Module: Carbon hotspots
Implementation note
January 2014
This implementation note accompanies a module developed for the Sustainable Development Strategy for the NHS, Public Health and Social Care System 2014 – 2020. It provides examples of practical approaches, actions, guidance and tools to help deliver the measures of success outlined in the module.
2
The four measures of success by 2020 are: Organisations understand and reduce carbon emissions in areas of their operations with the highest carbon footprint Opportunities are explored for cross agency and sector action to reduce carbon emissions Carbon emissions are monitored and publicly reported Existing good practice on delivering ambitious carbon reduction is shared and adopted across the system.
Introduction Reducing carbon dioxide equivalent emissions (CO2e) is measures our contribution to climate change and is a useful proxy measure for improved efficiency, decreased environmental harm and decreased harm to health. Two fundamental questions asked in the consultation and engagement exercise for the development of the NHS, Public Health and Social Care system Sustainable Development Strategy were:
Should we widen the scope beyond the NHS to the wider social care and public health system?
Should we widen the approach beyond carbon reduction to include other areas of sustainable development?
The answer to both questions was an emphatic “Yes” – as long as it does lead to a loss of clarity of focus and carbon reduction remains a central pillar of the sustainable development approach. The NHS Carbon Reduction Strategy (www.sduhealth.org.uk/sds) published in 2009 outlined ten areas for NHS organisations to focus on to reduce carbon emissions. The key actions outlined in the strategy are broadly applicable to other parts of the health and care system and therefore it remains an important resource for understanding how to reduce carbon emissions. It is important to emphasise that carbon reduction is a core objective of this health and care system sustainable development strategy. The ambition to reduce health and care system carbon dioxide equivalent emissions across building energy use, travel and procurement by 34% by 2020 is a key measure of success. The carbon footprint report for the NHS, Public Health and Social Care System 2012 data (available at www.sduhealth.org.uk/report) estimates the system carbon footprint to be 32 million tonnes of carbon dioxide equivalent (MtCO2e) – This is nearly 40% of public sector emissions. Clearly action on carbon hotspots can make a significant difference. Three carbon hotspot areas identified from the NHS, public health and social care system carbon footprint are:
1. Pharmaceuticals, medical devices and gases – 27% of carbon footprint 2. Energy – 15% of carbon footprint 3. Travel and transport – 13% of carbon footprint
3
Measure of Success 1: Organisations understand and reduce carbon emissions in areas of their operations with the highest carbon footprint Two things that all organisations could consider doing are:
Utilise available tools and evidence to understand potential carbon hotspots in their activities and operations.
Develop a Sustainable Development Management Plan (or equivalent) that includes a strong carbon reduction component setting carbon reduction goals and specific projects to achieve them.
Guidance on writing a Sustainable Development Management Plan (SDMP) and some real life examples of SDMPs for different types of organisation can be found at: www.sduhealth.org.uk/plan.
Social Care focus – Food and Accommodation Food and catering services contribute 13% of the Social Care carbon footprint. Many organisations and commissioners of services have already moved to more sustainable food in line with the Government Buying Standards. http://sd.defra.gov.uk/advice/public/buying/products/food/
Accommodation services are half the Business Services shown here contributing 5% to the Social Care carbon footprint.
For example: There is a requirement in the NHS Standard Contract - Service Conditions – SC15 Services Environment and Equipment – that requires all providers to:
Take all reasonable steps to minimise their adverse impact on the environment
Demonstrate their progress on climate change adaptation, mitigation and sustainable development, including performance against carbon reduction management plans, and must provide a summary of that progress in their annual report.
www.england.nhs.uk/nhs-standard-contract/
4
Primary Care focus – Pharmaceuticals 16% of the entire NHS, public health and social care system carbon footprint relates to pharmaceutical products.
Latest research: Identifying the Priority Prescription Items for Healthcare Green House Gas (GHG)
Environmental Resources Management Limited (ERM) and the Sustainable Development Unit
worked together to identify those prescription items with the highest GHG impact in order to
identify which ones could be prioritised for action. A list of 20 priority prescription items were
identified for further investigation and action. They are estimated to account for more than 60% of
the pharmaceutical footprint.
