Strategy Summary A strategy document that sets out the aims and objectives for the Trust’s environmental and social responsibility.
Document Detail Document Type Trust Strategy Document name Environmental Sustainability Strategy Refresh Document location Essentia SharePoint Document Library Version As recorded on Essentia SharePoint Document Library Effective from 24 April 2013 Review due date April 2015 Owner Director of Essentia Author Sustainability Manager Approved by, date Trust Board, 24 April 2013 Superseded documents Environmental Sustainability Strategy, 2010 Related documents Keywords Sustainability, carbon, corporate social responsibility Supporting references e.g. N/A
Change History Date Change details, since approval Approved by
This is a strategic document that aims to support the delivery of the best, most efficient and forward thinking healthcare. It supports the NHS Sustainable Development Unit’s view that a sustainable healthcare system must do more than focus on carbon. This strategy also considers how to minimise other negative impacts, for instance reducing waste and harmful environmental or social impacts. It also drives the Trust to maximise the positive impacts of delivering care by adding value at every point and by making every effort to enhance health and reduce the need for services in the first place.
Since the launch of the award-winning1 environmental sustainability strategy in 2010, Guy’s and St Thomas’ NHS Foundation Trust has established itself as a leader in the field of environmental sustainability in the healthcare and business sectors on a local, national and international scale.
This strategy is designed to reflect the developing nature of services, as well as complement partnerships with fellow King’s Health Partners (KHP). Since the original launch of this strategy, and as part of the KHP, Guy’s and St Thomas’ has grown to deliver care for nearly 1.6m patients each year in the hospitals and recently integrated community care and support services. This strategy aims to ensure a consolidated approach to sustainability in Guy’s and St Thomas’ operations in the acute and community settings, through co-ordinated communications and strategic support.
This strategy “refresh” serves not to replace the original strategy document, but to fortify it, adapt it to a changing and growing business and ensure that plans of action are practical, leading and ambitious.
Efforts to save energy at Guy’s and St Thomas’ NHS Foundation Trust have resulted in a reduction in energy use of 24% per patient contact since the baseline year of 2007/2008. Absolute emissions have been reduced by 1.6%.
1.1 Key initiatives proposed in strategy
Table 1 below summaries the key programmes of work for sustainability over the next 2-5 years.
Initiative
Strategic theme Timeframe Status
Implement sustainability strategy for capital development
Designing the built environment
2013/14 Part-implemented, training for project managers March/April 2013
Comprehensive water saving programme
Water conservation 2013/14 – 2018/19 Agreement to be signed March/April 2013
Maximise value of waste through ‘waste to energy’ technology
Waste minimisation 2014/15 Working with London Procurement Partnership (LPP) to consolidate waste across London NHS
Invest in energy efficiency to reach or
Energy and carbon 2013/14 – 2020/21 Absolute emissions reduced 1.6%,
1 Best Carbon Reduction Strategy in Acute Care, Building Better Healthcare Awards, 2010
Establish governance committee to oversee sustainability strategy implementation
Governance and finance
2013/14 Proposed in strategy refresh March 2013
Table 1 – Key sustainability initiatives proposed
1.2 Strategic timeframe
The Trust strategy, approved by the Board in 2010, has a lifecycle of 5 years in line with the government’s target for a 10% reduction in carbon emissions by 2015. This document serves as a mid-lifecycle review.
1.3 Financial savings and benefits to the Trust
The notion of sustainable development recognises the importance of environmental, social and economic components. In the case of the Trust, achieving financial savings is a crucial part of its ongoing economic sustainability; and cost savings achieved through environmental initiatives contribute towards these.
The programme of work associated with energy efficiency and environmental sustainability already delivers an estimated £3.2m in savings each year. These savings are illustrated in Table 2 below.
Project Date of implementation
Cost of implementation Financial savings (annual)
Installation of combined heat and power (CHP) engines
2009 No cost to Trust (£10,000,000 grant from Department of Health)
£2,000,000
Installation of motion sensing, daylight sensing and high efficiency LED lighting (dimmable in ward settings)
2010-ongoing £113,103 £203,977
Fitting more efficient pumps, inverters and VSDs
2007-11 £150,326 £91,843
Thermal insulation for heated services
2007-11 £250,000 £103,224
Upgrading BEMS / BMS 2007-11 £256,000 £151,514
Employee awareness and support of Local Environment Representatives
2007-ongoing £30,000 annually (approximately)
£70,000
New chiller at Guy’s 2012 £1,000,000 £450,000
Centralised computer power management
2012 £45,000 in year one, £9,000 in years two and three
Table 2 – Achieved energy efficiency savings to date
Through the implementation of the sustainability strategy refresh, the Trust has identified potential further savings of an additional £2,350,000 per annum. Table 3 details the interventions to achieve these savings.
