The NHS has ambitious sustainability goals. Currently responsible for 4-5% of the UK’s total carbon footprint, the NHS is the first health service in the world to commit to becoming net zero by 2040. To support this ambition, all trusts and integrated care systems (ICS) were tasked with creating Green Plans before 31 March 2022, which must be reported on annually and refreshed every three years.
In response to guidance from NHS England, most plans have common areas of focus and must incorporate how their initiatives will be governed, tracked and reported on. But whatever the specific initiatives and targets, in our experience there are three ingredients that should be embedded to support successful delivery, which all rely in part on culture.
Defining your starting point
ICS Green Plans should be based on the strategies of its member organisations, yet there are likely to be significant differences both in sustainability priorities and preparedness at this early stage. Typically, local authorities may be further ahead in quantifying and monitoring emissions than their system partners, while primary care has not traditionally been required to report on energy usage or emissions data. Targets and challenges will differ too, between those with more office-based activities and estates versus those delivering frontline care.
Acknowledging these differences and agreeing suitable targets for each partner, that recognise their respective starting points and capacity for change, can help to develop a plan which allows each part of the system to strive for meaningful, achievable progress.
To monitor progress, systems need to baseline their scope one and two emissions – those that are directly within the organisations’ control and the initial area of focus for carbon reduction – as well as making some inroads on scope three which relate to supplier emissions. While the quality of data and scale of the challenge may differ between partners, it is better to agree a consistent and transparent process for collecting, analysing and monitoring data, even if imperfect, to encourage early information sharing and accountability across the system.
Collaborating on your journey
Successful implementation of Green Plans doesn’t automatically mean you need to do more. For most integrated care boards (ICBs), the starting point is aligning what is already there. What are your partner organisations already doing about travel and transport, digitalisation, recycling and greener procurement, for example? And how can those plans be developed or aligned with other initiatives to strengthen impact? By coordinating plans, sharing learning and engaging across partners, ICBs can more easily identify opportunities to make better inroads into carbon reduction.
A good example of this is medication, one of the main sources of emissions in the NHS, and particularly for primary care. Real headway is starting to be made in tackling the worst offender – pressurised metered dose inhalers (pMDIs) – but systems can accelerate this progress by facilitating shared learning. While GPs and community pharmacists have a significant role to play in supporting patients to move to lower carbon footprint alternatives, by sharing clinical evidence, patient resources and impact data with colleagues in acute settings, systems can enhance results while offering a consistent approach for patients across all healthcare settings.
There is even greater gain to be had if we embed sustainability into existing initiatives. Growing use of social and green prescribing is starting to challenge reliance on medication, where appropriate. While this may be more focused on improving patient outcomes and access to services, there’s a climate benefit too. By looking at this from a system perspective, partner organisations can identify the full range of services and support available, tackle duplication and identify opportunities to expand social initiatives, whether, for example, by sharing patient outcome data or making better use of estates. As part of our carbon reduction commitment at Arden and GEM, for example, we’re exploring sharing our facilities with system partners to support more sustainable, cost effective services.
Investing in behaviour change
From our own organisational experience as well as working with NHS organisations in developing their Green Plans, success relies on changing people’s behaviour. This means investing in engagement with all those affected by the plans. Even relatively small-scale initiatives can be an unwelcome disruption for those affected if they are not part of the journey. By actively engaging with our own staff, including recruiting a team of green champions to develop ideas and encourage participation, we’ve seen interactive initiatives tackling issues such as food waste, fast fashion and transport generate broader interest and action, alongside core initiatives to reduce office and IT waste. The same engagement principles apply whether you work for a dentist, GP practice, NHS Trust or ICB.
Alongside grassroots engagement, senior level commitment to sustainability, evidenced through actions as well as words, matters. Although NHS England’s Greener NHS programme requires board level representation for sustainability, if this is an add-on to an already busy portfolio rather than a dedicated role, there is a danger the sustainability agenda will not get the attention it needs. And while the approach may need to differ depending on the partner organisation, leading by example is a powerful driver in supporting wider behaviour change.
We are already more than one year into NHS Green Plans and inevitably many will harness quick wins. By this time next year, it will be time to consider how to step up a gear ahead of developing revised plans in 2025. Systems will be far better placed to drive broader engagement and long-term impact if they can develop the culture, collaboration and data sharing needed now to meet their short-term goals.
By Justine Harding, estates and facilities manager, and Becky Jones, social value specialist, at NHS Arden & GEM CSU