Priority List Identified for Further Investigation (in Alphabetical Order)
BNF CHEMICAL NAME:
Adalimumab Amoxicillin Atorvastatin Beclometasone Dipropionate Budesonide Co-Codamol (Codeine Phos/Paracetamol) Co-Dydramol (Dihydrocodeine/Paracet) Enteral Nutrition Etanercept Fluticasone Propionate (Inh)
Gabapentin Ibuprofen Metformin Hydrochloride Naproxen Paracetamol Salbutamol Simvastatin Sodium Valproate Sulfasalazine Tiotropium
Examples of supply side action the health and social care should be encouraging are:
Encourage suppliers to use the sector and SDU developed footprinting methodology to identify carbon hotspots and target action1.
Supply side action needs to be simultaneously supported by demand side initiatives to reduce the number of pharmaceuticals and medical instruments purchased. All prescribers and users of resources can help drive this change by:
Propellants used in metered dose inhalers for treating respiratory conditions are powerful greenhouse gases. Switching to alternatives such as dry powder inhalers can help reduce harmful greenhouse gas emissions2. Where propellants are being used, recycling empty inhalers captures any unused propellant gas and reduces emissions.
Educate patients about how and when to take their medicines to improve effectiveness and discarded medicines polluting the environment and/or being used inappropriately by others3.
Review prescribing guidelines and benchmark prescribing practices to reduce inappropriate prescribing of medications.
Where clinically appropriate prioritize evidence based therapies over pharmaceutical interventions as the first stage of management4. For example:
o therapies such as cognitive behavioural therapy prior to prescribing anti-depressants
o diet and exercise in the management of hypertension
5
0 1000 2000 3000
CF3CHFOCHF2
CF3CHClOCHF2
(CF3)2CHOCH2F
N2O
Des
flu
ran
eIs
ofl
ura
ne
Sevo
flu
ran
eN
itro
us
oxi
de
Carbon intensity - Global Warming Potential (GWP 100 year in kgCO2e/kg)
Carbon intensity Global Warming Potential
Secondary Care focus - Medical instruments and equipment Medical instruments and equipment are used across primary and secondary care and contribute 9% to the NHS, public health and social care system. Examples of action could include:
Investigate manufacture, disposal and re-use or recycling of medical instruments and current single use items.
Consider more innovative products that will minimise waste, meet infection control requirements and are re-usable or re-process-able.
Use the Procurement for carbon reduction (P4CR) guidance which includes the energy efficiency of medical devices supporting low carbon investment decisions for electrical and electronic equipment.
Secondary Care focus - Medical gases Medical gases used as anaesthetics and analgesics (Nitrous Oxide, Desflurane, Isoflurane and Sevoflurane) are potent greenhouse gases. The relative carbon intensity (per kg of gas) is shown below with Desflurane having the greatest effect on our atmosphere and Sevoflurane the least. On the right below are the estimated total emissions for the NHS in England showing the Nitrous Oxide emissions are over 5 times the emissions the other gases.
Combined they account for 1.7% of the NHS, public health and social care carbon footprint. The majority of these emissions take place in an acute healthcare setting and it is estimated that they form 5% of the carbon footprint for organisations in this setting.
- 250 500
Des
flu
ran
eIs
ofl
ura
ne
Sevo
flu
ran
eN
itro
us
oxi
de
Carbon dioxide emissions (tCO2e)
Carbon dioxide equivalent emissions NHS in England (tonnes)
6
Across the system - Approaches to procurement hotspots Examples of supply side action the health and social care should be encouraging are:
Use lifecycle costing during the tendering processes to factor in resources used, carbon and costs during the lifetime of a product (purchase, use and disposal) – rather than just considering its impact on purchase – please see Commissioning and procurement module.
Collaborate with suppliers at the product design stage to co-create clinical solutions that are geared to not only healthcare outcomes but also sustainability outcomes.
Work with suppliers to eliminate unnecessary packaging for all products and in particular for
medical supplies and instruments5.
Supply side action needs to be simultaneously supported by demand side initiatives to reduce the number of items purchased. All prescribers and users of resources can help drive this change by:
Measuring, monitoring and reporting the carbon footprint from purchased items using the Procurement for carbon reduction tool (P4CR) or sustainability reporting guidance – please see the summary of tools at the end of this section for further details on the P4CR tool.
Identify organisational carbon hotspots and improve monitoring and measurement in these areas.
