NHS_Notts_County_Carbon_Management_Plan

NHS Nottinghamshire County Carbon Management Plan

Final version, 10th June 2010.

NHS Nottinghamshire County Carbon Management Plan Page 2 of 73

Acknowledgements

NHS Nottinghamshire County wishes to acknowledge the assistance of Nottingham Energy Partnership (NEP) in the production of this document, specifically Jerome Baddley, Sustainable Energy Development Manager and Project Lead, and

Laura Mayhew-Manchon, PCT Carbon Reduction Project Technical Officer and Operational Lead.

Note to readers: Please note that NHS Nottinghamshire County and PCT are used as interchangeable terms throughout this document i.e.: read ‘PCT’ as ‘NHS Nottinghamshire County’, and viceversa.


Contents

Page

Foreword ................................................................................................................................................................................ 5

1. Introduction ...................................................................................................................................................................... 6

2. Setting the context ............................................................................................................................................................ 6

2.1. Rationale and drivers for change ................................................................................................................................. 7

2.2. NHS Nottinghamshire County baseline carbon footprint ............................................................................................. 8

3. Monitoring, updating and reporting ................................................................................................................................... 9

4. The Carbon Management Plan: Vision and Strategy ............................................................................................................ 9 4.1. Procurement – Commissioning healthcare services ..................................................................................................... 11 4.2. Energy in buildings ...................................................................................................................................................... 13

4.2.1. Energy in buildings policy 4.2.2. Energy in buildings strategy

4.3. Travel, transport and access ........................................................................................................................................ 17

4.3.1. Sustainable travel and transport policy 4.3.2. Sustainable travel and transport strategy

4.4. Waste management ..................................................................................................................................................... 21

4.4.1. Waste management policy 4.4.2. Waste management strategy

4.5. Procurement – Goods and Services ............................................................................................................................... 24

4.5.1. Sustainable procurement policy 4.5.2. Sustainable procurement strategy


(Contents – continued) Page

4.6. Sustainability and people – Behaviour change in the workforce ................................................................................... 28

4.6.1. Sustainability and people policy 4.6.2. Sustainability and people strategy

5. NHS Nottinghamshire County Carbon Management Action Plan (CMAP) ............................................................................. 31

6. References, useful links and further reading ........................................................................................................................ 51

7. Glossary .............................................................................................................................................................................. 54

8. Appendices

• Appendix A: NHS Nottinghamshire County CRCEFS and Baseline CO2e footprints – April 2010 ......................................... 56

• Appendix B: Protocol for mapping sources of CO2e emissions in-house for footprinting purposes ................................... 61 • Appendix C: Energy andcarbon performance analysis of owned estate, including benchmarks ......................................... 63

• Appendix D: Procuring for Carbon Reduction (P4CR) Flexible Framework ......................................................................... 67 • Appendix E: Representation of different types of healthcare waste and recommended disposal route and end process ... 69

• Appendix F: Flowchart showing how sustainability can be integrated into procurement and associated benefits .............. 70

• Appendix G: Selected graphs from ‘Saving Carbon, Improving Health – Update’ ................................................................ 71

• Appendix H: Key results from the PCT CRP Behaviour change pilot project ........................................................................ 72


Foreword

There is now overwhelming scientific evidence that the climate is changing as a result of carbon dioxide emissions. At a national level, the Government and the NHS are clear that this presents a serious threat to environmental, health, social and economic wellbeing, and that action needs to be taken now to reduce and mitigate the harmful effects of climate change on our communities.

Additionally, there is a strong financial incentive for NHS organisations to address climate change, as reducing carbon emissions will save money that can be redirected into patient care, and will enable the healthcare sector to become more resilient in its use of natural resources and hence in its capacity to deliver frontline services in years to come.

As a leader of the local NHS and as one of the county’s largest employers, NHS Nottinghamshire County recognises that it has a responsibly to identify and act to reduce the impact of its own operations, and that it has an important role to play as a leading commissioner of low carbon healthcare. In recognition of the urgency to act on climate change, NHS Nottinghamshire County, with the support of Nottingham Energy Partnership, has developed this Carbon Management Plan, which defines the PCT’s long-term vision to reduce its carbon footprint, in line with national requirements, and sets some challenging targets for achieving effective reduction in carbon emissions across buildings, travel, waste, and procurement practices.

The Plan describes how NHS Nottinghamshire County, by working closely with staff, supply chain and healthcare providers, will play a leading and innovative role in achieving the shift to a low carbon economy across the PCT’s estate, in the health community and in Nottinghamshire. The Carbon Management Plan commits NHS Nottinghamshire County to:

• Reducing its own 2007/08 baseline carbon footprint by at least 10% by 2015; • Delivering carbon reduction through commissioning frameworks; • Understanding how healthcare delivery must be shaped for a low carbon future; • Encouraging and enabling NHS staff to take action in their workplace and promoting culture change; • Consolidating partnership working and making use of leverage within local frameworks including Local Area Agreements and Local Strategic Partnerships; • Providing reassurance to people living in Nottinghamshire and to partner organisations of NHS Nottinghamshire County’s commitment to tackling

climate change; • Measuring and monitoring performance on a regular basis, and communicating progress both internally and externally.

I commend the Plan to you and look forward to reporting significant progress in carbon reduction throughout NHS Nottinghamshire County.

Mike Alexander Director of Finance and Performance, NHS Nottinghamshire County

Chairman, Sustainability Steering Group 21st April 2010


1. Introduction NHS Nottinghamshire County’s core carbon footprint has been calculated with assistance from Nottingham Energy Partnership (NEP) as 6,313.45 of CO2e (Scope I, II and key III emissions) for the baseline year 2007/08. The methodology used was developed by the Department for Environment, Food and Rural Affairs (DEFRA), and is evidence of the PCT’s commitment to measure and manage the carbon and wider sustainable development impacts from its operations. This document describes the strategy and actions required to achieve effective carbon management across NHS Nottinghamshire County in respect of:

• Commissioning of healthcare services;

• Energy use in buildings;

• Travel, transport and access;

• Waste management;

• Procurement of goods and services;

• Facilitating behavioural change in the workforce. The Plan is divided into two clear sections:

a) Vision and Strategy (Section 4): The strategic element of the Plan, including visual representation of baseline performance, setting targets and benchmarks, and making recommendations for improvement in each of the above areas over time.

b) Action Plan (Section 5): The ‘live’, operational section of the Plan, for recording and monitoring specific action in each of the key areas of carbon against the recommendations of Section 4.

Initial priority is being given to actions resulting in both reduced carbon emissions and expenditure associated with energy use across the estate, which constitute the majority of the PCT’s core CO2e footprint. This is complemented by urgent work to embed sustainability and carbon management as a contractual obligation with organisations providing healthcare services.


2. Setting the context

2.1. Rationale and drivers for change Table 1: Summary of drivers for action to tackle carbon emissions in the NHS (Source: NEP, 2010).

The need to act The reasons why Related mandate 1. The legally binding Government and national frameworks and targets.

There are legally binding UK Government targets to reduce carbon emissions by 80% by 2050 compared to 1990 levels. This is a legal requirement and governance arrangements across all organisations will need to demonstrate how this is being measured, monitored, and managed. Furthermore, NHS organisations are audited on their use of natural resources and its impacts.

• Climate Change Act (2009) • UK 2020 carbon budgets (2009) • CRC Energy Efficiency Scheme (2010) • AC 3.1. Use of resources KLOE (09/10)

2. The strength of the scientific evidence to act now on climate change.

The strength of evidence that climate change is happening now due to rising GHG emissions, that it will lead to serious and dangerous climate change and that it is caused by human behaviour, is now too strong to ignore. This is destabilising the world’s climate and adversely affecting the population’s health.

• Intergovernmental Panel on Climate Change 3rd report (2008)

• UK Climate Impact Programme (2009)

3. The health co-benefits now for patients and populations, and for the health system itself.

Taking action now will not only reduce this risk in the long term. Action now will also have health benefits immediately. Increased levels of active travel, for instance, lead to a reduced risk of obesity, diabetes, heart disease, and mild mental illness, as well as reducing road traffic injuries and deaths, and improving air quality. Action will not only benefit the health of the population now, but also benefit and support changes in the health care system as a whole.

• Saving Carbon, Improving Health: Carbon Reduction Strategy for England’ (10% by 2015) (2009)

• ‘Taking the temperature’ – Towards an NHS response to Global Warming (2007)

4. The importance of cost reductions and energy resilience.

There are important cost savings to be made, initially in the area of energy efficiency. Energy prices are highly unpredictable but are much more likely to increase than decrease. All business plans need to be as resilient as possible to such price and availability fluctuations by sourcing and using energy wisely. Resources saved by such actions can be reinvested into direct patient care. Resilience towards the price and availability of energy should be a part of every organisation’s risk register.

• ENCO2DE targets (2006) • DH target: 15% energy reduction in NHS

estate by 2010 (2001) • DH target: 35-55 GJ/m3 in new build and

55-65 GJ per m3 in existing buildings (2006)

5. The willingness and commitment of NHS organisations and staff to act now.

The results of the 2008 consultation on carbon reduction for the NHS in England showed that there is a very strong willingness and commitment from NHS organisations and staff to take a lead. 66% of NHS organisations responded, with 95% strongly supporting the NHS in taking a lead to act. This commitment and willingness needs to be coordinated and galvanised by systematic support, guidance and leadership throughout the NHS and from the Department of Health.

• Saving Carbon, Improving Health: Carbon Reduction Strategy for England’ (10% cut in total footprint by 2015) (2009)

• DH regional Sustainability Networks • Campaign for Greener Healthcare • NHS Confederation

6. The need for the NHS to be a leading public sector exemplar now.

Finally, there is an important need and opportunity for the NHS to set an example. NHS organisations can demonstrate to partner organisations and the population that healthy people depend on a healthy environment. The rapidly increasing risk of adverse effects on health from climate change is happening on this generation’s watch - it will be this generation’s legacy. See Appendix G for details on the national NHS carbon targets and trends.

