CCGs must act now to meet NHS carbon targets

The new clinical commissioning groups are now responsible for 80 per cent of the NHS budget and, as such, will have a huge role to play in improving the organisation’s environmental performance.

‘Sustainability expectations are high and CCGs could be the main driving force behind the NHS’s agenda’

Procurement accounts for 60 per cent of the NHS’s overall carbon footprint and the CCGs’ commissioning decisions will be one of the determining factors in whether the NHS can successfully reduce its emissions by 10 per cent by 2015 and 34 per cent by 2020, as outlined in the NHS Sustainability Development Unit’s NHS Carbon Reduction Strategy.

The unit currently forecasts that the NHS is on track to reduce carbon emissions by just 5.4 per cent by 2015.

Sustainability expectations are high and, as well as having huge influence over budgets, the CCGs could also be the main driving force behind the NHS’s sustainability agenda.

Upon authorisation, the chair of each CCG made a commitment to promote environmental and social sustainability in their organisation. This was a self-certifying process that took place in the application phase. But this was not simply a tick-box exercise. Self-certification was the first step the organisation took to confirming wide-ranging and significant commitments, in particular in its commissioning actions.

As of April 2013, no specific sustainability requirements for the CCGs have been published.

Integrating sustainability

To ensure the CCGs in Leeds adopt a proactive approach to sustainability, renewable energy and sustainability consultancy CO2Sense developed a framework to help them integrate sustainability into their systems, processes and culture. The timeline sets out when significant commissioning activity is likely to take place, such as identifying their premises or developing procurement criteria, and ensures sustainability is integrated into each stage.

Adopting a long-term approach such as this is challenging for any organisation, particularly if it has only been fully operational for less than a fortnight, but it will deliver the greatest benefits for the CCGs − both environmentally and financially.

‘PCTs and CCGs are very different organisations and not all existing activity will be suitable for the new bodies’

The first stage of the timeline is around procurement or refurbishment of the CCG’s building and developing sustainability criteria to optimise building efficiency, travel planning and waste contracts.This involves a review of the building and looks at areas such as lighting, heating, ventilation, building fabric and waste management. The decisions the group makes now will be critical in avoiding high-running costs in future.

The Leeds CCGs have also conducted a “sustainability health check” of GP practices as part of the framework. This involves a detailed resource efficiency review and renewable energy feasibility study for a sample of surgeries in the Leeds area.

The framework also recommends appointing a “green champion” in each of the CCGs to engage staff in cultural, organisational and environmental behaviour change. Recommendations from NHS Employers suggest that improving staff engagement will help the NHS meet its £20bn efficiency savings target, which is intrinsically linked to environmental targets.

Critical framework

CCGs have the option of using some of the existing NHS sustainability activity as a template for their sustainable development plan. However, it is important to remember that primary care trusts and CCGs are very different organisations and not all existing activity will be suitable for the new bodies. For example, there are opportunities for the Leeds CCGs to adopt some of NHS Leeds’ existing measures to reduce travel, improve waste management and engage employees.

‘Some solutions can be easily implemented in the immediate future, while others will fit into the CCG’s long-term plans’

By reviewing and prioritising future procurement, CCGs can develop an understanding of the short, medium and long-term opportunities in the organisation to reduce carbon and increase value through its commissioning decisions. A review will also identify priority areas where the groups can take immediate action. Engagement with service providers and the supply chain is also crucial to ensure they understand sustainability requirements.

With procurement accounting for the majority of the NHS’s overall carbon footprint, this part of the framework is critical if it is to meet its carbon reduction targets.

The NHS Carbon Reduction Strategy Update, published by the Sustainability Development Unit in 2010, suggests if the service is to reduce carbon emissions by 34 per cent by 2020 then it may have to procure 20 per cent less pharmaceutical products, 20 per cent less medical equipment and 20 per cent less non-pharma/medical products, among other measures for building efficiency.

Every CCG in the country needs to make an individual decision on how far they will implement sustainability and they face a fine balancing act. Ambition from them is crucial if the NHS is to meet its carbon reduction targets, but they must also ensure they don’t overstretch as clarity around their sustainability role emerges.

As outlined in the framework, some solutions can be easily implemented in the immediate future, while others will fit into the CCG’s long-term sustainability plans. However, it is important to consider these now so the decisions being made today don’t prohibit future activity.

Lorna Peacock is a senior consultant at CO2Sense, Anna Frearson is a consultant in public health at Leeds city council