7
Energy 15% of the NHS, public health and social care system carbon footprint relates to energy usage. Experience across the system suggests that the following three principles can help guide action: Reduce unnecessary usage - Examples of action could include6:
develop energy awareness campaigns that target areas of energy wastage for example by encouraging people to switch off lighting and providing guidance on clinical equipment that can be safely turned off (and which can’t) when not in use;
review heating timing and zoning controls, and thermostat temperature set points to identify whether there is potential to reduce heating/cooling whilst ensuring adequate temperatures for the comfort of service users and staff as well as for building maintenance; and
use lighting controls to reduce lighting in areas that do not need to be fully lit at all times. For instance passive infrared sensors, photoelectric/ dimming controls and zonal switching.
Increase energy efficiency - Examples of action could include6:
Installation/upgrading of insulation for instance walls, roofs, pipework, window glazing, draught proofing.
Use of energy saving lighting technology for example high frequency lighting, LED lighting.
The efficient provision of heat, for example using high efficiency boilers or district heat networks.
Voltage optimisation also known as ‘voltage correction’ to eliminate the discrepancy between supply voltage and the optimum voltage needed by electrical equipment and to reduce energy losses.
Building Management System optimization - Installation of a computer-based control system that allows energy-using services to be centrally managed: notably heating, ventilation and air conditioning (HVAC) and sometimes lighting.
Measures to reduce the impact of electronic equipment and IT for instance by enabling energy saving features and purchasing equipment with the Energy Star logo.
Installation of Variable Speed Drives (VSD) to fan and pump motors.
Replacement of electric motors with higher efficiency motors where applicable. For example, borehole pumps, cooling pumps, drainage pumps and sewerage pumps.
Use of tri-generation systems that can provide cooling as well as electricity generation and heating as per standard Combined Heat and Power plants.
Increase amount of low carbon energy - Examples of action could include:
Analyse the potential for increasing the proportion of lower/zero carbon forms of energy supply through renewables for example wind turbines, photo-voltaic, geothermal, the potential for combined heat and power plants7&8and district heating schemes9.
Indicate to energy suppliers the expectation that they increase the proportion of renewable energy they provide.
8
Travel and transport 13% of the NHS, public health and social care carbon footprint relates to travel and transport. Three areas of action are suggested to support the system to start making progress in lower carbon travel and transport: Increase active travel (cycling and walking) and use of public transport by staff, service users and visitors - Examples of action could include10:
Develop care facilities with good access including public transport links and safe pedestrian/cycling routes to services.
Improve public transport access to health and care sites.
Implement shuttle buses linking care sites, sometimes also servicing other local destinations.
Install showers and secure storage facilities for cyclists.
Major sites such as hospital trusts work in partnership with local authority to improve local walking and cycling access.
Support health and care professionals to prescribe increased levels of physical activity such as walking and cycling to service users.
Senior staff demonstrate leadership by themselves travelling actively, and by declining incentives to drive (pride-of-place parking, for example).
Develop incentives for active travel such as; removal of car parking subsidies; flat mileage rate expenses regardless of engine size and mode of transport; subsidized bus passes; interest-free loans for cycles, equipment and season ticket purchases.
Reduce unnecessary travel - Examples of action could include:
Assess environmental impacts in business cases for proposed new models of care.
Utilise e-health solutions where this can contribute to improved experience and less travel for patients.
Review recurring business mileage expenditure to identify meetings that could be conducted by teleconference.
Agree to conduct more meetings by teleconference.
Train staff on how to use video and teleconferencing technology. Minimize pollution from necessary travel - Examples of action could include:
Using a fleet of well-maintained, low emission and low polluting vehicles for necessary travel.
Review car lease scheme arrangements to encourage the use of low emitting vehicles.
Factor the environmental impact of supplier’s transport into the decision making process for procuring goods.
Reduce carbon emissions by using electric vehicles for onsite logistics.
Using onboard telematics to monitor driver behaviour and encourage ‘green’ and safe driving.
Ensuring drivers within the fleet are educated on green driving techniques through a variety of schemes11:
o driver training – on-board telematics could provide targeted training and education o driver guides – how to drive more efficiently o championships for best and most efficient driver o incentive scheme for fuel-efficient driving o incentive scheme for accident free driving.
9
Summary of Useful Tools and Guidance
Department of Health: Health Building Notes (HBNs) and Health Technical Memoranda (HTMs) - 1. HBN 00-07 Resilience planning for the healthcare estate12 2. HTM 00 Best practice guidance for healthcare engineering13 3. HTM 07-07 Sustainable health and social care buildings14; design, construction and
refurbishment sets – links into BREEAM healthcare score rating. 4. HBN 11-01 Facilities for primary and community care services15.
