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Securing healthy returnsRealising the financial value of sustainable development

2 Securing healthy returns

This work has been produced by partners throughout the health and care system coordinated by theSustainable Development Unit (for NHS England and Public Health England) and the Healthcare FinancialManagement Association (HFMA) NHS Environmental Sustainability Special Interest Group. It providescrucial evidence on where the health and care system can improve sustainability both financially andenvironmentally.

“The £22bn efficiency saving is a huge challenge. We need to simultaneously exploit the financialopportunities of being socially and environmentally sustainable. The future of the sector and the healthand wellbeing of the public depends on us living within the limits of our available resources, but we can only do this if we are able to identify where we can at the same time save money and ensure thesustainability of our environment, on which all health depends.

Many healthcare finance professionals are already committed to action in this area as part of theirorganisational plans, and in wider Sustainability and Transformation Plans (STPs) locally. The HFMAsustainability group can play a distinctive role in engagement and leadership, providing a voice, tools,recommendations and guidance, in particular for financial and accountancy professionals.”

Sandra EastonChairHealthcare Financial Management Association (HFMA) NHS Environmental Sustainability Special InterestGroup

Foreword ........................................3

Introduction ................................... 4

Health and care system ................. 8carbon and cost benefit curve Operationalising sustainability ...12and finance

Integrated localised planning ......14

Considering wider benefits .........15

Implementation ............................16

Top opportunities for finance .....17professionals

Resources ......................................18

Contents

3Realising the financial value of sustainable development

The NHS, social care, and public health systemface challenging times to ensure theinvestments we make have the best possibleoutcomes for current and future generations.How we improve and transform the healthsector to be financially sustainable is animportant part of delivering the Five YearForward View1. The evidence presented hereshows that savings and investment are lastingand effective when the efficiencies andtransformations we make are also socially andenvironmentally sustainable.

Since 2007, NHS organisations, supported by theSDU, have ensured that in excess of £190m eachyear remains available for front line care, ratherthan being spent on energy, waste, water or fuel.We have exceeded the NHS and wider sector firsttarget of a 10% reduction in carbon emissions, by2015, contributing to the national and globalpublic health challenge of mitigating climatechange.

These efficiencies are welcome, but this is a long-term journey where everyone needs to be engagedto improve the health ecosystem. These futurefocussed health benefits must be acknowledgedand delivered in every improvement initiative, fromSustainability and Transformation Plans (STPs) toplans beyond the next five years. Only then can webe sure that both the population and theexchequer gain from living within financial andenvironmental limits.

The Carter Report highlighted opportunities forefficiency savings and environmental benefits withexamples such as energy used in the health caresystem. This report highlights further opportunitiesfor longer-term financial savings in areas such as

procurement, public health and better models ofcare, all of which have clear positive environmentaland health benefits.

The case for action is clear. What is needed is theleadership, clarity, and collaboration to deliver it;leadership at every level and collaboration betweenevery part of the health system, from clinicians topatients to managers to researchers. Mechanismssuch as Academic Health Science Networks arewell placed to facilitate this, to set out long termprinciples of improvement, not short term detailedmaps of quick fixes.

We need to develop a health system that is seen asthe best possible investment in people and longterm health for all, and not an unsustainableconsumer of finite resources. We must allow thestrong intrinsic motivation of our staff to performto the best of their abilities; to be able to practicethe values they have at home, whilst at work.

The evidence to support action is increasing but weneed to ensure the actions are possible andpervasive. There is a critical role for healthcarefinance professionals to play in this area, throughsupporting development of local leadership,governance arrangements and organisations’ plansand reporting. I look forward to the results of thisresearch improving patient care and public healthbefore the planet is too warm, and the resourcestoo depleted. By thinking and working in this waywe can build on a Five Year Forward View todevelop a longer term vision of a truly sustainablehealth service, now and for future generations.

Ed SmithChair, NHS Improvement

Foreword

1. NHS Five Year Forward View - sets out a shared vision for the future of the NHS based around the new models of care


There is a clear, proven financial case forsustainable development. Resource efficiency andimprovements in areas such as energy, waste,water and use of raw materials have alreadydelivered financial savings along with positiveenvironmental impacts and direct benefits tohealth. However there are opportunities forfurther savings and benefits that go beyond theareas of estates and facilities. This documentprovides an insight into the financial savings forprojects which deliver financial, social andenvironmental benefit. Along with the supportingresources this report is primarily intended to aidfinance professionals and those managers anddecision makers working with finance colleagues,to realise these benefits.