Plant upgrades in Lambeth and North Wings (St Thomas’) – bid to Dept. of Health Energy Efficiency Grant Fund (Feb 2013)
£2,500,000 £784,000
Efficient lighting throughout Trust – bid to Dept. of Health Energy Efficiency Grant Fund (Feb 2013)
£677,000 £170,000
Automated Meter Reading (AMR) system
£500,000 No direct financial payback, but system enables better management and engagement
Additional projects identified by the Carbon Trust and engineering teams
To be confirmed 846,0002
Strategic water saving programme No capital outlay - 50% of savings achieved to go to company funding interventions
£60,0003 (actual £120,000, but 50% goes to water saving partner)
Staff engagement and LER support. Examples of actions to be taken:
Governance board engagement,Communications and road shows,Engagement with ward staff to maximise pharmaceutical use,Staff training, Implementation of staff savings ideas, Engagement through staff social network.
Approximately £50,000 per annum
£480,000 per annum, based on a 5% reduction in energy used in 2011/12
Total £3,727,000 £2,350,000
Table 3 – Future energy saving projects
1.4 Strategy engagement and development
This strategic document has been developed with the input from a wide range of stakeholders through facilitated workshops and an online feedback survey. 66 key Trust leaders, including several from GSTT community services, contributed through
2 Estimated savings based on the findings of the Briar Associates / Carbon Trust report ‘Strategic Review of Carbon Management Practices and Project Register for Guy’s & St Thomas’ NHS Foundation Trust’, November 2012. 3 Savings based on a reduction in water consumption of 20% compared to 2011-12 baseline of 437,165m3.
workshops and 643 members of the community and staff responded to the online survey. This feedback has served to influence and prioritise implementation, and a summary can be found in appendix VI.
1.5 Carbon reduction targets and NHS progress to date
UK Government carbon reduction targets adopted in the 2008 UK Climate Change Act remain in place, and the NHS remains committed to cutting carbon dioxide equivalent (CO2e) emissions in line with these targets.
These carbon reduction targets are as follows:
10% by 2015
34% by 2020
At least 80% by 2050
Overall, the NHS has reduced its CO2e emissions from building energy, water and waste by 1.9% in 2011/12 when compared with 2007/84. These reductions have been achieved despite increases in clinical activity of 11.4%. The total savings to the NHS from these reductions are approximately £10m per annum.5
The NHS Sustainable Development Unit continues to support NHS organisations to deliver upon sustainability objectives and recently published its “Sustainability in the NHS: Health Check 2012”, which provides an update on progress against carbon reduction targets, as shown in the table below.
Figure 1 depicts the carbon reductions achieved by the NHS in England since 2010, as well as the targeted reductions to 2020. The trend shows that NHS emissions have stopped rising, but it remains clear that the NHS is still not doing enough to meet the ambitious targets set out by the Climate Change Act.
Figure 1 - NHS England historical and projected CO2e emissions and targets
4 NHS Sustainable Development Unit, 2012 5 Eastern Region Public Health Authority, 2012 http://www.erpho.org.uk/viewResource.aspx?id=21509
As a leading healthcare organisation already recognised for its work in environmental sustainability, it remains the Trust’s responsibility to continue to deliver new and significant carbon savings and work with other NHS organisations to help them do the same.
1.6 London’s progress to date
Figures from the NHS Sustainable Development Unit for 2011/12 show that London leads the rest of the NHS in carbon reduction, with a 12.1% reduction in overall emissions from a 2007/8 baseline6.
This is an encouraging trend and is partly due to the strong carbon reduction network in London and a focus on collaborative working and knowledge sharing.
1.7 Guy’s and St Thomas’ progress to date
Since 2010 the Trust has grown significantly and integrated community sites and services, increasing the range and complexity of services delivered and the numbers of patients served. In 2011/12, Guy’s and St Thomas’ served 1.6 million patients, nearly double the number in 2010; while employee numbers also grew significantly. Figure 2 below is a breakdown of the Trust’s carbon emissions in 2011/12, showing that the main emissions sources are energy use and procured goods and services, including pharmaceuticals and medical instruments Total emissions for the Trust were 113, 016 tonnes.
