emissions decreased by 59.0% and
nitrous oxide emissions decreased by 51.4%.
Office for National Statistics (2015)
8
This appears to be positive, however, there is an urgent need to do more to reduce emissions. According to the Scientific American Journal we have twenty years at most to stop and reverse the annual increase of CO2 emissions:
“Most climatologists agree that, while the warming to date is already causing environmental problems, another 0.4 degree Fahrenheit rise in temperature, representing a global average atmospheric concentration of carbon dioxide (CO2) of 450 parts per million (ppm), could set in motion unprecedented changes in global climate and a significant increase in the severity of natural disasters—and as such could represent the dreaded point of no return. Currently the atmospheric concentration of CO2 (the leading greenhouse gas) is approximately 398.55 parts per million (ppm). According to the National Oceanic and Atmospheric Administration (NOAA), the federal scientific agency tasked with monitoring the health of our oceans and atmosphere, the current average annual rate of increase of 1.92 ppm means we could reach the point of no return by 2042.” Doug Moss & Roddy Scheer (13 April 2015)
When adapting services to become low carbon services, there are often co-benefits that save money, time and energy and improve health and wellbeing. Key guidance includes: • the vision for a future sustainable health service set out by Forum for the Future in 2009 • the Marmot review (2010) which explained that sustainable development helps to reduce health
inequalities, improve health and reduce the unnecessary use of natural resources • the guide produced by the Faculty of Public Health “Sustaining a Healthy Future – taking action
on climate change” (2009) which urged those in the health and healthcare community to take the lead in tackling climate change and promoting sustainable development. It showed how the NHS, Public Health and local government are all ideally placed to use their immense spending power to make sustainable choices in their energy, building and transport policies. and highlighted their responsibility to provide powerful examples to others on reducing carbon emissions and promoting a healthy, sustainable future.
• the Faculty of Public Health, in conjunction with Natural England, who reported that: “green spaces can play a key part in reducing greenhouse gases” (2010).
• The Social Care Institute for Excellence which outlined the negative health impacts of climate change through the increased occurrence of extreme weather events such as flooding and heat waves, as well the growing risk of fuel poverty due to high energy prices (April 2010)
• “The health sector everywhere needs to play a central role in addressing climate change—the greatest health threat of the 21st century. We must reduce healthcare’s climate footprint, make our health systems more resilient, and most importantly advocate for a fundamental shift in energy, transport and agriculture policies. Our task is to end our dependency on fossil fuels, a move that can help tackle both climate change and the rise in non-communicable diseases such as diabetes, cancer, heart disease, stroke, and asthma.” The Global Climate and Health Alliance (2014)
• The Public Services (Social Value) Act of 2012 which “places a clear expectation on public services to demonstrate how their work makes a difference and delivers greater ‘social value’ ”. Sustainable Development Unit (2015).
4 Methods and Approaches
The range of methods utilised by the steering group enhanced the success of the project. These included: 1 A Logical Framework: a useful tool for the project lead and steering group to manage the development of the whole project.
2 Professional procurement and commissioning methods:- provided an excellent decision making mechanism to the steering group for commissioning technical support and external verification for phases 1 and 2. They were also utilised for identifying six pilots in phase 2 that were
9
likely to deliver the maximum carbon equivalent emissions, financial savings and well-being improvements.
3 The action learning approach:- very helpful in engaging the NHS in the East Midlands in the project generally and particularly with the development of the pilots.
4 The East Midlands NHS Sustainable Development Network:- provided invaluable support throughout the project.
5 A methodology for calculating carbon accounting in NHS organisations:- was developed during Phase 1 with the potential for adoption across the NHS.
6 External Verification:- very helpful, particularly in supporting pilot leads to develop the Key Performance Indicators and in assessing the accuracy of the technical details.
5 Outcomes
The outcomes for each phase are explained here briefly followed by a summary of the external
verification comments and social and wellbeing benefits for the whole project.
Phase 1
The methodology for calculating carbon accounting in the NHS was developed by Nottingham
Energy Partnership in collaboration with the NHS and the external verifier.
Accurate baseline information about the carbon equivalent emissions of health services in the East Midlands was then calculated and recommendations made for pilot projects to deliver carbon equivalent emission savings.
Carbon footprint: The carbon equivalent footprint of the NHS in the East Midlands was calculated to be 967,900 tonnes in 2007-8 and 1,070,000 tonnes in 2008-9. The 2007-8 footprint represented 4.8% of the national footprint, which was in line with the 4.95% of the national NHS budget spent in the East Midlands at that time.
Phase 1 inspired 26 NHS Trusts to become directly engaged with carbon management, and 12 used the Phase 1 report to make the case for their actions and plans.
Phase 2
The six pilots trialled ideas with 15 different Health Trusts and GP surgeries in NHS buildings and 4 Care Homes.
1. Energy in buildings: Improving energy efficiency and increasing renewables with Health Trusts and GP surgeries in NHS buildings and 4 Care Homes, resulting in lower financial and environmental costs. Savings made could be used to enhance the natural environment and contribute to more sustainable health and care services.
2. Procurement: Investigating ways with Health Trusts to reduce unnecessary procurement and procure a greater proportion of sustainable goods and services.
3. Sustainable Healthy Care Homes: Examining environmental impacts nationally of residential care homes and determining opportunities to improve environmental, social and economic sustainability while developing health co-benefits. The pilot focused on four care homes in Nottingham and Nottinghamshire and included:
Assessing and reducing waste including food and food packaging (such as sip feeds)
Increasing residents’ access to the natural environment e.g. by setting up Walking for Health routes with residents, staff, relatives and friends
Medicines management
Assessing the feasibility of installing renewable energy generation equipment.
10
4. Travel: Trialling by health and healthcare professionals of electric vehicles in Nottinghamshire
NHS Healthcare Trust to establish whether they could reduce their carbon equivalent emissions and reduce their impact on air quality when travelling to visit patients in the normal course of their work.
5. Food: Developing an East Midland sustainable food standard and working with 5 Health Trusts to encourage them to adopt the standard, so that they can procure and provide more sustainable and healthy food for their staff, patients and visitors.
6. NHS Forest: Increasing access to green space and especially trees, on or near to NHS land in 3 Health Trusts, in order to:
improve the health and wellbeing of staff, patients and communities
provide accessible opportunities for exercise and improve the working environment.
enhance the healing environment
increase staff and community cohesion and engagement with the NHS and sustainability objectives
The participating Health Trusts, GP surgeries and Care Homes included: Derbyshire Community Health Services, NHS Nottinghamshire County, NHS Lincolnshire, Lincolnshire Community NHS Health Services, Leicester, Leicestershire & Rutland Facilities Consortium, Lincolnshire Partnership NHS Foundation Trust, Leicestershire Partnership NHS Trust, Derbyshire Healthcare NHS Foundation Trust, Nottinghamshire Healthcare NHS Trust, Nottingham University Hospitals NHS Trust, Queenswood Care Home Care home, Laura Chambers Lodge Care Home, Wren Hall Nursing Home, Cherry Trees Resource Centre, Earls Barton Medical Centre, King Edward Road Surgery and Charnwood Surgery, Derby.
Carbon equivalent emission and Financial Savings
The savings summarised in Table 1 were difficult to quantify accurately. Nevertheless, the external verifier found that Phase 2 pilots:
were highly successful in terms of meeting their Key Performance Indicators (KPIs), with an overall weighted pass rate of 90%. Pilots 1-5 met 33 out of 34 KPIs.
did make significant financial and environmental annual changes to East Midland healthcare organisations and the wider community in which they operate.
The Energy in NHS Estates pilot assessment demonstrated that renewable energy solutions constitute a financially attractive and worthwhile investment for many healthcare organisations, which would enable them to generate a steady income stream, reduce their carbon footprint, and improve the energy cost resilience of their sites.
The assessment of renewable energy systems operating across the region demonstrated that they outperform energy generation predictions in many cases. In the case of at least four Nottinghamshire health centres, 10% of the site’s total electricity demand is met by their on-site solar PV system, making them less dependent on grid-supplied electricity and more resilient to electricity market price rises.
This pilot produced recurring annual savings and other pilots produced one off savings. Where there were a range of estimated savings the minimum savings are quoted, but the true savings are likely to exceed those figures
11
Table 1 – Summary of Key Savings for Phase 2 pilots
1 Pilot Project
2 Annual carbon savings tCO2e
3 Annual energy saving
MWh
4Social impact
£equivalent1
5 Savings identified / income £
[1]
6 Cost of pilot
1. 1 Energy in NHS Estates: £21,750 [2]
1.1 Renewable energy 96 381 £10,738 between £77,259 & £163,921
2
Part of costs above
1.2 Automatic Meter Reading (AMR)
[3] 3
647 2,151 £14,492 between £85,000 & £95,000
Part of costs above
1.3 Voltage Optimisation (VO) 80 140 [4]
£1,792 £12,800 Part of costs above
2. 2 Sustainable Procurement training
938 No data £12,194 £1,350,000 [5]
£3,564
3. 3 Sustainable Healthy Care homes
770 No data £10,010 £14,093pa[6]
£4,320
4. 4 Electric Vehicles 50-60% [7]
7-43% £39 0 £1,000
5. 5 Food standard No data No data No data No data £1,000
6. NHS Forest – 6.1 and 6.2 25[8]
No data £130 No data £4,920 £3,080
Total 2,556 2,672+ £49,395 between £1,539,152 & 1,635,814
£39,634
Phase 3
Eight Health Trusts received authorisation for funding to enable them to proceed with small scale work to apply and further develop the learning from the project on an individual Health Trust basis in the wider Midlands and East area. Outcomes: Phase 3 outcomes were not quantified in the same way as in Phase 2 due to the concurrent national, regional and local reorganisation of the Department of Health and NHS, which made it difficult to process the funding for the pilots and for the pilots to make and report on progress. Only four Health Trusts actually received the funds for their pilots. A summary of the key quantifiable outcomes for Pilots 2, 4, 5, 7 and 8 that did go ahead are outlined in Table 2.
[1] Note: the table is based on the external verification summary of key outcomes with additional data to illustrate the financial cost of the pilot and anticipated savings / income in columns 5 and 6. [2] total for 1.1 Renewable energy, 1.2 Automatic Meter Reading (AMR) and 1.3 Voltage Optimisation (VO) 2 includes income from feed in tariffs [3] estimated at 5% savings where AMR installed pa 3 The cost saving estimate is based on an average energy costs per unit of electricity and gas across the NHS trusts who stated they would install Automatic Meter Reading (AMR). If all trusts engaged in the pilot were to implement AMR, the potential savings would be the £600k and energy savings of 2,151 MWh pa. [4] independent analysis estimate. Not possible to project with certainty due to other variables [5] estimated at de-minimus 5% savings on contracts supported [6] NHS East Midlands Carbon Reduction Project – Sustainable Care Homes Pilot report Table 5 Identified potential bill savings (£/year) [7] Nottinghamshire Healthcare Electric Vehicle Trial Report – p10 [8] Leicestershire Partnership Trust planted 1,200 trees & Faculty of Public Health (2010) estimated saving of 22kg per CO2 per year per tree.
12
Table 2: Phase 3 - Midlands and East NHS Carbon Reduction Project Pilots
Key to Areas: East Midlands (EM), West Midlands (WM) & East (E).
No Lead, Title & Area Description of pilots Outcomes
1
Norfolk Community Health & Care NHS Trust
Carbon Reduction Champions training E *
Development, training and effective use of a new network of sustainability champions in the Trust
Funding not received
2 Mid Essex Hospital Services NHS Trust
Improved Waste Management E
Reduce waste and increase recycling by ensuring that all staff are aware of the correct waste management procedures in place and that they feel motivated to ensure that waste is segregated and recycled appropriately.
£2,000 allocated Final report not presented within the time available for external verification, however, the following progress was reported subsequently: 1.Trust reviewed waste management procedures and waste policy 2. Waste volumes are consistently measured, audited and reported on in the monthly waste management reports – these were reviewed throughout the project. 3. Carbon emissions from waste is measured and published in the Trust’s Carbon Footprint report. 4. A successful pilot was undertaken to introduce Dry Mixed Recycling and plans are now in place to roll out to other areas.
3
West Hertfordshire Hospitals NHS Trust
Sustainable Waste Management E
Focus on waste reduction and compliance in clinical areas by utilising the experience learnt from improving the non-clinical waste and using the funding to bring in dedicated specialist resource.
Funding not received
4 Nottingham North & East Clinical Commissioning Group (CCG)
Sustainable Training - EM
Develop comprehensive sustainable development sessions on the CCGs consumption footprint in relation to procurement and travel at three levels: 1. Governing Body - delivering
against the sustainability agenda and embedding within strategic objectives
2. CCG staff - making a difference as a small organisation
3. CCG sustainability team – prioritising and delivering for greatest impact and financial benefit
The development sessions could be made available to other CCGs in Nottinghamshire.
£1,920 allocated The development session was held and useful learning developed through presentations by Nottingham Energy Partnership and Helen Ross and an interactive learning style. This resulted in greater awareness of the key issues and enabled the CCG to apply a sustainable development approach to the development of the organisation. The session could be replicated for other CCGs in Nottinghamshire.
5 Northampton General Hospital NHS Trust
Freebay waste recycling - E
Encourage reuse of unwanted items through the hospital, reduce waste costs by preventing products being sent to landfill, indirectly focus attention on items being thrown away and allow greater recycling rates. To develop a web-based Freebay website to; 1. Reduce waste to landfill 2. Reduce expenditure on new items 3. Allow reuse of items across the
hospital 4. Allow reuse at other trusts /
charities
£2,000 allocated
The following positive outcomes were logged: 1. Recycling of approximately 250kg of aluminium crutches with a small revenue generated for the Trust 2. Donation of approximate 20 microscopes to the local Natural History Society Microscopy section. In return they made a donation to the hospital that matched the best offers received from commercial concerns. 3. Lists of shelving and other items from the Pathology department for rehoming 4. Unwanted curtains, bedding and walking aids that
13
External Verification: All pilots were externally validated by ARUP who concluded that overall,
Phase 3 pilots took place at a time when the NHS and Public Health were going through a root and branch re-organisation and successes were therefore not as comprehensively reported in the timescale available to the external verifier.
Action Learning: Support was provided across the pilots through the “Sustainable Health through
Action Research in Practice” (SHARP) Network
Project Wellbeing Outcomes
Sustainable Procurement Training: Procurement forms the single largest component of the NHS carbon footprint measured as part of this project. Promoting sustainable procurement practices through the pilots generated examples of a reduction in unnecessary procurement, re-use of products and low carbon purchasing. Examples of health and wellbeing benefits that resulted from the pilot included:
a greater sense of control over their treatment by patients through a new approach to a contract for incontinence products
5. Ensure correct recycling route if not rehomed
6. Allow reporting of annual reuse as well as recycling volumes
would otherwise have been sent to landfill were donated to a local charitable organisation. 5. A number of medical consumables with a value in excess of £700 that were marked for disposal were rehomed within the Trust. 6. Three analytical machines that were no longer required in the Pathology department were sold, increasing Trust revenue.
6
Derbyshire Community Health Services NHS Trust
Grounds & gardens sustainability pilots EM
Localised site composting for grass clipping and other garden waste at small community hospital sites.
Funding not received
7
Derbyshire Community Health Services NHS Trust
Sustainable Travel - EM
To enable individuals to create on-line personal commuting and business travel plans so that they could consider all their options for travel to/from work and shift from single occupancy car commuting to another greener/more active mode of transport.
Funding not received - £2,000 Even though funding was not received, the Health Trust went ahead with this pilot. It also covered options for business travel and so provided a comprehensive package to individuals to consider their journey options. 1. Personal Travel Planning website set up 2. 25 Personal Travel Plans were provided 3. New starters targeted at induction provided
contacts at the correct time – just when they were working out how to travel.
8 Wye Valley NHS Trust
NHS Forest Pilot - WM
To plant 60 fruit trees at the Community Hospital at Bromyard, Herefordshire. 1. To improve the environment for
patients, visitors and staff 2. To link with the local community,
including local schools 3. To reduce the Trust’s carbon foot
print. 4. To contribute to biodiversity
£1,300 allocated 1. 60 organic fruit trees were planted with help
from the local schools within 2 hours. 2. The League of Friends agreed to undertake
future pruning of the trees with the help of the Trust and pick the fruit, for consumption by patients or to raise funds by selling fruit, pies or chutneys.
3. A wildlife survey was taken by the hospital staff before the trees were planted. No wildlife was found. Four months after the trees were planted butterflies and moths were in evidence. A commitment was made to survey again, one year after planting.
4. A local beekeeper agreed to site 1 or 2 hives to help pollinate the trees and provide other benefits to the orchard area.
14
an easing of local congestion and improvement in air quality for the surrounding community resulting from a reduction in the number of deliveries of goods through careful procurement practices.
Using the Social Cost of Carbon approach, the carbon savings from the planned interventions as a result of this pilot would mitigate social damage to the magnitude of £21,001. Electric Vehicles: Health and wellbeing benefits included:
a reduction in adverse health outcomes associated with vehicle emission pollution in densely populated areas through the use of electric vehicles. Electric vehicles do not emit exhaust fumes such as CO2 or particulates. They are generally charged using grid electricity from the power station which emits a carbon content of 0.5246 kg/kWh, equating to a much lower level of CO2 emissions than a conventional petrol or diesel vehicle.
a very high level of overall satisfaction by mental health and community teams providing care to patients in their homes. Half of those who took part would be willing to swap to an electric vehicle. Those who said they would not swap, cite such reasons as purchase cost, charging times and vehicles being too small for family use.
No reported problems by staff delivering a normal service to patients whilst making use of the electric vehicles.
Food Standard: The data regarding the Carbon emissions, energy savings and financial savings were not quantified due to the small amount of funding available for the pilot. However, the Food for Life Catering Mark provides an independent endorsement that food providers are taking steps to improve the food they serve by using fresh ingredients that meet national animal welfare and nutrition standards. The Catering Mark has been cited by NHS England as a way to improve hospital food, and by the Department for Education as a national framework to support caterers to increase uptake of quality school meals. The Government's Plan for Procurement 2014 recognises the Catering Mark as a 'well-established' best practice tool DEFRA (2014). An Exemplar CQUIN on hospital food cites the Catering Mark as a way to raise food standards. Hospitals and Clinical Commissioning Groups have the opportunity to agree a financial incentive for achieving the Catering Mark Standards for food served to patients, staff and visitors: Food for Life (2014). NHS Forest: The NHS Forest initiative can promote improved clinical and healing environments on the NHS estate with the aims of every patient having a view of a ‘tree from every window’, accessible opportunities for health promotion for staff and visitors utilising pathways, green gyms and other dedicated ‘zones’ within the NHS Forest. Staff and community cohesion can also be improved by engaging volunteers, schools and community organisations to help provide seating and relaxation areas for people who need a break from daily pressures. It opens up NHS campuses to add real health promoting value.
6 Conclusions
The East Midlands NHS Carbon Reduction project is the result of hard work by many people with an interest in developing sustainable health services. As a result the project was highly successful overall and NHS organisations in the East Midlands took a great step forward in reducing their carbon emissions, saving unnecessary spend and improving health and wellbeing, despite the challenges that had to be met:
15
Key Challenges
1. Cultural change; a challenge for many health service organisations due in part to risk aversion in the NHS. This makes it difficult to introduce new ideas and utilise new technologies that could reduce unnecessary expenditure.
2. Carbon reduction not being properly resourced in the NHS either in terms of staffing, funding for innovation and implementation of innovation, or performance management of carbon emissions.
3. Structural change occurring at the same time as Phase 3.
Methods and Approaches utilised to overcome challenges
1 Cultural change: a variety of successful methods and approaches, with the support of a strong network of forward thinking innovators helped organisations to overcome many of the barriers to cultural change. These included:
the leadership shown by Nottingham City PCT, Public Health and the Department of Health in the East Midlands and the project steering group.
the development of key performance indicators using a logical framework,
all pilots having access to expertise through training sessions with ARUP as the external verifier who validated their outcomes.
utilisation of an action learning approach with support from an action learning expert, that enabled effective trials of new technologies and ideas
the development of the East Midlands NHS Sustainable Development Network which brought together NHS trust representatives with the skills, expertise and knowledge to turn ideas into action.
2 Resources: The resources for implementing the project were limited compared to its ambition. Resource constraints were overcome with Regional Innovation Funding and support from the East Midland Regional Innovation Fund team and an enormous amount of goodwill on the part of all those who contributed to the project. We are very grateful to the diverse range of people and organisations who were inspired to improve our health and environment whilst at the same time demonstrating that significant financial returns can be achieved with modest initial investment. 3 Structural Change: The root and branch national, regional and local changes in the NHS and Department of Health during Phase 3 presented a major challenge to the final phase of the project. Project leadership, funding and evaluation of the pilots was weakened. However, due to the methods and approaches utilised, the commitment of the Action Learning facilitator and the external verifier, the determination of the project and fellow Midlands and East Sustainable Development leads and the goodwill of the steering group, progress was made in taking forward the learning from Phases 1 and 2, and Phase 3 went ahead.
The Pilots
Conclusions about each pilot topic area are summarised in the main section, however, the pilots effectively tackled each of the 3 major areas of NHS carbon emissions: procurement, travel and transport and buildings and energy. The external verifier concluded that overall, Phase 2 pilots were highly successful in terms of meeting their Key Performance Indicators (KPIs). They gained an overall weighted pass rate of 90% and Pilots 1-5 met 33 out of 34 KPIs. The pilots made significant financial and environmental annual changes to East Midland healthcare organisations and the wider community in which they operate. Phase 3 pilots took place at a time when the NHS and Public Health were going through a root and branch re-organisation and successes were therefore not as comprehensively reported in the timescale available to the external verifier. Nevertheless the Phase 3 pilots delivered real benefits. The benefits of the pilots far exceeded the costs allocated to the total project. Carbon equivalent emissions were reduced and in the process, financial savings were delivered along with improvements to health and wellbeing.
16
Carbon Emissions: The pilots delivered a minimum of 2,556 tonnes of CO2e savings for at least one year and annually in some instances, with the potential for much more if scaled up across the NHS and if implemented in full utilising the technologies available. Financial Savings: The project demonstrated that initiatives that save carbon equivalent emissions can also result in financial savings. The pilots alone were estimated to save between £1.5 and £1.6 million. Health and Wellbeing: As carbon emissions damage health, all pilots in Phases 2 and 3 achieve wellbeing improvements by reducing carbon equivalent emissions. Other, more immediate health and wellbeing improvements were also made through in particular, the NHS Forest, Food, Electric Vehicle, Care Homes and Procurement pilots.
Key Questions
The key questions for the Health Service are: 1. How can these proven technologies and ideas be properly resourced to enable their
mainstreaming in the health and care system? 2. How can the ideas explored in the pilots be incorporated into mainstream work on quality
improvement and good business management in Health service commissioning, procurement and provision?
We are hopeful that these questions will be answered over time, because there is wide acceptance of the health and care service’s contribution to climate change. We need to take effective action because:
“climate change could be the biggest global health threat of the 21st century and effects on health of climate change will be felt by most populations in the next decades and put the lives and wellbeing of billions of people at increased risk.” (The Lancet 2009).
Recommendations
The project demonstrates that change is possible and should act as a springboard for NHS organisations to continue with their own carbon reduction journey. A full list of recommendations is included in section 9; however the key recommendations are that: 1 Health and care services should establish a rolling programme of innovative carbon reduction pilots on a regional basis, utilising a small Carbon Reduction Programme team that includes expertise in sustainable procurement and commissioning, logical framework development, action learning approaches and external verification. This team should develop the programmes with strong Sustainable Health Service Networks that are supported with sufficient resources to hold quarterly meetings and events. 2 As has been evidenced from the Phase 2 pilots, the money saved far exceeds the amount that the work costs. Savings from carbon reduction projects should be allocated to more sustainable, innovative and effective health and health care services so that staff, patients and visitors are able to lead more active and healthy lives, whilst reducing their impact on the environment and health inequalities. We commend this report to you and would encourage you to apply the learning from the East Midland NHS Carbon Reduction Project to your own organisations, so that the pilots become the norm. Dr Ian Campbell MBE & Helen Ross FPH MPH BA (Honours) Chair of Steering Group Project lead
17
4 Introduction
“We cannot solve our problems with the same thinking we used when we created them.” Albert Einstein
The East Midland NHS Carbon Reduction project was developed and co-ordinated by the project lead, Helen Ross, the East Midlands NHS Sustainable Development Lead and Senior Public Health Development Manager initially whilst on secondment to the East Midlands Public Health Team with the Department of Health and the NHS Strategic Health Authority, and continued when back in post with Nottingham’s Public Health Team. In January 2010 it was established and hosted by NHS Nottingham City (Primary Care Trust) on behalf of the East Midlands NHS Sustainable Development Network and initially supported by the network’s steering group, chaired by Andrew Kenworthy, the Chief Executive of NHS Nottingham City. The idea for the project came about as a result of the success of an inspirational local NHS project with Nottingham Energy Partnership, which measured and reduced the carbon footprint of Nottingham City and Nottinghamshire County NHS Primary Care Trusts. The project was recognised internationally when it received a prestigious BMJ Sustainable Healthcare award In June 2010.
4.1 Purpose & Aims
The purpose of the East Midlands NHS Carbon Reduction Project was “to equip NHS organisations to reduce their carbon footprint whilst improving the quality, productivity and effectiveness of their services”. The project aims were to:
accelerate the move of the NHS in the East Midlands to a low carbon economy
measure and reduce carbon equivalent emissions4 by piloting a variety of methods including developing the use of commercially viable low carbon technologies in the NHS.
The project sought to bring together public and private funding and encourage cross-sector partnerships.
4.2 The need for the project
The East Midlands NHS Sustainable Development Network identified the need for this project through its aim “to equip NHS organisations to reduce their carbon footprint whilst improving the quality, productivity and effectiveness of their services”. It had been working to meet Sustainable Development and health challenges since 2009 and included representatives from all commissioning and provider NHS organisations in the East Midlands, together with experts in NHS carbon footprint development, sustainable procurement and behaviour change. Having a strong regional network provided a supportive environment for the development of the project. The network received reports from the project and pilot leads during the development phase and members contributed to Action Learning Sets that supported the development of pilots. Potential financial savings: Evidence-based advice from DEFRA in 2009 indicated that if NHS organisations in the East Midlands were to reduce carbon, manage waste more effectively and reduce water consumption, significant financial savings could be made as follows:
4 An abbreviation from carbon dioxide equivalent, a metric measure used to compare the emissions from various greenhouse gases (e.g. methane) based upon their global warming potential.
18
on average a 25% reduction in carbon intensity could result in annual potential savings of £13-14m from energy bills, rising with energy price inflation and carbon taxation.
annual potential savings of £2.35m could be made from better waste management and segregation. These savings would rise with landfill tax increases and also result in significant carbon savings.
the region’s water bill at over £4m is 10% of the energy bill. Water costs increased by over 115% over the preceding 4 years and reducing water use would minimise the financial risk of likely increasing costs due to climate change.
As resource efficiency is a major priority in the health and care system, this relationship between carbon and financial savings helped to provide the business case for establishing the project.
Guidance
The need for Carbon Reduction programmes is strengthened by international and national guidance, some of which developed in tandem with the project, as follows: 1 The United Nations’ Convention on Climate Change set an overall framework in 1992 for intergovernmental efforts to tackle the challenges posed by climate change. It recognised that the climate system is a shared resource whose stability can be affected by industrial and other emissions of carbon dioxide and other greenhouse gases. The key objective of the convention was to achieve:
“stabilisation of greenhouse gas concentrations in the atmosphere at a level that would prevent dangerous anthropogenic interference with the climate system. Such a level should be achieved within a time-frame sufficient to allow ecosystems to adapt naturally to climate change, to ensure that food production is not threatened and to enable economic development to proceed in a sustainable manner.” United Nations (1992)
2 The precautionary principle
“provides a framework, procedures and policy tools for public policy actions in situations of scientific complexity, uncertainty and ignorance, where there may be a need to act before there is strong proof of harm in order to avoid, or reduce, potentially serious or irreversible threats to health or the environment, using an appropriate level of scientific evidence, and taking into account the likely benefits and drawbacks of action and inaction.” Marco Martuzzi and Joel A. Tickner (2004)
3 Nationally, Government principles to achieve sustainable development set out by the Department for Environment, Food & Rural Affairs (Defra) in 2005 are illustrated in Figure 1.