• Saving Carbon, Improving Health: Carbon Reduction Strategy for England’ (2009)

• SDC Good Corporate Citizenship Model • World Class Commissioning, LAAs, NI186


2.2. NHS Nottinghamshire County’s baseline carbon footprint NHS Nottinghamshire County’s baseline carbon footprint has been calculated by Nottingham Energy Partnership (NEP) using the national methodology for measuring and reporting greenhouse gas (GHG) emissions, published by the Government in 2009. Full details can be found in Appendix A. The PCT’s core CO2e footprint has been measured as 6,313.45 tonnes CO2e for the baseline year 2007/08, covering Scope 1, 2 and key 3 emissions, as is depicted on the right. The composition of the baseline core carbon footprint is broken down as follows: Scope I and II emissions: 5,969.96 tonnes CO2e

• Energy use in buildings (Scope I and II): 89% of total core footprint in 2007/08. • Fuel use in leased vehicles (Scope I): 3% emissions of total core footprint in 2007/08.

Scope III emissions: 343.50 tonnes CO2e

• Waste disposal (Scope III): 5% emissions of total core footprint in 2007/08. • Water (Scope III): Less than 1% emissions of total core footprint in 2007/08. • Sewage (Scope III): Less than 1% emissions of total core footprint in 2007/08.

You need to identify which activities in your organisation / organisations are responsible for GHG emissions being released into the atmosphere. The most widely accepted approach is to identify and categorise emissions-releasing activities into three groups (known as scopes). The three scopes are: ▪ Scope 1 (Direct emissions): Activities owned or controlled by your organisation that release emissions straight into the atmosphere. They are direct emissions. Examples of scope 1 emissions include emissions from combustion in owned or controlled boilers, furnaces, vehicles, and emissions from chemical production in owned or controlled process equipment. ▪ Scope 2 (Energy indirect): Emissions being released into the atmosphere associated with your consumption of purchased electricity, heat, steam and cooling. These are indirect emissions that are a consequence of your organisation’s activities but which occur at sources you do not own or control. ▪ Scope 3 (Other indirect): Emissions that are a consequence of your actions, which occur at sources which you do not own or control and which are not classed as scope 2 emissions. Examples of scope 3 emissions are business travel by means not owned or controlled by your organisation, waste disposal, or purchased materials or fuels. Source: Page 10, DEFRA and DECC (2009). Guidance on how to measure and report your greenhouse gas emissions.


NHS Nottinghamshire County will report, measure, monitor and report on its core CO2e footprint on an annual basis, across the above areas of emissions, as these are the ones which the PCT has the most control over, both in terms of data availability and capacity to action. The wider carbon impact derived from the PCT’s commissioning and purchase of goods and services has also been measured, in as carbon intensity per pound spent (tCO2e/£), which will be used for targeting specific areas of spend alongside financial data, as below:

Influence: The PCT’s overall 2008/09 carbon impact

from its commissioning was 293,581 tonnes CO2e. The single largest area of influence the PCT has is through contracts with commissioned healthcare services.

Control: The PCT’s 2008/09 procurement footprint, excluding commissioned

healthcare, was 40,129 tonnes CO2e. This includes all emissions from goods and services through supply chain organisations and from own utility use. The categories are based on the Government’s Standard Industry Codes (SICs). The inner circle is proportional and represents the subset of the procurement footprint that is the PCT’s core emissions from its estate and transport activities.

Duty: The PCT’s core carbon

footprint was 6,313.45 tonnes CO2e on baseline year 2007-08. This included a Scope 1+2 footprint (outlined in bold) of 5,970 tonnes CO2e, the de minimis level of carbon reporting, and a Scope 3 footprint (excluding procurement) of 343.5 tonnes CO2e.


3. Monitoring, updating and reporting

The Action Plan (Section 5. of the CMP) will be reviewed quarterly at meetings of the Sustainability Steering Group. Progress will be reported quarterly to the Governance Committee, who will include this in their quarterly reports to the Board. Furthermore, a summary of progress against strategic Key Performance Indicators (KPIs) on the PCT’s use of natural resources and resulting carbon emissions will be included in the Annual Report, making performance on internal sustainability both available to staff and to the public.

4. The Carbon Management Plan – Vision and Strategy Carbon emissions, like expenditure, cross all areas of the PCT’s work, from the commissioning of healthcare services to the disposal of waste; from staff journeys to their workplaces to constructing and maintaining healthcare premises. Saving carbon saves money that can be better spent on frontline services, reduces the risks associated with rising energy and natural resource costs, and protects the environment. Saving carbon can improve health within Nottinghamshire through combating climate change, and contributing to protecting public health nationally and internationally. As carbon emissions are associated to a greater or lesser extent with all NHS activities, it is essential that the PCT undertakes a carbon management approach that spans the entire organisation and reaches outward to all areas within its sphere of influence.

• As one of the largest commissioners of healthcare services in the East Midlands, the PCT has a significant sphere of influence through its contracts with healthcare providers to support best practice in carbon management.

• As a significant procurer of goods and services, the PCT has a large sphere of control over the emissions arising from the supply chain, the

purchasing decisions made and the amount of consumable goods purchased.

• As the operator of a large estate and as manager of leased vehicles, the PCT has a duty to reduce its own operational emissions and thus contribute to the national government and NHS commitment to combat climate change.

• As one of the largest employers in the county, the PCT has a responsibility to support and invest in the workforce, through whom it can reduce carbon emissions, costs and vulnerability to rising energy prices.

The PCT’s vision is an integrated approach to carbon management that crosses all areas of influence, control and duty in terms of sustainable use of natural resources. NHS Nottinghamshire County will lead by example and demand the same high level of commitment from partners.


The PCT’s Carbon Management Plan forms a key part of the PCT’s Board-approved Sustainable Development Strategy and follows the internationally-accepted definition of sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their own need”. In doing so, NHS Nottinghamshire County has a vision of a clear balance between Carbon, Cost and Care.

‘LOW CARBON VISION’ – NHS NOTTINGHAMSHIRE COUNTY WILL: 1. Influence the commissioning agenda by ensuring that provider organisations actively monitor and reduce their

own carbon emissions, reporting regularly to the PCT, as part of their contractual obligations. 2. Measure, monitor and report on overall CO2e emissions and use of natural resources across all relevant areas

of the PCT’s work, on an annual basis. 3. Make best practice energy and carbon performance (as defined by DH) a critical consideration within all

buildings owned and operated by the PCT. Through estates procurement, lease agreements and ongoing investment in the estate the PCT will reduce overall electricity, gas and water consumption by at least 10% by 2015. It will further achieve a 25% reduction in kgCO2e emissions from owned estate by 2013.

4. Implement a PCT-wide Sustainable Travel Plan, which will reduce the carbon emissions derived from both

leased car use and business mileage, and deliver important health and wellbeing and cost benefits. 5. Reduce its total waste arising year on year, and by 2015 the PCT will have significantly reduced both the

amount of clinical waste generated and waste sent to landfill each year, and continue to achieve exemplary recycling rates.

6. Work on the national Flexible Framework for informing and benchmarking progress on sustainable

procurement in public sector organisations, aiming to achieve Level 3 by 2012 and Level 4 or above by 2015. 7. Ensure that all staff are trained, empowered and actively supported to adopt low-carbon and more

sustainable behaviours in their roles and daily activities, and welcome their input and place them at the heart of decision-making around carbon reduction.

8. Continue to follow national best practice in carbon management as it evolves over the coming years, and the

PCT will aim to share lessons learned and experience with its partners.

‘Carbon management is an increasingly important issue for

all organisations. Taking sustainability and

carbon emissions seriously is an integral part of a high

quality health service’.

SDU ‘Saving Carbon, Improving Health’. 2009


4.1. Procurement – Commissioning of healthcare services NHS Nottinghamshire County is responsible for ensuring via the commissioning framework that services are continuously improved, delivered in a sustainable manner, use natural resources efficiently, and develop a holistic model of low carbon healthcare that is fit for the future. With an annual budget of circa £1 billion, over 3,000 employees and a responsibility for planning, paying for and overseeing the healthcare of 660,000 people, NHS Nottinghamshire County is one of the largest commissioners of healthcare services in the East Midlands. This gives NHS Nottinghamshire County an essential role in setting the standards for sustainability in healthcare commissioning. As a World Class Commissioner, NHS Nottinghamshire County is already required to meet and demonstrate the following competencies:

• Assess business cases according to financial viability, risk, sustainability and alignment with commissioning strategies; • Make sound financial investments to ensure sustainable development and value for money. • Monitor provider financial performance, activity and sustainability in accordance with its contractual agreements; • Actively work with other local commissioners and other partners to influence their actions; • Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration;

Every year, the Department of Health publishes the standard contract between PCTs and provider organisations delivering NHS funded services. As of 1st

April 2010, the contract’s terms and conditions stipulate under ‘Section 5.2.: National requirements for local definition’ that all providers must show their own progress on tackling climate change impacts, embedding sustainable development, and performing against carbon reduction management plans. The clause allows for the format, method and timeframe for delivery of this reporting to be defined locally.

PCTs are the driver of a continuously improving local NHS. They seek innovation, knowledge and best practice, applying this locally to improve the quality and outcomes of commissioned

services. In partnership with local clinicians, practice based commissioners and providers, they will specify required quality and outcomes, facilitating supplier and contractor innovation that

delivers the best value. Through open and effective commissioning and decommissioning decisions, PCTs transform clinical and service configurations, meeting local needs and securing

world class improvements in outcomes and quality.

‘Adding life to years and years to life. World Class Commissioning – Competencies’. DH.


In light of the above, NHS Nottinghamshire County recognises a priority to actively promote and embed carbon management across healthcare services through its commissioning frameworks, as this is one of the main areas where long-term carbon reduction will be achieved, and to monitor the performance of its provider organisations against key areas of CO2e emissions.

In light of the requirements of the Climate Change Act, the Department’s Sustainability Strategy “Taking the long time view”, and in line with the national NHS Strategy: “Saving Carbon, Improving Health”, the Provider shall, as applicable, demonstrate their measured progress on climate change adaptation, mitigation and sustainable development, including performance against carbon reduction management plans [format, method and timeframe for delivery to be defined locally]. DH (2010). Terms and Conditions for the provision of community health services – NHS Standard contract for community services (2010/11). Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111203

NHS Nottinghamshire County will work closely with providers of healthcare to:

Define an appropriate format (i.e.: metrics), method (i.e.: systems) and timeframe (i.e.: frequency) for providers to report on performance;

Liaise with and communicate the above arrangements to its provider organisations, to ensure that they are prepared and equipped with the skills, knowledge and resources needed to monitor and report on their own carbon performance;

Disseminate knowledge and best practice on carbon management across its providers, promoting a culture of transparency and lesson-sharing amongst the local healthcare community.