5. HTM 07-02 Encode, making energy work in healthcare16.
www.gov.uk/government/collections/health-building-notes-core-elements Improving the energy efficiency of our buildings. A guide to air conditioning inspections for buildings – Guidance developed by the Department for Communities and Local Government www.gov.uk/government/publications/air-conditioning-inspections-for-buildings International pharmaceutical and medical device carbon footprint guidelines - The SDU has worked with ERM and industry partners to develop a standard for carbon footprinting of pharmaceuticals and medical devices. www.sduhealth.org.uk/carbon NHS Carbon Reduction Strategy - Published in 2009 it outlined ten areas for NHS organisations to focus on to reduce carbon emissions. The key actions outlined in the strategy are broadly applicable to other parts of the health and care system. www.sduhealth.org.uk/sds NHS Goods and Services Carbon Hotspots Report - The SDU in collaboration with NHS Shared Business Services and @UK have identified the goods and services which are carbon hotspots by type of NHS organisation. www.sduhealth.org.uk/carbon Obesity and the environment: increasing physical activity and active travel – A briefing note from Public Health England and the Local Government Association. It addresses the issue of taking action to create environments where people are more likely to walk or cycle for short journeys. www.gov.uk/government/publications/obesity-and-the-environment-briefing-increasing-physical-activity-and-active-travel Premises Assurance Model (PAM) - The NHS PAM is a management tool developed by DH that provides NHS organisations with a way of measuring how well they run their estate. www.gov.uk/government/publications/nhs-premises-assurance-model-launch Procuring for Carbon Reduction (P4CR) Toolkit - A range of guidance, training and tools have also been developed under the NHS Procuring for Carbon Reduction (P4CR) project. www.sduhealth.org.uk/commproc Sustainable Development Management Plan (SDMP) Guidance - Guidance produced by the Sustainable Development Unit to support health and care organisations to develop board approved plans on sustainability and carbon reduction. www.sduhealth.org.uk/plan Sustrans - The Sustrans website provides a range of information on regulations, technical and engineering resources to support practical measures in favour of walking and cycling, as well as delivery services. www.sustrans.org.uk/our-services The Sustain Guide to Good Food – Brings together guidance on good food which provides social benefits, contributes to thriving communities and brings health benefits for plants animals and us all. http://www.sustainweb.org/sustainablefood/
10
Measure of Success 2: Opportunities are explored for cross agency and sector action to reduce carbon emissions Activities and interventions to reduce carbon emissions often deliver co-benefits for multiple agencies and sectors. These areas where collaboration leads to mutual benefits can be explored and maximised to ensure a place based approach to health and wellbeing. Opportunities exist beyond reducing the carbon footprint of the NHS, public health and social care system. For example:
Local authority schemes such as improved insulation in homes can reduce carbon emissions, reduce fuel poverty and reduce admissions from respiratory conditions.
Public and environmental health programmes around seasonal diets, increasing active travel, or improving air quality can improve health, reduce use of services and reduce carbon emissions.
One key action that local authority, NHS, public health and social care representatives on Health and Wellbeing Boards may wish to consider is:
Including carbon reduction (as one component of creating healthy and sustainable people and places) in Joint Strategic Needs Assessments (JSNAs) and Health and Wellbeing Strategies. Part of this could involve identification of, and taking forward things such as district heating schemes, active travel schemes, or reducing air pollution.
For example: Kent County Council Guidance. Joint Strategic Needs Assessment: A Guide to Integrating Sustainability This guidance developed by Kent County Council is designed to support partnership working in the integration of sustainability into the Joint Strategic Needs Assessment (JSNA) and demonstrate the clear benefits of this approach. Working through will help to ensure that key aspects have been considered and cross referenced throughout the JSNA.
www.sduhealth.org.uk/resilience
Summary of Useful Tools and Guidance
Carbon Trust - The Carbon Trust have worked with over 250 Local Authorities in England and around 150 NHS Trusts to produce carbon management plans. In many instances a particular area or town will already have a carbon management plan laid out in the same format. www.carbontrust.com/about-us Committee on Climate Change – The Committee on Climate Change report on local area carbon plans can help Local Authorities think about how to plan for sustainable, low carbon healthcare at the regional and local level. www.theccc.org.uk/publication/how-local-authorities-can-reduce-emissions-and-manage-climate-risks/ Module: Healthy, sustainable, and resilient communities - A measure of success in this module is “Public services work together within a high level framework for sustainable development.” www.sduhealth.org.uk/resilience
11
Measure of Success 3: Carbon emissions are monitored and publicly reported
As part of its sustainable development strategy the Government encourages both companies and public bodies to disclose their sustainability and environmental performance via their annual reports and accounts.