6 NHS Sustainable Development Unit, 2012 http://www.sdu.nhs.uk/corporate-requirements/measuring-carbon-footprint/nhs-carbon-footprint.aspx
Figure 2 – Guy’s & St Thomas’ carbon footprint summary
This analysis shows that procured goods and services account for 49% of the total carbon impact of the Trust. Pharmaceuticals and medical instrument manufacturing have a particularly high impact, comprising 12% and 8% respectively of the total. In England, research by the NHS SDU suggests that in 2010, 22% of NHS greenhouse gas emissions were attributable to pharmaceuticals and 8% to medical devices. The Trust’s proportions are slightly lower than this average7. Water has a small carbon impact when compared with energy and procurement, but its ecological and financial costs are far greater than demonstrated by a carbon footprint. For these reasons, the Trust will be systematically addressing water use across the Trust to reduce consumption. This analysis includes travel emissions from Guy’s and St Thomas’ fleet, which includes some patient transportation; however it does not include patient transport in taxis. The Trust does not have specific information on travel emissions from taxis, as this is not currently recorded by the Trust’s suppliers. Figure 3 below shows CO2e emissions from energy use for the Guy’s and St Thomas’ acute sites. The baseline year for reductions is 2007/8 and this graph demonstrates a 1.6% reduction on the acute sites.
7 “International pharmaceutical and medical device guidelines”, NHS Sustainable Development Unit, 2012.
Figure 3 - Absolute CO2e emissions for Guy’s and St Thomas’ acute hospitals
The Trust’s carbon emissions per patient contact have been reduced by 24% since the baseline year, demonstrating that more efficient use is being made of energy in delivering more services. Figure 4 below shows carbon emissions from energy per acute patient contact since 2006/07.
GSTT Acute Sites Emissions Per Patient Contact
0.000
0.010
0.020
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0.040
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2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
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Figure 4 - CO2e emissions per patient contact – Guy’s and St Thomas’ acute hospitals
There are significant risks to the Trust if action is not taken to reduce energy use. The term ‘value at stake’ (VAS) refers to the cumulative difference (both in carbon and financial costs) between a ‘business as usual’ (BAU) and ‘reduced emissions scenario’ (RES). Using a modelling tool developed by the Carbon Trust, the VAS has been estimated comparing achievement of the targeted 34% emissions reduction by 2020; and allowing emissions to increase by 3% per year under the BAU scenario. The financial analysis is based on energy prices only and assumes a conservative 5.7% annual rise in energy unit prices under both scenarios. The analysis shows a financial VAS of £12.8m in 2020/21 and £52.2m between 2011/12 and 2020/21. The carbon VAS is 37,325 tonnes in the year 2020/21; and a cumulative 172,196 tonnes.
Figure 5 below shows Guy’s and St Thomas’ CO2e emissions since 2005/06; and projected emissions to 2020/21 under the BAU (blue dashed line) and RES (yellow dashed line) scenarios. The area between represents the carbon ‘value at stake’.
Historical, Projected (BAU) and Target Energy CO2 Emissions
0
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20,000
30,000
40,000
50,000
60,000
70,000
80,000
2005
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2006
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2007
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2009
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2010
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2011
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2012
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2018
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Year
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Historicalemissions
Projectedemissions (3%annual increase)
Targetemissions
Figure 5 - GSTT historical emissions and projected emissions under BAU and RES scenarios
1.9 Notable areas of work and achievements
The Trust has made a conscious effort to take a holistic approach to environmental sustainability, considering not only the impacts of energy use, but also those from water use, waste, purchasing and travel. Staff and patient engagement has also been integral to this programme.
Energy and carbon Despite growing as an organisation, the Trust has seen a 1.6% reduction in carbon emissions from energy at acute hospital estate compared to the baseline. Trust emissions per patient contact have been reduced by 24% since 2007/08.
In 2012, centralised PC power management was installed on all Trust PCs to power down PCs and monitors when not in use. This is projected to save over £125,000 each year in energy costs and should have no negative impact on users.
The Trust invested £10m from the Department of Health’s Energy and Sustainability Fund to install low-carbon combined heat and power engines. These engines efficiently generate heat and electricity on site, reducing carbon emissions and cutting energy bills by nearly £2m each year.
Water The Trust’s water use in 2011/12 was 9% lower than the 2007/8 baseline; however, water use per square metre remains higher than best practice levels for acute care. Water use will be further reduced through a comprehensive approach to leak detection, demand reduction, monitoring and reporting.
Waste 30% of the Trust’s domestic waste is recycled; up from just 6% during the baseline year of 2007/8; however waste still represents a significant cost to the Trust. There is potential for the Trust to strategically approach waste management to reduce costs and generate value from its waste streams. Essentia will be working to develop a programme for maximising value from waste and ensure a continuing focus on waste compliance, avoidance and recycling, particularly through improved staff awareness.
Procurement In 2012 a detailed analysis of the carbon footprint of the Trust supply chain was carried out, in order to set a baseline and identify carbon ‘hot spots’, such as pharmaceuticals. The results will be used target engagement with those suppliers who have the highest impact; and will work to standardise and embed purchasing of goods and services with a reduced environmental impact.