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111203�


4.2. Energy in buildings 4.2.1. Energy in buildings policy Energy use and carbon emissions are controllable through a combination of estates investment, procurement and staff behaviour. The PCT commits to improving energy performance within the owned and leased estate, through cost effective capital investment, working closely with staff, and actively managing its leasehold arrangements. Energy use in buildings represents the single largest element of the PCT’s core carbon footprint. With rising energy prices inevitable over the coming years, this is the area most likely to be at risk of significantly increasing costs. Investment and contracts will be regularly tested and reviewed against the changing economics of energy prices and in light of any new financial incentives. At the time of writing, NHS Nottinghamshire County had an estate of 17 owned and 31 directly leased sites, across 63,783 m², spending over £2m on utilities annually. Energy use in buildings is responsible for over 89% of the PCT’s baseline CO2e footprint. The PCT recognises both the impacts and the opportunities resulting from the effective management of energy in the buildings it occupies. NHS Nottinghamshire County expects all employees to contribute to reducing expenditure on energy and cut carbon emissions. The PCT will raise energy awareness at all levels, ensuring energy management is communicated, integrated and supported throughout the organisation. Good energy management practice will be actively promoted through internal and external working relationships within the PCT management, through staff, patient, visitors, local community, partners, and the supply chain.

All NHS buildings need to have a significantly lower carbon impact, not only in their construction but also in their lifetime use and in their

decommissioning. NHS buildings must be designed to promote sustainable behaviours in staff, patients and visitors, and they must

be adaptable to support change towards low carbon patient pathways.

SDU (2009) ‘Saving Carbon, Improving Health’.

All NHS capital developments should be assessed to ensure options are evaluated

on a whole life cost basis. Low carbon options include more renewable energy, passive cooling, ultra-efficient lighting,

sustainable transport and natural environment.



4.2.2. Energy in buildings strategy

This strategy complements the 4.2.1. Energy in Buildings Policy and outlines the main actions the PCT is taking to minimise energy use across the buildings it operates from, and in doing so, the carbon emissions derived from it. Energy is increasingly expensive. The rates paid for utility use by the PCT increased significantly from 2007/08 to 2008/09. Electricity rates increased by 52.87%; from 5.98 pence per kWh to 9.14ppkWh. Gas rates increased by 47.61%; from 1.567ppkWh to 2.313ppkWh. Greater energy efficiency will ensure that, as the cost of energy increases, the total cost of providing energy services such as lighting and heat will not be a drain on the budgets for frontline services. Resilience towards energy price and supply will form a part of the PCT’s risk register. Energy cost security can also be increased by installing renewable energy systems. Renewables also represent a potential source of income through the Government’s Feed-in-Tariffs for electricity and the Renewable Heat Incentive for gas. The Government’s Office of Gas and Electricity Markets (OFGEM) have generated several scenarios for energy price increases over the coming years, the worst of which points to a 60% rise by 2016, a situation potentially amplified by the coming impact of ‘peak oil’. All of OFGEMs price scenarios project rising energy prices. Investment in energy saving and energy generation through capital works and supporting staff will thus represent incrementally increasing year-on-year financial savings, directly mitigating the financial risk of increased energy prices and reducing carbon footprint. The PCT will introduce methods of regular reporting and providing feedback to staff on performance for each of our premises, including benchmarking and other comparisons, as a means of encouraging local reductions in energy consumption. See Appendix C for examples.

NHS Nottinghamshire County will:

In retrofit / existing buildings: Deliver a 25% reduction in CO2e intensity of its owned estate over 5 years, from 2007/08 emissions.

In new buildings: Ensure that all new buildings in the estate perform to best practice energy and carbon targets for building type (currently detailed in EnCO2de). If not already zero carbon by design, all new buildings to have viable plans for zero carbon retrofit post-occupancy. As a benchmark, all new buildings will be expected to achieve the national BREEAM Excellent standard.

In leased assets: Enable access to data systems and/or install sub-metering. A minimum ‘C’ rating on Energy Performance Certificates (EPCs) will be requested of any new leased sites.


Sustainable buildings are those that are designed to reduce energy, resource use and waste, thereby saving money, reducing negative environmental impacts and benefiting health. The SDU identifies the built environment as an important factor in patient care, and good design is essential to help ensure that patients, staff and visitors are afforded appropriate facilities. All buildings occupied by the PCT will aim for best practice energy and carbon performance (as defined by DH, currently detailed in EnCO2de). Through estates procurement, lease agreements and ongoing investment in the NHS estate the PCT will reduce its overall electricity, gas and water consumption by at least 10% by 2015. By 2013 the PCT will achieve a 25% reduction in the carbon intensity of its owned estate as measured in kgCO2e/m². By setting a carbon target per m2, the estate may still grow, however all new buildings will need to meet high standards in energy and carbon performance. This is consistent with requirements within the Commissioners Investment and Asset Management Strategy (CIAMS) placed on all commissioning PCTs for ongoing assessment of their buildings in terms of environmental performance. Furthermore, in buildings with shared occupancy, the PCT will apply the principle of ‘shared pain, shared gain’ between landlord and tenants, in recognition that energy reduction targets can only be achieved with the co-operation of those operating and using the buildings, and that all parties doing so need to be provided with the tools, knowledge and awareness to implement energy efficiency and embed low-carbon behaviours into their use. In terms of the indoor temperature at PCT sites, the PCT will balance the thermal comfort needs of staff and patients, with the requirements in national energy regulations, and the requirement to use energy sources such as gas efficiently and effectively. The PCT will issue clear guidance on both heating and cooling to staff and other occupants of NHS buildings. In the 2008 Budget, the Government set out an ambition for all new non-domestic buildings to be zero carbon from 2019, with an earlier target (2018) for new public sector buildings. In order to support and meet this, the SDU and DH have recognised the need for all new NHS healthcare buildings to be low carbon by 2015.

The PCT will work towards: o Sourcing of energy supplies at minimum cost;

o Energy generation, ensuring efficient buildings and effective energy management;

o Leasing arrangements that ensure good energy performance and management;

o Ensuring that all staff recognise their responsibility to reduce energy use.


Buildings that provide healthcare traditionally bring together a wide range of carbon intensive activities and processes. There is a need for all NHS organisations making capital investment to integrate formal carbon reduction requirements in tender documents and contracts. Large refurbishment and new build schemes both represent opportunities for the PCT to “design in” future proofing, sustainability and energy saving measures. Capital developments will be assessed to ensure options are evaluated on a whole life cost basis. Some climate change is now inevitable over the next 40 years. The healthcare buildings we are now designing need to be fit for a future climate, as well as rising energy prices and falling carbon emissions. The PCT will ensure that all new buildings or major refurbishment are designed employing energy use models based on the most up to date climate projections from the UK Climate Impacts Programme. Good insulation can keep a building cool in summer as well as warm in winter, this will be the first consideration. There also may be the need to include elements of passive cooling or highly efficient active cooling in design; to ensure that there will not be the need to later retrofit inefficient cooling capacity. New air conditioning plant will only be installed as a last option, when all other possibilities have been exhausted.

NHS Nottinghamshire County will continue to meet and wherever possible exceed national NHS targets for buildings energy performance, in particular:

o Primary energy consumption to be reduced across the estate by at least 15%, or 0.15 million tonnes CO2e to be cut by March 2010, on 2001 levels.

o All new buildings, major redevelopments and refurbishments shall meet an energy performance target of 35–55 Gigajoules per one hundred cubic metres of occupied volume (GJ/100m³).

o All existing facilities shall achieve an energy performance target of 55–65 GJ/100m³.


4.3. Travel, Transport and Access

4.3.1. Sustainable Travel and Transport Policy NHS Nottinghamshire County recognises that some element of travel is required to carry out day-to-day activities. To ensure that the approach to travelling is sustainable and to minimise the carbon emissions derived from it, the PCT will implement a PCT-wide Sustainable Travel Plan, which will realise a wide range of environmental and financial savings. The PCT aims for its Travel Plan to result in positive health impacts to benefit employees and Nottinghamshire residents. It is widely accepted that there are two major ways in which an organisation can improve the sustainability of its travel:

• Avoiding travel – i.e.: ‘the greenest mile is the mile not driven’, and • Travelling differently, where there is no practical alternative to travelling.

The Sustainable Travel Plan will reflect the above, and will provide smart1

targets, deliverable recommendations, practical guidance and real incentives to enable and encourage staff to minimise the needs to travel, and when it is necessary, to travel more sustainably, both on business and in commuting to work. The Travel plan will be reviewed and updated annually. The PCT will ensure that good quality data will be recorded on travel claims and leased vehicles to support and monitor continuing improvement in sustainable travel.

1 Smart: Specific, Measureable, Attainable, Realistic and Time-bound.

10 to win target: Board approved Sustainable Travel Plan for all NHS bodies by 2010.


Every organisation should routinely and systematically review the need for staff, patients and visitors to travel; consistently monitor

business mileage; provide incentives for low carbon transport; and promote care closer to home, telemedicine and home

working opportunities.



4.3.2. Sustainable Travel & Transport Strategy

At present, staff, patients and visitors to the NHS travel over 25 billion kilometres a year nationwide, and over 80% of these journeys are made by car. Furthermore, pollution-related admissions are estimated to cost the NHS between £17 and £60mn each year. In terms of carbon, transport is the fastest growing source of GHG emissions in the UK, and commuter and business travel constitute nearly 40% of all miles driven by car. The NHS national carbon footprint is constituted by 18% emissions from healthcare-related travel, representing 5% of all road traffic in England. NHS Nottinghamshire County’s carbon emissions from leased cars accounted for just over 3% of the total core footprint in 2007/08. Sustainable travel can be defined as travel behaviours which contribute towards achieving sustainable development objectives, meeting the needs of today, without compromising the ability of future generations to meet theirs. The PCT understands its potential to influence how staff, visitors and patients travel to and from NHS sites. Making travel and transport in the PCT sustainable means decreasing carbon emissions from leased vehicles and business mileage, but also includes accounting for wider environmental, social, health and financial impacts, and presents a unique opportunity to make a positive contribution to these, including:

NHS organisations need to be exemplar in leading the population-wide shift from

sedentary travel to more active travel such as walking, cycling and public

transport.


NHS Nottinghamshire County will: Produce a Sustainable Travel Plan, as the main strategy and the means for implementing and actively

promoting sustainable travel over time across the whole PCT.