The following additional resources will beavailable at:www.sduhealth.org.uk/carboncostcurve

• A detailed technical annex containing full casestudies, endorsements and detailed calculations

• An interactive tool that scales interventions toorganisations: Healthy Returns: Your carboncost benefit curve2

• National carbon cost benefit curve• National organisation type carbon cost benefit

curve

Return on Investment – finances The SDU have estimated the cumulative savingsfrom energy measures alone implemented inEngland since 2007 is in the region of £1.85bn3,in addition to environmental and health benefitssuch as reduced air pollution. Continuing torealise the savings to date with investmentmaintained at the current expected rate to 2025would return a cumulative saving of £6.2bnagainst a business as usual case. Significantfurther savings have been made in waste, water,transport and increasingly procurement.

Saving money and resourcesEnsuring financial investments address social,economic and environmental sustainability meansthat saving money and resources for front linecare now, simultaneously helps to improve ourhealth and wellbeing in the future. Longer termsustainability in the health sector relies onrealising these savings.

The 2016 Carter Report4 highlighted opportunitiesfor systematic efficiency savings and environmentalbenefits with examples such as health sectorenergy use. HM Treasury forecasts energy prices toincrease above average inflation to 2020, so bothdirect and supply chain efficiency gains will beneeded to keep down costs (opposite).

Introduction

£540m has been invested over eight years in technologiessuch as LED lighting, insulation and better energy control.£1.85bn has been saved over that time and £190m cut offthe 2016 NHS energy bill.

2. Carbon cost benefit curves show the carbon and financial savings across interventions 3. Gross - details of calculations available in the Technical Annex4. Review of efficiency in hospitals


2015 20212016 2017 2018

Year

2019 2020 2021 2023 2024 2025

Rea

l pri

ce in

crea

se (

bas

e ye

ar 2

015

= 1

00)

Increase over inflation for electricity and roadfuel price (base year 2015 = 100)

80

90

100

110

120

130

140

150

160

170

Road fuel range

Electricity range

Electricity Central

Road fuel Central

While resource efficiency in facilities managementwill continue to release immediate cash savings,initiatives such as preventing ill health (asprioritised in the Five Year Forward View) andsustainable procurement address costs andimpacts at source and for the long term.

The Five Year Forward View stresses the need foraffordable models of care and health

improvement through, amongst other things,radical prevention of disease. This report capturesa number of individual interventions with shortand longer-term financial savings anddemonstrates their additional environmental andhealth benefits (which in turn save even moremoney). It also covers some of the existingorganisational and governance tools that supporta systematic integration of triple bottom line

“The evidence presented here shows that we don’t always have to choose between savingfinancial resources or protecting the environment – indeed, the most effective investments canoften save money, improve health now, and safeguard the environment on which all futurehealth depends. What’s good for the environment, and good for the patient’s health, can begood for the nation’s finances too.”

John Holden, Director of Policy Partnership & Innovation, NHS England

(Based on HM Treasury Green Book supplementary guidance)


Rampton Hospital replaced a coal fired heat plant with a Combined Heat and Power (CHP)unit, and a wood chip boiler (see above). The Trust reduced energy costs by 44% savingaround £790k per year, cut 8,614 tonnes of CO2e and produces significantly less airpollution.

(financial, social and environmental) accountingfor sustainability.

Achieving lasting benefits in prevention,procurement and resource use requires evencloser collaboration across local healthcommunities and wider local economies.

Sustainability and Transformation Plans can enablethe delivery of more integrated local models ofcare. Those that take into account financial,environmental and social sustainability can alsohelp address the social determinants of health.Harnessing every opportunity will be vital inachieving the £22bn efficiency savings outlined inthe Five Year Forward View.



Assessing savings - financial andcarbon impact curve

The Carbon and Cost Benefit Curve and theinterventions table overleaf present examples ofhealth and care interventions with their direct andindirect financial savings, and their carbonsavings. Measures are prioritised to supportdecision making and help develop localinvestment plans in organisations and withpartners.