Travel The Trust aims to encourage staff and patients to travel actively and sustainably to its hospitals, and has installed additional secure cycle parking at St Thomas’ and improved shower and changing facilities at Guy’s and at St Thomas’. The sustainability team is also working with the Patient Transport and Distribution team to measure and monitor the environmental impact of patient travel and the Trust vehicle fleet.
Engagement and awareness Environmental sustainability is now a core part of Corporate Induction for all new staff at the Trust. The sustainability team also supports over 100 Local Environment Representatives (LERs) through training, advice and support, a dedicated budget for implementing savings suggestions and bi-monthly training sessions. A monthly e-newsletter on sustainability issues, The Green Room, has also been developed.
1.10 Measurement and reporting
The sustainability team has developed a set of sustainability reporting metrics or key performance indicators (KPIs) in order to provide a succinct visual summary of progress in relation to sustainability priorities. They are presented in the form of a reporting ‘dashboard’, using a traffic light system that enables those reading the report to understand quickly and accurately whether or not the Trust is meeting its sustainability objectives.
The dashboard includes total or ‘absolute’ figures for energy, water, waste etc.; as well as a metric normalised by the number of patient contacts, to place the data in the context of GSTT activities. An example is shown in Table 4 below (note that this data relates only to the two acute sites):
The dashboard and a summary report will be included in the Trust’s Annual Report. Additionally the KPIs for use of energy, water and waste will be reported on a quarterly basis to the Trust and Essentia boards.
1.11 Guy’s and St Thomas’ commitment
The Trust has over 1.6m patient contacts each year, employs 12,500 staff and operates 24 hours a day, 7 days a week. This activity will inevitably impact the environment and Guy’s and St Thomas’ recognises that as a healthcare provider that promotes wellbeing, the Trust has an important responsibility to minimise its impact on the environment and ensure that resource use is as efficient as possible in order to maximise funds available for patient care.
Recognising the need for leadership, Guy’s and St Thomas’ NHS Foundation Trust seeks to meet NHS carbon reduction targets and this strategy has been developed to build upon national leadership. The strategy uses the thematic framework of the NHS Sustainable Development Unit (SDU) Carbon Reduction Strategy for England, Saving Carbon, Improving Health, published in January 2009 and updated in 2010 and 2012. A further update to this strategy is due in January 2014, and an engagement period will take place throughout 2013 to develop this. The Trust will contribute to these strategic developments and will ensure that they are reflected in this strategy.
1.12 Patients and sustainability
In 2012, the NHS SDU commissioned Ipsos MORI to conduct the first ever independent survey of NHS patients from across the UK on their views about environmental sustainability in the NHS8.
8 NHS Sustainable Development Unit, 2012, Page 5, http://www.sdu.nhs.uk/documents/publications/Sustainability_in_the_NHS_Health_Check_2012_On-Screen_Version.pdf
92% of patients surveyed stated that they believed the NHS should work in an environmentally sustainable way, and 19% said that sustainability should be a top priority.
Figure 6 – Patient attitudes to sustainability in the NHS
These survey results clearly demonstrate that environmental sustainability is not simply a “nice to have” in the NHS, but an integral part of what patients believe is quality care. Actions to improve environmental responsibility must be clearly communicated to patients and clinical and non-clinical staff must be seen to be acting in an environmentally responsible manner as part of delivering the best possible care.
1.13 Corporate Social Responsibility and the environment
This sustainability strategy continues to support the Trust’s Vision for Corporate Social Responsibility (CSR) and seeks to collaborate with the Workforce directorate to deliver upon this.
Vision for Corporate Social Responsibility Guy’s and St Thomas’ commits to enable patients and staff to contribute towards and participate in the corporate social responsibility agenda. The Trust will support the Guy’s and St Thomas’ community to deliver efficient, responsible and sustainable healthcare; and reduce barriers to patients and staff being involved. 1. We will seek to deliver the best and most ethical healthcare through developing
and promoting services and products that we buy that support a more sustainable way of life.
2. We will measure and publicly report on our environmental impact and set
challenging targets to lower our impact on the environment. 3. We will seek to foster strong positive relationships with our diverse local
communities and staff. We will meet diverse need, promote social mobility and tackle inequality.
4. We will team up with suppliers to minimise impacts: sourcing more sustainable and
local products and services where possible, with particular emphasis on reducing carbon emissions.
5. We will give our employees information to increase their awareness of the impact
of their actions on the planet both at work and at home. 6. We will work in partnership with our local and business communities in ways that
meet their environmental, economic and social needs and have a positive effect on our business.
7. We will use our influence and resources to support international health
development and enrich our community through shared learning. 8. We will promote healthy and sustainable lifestyles for our patients and staff and
enable them to take responsibility for this.
