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Change in the NHS will have huge effects

In every sector, the need for efficiencies is crucial to the way organisations function and gain competitive advantage.

Those who cannot do so will lose market share, run up deficits and operate in a manner that is financially, socially and environmentally unsustainable. Terms such as circular, low-carbon and green economies are becoming commonplace, even though they can mean different things to different people.

The UK’s health and social care sector is no different in its need to operate more efficiently. It is currently faced with significant financial, socio-demographic, logistical and legislative challenges, and these will increase in the future. According to the King’s Fund, during the next 50 years, the sector could become one of the largest in the economy. The Office for Budget Responsibility is arguing that, by 2062, it could account for around £1 trillion of a total spend of £4.8tr.

The NHS is one of the largest organisations in the world, employing around two million people and delivering an array of services to a population of more than 50 million. These services are delivered from hundreds of thousands of sites, to a public that expects choice and quality, whether it is at their acute site or local GP. Procurement of pharmaceuticals and medical instruments comprises 72% of the carbon emissions within the sector.

There are a number of corporate, financial and environmental drivers for the NHS to engage with the sustainability agenda. For example, the Public Services (Social Value) Act 2012 requires commissioners of public services to take into account economic, social and environmental value, not just price, when buying goods and services, while the Climate Change Act calls for lower carbon emissions. So is enhanced sustainability within the healthcare sector a reality or a pipe dream? The answer is it is a reality, and there are a number of instances of good practice across the UK. For example, the use of a combined heat and power system by Birmingham Heartlands and Solihull NHS Trust enabled the generation of its own electricity and savings of £688,000 annually and reduction of its carbon emissions by 1,627 tonnes. And through a waste minimisation project called ‘Waste it Not’, the Cornwall NHS Hospitals Trust was able to identify savings of £53,000 and cost avoidance of £200,000 in waste treatment and disposal costs in its first two years alone. 

But for sustainability to become truly embedded and long-term, various factors need to be put in place. First, there should be a greater evidence base on which to make decisions. The Healthcare Waste and Resources Research Group at Northampton university has promoted this, for several years. Second, sustainable resource consumption has to be incorporated into the strategic plans of sites, and there has to be commitment from senior management in the form of resources (ie finance and personnel).

Third, implementation of low-carbon technologies should be seen as an investment, and while it may not always realise significant short term financial savings, it can do so with time. The pressure to reduce costs and meet health services targets means that, too often, environmental management decisions within the sector tend to be made looking at shortterm gain, on small-scale project basis, rather than for the long-term. This leads to hesitancy in investment and limitations in success.

Fourth, there should be more partnership building, looking at ways in which healthcare facilities, as energy-intensive organisations, can work with others in the community. For example, the Gundersen Lutheran Health System in La Crosse, Wisconsin, US, uses biogas discharged from the nearby City Brewing Company’s waste treatment process and turns it into electricity.

Fifth, staff engagement is crucial if there is to be buy-in and behaviour change in terms of resource consumption. Sixth, rather than reinventing the wheel, it should learn from other sectors.

Given its size and reach, any improvements in the sector can have real effects across society and economy. Improved sustainability can lead not only to environmental compliance, but also to costs savings, sustainable resource management and public health benefits. For example, a reduction in travel and transport would lead to reduced air pollution and traffic noise, improved patient experience and increased levels of physical activity.

The challenge is making all this a reality.

Dr Terry Tudor is senior lecturer in waste management, University of Northampton

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