Figure 1: Government principles to achieve sustainable development
19
4 Forum for the Future set out a vision for a future sustainable health service whereby:
“Whenever possible, the health system will act first to prevent illness, disease and social harm. When such prevention is not possible the healthcare system minimises the impact of illness and social harm on people’s quality of life. Additionally the system also achieves sustainability, by operating within natural limits and where possible enhancing the natural environment, and by contributing positively to quality of life and economic prosperity.” Forum for the Future (2009 p9)
5 The Faculty of Public Health reported that:
“green spaces can play a key part in reducing ‘greenhouse gases’, particularly carbon dioxide. For example, a mature tree can save 22kg of CO2 in a year. The Read report, commissioned last year by the Forestry Commission, recommended the enhancement of woodland in the UK to act as a ‘carbon sink’.” Faculty of Public Health in association with Natural England (2010)
6 The NHS Carbon Reduction Strategy for England provided specific guidance:
“Climate change is one of the greatest threats to our health and wellbeing. It is already affecting health across the globe. The NHS, as one of the largest employers in the world, has an important role to play in reducing carbon emissions, a key cause of climate change.” Sustainable Development Unit (2009 - p63) and recommended that: “Every strategic health authority should receive at least annually, a report about progress in meeting the requirements of this strategy in their region.” Sustainable Development Unit (2009)
The graph in Figure 2 shows the NHS’s CO2e emissions to 2007 (the dark blue line) and the forecast emissions (light blue line). The targets, which were set to meet legal requirements under the UK Climate Change Act, are the points on the orange line. The interim target of a 10% reduction (on 2007 baseline data) by 2015 - from 21 million tonnes (MtCO2e) to 19 MtCO2e - requires reversal of the trend – an enormous challenge. The overall target (orange triangle) is an 80% carbon reduction (on 1990 levels) by 2050 to around 4 MtCO2e per year.
Figure 2: NHS Carbon Footprint: Sustainable Development Unit
20
7 The Sustainable Development Unit (SDU) explained that “Achieving these targets requires total transformation of the service. The world will need to be a very different place. For example, downsizing hospitals and moving patterns of care… clinical pathways will need to be very low carbon with minimal energy use, low travel, sustainable procurement and risk managed waste policies. Thus, this is an enormous change management project.” Sustainable Development Unit (2010)
8 Public Health in the 21st Century requires a focus on ill health prevention and reducing health inequalities. As the Sustainable Development Commission pointed out:
“In the developed world, healthcare services tend to be highly resource-intensive. If people in lower socio-economic groups enjoyed the same level of health as those in higher groups, there would be fewer people leading unhealthy lives and requiring healthcare. This would help to reduce healthcare costs and the carbon footprint of the NHS, and save money for treating unavoidable illness and tackling the causes of health inequalities.” Sustainable Development Commission (2010 – page 6)
9 The Marmot independent review of effective evidence-based strategies for reducing health inequalities (2010), made clear that sustainable development helps to reduce health inequalities, improve health and reduce the unnecessary use of natural resources:
“There is a close relationship between the challenges of climate change and the challenges of health inequalities; not least because both impact most on the poor and disadvantaged. Both health inequalities and the negative impacts of climate change give extra urgency to putting sustainable development at the heart of creating a fairer society” “Many measures to address climate change also bring health benefits such as more active travel (for instance walking and cycling), which, in addition to reducing carbon emissions, also increases physical activity, and reduces air pollution and traffic accidents. ” The Marmot Review (2010)
10 The negative health impacts of climate change through the increased occurrence of extreme weather events such as flooding and heat waves, as well the increasing risk of fuel poverty due to high energy prices, were outlined by the Social Care Institute for Excellence in 2010:
‘anxiety and depression linked to physical and economic insecurity – flooding increases the risk of depression fourfold’ Social Care Institute for Excellence (April 2010)
11 The role for Public Health with regard to sustainable development is clearly identified by Rayner and Lang:
“In the twenty-first century, the pursuit of public health requires the analysis of the composite interactions between the material, biological social and cultural dimensions of existence. This demands a new mix of interventions and actions to alter and ameliorate the determinants of health; the better framing of public and private choices to achieve sustainable planetary, economic, societal and human health; and the active participation of movements to that end. Ecological public health is about shaping the conditions for good health for all.”
Rayner Geoff and Lang Tim (2012)
12 The Sustainable Development Strategy supports the NHS to meet the targets set out in the NHS Carbon Reduction Strategy. At the launch of the consultation, Sir David Nicholson CBE, Chief Executive, NHS Commissioning Board & Duncan Selbie, Chief Executive, Public Health England set
21
out the following challenge and responsibility for the NHS with regard to sustainability:
“Assuring a sustainable health, public health and social care system is one of the greatest and most important challenges of our time and our vision and ambition should match the scale of these. We have a clear responsibility to take a leading role in tackling climate change and have a genuine opportunity to influence change for our patients, service users and the public. We must align, integrate, and coordinate a whole system approach to health and care which ensures the future is more environmentally, financially and socially sustainable. and ….. The healthcare and public health systems we represent are committed to meeting the carbon reduction targets set out in the Climate Change Act (2008). We are also committed to ensuring the nation has health, social care and public health services that will protect and better serve people in the decades ahead. This is an ideal moment to look at the way we deliver services across the entire system to make them more sustainable and to ensure we support people through their life journey.” Sustainable Development Unit (2013)
13 After looking at a variety of factors, natural and human, the Intergovernmental Panel on Climate Change concluded there is a 90% probability that human-related greenhouse gas increases have caused most of the observed increase in global average temperature since the mid-20th century.
“Anthropogenic greenhouse gas emissions have increased since the pre-industrial era, driven largely by economic and population growth, and are now higher than ever. This has led to atmospheric concentrations of carbon dioxide, methane and nitrous oxide that are unprecedented in at least the last 800,000 years. Their effects, together with those of other anthropogenic drivers, have been detected throughout the climate system and are extremely likely to have been the dominant cause of the observed warming since the mid-20th century.” Intergovernmental Panel on Climate Change (IPCC) 2014
14 The Public Services (Social Value) Act of 2012
“places a clear expectation on public services to demonstrate how their work makes a difference and delivers greater ‘social value’ ”. Sustainable Development Unit (2015).
22
5 Methods and Approaches
The Commissioning Process
The commissioning process was managed by the East Midlands NHS Sustainable Development Network steering group with specialist commissioning expertise from Chris Spark from the East Midlands Resource Hub and David Bailey from NHS Nottinghamshire supplies who supported the steering group to:
1. commission the delivery of accurate baseline information (Phase 1) 2. select Phase 2 pilots from 20 ideas, mainly from the Phase 1 report, that had the best chance
of maximum impact using current knowledge and expertise with the resources available 3. develop the pilots (Phase 2).
Logical Framework
A Logical Framework was developed in Phase 1 and used to guide the project and pilots and their evaluation (see Appendix 8). It took account of the guidance from the NHS Carbon Reduction Strategy for England. The Logical Framework was not static. It was further developed through Phase 2 in conjunction with the steering group and pilot leads. Each pilot was also expected to develop their own Logical Framework so that the reporting mechanisms fed into the overall Logical Framework, enabling each pilot to contribute to the outcomes of the whole project.
External Verification
ARUP were commissioned in Phase 1 to ensure the technical data was accurate and in Phase 2 to provide training for pilot leads and External Verification. The process was to verify the outturn performance versus original goals, via the following terms of reference: • Review performance vs original Key Performance Indicators (KPIs) • Review overall social, environmental and carbon performance • Assess key learning points
Action Learning
Action Learning provides space for people with a shared interest in making changes to reflect on the challenges and opportunities they face. Usually, a group of 6-8 people are brought together to form an action learning ‘set’ and meet several times to develop their action plans and reflect on progress. Figure 3 illustrates the cycles of action and reflection utilised in Action Learning.
Figure 3: Cycles of action and reflection
23
Phase 1: A small budget was allocated for Action Learning training for the East Midlands Sustainable Development Network, in order to lay the foundations for the active involvement of network members in the development and roll out of the pilots and engagement by NHS organisations with the pilots. Dr Claire Marsh from Leeds University supported the East Midlands NHS Sustainable Development network and Carbon Reduction project steering group to utilise this approach by facilitating effective Action Learning sessions at Network events. These were documented in the reports of each event on the East Midlands NHS Sustainable Development webpages here - http://www.sduhealth.org.uk/ .
Phase 2: Action learning was utilised throughout the development of Phase 2 to encourage innovation, good ideas and support for organisations to make sustainable changes. A key theme was to deliver practical outcomes in NHS Trusts through their practitioner representatives working with commissioned expertise. Pilot leads used action learning to develop realistic, yet forward-thinking action plans which could be monitored over time. Phase 3: Action Learning was utilised to support the transfer of learning and roll out of the pilots. Due to pressures of time and resources a scaled-down version of the ‘Action learning’ approach was taken to frame the support given to the leaders of each of the pilots who met twice. The ethos of action learning was used to view these pilot leaders as a ‘set’ who could benefit their individual pilots by coming together to learn from each other and from the Phase 2 pilots as they set their action plans (workshop 1 – April 2013), and again to review progress towards the end of their formal pilot (workshop 2 – June 2013). Claire Marsh as action learning facilitator, and Paul Brockway as KPI trainer, supported the pilot leaders directly. The project lead, Helen Ross and the East Midlands NHS Sustainable Development Network provided support through contributing to the workshops. The cycle of action and reflection was summarised to the pilot leaders as five steps: Step 1 A review of the context including relevant tools, models and guidance available to inform the plans for the pilots. Claire Marsh (supported by Terry Tudor, University of Northampton) conducted a review of the lessons learnt from Phase 2, by interviewing Phase 2 pilot leads before the Phase 3 leads met in April 2013. Some of these lessons were of direct relevance to Phase 3 pilots (where topics over-lapped), and others were more generally relevant (e.g. regarding the need for both short and long-term goals). These findings were presented along with Phase 2 pilot reports at Workshop 1, where the leads worked in groups to finalise the specific aims for their pilots. Also at this workshop, Paul Brockway supported the leads in developing key performance indicators (KPIs) so that specific measurable objectives of each pilot were stated. Step 2 Pilot leads were asked to think about the practicalities of implementing their goals. They were encouraged to think broadly about whom within their organisation (and outside) they could usefully collaborate with. Step 3 The KPIs were turned into detailed action plans with responsibilities and timescales. Step 4 Between Workshops 1 and 2, pilot leads were expected to work with their individually-defined teams to progress their aims. They were asked to submit progress reports ahead of Workshop 2. Step 5 The leads were invited to come together for the second and final time to reflect on progress. Expert-advisors were also invited to this workshop to provide additional support as the leads developed their final revisions to their action plans.
24
6 What was done?
The project comprised three phases and 7 main topic areas: Phase 1: The project was established and accurate baseline data about the carbon equivalent emissions of the NHS in the East Midlands was calculated. Phase 2: Six pilot projects were established to reduce carbon equivalent emissions within NHS organisations in the East Midlands, including the use of commercially viable low carbon technologies in the NHS. Secondary aims included making financial savings and improving well-being. Phase 3: This additional phase enabled successful pilots to be trialled in other parts of the health and care system and in the wider NHS Midlands and East area to see if they were replicable. Waste reduction was a theme throughout the project, however, there were 2 separate pilots in Phase 3 that focused specifically on waste. The 7 main topic areas were:
1. Energy in NHS Estates 2. Procurement 3. Sustainable Care Homes 4. Travel 5. Food 6. NHS Forest 7. Waste reduction
The summary of aims and outcomes for each phase in turn are set out in this section.
6.1 Phase 1
Aim: To develop and establish the East Midland NHS Carbon Reduction Project and to calculate the carbon equivalent footprint of the NHS in the East Midlands.
Funding and Resources
The East Midlands NHS Sustainable Development network was interested in testing whether the NHS could build on the Nottingham and Nottinghamshire NHS carbon emission reduction success by developing an East Midlands wide project. Helen Ross, supported by Nottingham City Primary Care Trust on behalf of the network, made a successful application in 2009 to the NHS East Midlands Regional Innovation Fund. The Regional Innovation Fund (RIF) was established as one of the suite of initiatives, flowing from Lord Darzi’s NHS Next Stage Review report High Quality Care for All (June 2008) and had two primary aims: 1. to help develop “an innovative culture” in the NHS, including developing the innovation skills of
staff 2. to develop and diffuse innovations to improve the quality of healthcare.
NHS East Midlands was the first regional NHS organisation in England to acknowledge the potential links between Sustainable Development and the Innovation agenda. It provided the opportunity to establish Phases 1 and 2 of this project by allocating Regional Innovation Funds of £20,000 for
25
Phase 1 in 2009/10 and £45,000 for Phase 2 in 2010/11 to NHS Nottingham City. (See Appendix 6 for full details of the Innovation Fund financial spend). The Improvement Network East Midlands established by the RIF team also provided events and a website to develop innovation and leadership skills with project leads, and support projects to develop their information resources so that good practice could be shared.
Project Steering Group
Once established and hosted by NHS Nottingham City in 2010 on behalf of the East Midlands NHS Sustainable Development network, the project’s steering group was formed, chaired by Dr Ian Campbell, a Nottinghamshire GP with a commitment to sustainable development. It included the project lead and people with a range of expertise from NHS Nottingham City, the Directorate of Public Health and Social Care East Midlands, Climate East Midlands, the SHA Estates Lead for the Midlands, the Carbon Trust, experts in NHS carbon footprint development, sustainable procurement and behaviour change, pilot project leads and representatives from commissioned organisations such as Nottingham Energy Partnership. Members are listed at Appendix 2. This steering group was very helpful in driving the project and utilising a number of methods to ensure that it delivered the biggest impact with the resources available. It continued until 2013.
The Calculation of the Carbon equivalent footprint of the NHS in the East Midlands
Although limited data for the calculation of the footprint in the baseline year of June 2009 was available through the NHS ERIC returns, NHS Nottingham City, Nottinghamshire County and Nottingham Energy Partnership’s Carbon Reduction Project had identified that data of sufficient quantity and quality needed to be gathered into a usable format before funding could be allocated to deliver pilot carbon reduction pilots. NHS Nottingham City (the host organisation), utilised commissioning expertise and the majority of Phase 1 funding to commission Nottingham Energy Partnership to calculate the Carbon equivalent emissions (tCO2e) for the NHS in the East Midlands. The calculation of the consumption footprint was based on three primary sectors forming the overall footprint: procurement, building energy and travel, summarised as follows:
Procurement Analysis - Goods and Services: collation/screening of data, mapping data to Statement of Internal Control (SIC) economic sectors: calculation of emissions
Travel – movement of people (i.e. patients, visitors and staff)
Building Energy Analysis – Heating, hot water, electricity consumption and cooling. The Carbon Footprinting Report was produced with input data, collation/screening of data analysis methodology, output results and recommendations for key emissions ‘hotspots’, and includes comparison with the national footprint and calculation of emissions using consistent carbon intensities. This report is available at Nottingham Energy Partnership's website: http://www.nottenergy.com/in_the_workplace/example_of_completed_work/nhs_east_midlands_carbon_redu
ction_project_phase_1/385/
Outcomes of Phase 1
The NHS carbon footprint: The East Midlands NHS footprint was calculated to be 967,900 tonnes in 2007-8 and 1,070,000 tonnes in 2008-9. The 2007-8 footprint represents 4.8% of the national footprint which was in line with the 4.95% of the national NHS budget that was spent in the East Midlands. The breakdown of emissions is illustrated in Figure 4.
26
Phase I highlighted a huge opportunity for NHS organisations in the region to generate their own electricity from renewable sources, and in doing so, create an income stream from Feed-in-Tariff revenue.
Figure 4 – Breakdown of NHS Carbon Emissions in the East Midlands
6.2 Phase 2
Aim: To develop six pilots to reduce carbon equivalent emissions within NHS organisations in the East Midlands, including the use of commercially viable low carbon technologies in the NHS. Secondary aims included making financial savings and improving well-being. The East Midlands NHS Sustainable Development Network, the Steering Group for the Carbon Reduction Project and commissioned expertise worked together to identify and develop pilots that would achieve maximum carbon and financial savings and improve health with the resources available. The original aim was to trial 5 pilots using the learning and recommendations gained from Phase 1. However, due to the wealth of ideas worthy of a trial in reducing carbon equivalent emissions in the NHS and one in Care Homes, six Carbon Reduction pilots were chosen in the areas of energy use, waste reduction, procurement, transport and green space. This section provides a summary of the pilots including the aims, commissioned lead organisations, funding allocated and outcomes which were externally verified by ARUP. Full details of the external verification can be found at Appendix 7. For full details of each pilot, see their reports on the Sustainable Development Unit’s website at www.sduhealth.org.uk
Summary of Pilots: Aims and Costs
1. Energy in NHS estates - £21,750 Improving energy efficiency and increasing renewables in NHS buildings and Care Homes resulting in lower financial and environmental costs by supporting East Midlands NHS organisations with the integration of sustainable energy technologies into a range of new and old, owned and leased, buildings, accompanied by engagement with staff. Savings made could be used to enhance the natural environment and contribute to more sustainable health and care services. The range of technologies included: 1 Renewable Energy: Feed in Tariff (FIT) assessments - engineering surveys of 16 sites across a
number of the East Midland NHS Trusts with recommendations for feasibility of renewable energy.
2 Smart metering - promoting and supporting smart electricity and gas metering including 3 training sessions with staff.
27
3 Voltage optimiser/ Power Factor Correction - preparation of the business case with 3 trusts for installation of voltage optimisers. Organisations benefiting to include Primary Care Trusts, Hospital Trusts, Mental Health / Community NHS Trusts, 1 GP surgery and 4 Care homes
2. Sustainable Procurement training - £3,564 Investigating ways of reducing unnecessary procurement and procuring a greater proportion of sustainable goods and services.by providing a practical hands-on training day, jointly for NHS procurement and finance staff. 3. Sustainable Healthy Care Homes - Waste reduction - £4,320 Examining environmental impacts of residential care and determining opportunities to improve environmental, social and economic sustainability, while improving residents’ health and /or well-being and the sustainability of up to 4 care homes. This included reducing waste and exploring opportunities for residents to lead more active lifestyles in the fresh air e.g. through “Walking for Health” activities. 4. Travel - £1,000 Supporting the development of an Electric Vehicle pilot, within one or more organisations with existing travel plans to ensure lesson sharing. Health and healthcare professionals trialled electric vehicles to see if they could reduce their impact on the environment and air quality on their journeys to visit patients in the normal course of their work. Before-during-after take up, savings and efficiency, of implementing Electric Vehicles in own/ leased / pool fleet were assessed. 5. Food - £1,000 Developing a Sustainable Food standard for adoption by the East Midlands NHS Sustainable Development network, so that more healthy and sustainable food can be procured and provided for staff, patients and visitors to healthcare premises. 6. NHS Forest – a) £4,920 b) £3,080 1 Providing information for and presentations to, NHS Trusts, staff and community and to the EM NHS Sustainable Development network about the NHS Forest initiative. 2 Developing NHS Forest pilots at 2 NHS Trusts in the East Midlands which increase access to green space, especially trees, on or near to NHS land, in order to:
Improve healthcare environments; specifically reduce NHS carbon emissions and increase biodiversity.
Provide accessible opportunities for exercise and improve the working environment.
Enhance the healing environment.
Increase staff and community cohesion and engagement with the NHS and sustainability objectives.
External Verification - £5,000 External verification for calculation of carbon equivalent emissions, financial savings and wellbeing improvements. Project report - £366: Production of final report / pop up posters
Pilot 1 - Energy in NHS Estates
Leads Robert Nettleton - NHS West Midlands [email protected] Laura Mayhew-Manchon - Nottingham Energy Partnership (NEP) [email protected] www.nottenergy.com
28
Aim: To support East Midlands NHS organisations with the integration of sustainable energy technologies into a range of their new and old, owned and leased, buildings accompanied by engagement of their staff. The range of developments included: 1.1 Renewable Energy: Feed in Tariff (FIT) assessments - engineering surveys of 16 sites across
a number of the East Midland NHS Trusts with recommendations for feasibility of renewable energy.
1.2 Smart metering - promoting and supporting smart electricity and gas metering including 3 training sessions with staff.
1.3 Voltage optimiser/ Power Factor Correction - preparation of the business case with 3 trusts for installation of voltage optimisers. Organisations benefiting to include Primary Care Trusts, Hospital Trusts, Mental Health / Community NHS Trusts, 1 GP surgery and 4 Care homes
1.1 Renewable energy Aim: Phase1 highlighted a huge opportunity for NHS organisations in the region to generate their own electricity from renewable sources, and in doing so, create an income stream from Feed-in-Tariff revenue. This pilot aimed to quantify that potential. Surveys of 16 sites were conducted across a number of East Midland NHS Trusts making recommendations for feasibility of renewable photovoltaic (PV) electricity energy solutions. These included: NHS Nottinghamshire County Primary care, NHS Lincolnshire, Lincolnshire Community NHS Health Services Community provision, Lincolnshire Partnership NHS Foundation Trust, Mental health, Leicestershire Partnership NHS Trust, Derbyshire Healthcare NHS Foundation Trust, Nottinghamshire Healthcare NHS Trust (2 options explored), Nottingham University Hospitals NHS Trust, Queenswood Care Home Care home, Laura Chambers Lodge Care Home, Wren Hall Nursing Home, Cherry Trees Resource Centre, Earls Barton Medical Centre, King Edward Road Surgery and Charnwood Surgery. Survey reports were produced addressing structural, design, electrical connection and planning issues, outline costs and savings. Six Key Performance Indicators were listed and reported against as shown in Table 3.
Table 3: Renewable Energy pilot Key Performance Indicators
1 Sites assessed for renewables
- identified as suitable for renewable energy systems 16
- found to be not suitable for renewable energy systems. 1
- either already had or was in the process of having renewables installed 14
Total 31
2 Net capacity of renewable energy supported to progress to install for the 16 new renewable energy systems – kW per annum (pa)
469
Annual output - kWh/pa 380,864
3 Potential annual kgCO2e p.a. savings of capacity supported to progress 96,013
Mitigated social cost of carbon derived from the energy output of all RES assessed £2,151
4 Potential range of annual financial income (i.e. revenue and savings combined) from the output of the renewable energy systems assessed ranges
£77,259 - £163,921
Net Present Value (NPV) calculations project net income (NI) on capital outlay (CaOu) for second wave Feed in Tariff rate
£205,494 NI on CaOu of £674,244
5 Payback period range for the renewable energy systems assessed dependent on the Feed-in-Tariff applied at the time of the systems being commissioned. Note: Internal Rate of Return (IRR) values are given in Table 6 of the NEP report for financial scenarios A-D, depending on the FIT available. Taking scenario C. 20p/kWh payment, the IRR average is 5.76%.
7.7 - 24 years
6 Capacity of systems supported installed or likely to be installed within next 12 months (during the Government’s Comprehensive Review of the Feed-In-Tariff regime.) Note: Most partners were discouraged from progressing to system installation stage.
--
29
Outcomes Barriers The uncertainty generated by the continuous changes to the national FITs regime, coupled with the financial and strategic pressures on healthcare organisations, were the two main barriers preventing many of the pilot partners to progress through to the physical installation of the renewable energy systems identified. 1 Health and Care organisations: The financial and strategic pressures on healthcare organisations are well understood. In the context of this project, renewable energy installations costs are immediate whilst benefits can be long term. Investment decisions can lead to short term or well-tried initiatives in a risk averse culture. 2 Feed in Tariffs (FITs): It was hard to define the savings identified from the Renewables Energy pilot. The FIT assessment applied to small-scale generation of electricity, paying a fixed sum for eligible technologies. Despite being called a ‘Feed-in Tariff’, the payment was for each unit of energy generated, and not for electricity fed into the grid. Electricity fed into the grid is called exported electricity, and receives a small additional export tariff. Costs for the programme were borne by all British electricity consumers proportionally; all consumers bore a slight increase in their annual bill, allowing electricity utilities to pay the FIT for renewable electricity generated at the rates set by the government. The financial case for renewables changed during the life of the pilot due to a national governmental decision to reduce Feed in Tariff rates. Successes Throughout the delivery of this pilot, NEP provided the partner organisations and the Strategic Health Authority with added value whenever and wherever possible. The main examples of the pilot’s value-added outcomes are summarised below:
Securing £235,875 of FITs income over 25 years NEP helped to secure £105,000 of FITs income for NHS Nottinghamshire County and £130,875 for Nottinghamshire Healthcare NHS Trust, which will be generated by each trust over the next 25 years. This financial benefit was enabled by advising, guiding and closely supporting these two partner trusts to complete and submit their applications for FITs income in advance of the 12th December 2011 and 3rd March 2012 cut-off deadlines when the FITs rates would reduce significantly.
Saving £1,200 on planning application fees NEP helped Nottinghamshire Healthcare NHS Trust to save £1,200 by avoiding paying unnecessary planning application fees for 7 out of the 8 solar PV systems it was in the process of installing, and saved considerable NHS staff time and efforts. This ensured that installation was achieved before the Feed in Tariff rates were reduced.
Production of additional energy efficiency audits reports NEP identified some capacity to provide a selection of the sites with a physical site survey in addition to their renewable energy assessment. The results of these additional surveys were written into energy efficiency audit reports, which provided site-specific recommendations on non-renewable energy measures such as insulation and glazing, together with the energy, cost and carbon savings they could result in. These additional surveys were distributed to each of the partners throughout the pilot to encourage early implementation of the measures recommended.
Linking to wider initiatives and crossover with other Phase 2 pilots The Cherry Trees Resource Centre and Queenswood Care Home were supported through the Phase 2 ‘Sustainable Care Homes’ (pilot 3). These two care homes were also partners in the Energy in NHS Estates ‘REA’ element (pilot 1a), and as such, were assessed for their renewable energy
30
potential. Moreover, the solar PV system identified as a potential installation at Queenswood Care Home was put forward in the Greening Beeston project.
Replicability NEP carefully documented the process of supporting this pilot’s partners. The lessons and feedback gained were incorporated into bespoke, independent guidance and examples of good practice in the appendices and annexes of the pilot’s report. Any healthcare organisation will therefore be able to use these to carry out further renewable energy assessments, installations and/or FITs claims across their own sites.
Summary This Renewable Energy pilot effectively put the Phase 1 recommendation into practice, by quantifying the extent to which East Midlands healthcare organisations could benefit from installing renewable energy solutions across their buildings. The findings from the pilot’s assessments demonstrate that renewable energy solutions constitute a financially attractive and worthwhile investment for many healthcare organisations, which will enable them to generate a steady income stream, reduce their carbon footprint, and improve the energy cost resilience of their sites. The significant financial and environmental savings that could be made to East Midland healthcare organisations, and the wider community in which they operate, are summarised below. A total annual: • carbon saving potential of 96,013 kgCO2e • energy saving potential of 380,864 kWh • financial saving potential of between £77,259 and £163,921 5
The assessment of some renewable energy systems already operating across the region demonstrated that, in many cases, these are outperforming energy generation predictions, which is an encouraging finding. Furthermore, in the case of at least four Nottinghamshire health centres, 10% of the site’s total electricity demand is now met by their on-site solar PV system, making them less dependent on grid-supplied electricity, and more resilient to electricity market price rises.
Future opportunities Due to the barriers identified above, no new renewable energy or energy efficiency investments could be confirmed at the end of the pilot. However, this pilot provided participating Health Trusts and other health and care organisations with the necessary confidence, knowledge and experience to make investments in renewable energy technology, across the East Midlands and beyond, when the time is right. 1.2 Smart Metering: The Automatic Meter Reading (AMR) pilot
Aim: To support East Midlands NHS organisations with Smart metering: promoting and supporting smart electricity and gas metering including 3 training sessions with staff. Automatic meter reading (AMR), is the technology of automatically collecting consumption, diagnostic, and status data from water meter or energy metering devices (gas, electric) and transferring that data to a central database for billing, troubleshooting, and analysing. This technology saves utility providers the expense of periodic trips to each physical location to read a meter. Another advantage is that billing can be based on near real-time consumption rather than on estimates based on past or predicted consumption. This timely information, coupled with analysis, can help both utility providers and customers to better control the use and production of
5 accurate at the time that the project took place
31
electric energy, gas usage, or water consumption. AMR technologies include handheld, mobile and network technologies based on telephony platforms (wired and wireless), radio frequency (RF), or power line transmission. What was done and Outcomes
Automatic Meters - Smart electricity and gas metering were promoted and NHS staff were
supported in their applicability and use with training sessions and information.