Annual savings have been calculated for thehealth and care sector in England using existing

case studies and research evidence with anassumption of moderate implementation in fiveyears. If delivered nationally these measures alonecould save the health sector a further one milliontonnes of carbon and £414 million each year by2020.

More detailed and organisation type specificcarbon cost benefit curves are provided in theassociated documents and the interactive onlinetool via:

www.sduhealth.org.uk/carboncostcurve

York Teaching Hospital built their estates investment plans on the 2010 SDU MAC Curve.Direct investments by the trust, and those through an Energy Performance Contract,including a large Combined Heat and Power system, have saved £680k in annual energycosts. The Trust have reported a Net Present Value for the project of £3m and emissionreduction of 24.5% on their baseline, cutting 2,997 tonnes of CO2e

Health and care system Carbon and Cost BenefitCurve


A Worcestershire County Council and local CCGs programme to reduce social isolation for3,000 older people, will deliver £1.3m direct savings annually and 244 QALYs (worth £15m inavoided social cost), reducing carbon emissions by 217 tonnes. The Age UK and localcommunity organisation partnership was awarded the UK’s first ‘payment by results’ SocialImpact Bond.

The sector could save £414 millionand one million tonnes of carbon peryear by 2020.


tonnes of CO2e saved

cost

per

to

nn

e C

O2e

sav

ed

0 5,000 10,000 15,000 20,000 99,000 99,250 99,750 100,000

0

-1,500

-500

-1,000

-2,000

-2,500

-3,000

-3,500

-4,000

-9,000

-31,500

1. Theatre kits�£ saving: £11.5mOnly including instruments needed reduces cost, resource use and improves theatre efficiency

1

3

4

5

6

A full interactive version of this, other graphs and the interventions table are at:sduhealth.org.uk/carboncostcurve

3. Combined Heat & Power (CHP)†��£ saving: £26.4mInstallation of a CHP system that simultaneously generates usable low cost, low carbon heat and electricity.

4. Medicine waste��£ saving: £37.5mImproving patient adherence to prescriptions and reducing over-prescribing in new medication and repeat prescriptions.

5. Active staff travel��£ saving: £2.9m* (in 2026)Encouraging staff and visitors to walk, cycle or use public transport to site. Reduced vehicle use and air pollution. Added health benefits from exercise.

6. Psychiatric liaison�£ saving: £259m�Introduction of Rapid Assessment, Interface and Discharge service, including improved A&E response and ward referral times

10. Social isolation�£ saving: £421k* (in 2026)Reducing loneliness amongst over-65s to improve health and wellbeing and reduce demands on services.

-32,000

-8,500

-8,000

-7,000

-7,500

99,500

-6,000

-5,500

-5,000

-4,500

-6,500

10

Carbon and Cost Benefit Curve

These 35 interventions do not represent acomprehensive list. They have been selectedbecause they are supported by robust data andevidence to enable analysis and scaling. The dataseton procurement, prevention and models of caremeasures in particular is still growing.It can be seen that the most dramatic absolutesavings, both financially and environmentally, are

in the areas of prevention, waste (especiallypharmaceuticals), new models of care and staffbehaviour.

One intervention from each category has beenselected and their potential savings plotted onthe graph below.


�

��£

��

��£ saving: £2.9m* (in 2026)E

� �

�

Product and procurement innovation

Healthcare delivery/service innovation

Health Protection (£ saving not until 2026)

Waste reduction

Interventions category key:

* Interventions' direct financial savings for the sector not realised until 2026 so excluded from total.† From 2021 gas CHP is higher carbon than grid electricity is expected to be.

