Making savings while saving the environment

The Securing Healthy Returns report has calculated potential NHS savings of £414 million and the potential to cut one million tonnes of carbon emissions every year by 2020. Health Business’ Rachel Brooks explores the research

In a time where the NHS is facing a myriad of challenges, ranging from dwindling numbers of health professionals and a burgeoning financial deficit, it is wise to be conscious of the numerous ways in which the healthcare system can implement strategies to ensure the long term sustainability of the service.

With over 1.3 million people working in the NHS alone, the health service is both a significant component of the regional economy and owner of a vast carbon footprint. Data shows that the NHS is the largest public sector contributor to climate change in Europe, emitting 22.8 million tonnes of carbon dioxide equivalents (CO2e) each year.

The Sustainable Development Unit (SDU) is accountable to NHS England and Public Health England and exists to support the NHS, public health and social care to embed and promote the three elements of sustainable development - environmental, social and financial. The SDU’s Securing Healthy Returns report, compiled in coordination with the Healthcare Financial Management Association (HFMA), outlines a number of methods which can be used to mitigate the environmental effects of the NHS, whilst also making impressive financial savings.

Securing Healthy Returns draws attention to a series of instances where the health and care system has the potential to improve sustainability through financial and environmental means, to aid decision makers in making the right choices for their healthcare business. In fact, data from the study claims the health sector could save £414 million per year, along with an annual reduction of one million tonnes of CO2e by 2020.

The research encourages managers of healthcare organisations to assume a kaleidoscopic approach to implementing sustainability initiatives, to choose financial investments that address social, economic and environmental issues, over those which merely cut the numbers.

The Five Year Forward View
As voiced by Sandra Easton, chair of the HFMA, we need to ‘exploit the financial opportunities of being socially and environmentally sustainable’, in order to meet the £22 billion efficiency savings outlined in the Five Year Forward View.

At the end of last year, NHS England shared new guidance directing every health and care system in England to produce a Sustainability and Transformation Plan (STP). The STPs should be designed to set out how local services will evolve to become more sustainable over the next five years. The report advised moving towards more long term principles of improvement, as opposed to short term routes involving quick fixes. It claimed that using this technique in areas ranging from procurement, public health and better models of care can significantly improve the NHS’s financial and environmental forecast.

Carbon cutting interventions
Examples of sustainable measures were included in the SDU’s Carbon and Cost Benefit Curve, which displayed 35 carbon cutting interventions. The graph measured the tonnes of CO2 emissions saved against the cost per tonne of CO2 emissions saved. The resulting data highlighted that the most dramatic savings were made, both financially and environmentally, through measures such as waste prevention, waste reduction, alternative models of care and staff behaviour.

The top ten ranked interventions which sustained a top figure of savings and a reduction in CO2 included: theatre kits in hospitals - reducing packaging; sugar reduction in soft drinks; combined heat and power (CHP); reducing medicine waste; active staff travel; psychiatric liaison; biomass boilers; effective use of long-acting injections; driver training for fuel efficiency and safety; and reducing social isolation in older people.

For example, the graph plotted potential savings made from active staff travel, which involves encouraging staff and visitors to walk, cycle or use public transport to get to sites. The benefits from switching to this mode of transport could mean the NHS would generate £2.9 million in savings, thanks to reduced vehicle use and air pollution and added health benefits from exercise.

Collaborative working is successful working
The report outlined the importance of collaborative working to ensure smooth and effective implementation. The analysis pointed to the importance of considering the wider benefits when contemplating a particular sustainability initiative. Since the financial decision made by health organisations will ultimately impact on local health and well-being, health sector organisations have a responsibility to select financial processes which minimise negative impacts on local public health and social value.

It recommended that an integrated approach to sustainability should: support local employment in the supply chain through sustainable procurement; support innovation and participation in efficiency through staff and community engagement; protect local public health through reduced air, water and ground pollution; and use investment in NHS infrastructure to leverage social value. This could be done by connecting a new energy plant to a district heating network to supply low cost heat to people in fuel poverty, for example.

The report also highlighted the importance of using Organisational Sustainable Development Management Plans (SDMPs), which are in place in most NHS organisations. The aim of SDMPs is to bring together measures that drive down the use and cost of finite resources, as directed by the NHS Constitution Commitment, Number 6, which states: “The NHS is committed to providing best value for taxpayers’ money - it is committed to providing the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.”

Another measure which performed well on the graph included the installation of combined heat and power (CHP) systems which generates usable low cost, low carbon heat and electricity. Rampton Hospital replaced its coal fired heat plant with a CHP unit and a wood chip boiler. Following its implementation, the trust managed to reduce energy costs by 44 per cent, making an annual saving of around £790,000 and cutting 8,614 tonnes of CO2e.

Cost cutting case studies
A further case study from the SDU documents the savings made by Sussex Community NHS Foundation Trust. Staff across the trust were travelling almost six million business miles per year, representing a collective cost of £3 million and producing a similarly significant quantity of carbon emissions.

In order to help alleviate the costs, the trust created a Business Travel Plan with resources to assist staff in reducing their business mileage. The strategy involved encouraging staff to book one of 15 low emission vehicles for use during work hours, allowing them to travel to work on foot, by bike or on public transport. As a result of the Travel Bureau initiatives, the trust was able to shed 949,500 miles from its business milage, translating to a saving of £500,000 and 60 tonnes of CO2e, in the first year after launch.

Meanwhile, a Worcestershire County Council and local CCGs programme launched a Social Impact Bond, whereby social investors covered the upfront costs for social enterprises and charities to deliver new and exciting programmes to address the needs of vulnerable groups and reduce social isolation for 3,000 older people. The programme will deliver £1.3 million in direct annual savings and 244 Quality Adjusted Life Years (QALYs – worth £15 million in avoided social cost), reducing CO2e by 217 tonnes.

More progress needed
The report maintained that many organisations have already made progress in aligning financial and environmental sustainability. However, in order to fully reap the financial, social and environmental benefits and potentially save £414 million annually, the report calls for improved collaborative working with finance, sustainability facilities, procurement, commissioning and between all health staff.

Michael Brodie, Finance and Commercial director for Public Health England, commented: “In addition to the legal and scientific reasons for taking sustainable development and climate change seriously, there are equally important financial and organisational reasons for action. In PHE, we have already saved millions of pounds and reduced our carbon footprint by rationalising processes and estate, empowering our staff and the public with the latest opportunities in IT. We will continue to work with our partners in health and local government to create the right conditions for a fair, healthy and sustainable future for us all.”