1.14 London 2012 Olympic and Paralympic Games legacy
The London 2012 Olympic and Paralympic Games, held from July – September 2012, provided a once-in-a-lifetime opportunity to increase levels of physical activity and improve health and wellbeing. Key areas of focus for the sustainability agenda were the promotion of sustainable active travel and interventions to save energy and reduce waste. Through the 2012 Challenge, a competition amongst teams comprised of staff groups from across the Trust, new ways of working to reduce waste and energy use were implemented, as were initiatives to promote healthy living. Examples included:
The development of a GSTT staff cycle challenge Installation of energy saving lighting and recycling bins in staff and patient areas Creative use of second-hand and unwanted items for art projects Installation of 80 new secure bicycle racks at St Thomas’ to enable more staff to
travel actively, Upgrade of shower and changing facilities at both hospital sites Continued bi-monthly led lunchtime walks in the local area, open to all staff
Increased physical activity through active commuting and in the workplace can improve productivity and staff morale, as well as reduce sickness absence. It also serves to reduce vehicles on the road and can bring people together to promote a community spirit.
2. Revised Sustainability Aims for the Trust’s Sustainability Strategy
2.1 To achieve its sustainability aims, Guy’s and St Thomas’ NHS Foundation Trust will:
Recognise our responsibility to mitigate and prepare for the impacts of climate change
Promote the health & wellbeing of staff, patients and visitors through sustainable behaviours
Promote environmental stewardship and the responsible use of resources to minimise costs and maximise funds available for patient care
Work collaboratively within the NHS & the wider community to promote
sustainability Embed environmentally sustainable practices and understanding of sustainability
within the Trust
Develop a process to measure & report progress on performance 3. Strategic themes
3.1 The themes of the strategy were developed by the NHS SDU and are intended to cover the key areas of sustainability. They are:
Procurement and food – Addressing sustainability in the supply chain Low carbon travel and transport – Encouraging active and sustainable travel for patients and staff Energy and carbon management – Reducing carbon dioxide and other greenhouse gas emissions
Designing the built environment – Building sustainability into the trust estate Communications and engagement – Communicating to staff and patients, training and developing staff to encourage sustainable behaviour as the norm
Water conservation – Promoting efficient use and innovative solutions for conservation Waste minimisation – Promoting appropriate use of materials and sorting of waste The role of partnerships and networks – Collaborating and sharing lessons with other businesses addressing their environmental impacts Adapting to a changing climate – Building resilience into clinical services and the Trust estate Governance and finance – Budgeting for, financing and integrating sustainability into Trust processes
4. Development of Strategic Themes and forward direction
4.1 Procurement and food:
The Trust spends nearly £500,000,000 on products and services each year, making it one of the largest single buyers in all of London. Purchasing choices impact on the environment, society and communities. 65% of the total carbon impact of the NHS is
embodied in the supply chain9. These facts make it imperative that procurement is one of the key areas of strategic focus.
The impacts of how products, including food, are produced, transported, used and disposed of on the environment, society and the local economy must be considered. The Trust must ensure that buys from environmentally and socially responsible suppliers and that its strategic commitments reflect this.
As a responsible public company, Guy’s and St Thomas’ commits to understanding and interrogating the ethical and environmental credentials of its procurement partners. The Trust has committed to be the first healthcare organisation to sign up to the “Ethical Trading Initiative” (ETI), a global alliance of companies, trade unions and voluntary organisations that works to improve the working conditions of vulnerable workers who grow or make consumer goods. Additional information about the ETI is provided in Appendix IV.
The Trust will:
Ratify and follow the Trust Sustainable and Ethical Procurement Charter, which sets
out the Trust’s aims and provides guidance and support for those making procurement decisions.
Become the first healthcare organisation to sign up to the Ethical Trading Initiative10, an alliance of companies, trade unions and voluntary organisations that work in partnership to improve the working lives of poor and vulnerable people across the globe who make or grow consumer goods.
Set a baseline carbon footprint for the products and services that the Trust buys, based on an assessment carried out by independent experts; and focus attention on those areas with the highest carbon impact, for example construction and pharmaceuticals.
Work with the London Procurement Partnership (LPP) to maximise potential for the Trust and other NHS bodies to purchase sustainably and ethically sourced goods and services.
Promote use of the “Greenhouse Gas Accounting Sector Guidance for Pharmaceutical Products and Medical Devices” developed by the NHS Sustainable Development Unit to guide purchasing decisions.
4.2 Low carbon travel and transport:
A survey of 3,146 Trust staff in March 2012 shows that two thirds of staff walk, run or cycle as part of their journey to work. Nearly 17% of staff actively commute as their main form of transportation, up from 15% the previous year. These active travel choices have not only been proven to improve health11, but also reduce road congestion and improve air quality and road safety by reducing the number of vehicles on the road.