Resources, guidance and case study documents were produced for staff training sessions that
improved understanding about smart meters, their procurement, installation and how to get the most
out of smart metering. NEP showed how the information gained led to an increase in energy
monitored through smart meters.
Table 4: AMR smart meters – Key Performance Indicators review No KPI East
Midlands Only
Total
1 Number of East Midlands NHS organisations engaged around AMR
Trusts 8 16
Staff 16 17
2 Number who installed or planned to install AMR units within the next 12 months
Trusts 3 5
Number installed or planned to be installed over the next 12 months
AMR units 226 243
3 Savings from AMR (smart metering) installed/likely to be installed within 12 months.
Energy in kWh 1,744,000 2,151,000
Carbon in tCO2e 529 647
. Financial savings from the AMR pilot were estimated at £600k (estimated at 5% savings where AMR installed) pa. Carbon savings were estimated at 647 tonnes CO2e (estimated at 5% savings where AMR installed) pa 1.3 Voltage Optimiser (VO) / Power Factor Correction pilot
Aim: Preparation of the business case with 3 trusts for installation of voltage optimisers. Organisations benefiting to include Primary Care Trusts, Hospital Trusts, Mental Health / Community NHS Trusts, 1 GP surgery and 4 Care homes What was done? Each partner organisation was advised on how to best put forward a selection of their sites for VO assessment. This support was carried out via telephone, email and in person communications by NEP. The data provided by each partner organisation included site name and full address if VO systems were already installed on-site and wherever possible, total annual site energy demand/use. Sites were visited by an engineer and potential was assessed along with an interview with estates and energy management staff about experiences to date with VO, including any previous experience of VO assessment by VO sales staff. Potential energy savings from VO were calculated using information from engineer surveys and the S-VAT excel tool developed to support this project. Outcomes Derbyshire Community Healthcare Services, Leicestershire Partnership Trust and Nottinghamshire Healthcare NHS Trust participated in this pilot. Financial savings estimated from the Voltage Optimiser (VO) pilot were £12,800 pa. Carbon savings were estimated at 80 tonnes CO2e pa. The outcomes are listed in Table 5.
32
Table 5: KPIs for Voltage Optimiser (VO) / Power Factor Correction pilot 1 Three Trusts engaged with as
pilot partners and supported throughout this pilot strand.
Derbyshire Community Healthcare Services (DCHS)
Leicestershire Partnership Trust (LPT)
Nottinghamshire Healthcare NHS Trust (NHT).
2 From involved trusts, number of VO units/interventions undertaken or likely to be undertaken within next 12 months.
1x site investigated: Ilkeston Community Hospital. Possible installation if business case was strong enough.
1x site investigated (Bradgate Unit). Possible installation elsewhere if business case was strong enough
2x units installed and working at Wells Road Centre & Duncan MacMillan House. One installed at Wathwood Hospital but not operational due to technical issues.
3 Energy consumption (kWh) covered by VO interventions or interventions likely within next 12 months.
Ilkeston Community Hospital – 1,277,791kWh
Wells Road Centre 1,063,009 kWh Duncan Macmillan House 1,422,870 kWh Wathwood Hospital – 717,572 kWh All 3 NHT installations in place: however, not fully utilised due to technical issues. Support from this pilot enabled some of these issues to be overcome, so that the sites could begin to realise the benefits of VO.
4 % of Trusts’ electricity consumption to be covered by VO
Ilkeston Community Hospital – 4%
18.4% overall Wells Road Centre – 6.1% Duncan Macmillan House – 8.2% Wathwood Hospital – 4.1%
5 It was not possible to project independently with full certainty the annual energy +carbon saving from above VO calculations given that site-wide holistic effects may well undermine any projected carbon savings from voltage reduction and future equipment upgrades may degrade projected carbon savings. However, independent analysis estimated the following
Ilkeston Community Hospital - Suitable for VO. 5% annual energy saving (68 MWh), equating 39 tCO2e saved annually.
Bradgate Unit - Unsuitable for VO. ~2% annual energy saving (14.278 MWh), equating 8.138 tCO2e saved annually.
The Wells Road Centre was assessed and verified for potential savings. Marginal case for VO, better data pre-and-post install would be beneficial. ~5.5% annual energy saving (58MWh), equating 33 tCO2e saved annually.
Payback period and IRR for investment in each case: IRR not calculated due to too many unknowns factors to give clear and meaningful figure on Internal Rate of Return in the cases studied
, Ilkeston CH ~5 years
Bradgate Unit ~13 years.
Wells Road Centre ~8 years
33
Pilot 2 Sustainable Procurement Training
This diagram shows the four types of procurement intervention in a hierarchy which is designed to help identify the best interventions for different products or services being procured. In general terms those interventions that are higher up the hierarchy are likely to be easier to implement and should offer a better return on time and resource invested, in terms of carbon reduction and financial savings. In developing procurement for carbon reduction approaches and action plans, organisations should consider interventions at the top of the hierarchy first and work down to other interventions in the event that the higher interventions have already been implemented or the product or service situation favours interventions further down the hierarchy. David Wathey – Dept. of Health Sustainable Procurement lead. Jenny Strong - Nottingham Energy Partnership lead [email protected]
The baseline measurement in Phase 1 had identified that 60% of NHS carbon emissions nationally and 56% in the East Midlands were from Procurement; the single largest component of the NHS carbon equivalent footprint. With an annual procurement budget of £100bn, the NHS makes a large contribution to the procurement of goods and services in society which in turn contributes to climate change. This is because natural resources are consumed at every stage of the process of turning raw materials into finished products. Goods require the extraction, processing, packaging and transportation of raw materials and, after their productive lifespan, more natural resources are required for transportation and recycling or disposal. The Public Services (Social Value) Act of 2012 places a clear expectation on public services to demonstrate how their work makes a difference and delivers greater ‘social value’. It emphasises the importance of considering social value well before the commissioning and procurement processes start, because that can help inform and shape the purpose of the products needed and, more importantly, the design of the services required. Sustainable Development Unit 2015. Aim: To provide information to NHS Trusts in the East Midlands about how to build sustainability measures into procurement.
What was done?
Three training sessions provided information about building sustainability measures into procurement to procurement and finance staff in NHS Trusts in the East Midlands.
Reduce Demand
Reduce ‘in use’ Emissions
Substitution and Innovation
Supply Chain Management
34
Table 6: KPIs for Sustainable Procurement Training
East Midlands Only
Total Healthcare
1 Number of East Midlands NHS organisations and staff engaged in events
Trusts 16 Staff 19
Trusts 22 Staff 26
2 Split of those who have / haven’t used Procurement for Carbon (P4CR) identified
Before 2 After 6
3 Total spending procurement power represented by engaged organisations
£3,999,774,614 £4,815,774,614
4 No of people at end of training day who have clear idea about sustainable procurement and use of P4CR
19 26
5 No of contracts Value of contracts that will be amended following training days
9 £22,661,000
14 £27,011,000
6 Number and value of contracts now or likely to be targeted for carbon reporting at PQQ or embedded into contractual reporting cycle
As above
As above
7 Estimate of minimum tonnes of CO2e saved from value of contracts equivalent social cost of carbon prevented, through shadow price for carbon
689 £15,428
938 £21,001
Outcomes Promoting more sustainable procurement practices through these pilots generated local examples of a reduction in unnecessary procurement, re-use of products and low carbon purchasing. This helps the NHS to reduce unnecessary costs, minimise its contribution to climate change and increase the health and wellbeing of society. In specific contracts the interventions have obvious health and wellbeing benefits, for example:
a new approach to an incontinence products contract that enables patients to manage their own orders, will help users to have a greater sense of control of their treatment and enhance their wellbeing.
reducing the number of deliveries to minimise the carbon impact from fuel could significantly contribute to easing local congestion and improving air quality and the local environment.
Using the Social Cost of Carbon approach, the carbon savings from the planned interventions as a result of this pilot would mitigate social damage to the magnitude of £21,001. The financial savings estimated from the procurement pilot were £1.35m pa (estimated at de-minimus 5% savings on contracts supported) The carbon savings estimated were 938 tonnes pa (estimated at de-minimus 5% savings on contracts supported).
Pilot 3 Sustainable Healthy Care Homes
Helen Ross - NHS lead [email protected]. (Public Health moved from the NHS into
the Local Authority with effect from 1 April 2013). Jerome Baddley & Nottingham Energy Partnership [email protected] www.nottenergy.com Aim: Examining environmental impacts nationally of residential care homes and opportunities to improve environmental, social and economic sustainability while developing health co-benefits. The pilot focused on four care homes in Nottingham and Nottinghamshire and included:
Assessing and reducing waste including food and food packaging (such as sip feeds)
Increasing residents’ access to the natural environment e.g. by setting up Walking for Health routes with residents, staff, relatives and friends
Medicines management
Assessment of the feasibility of installing renewable energy generation equipment.
35
What was done?
NEP were commissioned to identify carbon and cost savings for care homes that provide health and wellbeing co-benefits. The objectives were to: 1. conduct surveys with four care homes and a range of supporting services, to assess the levels
of waste and associated carbon emissions and to identify site-specific recommendations for reduction and examples of good practice.
2. produce summary reports showing waste flows and opportunities. They also examined environmental impacts nationally of residential care homes and opportunities to improve environmental, social and economic sustainability while developing health co-benefits. Outcomes This pilot was relatively small, but has national significance. Further information is included in Appendix 5 and the full care homes pilot report is available at Nottingham Energy Partnership’s website here . Key findings of the research were:
The residential care sector nationally accounts for at least 3.4 million tonnes of CO2e each year and £1.07 billion in natural resource costs. The social cost of carbon adds a further £76 million in costs to the economy per year.
In 2008/9 energy use in residential homes accounted for around £468.5 million in utility costs and around 2.3 million tonnes of CO2e, representing 0.42% of the 2009 UK carbon footprint (National Statistics, 2012).
In 2008/9 residential homes also accounted for around £505 million in food costs generating around 622,250 tonnes of CO2e.
Table 7: KPIs for Sustainable Healthy Care Homes
1. Waste flow charts produced for each care home identifying key relationships. 2. Quantification of cost and carbon emissions from prescribed goods with reference to a national
study of 14 care homes across the UK. A qualitative assessment and commentary was included on potential for waste reduction, derived from interviews.
3. Emissions and costs from care home waste were quantified. Care home waste costs and contracts are often externalised and records of waste are inconsistent or not kept within the home setting. Analysis and figures were derived from homes’ data and national studies. The concept of waste was widened to encompass energy and material wastes.
4. Options for each care home to link natural resource waste reduction with wellbeing were identified and recommendations were included in the report and the case studies, such as the opportunities for energy savings and renewable energy generation which could generate financial savings or revenue to support residents’ activities.
5. There were insufficient resources to explore increasing residents’ access to the natural environment in depth by NEP. However, this was achieved by the project lead.
6. No of walking for health events planned / delivered. 7. No of people walking / being pushed in wheelchairs. 8. Energy efficiency measures introduced. A thorough assessment of energy efficiency
opportunities and benchmarking against national averages from a separate study was undertaken and significant potential energy waste savings identified. Recommendations were made to the care homes and the local authority re energy metering data.
9. A thorough assessment of renewable energy opportunities identified several opportunities for installations, one recommendation not to install a proposed system and the potential to earn a significant additional income from an existing installation. No new installations were implemented.
36
Besides waste, the costs of energy and food are likely to rise significantly. With increasing competition for natural resources, there is clearly a need to prioritise these areas for reasons of both cost and carbon management. The study’s assessment of the national picture and the four case study care homes showed that care homes lack support and information, making it very difficult for this sector to make an active contribution to the UK carbon reduction targets. This is increasingly critical given the need to protect the sector and vulnerable older people from rising natural resource costs. Pockets of good practice notwithstanding care home managers do not seem to be regularly encouraged by operators, Local Authorities or health trusts to engage with environmental sustainability, even where they are keen to contribute. The costs and carbon emissions associated with residential care are high. The benefits of addressing these issues are not just financial and environmental, but a key component of high quality care. Care Quality Commission (CQC) inspection reports deal with quality of care, life, environment and management. While recent issues raised by the CQC around medicines management and record keeping have some cross-over, there is little inspection that clearly addresses the issues of environmental sustainability. Additional Wellbeing benefits: An additional Care Home, - Longmoor Lodge in Derbyshire , trialled a “Walking for Health” walk with staff, relatives and residents. A short route was risk assessed by the Manager, a Walking for Health Co-ordinator and a walking for health trained relative. Small groups of residents, relatives and a staff member took the route on 2 occasions and found it to be a free and enjoyable experience, particularly for a resident who used to be a rambler and really enjoyed the opportunity to go out for a walk in the fresh air.
Pilot 4 Travel
Lynsey Harris - Integrated Transport Planning Ltd [email protected]
Neil Alcock – Nottinghamshire Healthcare Trust Electric Vehicles are often advertised as “zero emissions” vehicles as they do not emit any exhaust fumes, in particular CO2. However they are usually charged using grid electricity which emits a carbon content of 0.5246 kg/kWh from the electricity power station. This still equates to a much lower level of CO2 emissions than a conventional petrol or diesel vehicle and the emissions are also well away from densely populated areas which reduces the adverse health outcomes associated with vehicle emission pollution. Aim: To support the development of an Electric Vehicle (EV) pilot, within one or more organisations with existing travel plans to ensure lesson sharing. The pilot to assess before-during-after take up, savings and efficiency, of implementing Electric Vehicles in own/ leased / pool fleet.
What was done?
Integrated Transport Planning (ITP) consultancy was commissioned by East Midlands NHS Sustainable Development Network to produce a scoping note in order to inform and guide East Midlands NHS Trusts interested in undertaking an electric vehicle trial. Five KPIs were listed by ITP for NHS trusts interested in undertaking the trial as shown in Table 8.
37
Table 8: KPIs for Travel 1 Number of staff who used a EV in the pilot and number of times each person used an EV 2 Number of miles/kms travelled by the EV 3 Projected annual cost and carbon calculations - It was anticipated the fuel cost should be in the region of
25% of the equivalent petrol vehicle and the carbon emissions around 50% of an equivalent petrol vehicle. Detailed calculations would be carried out to verify whether the above are accurate during the practical trial.
4 Qualitative feedback - questionnaire from EV users 5 Number of Trusts who state they will continue to use an EV after the pilot has ended (and number of
vehicles)
Outcomes 1 The scoping note for NHS Trusts included suggestions and recommendations regarding the:
circumstances in which an electric vehicle trial may be effective
companies / organisations where electric vehicles can be obtained free of charge /for relatively small amounts of money for certain time periods
choice of electric vehicle
methods of evaluation to determine financial and carbon savings as well as social and well-being benefits.
2 Two health teams trialled two of the electric vehicles; a Nissan Leaf EV at Highbury Hospital and a Peugeot Ion EV at Stapleford Healthcare Centre after the External verification report was produced. Therefore the results were not included in the External Verification table at Appendix 7. 2 Nottinghamshire Healthcare NHS Trust used the information to develop a pilot electric vehicle trial with support from Nottinghamshire Primary Care Trust at two sites; Highbury Hospital and Stapleford Healthcare Centre. The sites were chosen because:
at least 10 staff at both locations were keen to participate and fitted the key criteria of needing to travel to patients’ homes to deliver services and make good use of the vehicles on a daily basis in a wide range of urban and rural settings.
the sites offered secure parking locations where the vehicles could be charged over-night using the slow charging system.
Three vehicles were assessed for trial by Neil Alcock, Energy & Environmental Manager, Nottinghamshire Healthcare NHS Trust: a Nissan Leaf, a Citroen C Zero and a Peugeot Ion electric vehicle. The results of both trials are summarised in Tables 9 and 10
Table 9 KPIs for Electric Vehicle pilot
Description Leaf Ion
Total Miles 1,303 1,134
Total km 2,097 1,825
Total Electricity Charge kWh 312 160
Total Electricity Charging Cost £ £21 £11
Total CO2 emissions kg (from electricity) 164 84
Energy Use per kWh/ km Secondary 0.15 0.09
Fuel Cost Pence/Mile 1.63 0.96
CO2/km (g/km) 78 46
CO2/mile (g/mile) 126 74
38
Conversion Factors used above
Miles to km 1.609 Electricity (all inclusive cost) pence/kWh 6.8
CO2 emissions grid electricity Defra scope 2 kg/kWh 0.5246
CO2 emissions Petrol (average biofuel blend ) Defra scope3 kg CO2/litre 2.7173
Comparison petrol fuel cost of 1.332 / litre or 6.06 £/gallon
Table 10 – Comparison of energy use, CO2/km and energy use in the 3 cars
Core Data Comparison Leaf Ion Peugeot 208
Fuel Cost p/mile 1.63 0.96 7.5
CO2/km (g/km) 78 46 117
Energy Use per kWh/km Secondary 0.15 0.09 n/a
Energy Use per kWh/km Primary (thermal effy grid elec 38%) 0.39 0.24 0.42
Financial costs
The electric vehicles were charged once at night using a standard 13 amp socket outlet and did not require the much more expensive rapid charging system.
The limiting factor was not the practical constraints of charging or limited range, but the current very high capital cost of purchasing the vehicles. Until the cost of EV’s is considerably reduced it was difficult to envisage that they could be considered a cost effective solution for delivering community healthcare compared with a conventional small petrol or diesel car of similar carrying capacity.
Carbon emissions
The Electric Vehicles show a considerable reduction in CO2 emissions. The Ion showed a reduction of over 50% when compared with a Yaris and greater than 60% when compared with a Peugeot 208, a significant saving.
Social benefits to staff, patients and the public
Carbon emissions from petrol or diesel cars have been shown to have adverse health outcomes. Emissions from the electricity required to run electric vehicles are produced well away from densely populated areas.
There was a very high level of overall satisfaction with the EVs by mental health and community teams providing care to patients in their homes. Half of those who took part would be willing to swap to an EV. Those who said they would not cited such reasons as purchase cost, charging times and too small for family use. During the course of both trials:
o no mechanical or any other problems were reported o no support was required from the Transport Manager other than the original briefing on
the car. o no staff reported any problems encountered in delivering a normal service to patients
whilst making use of the EV’s. It was confirmed that both the Nissan Leaf and Peugeot Ion were suitable for delivering community and mental health services to patients. Full details are available in the report of this pilot at the Sustainable Development Unit website http://www.sduhealth.org.uk/ .
39
Pilot 5: Food
Helen Ross - [email protected] . . As the Hospital Caterers Association (2013) point out, nationally:
“With over 300 million meals served every year and around £500 million spent on food annually by around 300 NHS Trusts across approximately 1200 hospitals, the NHS is the UK catering industry’s largest provider of meals”
Aim: This pilot aimed to develop a Sustainable Food standard for adoption by the East Midlands NHS Sustainable Development network.
What was done?
The pilot included planning and delivering workshops on the development of an East Midlands food standard, utilising existing good practice and presenting the Food Standard for adoption to the EM NHS Sustainable Development network. Three KPIs were listed as shown in Table 11.
Table 11: KPIs for Food
1. Has the Food standard been developed? 2. Number of Trusts involved in the development of the standard 3. Number of trusts pledging to achieve the standard
Outcomes
Four East Midland NHS organisations were involved in developing the standard together with the
Department of Health, the Soil Association and Sustain at the workshop held on 9 December 2011.
These were Nottingham University Hospital Trust (NUH), Derbyshire Mental Health trust, Sherwood
Hospital Trust and NHS Nottinghamshire Healthcare Trust.
Although the data regarding the carbon equivalent emissions, energy savings and financial savings were not quantified due to the small amount of funding available for the pilot, The Food for Life Catering Mark provides an independent endorsement that food providers are taking steps to improve the food they serve, using fresh ingredients, free from undesirable additives and trans fats, are better for animal welfare, and comply with national nutrition standards. Carbon emissions A reduction in carbon emissions is likely for participating organisations as the standard encourages sourcing sustainable food from local food producers. Nottingham University Hospitals Trust reduced its carbon emissions from food transportation of over 100 miles per day simply by preparing food on site instead of procuring food prepared in Colchester. Financial NUH reported a cost saving by the hospital in meeting the Bronze Food standard. The process resulted in more food being prepared locally in the hospitals instead of through a private contractor who had to find additional transport and profit costs. With regards to the regional economy, in similar work with schools, the New Economics Foundation’s (NEF), Social Return on Investment (SROI) research, carried out in Nottinghamshire and Plymouth found that the share of ingredient spend on seasonal, local produce had risen dramatically as a result of adopting Food For
40
Life Partnership practices in schools, by a nominal £1.65 million in Nottinghamshire and £384,000 per year in Plymouth (Kersley, 2011 p.2). Social benefits The criteria for this food standard include “making healthy eating easier”. Good hospital food is an integral part of good patient care; a better diet is known to improve patient outcomes and public health, delivering multiple benefits for hospitals and their patients. If hospitals implement the standard this could have a profound impact on patients, staff and visitors.
Adoption of the Food Standard: As a result, the East Midlands NHS Sustainable Development
Network agreed to:
1. adopt the existing national Food for Life Catering Mark as the East Midlands NHS Sustainable
Food Standard as it provides a sustainable framework for hospitals to take steps to improve the
food they serve to patients, staff and visitors. The Bronze, Silver and Gold awards provide an
independent endorsement that food is fresh, trustworthy and traceable, and free from harmful
additives and trans fats.
2. The Network pledged to work with the East Midlands Platform on Food and Physical Activity (now the Platform for Health and Well-Being), to support up to 5 NHS organisations to work towards achieving a Bronze, Silver or Gold Standard with the Soil Association, for commissioning and / or providing sustainable food to patients, staff and visitors. Nottingham University Hospitals Trust (NUH) had already achieved Bronze and pledged to write the standard into the specification for food services. Others expressed an interest in achieving the standard.
Pilots 6a and 6b - NHS Forest
Roger French [email protected] Sarah Dandy - Centre for Sustainable Healthcare [email protected] www.sustainablehealthcare.org.uk The NHS Forest initiative increases access to green space, especially trees, on or near NHS land. It is designed to make a visible difference and to improve healthcare environments in order to:
• reduce carbon emissions and support biodiversity • provide accessible opportunities for exercise at work • enhance healing • increase staff and community cohesion and engagement with the NHS and
sustainability objectives. Aim: To develop NHS Forest pilots at three NHS Trusts in the East Midlands including the provision of information for, and presentations to, NHS Trusts, staff and community and the East Midlands NHS Sustainable Development Network.
What was done?
Presentations about NHS Forest were made to the East Midlands NHS Sustainable Development Network at network events. This raised awareness of the benefits of the programme and paved the way for two separate organisations to be commissioned to engage three NHS Trusts in the East Midlands in the NHS Forest Programme.
Outcomes
Three Trusts committed to the East Midlands NHS pilot and registered with NHS Forest nationally.
The three participating Health Trusts were Chesterfield Royal Hospital Trust, Leicestershire NHS
Partnership Trust and Nottingham University Hospital Trust.
41
Table 12: KPIs for NHS Forest 1. Three Trusts have committed
to the pilot and have registered with NHS Forest. Achieved
Royal Chesterfield Hospital Trust
Leicestershire Partnership Trust
Nottingham University Hospital Trust
2. No of people engaged/present at information meetings, no. of pledges of support
Evidence not presented at time of external verification report
Evidence not presented at time of external verification report
Evidence not presented at time of external verification report
3. Display information at Trusts: NHS Forest display boards/info,
Evidence not presented at time of external verification report
Evidence not presented at time of external verification report
Evidence not presented at time of external verification report
4. NHS Forest plans clearly developed in their planned use of grounds for patient/staff/visitor use
See Figure 5 See figure 6 See milestones
5. Assessment of the estimated short term and long term carbon reduction contribution of each scheme plus scope for additional planting
Estimated carbon stock gain = 10tCO2e per year for estimated 1 hectare initial planting area
Estimated carbon stock gain = 10tCO2e per year for estimated 1 hectare initial planting area
Estimated carbon stock gain = 10tCO2e per year for estimated 1 hectare initial planting area
6. Estimated Improvement in bio diversity
No information
Qualitative information regarding wildlife corridor
No information
7. Direct costs of the plans £20,000+ £3,000 so far £16,000+
8. m2 of land ‘adopted’ for NHS Forest
0.3 hectares estimated
0.67 hectares so far <0.1 hectare estimated
9. Number of trees planted with a descriptive narrative of each plan
300 1,200 20
10. No and type of landscape garden areas planted
to plant a rehabilitation garden
see no of trees planted
planting a garden for Cystic Fibrosis patients.
1 Chesterfield Royal Hospital NHS Foundation Trust linked this pilot into their corporate citizenship work and built on their existing tree planting in various gardens on site, to create a stroke rehabilitation garden to provide patients with an area to engage in therapeutic outdoor activities. Plans were also put in place to create an area of outdoor space for the local school to utilise on a regular basis for planting activities – see Figure 5. Figure 5 - NHS Forest pilot - Map showing the location of gardens, courtyards and tree planting
areas at Chesterfield Hospital
42
2 Leicestershire Partnership NHS Trust planted a mixture of 1200 native trees on and opposite their Glenfield Hospital site. A number of the trees and almost all of the hedgerow species planted at Glenfield Hospital are fruiting varieties which will provide food for local wildlife. In the fullness of time the hedgerow will act as a green corridor for local wildlife to move along and link with the adjoining Goss Meadows Nature Reserve which protects grasses and wildflowers. The hedgerows created as part of the pilot provide green corridors for wildlife and link to areas of existing greenspace within the vicinity of the hospital. The trust was also keen to involve the local community in the NHS Forest site and to create seating, pathways and quiet areas.
Figure 6: NHS Forest at Leicestershire Partnership NHS Trust shows Gorse Hill paddock
planting completed.
3 Nottingham University Hospitals NHS Trust has a five year plan to create both fruit and nut orchards, allotments and establish bee hives. Central to this pilot was the involvement of volunteers from local community groups and schools in planting and maintaining the NHS Forest. The hospital aims to create both a pleasant and therapeutic environment whilst reducing their carbon footprint and improving biodiversity. Milestones Year one: Project group formed and formalised. Groundwork Greater Nottingham carried out site survey. First orchard planted. Project launched in partnership with the Trust Charity. The first tree to be planted was a large Bramley apple in front of the trust HQ. Short, medium and long term goals to be set and agreed by board. Bee hives established. Media campaign to develop interest. Project signage is developed and installed. Year two: Nut orchard planted along with phase two fruit orchards. Plans developed for allotments. Schools and community groups recruited. Year three: First fruit from orchard one. Orchard 3 planted. City Campus 1m walk established taking in the project. Year four: Allotments become established. Fruit from orchard 1 and 2. Orchard 4 is planted. Year five: Fruit from orchards 1, 2 and 3.
Outcomes
Financial: The pilot’s considerable potential to add value at low cost will be of major interest to Health and Well Being Boards.
43
Carbon emissions and environment: The CO2e figures shown are lower than in the other pilots. Due to the long term nature of these initiatives it was not possible to assess the true carbon emissions savings within the timescale of the pilot. However, they are significant because trees absorb carbon throughout their long lives. Leicestershire Partnership Trust estimated that in the course of their natural lifetime, the trees planted within the Leicestershire pilot have the potential to absorb 260 tonnes of carbon dioxide. Climate change threatens many species with extinction (RSPB January 2012). NHS Forest improves the quality of the natural environment and increases bio-diversity as well as promoting human wellbeing. Social: NHS Forest can promote improved clinical and healing environments with the aim of every patient having a view of a ‘tree from every window’, accessible opportunities for health promotion for staff and visitors utilising pathways, green gyms and other dedicated ‘zones’ within the NHS Forest. It illustrates how staff and community cohesion can be improved by engaging volunteers, schools and community organisations to help provide seating and relaxation areas for people who simply need a break from daily pressures and opens up NHS campuses to add real health promoting value. Some of the headline social benefits include the discovery of enthusiastic expert volunteers (at Leicestershire) to assist with design, sourcing and planting through involving a social enterprise working with disadvantaged youngsters. In Chesterfield the connection with the local school is notable; relationship that could develop over time. Their involvement with the local Olympic organisation is particularly noteworthy, as is the specific patient centred development of the stroke garden. In Nottingham the scheme is heavily focussed on local food production, with the close involvement of the local hospital charity and ‘Groundforce’, which is a well-established social enterprise organisation working with a range of disadvantaged people including ex-offenders.