Energy saving

Travel

Rank £/tCO2e

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

Name

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

Reducing social isolation in older people

Teleconferencing

Furniture reuse scheme

Telehealth/Telecare for long term conditions

Solar - photovoltaic

Variable speed drives

Staff energy awareness & behaviour change

Lighting - controls

Building Management System (BMS) -

optimisation of existing systems

Lighting - high efficiency

Optimising office electrical equipment

Temperature set points - '1 degree C'

Building Management Systems (BMS) -

new systems

Heating upgrade

Decentralisation of hot water boilers

Boiler plant optimisation

Dry recycling of general waste

Building fabric - glazing, insulation

& draft proofing

Reducing waste anaesthetic gases

District heating

Boiler replacement

Smoking cessation

Solar - thermal

Prescribing non-propellant inhalers

for asthma

Travel planning

Reducing fuel poverty through referrals

for home insulation

Grand total savings in 2020

£ / tCO2e

-31,600

-7,380

-6,340

-4,430

-3,790

-2,000

-1,870

-1,620

-1,570

-1,320

-981

-527

-341

-261

-231

-210

-167

-153

-141

-125

-111

-93

-91

-87

-76

-45

-24

-15

-15

-3

-1

0

0

1

1,480

tCO2e saved in 2020

329

1,420

3,750

7,030

4,180

84,500

28,400

166

3,960

62

4,100

175,000

6,740

2,690

10,300

75,100

2,250

14,100

18,800

11,100

46,200

29,200

18,200

18,000

2,050

1,240

11,400

11,900

27,900

6,160

42,200

2,350

341,000

48,900

17,400

1.1 million tonnes

£000s saved in 2020

11,500

0 (saving in 2026: 32,200)*

26,400

37,500

0 (saving in 2026: 19,500)*

259,000

4,690

297

1,480

0 (saving in 2026: 421)*

5,020

425

2,550

1,030

3,930

21,500

863

3,440

7,190

4,250

6,260

4,440

2,470

2,430

278

387

1,540

201

3,780

834

0 (saving in 2026: 248)*

319

0

23

0 (saving in 2026: 171,800)*

£414 million


Organisational Sustainable DevelopmentManagement Plans (SDMPs) are in place in mostNHS organisations. They bring together theinterventions (such as those detailed on theprevious page) that drive down use and cost offinite resources, in line with the NHS Constitutioncommitment, Number 65.

“The NHS is committed to providing best valuefor taxpayers’ money - it is committed toproviding the most effective, fair and sustainableuse of finite resources. Public funds for healthcarewill be devoted solely to the benefit of the peoplethat the NHS serves.”

SDMPs and sustainability reports are requiredfrom all providers through the NHS StandardContract6 and are a key performance indicator(KPI) in the Public Health Outcomes Framework

(PHOF)7. The majority of providers andcommissioners follow best practice in detailingfinancial and non-financial indicators of progresson their SDMP in their annual report.

The requirement for sustainability reporting aspart of annual reports is also emphasised by DH8

and in guidance from HM Treasury9. In buildingan investment plan for sustainable developmentan SDMP can help contribute towards building aStrategic Outline Case/s for investment.

Increasingly organisations are includingsustainability impact assessments into businesscase development to identify opportunities toleverage social and environmental value.

Finance professionals are crucial to realising andreporting savings from SDMPs, by ensuring they

Operationalising sustainability and finance

5. NHS Constitution establishes the principles and values of the NHS in England6. NHS Standard Contract - clause 18 service conditions7. Public Health Outcomes Framework - a vision for public health, desired outcomes and the indicators

“In addition to the legal and scientific reasons for taking sustainable development and climatechange seriously, there are equally important financial and organisational reasons for action. InPHE, we have already saved millions of pounds and reduced our carbon footprint by rationalisingprocesses and estate, empowering our staff and the public with the latest opportunities in IT. Wewill continue to work with our partners in health and local government to create the rightconditions for a fair, healthy and sustainable future for us all.”

Michael Brodie, Finance and Commercial Director, Public Health England


8. Department of Health Group Accounting Manual 2016 to 2017- ‘Reporting entities are expected to comply with mandatory sustainability reportingrequirements’

9. HM Treasury Financial Reporting Manual 2016-17: ‘mandatory sustainability reporting requirements’

are valued and integrated into Cost ImprovementProgrammes (CIPs) and given sufficient coveragein annual reports. Inclusion allows organisationsto demonstrate financial savings alongside non-monetised social and environmental returns oninvestment, such as carbon reduction, cleaner air,community partnership or support for localemployment and skills.