Review, adequately resource and widely communicate the Plan to the workforce, to ensure that its targets are met and that its recommendations are successfully implemented.

Actively work with providers to decarbonise PCT leased vehicles, and explore alternative fuels such as

electric vehicles (EVs).

Record and monitor all PCT business travel on a continuous basis and in a format compatible with carbon accounting.

Provide adequate incentives and resources to staff to maximise the uptake of more sustainable travel modes and practices.

Work in partnership with local and regional organisations to promote integrated sustainable travel measures and share the environmental, financial, social and health benefits to be realised. Figure 1: Hierarchy of CO2 intensity by travel mode

(Source: Buying Solutions).


• Saving money on the cost of providing and maintaining parking spaces, whilst continuing to meet the needs of drivers with a disability. • Solving problems caused by traffic congestion in and around NHS sites will contribute to improving local air quality and noise. • Realising savings both in terms of expenditure and CO2e emissions from reducing business travel. • Assisting with recruitment and retention of the workforce by making staff journeys to/from work easier and cheaper. • Opportunities to improve staff health, wellbeing and work-life balance derived from more flexible working arrangements. • Reducing staff downtime spent travelling on business, hence increasing productivity. • Enhancing the experience of patients and visitors across PCT sites derived from improved access and facilities.

During the summer of 2009, a staff travel survey was carried out across the whole organisation. Over 1 in 4 of staff responded to the survey, equivalent to 27.45% of the workforce, across both the commissioning and the provider side. Key findings from the survey included:

• 91% of staff surveyed use their car as the main mode of transport to get to and from their workplace, often driving alone. • It takes a quarter of the staff under 15 minutes to reach their place of work. • One third of staff live within 4 miles of their workplace. • 62% of staff use their own car for work purposes 3 or more days per week, a large proportion of which involved travelling to meetings.

The results of the survey highlighted a large opportunity to explore opportunities to incentivise more sustainable travel options in-house, such as car sharing, incentives for public transport, better facilities for cyclists, and greater flexibility in working practices. Moreover, the feedback received made clear that staff are keen to work to improve the travel and transport options available to them across the PCT. To maximise this opportunity, and in line with SDU guidance, NHS Nottinghamshire County has committed to produce a Sustainable Travel Plan, as the main strategy to implement and actively promote sustainable travel and transport across the whole PCT. The Sustainable Travel Plan will: Recommend a number of smart targets to remove the need to travel in the first place, minimise single vehicle usage, and promote wide modal shift,

tailor-made around the needs of employees and consistent with the feedback provided in the 2009 staff travel survey.

Provide practical information to help staff make adequate and more integrated choices when travelling to and from work and on business. The latter may also be useful for patients and the public when planning to visit NHS premises, enabling them to make more sustainable travel choices too.

Offer consistent and clear guidance to all staff on procedures to follow with regards to travelling on business, such as parking policies, mileage rates

by travel mode, available incentives and rewards, and data recording requirements. Some sites may already have site-specific travel plans due to planning and other requirements. The PCT-wide Sustainable Travel Plan will work alongside these, and could be used in future as a basis for producing own site plans and initiatives.


The Sustainable Travel Plan will be actively promoted to the workforce. Wherever possible, its principles will be communicated to patients, the public, suppliers and contractors, and we will encourage them to consider making their own travel and transport methods and practices more sustainable. To maximise success in this area, the PCT will work in partnership with local healthcare organisations, local government, public transport operators and other relevant agencies to explore, enhance and promote the provision of lower carbon transport through a range of actions including car sharing initiatives, public transport services, cycling facilities and walking options. Since the use of fuels in the leased fleet contributes to the core carbon footprint, the PCT will work to maximise the efficiency of our existing and future leased fleet, aiming to introduce a maximum threshold for carbon emissions in cars, using the national Vehicle Excise Duty (VED) banding. As vehicle fuel supply is increasingly vulnerable to price volatility, the PCT will also work to minimise its reliance on fossil fuels, by exploring alternatives such as electric vehicles (EVs). In order to measure, monitor and manage progress against the Sustainable Travel Plan’s recommendations, the PCT will record relevant data on both its leased vehicles and on business travel, on a regular basis, and in a format that can be used to calculate the carbon emissions derived from travel (see Appendix A and B). Doing this is essential to ensure that the PCT meets the requirements of the Audit Commission under the Key Lines of Enquiry (KLOE) 3.1. Use of Natural Resources assessment, and to successfully identify and account for cashable and non-cashable savings and target areas in travel expenditure across different travel modes.


4.4. Waste Management

4.4.1. Waste Management Policy NHS Nottinghamshire County recognises the significant environmental, health and financial impacts associated with waste generation and disposal. The PCT commits to minimising these by applying an integrated and holistic approach to the way it manages its waste, guided by the principles of the waste hierarchy and achieved through working closely with staff. The PCT will equip itself with the necessary resources to manage waste sustainably and cost-effectively, meeting or exceeding current and future national requirements and legislation. The PCT will demonstrate continuous improvement in its waste practices in terms of quantity, cost, and resulting carbon emissions, by meeting a number of appropriate and quantitative targets, by working closely with waste contractors to monitor and target performance across each waste stream, and by actively promoting a culture of awareness and best-practice accross NHS sites. The PCT’s waste management approach is based on the principle that the preferred priority of action on waste is to follow the following hierarchy:

Every organisation should monitor, report and set targets on its management of domestic and clinical waste.


In a low carbon NHS, waste is minimised, and managed to consistently comply with legislation,

and is recycled or composted routinely.


PREVENT REDUCE RE-USE RECYCLE RECOVER DISPOSE

Figure 2: NHS Nottinghamshire County Green Champions on a visit to Wastecycle’s recycling plant in Colwick, Notts.


4.4.2. Waste Management Strategy W 1 in every 100 tonnes of domestic waste generated in the UK comes from the NHS. The NHS produces an average of 250,000 tonnes of waste a year, with a cost of £71.2 million. Waste is an important area of expenditure, and a key contributor to the PCT’s environmental impacts. As a producer of both domestic and clinical waste, NHS Nottinghamshire County is legally responsible for complying with national waste regulations, and taking reasonable steps to dispose of waste adequately and effectively. Given the nature of healthcare services, there is a health and safety risk associated with the waste the PCT generates, which places the PCT under a duty of care to put effective measures in place, across all premises, to ensure correct segregation and disposal of waste. See Appendix E for a full list of healthcare waste types and their disposal routes and segregation procedures.

NHS Nottinghamshire County will: Minimise the production of total waste derived from its activities across the whole PCT, by meeting the following targets:

• Reduction in the total weight of waste arising across all streams, year on year.

• Reduction in the % of total waste sent to landfill, year on year.

• Reduction in the total weight of clinical waste disposal, year on year.

• Increase levels of in-house recycling across NHS sites by at least 35% by 2015.

• Maintain its exemplary overall domestic waste recycling rate of over 80%. (i.e.: segregated in-house + recovered by contractors).

• Falling CO2e emissions derived from total waste disposal, year on year. Regularly monitor and report progress against the above targets, alongside financial expenditure on waste disposal. Actively manage all corporate waste contracts and work closely with both domestic and clinical waste contractors to realise environmental

and financial savings, ensure compliance, and maximise VFM over time. Meet –and wherever possible, exceed– all current and forthcoming legislative requirements governing the safe and correct handling, storage,

treatment and disposal of all waste from its operations.


The PCT believes that by employing an environmentally sustainable and integrated approach to managing its waste, it will also realise important financial benefits, both by reducing waste collection costs and by minimising additional costs that certain waste streams present, such as landfill tax and incineration charges. Following the waste hierarchy (see Fig.3), the most favoured option is often so in terms of cost, carbon, and ease of implementation. Preventing waste being disposed of in the first place, utilising resources efficiently, and re-using materials, will clearly make financial and carbon savings. Moreover, given that recycling waste is cheaper as a process than incinerating it or sending it to landfill, and that it has a positive carbon footprint under the national DEFRA carbon accounting methodology, maximising the amount of waste being recycled is a high priority. Research nationally indicates that 40-50% of waste placed in clinical waste containers at healthcare sites is actually domestic waste. An NHS Purchasing and Supply Agency (PASA)-funded project2

which looked at waste practices across a number of the PCT’s sites reflected this, and highlighted that there is a great opportunity to improve waste segregation in the clinical waste stream across the PCT, for compliance, cost and carbon purposes.

To achieve the PCT’s targets for waste disposal, it is paramount that the following is in place: Continuous, accurate records of waste generated, broken down site-by-site, by waste

stream type, and by weight. The PCT will continue to work with its waste contractors to ensure access to this information by directorates and staff members in the PCT, and will report on progress against KPIs that reflect waste quantities, carbon emissions and cost over time.

Regular communications, active awareness-raising and visible and clear guidance on waste segregation and practices. Anyone who disposes of waste at any NHS premise has a personal responsibility to abide both by legislation and by the PCT’s commitment to sustainable waste management. To ensure that this met, NHS Nottinghamshire County commits to providing the appropriate training to relevant staff on safe waste procedures, and providing up-to-date resources and guidance to all staff, visitors and the public to enable them to follow the principles of its waste policy and strategy.

2 ‘Lean Management Principles’ project, led by the EM Re:Source Hub, 2009/10.

Recycling all the waste paper, cardboard, magazines and newspapers produced by the NHS as a whole could save up to 42,000 tCO2e. This is equivalent to the

carbon savings made by taking 17,000 cars off the road for a year.

NHS Confederation & NEF.

Figure 3: The waste hierarchy.