6.3 Phase 3: Development and Replication in Midlands & East
Aim: To disseminate the learning from the East Midlands NHS Carbon Reduction Project to the Health Service in the West Midlands, East Midlands and East of England in order to support organisations to commission and deliver more sustainable, low carbon health services. The steering group were keen that the learning from the Pilots in Phase 2 be utilised by the NHS across the Midlands and East area. Phase 3 was a small project to establish whether the 6 pilots developed in Phase 2 could be replicated, with a view to collecting evidence for a wider national Sustainable Development project.. Funding and Resources Phase 3 was approved for funding through NHS Midlands & East. The funding allocated by the Midlands and East NHS Sustainable Development leads for Phase 3 was initially £19,108 for eight pilots and their external verification and Action Learning support. They are summarised in Table 13.
44
Table 13: Phase 3 - Midlands and East NHS Carbon Reduction - Summary of Pilots Key to Areas: East of England (E) East Midlands (EM) West Midlands (WM)
* Funding not received
No Title & Area Description of pilots Amount allocated
1 *
Carbon Reduction Champions training E
Development, training and effective use of a new network of sustainability champions in the Trust
£2,000 *
2 Improved Waste Management East
Reduce waste and increase recycling by ensuring that all staff are aware of the correct waste management procedures in place and that they feel motivated to ensure that waste is segregated and recycled appropriately.
£2,000
3 *
Sustainable Waste Management E
To focus on waste reduction and compliance in clinical areas by utilising the experience learnt from improving the non-clinical waste and using the funding to bring in dedicated specialist resource.
£2,000 *
4 Sustainable Training - EM
To offer comprehensive development sessions on the consumption footprint in relation to procurement and travel on three levels: 4. Governing Body - delivering against the sustainability agenda and
embedding within strategic objectives 5. CCG staff - making a difference as a small organisation 6. CCG sustainability team – prioritising and delivering for greatest
impact and financial benefit The development sessions could be made available to other CCGs in Nottinghamshire.
£1,920
5 Freebay waste recycling - E
Encourage reuse of unwanted items through the hospital, reduce waste costs by preventing products being sent to landfill, indirectly focus attention on items being thrown away and allow greater recycling rates.
£2,000 Payment confirmed
6 *
Grounds & gardens sustainability pilots EM
Localised site composting for grass clipping and other garden waste at small community hospital sites. The main objectives of the pilot were to: 1. Reduce waste to landfill 2. Reduce expenditure on new items 3. Allow reuse of items across the hospital 4. Allow reuse at other trusts / charities 5. Ensure correct recycling route if not rehomed 6. Allow reporting of annual reuse as well as recycling volumes
£1,888.00 *
7 *
Sustainable Travel - EM
To enable individuals to create on-line personal commuting and business travel plans so that they could consider all their options for travel to/from work and shift from single occupancy car commuting to another greener/more active mode of transport. To include their options for business travel and so provide a comprehensive package to individuals to consider their journey options.
£2,000 *
8 NHS Forest Pilot - WM
To plant 60 fruit trees at the Community Hospital at Bromyard, Herefordshire. 1. To improve the environment for patients, visitors and staff 2. To link with the local community, including local schools 3. To reduce the Trust’s carbon foot print. 4. To contribute to biodiversity
1,300
External Verification
External verification for calculation of carbon equivalent emissions, financial savings and wellbeing improvements.
£2,000
Action Learning support
Action Learning support provided across the pilots through the “Sustainable Health through Action Research in Practice” (SHARP) Network
£1,500
Project report Contribution to Workshop and Project report to disseminate findings £500
Total £19,108
45
Outcomes Phase 3
Due to the concurrent reorganisation of the NHS and Department of Health at national, regional and
local levels, that included winding down NHS East Midlands and changing personnel at high levels,
it was extremely difficult for the funding to be allocated for this Phase. Therefore although all pilots
started, only pilots 2, 4, 5 and 8 received funding and were able to proceed. Although the Health
Trust did not receive their allocation for Pilot 7, they decided to proceed with it anyway.
The pilots drew on the learning from Phase 2 through action learning sessions and applied them in
different formats. Key differences included focusing on reducing waste in a Care Home Setting in
Phase 2, but in Health Trusts in Phase 3. Sustainable travel was piloted through the use of Electric
Vehicles in Phase 2 and through travel planning measures in Phase 3.
The outcomes for these pilots are summarised as follows:
Pilot 2 – Improved Waste Management Lead: Elmarie Swanepoel: Mid Essex Hospital Services NHS Trust
The pilot aimed to carry out an audit of the organisation’s waste and to review and update the Trust
Waste Policy and promotional and training materials with a view to improving waste management.
The Trust did review all its waste management procedures and updated the waste policy. A full
carbon footprint was also completed for the Trust which included emissions from waste. The
emissions report, coupled with improved monthly management information enabled the Trust to
develop a small pilot to introduce opportunities for dry mixed recycling into a few departments.
The Trust recognised that working closely with the waste contractor could lead to an improved
waste management service and much higher levels of recycling, however due to various time
constraints the roll-out across the organisation did not take place before the end of the project. It
has been recognised however that the delivery of this project will have significant triple bottom line
benefits and will contribute to the Trust’s sustainable development ideals.
Pilot 4 – Sustainable Training Lead: Hazel Buchananan Nottingham North & East CCG
Nottingham North and East Clinical Commissioning Group (NNE CCG) was one of the first CCGs to
develop a Sustainable Training workshop to define priorities for how the CCG can impact and
develop actions in relation to their Quality, Innovation, Productivity and Prevention (QIPP) plan. The
workshop led by Hazel Buchanan commissioned Nottingham Energy Partnership to deliver the
learning and was supported by Helen Ross with the Public Health perspective. It engaged key staff
in thought provoking work that increased awareness of key Sustainable Development principles and
guidance and how they relate to core CCG issues.
The CCG made a commitment to work closely with partners and stakeholders to embed
sustainability and carbon reduction into everything it does, from internal activities to delivering and
commissioning frontline services in the communities it serves. They appointed the internationally
award winning environmental and public heath social enterprise NEP energy services to support
NNE staff to make a difference through their own actions, alongside developing a clear action plan
on how the organisation influences decision making and agreements towards sustainability.
Nottingham North and East 2013-4.
Pilot 5 – Freebay Lead: Clare Topping: Northampton General Hospital NHS Trust - Cliftonville This pilot set plans in train to develop a recycling website and in the process realised the following outcomes:
1. Recycling of approximately 250kg of aluminium crutches with a small revenue generated for the Trust
46
2. Donation of approximate 20 microscopes in various states of working order to the local Natural History Society Microscopy section who also run a U3A microscopy group. In return they made a donation to the hospital that matched the best offers received from commercial concerns.
3. Listed shelving and other items from the Pathology department for rehoming 4. Unwanted curtains, bedding and walking aids that would otherwise have been sent to landfill
were donated to a local charitable organisation for distribution across developing countries. 5. A number of medical consumables with a value in excess of £700 that were marked for
disposal were rehomed within the Trust. 6. Three analytical machines that were no longer required in the Pathology department were
sold, increasing Trust revenue. Pilot 7 – My PTP Personal Travel Planning Project Lead: Mark Armstrong-Read: Derbyshire Community Health Services NHS Trust
This project was limited by barriers to progress, including time availability for supporting staff with
their personal travel plans, availability of sustainable alternatives to the car and reluctance by senior
managers and unions to promote car sharing due to the ubiquitous car dependency culture.
Outcomes:
25 personal travel plans were provided with positive early feedback.
Targeting new starters at induction provides a number of contacts at an early stage, which was helpful in developing sustainable travel habits.
Pilot 8 - NHS Forest project at Bromyard Community Hospital, Hereford Lead: Martin McKay: Wye Valley NHS Trust -
Outcomes
£1,300 was used to purchase 60 organic fruit trees, tree guards, stakes and ties. The trees were
planted in 2 hours by staff who gave their own time, together with an active Hospital League of
Friends group and involvement from a number of local schools. The initial pruning of the trees after
planting was carried out by the tree supplier at no charge. This pruning will be undertaken by the
League of Friends thereafter, eliminating on-going costs. A local bee-keeper proposed the siting of
1 or 2 hives on the grounds by the orchard area, which helps with the pollination of the trees and
provides many other benefits to the area. The Trust aimed to identify additional areas within the
Trust’s limited sites where more trees can be planted over time. The amount of fruit produced and
used by the hospital and the League of Friends will be monitored over time to evaluate whether the
fruit production is being maximised for the benefit of the patients.
Local staff were due to compare the results of a follow up survey on the anniversary of the tree
planting, with a survey undertaken before the tree planting, to determine if there is an increase in
wildlife in the area.
Benefits
Improvement of the environment for patients, visitors and staff and visual impact on the landscape.
Provision of fruit for the patients to eat, which is organic, local and offers a choice of different varieties of apple.
Improved biodiversity and wildlife within the site
Tree planting is easily recognised by the community as being a positive eco-action. Planting trees can be an effective way to complement the Trust’s sustainability aims and help to off-set the hospital’s carbon foot print by reducing CO2 in the atmosphere.
Improved links with the local community including schools, not only during the planting, but through the lifetime of the trees for fruit picking, pruning, etc.
47
7 Summary of Outcomes
7.1 Influence on Strategy
The project directly influenced the strategy of NHS East Midlands by raising awareness of the key issues and the national strategy and showing that progress can be made in tackling carbon equivalent emissions reduction in the NHS. NHS East Midlands agreed at its Executive meeting on 13 June 2011 to add the following to their Sustainable Development action plan: Every NHS organisation needs to take into account: a) the required Statement of Internal Control (SIC) of adaptation and mitigation to Climate Change
(ref www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/dearcolleagueletters/DH_111781) b) the sustainability reporting framework highlighted by David Nicholson in February 2011 (ref:
www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124754.pdf on p6) c) the government's Carbon Reduction Commitment Energy Efficiency Scheme (CRC EES) and
European Union Emissions Trading Scheme (EUETS) requirements. Nearly every Strategic Health Authority had a regional transition plan for sustainable development and carbon reduction in place, to ensure that sustainability was clearly defined in the new structures. This project influenced the NHS Midlands and East transition plan.
7.2 Outcomes of the three Phases of the Project
Phase 1
The development of Phase 1 was crucial to the success of the project. It provided the leadership,
expertise and blueprint through the Logical Framework, to set the project off in the right direction
and it established an excellent steering group with the necessary expertise and a real commitment
to tackling carbon emissions in the NHS.
Key outcomes of Phase 1 were:
1. The methodology for calculating carbon accounting in the NHS was developed by
Nottingham Energy Partnership in collaboration with the NHS and the external verifier.
2. Accurate baseline information was calculated about the carbon equivalent emissions of
health services in the East Midlands 6
3. Recommendations for prioritising areas for focus and pilots that would deliver and measure
carbon equivalent emission savings were made. The project’s action learning approach was developed.
Phases 2 & 3: Overall assessment
Overall, the pilots in Phase 2 were highly successful and in Phase 3, 4 pilots showed partial success resulting in real pilots delivering real carbon reduction. In terms of learning points, the KPIs were developed and agreed with the pilot teams, and this was a key factor in success particularly of the Phase 2 pilots. As has been evidenced from the Phase 2 pilots, the money saved as a result, far exceeds the cost of the project.
6 A system of calculating carbon equivalent emissions was in place through the NHS ERIC returns, however, it was not robust enough to provide accurate baseline data.
48
Table 14 – Summary of Key Savings for Phase 2 pilots
1 Pilot Project 2 Annual carbon savings tCO2e
3 Annual energy saving
MWh
4 Social impact £ equivalent
5 Savings identified / income £
[1]
6 Cost of pilot
1 Energy in NHS Estates £21,750 [2]
1.1 Renewable energy 96 381 £10,738 between £77,259 & £163,921
7
Part of costs above
1.2 Automatic Meter Reading (AMR)
[3] 8
647 2,151 £14,492 between £85,000 and £95,000
Part of costs above
1.3 Voltage Optimisation (VO)
80 140 [4]
£1,792 £12,800 Part of costs above
2 Sustainable Procurement training
938 No data £12,194 £1,350,000 [5]
£3,564
3 Sustainable Healthy Care homes
770 No data £10,010 £14,093pa[6]
£4,320
4 Electric Vehicle 50-60% [7]
7-43% £39 0 £1,000
5 Food standard No data No data No data No data £1,000
6 NHS Forest – 6.1 and 6.2 25[8]
No data £130 No data £4,920 £3,080
Total 2,556 2,672+ £49,395 From £1,539,152 to 1,635,814
£39,634
The Social Impact Equivalent value calculated represents the annual social cost of carbon mitigated at 2011 prices. The social cost of carbon taken as £13/tCO2e, for traded price at 2011 value, based on DECC publication in 2011.
External Verification – Phase 2
Overall, the Phase 2 pilots were highly successful in terms of meeting their Key Performance Indicators (KPIs), with an overall weighted pass rate of 90%. Pilots 1-5 met 33 out of 34 KPIs, and resulted in real pilots delivering real carbon reduction. The Key Performance Indicators (KPIs) for the six pilots emerged from the Logical Framework evaluation matrix, (Appendix 8) and the action learning approach and were developed and agreed with the pilot teams. This was a key component in the high pass rate. In addition, the KPIs were regularly discussed and draft assessments given to pilot teams, so that progress was able to be seen during the pilot schemes. In that sense the use of agreed and transparent KPIs were beneficial to the overall project success. The KPI report was prepared by Paul Brockway to inform the outcomes of each of the pilots and provide a summary of overall outcomes of Phases 2 and 3.
[1]
Note: the table is based on the external verification summary of key outcomes with additional data to illustrate the financial cost of the pilot and anticipated savings / income in columns 5 and 6. [2]
total for 1.1 Renewable energy, 1.2 Automatic Meter Reading (AMR) and 1.3 Voltage Optimisation (VO) 7 includes income from feed in tariffs
[3] estimated at 5% savings where AMR installed pa
8 The cost saving estimate is based on an average energy costs per unit of electricity and gas across the NHS
trusts who stated they would install Automatic Meter Reading (AMR). If all trusts engaged in the pilot were to implement AMR, the potential savings would be the £600k and energy savings of 2,151 MWh pa. [4]
independent analysis estimate. Not possible to project with certainty due to other variables [5]
estimated at de-minimus 5% savings on contracts supported [6]
NHS East Midlands Carbon Reduction Project – Sustainable Care Homes Pilot report Table 5 Identified potential bill savings (£/year) [7]
Nottinghamshire Healthcare Electric Vehicle Trial Report – p10 [8]
Leicestershire Partnership Trust planted 1,200 trees & Faculty of Public Health (2010) estimated saving of 22kg per CO2 per year per tree.
49
Table 15 – Summary of Phase 2 Pilot KPI assessments
Pilot Project Total No of KPIs
No of current
1
KPIs
No of KPIs at PASS
No of KPIs at Part-Pass
No of KPIs FAIL Weighted2 % of KPIs
at PASS
1. Renewable energy 15 15 14 1 0 96%
2. Procurement training
7 7 7 0 0 100%
3. Care homes 9 6 6 0 0 100%
4. Electric Vehicle 5 3 3 0 0 100%
5. Food standard 3 3 3 0 0 100%
6. NHS Forest 10 10 4 4 2 60%
Total 49 44 37 5 8 90%
1 Some KPIs are not ‘current’, i.e. are based on events to happen in the future and so cannot be assessed in this verification report. 2 Part-Pass given 50% weighting for overall weighted Pass calculations External Verification: Phase 3 pilots: Pilot 5 (63%) and Pilot 8 (80%) were deemed to be successful, with two further pilots (Pilots 2 and 7) showing at least partial progress in the time. However, overall, phase 3 pilots scored poorly in terms of meeting their KPIs within the time allocated for external verification. The weighted pass rate of 13% was mainly due to half the pilots did not receive their funding allocation and 3 pilots could not therefore proceed to completion. A root and branch reorganisation of the NHS and Dept. of Health was happening which led to the funding body being abolished and senior personnel with responsibility for the funds, changing roles and organisations at the same time.
Table 16 Phase 3: Summary of KPI Assessments
Pilot Project Total No of
KPIs
No of current1 KPIs
No of KPIs at PASS
No of KPIs at Part-Pass
No of KPIs FAIL
Weighted2 % of KPIs at
PASS 1. Carbon Reduction
Champions training *
5 5 0 0 5 0%
2. Improved Waste Management
9 9 0 2 7 11%
3. Sustainable Waste Management
9 9 0 ^ 0 ^ 9 ^ 0%
4. Sustainable Training 13 13 0 0 13 0%
5. Freebay waste recycling 5 4 0 3 1 63%
6. Grounds and gardens sustainability projects *
9 9 0 0 9 0%
7. Sustainable Travel 9 9 1 0 8 11%
8. NHS Forest Pilot 7 5 4 0 1 80%
Total 63 60 5 5 50 13% 1 Some KPIs are not ‘current’, i.e. are based on events to happen in the future and so cannot be assessed in this verification report. 2 Part-Pass given 50% weighting for overall weighted Pass calculations * funding not received by pilot ^ additional KPIs achieved after external verifier completed work. increased 0 - 3 0 - 3 and fails reduced 7-3
50
8 Conclusions
8.1 Towards a sustainable health service
Forum for the Future set out a vision for a future sustainable health service whereby: “Whenever possible, the health system will act first to prevent illness, disease and social harm. When such prevention is not possible the healthcare system minimises the impact of illness and social harm on people’s quality of life. Additionally the system also achieves sustainability, by operating within natural limits and where possible enhancing the natural environment, and by contributing positively to quality of life and economic prosperity.” Forum for the Future (2009 p9)
The NHS Carbon Reduction Strategy for England provided specific guidance: “Climate change is one of the greatest threats to our health and wellbeing. It is already affecting health across the globe. The NHS, as one of the largest employers in the world, has an important role to play in reducing carbon emissions, a key cause of climate change.” Sustainable Development Unit (2009 - p63)
The Marmot review made clear that sustainable development helps to reduce health inequalities, improve health and reduce the unnecessary use of natural resources:
“There is a close relationship between the challenges of climate change and the challenges of health inequalities; not least because both impact most on the poor and disadvantaged. Both health inequalities and the negative impacts of climate change give extra urgency to putting sustainable development at the heart of creating a fairer society” Marmot (2010)
A new leadership model that can be incorporated into the existing Public Health system is needed to addresses the challenges of the 21st century of climate change and sustainable development. This is clearly stated by Rayner and Lang who identify the need for a:
“new mix of interventions and actions to alter and ameliorate the determinants of health; the better framing of public and private choices to achieve sustainable planetary, economic, societal and human health; and the active participation of movements to that end. Ecological public health is about shaping the conditions for good health for all.”
Rayner Geoff and Lang Tim (2012)
The determinants of health bounded by global ecosystems including our climate are clearly illustrated in the diagram adapted by Barton, H. and Grant, M. (2006).
51
8.2 The Challenges
The project had to tackle several challenges:
1. cultural change which is a challenge for many health service organisations, due in part to risk aversion in the NHS making it difficult to introduce new ideas and utilise new technologies that could reduce unnecessary expenditure
2. insufficient resources in the NHS for carbon reduction in terms of staffing, funding for innovation and implementation of innovation, and for performance management of carbon emissions
3. structural change occurring during the life of the project: there was a major re-organisation of the NHS and Department of Health at national, regional and local level which affected developments, particularly the roll out at Phase 3 where pilots were promised funding but did not receive it. Even the principles of the Action Learning approach are difficult to achieve when organisations are in as much flux as they were when Phase 3 pilots took place.
These challenges were met by employing a combination of methods that contributed to the overall success of the project. Their outcomes are summarised here.
8.3 What made the project a success?
We are very grateful to the diverse range of people and organisations who, through this project, were inspired and supported to overcome the challenges mentioned above in order to improve our health and environment. At the same time significant financial returns were achieved with modest initial investment. NHS organisations in the East Midlands took a great step towards reducing their carbon emissions, saving unnecessary spend and improving health and wellbeing as a result. Success was due to the leadership shown, development of the network, contributions made, methods, approaches and resources utilised in this project, as follows:
1 Cultural change:
A variety of successful methods and approaches, with the support of a strong network of forward thinking innovators helped organisations to overcome many of the barriers to cultural change. These included: Leadership: The leadership model incorporated within the existing Public Health system is well placed to address the challenges of climate change and sustainable development. Where this leadership is supported by leaders in the NHS and Department of Health, real progress can be made. The leadership shown by Public Health, NHS Nottingham City Primary Care Trust and the Department of Health in the East Midlands in putting the new model of public health into practice in conjunction with a range of experts from a variety of disciplines and organisations enabled the project to succeed. The development of the East Midlands NHS Sustainable Development Network which brought together NHS trust representatives, with individuals and organisations with the skills, expertise and knowledge to turn ideas into action. This provided a strong network of forward thinking innovators which helped NHS organisations to overcome many of the barriers to cultural change. Contributions of time, ideas and energy: by the steering group, pilot leads, and the East Midlands NHS Sustainable Development Network
52
Methods and approaches
The Logical Framework approach with Key Performance Indicators (KPIs): The Logical Framework evaluation tool provided a very useful method of planning, implementing and evaluating the project and kept the project on track. The use of KPIs was a valuable way of developing, specifying and measuring the outcomes of the project, which are essential for rolling out the learning from innovation. Whilst pilot leads contributed to the development of the main Logical Framework, they did not all complete and present frameworks for their own pilots due to the complexity of the tool and the limited resources to support them in doing so.
On the spot training: all pilot leads had access to expertise through training sessions with ARUP as the external verifier who validated their outcomes.
The Action Learning approach: Action Learning aids critical thinking and encourages collaborative, group reflection through partnerships with shared goals across departmental and organisational boundaries to enable change. Sustainability has its own challenges and needs commitment, time and facilitation to enable people to attend action learning sets. Action Learning, established through workshops with the East Midlands NHS Sustainable Development Network, proved helpful for developing the project’s Logical Framework which kept the project on track. It was effective in supporting staff to challenge existing organisational priorities and ways of working in order to put ideas into practice together, in a supportive environment, with input from experts and professionals which enabled trials of new technologies and ideas in Phase 2 and 3 pilots. Action learning also added value to the development of specific and ambitious KPIs by the project and pilot leads by incorporating KPI training into the cycles of action and reflection and being able to reflect tangibly on progress. The addition of contextual information for pilot leads and the opportunity to discuss plans with others, appeared to help leads develop their pilots. Solutions to many of the challenges of implementing changes in practice necessary for sustainability were therefore developed together through action learning.
2 Resources: The resources for implementing the project were, of course limited compared to its ambition. Funding: The foresight of NHS East Midlands in allocating their Regional Innovation Funding for this project, together with an enormous amount of goodwill on the part of all those who contributed enabled resource constraints to be overcome. Staffing: The project team consisted of the Project lead, the steering group and commissioning and commissioned expertise, who had a wide range of skills and experience including:
professional procurement and commissioning experts, who provided the steering group with an excellent decision making mechanism designed to identify those pilots likely to deliver the maximum carbon equivalent emissions, financial savings and well-being improvements with the resources available
technical knowledge and expertise in the full range of topic areas within the pilots
External Verification: Having an external verifier was vital for technical expertise and valuable independent advice to the steering group and pilot leads in the development of the project as a whole. Specific advice through the training workshops was helpful in developing the Logical Framework and key indicators for the pilots..
3 Structural Change:
Despite the enormous amount of change in the structures of health and care services, the implementation of learning from Phases 1 and 2 and four Phase 3 pilots went ahead. This was made possible by:
53
1 the commitment of the project lead and fellow Midlands and East SD leads, the Action Learning facilitator and the external verifier, the determination of the Midlands and East Sustainable Development leads and the goodwill of the steering group. The Logical Framework and KPIs also helped with the systemic challenges of Sustainable Development in the midst of structural change.
8.4 The Pilots
The pilots effectively tackled each of the 3 major areas of NHS carbon emissions
procurement
travel and transport
buildings and energy. Sustainable procurement provided the largest measured short term carbon reductions and financial outcomes. However, the development of sustainable health and care services requires system wide changes and therefore it is important to make progress in all areas. The resulting financial savings, should be invested in sustainable food, natural environments (NHS Forest) and outdoor activities for the improved health and wellbeing of residents, patients, carers, staff, and visitors. It is in our power to take action in all areas of NHS carbon emissions. The resources required to support commissioners and providers in embedding the learning from the pilots into all health and care services in all settings, are modest in comparison to the potential outcomes. The financial, social and wellbeing benefits, feed back into the improved health and wellbeing of all stakeholders in the services.
Conclusions about carbon emissions for each topic area are as follows: Energy in NHS Estates: Energy efficiency measures and renewable energy solutions constitute a financially attractive and worthwhile investment for many healthcare organisations, which will enable them to generate a steady income stream, reduce their carbon footprint, and improve the energy cost resilience of their sites. Procurement: With an annual procurement budget of £100bn, the NHS could make a large contribution to reducing climate change through the sustainable procurement of goods and services in society. Procurement forms the single largest component of the NHS carbon footprint measured as part of this project. Promoting sustainable procurement practices through these pilots, generated localised examples of a reduction in unnecessary procurement, re-use of products and low carbon purchasing. It helps the NHS to minimise its contribution to climate change, reduce unnecessary costs and improve health and wellbeing in society. Care Homes: All health and care settings, including care homes, can benefit financially and through reducing carbon emissions. However, care homes especially need technical and development support with the methods and type of resources employed in this project, to enable them to invest in appropriate energy efficiency and renewable energy measures. The financial savings made as a result can be used to improve the quality of life of residents through the development of additional sustainable health and care services. Travel: As soon as the cost of Electric Vehicles (EVs) are reduced, they could be considered an effective and healthier solution for community healthcare services compared with a conventional small petrol or diesel car of similar carrying capacity. Carbon equivalent emissions from petrol or diesel cars have adverse health outcomes, whereas emissions from the electricity required to run electric vehicles are lower and are produced well away from densely populated areas. There was a
54
very high level of overall satisfaction with the EVs by mental health and community teams providing care to patients in their homes. Food: The Catering Mark adopted as the East Midlands NHS Sustainable Food Standard has been cited by NHS England as a way to improve hospital food, and by the Department for Education as a national framework to support caterers to increase uptake of quality school meals. The Government's Plan for Procurement 2014 recognises the Catering Mark as a 'well-established' best practice tool DEFRA (2014). A new Exemplar CQUIN on hospital food cites the Catering Mark as a way to raise food standards, so hospitals and Clinical Commissioning Groups now have the opportunity to agree a financial incentive for achieving the Catering Mark Standards for food served to patients, staff and visitors: Food for Life (2014). NHS Forest: There would be huge benefits to the health and wellbeing of staff, visitors and patients to NHS sites and their communities and an improvement in biodiversity if all health and care sites incorporate greenspace in line with the NHS Forest pilots. A local study of the NHS Forest initiative investigated awareness of the NHS Forest by NHS staff, explored NHS staff perception of the use of green space and the potential for use of it by NHS staff and patients. The study identified the key obstacles and drivers affecting its success. “Seven potential factors were identified that would encourage NHS staff to use the NHS Forest; information about the space, things to do in the space, better access, encouragement from management, more seating, and more space.” E Mills (2012) Waste Reduction:
All pilots were concerned with reducing unnecessary use of resources. However, the Care Homes
pilot illustrated clearly that by taking a whole systems approach, waste could be reduced in energy
and pharmacy and recycling could be increased. Although the phase 3 pilots did not have time to
report fully on progress it was clear that waste could be reduced by establishing clear recycling
processes.
If this was replicated across the NHS, it is likely that carbon equivalent emissions could be reduced and financial savings and community benefits could be made.
55
9 Recommendations
We very much hope that this report is utilised by the NHS and Public Health at national regional and local level, to contribute to the implementation of the vision of a sustainable health service described in the conclusions. Here is a summary of recommendations for consideration by the NHS and Public Health to help in that task: 1. Board-level plans: Every organisation should update their board-approved Sustainable
Development Management Plans (SDMPs) on at least a yearly basis, and embed carbon reduction requirements into their reporting mechanisms.
2. Embed the learning from innovation: Each aspect of the holistic approach to health and care,
demonstrated through this project is crucial and realisable for the health and wellbeing of the planet and for commissioners, providers and those who benefit from health and care services. The learning should be embedded throughout the health and care system.
3. Robust data: The Sustainable Development Unit releases regional carbon reduction maps
based on the Estates Returns Information Collection (ERIC) data. Health and Well Being Boards and Health and care organisations need to ensure that the information is robust and utilised to inform local action.
4. Evidence: The evidence that carbon equivalent emissions contribute to climate change is clear.
Even for those still sceptical, the precautionary principle should drive the need to reduce carbon emissions to prevent further climate change. However, it is really important that actions taken contribute to the evidence base in order to help change the culture in a more sustainable direction. Therefore all carbon reduction actions should be clearly evaluated.