The SDU provides guidance on SDMPs andsustainability reports at:

www.sduhealth.org.uk/plans

www.sduhealth.org.uk/reporting

Derbyshire Community Healthcare Services Foundation Trust estimate they are now savingalmost £2m and 3,224 tonnes of carbon per annum against a business as usual case, bytaking a whole trust approach rooted in their Sustainable Development Management Plan

Ensuring a best value approach to local healthsystem planning and commissioning, including allthree aspects of sustainability, protects and improveshealth, reducing later demand on services andsaving money.

SDMPs and sustainability reporting are a commonthread across the health system. The social andenvironmental issues they address, such as airquality and carbon reduction, are common currencywith all organisations engaged in local healthsystem planning.

SDMPs are valuable tools to support the delivery ofaligned approaches to local cross system efficiency,in line with the objectives of the FYFV andSustainability and Transformation Plans (STPs).

The Public Service Social Value Act 201210 requiressocial, economic and environmental factors to beconsidered in service procurement where “relevant”and “proportionate”. Social determinants of health

and health inequalities such as air quality, climatechange resilience or local economic growth andemployment priorities are ‘relevant’ matters inprocurement and commissioning as they havelonger term health implications11.

A triple bottom line approach to sustainability withpartners and supply chains across local geographiesalso provides opportunities to draw in and alignresources from outside the health system,particularly for innovation and efficiency. Forexample public funding is often awarded throughlocal enterprise partnerships (LEPs) to universities tosupport small businesses in innovation and resourceefficiency, or to public bodies to supportinfrastructure investment in energy equipment.There are often central government infrastructureinvestment programmes, channelled through localauthorities, for clean transport such as the currentClean Air Zone12 funding (through the Office ofLow Emission Vehicles) and community energy, suchas district heating13 (through DECC).


Sussex Community Trust’s comprehensiveapproach to sustainable transport is one ofseven elements supported by itsSustainable Development ManagementPlan called Care Without Carbon. TheTrust provided a Travel Bureau advisingstaff on sustainable travel choices as wellas providing access to 15 low-emissionpool cars and electric bikes.

This was backed up by annual travel surveysand quarterly reports. The Trust reducedgrey fleet (personal cars used for work)mileage by 16.7% in one year - almost onemillion miles, saving £500k and 60 tCO2e.

10. The Public Service Social Value Act 2012 - requires commissioners of public services to think about how they can also secure wider social, economicand environmental benefits

11. PHE and UCL guidance for using the Social Value Act for action on the social determinants of health12. Office of Low Emission Vehicles – cross department government team supporting use of ultra-low emission vehicles (ULEV)13. DECC support and guidance for local authorities developing heat networks.

Integrated localised planning


North East Ambulance Trustfitted telematics technology in50 vehicles which included speedlimiters when not on emergencyresponse. This cut accident ratesand improved patientexperience, saved 3 million litresof fuel which would have cost£100k, and cut 250 tonnes ofCO2 per year improving local airquality.

Ill health prevention and health improvementdepend significantly upon local social andenvironmental determinants of health.

The financial decisions made by healthorganisations themselves have a significant impacton local health and wellbeing.

Health sector organisations have very largefinancial, social and environmental footprints: asemployers in their local community, as procurers inthe local economy and as major infrastructure inthe environment. In ‘getting serious aboutprevention’, health sector organisations have aresponsibility through financial decision making, tominimise negative impacts from their localfootprint, and maximise local public health andsocial value.

An integrated organisational approach tosustainability can for example:

• Support local employment in the supply chainthrough sustainable procurement

• Support innovation and participation inefficiency through staff and communityengagement

• Protect local public health through reduced air,water and ground pollution

• Use investment in NHS infrastructure toleverage social value, for example byconnecting a new energy plant to a districtheating network to supply low cost heat topeople in fuel poverty.

All these examples can help to reduce levels ofpreventable illness and therefore the burden onNHS resources.

Financial benefits also accrue from indirect andwider impacts from interventions. For example anEngland wide approach to promoting staff cyclingor walking. If taken up by a quarter of NHSorganisations by 2020, and with just 3% of staffswitching to be more active, this could reduce carmiles as well as increasing exercise and improvinghealth in NHS staff by 114,000 Quality AdjustedLife Years (QALYs). This will also help improve localair quality and reduce road traffic.