The percentage of public sector organisations with a board approved sustainable development management plan is also a measure in the Health Protection domain of the Public Health Outcomes Framework (PHOF). www.phoutcomes.info/ Examples of action to align with these requirements could be:
Publish your organisational carbon footprint in your annual report, set out your reduction aspirations and detail any projects to help achieve them.
Benchmark progress against similar organisations.
Highlight progress and organisation targets in your annual report. Advice on measuring the carbon footprint can be found on the SDU website at: www.sduhealth.org.uk/delivery/measure.aspx Advice on reporting sustainability performance can be found on the SDU website at: www.sduhealth.org.uk/delivery/measure.aspx
For example: There is a requirement in the NHS Standard Contract - Service Conditions – SC15 Services Environment and Equipment – that requires all providers to:
Take all reasonable steps to minimise their adverse impact on the environment
Demonstrate their progress on climate change adaptation, mitigation and sustainable development, including performance against carbon reduction management plans, and must provide a summary of that progress in their annual report.
www.england.nhs.uk/nhs-standard-contract/
For example: There is a requirement in the Department of Health Annual Reporting guidance: Sustainability Report
2.9. NHS bodies are required to produce a Sustainability Report (SR) as part of their Annual Report: this element of the Annual Report is not subject to audit. The Sustainability Development Unit (SDU) and the Department of Health have developed a standard reporting format for NHS bodies, and this should form the basis of the report (see the ‘summary of useful tools and guidance’ section) Public sector bodies may also wish to refer to general HM Treasury guidance for the preparation of sustainability reports at: www.gov.uk/government/publications/public-sector-annual-reports-sustainability-reporting-guidance.
12
Summary of Useful Tools and Guidance
Estates Return Information Collection (ERIC) – Useful benchmarking data on carbon emissions from NHS organisations has been made available. http://www.erpho.org.uk/viewResource.aspx?id=21509 Fact sheet: Sustainability Reporting - National Audit Office summary of good practice in sustainability reporting. www.nao.org.uk/report/sustainability-reporting-factsheet/ Sustainability Reporting Template - A template (based on Government Financial Reporting Manual [FReM] which includes mandatory sustainability and environmental reporting from 2011/12) has been created by the Department of Health to simplify the reporting for organisations and is available on the Sustainable Development Unit website. www.sduhealth.org.uk/delivery/measure/reporting.aspx Sustainable development reporting - best practice examples - Compiled by the Sustainable Development Unit to highlight excellent sustainability reports in 2012/13. www.sduhealth.org.uk/delivery/measure/reporting.aspx
13
Measure of Success 4: Existing good practice on delivering ambitious carbon reduction is shared and adopted across the system. A national cross system group for sustainable development with representation across the whole NHS, public health and social care system has been established. One purpose of this group is to facilitate the sharing of good practice and encourage adoption across the system. The Sustainable Development Unit produces a monthly news bulletin that shares news, latest initiatives and events. People can sign up to receive the newsletter form the Sustainable Development Unit homepage – www.sduhealth.org.uk. The Sustainable Development Unit convenes a face to face sustainable route map group every six months. This is a great opportunity to network, share good practice and to connect what is happening at a national level with what is happening at a local level. This two way dialogue is crucial to ensure local systems are supported to take this agenda forward. In many areas local sustainability networks already exist for peer support and advice. Examples of action could include:
Sign up to the Sustainable Development Unit newsletter
Contact the Sustainable Development Unit to become part of the route map community
Understand whether networks already exist in your local area
Case Studies
The Sustainable Development Unit collect examples of good practice.