9 Sustainability in the NHS: Health Check 2012. NHS Sustainable Development Unit, 2012. 10 Ethical trading initiative (ETI), base code: http://www.ethicaltrade.org/sites/default/files/resources/ETI%20Base%20Code%20-%20English_0.pdf ETI Principles of Implementation: http://www.ethicaltrade.org/sites/default/files/resources/Principles%20of%20Implementation%2C%20ENG.pdf] 11 Woodcock J, Edwards P, Tonne C, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: urban land transport. Lancet 2009;
Amongst other activities, the Trust has supported active and sustainable travel through:
Commitment to the Mayor of London’s NHS cycle strategy (1st and 2nd phases
completed) Development of new secure cycle parking facilities at St Thomas’, adding 85 parking
places Refurbishment of showers and changing facilities in the Thomas Guy Clubs at Guy’s
and St Thomas’ Regular free cycle maintenance, training and safety awareness
The Trust will:
Complete the 3rd phase of the London NHS Cycle Strategy, as detailed in Appendix
II
Seek to further invest in additional secure cycle parking, particularly at Guy’s Hospital, as well as work to increase shower and changing facilities for staff
Improve efficiency of patient and community transport through fleet management
and maximising patient journeys
Continue to provide support to cyclists through regular cycle maintenance and safety days
4.3 Energy and carbon reduction
Fuel and electricity are used to heat, cool and light Trust buildings, provide hot water, and power IT systems as well as a range of energy intensive equipment that is essential to modern healthcare. As a result, gas and electricity alone cost the Trust over £9m each year and created around 56,000 tonnes of carbon dioxide emissions in 2011/12. Cutting energy use by just 1% we would save enough money to pay for 14 heart bypass operations. A 5% cut would save enough to pay for 18 junior nurses’ salaries.
Since developing its first carbon management plan and launching the Earthcare & Environment campaign in 2007, the Trust has:
Installed combined heat and power (CHP) engines at Guy’s and at St Thomas’ hospitals, which supply low-carbon heat and electricity and save some £2m each year in energy and around 11,000 tonnes of carbon.
Installed new, energy-efficient lighting around the Trust, and fitted automatic controls in areas such as corridors, toilets and plant rooms.
Rolled out PC power management across the Trust to power down computers and monitors when not in use. This will save around 700 tonnes of carbon each year – the equivalent of taking 230 cars off the road every year.
Commenced the re-cladding of the exterior of Guy's Tower, including replacing windows, helping to improve insulation and reducing carbon emissions by 8000 tonnes over 30 years.
But that isn’t enough. The Trust is committed to an ambitious 34% cut in carbon emissions by 2020. Reducing energy consumption by this amount would save some £52m in energy costs over the same period, but it requires a transformation in the way
that energy is used in delivering services. Over the last year the Trust has worked with the Carbon Trust again to find new ways to save energy and cut carbon.
Sustainable technology is a key component of the energy and carbon savings achieved, and the Trust, as part of its IT Strategy will be guided by the principles of HMG Greening Government: ICT Strategy. The Trust aims to achieve its vision of, “a cost effective and energy efficient ICT estate, which is fully exploited, with reduced environmental impacts to enable new and sustainable ways of working for the public sector.”
In particular, the Trust recognises the need to design and procure the most energy and resource efficient IT systems; to use IT to develop more sustainable ways of working that benefit patients and the environment; and reuse or refurbish surplus equipment in order to avoid unnecessary procurement of new equipment, ensuring that where equipment must be disposed of this is done in an environmentally and socially responsible way. The Trust will:
Install automated meter reading (AMR) across its sites to help to develop an informed understanding of how and where electricity, gas and water are used; and where to focus further reduction efforts
Further optimise heating, ventilation, cooling and lighting systems on site, replacing them with more efficient types and making adjustments so that equipment is only in use when it needs to be. This is an ongoing task and one that needs to be balanced with the needs of patients and staff
Engage with clinical leaders in models of care that support environmental responsibility, for example, seeking ways to reduce waste and improve resource use in operating theatres
Seek to implement the HMG Greening Government: ICT Strategy, aiming to reduce energy use, maximise current ICT assets and ensure responsible disposal
Set energy efficiency standards for all Trust IT equipment
Build on internal capability and resources to provide increased focus on energy and carbon reduction, so that the Trust can cut its impact and save more money for patient care
4.4 Designing the built environment
The Trust operates a large and varied estate and it is crucial that sustainability is designed into refurbishments and new buildings across hospitals and community sites. New buildings and refurbishment need to be future-proof: designed to be as efficient as possible while flexible enough to be able to adapt to evolving service demands and projected changes in climate. The inclusion of community sites into the Trust brings opportunities - for care closer to the community, innovative and personal building designs; as well as risks, such as more complicated utility management, to the programme. The Trust has a capital programme with a value of more than £400m over the next 5 years, including a new cancer treatment centre at Guy's and the re-cladding of Tower and East Wings.