Quantifying social, local economic andenvironmental value can be challenging, howeversome examples are covered in the annex of thisreport.

www.sduhealth.org.uk/carboncostcurve

Considering wider benefits


The Five Year Forward View challenges the systemto consider direct financial savings and highlightsthe greater savings from health improvement andprevention. In addition the system will need tolook to social impacts such as inequalities andenvironmental impacts such as air pollution. Bothcurrent and future financial costs and systemwide savings will need to be considered inplanning locally integrated health services. Thiswill help develop an efficient, patient andcommunity focused health and care system. Asystem that is serious about prevention is thelowest cost route to sustainable healthcare.

The HFMA Environmental Sustainability Grouphas received feedback from many finance andaccounting professionals who are already awareof the benefits and committed to sustainabledevelopment but are struggling to realise them.

Collaborative working with finance, sustainability,facilities, procurement, commissioning and othercolleagues will be needed to ensure that all threeareas of sustainability are integrated into planningand decision making. Where this is done well it isalready providing mutually reinforcingopportunities to achieve the sector’s challengingambitions.

Next stepsMany organisations are already making progresson aligning financial and environmentalsustainability by acting on some of theopportunities opposite. The resources here and inthe technical annex are designed to helpaccelerate the scale and pace at which theseapproaches are adopted.

The HFMA and SDU will continue to support thiswork through further engagement, research andanalysis. Together they have committed toexamine in detail five interventions and provide indepth case studies, data and outline businesscases. The aim is to provide finance professionalswith all the evidence and resources to enableimplementation of interventions at theirorganisation.

Support and guidanceThe SDU offer support and guidance fororganisations across the sector to embed andpromote sustainable development. For help andsupport, or to be involved in this area of workplease contact the SDU on [email protected],0113 825 3220 or via www.sduhealth.org.uk

The HFMA Environmental Sustainability SpecialInterest Group was launched to identify how thefinance community can help move theenvironmental sustainability agenda forward. Thegroup will help spread good practice in relation tolinking of environmental issues financial bestpractice. If you are interested in joining the groupas a full or associate member contact DebbiePaterson on [email protected] or theHFMA’s committee executives on

[email protected]

Implementation


Top opportunities for finance professionals

1. Work across the organisation (and if possible the local economy) to ensure plans are in place toimplement improvements. The SDMP is the best place to start.

2. Ensure your organisation’s SDMP is aligned with and recognised within the Cost Improvement Planand organisational business plan. Where possible, ensure that the SDMP authors/contributors areaware of the possible progression route to and requirements for a Strategic Outline Case in businesscase developments.

3. Check that your organisation’s annual sustainability report identifies financial savings and non-financial indicators such as carbon reduction, staff mileage claims, use of finite natural resources andsocial value indicators.

4. Include non-financial returns in business case, value for money and impact assessments using bothquantitative impacts and non-financial or non-monetised indicators for social and environmentalimpacts, such as carbon emissions, air quality and local employment.

5. Work with sustainability and procurement colleagues to realise supply chain efficiency opportunities,which reduce indirect costs, environmental impacts and increases social value.

6. Identify opportunities for sustainable development investment from outside the health sector,through match funding, partnerships and collaboration; e.g. transport infrastructure funding withlocal authorities, energy infrastructure funding through Local Enterprise Partnerships and centralgovernment, or funding for supply chain collaboration and innovation through universities.

7. Use planning processes (especially the current STP process) to encourage a collaborative approach toefficiency savings and health improvement. Align financial savings with longer term health benefits,ensuring all health spending, from business case to contract management, is in the spirit of thePublic Service Social Value Act; supporting the social and environmental determinants of health.

8. Use the interactive tools and work with colleagues to help build cost saving projects with social andenvironmental value in your SDMP.