5. Systems Approach: It is helpful for those considering which areas of carbon emissions to tackle first, to map the easiest and most difficult against the smallest and biggest impacts. This requires a systems approach, an assessment of available expertise and resources and both qualitative and quantitative judgements, due to the nature of health and wellbeing services and facilities.
6. Allocating savings to sustainable health and care services: The funds saved as a result of
this project and subsequent NHS s programmes should be allocated to more sustainable, innovative and effective health and care services so that staff, patients and visitors are able to lead more active and healthy lives, whilst reducing their impact on the environment and minimising health inequalities
7. Leadership: Public Health, the Department of Health and the NHS have leadership roles with
regard to sustainable development including:
supporting the development of sustainable development networks
encouraging an Action Learning approach between different disciplines and organisations
Public Health professionals should consider how to embed ecological public health into the mainstream of the profession so that sustainable development can be given the necessary priority. This also provides a golden opportunity for Public Health to show how it can add value to other Local Authority services.
8. Health Service commissioners and providers should specifically show leadership in using the learning from this innovative project to ensure that health and care services are building in the use of sustainable new technologies by:
investing in their estates; particularly in-house renewable energy systems and green spaces
developing sustainable commissioning and procurement practices including for food
changing travel options and behaviours of staff
56
establishing a rolling programme of innovative carbon reduction projects on a regional basis.
9. Expertise: A small Carbon Reduction Programme team that includes expertise in sustainable procurement and commissioning, logical framework development, action learning approaches, external verification together with a strong Sustainable Health Service Network, are needed to embed the learning from the project to ensure resources are used effectively in health and care services.
10. Methods:
Logical Framework: The logical framework is recommended for future projects and service changes because it really helps to develop and keep projects on track. It also addresses the issue of insufficient resources to measure changes for work that is carried out on a low budget because it explains the assumptions upon which the project is based.
Action Learning: Resources for supporting the action learning approach as an ongoing format for working within the health and social care system for sustainability should be built in to ensure that this vital work is embedded into a whole system approach. Support for these principles is a necessity to achieve complex goals associated with sustainable development. The experience gained provides insights into ways of working which could be usefully integrated into any plans for ongoing support for organisations working on this agenda (e.g. Sustainable Development Networks).
Clarity of guidance over carbon equivalent emissions data: There is a need for clarity of key assessment terms/guidance from the NHS SDU to allow like-for-like assessment to enable carbon reduction projects to be compared. Examples are:
o IRR calculation method i.e. covering key variables and values for inflation, discount rates, etc.
o Social Return on Investment (SROI). o Timeframe for assessment – i.e. first year savings, average or cumulative over a
given timeframe, e.g. 25 years.
11. Energy: Nottingham Energy Partnership (NEP) carefully documented the process of supporting this pilot’s partners. The lessons and feedback gained were incorporated into bespoke, independent guidance and examples of good practice which can be found in the appendices and annexes of the pilot’s report. Any healthcare organisation can therefore use these to carry out further renewable energy assessments, installations and/or FITs claims across their own sites. When health service organisations decide to invest in renewable energy solutions, they should take advantage of the information provided through the Energy pilots, to make appropriate purchasing and installation decisions. The report is available through Nottingham Energy Partnership.
12. Procurement: It is vital that sustainable procurement practices are built into the training of
procurement staff throughout the health and care sector for the dual reasons of reducing CO2e emissions and unnecessary spend and generating income through recycling of goods.
13. Care Homes: Besides waste, the costs of energy and food are likely to rise significantly and are
major areas for change. With increasing competition for natural resources, there is clearly a need to prioritise these areas for reasons of cost, wellbeing and carbon management. Therefore the following recommendations have been made for care homes:
Develop a Sustainable Care Homes standard in collaboration with commissioners, care home owners, managers and staff, relatives, residents, inspectors, innovative architects and energy and waste managers that draws on the learning from the Sustainable Food Standard and the Care Homes pilot. Build into the standard, the use of the financial savings from
57
energy efficiency savings to resource sustainable care services and activities such as walking for health that improve the health and wellbeing of care home residents, staff, their relatives and friends. Details of the potential outcomes of the standard, including ideas for quality of life indicators for residents, food, waste reduction - specifically offensive and pharmacy waste - and energy savings, are outlined in Appendix 5.
Provide resources to care homes for assessment, development and implementation of the Sustainable Care Homes standard.
Give consideration to broadening inspection criteria to include resource efficiency and environmental impacts of care.
Educate care home managers about how to reduce energy consumption and waste and utilise the savings for sustainable health and care services that can improve the quality of life of residents, carers and visitors.
14. Travel: Health and care commissioners and providers should regularly review the purchase
cost of electric vehicles and their batteries as they are cheaper to run per mile once purchased and show a considerable reduction in CO2 emissions. Their impact on air quality on the roads is considerably less than petrol and diesel cars, making them a less unhealthy alternative. Information about the alternatives to petrol and diesel cars should be made available to staff on an annual basis.
15. Food: The Food Standard should be applied to health service organisations across the UK to
produce major benefits to the economy and improve the quality of food procured and provided for patients, staff and visitors on health service premises.
16. NHS Forest: Health and care organisations should consider how they can increase sustainable
greenspace in their estates in order to:
reduce carbon emissions and support biodiversity
provide accessible opportunities for exercise at work
enhance healing
improve staff and community cohesion and engagement with the NHS and sustainability objectives.
For the NHS Forest to become a sustainable venture in its own right, voluntary and third sector involvement supported by an enlightened estates department is essential.
17. Waste: Health services should review waste management procedures and policies and include
emissions from waste in their carbon footprint. The emissions report, coupled with improved monthly management information will enable the Trust to introduce opportunities for recycling. By working closely with the waste contractor, this could lead to an improved waste management service and much higher levels of recycling. This work will result in significant triple bottom line benefits and will contribute to the Trust’s sustainable development progress.
18. Feedback: This project aimed to inform and inspire further action. If you would like to comment
on the contents of the report, or inform us of any progress inspired by the project, then a feedback form is provided for your use at the end of this document.
58
Appendix 1- References
Barton, H. and Grant, M. (2006) A health map for the local human habitat http://dx.doi.org/10.1177/1466424006070466 BizEE Energy Lens www.EnergyLens.com accessed 2014 December Centre for Sustainable Health Care NHS Forest in the East Midlands 2012 Department of Energy and Climate Change (DECC) 2013 UK Greenhouse Gas Emissions, Final Figures 3 February 2015 https://www.gov.uk/government/statistics/final-uk-emissions-estimates Accessed 2 June 2015 Department for Environment Food and Rural Affairs (DEFRA) UK's Carbon Footprint 1997 – 2012 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414180/Consumption_emissions_Mar15_Final.pdf Accessed 2 June 2015 DEFRA ‘Securing the future - the government’s sustainable development strategy for England 2005 DEFRA Dr Peter Bonfield, OBE, FREng – Chairman “A Plan for Public Procurement Enabling a healthy future for our people, farmers and food producers” 2014 Faculty of Public Health “Sustaining a Healthy Future – taking action on climate change” 2009 Faculty of Public Health in association with Natural England “Great outdoors: How our Natural Health Service Uses Green Space to Improve Wellbeing Briefing Statement” 2010 Food for Life Partnership Food for Life Catering Mark http://www.sacert.org/LinkClick.aspx?fileticket=XQeUd-
toPWk%3D&tabid=2185 accessed 2014
Forum for the Future “The Health System in 2025: a Vision of Health and Sustainability in England (2009) Accessed August 2014 https://www.forumforthefuture.org/sites/default/files/project/downloads/healthsystem2025marmotfinal.pdf
The Global Climate and Health Alliance “Civil Society Call To Action” WHO Health and Climate Conference, Geneva, August 29, 2014: http://www.env-health.org/IMG/pdf/final_statement_who_health_and_climate_summit_august_2014.pdf
Hospital Caterers Association (2013) http://www.hospitalcaterers.org/press-releases/2013/fs-panel.php Accessed August 2014 Intergovernmental Panel on Climate Change (IPCC) Climate Change 2014 Synthesis Report Summary for Policymakers http://www.ipcc.ch/ accessed April 2015 Kersley H, 2011 New Economics Foundation (nef) The Benefits of Procuring School Meals through the Food for Life Partnership: An economic analysis for FFLP: nef looked at the Social Return on Investment (SROI) of the Food for Life Partnership in two areas (Nottinghamshire and Plymouth). http://www.neweconomics.org/publications/entry/the-benefits-of-procuring-school-meals-through-the-food-for-life-
partnership Accessed August 2014 The Lancet, A commission on climate change. Lancet 2009; 373:1659 The Lancet, September 2014 – Climate change and health—action please, not words Sep 20, 2014 Volume 384 Number 9948 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61656-1/abstract Marco Martuzzi and Joel A. Tickner editors “The precautionary principle: protecting public health, the environment and the future of our children” World Health Organisation 2004 ISBN 92 890 1098 3
59
The Marmot Review “Fair Society, Healthy Lives” 2010 http://www.instituteofhealthequity.org/ ISBN 978–0–9564870–0–1 Accessed August 2014 Mills E “An investigation into awareness, perception and use of the NHS Forest by NHS staff and the implications for its success: a case study of the East Midlands NHS Forest project. Dissertation presented for the Degree of MSc in Environmental Management University of Nottingham 2012 Moss D & Scheer R – Earthtalk in Scientific American 13 April 2015 http://www.scientificamerican.com/article/have-we-passed-the-point-of-no-return-on-climate-change/ accessed May 2015 Sustainable Development Unit NHS CARBON REDUCTION STRATEGY FOR ENGLAND January 2009 http://www.sdu.nhs.uk/documents/publications
Sustainable Development Unit: Summary of the key provisions of the Climate Change Act 2008: http://www.sdu.nhs.uk/documents/publications/1232893824_kmNp_3_summary_of_the_main_provisions_of_the_climat
e_change act pdf Accessed August 2014 Sustainable Development Unit “Sustainable Development Strategy For The Health, Public Health And Social Care System” 2013 Sustainable Development Unit Sustainable, Resilient, Healthy People and Places Module: Creating Social Value January 2015. Nottingham North and East Clinical Commissioning Group Annual Report 2013-4 Page 40 Nottinghamshire Healthcare Trust Electric Vehicle Trial Report February 2015 SDU website Office for National Statistics UK Environmental Accounts, Greenhouse Gas Emissions – 2013 released 2 June 2015 http://www.ons.gov.uk/ons/rel/environmental/uk-environmental-accounts/greenhouse-gas-emissions---2013/rpt-greenhouse-gas-emissions---2013.html#tab-Introduction and http://www.ons.gov.uk/ons/dcp171776_405623.pdf accessed 2/6/2015 Rayner Geoff and Lang Tim –“Ecological Public Health; Reshaping the conditions for good health” 2012 Earthscan from Routledge isbn 978-1-84407-832-5 Royal Society for the Protection of Birds: http://www.rspb.org.uk/news/303832-increasing-emissions-targets-will-
save-billions-report-finds 30 January 2012 accessed November 2014 Schaar John http://www.memorable-quotes.com/john+schaar,a4643.html accessed August 2014 Social Care Institute for Excellence in collaboration with the Sustainable Development Commission “23: Sustainable social care: climate change” April 2010 accessed December 2014: http://www.scie.org.uk/publications/ataglance/ataglance23.asp
Soil Association Food for Life Catering Mark http://www.sacert.org/catering/whatisthecateringmark accessed August 2014 Sustainable Development Commission “Sustainable Development: The Key to Tackling Health Inequalities” Feb 2010 – page 6 Trueman Taylor et al “Evaluation of the Scale, Causes and Costs of Waste Medicines” (2010) http://discovery.ucl.ac.uk/1350234/1/Evaluation_of_NHS_Medicines_Waste__web_publication_version.pdf accessed December 2014 United Nations Framework Convention on Climate Change (1992) http://unfccc.int/essential_background/items/6031.php accessed August 2014
60
Appendix 2: Contacts list
This project has required the cooperation and input from a wide spectrum of representatives and their organisations. We express our sincere thanks to all who have contributed including;-
1 Project Steering Group:
Project Chairs: Andrew Kenworthy – Former Chief Executive - NHS Nottingham City
Dr Ian Campbell – GP in Gedling Borough - c/o [email protected]
Project and East Midlands NHS Sustainable Development lead: Helen Ross, Senior Public Health Manager, on secondment to The Directorate of Public Health and Social Care East Midlands: Department of Health from NHS Nottingham City & County e mail: [email protected] - w.e.f. 1.4.2013 changed to [email protected]
Mike Peverill – Climate East Midlands: http://www.climate-em.org.uk/
Mike Meech – Government Office East Midlands
The Resource Hub: Chris Sparks & NHS Nottingham Supplies: David Bailey for guidance with commissioning the pilots
Dept. of Health East Midlands:, Dr Nick Salfield and Anna Morris;
NHS East Midlands the Innovation Fund Team: Bernie Stocks and Catherine Gillam and Public Health: Professor David Walker, Giri Rajaratnam, Sarah Norrish and Marysia Zipser.
East Midlands NHS Sustainable Development network members for contributing their knowledge and expertise through Action Learning Sets
Action Learning Set support:: Dr Claire Marsh - Leeds University and the SHARP Network
Pilot providers, NHS leads and action learning set members including; -
Phase 2 Pilots 1 - Energy in NHS Estates: Lead: Robert Nettleton: NHS Midlands and East and Nottingham Energy Partnership [email protected] and Laura Mayhew-Manchon - Nottingham Energy Partnership: main lead - Laura Mayhew-Manchon with Jerome Baddley [email protected] www.nottenergy.com 2 - Procurement; Nottingham Energy Partnership main lead - Jennifer Strong with Jerome Baddley [email protected] and David Wathey – Dept. of Health Sustainable Procurement lead. 3 - Sustainable Healthy Care Homes Helen Ross - NHS lead [email protected]. Jerome Baddley & Nottingham Energy Partnership [email protected] www.nottenergy.com the Care Homes pilot steering group, Louis Mullan – student in MSC in Environmental Governance at University of Manchester, Participating Care Homes: Cherry Trees Resource Centre, Queenswood Care Home, Laura Chambers Lodge Care Home, Wren Hall Nursing Home and Longmoor Lodge Residential Home that set up Walking for Health with their staff and residents, Mindy Bassi for advice on medicines management and Nottingham City Council for advice on waste management 4 Travel: Lynsey Harris - Integrated Transport Planning Ltd [email protected] Neil Alcock – Nottinghamshire Healthcare Trust & Jenny Cawkwell – NHS Nottinghamshire 5 Food: Helen Ross - [email protected], John Hughes, Nottingham University Hospitals NHS Trust for providing inspiring leadership in sustainable hospital catering; Ann Goodwin; Dept. of Health, the Soil Association for the use of their sustainable catering mark, Sustain for their support and Trish Crowson and the Platform for Health & Well Being
61
6a and 6b - NHS Forest: Yorkshire NHS Sustainable Development lead Roger French [email protected] Sarah Dandy - Centre for Sustainable Healthcare [email protected] www.sustainablehealthcare.org.uk: Chesterfield Royal Hospital, Andrew Jones Leicestershire Partnership NHS Trust: Mark Evans, Nottingham University Hospital Trust Alberto Rodriguez Jaume and John Hughes, Masters student taking a Degree in MSc in Environmental Management at the University of Nottingham: Ellie Mills. Phase 3 Pilots 1 Samantha Whiteley Project Manager Norfolk Community Health & Care NHS Trust [email protected] 2 Elmarie Swanepoel Mid Essex Hospital Services NHS Trust [email protected] 3 Louise Gaffney - West Hertfordshire Hospitals NHS Trust [email protected] 4 Hazel Buchananan - Nottingham North & East CCG - [email protected] 5 Clare Topping - Northampton General Hospital NHS Trust Cliftonville [email protected] 6 Sid Siddiqui - Derbyshire Community Health Services NHS Trust [email protected] 7 Mark Armstrong-Read - Head of Programme Management and Business Analysis Derbyshire Community Health Services NHS Trust - [email protected] 8 Martin McKay - Wye Valley NHS Trust [email protected] External Verification: - Paul Brockway from Arup who provided positive and constructive external verification with training for the project [email protected] The Sustainable Development Unit: Imogen Tennison, Lead data analyst for support with data issues, David Pencheon and Sonia Roschnik for their support and encouragement. http://www.sduhealth.org.uk/
62
Appendix 3 Glossary
Anthropogenic: Caused or produced by humans Adaptation: Changes to behavior or practice to adjust to the impacts of climate change. Calorie: a unit of energy contained within food that can be converted into human energy – e.g. a biscuit may contain 172 calories which is equivalent to 0.2 kWh (BizEE (2014) CO2e: An abbreviation from carbon equivalent emissions, a metric measure used to compare the emissions from various greenhouse gases (e.g. methane) based upon their global warming potential. Carbon neutral: An organisation or product with zero net emissions. Carbon literacy: General knowledge or awareness of the concepts, causes, and the effects of atmospheric pollution or greenhouse gases. Climate: Average weather and its variability over a period of time, ranging from months to millions of years. The World Meteorological Organization standard is a 30-year average. Climate change: A change in the climate’s mean & variability for decades or more. Climate feedback: An initial process in the climate leads to a change in another process in the climate, which in turn influences the initial one. A positive feedback intensifies the original process, and a negative feedback reduces it. A warming climate could increase the release of carbon dioxide from soils. Since carbon dioxide is a greenhouse gas, the additional release of carbon dioxide would further warm the climate — this is an example of a positive feedback Fossil-Fuels: Biomass lain down in the Earth millions of years ago, such as coal, oil, and natural gas, which when burnt produce carbon dioxide. Global warming: A rise in the Earth’s temperature, often used with respect to the observed increase since the early 20th century Good Corporate Citizenship (GCC): Describes how NHS organisations can embrace sustainable development and tackle health inequalities through their day-to-day activities. The Sustainable Development Commission (SDC) developed a self-assessment model to help organisations identify and assess their contribution to good corporate citizenship. Greenhouse gases (GHG): Include carbon dioxide, nitrous oxide, methane, hydrofluorocarbons, perfluorocarbons and sulphur hexafluoride. They trap heat in the earth’s atmosphere. A rise in levels of GHG increases temperature – the so-called greenhouse effect Greenhouse effect: The natural process of the atmosphere letting in some of the sun’s energy (ultraviolet and visible light) and stopping it being transmitted back into space (infrared radiation or heat). This makes the Earth warm enough for life. For thousands of years the atmosphere has been delicately balanced, with levels of greenhouse gases relatively stable. Human influence has now upset that balance resulting in climate change. Joule (J): a measure of energy – joules per second is a measure of the rate at which energy is being generated or used and is the same as a watt. 1,000 watts = 1 kilowatt BizEE (2014) Kilowatt (kW): a unit of power = 1 kW a measure of how fast something is generating or using energy. BizEE (2014) Kilowatt hour (kWh): a unit of energy that can be used to heat buildings or power equipment. for example, a boiler takes energy in the form of gas, and turns it into heat. A solar panel takes in heat from the sun and turns it into electricity. 1,000 kW = 1 Megawatt hour
63
Low carbon: A building, project or product that has low carbon dioxide (CO2) emissions. Mitigation: Action to reduce the emissions of greenhouse gases to slow the rate of human-induced climate change. One planet living: One planet living means living within the limits of the earth’s resources. Currently, the average UK resident consumes resources at a rate at which it would take three earths to replenish. Since we only have one earth, we are living way beyond our means. Peak Oil: A range of oil analysts are expecting global oil production to reach a peak and then begin its decline within the next 10 years. Peak oil is the point in time when the maximum rate of global petroleum extraction is reached, after which availability of production will decline. Primary Care Trust (PCT): Primary care trusts (PCTs) were launched in 2000 and were fully established across the country by 2002. PCTs across England were initially established with three clear objectives, to:
purchase care for local communities from hospitals and other local providers
directly provide services such as community care
work with local agencies to tackle health inequalities and improve public health. The role was later expanded to take on more specific and enhanced responsibilities for improving the health of the community, securing the provision of high-quality services and integrating health and social care locally. Reform and restructuring of the NHS meant that as of 31 March 2013 Primary Care Trusts ceased to exist and commissioning responsibilities for local health services, in the main, passed to Clinical Commissioning Groups with unitary and county Local Authorities and the NHS Commissioning Board also taking on responsibility for some areas of health commissioning. Social Cost of Carbon: The social cost of carbon is an economic approach used to quantify the marginal cost of climate change impacts, i.e. what direct and indirect effects of an additional tonne of carbon will have on the climate and society over time and what the financial consequences of these will be. This typically includes impacts such as water availability, coastal protection and the effect on agriculture and energy requirements due to global temperature rises caused by greenhouse gases. In the context of this pilot, the social cost of carbon method is adopted to quantify the damage caused to the environment and society and is used as an indication of the health and wellbeing impacts. There has been extensive research in this field utilising different methodological approaches, however the most sophisticated model of £22.4 per tonne of CO2e has been used for the analysis within this pilot. This figure enables the reader to quantify the negative externalities of greenhouse gases on society that are not currently acknowledged by the market price of the goods and services that emit these gases. Social Value: describes the wider social benefits that can be derived from delivering high quality services. This means specifically investing to maximize contributions to people’s health and well-being in the best possible ways e.g. by encouraging community cohesion and support, ensuring a living wage, encouraging apprenticeships and tailoring services to local needs. This means recognising, supporting and enhancing natural social and environmental assets within communities such as voluntary networks, green spaces or a rich cultural heritage through the delivery of public services. Urban Heat Island: a metropolitan area which is significantly warmer than its surroundings. The large amounts of concrete, asphalt & bricks used in buildings and roads 'soak up' and store heat in the daytime. Energy is released during the night time. Other causes are: heat released from vehicles & energy generation; and a lack of natural vegetation (e.g. parks and trees). The urban heat island effect already warms central London by more than 10ºC on some nights.
64
Appendix 4: Carbon Footprint Calculations
Atmospheric emissions of greenhouse gases are widely believed to contribute to global warming
and climate change. They comprise carbon dioxide (CO2), methane (CH4), nitrous oxide (N2O)
and the four fluorinated gases: Hydro-fluorocarbons (HFCs); Perfluorocarbons (PFCs); Sulphur
hexafluoride (SF6) and Nitrogen trifluoride (NF3). The potential of each greenhouse gas to cause
global warming is assessed in relation to a given weight of carbon dioxide. Consequently, all
greenhouse gas emissions are measured as carbon dioxide equivalents (CO2e).
ONS (2015)
Carbon dioxide equivalent emissions are measured in 3 different ways in the UK.
1 The Office for National Statistics provides estimates of 2013 greenhouse gas emissions on a
UK residency basis. This approach focuses attention on responsibility for emissions which means
they include emissions which UK residents and UK-registered businesses are directly responsible
for, whether in the UK or overseas, but exclude emissions resultant from foreign visitors and
businesses in the UK. These estimates also include emissions associated with international aviation
and shipping by UK operators.
The residency approach adopts UK national accounting principles, allowing environmental impacts
to be compared on a consistent basis with economic indicators such as GDP. These estimates are
also consistent with the System of Environmental-Economic Accounting – Central Framework,
adopted by the United Nations Statistical Commission. The residency principle therefore provides
an important indicator for the environmental pressure caused by the UK’s economic activities and
includes public and private sector and households emissions.
ONS reported that:
emissions of greenhouse gases were estimated to be 643.1 million tonnes of carbon dioxide equivalent (Mt CO2e) in 2013. This was 2.0% lower than 2012 (656.5 Mt CO2e), and 23.6% lower than 1990 (842.0 Mt CO2e).
Carbon dioxide was the dominant greenhouse gas, accounting for 84.4% of total emissions in 2013.
Between 1990 and 2013, carbon dioxide emissions decreased by 14.1%, methane emissions decreased by 59.0% and nitrous oxide emissions decreased by 51.4%.
The "energy supply, water and waste" sector emitted the largest amount of greenhouse gases in 2013 (189.8 Mt CO2e). This represented 29.5% of all greenhouse gas emissions.
Office for National Statistics (2015).
2 Embedded emissions, published by the Department for Environment, Food and Rural Affairs
(Defra), refers to ‘consumption emissions’ and takes account of emissions associated with the
consumption spending of UK residents on goods and services, irrespective of where in the world
these emissions arise. This approach also incorporates emissions directly generated through
households’ private motoring and heating. To find out what effect UK consumption has on GHG
emissions we need to take into account where the goods we buy come from and their associated
supply chains. DEFRA report that between 2011 and 2012, the UK’s carbon footprint is estimated
to have risen by 2 per cent following an estimated 6 per cent fall in 2011. This slight increase
reflects some increase in production-based and household emissions.
The carbon footprint peaked at 1,091 million tonnes carbon dioxide equivalents in 2007 and in 2012 was 21 per cent lower than this.
65
GHG emissions relating to imports rose 41 per cent from 1997 to a peak in 2007 and in 2012 were 2 per cent lower than 1997. Emissions associated with imports from China also showed a peak in 2007. In 2012 they were 78 per cent higher than in 1997.
In 2012, emissions relating to the consumption of goods and services produced in the UK were 19 per cent lower than in 1997. The findings indicate that the UK’s carbon dioxide footprint also rose by 2 per cent between 2011 and 2012.
Department for Environment Food and Rural Affairs (2015).
3 Emissions based on the UK greenhouse gas inventory are published by the Department of Energy and Climate Change (DECC). The inventory measures emissions on a territorial basis, as opposed to a residency basis, so only includes emissions which occur within the borders of the UK, Crown Dependencies and Overseas Territories. They provide the basis for assessing progress towards UK emissions reduction targets including Kyoto Protocol, EU Effort Sharing Decision and UK Carbon Budgets. DECC estimate that the UK emissions of the basket of seven greenhouse gases covered by the Kyoto Protocol were estimated to be 568.3 million tonnes carbon dioxide equivalent (MtCO2e). This was 2.4 percent lower than the 2012 figure of 582.2 million tonnes.
Between 2012 and 2013, the largest decreases were experienced in the energy supply sector, down 6.8 percent (13.8 MtCO2e) due to a decrease in the use of coal and gas for electricity generation, and the waste management sector, down by 14.1 percent (3.7 MtCO2e) due to a reduction in emissions from landfill waste.
Carbon dioxide (CO2) is the main greenhouse gas, accounting for 82 percent of total UK greenhouse gas emissions in 2013. In 2013, UK net emissions of carbon dioxide were estimated to be 467.5 million tonnes (Mt). This was around 1.8 percent lower than the 2012 figure of 476.3 Mt.
For the purposes of carbon budgets reporting, UK greenhouse gas emissions in 2013 were 566.6 MtCO2e. However, this does not take account of the net EU ETS trading position as net UK ETS emissions for 2013 were not available. Department of Energy and Climate Change (2015)
66
Appendix 5: Care Homes Project
The project identified the risks, opportunities, barriers and co-benefits and the scale of these in the case study homes and nationally. The report about the pilot has national implications. A growing ageing population means greater demand for residential care services.
Is the notion of an environmentally sustainable care home realistic?
What is the current environmental impact of the residential care sector?
Can reducing environmental impact have cost, health and wellbeing co-benefits? These questions are explored in the full report, Sustainable Care Homes, carried out by NEP Energy Services in 2012, a charity-owned social enterprise commissioned by NHS Nottingham City on behalf of the East Midlands NHS Sustainable Development Network and funded by NHS East Midlands Regional Innovation Fund. The key findings of the research were:
The residential care sector accounts for at least 3.4 million tonnes of CO2e each year and £1.07 billion in natural resource costs. The social cost of carbon adds a further £76 million in costs to the economy per year.
In 2008/9, energy use in residential homes accounted for around £468.5 million in utility costs and around 2.3 million tonnes of CO2e, representing 0.42% of the 2009 UK carbon footprint (National Statistics, 2012)
In 2008/9, residential homes accounted for around £505 million in food costs generating around 622,250 tonnes of CO2e.
Waste management: The research investigated pharmaceutical, offensive and commercial waste, finding significant opportunities for carbon and cost savings.