The Trust has developed a sustainable capital projects strategy, provided in Appendix III, which is being integrated into the process used by project managers. It will guide project managers, based on the type and value of their project, to integrate sustainable principles into the project.
The Trust will:
Implement the newly developed comprehensive sustainability strategy for capital projects, ensuring that sustainability objectives are consistently considered at appropriate stages of the capital development
Ensure spaces, such as wards, are designed flexibly to accommodate future
service changes
Use sustainable materials that promote health, for example volatile organic compound- (VOC-) free paint
4.5 Communications and engagement
People have a vital role to play in reducing energy, water and waste. It is only through the engagement of staff and patients that services can be operated in a sustainable way. A vibrant group of staff volunteers serve as Local Environment Representatives (LERs) across the Trust. These LERs are based in clinical and administrative areas and look out for ways – large and small – that the hospitals can save resources. The Trust supports these volunteers through training sessions and by providing a dedicated “spend to save” budget to implement projects that deliver savings. A monthly environment and sustainability newsletter, the Green Room, started in 2012 and now has over 300 staff subscribers. The sustainability team presents to all new staff at corporate induction about the achievements and value delivered by the sustainability programme, as well as how people can get involved. This is crucial as it demonstrates to new staff who will be working in the acute and community settings that environmental sustainability is integral to the ethos and values of the Trust. The Trust will: Continue to support Local Environment Representatives (LERs) through training
sessions, modules on www.thelimezone.co.uk and the “spend to save” budget to deliver upon saving suggestions.
Deliver and disseminate the Green Room newsletter to all staff. The Green Room is
a monthly electronic publication that provides updates on sustainability achievements, useful tips, facts, and resources, as well as information on activities for participation
Integrate sustainability further into www.thelimezone.co.uk, the Trust’s staff social
network. This network will be greatly enhanced in 2013 and beyond to include training modules on sustainability, as well as develop a revitalised poster and awareness campaign.
Develop engaging and informative signposting to encourage patients and staff to use
the stairs, freeing up lifts for those who need them and encouraging healthy lifestyle choices.
Work closely with Guy’s and St Thomas’ community services to ensure communications and awareness campaigns are aligned and resources are maximised.
Investigate use of the SIMPLE tool, developed by Essentia Community Services to
record, manage and report on resource use.
Develop a specific section of the Trust’s annual report dedicated to environmental sustainability.
4.6 Water conservation
Water is a precious resource that is in limited supply and the southeast of England is already the most water stressed region in the UK. Water shortages are expected to become more severe as rainfall and temperature patterns change under climate change projections. London needs to better manage its water supplies and reduce usage if it is to avoid severe water shortages in future years. In 2011/12, Guy’s and St Thomas’ acute hospitals used 437,165,000 litres of water. This is a total of 40,000 litres of water per employee; and enough water to fill 175 Olympic swimming pools. Water consumption is down by 9% since the baseline year (2007/8), and currently stands at 1.56 m3 of water per square metre of floor space in the acute hospitals. The improvement represents a positive trend, but consumption remains above best practice of 1.38 per square metre (m3). Water used m3
Floor area m2
Water m3 / m2
Per employee
Typical practice
Best practice
20% reduction
437,165 280,597 1.56 39.74 1.66 1.38 1.09
The Trust will: Establish a water saving target of 20% by 2015/16 as compared to the baseline year,
2007/8.
Embark on a comprehensive water saving programme of work across the hospital sites, including key community services. This will include improved leak detection and water metering, installation of water saving devices, with the aim of delivering a 20% saving in water consumption
Water grounds in the evenings, and where possible, utilise harvested rain water
Ensure water saving devices are standard for all refurbishment and new-build
projects Develop standards for operation in key high-water use areas, such as catering,
sterilisation services and renal dialysis.