4.5. Procurement – Goods and Services 4.5.1. Sustainable Procurement Policy

NHS Nottinghamshire County is committed to identifying and reducing, on a cost-effective basis, the carbon footprint and wider sustainable development impacts associated with the goods and services it buys. The PCT will work with its suppliers and providers to enhance sustainability in contracts, and will actively encourage them to reduce the impacts of the goods and services they provide the PCT with, and in doing so help mitigate both cost and resource vulnerability risks across the supply chain. The public sector has a duty to spend public money in the long-term public interest – in ways that avoid undermining people’s health, opportunities and the environment. Sustainable procurement involves taking action at each and all stages of the procurement process. Simply requiring suppliers to respond to an environmental questionnaire at prequalification will not deliver more sustainable outcomes. This action should be part of a package of measures planned and implemented throughout needs analysis, prequalification, specification, evaluation and supplier development and engagement. With a strong national drive towards increasingly better procurement, and a pressing need to achieve VFM, delivering more with less, the case is clear for embedding sustainability into procurement practices, alongside commissioning. The costs for natural resources are increasingly volatile and generally rising, reflecting the constraints of our natural environment to support the consumption patterns of the 20th century. This is particularly critical for fuel and energy resources, represented through supply chains in terms of carbon. It is essential that carbon features not just in the PCT’s risk registers and performance frameworks, but also in those of its supply chains. Identifying areas where carbon savings enhance impact of cost savings is a priority for the PCT. NHS Nottinghamshire County will work closely with its staff and in partnership with its suppliers so that PCT procurement activities reflect best practice in sustainability. The PCT will also implement a programme of measures designed to improve its sustainable procurement capability over time.

The NHS has a responsibility, as the largest employer and public sector emitter of carbon, to take this issue seriously. It

has a unique status, given its size and procurement budgets, to lead the change and drive the creation of low

carbon markets. Substitution, innovation and effective engagement with suppliers will all become significant

elements of carbon reduction strategies.

SDU (2010). P4CR Executive Summary.

Figure 4: Hierarchy of choices for sustainable and low-carbon procurement (Source: SDU, P4CR, 2010).


4.5.2. Sustainable Procurement Strategy Nationally, procurement of goods and services in the NHS costs over £20billion per annum and constitutes over 60% (11mn tCO2e) of its total carbon footprint. Regionally, the NHS in the East Midlands spends around £1.5 billion annually on the procurement of goods and services. In the PCT, purchasing goods and services, excluding commissioning healthcare, accounted for over £66 million and emitted 40,129 tonnes CO2e in 2008/09. Procuring goods and services does not just represent high cost and high carbon implications for the PCT. From 2009/10, the Audit Commission’s Key Lines of Enquiry (KLOE) assessment includes several clauses requiring that the principles of sustainable procurement are embedded into NHS organisations buying activities, and that evidence of this is provided on an annual basis.

NHS Nottinghamshire County will: Work towards the decarbonisation of its supply chain and actively promote this amongst staff, suppliers and partners.

Use existing toolkits and resources to enable the PCT to review its own procurement practices as a whole and in specific purchasing areas, to

prioritise those of both high financial and environmental risk, and develop appropriate measures to address them effectively.

Provide procurement staff with the tools, knowledge and skills to enable them to embed sustainability into all steps of buying decision-making, and into day-to-day procurement practices.

Measure PCT progress on procuring sustainably using the national Flexible Framework, and aim to achieve Level 3 by 2012 and Level 4 or above by 2015.

Routinely require all suppliers to disclose their own approach to sustainable development and carbon management, and to report on progress

on a regular basis throughout the length of the PCT’s contracts with them. Maximise existing and new opportunities to set high environmental standards in pre-qualifications, tender specifications, contracts, and SLAs.

Key aspects of the Audit Commission’s KLOE relating specifically to sustainable procurement:

1.2 Does the organisation have a sound understanding of its costs and performance and

achieve efficiencies in its activities? - Understanding costs, including whole life, transaction and unit costs, the main

factors that influence these and how they link to performance.

2.1 Does the organisation commission and procure quality services and supplies tailored to local needs, to deliver sustainable outcomes and value for money? - Reviews competitiveness of services and achieves value for money, while meeting

wider social, economic and environmental objectives.

3.1 Is the organisation making effective use of natural resources? - Note: To achieve Level 3 ‘Performing Well’, our PCT needs to demonstrate that it

‘considers the environmental impact of its suppliers of goods and services within its procurement decisions and is working with them to achieve improvements’.


Sustainable procurement is defined as “a process whereby organisations meet their needs for goods, services, works and utilities in a way that achieves value for money on a whole life basis in terms of generating benefits not only to the organisation, but also to society and the economy, whilst minimising damage to the environment. It demonstrates that procurement’s contribution to a sustainable society is far beyond the financial” (SDC ‘Procuring the Future’, 2006). A sustainable approach to our procurement will therefore help us deliver long-term value for money, together with protecting our reputation, future-proofing our supply chains and investments, and therefore making them viable in the long-term. By considering the financial, social and environmental impacts of what the PCT buys throughout the whole lifecycle –from raw materials to disposal / end of life, not just the impacts related directly to product ownership or service delivery– the PCT will be able to make more informed and realistic decisions towards purchasing. Sustainable procurement will also support the PCT in achieving true Quality, Innovation, Prevention and Productivity (QIPP). Forum for the Future in their ‘Buying a Better World: Sustainable Public Procurement’ guide identifies two basic principles that underpin sustainable procurement and should be integral to the sourcing process of goods and services:

1. Upstream thinking: The ability to influence cost, performance and sustainability declines as the procurement process progresses. To maximise opportunities for sustainability and carbon reduction, it should be considered from the very outset:

2. Life cycle thinking: As with costs, sustainability impacts are created throughout the whole product lifecycle. The impact and cost of resource use and

should be considered across all stages of production, transport and disposal of the goods and services. Nationally, it is recognised that the NHS does not have direct control over absolutely all the actions of its supply chains, and while the overall expenditure of the NHS is large, the scope for improvement and influence is not uniform across all of the products and services procured. Recognising this, and given the size of the challenge all NHS organisations face in meeting national carbon reduction targets, it is recommended by the DH and the SDU that NHS organisations use resources available to enable them to understand the carbon impacts of what they buy, use and waste, and to start tackling their carbon emissions immediately. NHS Nottinghamshire County has identified several ways by which it will be able to meet this challenge:


Delivering sustainable procurement as a whole PCT:

Use the Flexible Framework: This national framework is a maturity matrix that has been successfully tried and tested across the public sector. It sets out the steps recommended to consider the carbon impacts of procurement decisions effectively, across the procurement elements of People, Communications and Policy, Processes, Engaging Suppliers, and Measuring & Results. Working through the Framework will enable the PCT to measure and monitor progress in establishing a robust sustainable procurement practice. In doing so, the PCT will deliver quantifiable carbon and cost reductions over time, and benchmark performance in its own setting and against that of other NHS organisations, in a consistent way. See Appendix D for both the steps in the Flexible Framework and a list of supporting materials.

Identifying and targeting our procurement-related carbon emissions:

Use the SCO2PE supply prioritisation tool: An Excel based tool allowing organisations to calculate an approximate carbon footprint by inputting expenditure data by category. This is how the PCT’s 2008/09 baseline carbon footprint from procuring goods and services was calculated (see ‘Control’, section 2.2). The tool will provide the PCT with a screening methodology that will help prioritise which categories of spend offer the greatest potential for both in carbon emission and in cost reductions, and a means to report carbon alongside financial expenditure.

Targeting specific purchases and areas of spend:

Forum for the Future ‘Sustainable Procurement Toolkit’ was produced with the EM Re:Source Hub in 2006 and is a spreadsheet-based tool which helps buyers to identify sustainability impacts and opportunities of specific goods, and guides them through realistic interventions throughout the procurement process. The PCT will use this toolkit to further identify and target specific products or services with both high carbon and high financial risks.

The Government’s 'Buy Sustainable – Quick Wins' are specifically designed for procurers, and set a number of sustainable specifications for a range

of commonly-purchased products across the public sector including the NHS, such as IT equipment, white goods, paper and stationery. The PCT will use this guide as a basis when considering the purchase of these products.

Lastly, NHS Nottinghamshire County will maximise the scope of the www.sid4health.com portal and other contracts platforms, in terms of assessing potential suppliers’ sustainability credentials prior to tendering for work, via their pre-qualification questionnaire (PQQ). Where specific sustainability or carbon reduction requirements cannot be delivered through the tender process, the PCT will work on Terms and Conditions and Memorandums of Understanding with suppliers to ensure commitment to meet these within the contracts.

The relationship and collaboration with suppliers has the potential to provide the largest carbon savings. The NHS is not in this alone; all

organisations are beginning to look at their carbon impacts and are addressing the same

challenges. There will be more chance of success by working together.

SDU (2010). P4CR Executive Summary.

http://www.sid4health.com/�


4.6. Sustainability and people – Behaviour change in the workforce 4.6.1. Sustainability and people policy NHS Nottinghamshire County will provide its staff with the right tools, knowledge, skills and support to work in a carbon-friendly and environmentally responsible manner, and expects its staff to fully commit to, comply with and contribute towards all the PCT’s policies, strategies and actions that will address carbon emissions. In any setting, the key to achieving successful carbon reduction is behavioural and culture change. No technological improvement, financial investment or strategic framework in sustainability can be truly successful without taking the ‘people factor’ into careful consideration from the start. As a large local employer, with over 3,500 employees, each with a workplace carbon footprint of 1.5 tCO2e, the PCT recognises that it needs to inspire and motivate staff to successfully deliver carbon reduction and the wider sustainable development agenda.

Figure 5: NHS Nottinghamshire County staff celebrate becoming trained as Green Champions, Lings Bar Hospital, 2009.


4.6.2. Sustainability and people strategy As stated in 4.6.1. Sustainability and People Policy, the PCT will only achieve successful carbon management if it can secure the necessary commitment of its workforce. It is widely recognised that the implementation of no-cost measures such as reduced use of energy, better segregation of waste, or more efficient use of vehicles can save over 10% of expenditure in these areas. Lastly, individuals everywhere are becoming more aware of carbon reduction and sustainability, and there is evidence to suggest that people want to work for sustainable organisations. In response to this, the PCT commissioned an environmental behaviour change project across pilot sites throughout 2009, undertaken with Global Action Plan as part of the wider PCT Carbon Reduction Project. This pilot project included (1) recruiting volunteers at the sites to act as environmental “Green Champions”, who provide advice and engage colleagues on environmental/sustainability issues, (2) training for those Champions, (3) auditing typical environmental behaviour and (4) supporting Champions to engage and communicate with colleagues. Both the lessons learned and the successes from the pilot have helped shape the wider behavioural change work with staff throughout 2010 and beyond, and a summary can be found under Appendix H. Following the pilot, NHS Nottinghamshire County has now recruited and trained over 50 Green Champions, including the majority of site managers from health centres, hospitals and headquarters buildings, to influence colleagues to change behaviour in respect of energy use, waste management and transport choices. Green Champions are allocated a minimum of one hour per week to undertake this valuable work. Additionally, the PCT has a Sustainability Steering Group which provides strategic leadership, complemented by a Green Champions Group that meets regularly and provides operational leadership on the best ways to embed sustainability into staff’s day-to-day work. To date, the Champions have led a campaign to encourage staff

NHS Nottinghamshire County will: Motivate and empower its staff to play a full part in developing new ideas and initiatives around carbon reduction. Ensure that all existing and new staff are fully aware of the Sustainability and People Policy &

Strategy, and are committed to implementing it in their day-to-day work. Communicate regularly with staff about progress and share best practice, and will proactively

consult as widely as possible on ways to improve performance. Formalise training and continuous professional development (CPD) opportunities for staff on

carbon and resource use related matters. Explore the integration of carbon reduction into personal objectives, job descriptions, appraisal processes and competency profiles.