Resources inner back cover

The references below will support organisations to act on the opportunities. More detail about supportalongside explanation and calculations can be found in the supporting resources:

• A detailed technical annex • Your carbon cost benefit curve - interactive tool that scales interventions to organisations • A national carbon cost benefit curve• A national organisation type carbon cost benefit curveall available via: www.sduhealth.org.uk/carboncostcurve

• Sustainable Development Strategy - Commissioning and Procurement module www.sduhealth.org.uk/CP• Sustainability Impact Assessment www.sduhealth.org.uk/SIA• SDMP guidance www.sduhealth.org.uk/plan• 5 to Survive – short guide to Sustainable Development for Finance Professionals

http://www.sduhealth.org.uk/documents/publications/5_to_survive_finance.pdf• HFMA Environmental Sustainability Special Interest Group resources

https://www.hfma.org.uk/our-networks/committees-special-interest-groups/environmental-sustainability-special-interest-group

Key legal, mandatory and reputational driversSustainable Development Strategy – provides a vision and goals for the sector up to 2020www.sduhealth.org.uk/SDSNHS Five Year Forward View - sets out a shared vision for the future of the NHS based around new models of carewww.england.nhs.uk/ourwork/futurenhsCarter Review 2016 - Review of efficiency in hospitals including some environmental benefitswww.gov.uk/government/publications/productivity-in-nhs-hospitalsPublic Services (Social Value) Act 2012- Legislation that requires commissioners of public services tothink about how they can also secure wider social, economic and environmental benefitshttps://www.gov.uk/government/publications/social-value-act-information-and-resources/social-value-act-information-and-resourcesClimate Change Act 2008 – legislation that commits the UK to reducing emissions by at least 80% in2050 from 1990 levelshttp://www.legislation.gov.uk/ukpga/2008/27/contents


NHS Constitution - establishes the principles and values of the NHS in Englandhttps://www.gov.uk/government/publications/the-nhs-constitution-for-englandNHS Standard Contract - clause 18 within service conditions relates to sustainability reporting andplanswww.england.nhs.uk/nhs-standard-contract/16-17/Office of Low Emission Vehicles - cross department government team supporting use of ultra-lowemission vehicles (ULEV)https://www.gov.uk/government/organisations/office-for-low-emission-vehiclesDECC District Heating - Support and guidance for local authorities developing heat networks. https://www.gov.uk/guidance/heat-networks-delivery-supportPHE Guidance - Local action on health inequalities -Using the Social Value Act to reduce healthinequalities in England through action on the social determinants of healthhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/460713/1a_Social_Value_Act-Full.pdfSTP ‘Quick guides’ - Guides from NHS England to support STP developmenthttps://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/stp/support/HM Treasury Financial Reporting Manual 2016-17 - Reporting entities are expected to comply withmandatory sustainability reporting requirements https://www.gov.uk/government/publications/public-sector-annual-reports-sustainability-reporting-guidance-2014-to-2015Public Health Outcomes Framework - a vision for public health, desired outcomes and the indicatorshttps://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparencyDepartment of Health Group Accounting Manual 2016 to 2017https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/521881/DH_GAM_1617.pdfTreasury Green Book – supplementary guidancehttps://www.gov.uk/government/publications/valuation-of-energy-use-and-greenhouse-gas-emissions-for-appraisal

Healthcare Financial Management Association (HFMA) NHS Environmental SustainabilitySpecial Interest GroupThis group is coordinated by the HFMA with partners from the NHS/PHE Sustainable Development Unit,the Accounting for Sustainability project (A4S)*, CIPFA, and the Department of Health.

*HRH The Prince of Wales established his Accounting for Sustainability project (A4S) in 2004 and tasked finance and accountancy professionals withincreasing engagement and building capacity to drive behaviour change that results in sustainable business practices, as well as develop tools, guidance andapproaches that enable environmental, social, and economic risks and opportunities to be reflected in decision making.

Additional references

The Sustainable Development UnitVictoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB

T: 0113 8253220 E: [email protected]: www.sduhealth.org.ukFollow us on Twitter - @sduhealth This publication is printed on 100% recycled paper and is printed using vegetable-based inks and a water-based sealant.

Designed and produced by: MJWebb Associates Ltd

Published June 2016

Document produced by the Sustainable Development Unit (SDU) which is funded by, and accountable to, NHS England and Public Health England towork across the NHS, public health and social care system.

NHS England Publications Gateway Reference 05390

The SDU supports the NHS, Public Health and Social Care system to be sustainable environmentally and socially. This is done by engaging across thesystem to identify the frameworks, networks and mechanisms that will encourage a healthier environment, better health and enable communities andservices to be resilient to adverse weather events and climate change.

Responsibility for the content of this document lies with the Sustainable Development Unit.

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