Key issues 1 Waste management
1.1 Pharmacy waste: Annual pharmacy waste from UK care homes amount to £49 million in value and correspond to up to 28,764 tonnes of CO2e. Opportunities to reduce this waste are identified in other reports, particularly Evaluation of the Scale, Causes and Costs of Waste Medicines by Trueman Taylor et al 2010). A major issue identified was that pharmaceutical interventions were paid for by the GP prescription budget, while non pharmaceutical interventions, such as additional sensory stimulation as an alternative to antipsychotic drugs, had to be paid for by the home, despite NICE recommending these alternative therapies over drugs. The disposal of drugs waste through pharmacy returns is paid for by NHS commissioning organisations and comprehensive records of reasons for drugs wastage are not usually available. As waste and returns are not visible to or paid for by GPs, there is less incentive at practice level to evaluate and address how and why this waste occurs. 1.2 Offensive waste: Offensive waste is mainly hygiene and continence waste. In 2008 a staggering 50% of the UK‘s 217,000 tonnes of non-hazardous healthcare and biological waste was generated by care homes (calculated from Defra data). Offensive wastes from UK care homes have an estimated cost of £29.3 million per year and give rise to more than 30,724 tonnes of CO2e, assuming disposal to landfill. It was analysed in some detail, as a key component of care home waste disposal costs and carbon emissions. 1.3 Commercial and Municipal Waste: Care home municipal waste disposal is likely to cost around £19.5 million across the UK and result in around 427,000 tonnes of CO2 emissions from disposal to recycling and landfill.
67
Local Authorities have been able to charge for both the collection and the disposal of waste from residential homes or premises forming part of a hospital or nursing home since April 2012. Although such waste is classified as household waste, it is treated as commercial waste for the purposes of disposal charge powers in the Environmental Protection Act 1990. 2 Energy
2.1 Energy use and Consumption: The study showed energy use and consumption in the four case study homes could be cut by an average of 11% if recommendations were implemented. Nationally, this could save £52.8 million in energy costs and 220,000 tonnes of CO2e each year. Three of the four homes studied had smart meters, however none of the care home staff were given access to the half hourly data, or trained on how to spot trends and energy waste. . 2.2 Renewables: If a care home site is suitable for a ground sourced heat pump energy system, this is an option worth considering. Two of the homes studied in detail were fully or partially heated with heat pump systems and under floor heating. Both of these homes should be able to achieve near zero carbon heating by 2050. Heat pumps also have the capacity to offer low-cost low-carbon cooling in heat wave conditions. Ground sourced heat pumps also offer long-term income in terms of the renewable heat incentive, with one home having the potential to earn £10,000 per annum from this route. 3 Food, community and environment: The links each home formed with their local community were found to have helped improve the care home grounds and their local environment, and ensured residents had regular and varied external contact, improving the capacity to carry out activities that kept residents physically and mentally active. These sorts of relationships play a critical part of a healthy sustainable care home and should be valued and encouraged. Three of the homes visited were growing food on-site. This approach involved engaging residents, staff and external community groups. In one case a city farm supported the home by cultivating the grounds.
Conclusion The study’s assessment of the national picture and the four case study care homes shows significant shortfall in support and information; this currently makes it very difficult for this sector to make an active contribution to the UK carbon reduction targets. This is increasingly critical given the need to protect the sector and vulnerable older people from rising natural resource costs. Pockets of good practice notwithstanding care home managers do not seem to be regularly encouraged by operators, Local Authorities or health trusts to engage with environmental sustainability, even where they are keen to contribute. The costs and carbon emissions associated with residential care are high. The benefits of addressing these issues are not just financial and environmental, but a key component of high quality care. Care Quality Commission (CQC) inspection reports deal with quality of care, life, environment and management. While recent issues raised by the CQC around medicines management and record keeping have some cross-over, there is little that clearly addresses the issues of environmental sustainability dealt with here.
Recommendations General 1. Consideration should be given to broadening inspection criteria to include resource efficiency
and environmental impacts of care. 2. Besides waste, the costs of energy and food are likely to rise significantly and major areas for
change. With increasing competition for natural resources, there is clearly a need to prioritise these areas for reasons of both cost and carbon management.
68
Pharmacy Waste 1. Care home pharmacy waste only represents a fraction of care home pharmacy consumption, but
there is scope for carbon and cost saving in reducing pharmacy waste through better communication between GPs homes, residents and pharmacies. In research visits for this report, two managers identified that a well managed 28-day prescription cycle with better communication and cross checking between home, GP and pharmacy, was effective in reducing unnecessary over prescription from repeat prescriptions.
2. Good medicine management and capping over-prescribed drugs makes sense in terms of both cost and health. Laxatives, Paracetamol, Aspirin and calcium supplements represented the most significant areas of waste, cost and carbon emissions, representing around 40% of all care home pharmaceutical waste and 27.5% by both value and carbon emissions.
3. Central treatment rooms, with fewer goods in residents’ rooms, were identified as being effective in aiding better management of stocks to prevent over-ordering.
4. GPs could review their prescriptions for any unnecessary use of antipsychotic drugs and follow NICE guidance to prioritise support for residents to increase indoor and outdoor activities and sensory stimulation
Offensive Waste 1. Commissioners and providers of care in care homes and hospitals should support and fund
continence care to ensure residents stay off continence pads or move off continence pads after temporary essential use. This has benefits for resident dignity, health and wellbeing and offers significant potential for carbon and cost savings across the whole lifecycle of a continence product’s manufacture procurement, delivery and disposal.
2. Procurement of continence contracts that favour more sustainable, lower weight products with user controlled delivery, to avoid over supply, also has a huge potential to cut waste and emissions. Clinical Commissioning Groups should consider employing sustainable procurement practices in addressing these contracts.
3. Care homes should explore the potential for alternative collaborative arrangements around waste management, possibly in partnership with GPs or local health centres. Where possible, these contracts should favour providers who offer good data on weight of waste collected, additional off-site segregation and recycling of municipal waste and / or energy from waste for offensive waste
4. If offensive waste is incinerated using energy from waste locally, rather than disposal through landfill, at least 66,750 tonnes of CO2 would be saved every year, equivalent to the carbon footprint from energy use of 13,350 houses in the UK.
Energy 1. Educating the home managers is key to reducing energy consumption. They are better placed
and are more likely to be aware of the local causes of energy waste, given the right training. 2. A national programme of better metering and training alone could potentially save £12 million
and 50,000 tonnes CO2e per annum 3. The easiest way to achieve savings is by empowering site staff to identify areas of waste. The
simplest way to do this is to provide care home managers with access to smart meter data 4. Encouraging the inclusion of ground sourced heat pumps in new build care homes, and gas
combined heat and power (CHP) for retrofit, would help ensure care homes contribute to the UK’s carbon targets, offer a better environment for residents and protect homes against rising energy costs.
Food 1. The use of care home grounds to grow food, particularly in raised beds, animals and use of
suitable tools provides both diversion and stimulation for residents, helping them to maintain an active lifestyle. The cost savings are fairly small but the health and wellbeing benefits more significant.
2. Producing food on-site also provides an incentive to compost uncooked food wastes rather than dispose of them to landfill or incineration.
69
Appendix 6: Financial Account
Introduction This report provides a final financial account of the East Midlands NHS Carbon Reduction Project
undertaken during the financial years 2009 – 2012 by NHS Nottingham City, funded by the NHS
East Midlands Innovation Fund on behalf of the East Midlands NHS Sustainable Development
Network. This does not account for the additional resources matched by a variety of different
organisations and individuals who contributed their time, ideas and energy to the project.
Project Development and Funding The project is hosted by NHS Nottingham City and developed by their Senior Public Health Manager initially while on secondment from NHS Nottingham City with the Dept. of Health in the East Midlands. Project funding of £20,000 for Phase 1 and £45,000 for Phase 2 was provided by NHS East Midlands to NHS Nottingham City.
Phase 1 - East Midlands NHS Carbon Footprint and Action Learning
A East Midlands NHS Carbon Footprint
The majority of the funding for Phase 1 was used for the calculation of the consumption footprint based on three primary sectors; procurement, building energy and travel, - which form the overall footprint. Phase 1 commenced with the completion of a scoping study to verify that data was in a usable format and of sufficient quantity and quality before moving into the main activities as follows;-
Procurement Analysis Goods and services: collation/screening of data; mapping data to SIC economic sectors; calculation of emissions.
Travel and Building Energy Analysis: collation/screening of data; calculation of emissions using consistent carbon intensities with national level carbon footprint report for movement of people (i.e. patients, visitors and staff) and heating, hot water, electricity consumption and cooling in buildings.
Carbon Footprinting Report: input data; analysis methodology; output results; comparison to national level footprint; key emissions ‘hotspots’; recommendations.
Project management / liaison: kick off and progress meetings; presentation of report/results at board meeting including recommendations for Phase 2.
B Action Learning
A minor part of the Phase 1 funding supported the development of an Action Learning approach to
the development of the East Midlands NHS Sustainable Development Network. Utilising the skills of
a researcher from Leeds University, good progress was made in developing this approach to
encourage learning about and developments in Carbon Reduction between network members. This
approach was so successful it was utilised to support the development of Phase 2 pilot projects, to
ensure that the pilots work well for the NHS in the East Midlands.
Phase 2 A summary of the pilots commissioned and delivered in Phase 2 is set out in Figure 7 with a pie chart to show the actual expenditure.
70
Figure 7
1. Energy in NHS Estates – Nottingham Energy Partnership were commissioned to support the Estates Departments with the integration of sustainable energy technologies into a range of new and old, leased and owned buildings.
2. Sustainable Procurement Training – Nottingham Energy Partnership were commissioned to provide practical hands on training days jointly for finance and procurement staff across the region on sustainable low carbon procurement.
3. Sustainable Healthy Care Homes – Nottingham Energy Partnership were commissioned to work with the Care Homes steering group to improve residents’ health & wellbeing and the sustainability of up to 4 Care Homes through reducing waste and energy in Care Homes.
4. Electric Vehicle Pilot - Integrated Transport Planning Ltd supported the development of an Electric Vehicle pilot in owned/leased/pool fleet with NHS Nottinghamshire Healthcare Trust.
5. Sustainable Food - The East Midlands NHS Sustainable Development Network developed and adopted a Sustainable Food Standard with the Department of Health and the Soil Association. They then worked with the Platform for Health and Wellbeing to roll out good practice in the East Midlands through planning and delivering a focused workshop.
6. NHS Forest - The Centre for Sustainable Healthcare and Leicestershire Partnership Trust developed NHS Forest pilots at 3 NHS Trusts sites in the East Midlands including the provision of information for and presentations to NHS Trusts, staff and communities and the EM NHS Sustainable Development Network.
External Verification - The external verification for the project for the calculation of carbon emissions, financial savings and wellbeing improvements was carried out by Arup. Action Learning – The network and pilot leads were supported in developing an action learning approach, by Dr Claire Marsh from Leeds University. Project Report/Exhibition Posters - Design and printing of posters and report including photographs were undertaken by DAPR.
East Midlands NHS Carbon Reduction Project
48%
8%
10%
2%2%
18%
11% 1%
Energy in NHS Estates
Sustainable Procurement Training
Sustainable Healthy Care Homes
Electric Vehicle Pilot
Sustainable Food
NHS Forests
Carbon Emissions (External
Verif ication)
Project Report/Exhibition Posters
71
Table 17 Phases 1 and 2 - Expenditure
Phase 1 Organisation / consultant Amount
Action Learning Dr Claire Marsh 1,000
Calculation of Carbon Footprint Nottingham Energy Partnership 19,000
Total 20,000
Phase 2
1 Energy in Estates Nottingham Energy Partnership 21,750
2 Sustainable Procurement Nottingham Energy Partnership 3,564
3 Sustainable Healthy Care Homes Nottingham Energy Partnership 4,320
4 Electric Vehicle Pilot Integrated Transport Planning Ltd 1,000
5a Sustainable Food workshop – food and
refreshments
Eco Works Food & Integral -
refreshments for workshop 9-12
197
5b Sustainable Food Standard; - planning and
delivery of focused workshop on the
development of the standard
Leicestershire County Council
(Platform for Health & Well Being)
800
6a NHS Forest Centre for Sustainable Healthcare 4,100
6b NHS Forest Leicestershire Partnership Trust 3,080
7 External Verification ARUP 4,975
8 Project report & posters DAPR and printers 1,147
Phases 1 and 2 Total 64,933
Phase 3 - Midlands and East NHS Carbon Reduction Project – Financial Summary
* Funding not received by pilot organisations from NHS Midlands and East
No Lead Organisation & Area Title Amount allocated
1 *
Norfolk Community Health & Care NHS Trust – East
Carbon Reduction Champions training
£2,000 *
2 Mid Essex Hospital Services NHS Trust - East
Improved Waste Management £2,000
3 *
West Hertfordshire Hospitals NHS Trust – East Sustainable Waste Management £2,000 *
4 Nottingham North & East Clinical Commissioning Group (CCG) East Midlands
Sustainable Training £1,920
5 Northampton General Hospital NHS Trust Freebay waste recycling – East
Freebay waste recycling £2,000
6 *
Derbyshire Community Health Services NHS Trust - East Midlands
Grounds & gardens sustainability pilots
£1,888.00 *
7 *
Derbyshire Community Health Services NHS Trust - East Midlands
Sustainable Travel £2,000 *
8 Wye Valley NHS Trust – West Midlands
NHS Forest Pilot
1,300
ARUP External Verification
£2,000
Claire Marsh - Action Learning Action Learning support £1,500
Nottingham City Council Project report £500
Total promised for Phase 3 £19,108
72
Appendix 7: External Verification
This Appendix gives more detailed information about the External Verification for Phases 2 and 3.
Phase 2
The process was to verify the outturn performance versus original goals, via the following objectives:
Review performance vs original Key Performance Indicators (KPIs)
Review overall social, environmental and carbon performance
Assess key learning points Key Performance Indicators (KPIs) The KPIs for the six pilot studies emerged from the Logical Framework evaluation matrix, which is given in Appendix 8. The KPIs are given for each pilot in each relevant section of this report Pilot 1 – Energy in NHS Estates Summary of pilot study The pilot was split into three parts: 1.1 Renewable energy: Conduct surveys of 16 sites across a number of EM NHS Trusts making recommendations for feasibility of renewable PV electricity energy solutions. Production of survey reports addressing structural, design, electrical connection and planning issues, outline costs & savings. 1.2 AMRs – Automatic Meters - Promoting and supporting smart electricity and gas metering including training session with NHS staff. Produce resources, guidance and case study documents for staff training sessions that improve understanding about smart meters, their procurement, installation and how to get the most out of smart metering. Show how the information gained has led to an increase in energy monitored through smart meters. 1.3 Voltage Optimisation (VO): Preparation of the business cases with 3 trusts for installation of voltage optimisers. 1.1 Renewable energy - There were 6 KPIs listed:
Key Performance
Indicator
(KPI)
Summary of NEP stated performance in Final report
(Table 1)
Assessme
nt
1. Number of sites identified
as being suitable for
renewable energy.
Total number of sites assessed as part of the REA element of
the pilot: 31. Out of which:
16x sites were identified as suitable for renewable energy
systems.
1x site was found to be not suitable for renewable energy
systems.
14x sites were assessed which either already had or was in
the process of having renewable energy systems installed
before the 31/03/12. The renewable energy output and the
potential carbon savings from these 14 sites have been
excluded from the calculation of performance against KPIs 2
and 3, so as to avoid any double-counting, given that these
systems were already installed or ‘in the pipeline’.
Pass1
2. Capacity of
renewable energy supported
to progress to install (annual
For the 16 new renewable energy systems, NEP calculated the
following values:
Total net capacity = 469 kWp
Pass2
73
Key Performance
Indicator
(KPI)
Summary of NEP stated performance in Final report
(Table 1)
Assessme
nt
kWh and kWp) Total annual output 380,864 kWh/year
3. Total potential
annual CO2 savings of
capacity supported to
progress (in kgCO2).
Total annual CO2 savings averaged over the next 25 years,
calculated by applying a carbon factor of 0.2521 kgCO2e per
kWh to the annual output of all the renewable energy systems
assessed: 96,013 kgCO2e p.a.
Total mitigated social cost of carbon derived from the energy
output of all RES assessed: £2,151.
Pass3
4. Total potential
financial revenue + savings
from supported systems
(annual and whole life cycle
NPV cost/saving over 25
year FIT lifespan).
Total potential financial income (i.e. revenue and savings
combined) from the output of the renewable energy systems
assessed ranges between £77,259 and £163,921 p.a., and
depends on the Feed-in-Tariff scenario which applies at the
time of the systems being commissioned.
NPV calculations project £205,494 net income on £674,244
capital outlay for second wave FIT rate
PASS4
5. Payback period and
IRR for investment in each
case.
Payback periods for the renewable energy systems assessed
start as little as 7.7 years. There is a wide range of payback
periods between this figure and all the way to 24 years, as
these depend on the Feed-in-Tariff scenario which applies at
the time of the systems being commissioned.
IRR values are given in Table 6 of the NEP report for financial
scenarios A-D, depending on the FIT available. Taking
scenario C c. 20p/kWh payment, the IRR average is 5.76%
Pass5
6. Capacity of systems
supported installed or likely
to be installed within next 12
months.
NEP state that “The Government’s Comprehensive Review of the
Feed-In-Tariff regime … has discouraged most of the partners
from progressing to system installation stage”.
Pass6
Table 18: Pilot 1.1 - Verification summary Assessment Notes 1. KPI 1: 16 new sites fully described in report 2. KPI 2: A typical domestic installation of a 3.2kWp PV system gives around 2,600kWh, so 469kWp would
produce around 381,000kWh, so NEP calculation is valid. 3. KPI 3: Based on average DECC electricity factor of 0.25kgCO2e/kWh, annual average saving of
96tCO2e/year is valid. Finally, social cost of carbon mitigated assumed by NEP is £22/tCO2e, which is taken as valid as it is similar to the average DECC value
9 for 2010-2020 for electricity (as an EU-ETS
traded sector). 4. KPI 4 - At 20p/kWh, annual financial return is around £76,000, at 40p/kWh return would be £152,000. So
NEP calculation is valid. NPV check calculations on income indicate net income would be higher than indicated, so values are a lower bound estimate.
5. KPI 5 – The stated discount rate of 3% is reasonable, leading to a valid estimation of IRR values for each scenario.
6. KPI 6: Currently no additional Renewable energy systems, due to Feed-in-Tariff review uncertainty.
9 DECC (2011) A brief guide to the carbon valuation methodology for UK policy appraisal, available at
http://www.decc.gov.uk/media/viewfile.ashx?filetype=4&filepath=11/cutting-emissions/carbon-valuation/3136-guide-carbon-valuation-methodology.pdf&minwidth=true
74
1.2 Automatic Meter Reading (AMR) smart meters - There were 3 KPIs listed:
Key Performance Indicator
(KPI) Summary of NEP stated performance in Final report Assessment
1. Number of Trusts
engaged around AMR
Number of East Midlands NHS organisations engaged around
AMR: East Midlands Only : Trusts: 8 Staff: 16
Total : Trusts: 16 Staff: 17
Pass1
2. Of trusts engaged,
number taking forwards
AMR + number of AMR
units installed or likely to
be installed within next
12 months
Number of Trusts who have installed AMR units or are planned
to be installed within the next 12 months.
East Midlands Only: 3
Total: 5
Number of AMR units installed or are planned to be installed
over the next 12 months.
East Midlands Only: 226 Total: 243
Pass2
3. Energy + carbon
covered by AMR (smart
metering) installed or
likely to be installed
within next 12 months.
Energy & carbon savings from AMR (smart metering) installed
or likely to be installed within next 12 months.
East Mids. Only
Energy: 1,744,000 kWh
Carbon: 529 tCO2e:
Total
Energy: 2,151,000 kWh
Carbon: 647 tCO2e
PASS3
Table 19 – Pilot 1.2 - Verification summary Assessment Notes 1. KPI 1: Number of Trusts fully described in report
2. KPI 2: It is not clear how many are additional vs those planned to be installed without this pilot study
intervention 3. KPI 3: energy/carbon saving is correct, based on 5% energy saving assumption which is referenced to
Carbon Trust publication. 1.3) Voltage Optimisation (VO) - There were 6 KPIs listed:
Key Performance
Indicator
(KPI)
Summary of NEP stated performance in Final report Assess
ment
1. Number of Trusts
involved in VO in
this pilot
3 trusts were engaged with as pilot partners and supported throughout this
pilot strand: Derbyshire Community Healthcare Services (DCHS),
Leicestershire Partnership Trust (LPT), and Nottinghamshire Healthcare
NHS Trust (NHT).
Pass1
2. From involved
trusts, number of
VO
units/interventions
undertaken or
likely to be
undertaken within
next 12 months.
DCHS: 1x site investigated (Ilkeston Community Hospital). Possible
installation if business case was strong enough.
NHT: 2x units installed and working (Wells Road Centre and Duncan
MacMillan House). One more installed (Wathwood Hospital) but not
operational due to technical issues.
LPT: 1x site investigated (Bradgate Unit). Possible installation elsewhere
if business case was strong enough.
Pass2
3. Energy
consumption
(kWh) covered by
DCHS, Ilkeston Community Hospital – 1,277,791kWh
NHT:
Wells Road Centre – 1,063,009 kWh
Pass3
75
Key Performance
Indicator
(KPI)
Summary of NEP stated performance in Final report Assess
ment
VO interventions
or interventions
likely within next
12 months.
Duncan Macmillan House – 1,422,870 kWh
Wathwood Hospital – 717,572 kWh
All 3 NHT installations are now in place; however, they were not being fully
utilised due to technical issues. Support from this pilot has enabled some of
these issues to be overcome, so that these sites could begin to realise the
benefits of VO.
4. % of Trusts’
electricity
consumption to be
covered by VO
DCHS, Ilkeston Community Hospital – 4%
Nottinghamshire Healthcare Trust (NHT) – 18.4% overall, details are given
below:
Wells Road Centre – 6.1%
Duncan Macmillan House – 8.2%
Wathwood Hospital – 4.1%
Pass4
5. Projected annual
energy +carbon
saving from above
VO calcs, supplier
and independent
data
Not possible to project independently with full certainty, given that site-wide
holistic effects may well undermine any projected carbon savings from
voltage reduction and future equipment upgrades may degrade projected
carbon savings.
Independent analysis has estimated the following:
• DCHS, Ilkeston Community Hospital: Suitable for VO. 5%
annual energy saving (68 MWh), equating 39 tCO2e saved
annually.
• NHT, Wells Road Centre (only the Wells Road Centre was
assessed and verified for potential savings): Marginal case for
VO, better data pre-and-post install would be beneficial. ~5.5%
annual energy saving (58MWh), equating 33 tCO2e saved
annually.
• LPT, Bradgate Unit- - Unsuitable for VO. ~2% annual energy
saving (14.278 MWh), equating 8.138 tCO2e saved annually.
Pass5
6. Payback period
and IRR for
investment in
each case
Paybacks estimated as follows:
DCHS, Ilkeston CH: ~5 years;
NHT, Wells Road Centre: ~8 years;
LPT, Bradgate Unit: ~13 years.
Report states “IRR not calculated as there are too many unknowns factors
to give any clear and meaningful figure on Internal Rate of Return in the
cases studied”
Part-
Pass6
Table 20 – Pilot 1c - Verification summary Assessment Notes 1. KPI 1: Trusts cleared stated 2. KPI 2: Outcomes fully described. 3. KPI 3 – kWh data fully disclosed. 4. KPI 4: % coverage by VO cleared described 5. KPI 5: Independent savings analysis 2-6% are credible. 6. KPI 6: Payback periods noted and appear valid. IRR calculation not performed, so KPI 6 is
assessed as Part-Pass.
76
Pilot 2 – Procurement training Summary of pilot study: The pilot was described as a “Practical hands-on half day training days provided jointly for procurement and finance staff across the region on sustainable low carbon procurement”. There were 7 KPIs listed:
Key Performance Indicator
(KPI)
Summary of NEP stated performance in
Final report Assessment
1. Number of East Midlands NHS
organisations and staff engaged in
events
Number of East Midlands NHS
organisations and staff engaged in events
East Midlands Only : Trusts: 16, Staff: 19
Total Healthcare Trusts: 22 , Staff: 26
Pass1
2. Split of those who have / haven’t used
P4CR identified before and after
Before: 2 After: 6 Pass2
3. Total spending procurement power
represented by engaged organisations
East Midlands: £3,999,774,614
Total Healthcare: £4,815,774,614
Pass3
4. no of people at end of the day who
have clear idea about sustainable
procurement and use of P4CR
East Midlands Only: 19
Total Healthcare: 26
Pass4
5. No of contracts and value that will be
amended following training days
East Mids. only Number of contracts: 9
East Mids. Value of Contracts: £22,661,000
Total Number of Contracts: 14
Total Value of Contracts: £27,011,000
Pass5
6. Number and value of contracts now or
likely to be targeted for carbon reporting
at PQQ or embedded into contractual
reporting cycle.
As above Pass6
7. Estimate of minimum carbon savings
from value of contracts + social cost
savings, through shadow price for
carbon
Estimate of minimum carbon savings
East Mids.
Tonnes CO2e saved: 689
Equivalent Social Cost of Carbon
prevented: £15,428
Total
Tonnes CO2e saved: 938
Equivalent Social Cost of Carbon
prevented: £21,001
Pass7
Table 21: Pilot 2 - Verification summary Assessment Notes 1. KPI 1: No of Trusts and staff engaged stated and assumed to be correct 2. KPI 2: No of staff who have used P4CR assumed to be correct 3. KPI 3: Total NHS procurement spend in England is around £40Bn, so NHS East Midlands spend
at 1/10th of this values seems credible. 4. KPI 4: No of staff clearly stated and assumed correct. 5. KPI 5: No of contracts and value clearly stated and assumed correct. 6. KPI 6: As KPI 5. 7. KPI 7: Carbon saving calculation is correct but is based on a central assumption of 5%
saving in spend. This assumption has no direct evidence to date as P4CR is new, so should be revisited in future when more data/studies exist. However in interim 5% saving seems reasonable estimate. Finally, social cost of carbon mitigated assumed by NEP is £22/tCO2e,
77
which is taken as valid as it is similar to the average DECC value10 for 2010-2020 for electricity (as an EU-ETS traded sector).
Pilot 3 – Care Homes Summary of pilot study: The pilot was described in the NEP report as follows: “The key aim of the sustainable care homes pilot was to identify carbon and cost savings for care homes that provide health and wellbeing co-benefits and supporting them to become more environmentally, financially and socially sustainable. This overall aim was designed to be met through two key objectives: 3. To conduct surveys with four care homes and a range of supporting services, to assess the
levels of waste and associated carbon emissions and to identify site-specific recommendations
for reduction and examples of good practice;
4. To produce a summary reports showing waste flows and opportunities.”
There were 9 KPIs listed:
Key Performance Indicator (KPI)
Summary of NEP stated performance in Final report
Assessment
1. Production of 1 waste flow chart for each care home identifying key relationships
These are included in the body of the report, and with the case studies
Pass1
2. Quantification of cost and carbon emissions from prescribed goods (using procurement methodology and SIC code procurement emissions factors)
A calculation has been made with reference to a national study of 14 care homes across the UK and a qualitative assessment and commentary has been included on potential for waste reduction from interviews. This is included within section 6.2
Pass2
3. Quantification of emissions and cost from care home waste arising by tonne of waste and waste disposal pathway also where costs sit.
Care homes waste costs and contracts are often externalised and records of waste arising inconsistent or not kept within the home setting. Analysis and figures have been derived from homes data and national studies these are included within section 6.3. The concept of waste has been widened to encompass energy and material wastes. Recommendations have also been made on energy waste reduction in 6.1.
Pass3
4. Identification of options for each care home to link natural resource waste reduction with wellbeing.
A number of recommendations and findings have been possible; these are included in the report and the case studies. Some are general findings such as the opportunities for energy savings and renewable energy generation which could generate financial savings or revenue to support resident’s activities.