A culture of carbon awareness should become an integral part of working for the NHS. Particularly as a significant amount of the

energy used, travel choices and goods purchased throughout the NHS is in the direct

control of individual members of staff.


As Europe’s biggest employer, the NHS has a big opportunity to have ‘exemplar employees’

who are likely to have far reaching positive impacts, not only on the NHS supply chain, but

also on communities throughout the UK.



to switch off PCs, monitors, printers and lights to help reduce energy consumption, together with one to raise awareness on waste disposal, increasing recycling, and promoting a more careful use of resources. Further recruitment of Green Champions, together with the provision of a Site Sustainability Log Book and relevant resources are scheduled in the near future. In order to enable staff to measure, monitor and manage carbon emissions and wider resource use in their own setting and/or the area of the organisation they are responsible for, be it a Green Champion or a Director, it is paramount that the PCT invests and continues to put in place “people solutions”. This includes ensuring appropriate access to resource consumption data via Smart metering technology, consistent and accessible records systems, appropriate training, and the wider support to enable them to deliver this work effectively when faced with other competing priorities. In terms of wider communications, regular articles on sustainability appear in the weekly staff update and in the monthly staff magazine and green pages have been developed for the Intranet. An internal communications plan is being developed to maximise opportunities for publicising sustainability issues, green incentives, and celebrating progress made on internal carbon reduction. A staff suggestions scheme for green ideas is in place, and a Green Week is held annually. NHS Nottinghamshire County strongly believes that workforce engagement and commitment are critical to the successful delivery of the Carbon Management Plan. The PCT will support staff in understanding and interpreting the strategic priorities on carbon reduction and wider sustainability, and empower staff to make changes to achieve a sustainable workplace.

Every member of the NHS workforce should be encouraged and enabled to take action

in their workplace. NHS organisations should support their staff by promoting

increased awareness, conducting behavioural change programmes,

encouraging home working, low carbon travel, the use of ICT, and by ensuring

sustainable development is included in every job description.


Figure 6: Display at Hucknall Health Centre, 2009.


5. NHS Nottinghamshire County Carbon Management Action Plan

Last updated: 11/05/10


How to interpret the CMAP: Internal priority Category Definition / Range Essential (E) This action is indispensable for effective carbon reduction to take place, and other actions’ impacts

will directly depend on this action being implemented first/successfully.

Desirable (D) This action is recommended in order to reduce carbon emissions across its particular area.

Financial savings (£) Definition / Range Whenever an action is identified with the potential to result in financial savings, the saving is stated in this column.

Carbon impact (tCO2e) Category Definition / Range The categories below are used only where quantifiable CO2e savings are not available i.e.: it will be preferable to feature a numerical value for the carbon impact of each measure, wherever possible. High Actions which will result in a reduction of >5% of the core annual CO2e footprint.

Medium Actions which will result in a reduction of >1% of the core annual CO2e footprint.

Low Actions which will result in a reduction of less than 1% of the core annual CO2e footprint.


STRATEGY AND GOVERNANCE (3 pages)

Recommendations Action Related target/

mandate

Prio

rity

Lead

Progress to date

Timescale/ Milestone/DL

Fina

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Carb

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1. Board-level approved Carbon Management Plan: a) Setting out vision on reducing emissions over time across the whole organisation and in partnership with health care providers and partner organisations; b) Including sections for delivery, with a subset of specific actions, timescales, responsibilities, impacts, and prioritisation.

1. Final draft to be approved by SSG. 2. CMP to go to Board for approval. 3. Once approved, NEP to support on implementation of recommendations as per PCT Carbon Reduction Project (CRP) SLA.

A Board approved Carbon Management Strategy for all NHS organisations by 2009 (NHS SDU).

E Sustainability Steering

Group (SSG).

Draft Action Plan completed + structure agreed in March 2010. CMP approved by SSG on 07/05/10.

CMP to be taken as a paper to Board 27th May 2010.

2. Sustainability Steering Group to be established, meeting regularly to review the progress of the Carbon Management Plan, monitor its implementation, and report quarterly to the Board on performance and on any issues arising.

1. Continue to meet throughout 2010.

E Director of Finance,

Achieved. Group formed, meeting on a monthly basis.

3. Consider drivers and incentives to promote and support organisation-wide carbon reduction in the short, medium and long term, and use them whenever/wherever appropriate.

Examples: ▪ Financial (e.g.: revenue from Feed-in-Tariffs) ▪ Publicity, marketing and showcasing (e.g.: awards, case studies). ▪ Compliance (e.g.: Carbon Reduction Commitment (CRC), Audit Commission's Use of Resources (KLOE) ▪ Education, training and awareness (e.g.: Global Action Plan training).

E SSG Ongoing. SSG reviews at monthly meetings.

Ongoing.


4. Identify strategic and operational leads to ensure effective and successful delivery of Carbon Management Plan.

1. Identify strategic and operational leads to ensure internal delivery across all the areas of carbon management, to include: - Governance e.g.: CRC EFS, KLOE 3.1 - Carbon footprinting and reporting - Energy management - Transport and Travel planning - Procurement & Commissioning healthcare - Waste management - Behavioural change & awareness

E SSG Draft Action Plan completed + structure agreed in March 2010. CMP approved by SSG on 07/05/10.


5. Provide information in line with Treasury guidance for inclusion in Annual Report.

1. SSG, with support from NEP, to develop own set of relevant KPIs for internal and external reporting on performance against carbon and wider sustainability, in line with national best practice. 2. Once agreed, include the first report on progress against them in the 2009/10 Annual Report.

Treasury guidance on information to be included in Annual Report.

E Task & Finish Group,

responding to Audit Report

on Sustainability.

Paper on proposed KPIs to be taken to June SSG for consideration.

SSG meeting on 7th June 2010. Deadline for inclusion in Annual Report: July 2010.

6. Develop supporting Communications Plan.

1. Communications lead to attend SSG, Green Champions Group and liaise with Head of Corporate Services and NEP, to ensure that messages on carbon and sustainability are disseminated to staff and stakeholders.

D Head of Comms

Ongoing.

7. Actively work with NHS/DH regional sustainability network and other relevant networks and partnerships (e.g.: County LSP Climate Change Steering Group), to share lessons, showcase best practice, and identify resources.

1. Identify networks and relevant partnerships. 2. Liaise/establish contact. 3. Become involved as/when appropriate/feasible.

D Head of Corporate Services.

NHS Nottinghamshire County is represented and attends the East Midlands NHS Sustainable Development and Health network.


8. Embed carbon accounting alongside financial accounting.

Finance, Corporate Services and Property Services staff to be trained by NEP to calculate carbon footprint using DEFRA methodology and opportunities for embedding wider carbon accounting in-house.

E Head of Finance.

A carbon accounting masterclass took place on 28/04/10.

Ongoing. Annual report in September 2010 to include financial KPIs.

9. Carbon management is accorded appropriate priority within corporate priorities and policies.

Work with directorates to integrate this into internal policy documents and cycles.

Saving Carbon, Improving Health (NHS SDU).

E SSG Ongoing.

10. Comply with the Carbon Reduction Commitment Energy Efficiency Scheme (CRC EFS).

Provide information disclosure to the CRC Administrator (EA) between April and September 2010.

CRC EFS (2010). Head of Corporate Services.

NEP has advised PCT current liability is limited to registration. Liability will be kept under review.

Register and make information disclosure before end of Sept’2010.


PROCUREMENT – COMMISSIONING HEALTHCARE SERVICES (1 page)


mandate

Prio

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date Timescale/

Milestone/DL

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1. Influence the commissioning framework to ensure that provider organisations with contracts with NHS Nottinghamshire County actively reduce, monitor and report on their own carbon emissions regularly to the PCT.

1. Define local format, method and timeframe for provider organisations to use when reporting their own performance on carbon management to the PCT. 2. Work to roll this clause out to provider organisations appropriately e.g.: with accompanying letter, at ‘Meet the Buyer’ or similar forum.

Saving Carbon, Improving Health (2009). AC KLOE 3.1. requirements for obtaining Level III World Class Commissioning i.e.: competencies 1, 2, 8, 10. Documented objectives within SLAs for all commissioned services (internal).

E Primary Care Mental Health Implementation Manager

The SSG is developing environmental standards for inclusion in existing and future specifications and contracts.

Sept 2010 for inclusion in 2011 /2012 commissioning agenda.


ENERGY IN BUILDINGS (4 pages)


mandate

Prio

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Progress to date Timescale/

Milestone/DL

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1. Full buildings survey of the entire estate, to assess energy and carbon savings.

1. Carry out a detailed survey of each building within the estate, by a qualified surveyor. 2. NEP to provide the PCT with the detailed, site-by-site reports for their records.

Strategic Service Development Plan (SSDP) CIAMS Section 6. Environmental

E NHS Property Services

Achieved. Provide site reports by June 2010.

2. Analysis of the quality of data sources available to Estates with regards to energy consumption for use in carbon footprinting, to ensure accuracy and consistency, and to enable accurate monitoring, reporting and reviewing of emissions over time.

1. Review all data sources available, and rate them with regards to carbon footprinting criteria provided in national guidelines and by NEP. 2. Clarify what emissions are accounted for in each data source and which ones are not measured. 3. Identify the best source of data available, decide which data source will be used to calculate a baseline carbon footprint, and identify a way forward for improving data and gaps in future.

D NHS Property Services

Achieved for 2007/2008.

To be completed for 2008/2009 and 2009/2010.

3. Calculate the buildings-related CO2e emissions across the whole estate.

1. Identify lead or teams that will be responsible for delivering this recommendation. 2. Carry out the footprinting exercise, following the format and methodology used for the baseline.

