Supplement case studies: Steps to minimise impact on environment

University Hospitals Bristol Trust

Engaging staff and working with the wider community has been key to improving environmental and social sustainability at University Hospitals Bristol Foundation Trust.

The organisation has been developing and expanding its suite of Green Impact awards, an innovative project that allows groups of staff to register as “green teams” (generally the department they work in), and fill in an online workbook listing green actions. When the staff can tick off the actions, they can apply for four levels of award up to gold.

According to Sam Willitts, energy and sustainability manager at the trust, a greener way of life is becoming an essential part of the organisation, and the Green Impact awards are key to this. “The awards encourage and recognise staff for taking action to make our hospitals more sustainable,” he says.

“Having an executive lead is also essential to making staff feel empowered to take forward green activities.”

There are some 70 green teams across the organisation, around double the number there were in January 2014. In the most recent green impact year (2014-15) teams completed a total of 498 actions, and doubled the number of green impact points compared to the previous year.

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Actions don’t stop at the hospital door, however. The trust has taken on board Bristol’s position as European Green Capital for 2015 and has taken a system-wide approach to promote sustainable behaviour and positive links to health.

’Viewing the challenges through the lens of sustainability enables long term strategic solutions to emerge’

Examples include monthly invitations to not-for-profit groups to come on site to promote sustainable behaviours and positive impact on health, and feeding into the Bristol Green Capital partnership through the health and wellbeing action group. The trust also played an active part in Bristol’s Healthy City Week, which aimed to inspire people to achieve healthier lifestyles as part of a more sustainable future.

Other initiatives include enabling projects such as “kitchen on prescription” – to promote healthy eating and cooking. There are also plans for a district heating project, extending the use of the trust’s energy centre to deprived areas in the first instance.

“The success of our sustainability initiatives stems from working in partnerships with organisations across the health and social care system and beyond it, which we have found to be the most effective way to start to tackle complex problems such as climate change,” says Mr Willitts.

He would like to see action to ensure that sustainability becomes a way of life across the health and social care system. “We need a wider realisation that viewing the challenges the health services face through the lens of sustainability enables long term strategic solutions to emerge,” he says. “This is better than stumbling from short term crisis to short term crisis.”

Barts Health Trust

In the last five years, Barts Health Trust’s sustainability strategy has made demonstrable financial savings, as well as improving social and environmental impact.

What’s more, its 20:20 vision is also spreading out to the wider NHS and to local communities, by, for example, addressing health and social care inequalities, and improving local air pollution.

It’s an ambitious programme, and environmental manager Fiona Daly says that making it work has meant getting everyone involved. “My one key message is think big, have a vision, share it often, engage other sectors, align your values and never, ever give up,” she says.

“We are committed to making a change, to investing in that change and to the time it takes to shape the culture we want to deliver at Barts Health.”

A broad spectrum of elements is ensuring that sustainability is being embedded. This includes everything from the corporate vision to change the lives of those who live and work in east London, clear direction and support from board level, and working with partner organisations.

’Everything we do, we share, even the things that go wrong’

But it’s about people too. “It’s down to the dedication of the management teams who strive to incorporate sustainable changes in their everyday practices and the amazing and empowered staff base we have,” she says. “And it’s also our patients, who are screaming out for a system that is fit for now and for the future.”

She believes that the trust’s strategy has lessons for the wider NHS. “Everything we do, we share, even the things that go wrong,” she says. “We are striving to innovate, to create groundbreaking partnerships to deliver a real difference to our health communities and to share what we are doing across the system.”

Operation TLC, a collaborative behavioural change programme, empowers individuals to take action to reduce energy and carbon, measuring and recording changes and improving patient experience, while saving money – potentially £35m if adopted across the NHS.

The programme pioneered by Barts has now been deployed in four NHS trusts, and at Barts alone, has saved £428,000, 1,900 tonnes of CO2, and has improved sleep quality and privacy for patients.

Activity in the community is arguably having a longer term impact on health and sustainability.

This has included a programme to reduce fuel poverty in Tower Hamlets, community-led sustainable growing projects and food and nutrition information for local school children.

Ms Daly believes that sustainability should be embedded in the NHS – and that everyone should be involved. “It needs to be a core corporate priority, supported long term investment and cross-sector funding pools,” she says.

“The leaders need to have vision and be committed to delivering it, no matter what the priorities of today are. We need to engage the public, at scale, on their part of mobilising this change.”

Central Manchester University Hospitals Foundation Trust

Just two years ago, managers at Central Manchester University Hospitals Foundation Trust knew that they weren’t doing as well as they could on the sustainability front.

While other trusts were forging ahead with initiatives that were winning them green plaudits and saving them money, Central Manchester did not even have a dedicated sustainability resource – and was spending £15m annually on energy, waste and water. Something had to change and today things already look very different.

A multidisciplinary sustainability team, led by senior management, was set up in 2013. Action was taken on many levels, based on a three-pronged approach of engagement, effective partnership and capital investment.

A campaign to encourage staff to improve workplace sustainability included videos for all hospital screens, showing the benefit in terms of economic savings, patient care and impact on the environment. Waste labels and posters were rebranded to make them more engaging, a new community gardening project was agreed for the main site, providing apprenticeship opportunities for the local community and benefit to patients and local people.

Claire Igoe, sustainability and energy manager at Central Manchester University Hospitals Foundation Trust, says it’s important to show the impact that initiatives have both on trust finances and on care.

’The Manchester approach makes it clear trusts should not be working in isolation’

“Embedding sustainability in our organisation has meant clearly defining the link between improved environmental performance and core NHS priorities of financial performance and patient care,” she says. “Buy-in from senior management, and in particular our board chairman Steve Mycio and his predecessor Peter Mount, has been essential to engage staff with this agenda, and ensure top-down as well as bottom-up engagement.”

Capital investment has included spending £185,000 on LED lighting, predicted to save £65,000 per year, while cutting carbon. Reducing gas consumption is expected to save £75,000 per year and savings are already showing from making other improvements.

Innovative ideas include a “re-use” classified ads scheme for staff, which has already seen hundreds of items re-used, a new process for sharps that has reduced numbers sent for incineration by a third, and a free park and ride shuttle for staff and business travellers.

The Manchester approach makes it clear trusts should not be working in isolation. A partnership with GlaxoSmithKline to recycle inhalers has led to more than 300 being recycled each month, while a Green Impact campaign delivered with the National Union of Students led to more than 2,000 actions to improve sustainability and efficiency.

Senior representatives throughout the trust steer the overall strategy and enable staff to make changes.

Now 90 per cent of staff feel more aware of sustainability, and £100,000 in savings through staff engagement alone already identified.

“As pressure on services continues to grow, working in partnership with our stakeholders and engaging staff in delivering services in a more environmentally efficient manner is key to our future,” says Ms Igoe.