Pass4
5. Increasing residents access to natural environment. An outcome could be a measurement of the amount of time spent by residents outside before/after pilot, or a change in the care homes ‘daily plan for residents’
N/A – by others N/A5
10 DECC (2011) A brief guide to the carbon valuation methodology for UK policy appraisal, available at
http://www.decc.gov.uk/media/viewfile.ashx?filetype=4&filepath=11/cutting-emissions/carbon-valuation/3136-guide-carbon-valuation-methodology.pdf&minwidth=true
78
Key Performance Indicator (KPI)
Summary of NEP stated performance in Final report
Assessment
6. No of walking for health events planned / delivered
N/A – by others N/A6
7. No of people walking / being pushed in wheelchairs
N/A – by others N/A7
8. Energy efficiency measures introduced
A thorough assessment of energy efficiency opportunities and benchmarking against national averages from a separate study has been undertaken and significant potential energy waste savings identified. While recommendations have been made and contact has been made with the local authority re energy metering data. It is unknown to date if any measures have yet been implemented
Pass8
9. Renewable energy measures introduced
A thorough assessment has been made of renewable energy opportunities which has identified several opportunities for installations, one recommendation not to install a proposed system and the potential to earn a significant additional income from an existing installation No new installations have been implemented
Pass9
Table 22: Pilot 3 - Verification summary Assessment Notes
1. KPI 1: waste flow tables are clearly marked in the report. 2. KPI 2: Calculation based on SIC carbon intensity data and national data on care homes is
valid. 3. KPI 3: Calculation based on national level data valid in lieu of bottom-up data from care
homes. 4. KPI 4: qualitative evidence is presented in Section 3.8, such as continence care and on-site
food production. 5. KPI 5: N/A – by others in future 6. KPI 6: N/A – by others in future 7. KPI 7: N/A – by others in future 8. KPI 8: An assessment of energy efficiency potential was undertaken leading to summary
reports to the care homes. No measures have been confirmed as being implemented to date 9. KPI 9: An assessment of renewable energy potential was undertaken leading to summary
reports to the care homes. No measures have been confirmed as being implemented to date.
79
Pilot 4 – Electric Vehicles Summary of pilot study The pilot was described as a “Support the development of an Electric Vehicle pilot, within one or more organisations with existing travel plans to ensure lesson sharing. The project will assess before-during-after take up, savings and efficiency, of implementing Electric Vehicles in own/ leased / pool fleet”. There were 5 KPIs listed:
Key Performance Indicator (KPI)
Summary of stated performance Assessment
1. Number of staff who used a EV in the pilot, and no. of times each person used an EV
At least 10 Pass1
2. Number of miles/kms travelled by the EV
3 No vehicles being trialled by Neil M Alcock, Energy & Environmental Manager, Nottinghamshire Healthcare NHS Trust
a Nissan Leaf,
a Citroen C Zero and
a Peugeot Ion electric vehicle 2400 miles for each vehicle over about 3 months, so estimated at 7200miles for total of 3 vehicles
Pass2
3. Quantitative: projected annual cost and carbon calculations
It is anticipated the fuel cost should be in the region of ¼ of the equivalent petrol vehicle. It is anticipated that the carbon emissions would be around ½ of an equivalent petrol vehicle. Detailed calculations will be carried out to verify whether the above are proven during the practical trial.
Pass3
4. Qualitative feedback: questionnaire from EV users
N/A – pilot not started N/A4
5. Number of Trusts who will continue to use an EV after the pilot has ended (and number of vehicles)
N/A – pilot not started N/A5
Table 23: Pilot 4 - Verification summary Assessment Notes 1. KPI 1: trial is being set up to be used by regular staff users, i.e. for home visits etc. 2. KPI 2: average of 200 miles/week for each vehicle (50 miles/day) seems credible at this stage. 3. KPI 3: 7,200 miles at 50% carbon saving (~160gCO2e/mile) would realise around 1.15tCO2e
savings per car, or 3.45tCO2e savings over whole trial 4. KPI 4: N/A – pilot not started 5. KPI 5: N/A – pilot not started
80
Pilot 5 – Sustainable Food Standard Summary of pilot study: The pilot was described as follows: “This pilot will develop a Sustainable Food standard for adoption by the East Midlands NHS Sustainable Development network. This will include the planning and delivery of a focused workshop on the development of the standards, utilising existing good practice and presenting the Food Standard for adoption to the EM NHS Sustainable Development network”. There were 3 KPIs listed:
Key Performance
Indicator
(KPI)
Summary of stated performance Assess
ment
1. Has the Food
standard been
developed?
Yes The East Midlands NHS Sustainable Development Network endorsed
the recommendation from the East Midlands NHS Carbon Reduction Food
workshop to adopt the Soil Association’s Catering Mark as our standard,
subject to the network being able to view the details. Details have now been
circulated by e mail to the network in March 2012, see
http://www.sacert.org/catering/standards. The standard was accepted and
the Sustainable Food pilot group are now working with the Platform for
Health and Well Being to support NHS trusts to meet the Bronze, Silver or
Gold standard.
Pass1
2. Number of Trusts
involved in the
development of the
standard
5 East Midland NHS organisations were involved in the development of the
standard together with the Dept. of Health, the Soil Association and Sustain.
These included Nottingham University Hospital Trust, Derbyshire Mental
Health trust, Sherwood Hospital Trust and NHS Nottinghamshire Healthcare
Trust.
Pass2
3. Number of trusts
pledging to achieve
the standard
The East Midlands NHS Sustainable Development Network has pledged to
work with the East Midlands Platform on Food and Physical Activity to
support up to 5 NHS organisations to work towards achieving a bronze,
silver or gold standard with the Soil Association for commissioning and / or
providing sustainable food to patients, staff and visitors. A further workshop
is being planned for this purpose. One Trust has already achieved Bronze
and is pledging to write the standard into the specification for food services.
Others have expressed an interest in achieving the standard and will be
asked to make a formal pledge at the workshop.
Pass3
Table 24: Pilot 5 - Verification summary Assessment Notes 1. KPI 1: Food standard has been developed and endorsed by the SD network. 2. KPI 2: No of Trusts clearly stated and assumed correct. 3. KPI 3: No of Trusts clearly stated and assumed correct. Pilot 6 – NHS Forest Summary of pilot study: This pilot comprises two parts – 6a and 6b, commissioned through two separate organisations to engage three NHS Trusts in the East Midlands in the NHS Forest Programme in order to:
improve the environment; specifically bio diversity and NHS Carbon Reduction
81
improve wellbeing by developing healing environments
provide accessible opportunities for health promotion
increase staff and community cohesion and engagement with Sustainability objectives The project included the provision of information and presentations to, NHS Trusts, staff and community and to the EM NHS Sustainable Development network. There were 10 KPIs listed:
Key Performance Indicator (KPI)
Summary of stated performance Assessment
1. 3 Trusts have committed to the project and have registered with the NHS Forest Project
3 No Trusts Pass1
2. # of people engaged/present at information meetings, # of pledges of support
Evidence not presented FAIL2
3. Display information at Trusts; - NHS Forest display boards/info,
Evidence not presented FAIL3
4. NHS Forest plans clearly developed in their planned use of grounds for patient/staff/visitor use
See East Midlands Report and individual site reports to review
Pass4
5. Assessment of the estimated short term and long term carbon reduction contribution of each scheme plus scope for additional planting
Estimated carbon stock gain = 10tCO2e per year for estimated 1 hectare initial planting area
Pass5
6. Estimated Improvement in bio diversity
Qualitative information regarding wildlife corridor included in Leicestershire report
Part-Pass
6
7. Direct costs of the plans Leicestershire Partnership Trust= £3,000 so far Royal Chesterfield Hospital= £20,000+ Nottingham University Hospital= £16,000+
Pass7
8. m2 of land ‘adopted’ for NHS Forest Leicestershire Partnership Trust= 0.67 hectares so far
Royal Chesterfield Hospital= 0.3hectares estimated Nottingham University Hospital= <0.1hectare estimated
Part-Pass
8
9. Number of trees planted with a descriptive narrative of each plan
Royal Chesterfield Hospital= 300 Leicestershire Partnership Trust= 1,200 Nottingham University Hospital= 20
Part-Pass
9
10. no and type of landscape garden areas planted
Royal Chesterfield Hospital to plant a rehabilitation garden Nottingham University Hospital planting a garden for Cystic Fibrosis patients.
Part-Pass
10
Table 25: Pilot 6 - Verification summary Assessment Notes 1. KPI 1: 3 trusts registered 2. KPI 2: evidence not presented 3. KPI 3: evidence not presented 4. KPI 4: site plans show NHS Forest elements 5. KPI 5: Calculation based on average 3tC/ha/yr referenced by UK Forestry commissions for gain
in carbon stock from average forest in UK.11
11 Forestry Commission (2003) Forests, Carbon and Climate Change: the UK Contribution, Information Note by mark Broadmeadow and
Robert Matthews of Forest Research
82
6. KPI 6: Qualitative information regarding wildlife corridor included in Leicestershire report, but not other reports.
7. KPI 7: cost of implementing plans clearly stated. 8. KPI 8: area for Chesterfield and Nottingham estimated based on number of trees stated. 9. KPI 9: number of trees stated but not detailed plans of type and sub-number in all cases 10. KPI 10: Detailed landscape plan included in Royal Chesterfield report, but not Nottingham
report. Summary and conclusions Summary of key outcomes The table below summarises the main expected annual changes from the pilots:
Pilot Project Annual carbon savings (tCO2e)
Social impact £equivalent1
Wellbeing data/evidence
1. Renewable energy 96 (Pilot 1a) 650 (Pilot 1b) 80 (Pilot 1c)
£10,738 Qualitative evidence in report
2. Procurement training 938 £12,194 Qualitative evidence in report
3. Care homes 770 £10,010 Qualitative evidence in report
4. Electric Vehicle 3 £39 No evidence presented
5. Food standard N/A No evidence presented
6. NHS Forest 10 £130 Qualitative evidence in reports
Total 2,547 £33,111
Table 26 – Summary of impacts of pilot studies 1 The value calculated represents the annual social cost of carbon mitigated at 2011 prices. The social cost of
carbon taken as £13/tCO2e, for traded price at 2011 value, based on DECC12
publication in 2011.
Pilot Project Total No of KPIs
No of current
1
KPIs
No of KPIs at PASS
No of KPIs at Part-Pass
No of KPIs FAIL Weighted2 % of
KPIs at PASS
1 Energy 15 15 14 1 0 96%
2 Procurement training 7 7 7 0 0 100%
3 Care homes 9 6 6 0 0 100%
4 Electric Vehicle 5 3 3 0 0 100%
5 Food standard 3 3 3 0 0 100%
6 NHS Forest 10 10 4 4 2 60%
Total 49 44 37 5 8 90%
Table 27 – Summary of Pilot project KPI assessments
1 Some KPIs are not ‘current’, i.e. are based on events to happen in the future and so cannot be assessed in this verification report. 2 Part-Pass given 50% weighting for overall weighted Pass calculations
12 DECC (2011) A brief guide to the carbon valuation methodology for UK policy appraisal, available at
http://www.decc.gov.uk/media/viewfile.ashx?filetype=4&filepath=11/cutting-emissions/carbon-valuation/3136-guide-carbon-valuation-methodology.pdf&minwidth=true
83
Conclusions The following conclusions were drawn from the pilot project assessments by the External Verifier: Overall assessment Overall, the projects were highly successful in terms of meeting their Key Performance Indicators (KPIs), with an overall weighted pass rate of 90%. Pilots 1-5 met 33 out of 34 KPIs, and have all resulted in real projects delivering carbon reduction. Pilot 6 (NHS Forest) had the lowest weighted KPI pass rate (6/10). This may reflect a lack of presented evidence targeted at meeting KPIs, rather than a lack of progress ‘on the ground’. Key learning points 1. The KPIs were developed and agreed with the pilot teams, and this was a key component in the
high pass rate. In addition, the KPIs were regularly discussed and draft assessments given to pilot teams, so that progress was able to be seen during the pilot schemes. In that sense the use of agreed and transparent KPIs were beneficial to the overall project success.
2. To enable carbon reduction projects to be compared, there is a potential need for clarity of key assessment terms/guidance from the Sustainable Development Unit (SDU) to allow like for like assessment. Examples are given below:
a. IRR calculation method: i.e. covering key variables and values for inflation, discount rates, etc.
b. Social Return on Investment (SROI). c. Timeframe for assessment – i.e. first year savings, average or cumulative over a given
timeframe, e.g. 25 years.
Phase 3 Key Performance Indicators (KPIs) - Verification Report The verification process was to verify the outturn performance versus original goals, via the following terms of reference:
Review performance vs original Key Performance Indicators (KPIs)
Review overall social, environmental and carbon performance
Assess key learning points
The KPIs for the six pilot studies emerged from the Logical Framework evaluation matrix, which is given in Appendix 8. The KPIs are given for each pilot in each relevant section of this report
1.1 Pilot 1 – Carbon Reduction Champions training
There were 5 KPIs listed:
Key Performance Indicator (KPI)
Summary of stated performance in Final report
Assessment1
1. Appointment of Sustainability officer. No evidence presented Fail
2. No. of sustainability champions appointed No evidence presented
Fail
3. No. of champions attending training No evidence presented
Fail
4. No of additional reports produced No evidence presented
Fail
5. Evidence of the network functioning: No. of meetings held, intranet site location, incorporation into Trust reporting / board meeting etc.
No evidence presented
Fail
Table 28: Pilot 1 - Verification summary
84
Assessment Notes Final report not presented
1.2 Pilot 2 – Improved Waste Management There were 9 KPIs listed.
Table 29 shows the outcomes at the time that the external verifier completed his work, however subsequent to this the following achievements were reported which would change the assessments if the external verifier had more time and funding allocated to the project. These changes are shown in brackets in the assessment column.
KPI Number & progress 1 New waste segregation information published with waste policy review 2 Waste volumes are consistently measured, audited and reported on in the monthly waste management reports – these were reviewed throughout the project. 3 carbon emissions from waste is published in the Trust’s Carbon Footprint report. 4 A successful pilot was undertaken throughout the project and plans are now in place to roll out to other areas. 6 Informal audits were undertaken in pilot areas – not rolled out as yet 8 Costs of waste disposal have been measured and did not highlight a significant cost reduction – this is due to the fact that the DMR waste stream was not rolled out across the Trust.
Key Performance Indicator
(KPI) Summary of stated performance in Final report Assessment
1
1. Produce Waste Flow Chart to understand current and planned new waste streams
No evidence presented
Fail (Pass)
2. Produce a baseline audit of the current volumes produce in each waste stream
Was reported in interim progress report as ‘in progress’
Part-pass (Pass)
3. Work out the carbon produced measured against Trust current waste volumes
No evidence presented
Fail (Pass)
4. Carry out a baseline audit of each ward or dept. in regards to the household waste they produce. This should be done prior to the area being move onto DMR.
No evidence presented
Fail (part pass)
5. Measures each ward or dept. volumes of Household and DMR following introduction of DMR.
Was reported in interim progress report as ‘in progress’
Part-pass (Fail)
6. Carried out sample audits of items being placed in DMR following introduce of this waste stream
No evidence presented
Fail (part pass)
7. Record number of non-compliance events with in correct items being placed in DMR
No evidence presented
Fail
8. Measure and compare the cost of waste disposal pre & post introduction of DMR
No evidence presented
Fail (part pass)
9. Measure the number of staff who have received training on new DMR waste stream.
No evidence presented
Fail
Table 29: Pilot 2 - Verification summary
Assessment Notes 1. Final report not presented
85
1.3 Pilot 3 - Sustainable Waste Management There were 9 KPIs listed:
Key Performance Indicator (KPI)
Summary of stated performance in Final report
Assessment1
1. Measure existing clinical waste streams to determine quantity and carbon content of each sub category of clinical waste.
No evidence presented
Fail
2. Compare with national data (ERIC etc.) No evidence presented
Fail
3. Produce a waste flow chart for each site identifying key relationships
No evidence presented
Fail
4. Identify options from 2 & 3 above to reduce (supply chain) or change sub category (non-infectious v infectious clinical waste )(Tiger Waste, lower disposal costs)
No evidence presented
Fail
5. No of staff uptake on training No evidence presented
Fail
6. No. of “waste champions” appointed & recognised by Trust No evidence presented
Fail
7. Calculate cost/carbon savings of new clinical waste strategy No evidence presented
Fail
8. Measure and compare the cost of waste disposal pre & post introduction of DMR
No evidence presented
Fail
9. Measure the number of staff who have received training on new DMR waste stream.
No evidence presented
Fail
Table 30: Pilot 3 - Verification summary Assessment Notes 1. Final report not presented
1.4 Pilot 4 - Sustainable Training There were 13 KPIs listed:
Key Performance Indicator
(KPI)
Summary of stated
performance in Final report Assessment
1
1. Action plan with sustainable Impact and cost savings. No evidence presented Fail
2. Ownership through champions within CCG team No evidence presented Fail
3. Embedded sustainability through visuals, admin process i.e. o Governing Body papers front sheet o Staff carbon footprint o Mileage claims o Comms cell o Committee mtg agendas/front sheets
No evidence presented
Fail
4. Actions implemented by providers No evidence presented Fail
5. Sustainability reporting part of contractual process No evidence presented Fail
6. Contracts identified where can make a difference. Estimate of minimum carbon savings from value of contracts identified, plus social cost savings through shadow contract.
No evidence presented
Fail
7. Governing body champion and impact on decision making No evidence presented Fail
8. Identified pathways from current service changes where can identify sustainable actions (written into service specifications)
No evidence presented
Fail
9. Outcomes communicated to other CCG’s – CCG involvement in training.
No evidence presented
Fail
86
Key Performance Indicator
(KPI)
Summary of stated
performance in Final report Assessment
1
10. Outcomes indicators monitored (on balance scoreboard). No evidence presented Fail
11. Governing body champion and impact on decision making No evidence presented Fail
12. Individual change in behaviour (survey individuals - monitor travel budget)
No evidence presented Fail
13. Communication plan with stakeholders No evidence presented Fail
Table 31: Pilot 4 - Verification summary
Assessment Notes
1. Final report not presented
1.5 Pilot 5 - Freebay waste recycling There were 5 KPIs listed:
Key Performance Indicator (KPI)
Summary of stated performance in Final report Assessmen
t1
1. Fully Functioning Web Site. Report states ”To date the KPIs have not been possible to evaluate as there is not a functioning website”.
Fail
2. Number of users and number of departments using the website
Not applicable as web site not working yet N/A
3. Approximate avoided cost of items if purchased new
No evidence presented, but materials are being re-used Part-pass
4. Approximate avoided cost of disposal to landfill
No evidence presented, but materials are being re-used Part-pass
5. Carbon savings from non-disposal No evidence presented, but materials are being re-used Part-pass
Table 32: Pilot 5 - Verification summary
Assessment Notes Final report notes that materials are being re-homed even though the website is not functioning at the date of the final report
1.6 Pilot 6 - Grounds and gardens sustainability projects
There were 9 KPIs listed:
Key Performance Indicator
(KPI)
Summary of stated performance in Final
report Assessment
1
1. Select site/s to be piloted. No evidence presented
Fail
2. Select most suitable and economical equipment needed
No evidence presented
Fail
3. Carry out cost/savings feasibility exercise No evidence presented Fail
4. Purchase equipment No evidence presented Fail
5. Rollout project No evidence presented Fail
6. Monitor and collate date over specified period No evidence presented Fail
7. Analyse data No evidence presented Fail
8. Establish outcomes No evidence presented Fail
9. Report to stack holder No evidence presented Fail
87
Table 33: Pilot 6 - Verification summary
Assessment Notes 1. Final report not presented
1.7 Pilot 7 - Sustainable Travel
There were 9 KPIs listed:
Key Performance Indicator
(KPI)
Summary of stated performance in Final
report Assessment
1
1. No of staff PTPs discussed/issued 25 PTPs issued Pass
2. No/% of staff who change some aspect of their travel No evidence presented Fail
3. CO2e reduction through changing practices No evidence presented
Fail
4. Take up of car sharing through PTP No evidence presented Fail
5. No of lease cars taken due to PTPs No evidence presented Fail
6. Pool car registrations due to PTPs No evidence presented Fail
7. No of staff transferring to active travel No evidence presented
Fail
8. No of staff moving to public transport No evidence presented Fail
9. Cycle to work uptake No evidence presented Fail
Table 34: Pilot 7 - Verification summary
Assessment Notes 1. The final report states “No surveys have yet been carried out on people who have received personal
travel plans. Therefore many of these KPIs cannot be measured at the moment.”
1.8 Pilot 8 - NHS Forest Pilot
There were 7 KPIs listed:
Key Performance Indicator (KPI)
Summary of stated performance in Final report Assessme
nt1
1. Trees to be planted on 30th April 2013
Trees planted Pass
2. Undertake survey’s on bird/insect that use the area both before the planting and then one year on
Report states “Prior to the planting, a survey was taken by the hospital staff to determine what, if any, wild life was noticed to be using the area. No wild life were noted at the time, another survey will take place in a year’s time to see what difference the trees have made to the wild life”. Now that the trees have been in place for around 4 months, butterfly and moths are now appearing in the area, so it will be interesting to see the difference a year makes to the wildlife.
Pass
3. Reaction of patients to the project over the coming years
Not applicable yet
N/A
4. Is the fruit being picked Report states “The trees are growing and will take a year for fruit to be produced”,
N/A
5. Check the trees are being pruned each year
Final report states “The supplier of the trees came the following week and pruned the trees, so that they will have a good start in life”.
Pass
88
Key Performance Indicator (KPI)
Summary of stated performance in Final report Assessme
nt1
6. At the appropriate time of the year ensure that wild flower seeds are sown
No evidence presented
Fail
7. Discuss this with a local bee keeper
A meeting with a local bee-keeper was undertaken and they have proposed the siting of 1, possibly 2 hives on the grounds by the orchard area. This will help the pollination of the trees and provide many other benefits to the area in general.
Pass
Table 35: Pilot 8 - Verification summary Assessment Notes 1. Final report not presented
11.9 Summary of KPIs
Pilot Project Total No of
KPIs
No of current1
KPIs
No of KPIs at
PASS
No of KPIs at
Part-Pass
No of KPIs
FAIL
Weighted2 % of
KPIs at PASS
1. Carbon Reduction Champions training *
5 5 0 0 5 0%
2. Improved Waste Management
9 9 0 2 7 11%
3. Sustainable Waste Management
9 9 0 0 9 0%
4. Sustainable Training 13 13 0 0 13 0%
5. Freebay waste recycling 5 4 0 3 1 63%
6. Grounds and gardens sustainability projects *
9 9 0 0 9 0%
7. Sustainable Travel 9 9 1 0 8 11%
8. NHS Forest Pilot 7 5 4 0 1 80%
Total 63 60 5 5 50 13%
Table 36 – Summary of Pilot project KPI assessments
1 Some KPIs are not ‘current’, i.e. are based on events to happen in the future and so cannot be assessed in this verification report.
2 Part-Pass given 50% weighting for overall weighted Pass calculations
* funding not received by pilot
89
Appendix 8: Project Logical Framework
The purpose of this Logical Framework is to break down the steps for how this project contributes to identifying and reducing the Carbon Footprint of the NHS in the East Midlands.
Evaluation question: Climate change is “one of the greatest threats to our health and wellbeing”
1 and the
NHS has to play its part in reducing carbon emissions, a key cause of climate change. Will this project, with support from the East Midlands NHS Sustainable Development Network have a positive impact on the environment?
Description Indicators Data / Resources / Information
source
Assumptions
Goal: What is the overall
purpose that the project
intends to contribute to?
How do we verify that the project
has contributed to achieving this
purpose?
The most appropriate indicators for
this pilot are; -
What information exists which will
help assist this?
What assumptions are being
made regarding the
appropriateness of the project?
To contribute to the NHS
having a positive impact
on the environment by
bringing together public
and private resources to
accelerate the move of
the NHS in the East
Midlands to a low carbon
economy.
Measurement of the impact of the
project and specifically for each
pilot as follows; -
1 Can the project reduce Carbon
Dioxide equivalent (CO2e)
emissions in the NHS in the East
Midlands?
If so by how much?
2 Can the project support the NHS
in the East Midlands to make
financial savings? If so by how
much?
3 Can the project improve well-
being?
If so what are the estimated well-
being improvements for project
beneficiaries?
National policy /strategy indicators; -
1 NHS East Midlands and successor
performance management tools e.g.
Carbon Reduction Commitment
returns, ERIC returns
2 Sustainable Development Unit
regional returns, Good Corporate
Citizenship assessment model (GCC)
& NHS Trust board-approved
Sustainable Development
Management Plans (SDMPs) and
NHS Trust Annual reports.
3 The Sustainable Development
Unit’s Guidance for Commissioners
and NHS Procuring for Carbon
Reduction (P4CR) publications
4 Event Evaluation Forms, anecdotes
& project reports.
Wellbeing improvements are
important, however are not the
primary aim of this project.
Due to the limitations of the
resources available to the
project this means that we will
take account of anecdotal
evidence in the evaluation in
assessing whether or not
wellbeing has improved.
Our assumption is that this will
only provide us with an indicator
of change.
Aims: - What are the
specific targets that the
project hopes to achieve?
How can it be judged whether the
project has achieved these aims?
What baseline info exists? Does this
need to be mapped? Are systems for
collection and comparison of
information set up?
To measure and then
reduce the carbon
equivalent emissions of
NHS organisations in the
East Midlands
This project comprises
two main
phases; -
1 Phase 1: To identify the carbon equivalent footprint of the NHS in the East
1 The carbon equivalent footprint is
calculated using robust
methodology.
2 Are pilots established?
3 Have the pilots reduced carbon
equivalent emissions?
NHS ERIC returns and DEFRA
footprinting methodology
1 Four data sources cross checked; -
1.1 Proportional allocation of national
data on regional spending as a %age of national
1.2 organisation by organisation bottom up procurement data
1.3 EnCO2de estates benchmark data
1.4 Organisation by organisation bottom up ERIC data. To be recalculated at the end of
the project.
If we reduce carbon emissions; -
a. we reduce the negative
impact of the NHS in the EM on
the environment
b. We will contribute to DH/
NHS national targets
c. the project will help the NHS
in the East Midlands to meet
national Carbon reduction
targets
d. We will manage resources
more effectively and save
money.
1 Sustainable Development Unit “Saving Carbon Improving Health” 2009
90
Description Indicators Data / Resources / Information
source
Assumptions
Midlands. 2 Phase 2: To work with the Carbon Trust and 5 pilots to
reduce carbon dioxide equivalent emissions within NHS organisations in the East Midlands.
2 & 3 Pilot reports to include
measure of carbon emissions
e. We will make efficiency
savings
f The quality of life of patients,
staff and/or visitors will improve.
What are the expected
outputs of the project?
How many? When? Where?
Who?
What baseline info exists? Does this
need to be mapped? Are systems for
collection and comparison of
information set up?
Assumptions
Phase 1
To establish the
conditions for the
CO2 e footprint to be
calculated at a time when
this is not being done as
a matter of course.
Phase 2
Five pilots established
that aim to reduce carbon
emissions in NHS
organisations in the East
Midlands and that report
accurately on their
findings at the end of the
project.
Phase 1
Technical expertise commissioned
to calculate the CO2e footprint of
the NHS in the East Midlands.
Phase 2
1 Four commissioned organisations
to deliver 5 projects that deliver a
reduction in carbon equivalent
emissions by December 2011 with
the NHS in the East Midlands.
2 Pilot project reports verified by an
independent organisation.
1 Resource Hub and NHS
Nottinghamshire Supplies to help
with commissioning the organisation
to deliver CO2e calculation,
prioritisation of pilots and
commissioning of provider
organisations to work with the NHS to
develop the projects.
2 DEFRA & ERIC returns provide
systems for collection and
comparison of information.
3 The Sustainable Development Unit
are a source of NHS ERIC, financial
information and other data.
4 The project to develop a toolkit for
NHS organisations to input their
Carbon Emission equivalent data in
order to collect more accurate data
for the calculation of carbon
equivalent emissions of the NHS in
the East Midlands.
1 Resource hub and NHS
Nottinghamshire Supplies will
be resourced to provide the
assistance needed for the
project.
2 Defra and ERIC return data is
not completely accurate.
3 The SDU will share the data
4 There isn’t an existing toolkit
for the collection of accurate
data.
Methods: what are the
most appropriate
methods for this project?
How will we know if we are using
the methods employed?
What resources are available to the
project to develop and utilise good
methodology?
Good methods will deliver a
quality project
1 Develop a Logical
Framework to guide the
development of the whole
project
Draft versions of the logical
framework circulated.
Project lead to develop drafts and
circulate to steering group and
external evaluator for comment.
Project lead to amend the drafts in
the light of comments received.
Logical framework is a useful
method for developing a project
of this kind.
2 Develop a
commissioning method
for selecting
organisations to work
with the NHS in the East
Midlands to identify and
reduce their carbon
emissions.
Commissioning tools developed
and utilised.
Resource Hub & NHS
Nottinghamshire Supplies team to
help to commission providers and
external verifier.
Good commissioning method
will deliver quality providers
delivering quality services at the
right price within the resources
available.
91
Description Indicators Data / Resources / Information
source
Assumptions
3 Engage the NHS in the
East Midlands in the
development of the
project through Action
Learning.