25% reduction in kgCO2e emissions from owned estate across 5 years (SSDP).

E NHS Property Services

Achieved (2009). To be completed for 2008/2009 (with support from NEP) and 2009/2010.


4. Reduce electricity, gas and water consumption by 10% by 2015.

1. Reduce ambient room temperature in all premises to 19 degrees.

SSDP D NHS Property Services

Reduced HQ energy consumption by better energy controls, regular monitor checks, removable plugs identified, double sided printing as standard, removal of personal heaters and fans.

3% reduction August 2010. 7% reduction December 2011. 10% reduction by January 2015.

Yes M

5. Adopt a Corporate Energy Policy, Strategy and Action Plan, providing a public statement of intent to manage carbon emissions.

1. Approve by SSG and Board as part of CMP. 2. Monitor progress and review actions required regularly.

SSDP E NHS Property Services +

SSG



6. Capital plan for owned estate, with prioritised measures for investment to include their carbon saving potential and paybacks at current and future energy prices. To be updated annually and linked to the overall financial planning cycle.

1. Produce a full, costed list of measures for investment in the owned estate, using the data from the site surveys. 2. Calculate energy and carbon saving, capital cost, and paybacks. 3. Put recommended measures into a prioritised list by carbon saving and payback, to advise on investment.

SSDP E NHS Property Services

Achieved (2009) Dec'2009: Recommendations for investment in carbon and energy reduction measures across owned provider sites is produced and presented to Finance and Estates for consideration, circa <£1.1m.

Yes H

7. Assess all planned and future capital investments in terms of their relative carbon saving as a means of targeting and prioritising investment over time, in CO2e per relevant unit e.g.: m2.

Use the criteria NEP applied for recommending investment in the capital works programme 2009/2010 (see Recommendation 6.).

SSDP E NHS Property Services

Use in 2010/2011 Capital investment planning.


8. Use carbon as the key metric for assessing and benchmarking buildings performance, replacing now dated energy measurements (e.g.: GJ per 100m3).

Rate all buildings for which energy data is available in terms of their carbon emissions, and establish comparisons between similar types of buildings for benchmarking purposes.


Completed in 2010 for owned and directly leased sites.

9. Introduce half-hourly metering of electricity, gas and water.

1. Install Smart/half-hourly electricity metering in all owned estate. 2. Pilot gas and water submetering across a selection of representative sites.


Estates and NEP are currently leading a roll-out programme of Smart electricity meters across the owned Estate. 6 HCs installed (April 2010).

Aim to finalise electrical Smart meter installations end of May 2010. Pilot gas and water in 2010 (TBC).

10. Carry out a renewable energy survey for potential on-site generation across the whole estate (including land and leased assets), with an aim to develop a strategic plan on renewable energy generation and developing energy resilience.

1. Identify potential sites (desktop analysis). 2. Physical survey of potential sites. 3. Calculate the potential for energy generation. 4. Explore logistics and financial options for on-site renewable energy generation. 5. Produce a renewable energy strategic plan reflecting the findings and making recommendations for action.


Potential for solar hot water and photovoltaic systems in owned estate sites has been identified, and recommendations have been made for investment.

H


11. Establish a protocol of 'shared pain, shared gain’ of financial and environmental savings derived from acting upon the impacts of landlord and tenants’ use of energy and other resources on-site, that establishes regular communication and relative responsibilities for either party, as there is an inability for either party to take full control over these buildings in a changing environment and in unforeseen weather events, without the other party's involvement.

1. Pilot the Energy Protocol produced by NEP & GN LIFTco in a LIFT site. 2. Monitor progress and take-up. 3. If deemed successful, expand to all PFI sites within the organisation.

NHS Property Services

LIFTco

Energy Protocol has been produced which incorporates the key elements of 'shared pain, shared gain' thinking applied to the landlord-tenant relationship and their use of resources on split/PFI sites.

November 2010.

12. In all new leasing arrangements, minimum standards of CO2e emissions to be assessed and benchmarked.

SSDP. NHS Property Services

LIFTco

13. All new leased assets must have a minimum of submetering facilities for energy and water for the area we will occupy. Independent metering such as Smart half-hourly meters should be introduced whenever possible, and continuous utility monitoring (of both consumption and billing) to become the norm.

1. Consider the existing metering arrangements -and the opportunities to improve these easily/cost-neutrally- when looking into new leases. 2. Ensure appropriate mechanisms are put in place to enable access to accurate metered data before commissioning new leased sites e.g.: agreement in the contract, agreement with the supplier, etc.


14. Ensure that when procuring building elements in existing or new buildings: - carbon is used as a metric - major refurbishments are designed to withstand significant climate change - have a requirement for persistent low carbon footprint - Whole Life Costing is applied

1. NEP to advise and work with NHS Property Services.

SSDP All new healthcare buildings to be low carbon by 2015 and zero carbon by 2018 (DCLG & DH).



TRAVEL, TRANSPORT AND ACCESS (3 pages)


mandate

Prio

rity

Lead


Milestone/DL

Fina

ncia

l sa

ving

s (£

)

Carb

on

impa

ct

1. Calculate the travel-related CO2e Scope III emissions i.e.: business mileage, when data is available.

1. Calculate the Scope III carbon footprint on a baseline year. 2. Identify the contribution that business mileage has on overall footprint.

SHA target to have Board approved Travel Plan.

E NEP contracted under SLA to do this.

Currently work is underway to ascertain best available dataset to calculate Scope III i.e.: business mileage in own vehicles.

Calculate emissions for 2008/2009 and 2009/2010 from d leased vehicles and business mileage, by September 2010.

2. Agree smart targets for corporate travel practices on a 2007/2008 baseline year and adopt it in NHS Nottinghamshire County's Sustainable Travel Plan.

1. Analyse current travel and transport data. 2. Compare to national benchmarks. 3. Work to design appropriate targets, together with a consistent mechanism to measure emissions reduction this over time. 4. Embed this target into the Sustainable Travel Plan. 5. Review any existing systems that remove the need for travel, and their uptake amongst staff / effectiveness e.g.: teleconferencing, home working, e-meetings, etc.

Reducing the carbon footprint (from energy use, procurement and travel) by 10% by 2015 on a 2007 baseline across the whole of the NHS (NHS SDU).

E Head of Corporate Services.

Summer 2009: Staff travel survey took place with 27% response rate, providing evidence for setting targets, together with informing the Sustainable Travel Plan and recommendations.

June 2010.


3. Adopt a corporate Sustainable Travel Policy, Strategy and Action Plan as the public statement of intent on managing the carbon emissions and reducing the wider environmental impacts derived from staff, patients and visitors' travel and transport practices.

Take from the Sustainable Travel Plan, once it is available.

A Board approved Sustainable Travel Plan for all NHS bodies by 2010 (NHS SDU). Reducing the carbon footprint (from energy use, procurement and travel) by 10% by 2015 on a 2007 baseline across the whole of the NHS (NHS SDU)

E Head of Corporate Services /

NEP.


Aim to finish Travel Plan by end of May 2010, then consult and approve at strategic level early summer 2010.

4. Record mileage claims from staff business travel in a format that is compatible with national travel carbon footprinting guidelines.

1. NEP to provide advice and support in producing a format for this. 2. Liaise with Finance and possibly SBS on how to implement this.

E Head of Finance

5. Decarbonisation of a) leased vehicles and b) business mileage.

Implement the Sustainable Travel Plan recommendations, once they are agreed and it is published.

Reducing the carbon footprint (from energy use, procurement and travel) by 10% by 2015 on a 2007 baseline across the whole of the NHS (NHS SDU)

E Sustainability Steering

Group (SSG)

Sustainable Travel Plan is currently being developed.

Aim to finish Travel Plan by end of May 2010, then consult and approve at strategic level early summer 2010.

6. Review directorate travel budgets and set targets to reduce them.

SSG November 2010.


7. Publicise current travel initiatives so that staff are aware of them and their take-up is maximised.

1. Review current sustainable travel initiatives e.g.: car sharing scheme, cycle2work, cycle training, etc., and where they are publicised. 2. Work with HR, Workforce and Corporate Services on improving the offer of initiatives available, guided by the feedback from the 2009 Staff Travel Survey. 3. Work with Comms Team on publicising the initiatives.

E Head of Comms

HR Manager

Car sharing scheme launched in April 2010.

Travel Plan and sustainable travel options to be publicised to staff throughout Green Week 14-18 June 2010.

8. Identify patients’ travel needs.

A Board approved Sustainable Travel Plan for all NHS bodies by 2010 (NHS SDU).

D SSG Sustainable Travel Plan is currently being developed.

Aim to finish Travel Plan by end of May/June 2010, then consult and approve at strategic level early summer 2010.


WASTE MANAGEMENT (2 pages)


mandate

Prio

rity

Lead


Milestone/DL

Fina

ncia

l Sa

ving

s (£

)

CO2

impa

ct

1. Calculate the CO2e Scope III emissions derived from waste management practices across the whole owned and directly leased estate, divided into a) clinical, b) domestic, and c) confidential waste streams.

1. Calculate the Scope III carbon footprint for 2008/09 and 2009/10.

Reducing the carbon footprint arising from waste by 10% by 2015 on a 2007 baseline across the whole of the NHS (NHS SDU).

E NEP contracted under SLA to do this.

Jan'2010: Work underway with Supplies team and waste contractors to acquire data on historical waste to calculate the footprint.

By June 2010.

2. Agree a specific year-on-year CO2e reduction and/or waste stream reduction target from waste management practices on the 2007/2008 baseline year and adopt it in the most appropriate internal strategy/policy.

1. Analyse current waste data. 2. Compare to national benchmarks. 3. Work to design an appropriate reduction target, together with a consistent mechanism to measure emissions reduction this over time. 4. Embed this target into the Waste Management Strategy.



CMP to be taken as a paper to Board 27th May 2010 .

3. Adopt a corporate Waste Management Policy, Strategy and Action Plan as the statement of intent on managing the carbon emissions and wider environmental impacts derived from waste management practices.

E SGG Draft Action Plan completed + structure agreed in March 2010. CMP approved by SSG on 07/05/10.


4. Develop communications plan to ensure staff are aware of waste management procedures.

E Head of Communica

tions

Dec-10


5. Ensure better management of corporate waste contracts for all waste streams to maximise environmental and financial savings, and ensure compliance and VFM over time.