4.7 Waste minimisation
Guy’s and St Thomas’ produces over 4,000 tonnes of waste every year. Over 30% of domestic waste was recycled in 2011/12, but there is much more that can be done to avoid waste and maximise recycling. People need to be encouraged not to produce waste in the first place by thinking about how they can order supplies and perform their jobs more efficiently. At Corporate
Induction, the cost of each waste stream, as well as the importance of correct bin use, is emphasised to all new staff. Guy’s and St Thomas’ is keen to make the most of the waste it produces, and is developing a strategic approach to sell waste to be recycled and turned into energy. The Trust will: Set a target to recycle 50% of domestic waste by 2015/16
Provide more clarity on how to correctly use the bins. Pictorial posters, labels and
stickers will be developed
Continue to re-home redundant and out of date stock and equipment, where appropriate
Recycle glass
Minimise paper use in patient letters and improve electronic communications, such
as text messages and email
Ensure construction waste is minimised and reuse is encouraged
Develop and deliver training sessions for staff on waste management
Reduce prescribing of pharmaceuticals where appropriate, and minimise waste
Finalise and implement a strategic approach to maximising the value of NHS waste in London in collaboration with the London Procurement Partnership (LPP)
4.8 The role of partnerships and networks
Guy’s and St Thomas’ award winning sustainability strategy and early carbon reduction successes mean that it is viewed by many as a leader in environmental sustainability in the NHS. The Trust aims to leverage this influence and work collaboratively with public, private and third sector partners to share knowledge, learn lessons, maximise resources, inspire and be inspired. The Trust will participate in and lead carbon reduction networks, as well as influence business and public sector sustainability programmes to deliver widespread benefits for sustainability. Key partners include, but are not limited to: King’s Health Partners Other NHS Trusts and international healthcare institutions The London NHS Carbon Reduction Leads Network Greater London Authority The NHS Sustainable Development Unit The Carbon Trust UK Government and trade bodies The Future Sustainability Leaders Forum, part of Green Mondays Collaboration and long-term relationships with fellow King’s Health Partners It is crucial that connections continue to be built and that collaboration with fellow members of the King’s Health Partners continues. This includes coordinating systems for energy and water monitoring; and sharing resources for awareness campaigns and staff
training programmes. The joint-procurement function with King’s College Hospital NHS Foundation Trust is an excellent opportunity to further influence purchasing and encourage the supply chain to behave more sustainably. The Trust will continue to participate in and support the Sustainability Steering Group for the King’s Health Partners, and will seek to identify and implement collaborative initiatives that drive financial savings and improve the sustainability credentials of the King’s Health Partners.
4.9 Adapting to a changing climate
While the Trust has a responsibility to minimise its contribution to climate change by cutting carbon emissions, it also recognises that the climate is already changing faster than previously thought. Globally, the eight warmest years on record have all occurred since 1998. There is strong evidence that aspects of the climate are changing, such as rainfall patterns, snow and ice cover; and frequency and severity of storm events. Climate change is a potential threat to society through impacts on water supplies, food production; health and transmission of diseases. It therefore has significant potential to impact upon the healthcare sector and the NHS. Climate adaptation seeks to lower the risks posed by the consequences of climate changes. This means ensuring that buildings are able to operate effectively in a different climate; and ensuring that to the Trust adapts to changing demand for services as a result of, for example, more summer heat waves and less winter cold periods. The Trust has already begun to evaluate the risks posed to its sites, for example due to flooding and other extreme weather events; and has integrated the findings into its emergency planning. The Trust will:
Undertake additional analysis of the risks that a changing climate and extreme weather pose for its sites, for example by undertaking a detailed fluvial and surface water flood risk assessment with support from the Greater London Authority (GLA)
Identify potential vulnerabilities on Trust sites and ensure that these are mitigated against
Consider the ways that demand for services may change as a result of projected health impacts of climate change
Consider ways to adapt Trust buildings to the effects of climate change, for example looking at using green and reflective roofs to reduce urban heat island effect and the need for air conditioning in buildings
4.10 Governance and finance
A successful environmental sustainability programme hinges on how sustainability is considered in decision making and performance reviews. In order to make long term, consistent decisions that deliver upon sustainability objectives and to provide clarity of expectations, a clear form of sustainability governance must be implemented.
The Trust has included sustainability in the job descriptions of all new staff since September 2010, and it has been integrated into corporate induction, but there is more that can be done to ensure that everyone feels that sustainability is their responsibility.
The sustainability team proposes to establish a sustainability governance board, comprised of leading influencers from across the Trust, with emphasis on areas of the Trust that have the greatest potential to deliver upon the strategy, and to include parts of the Trust that have not previously been actively engaged with environmental sustainability. The governance board will be led by the Trust Chairman, Sir Hugh Taylor. This group will meet quarterly, and will be responsible for reviewing the progress of the strategy and influencing the implementation of key actions. Securing financial investment is also crucial, and the Trust’s annual £250,000 spend to save budget has provided a foundation for energy and resource saving projects throughout the acute hospitals. With a growing pressure on finances, the Trust appreciates the value in exploring low and no-cost alternative means of financing its carbon reduction and sustainability initiatives. The Trust will: Establish a governance board to oversee the sustainability strategy and ensure
ongoing implementation Ensure all business cases consider true whole life cost, including utility costs over at
least 10 years Integrate performance on sustainability into staff objectives and appraisal processes
Incorporate sustainability into property lease agreements to ensure utility and
building performance are considered so that there is an incentive to reduce consumption
Seek strategic ways to finance sustainability projects to deliver on potential savings
Prepared by: Alexandra Hammond, Sustainability Manager Will Syddall, Sustainability Officer April 2013