Has the East Midlands NHS
Sustainable Development Network
been engaged?
No of Action Learning Group
presentations and meetings
(including by telephone) for the
project and for each pilot.
• A PhD student to develop
understanding and use of the
Action Learning approach at East
Midlands NHS Sustainable
Development network meetings.
• At least one action learning set
will support the development of
each pilot
• Minutes of meetings and reports.
Action learning is a useful
method for engaging the NHS in
the development of the project
and making the results relevant
to practitioners.
4 Develop methodology
for calculation of carbon
accounting in NHS
organisations for
adoption / rolling out
across the NHS.
Clear outline of methodology in the
report
• National guidance from DEFRA and the Sustainable Development Unit.
• Commissioned organisations to deliver accurate carbon emissions account pilots.
• External evaluator commissioned to ensure consistency and
accuracy of data
The methodology needs to be
developed in the East Midlands.
External evaluation will provide
technical support in the
development and evaluation of
the method.
Activities Key Performance Indicators; - How
many? When? Where? Who?
Resources (financial, human and
material) needed to carry out the
activities? Data/ information source
Assumptions
Phase 1
1.1 Development Phase
Establish project steering
group; -
The project will be
steered by a regional
steering group
established in
consultation with the East
Midlands NHS
Sustainable Development
network.
Evidence of commitment by key
stakeholders to the project
Steering group established
Record of meetings held illustrating
activities carried out and decisions
made.
Dept. of Health & PCT funded Senior
Public Health Manager
Members of the steering group from a
variety of organisations.
Room availability.
East Midlands NHS Sustainable
Development Network.
Meeting attendance and minutes
There is a commitment by key
stakeholders to carbon
reduction and this project as a
vehicle to do it.
Projects work best if they are
steered by a steering group.
Transparency of decision
making is important.
1.2 Project promotion
Raise awareness of, and
gather support for, the
project with key
stakeholders by; -
• presenting information about the project at key meetings
• Utilising an action learning approach
Stakeholder analysis completed
Information about the projects
presented at meetings and events.
Evidence of project providers
presenting technical information.
Press releases drafted and sent out
PhD student providing support,
guidance and facilitation at
meetings.
Survey of EM NHS SD network
Notes from meetings
Innovation fund network events and
brochures
Climate Change week events and
newsletters.
Ph student report
Survey results – use of survey
monkey.
Resources available for
production of surveys, meetings
and press releases.
Raising awareness of the
project will engender support
and interest in the findings.
1.3 Gather baseline
information
Commission an
organisation to calculate
the carbon footprint of the
NHS in the East Midlands
by producing a toolkit for
1 Sustainable commissioning
method applied
2 Provider commissioned.
3 NHS organisations participating
via e mail and website and one
to one discussions with
Senior Public Health Manager and
PCT governance processes to
manage the funding for the project
Resource Hub and NHS
Nottinghamshire Supplies to help with
commissioning of the provider
Accurate baseline information
not available elsewhere.
92
Description Indicators Data / Resources / Information
source
Assumptions
NHS Trusts to input their
carbon emissions data.
provider.
Timely commissioning
Phase 2: Development of
Pilot Carbon projects
Using information from
the East Midlands NHS
Sustainable Development
network and the Phase 1
report, develop 5 pilots by
March 2011 in East
Midlands NHS
organisations.
5 pilot projects established
including provider organisations to
develop the pilots and NHS
organisations engaged.
Resource Hub and NHS
Nottinghamshire supplies for support
with commissioning the pilots.
East Midlands NHS Sustainable
Development Network engaged with
the development of the pilots.
Resources available from
Resource Hub and NHS
Nottinghamshire for
commissioning support.
The network resourced to
support the development of the
pilots.
Pilot 1 – Renewable
energy in the NHS
Estate.
1a FIT/ Renewable
energy assessment
Aims: - 1 Conduct
surveys of 16 sites
across a number of EM
NHS Trusts, making
recommendations for
feasibility of renewable
PV electricity energy
solutions.
2 Produce survey reports
addressing structural,
design, electrical
connection and planning
issues, outline costs &
savings.
1. No of sites (out of 16) identified as being suitable for PV
2. Capacity of PV supported to progress to install (in m
2
annual kWh and kWp) 3. Total potential annual CO2
savings of capacity supported to progress (in kgCO2)
4. Total potential financial revenue + savings from supported systems (annual
and whole life cycle NPV cost/saving over 25 year FIT lifespan)
5. Payback period and IRR for investment in each case
6. Capacity of systems supported installed or likely to be installed within next 12
months.
Outcomes; -
• Anticipated Carbon savings
• Anticipated impact on finance • Anticipated wellbeing improved
Reports to steering group
summarising information gathered; -
1. Renewable Energy systems data
2. FIT data
3. FIT review of tariffs (late 2011)
4. Utility costs
In all 3 installations if post install
data is available during the
timescale of the project, it will be
compared with equivalent pre
install period.
1 Annual maintenance in
renewable energy system(s)
included in costs
2 Grid electricity price over 25
years – assume linked to
inflation (conservative), or use
low, med and high estimates.
1b Smart metering
Aim: - 1Promote and
support smart electricity
and gas metering
including training session
with NHS staff.
2 Produce resources,
guidance and case study
documents for staff
training sessions that
improve understanding
about smart meters, their
procurement, installation
and how to get the most
out of smart metering.
3 Show how the
information gained has
led to an increase in
energy monitored through
1. Number of Trusts engaged
around AMR
2. Of trusts engaged, number of
AMR units installed or likely to
be installed within next 12
months.
3. Energy + carbon covered by
AMR (smart metering) installed
or likely to be installed within
next 12 months.
1. Reports to steering group
2. Feedback from staff via
evaluation reports of events /
training sessions.
3. Evaluation forms / survey
Assuming 5% (CT) carbon
saving from better metering and
data, likely carbon saving from
AMR.
93
Description Indicators Data / Resources / Information
source
Assumptions
smart meters.
1c. Voltage optimization
(VO)
Aim: Prepare the
business cases with 3
trusts for installation of
voltage optimisers.
1. Number of Trusts involved in VO in this pilot
2. From involved trusts, number of VO units/interventions undertaken or likely to be undertaken within next 12
months. 3. Energy consumption (kWh)
covered by VO interventions or interventions likely within next 12 months.
4. % of Trusts’ electricity consumption to be covered by VO
5. Projected annual energy +carbon saving from above VO, supplier and independent
6. Payback period and IRR for investment in each case.
1. Annual reports of NHS Trusts
2. Sustainable development
management plans
3. Manufacturers data
4. Independent data
5. Literature review of real VO case
studies and real benefits/savings
Voltage optimizers are worth
testing in the NHS in practice.
Pilot 2 – Sustainable
Procurement Training
Aim: - To provide 3
Practical hands-on half
day training days jointly
for NHS procurement and
finance staff across the
region on sustainable low
carbon procurement.
This includes the
contractual outputs,
together with the
proposed metrics for
quantifying impacts of the
projects and wherever
possible calculating CO2
savings.
Estimation methodology
To estimate a de minims
financial saving we will
convert the carbon
covered by monitored
contracts into kWhs of
natural gas equivalent
and calculate the
financial impact of a low
(10%) reduction in carbon
emissions within those
contracts at the prevailing
natural gas price.
1. Number of East Midlands NHS organisations and staff
engaged in events 2. Split of those who have /
haven’t used P4CR identified before and after
3. Total spending procurement power represented by engaged organisations
4. no of people at end of the day
who have clear idea about sustainable procurement and use of P4CR
5. No of contracts and value that will be amended following training days
6. Number and value of contracts now or likely to be targeted for
carbon reporting at PQQ or embedded into contractual reporting cycle.
7. Estimate of minimum carbon savings from value of contracts + social cost savings, through shadow price for carbon
8. Much of ‘sustainable procurement training’ is
qualitative currently, i.e. ensuring that the right questions are being asked in contracts.
9. Outcomes; - • Anticipated Carbon savings • Anticipated impact on finance
• Anticipated wellbeing improved
1. David Wathey, national lead for
sustainable procurement from
NHS supply chain, contributed to
the training events.
2. Evaluation forms
3. Survey before the events and
after the events.
4. Report
5. P4CR definition
6. NHS Annual Reports
7. Follow up information
8. Application of method to results.
1. Joining up national and
regional resources is a
good idea.
2. Reduced carbon emissions
will lead to reduced energy
costs in the businesses
resulting in costs not
passed through to the
customer. So savings for
the NHS.
3. Assuming a 10% saving of
the contracts covered by
the attendees.
4. Higher savings than 10%
carbon emission reductions
or savings in a more
expensive commodity such
as fuel or electricity could
result in higher financial
savings for the supplier and
potentially the customer.
5. There is no guarantee that
a supplier will pass on
savings and these will be
de minimus estimates or
what could be saved in
emissions and passed
through in financial savings.
6. Natural gas is the cheapest
fossil fuel source, and a
10% carbon intensity
94
Description Indicators Data / Resources / Information
source
Assumptions
saving is a low and
universally achievable
target for an organisation to
aim for if under pressure to
do so from its clients.
Pilot 3: the ‘Sustainable
Care Homes’
Aim: To contribute a
sustainable development
dimension to a Care
Homes pilot project that
improves resident’s
health and /or well-being
and the sustainability of
up to 4 care homes.
The project focuses on: -
a. Medicines
management,
including a reduction
of the use of anti-
psychotic drugs and
minimising waste in
poly pharma.
b. Reducing waste
including food and
food packaging
(such as sip feeds)
by tracking and
mapping goods flows
and responsibilities
and improving
communication
between packaging
producers, users of
the products and
those responsible for
disposal of waste.
c. Increasing residents’
access to the natural
environment
d. Incorporating
learning from Pilot 1
the assessment of
the feasibility of
installing renewable
energy generation
equipment.
This includes the
contractual outputs,
together with the
1. Production of 1 waste flow chart for each care home identifying key relationships
2. Quantification of cost and carbon emissions from prescribed goods (using
procurement methodology and SIC code procurement emissions factors)
3. Quantification of emissions and cost from care home waste arisings by tonne of waste and waste disposal pathway also where costs sit.
4. Identification of options for each care home to link natural resource waste reduction with wellbeing.
5. KPI for output c: increasing resident’s access to natural environment. An outcome could be a measurement of the
amount of time spent by residents outside before/after pilot, or a change in the care homes ‘daily plan for residents’
6. No of walking for health events planned / delivered
7. No of people walking / being pushed in wheelchairs
8. Energy efficiency measures introduced
9. Renewable efficiency measures introduced
10. Outcomes; - • Anticipated Carbon savings • Anticipated impact on finance
• Anticipated wellbeing improved
Pre- pilot project steering group
developed the specification for the
pilot.
Student placement kick started the
project by working with the provider; -
NEP to gather information about the
energy use in care homes.
Care Homes; - a source of
information and data.
NEP will attempt to establish a
prescribed goods flow baseline as far
as the data and time allow.
NEP will attempt to display this in
disposal costs, purchase costs and
carbon emissions using DEFRA or
where available NHS waste stream
specific emissions factors for waste
disposal.
NHS P4CR Procurement emissions
factors will be used against
prescribed goods costs, unless better
lifecycle emissions factors are
available for specific products.
Sustainable Development Unit expert
on carbon calculation of drugs.
NEP will examine the potential
savings available from the alternative
options from less prescription, to
alternative waste disposal
methodologies. In each case they will
attempt to attribute these against the
relevant benefiting party, to establish
the most useful partners for
intervention measures.
Where possible NEP will also account
carbon savings in terms of the social
cost of carbon, which represents the
cost on society and public health of
the detrimental effects of avoidable
climate change.
NEP will attempt to assess any
Pilot project steering group will
steer the project.
DH guidance on reduction of
anti-psychotic drugs in older
people with dementia is being
considered seriously.
95
Description Indicators Data / Resources / Information
source
Assumptions
proposed metrics for
quantifying impacts of the
projects and wherever
possible calculating CO2
savings.
potential increases in access to the
natural environment arising from the
project and if possible any achievable
reductions in the use of, or wastage
of antipsychotic drugs.
NEP will note any other quality of life
or wellbeing benefits arising from
better medicines management such
as prescription and monitoring on the
application of sip feeds vs alternative
food provision.
How will you liaise with the other
pilots to ensure cross fertilisation of
ideas and techniques?
There are clear linkages between this
Pilot and Pilot 1. NEP have detailed
above how they will ensure that this
link is clear and valuable.
NEP will as far as possible promote
all the other pilots to trusts that they
work with.
Pilot 4: Electric Vehicle
(EV) pilot
Aim: Support the
development of an
Electric Vehicle pilot,
within one or more
organisations with
existing travel plans to
ensure lesson sharing.
The project will assess
before-during-after take
up, savings and
efficiency, of
implementing Electric
Vehicles in own/ leased /
pool fleet.
1. Number of staff who used a EV in the pilot, and no. of times each person used an EV
2. Number of miles / kms travelled by the EV
3. Quantitative: projected annual cost and carbon calculations
4. Qualitative feedback: questionnaire from EV users
5. Number of Trusts who will continue to use an EV after the pilot has ended (and number of vehicles)
Outcomes • Anticipated Carbon
savings • Anticipated impact on
finance • Anticipated wellbeing
improved
1. Manufacturers data 2. Energy prices
(petrol/diesel/electricity prices)
3. Previous pool car(s) replaced by Electric Vehicle
(EV) 4. EV conversion factors (kWh
/ km) 5. Travel Plan consultancy 6. NHS organisations willing to
trial the pilot. 7. Pilot report.
Pilot 5: Sustainable Food
Standard
The main purpose of the
NHS is to commission
and provide health and
healthcare services.
However in order to do
this effectively, it also
provides food for
patients, visitors, staff
and carers.
Has the Food standard been
developed?
Number of Trusts involved in the
development of the standard
Number of trusts pledging to
achieve the standard
This will include the planning and
delivery of a focused workshop on
the development of the standards,
National food standards.
Dept. of Health guidance on the
provision of food for NHS Trusts.
Report of food event(s)
NHS trust reports
Healthy sustainable food
delivers carbon savings at no
extra cost.
The amount of money available
for feeding patients, staff and
visitors sustainably is sufficient
to meet basic health needs for
the majority of its population.
96
Description Indicators Data / Resources / Information
source
Assumptions
There is evidence to
show that the quality of
food impacts on the
health and wellbeing of
all.
Aim: This pilot will
develop a Sustainable
Food standard for
adoption by the East
Midlands NHS
Sustainable Development
network.
utilising existing good practice and
presenting the Food Standard for
adoption by the EM NHS
Sustainable Development network.
Outcomes:
Anticipated Carbon savings
Anticipated impact on finance
Anticipated wellbeing improved
Pilot 6: NHS Forest
The main purpose of the
NHS is to commission
and provide health and
healthcare services.
However in order to do
this effectively it also
provides buildings and
grounds for use by
patients, visitors, staff
and carers. There is
evidence that the quality
of these things impact on
the health and wellbeing
of all.
This pilot comprises 2
parts – 6a and 6b,
commissioned through
two separate
organisations to engage
3 NHS Trusts in the East
Midlands in the NHS
Forest Programme in
order to; -
1. Improve the
environment:
specifically bio
diversity and NHS
Carbon Reduction
2. Improve wellbeing by
developing healing
environments
3. Provide accessible
opportunities for
health promotion
General Outcome indicators; - 1. three NHS Trusts have
committed to the project and
have registered with the NHS Forest Project Resource/information based outcomes indicators; -
2. Number of people engaged/present at information meetings,
3. Number of pledges of support
4. Display information at Trusts; - NHS Forest display boards/info,
5. NHS Forest plans clearly developed in their planned use of grounds for patient/staff/visitor use
6. Assessment of the estimated
short term and long term carbon reduction contribution of each scheme plus scope for additional planting
7. Estimated Improvement in bio diversity
8. Direct costs of the plans 9. Physical interventions
10. m2 of land ‘adopted’ for NHS
Forest 11. Number of trees planted with a
descriptive narrative of each plan
12. no and type of landscape garden areas planted
Outcomes
• Anticipated Carbon savings • Anticipated impact on finance • Anticipated wellbeing improved
- How can we increase the likelihood that people will benefit from the NHS Forest areas?
General Outcome indicators; - 1. Letters and notes that evidence
agreement i.e. clearly state their
commitment to develop specified NHS Forest sites together with a timescale for implementation and an identified lead from 3 Trusts involving Director level or above and Project Report via Trust project manager and Roger French
Resource/information based outcomes; 1. Staff/Volunteer sample survey of
‘user’ understanding and satisfaction with the project undertaken in conjunction with ARUP
2. Leaflets / posters / Photos of displays / display boards
3. Copies of plans 4. Carbon reduction calculation
including estimates of subsequent (known) planting schemes in Project Report via Trust project manager and Roger
French 5. Bio Diversity baseline
assessment in Project Report via Trust project manager and Roger French in consultation with Wildlife
6. Trust and ARUP 7. Minutes / letter from Finance
Physical interventions. 8. Project Report via Trust project
manager and Roger French including Photos of greenery / trees planted or sites where this will take place / where first trees are planted
2 Subject to identification of
third party input and agreement
on costs. Longitudinal studies
would ideally be required (as
would any measurable health
benefit) but these may be
outside the scope of this project
5 Subject to design and
agreement with ARUP, the
external evaluator
6 Wildlife Trust will contribute
Physical interventions
Outcomes: - Growing trees /
plants locally reduces carbon
97
Description Indicators Data / Resources / Information
source
Assumptions
4. Increase staff and
community cohesion
and engagement
with Sustainability
objectives
The project includes the
provision of information
and presentations to,
NHS Trusts, staff and
community and to the EM
NHS Sustainable
Development network.
Notes - CO2e = Carbon Dioxide equivalent emissions
98
Appendix 9:
Midlands & East Phase 3 Logical Framework
Description Indicators Data / Information source Assumptions
To contribute to the NHS
having a positive impact on
the environment
Two specific goals this
project aims to
- Work with the 8 Phase
3 NHS projects to
reduce carbon
emissions and improve
the environment within
in the Midlands and
East.
- Use an Action learning
approach to engage
people in the NHS
1. Development and use of log
frame evaluation matrix.
2. The evidence collected for
carbon and resource savings
are founded on robust
methodologies.
3. Whether the 8 pilots are
established
4. Eight commissioned projects
are completed by December
2013
5. Two training / feedback
workshops run in April 2013
and June 2013
6. Explanation and use of Action
Learning in workshop II (June
2013).
7. Evidence of action learning
recorded in project reports.
8. The projects are reported at
national level in the NHS, to
disseminate the successes and
failures.
1. NHS and DEFRA
footprinting methodology.
2. SDU carbon reduction
strategy
3. NHS Forest information
4. Phase 2 project reports to
be made available
5. Contacts from Phase 2 to
be put in touch with
appropriate contacts from
Phase 3, to share lessons
learned
6. Financial information and
other available data sources
e.g. Sustainable
Development Unit.
7. Pass Action Learning
materials / methodology to
project leads
If we reduce carbon
emissions and resource use,
and improve the
environment; -
• We reduce the negative impact of the NHS on the environment
• The projects will have a positive role as exemplar projects
• The projects will help
the NHS in the Midlands and East to meet national Carbon reduction targets
• We manage resources more effectively
• We make efficiency
savings • The quality of life of
patients, staff and/or visitors will improve.
Project 1: Carbon
Reduction Champions
training
Organisation
Norfolk Community Health
& Care NHS Trust
Key contact(s)
Samantha Whiteley
What?
To develop and implement
a network of sustainability
champions
1. Appointment of Sustainability
officer
2. No. of sustainability champions
appointed
3. No. of champions attending
training
4. No of additional reports produced
Evidence of the network functioning:
No. of meetings held, intranet site
location, incorporation into Trust
reporting / board meeting etc.
• Time of EFP project manager
Funding for communications and
training
Assumed that the project will
lead to an improvement in
communication and
knowledge of the Trust’s
SDMP
Assumed that there will be
capacity and interest to
accommodate additional
requirements amongst
appointed sustainability
champions
Project 2: Improved Waste Management
Organisation:
1. Produce Waste Flow Chart to
understand current and
planned new waste streams
2. Produce a baseline audit of the
current volumes produce in
• Waste contractor monthly
reports which include
breakdown of volumes
produce of all waste
streams
99
Description Indicators Data / Information source Assumptions
Mid Essex Hospital Services NHS Trust
Broomfield Hospital Key contact(s): Elmarie Swanepoel & Andy Wright
What?
The Trust has an
opportunity to further
segregate its waste by
introducing a new waste
stream of DMR (Dry Mixed
Recycling). When this
waste stream has been
introduced the aim would be
to increase our recycling
figures with the target of
50% of all Domestic Waste
produced being recycled by
2015.
The scheme is planned to
commence in Sept 2013.
each waste stream
3. Work out the carbon produced
measured against Trust current
waste volumes
4. Carry out a baseline audit of
each ward or dept in regards to
the household waste they
produce. This should be done
prior to the area being move
onto DMR.
5. Measures each ward or dept
volumes of Household and
DMR following introduction of
DMR.
6. Carried out sample audits of
items being placed in DMR
following introduce of this waste
stream
7. Record number of non-
compliance events with in
correct items being placed in
DMR
8. Measure and compare the cost
of waste disposal pre & post
introduction of DMR
9. Measure the number of staff
who have received training on
new DMR waste stream.
• Monthly financial budgets
statements to show
breakdown of cost waste
disposal
• Internal Waste Audits
• Trust carbon footprint data
• Defra GHG emissions data
for different waste streams
Project 3 Sustainable
Waste Management
Organisation: West
Hertfordshire Hospitals NHS
Trust
Key contact(s)
Louise Gaffney
Phil Child
What?
• Develop a sustainable
clinical waste
management plan.
• Baseline the existing
model & compare this
to national benchmark
data.
• Using existing audit
7. Measure existing clinical waste
streams to determine quantity
and carbon content of each sub
category of clinical waste.
8. Compare with national data
(ERIC etc.)
9. Produce a waste flow chart for
each site identifying key
relationships
10. Identify options from 2 & 3
above to reduce (supply chain)
or change sub category (non-
infectious v infectious clinical
waste )(Tiger Waste, lower
disposal costs)
11. No of staff uptake on training
12. No. of “waste champions”
Existing audit data and
benchmarking data from
national sources
£ to employ an accredited waste
consultant, engage with
Facilities manager, waste
contractor, clinicians, HR,
Training department, Comms
dept.
Compare and contrast our
approach with other Trusts that
have undertaken similar projects
Raising awareness of the
project will engender
support.
We will manage resources
more effectively and save
money.
We will make efficiency
savings
We will reduce the negative
impact of the NHS in West
Hertfordshire on
the environment
100
Description Indicators Data / Information source Assumptions
data, produce a waste
flow chart.
• Calculate the emissions
and cost of waste
arisings per tonne and
determine where the
costs sit.
• Develop a new clinical
waste strategy using
the waste hierarchy:
o Reduce
o Re-use
o Recycle
o Recovery
o Disposal
• Provide and deliver an
updated clinical waste
education program for
all Trust staff that
generate clinical waste.
• Based on good practice
and “Train the Trainer”
to create a “waste
champion” in each
clinical area.
• Provide publicity
materials, signs, and
intranet campaign
appointed & recognised by Trust
13. Calculate cost/carbon savings of
new clinical waste strategy
Project 4
Nottingham North & East
Clinical Commissioning
Group (CCG)
Sustainable Training -
EM
Comprehensive sustainable
development sessions on the CCGs
consumption footprint developed in
relation to procurement and travel at
three levels:
1. Governing Body - delivering against the sustainability agenda and embedding within strategic
objectives 2. CCG staff - making a difference
as a small organisation 3. CCG sustainability team –
prioritising and delivering for greatest impact and financial benefit
CCG £1,920 allocated
The session could be
replicated for other CCGs in
Nottinghamshire.
101
Description Indicators Data / Information source Assumptions
Presentations by Nottingham Energy
Partnership and Public Health
Interactive learning style.
Greater awareness of the key issues
enabling the CCG to apply a
sustainable development approach
to the development of the
organisation.
Key actions identified from the
development session
Project 5 - Freebay waste recycling
Organisation: Northampton General Hospital NHS Trust Key contact(s) Clare Topping What? FreeBay style website to advertise
unwanted items across the hospital for reuse, from statioery to medical equipment. Objectives of the website are: • Reduce waste to landfill • Reduce expenditure on
new items • Allow reuse of items
across the hospital • Allow reuse at other
trusts / charities • Ensure correct recycling
route if not rehomed • Allow reporting of reuse
annually as well as recycling
1. Fully Functioning Web Site
2. Number of users and number of
departments using the website
3. Approximate avoided cost of
items if purchased new
4. Approximate avoided cost of
disposal to landfill
5. Carbon savings from non-
disposal
1. Cost of hosting the site
2. IT management of the site
3. Procurement to look at
costs saved and provide
access to network of
procurement teams across
other trusts
4. Space for storage prior to
rehoming outside the
hospital
5. Communication route to
advertise the site
• IT will be able to source
a suitable provider and
allow sufficient server
access
• Website will have a
content management
system to allow data to
be pulled directly for
reporting purposes
• 12 month initial trial with
reporting every 3
months and continuation
if there is sufficient use
Project 6
Organisation:
Derbyshire Community
Health Services NHS Trust
Grounds and gardens
sustainability pilots
Localised sites identified and
established for composting grass
clipping and other garden waste at
small community hospital sites.
Derbyshire Community Health
Services NHS Trust
Funding for project allocated.
Project 7 –
Sustainable Travel
Organisation: Derbyshire
Community Health Services
NHS Trust
Key contact(s) Mark
Armstrong-Read
What?
1. No of staff PTPs
discussed/issued
2. No/% of staff who change some
aspect of their travel
3. CO2e reduction through
changing practices
4. Take up of car sharing through
PTP
5. No of lease cars taken due to
PTPs
1. My PTP website 2. Staff volunteering for
delivery of PTPs 3. Training of volunteers 4. Info on pool cars, lease
cars, etc 5. Time for volunteers to carry
out PTPs
6. Questionnaire Simon
My PTP website set up
Staff volunteer training
Develop questionnaire
Car share site and group set
up
Volunteers to do PTPs
102
Description Indicators Data / Information source Assumptions
To enable individuals to
create on-line personal
commuting and business
travel plans to encourage a
shift from single occupancy
car use, via:
• Personal Travel
Planning
• 1-2-1 sessions with staff
to look at options for
home-base travel and
business travel.
Main Goals:
• Reduce CO2 emissions
from home-base and on
business travel
• Increase active travel
• Reduce car park
pressure (and
congestion
6. Pool car registrations due to
PTPs
7. No of staff transferring to active
travel
8. No of staff moving to public
transport
9. Cycle to work uptake
1. Trees to be planted on 30th
April
2013
Volunteers to plant the trees Trees purchased
2. Undertake survey’s on
bird/insect that use the area both
before the plnting and then one
year on
Someone to undertake the
surveys
None
3. Reaction of patients to the
project over the coming years
Hospital staff to ask and gauge
the patients comments and
reactions to the varying changes
to the trees over the seasons
None
4. Is the fruit being picked Get the hospital’s League of
Friends to pick the fruit, when
ripe
That patients will be allowed
to eat the fruit and that the
League of Friends can use
the fruit to raise money for
patient related items
5. Check the trees are being
pruned each year
Get the League of Friends to
take ownership of this
None
6. At the appropriate time of the
year ensure that wild flower
seeds are sown
Get the Estates Department’s
gardener to undertake this task
That the seeds will grow
anywhere
Project 8 –
NHS Forest Pilot
Organisation:
Wye Valley NHS Trust
Key contact(s)
Martin McKay
What?
Aim: to plant 60 fruit trees at
our Community Hospital at
Bromyard, Herefordshire
7. Discuss this with a local bee
keeper
Names of local bee keepers What with the fruit trees and
hopefully the wild flower
meadow, this area will be
suitable for bees
103
Feed Back Form
This report is intended to inform and inspire action. We are interested in hearing your comments, constructive criticisms and especially reports of progress inspired as a result of the project. You can use this form to do so if you wish. Please e mail it to [email protected]
Name: _______________________________________________________________________________________________ Organisation: _________________________________________________________________________________________ Phone Number: E Mail address: __________________________________________________________________________
Comment:
East Midlands NHS Sustainable Development Network
East MidlandsClinical Commissioning Group
Park House Medical Centre
Cover designed by dapr collective ltdwww.daprcollective.co.uk
EM NHS COVER final:EMNHS COVER 19/06/2015 12:19 Page 2