www.sduhealth.org.uk/resources/case-studies.aspx
A range of other organisations also develop and share examples of good practice:
SHINE Network for sustainable healthcare buildings - www.shine-network.org.uk/?p=home
Centre for Sustainable Healthcare - http://sustainablehealthcare.org.uk/
Healthcare without Harm - http://www.noharm.org/
Climate and Health Council - www.climateandhealth.org/
Global Green and Healthy Hospitals - http://greenhospitals.net/
TUC Green and healthy workplaces - www.tuc.org.uk/workplace-issues/green-workplaces
14
References:
1 Sustainable Development Unit, 2012. International pharmaceutical and medical device guidelines [Online]
Available at: www.sduhealth.org.uk/carbon [Accessed 06 January 2014] 2 Toby Hillman, Frances Mortimer, Nicholas S Hopkinson, 2013. Inhaled drugs and global warming: time to shift
to dry powder inhalers. BMJ 2013;346:f3359 [Online] Available at: http://dx.doi.org/10.1136/bmj.f3359 [Accessed 06 January 2014] 3 World Health Organization, 2010. World Health Organization Medicines: rational use of medicines Fact sheet
N°338 [Online] Available at: www.who.int/mediacentre/factsheets/fs338/en/index.html [Accessed 06 January 2014] 4 National Prescribing Centre, National Institute for Health and Clinical Excellence, 2012. Key therapeutic topics – Medicines management options for local implementation [Online] Available at: www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf [Accessed 06 January 2014] 5 Sustainable Development Unit, 2010. Update: NHS Carbon Reduction Strategy, pg. 5 [Online]
Available at: www.sduhealth.org.uk/sds [Accessed 06 January 2014] 6 AEA Technology plc. and Sustainable Development Unit, 2010. NHS England Marginal Abatement Cost Curve.
[Online] Available at: www.sduhealth.org.uk//delivery/measure/finance.aspx [Accessed 06 January 2014] 7 World Health Organization and Health Care Without Harm, 2009. Healthy hospitals, healthy planet, healthy
people - Addressing climate change in health care settings [Online] Available at: www.who.int/globalchange/publications/climatefootprint_report.pdf [Accessed 06 January 2014] 8 Vardoulakis, S. and Heaviside, C. (Eds), 2012. Health Effects of Climate Change in the UK 2012 [Online]
Available at: www.hpa.org.uk/hecc2012 [Accessed 06 January 2014] 9 Committee on Climate Change, 2012. How local authorities can reduce emissions and manage climate risks
[Online] Available at: www.theccc.org.uk/publication/how-local-authorities-can-reduce-emissions-and-manage-climate-risks/ [Accessed 06 January 2014] 10
Sustainable Development Commission. Progress in Practice - Safe Routes to Health Care [Online] Available at: www.sd-commission.org.uk/data/files/publications/SDC-Sustrans-PiP.pdf [Accessed 06 January 2014] 11
Carbon Trust, 2012. A Green Response to an Emergency Situation. [Online] Available at: www.carbontrust.com/media/164603/cts302-yorkshire-ambulance-service.pdf [Accessed 06 January 2014] 12
Department of Health, 2007. HBN 00-07: Resilience planning for the healthcare estate [Online] Available at: www.gov.uk/government/publications/resilience-planning-for-nhs-facilities [Accessed 06 January 2014] 13
Department of Health, 2000. Health Technical Memorandum 00: Policies and principles of healthcare engineering [Online] Available at: www.gov.uk/government/publications/guidance-policies-and-principles-of-healthcare-engineering [Accessed 06 January 2014] 14
Department of Health, 2007. Health Technical Memorandum 07-07: Sustainable health and social care buildings: Planning, design, construction and refurbishment [Online] Available at: www.gov.uk/government/publications/sustainable-health-and-social-care-buildings-planning-design-construction-and-refurbishment [Accessed 06 January 2014] 15
Department of Health, 2001. Health Building Note 11-01: Facilities for primary and community care services [Online] Available at www.gov.uk/government/publications/guidance-for-facilities-for-providing-primary-and-community-care-services [Accessed 06 January 2014] 16
Department of Health, 2002. HTM 07-02: Encode - Making Energy Work in Healthcare [Online] Available at www.gov.uk/government/publications/encode-guidance-on-the-procurement-and-management-of-energy-in-the-nhs [Accessed 06 January 2014]
16
Sustainable Development Unit Victoria House Capital Park Fulbourn Cambridge CB21 5XB e: [email protected] w: www.sduhealth.org.uk Twitter @sduhealth
Document published January 2014 – Version 1
Please note that this implementation note is intended to be a supporting document to the Sustainable
Development Strategy for the NHS, Public Health and Social Care System for those interested in taking
forward action in specific areas. They are not intended to be must-dos and they will evolve over the
lifetime of the strategy.
We are particularly keen to be made aware of public health and social care actions in these areas so
please do get in touch if you feel key information, tools and guidance are missing from the
implementation note.