Review legal duties, data availability, current costs and rates, disposal methods, providers’ credentials, etc. - access to data on waste produced in-house by volume and waste stream on a daily/weekly basis from the suppliers. - Agree monitoring and reporting duties and systems with the suppliers. - Monitor and manage the quantity and cost of all waste streams and set trajectories to Monitor, manage and reduce them over time.

E SSG & Supplies

Work currently underway between Supplies, Corporate Services, Estates, providers, the Re:Source Hub and NEP to review current contracts and try to embed lean management principles, improve communications and records, and maximise opportunities for savings. Recycling facilities provided at all HQ premises and health centres.

6. Develop training and awareness programmes to ensure correct segregation of waste.

Develop training programme. E SSG Workforce

representative

Dec-10

7. Undertake periodic (at least 6-monthly) waste audit trails, to assess the effectiveness of current systems and make improvements wherever necessary.

Waste audit system to be developed and implemented.

E Karen Sullivan

Site logbook to include information on waste management and surveys.

8. Identify “quick hits” to prevent waste arising in the first place, to reduce waste and the cost of waste disposal for the PCT. Identify no-cost/low-cost opportunities for preventing/recycling waste or waste recovery.


PROCUREMENT – GOODS AND SERVICES (3 pages)


mandate

Prio

rity

Lead

Progress to date

Timescale/ Milestone/DL

Fina

ncia

l Sa

ving

s (£

)

CO2

impa

ct

1. Calculate the CO2e Scope III emissions derived from purchasing goods and services across the organisation.

1. Calculate the Scope III carbon footprint on a baseline year, using P4CR Scope tool. 2. Identify the contribution that procurement (goods and services purchased) has on overall footprint.


E NEP Provisional baseline footprint achieved for 2008/09, in partnership with Re:Source Hub using P4CR toolkit, based on tCO2e/£ spent.

Do again for 2009/10 (by July 2010).

2. Attain Level 3 in flexible framework on sustainable procurement by 2013.

Based on the results of the footprinting exercise, set specific reduction targets for the largest areas of procurement i.e.: the ones with the largest expenditure, with the highest carbon impact. Use Flexible Framework to guide this process.

Reducing the carbon footprint by 10% by 2015 on a 2007 baseline across the whole of the NHS (NHS SDU).

E Sustainability Steering Group

(SSG)



3. Use theP4CR to target high areas of carbon emissions.

Reducing the carbon footprint by 10% by 2015 on a 2007 baseline across the whole of the NHS (NHS SDU).

E Sustainability Steering Group

(SSG)




4. Adopt a corporate Sustainable Procurement Policy, Strategy and Action Plan on managing the carbon emissions and wider environmental impacts of its procurement practices.

Use Flexible Framework to guide this process.



5. Incorporate national and regional best practice, knowledge, resources and guidance into PCT’s own practices.

E Supplies representative

on SSG.

HQ stationery now from sustainable sources if financially viable.

Jan-11

6. To train and regularly update procurement staff on new procurement systems and to enable them to gain new skill and knowledge on sustainability.


7. As a key procurer of goods and services, NHS Nottinghamshire County works towards the decarbonisation of its supply chain and actively promotes this amongst its suppliers and providers.

e.g.: - Setting environmental standards in tender specifications, contracts and SLAs whenever possible. - Including internal policy on sustainable procurement in all tender and contract information/ documentation. - Routinely requiring all suppliers to disclose their own approach to sustainable development and to carbon management. - Identify key suppliers and target them directly for joint thinking and cooperation on enhancing sustainability in contracts - ideally, work with other Trusts and/or the Re:Source Hub on the potential to do this regionally. - Encourage suppliers to submit variant bids or greener alternatives for goods and services required. - Introduce Electronic Tendering systems as an alternative to hard copy documents.


E Supplies representative

on SSG.

Working with Supplies team to assess potential for implementing this recommendation in current and near future contracts.


BEHAVIOUR CHANGE IN THE WORKFORCE (2 pages)


mandate

Prio

rity

Lead

Progress to date Timescale/ Milestone/

DL Fina

ncia

l Sa

ving

s (£

)

CO2

impa

ct

1. Identify staff to become Green Champions to support colleagues in promoting reduction in energy consumption, increased recycling and greener travel options.

Approx 50 Green Champions trained, meetings held monthly.

2. Ensure continuous access to resource consumption data by key members of staff e.g.: Estates, Site Managers, Sustainability Co-ordinator, Green Champions etc, to enable them to understand and record energy, carbon and waste trends in their own settings and act upon them accordingly.

1. Review current systems for data collation and analysis. 2. Identify gaps and areas for improvement. 3. Benchmark against national data.

Audit Commission KLOE 3.1. Use of natural resources.

E Head of Corporate Services

Smart meters are being installed and will include an online facility where staff will be able to log on and check electricity consumption on-site on a continuous basis. Monthly reports on consumption to be made to SSG and Green Champion meetings

May 2010.

3. Adopt a corporate Sustainability and People Policy, Strategy and Action Plan supporting its workforce and service users in tackling their corporate carbon emissions and wider environmental impacts, promoting more sustainable behaviours, and becoming a green employer.

1. Summarise the key elements of the Sustainability and People Strategy. 2. Make available and publicise.

E Head of Communica

tions




4. Ensure all staff are actively supported and encouraged to adopt carbon reducing and energy saving behaviours.

1. Site managers and green champions to be trained on practical sustainability and behavioural change. 2. A clause on sustainability and carbon reduction to be included in all job descriptions. 3. Sustainability, carbon reduction and the approach to them to be included in new employee's induction. 4. Encourage all staff to take responsibility for energy consumption and carbon reduction via internal communications.

E Head of Corporate Services

March 2010 - 1 in 50 staff have been trained as Green Champions. Train the trainer CPD on sustainability taking place on 10+11 May 2010. Staff ‘green’ suggestion scheme.. Green Champion training planned for 2010/2011. Green Week , 14 – 18 June 2010 including Green Champions conference. Green articles in staff newsletter.

5. Carbon management is accorded appropriate priority within corporate priorities and policies.

Work with Directorates to integrate this into internal documents and cycles.

D TBC Draft Action Plan completed + structure agreed in March 2010. CMP approved by SSG on 07/05/10.


6. Carbon management is integrated into responsibilities of senior managers in different departments.


6. References, useful links and further reading

NHS SPECIFIC

• SDU (2010). Update: NHS Carbon Reduction Strategy. Available at: http://www.sdu.nhs.uk/page.php?page_id=160

• SDU (2010). Writing sustainability into Annual Reports – Knowledge Brief. Available at: http://www.sdu.nhs.uk/page.php?page_id=142

• SDU (2010). P4CR Procuring for Carbon Reduction (includes the SCO2PE and the Flexible Framework tools). Available at: http://www.sdu.nhs.uk/page.php?page_id=159

• The Audit Commission's Use of Resources framework (2009/10). Available at: www.audit-commission.gov.uk/health/audit/uor/Pages/Default_copy.aspx

• SDU (2009). Fit for the Future: Scenarios for low-carbon healthcare 2030. Available at: http://www.sdu.nhs.uk/page.php?page_id=132

• SDU (2009). Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England. Available at:

www.sdu.nhs.uk/page.php?area_id=2

• SDU (2009). Carbon Footprints in the NHS in England. Available at: www.sdu.nhs.uk/page.php?page_id=112

• SDU (2009). How will NHS England organisations measure and report on progress to meeting carbon targets? Available at:

www.sdu.nhs.uk/page.php?page_id=111

• SDU (2009).Getting started: 10 things to do now. Available at: www.sdu.nhs.uk/page.php?page_id=127

• SDU (2009). NHS Board Level Sustainable Development Management Plan Guidance. Available at: http://www.sdu.nhs.uk/page.php?page_id=92

• NHS Confederation, SDU and DH (2009). The CRC Energy Efficiency Scheme and the NHS. Available at: www.sdu.nhs.uk/page.php?page_id=138

• DH (2008). Taking the long term view: the Department of Health’s strategy for delivering sustainable development 2008-2011. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_089049

• Community Health Partnerships (2008). Commissioners Investment and Asset Management Strategy (CIAMS). Available under:

www.communityhealthpartnerships.co.uk/index.php?ob=1&id=63

• SDU and Stockholm Environment Institute (SEI) (2008). NHS England Carbon Emissions: Carbon Footprinting Report – September 2008. Available at:

www.sdu.nhs.uk/page.php?page_id=93

http://www.sdu.nhs.uk/page.php?page_id=160�



http://www.audit-commission.gov.uk/health/audit/uor/Pages/Default_copy.aspx�


http://www.sdu.nhs.uk/page.php?area_id=2�







http://www.communityhealthpartnerships.co.uk/index.php?ob=1&id=63�



• NHS Confederation (2007). Taking the Temperature: Towards an NHS response to global warming. Available at: http://www.nhsconfed.org/Publications/Documents/Taking%20the%20temperature.pdf

• DH (2006). Health Technical Memorandum 07-01: Safe Management of Healthcare Waste. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_063274

• DH (2006). Health Technical Memorandum 07-02: EnCO2de- Making energy work in healthcare: environment and sustainability. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4131671

• DH portal on World Class Commissioning programme:

http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm

• DH Estates and Facilities portal – Targets for energy performance in the NHS: http://www.dh.gov.uk/en/Managingyourorganisation/Estatesandfacilitiesmanagement/Sustainabledevelopment/DH_4119497

• The PCT Carbon Reduction Project homepage: www.nottenergy.com/nhscarbonreduction

NATIONAL • DEFRA and DECC (2009). Guidance on how to measure and report your greenhouse gas emissions. Available at:

www.defra.gov.uk/environment/business/reporting/index.htm

• DEFRA (2009). 2009 Guidelines to Defra / DECC's GHG Conversion Factors for Company Reporting. Available at: www.defra.gov.uk/environment/business/reporting/pdf/20090928-guidelines-ghg-conversion-factors.pdf

• DECC (2009). The UK Low Carbon Transition Plan: National Strategy for Climate and Energy. Available at:

www.decc.gov.uk/en/content/cms/publications/lc_trans_plan/lc_trans_plan.aspx

• HMGO (2005). Securing the future: Delivering UK Government Sustainable Development Strategy. Available at: http://www.defra.gov.uk/sustainable/government/publications/uk-strategy/documents/SecFut_complete.pdf

• Forum for the Future (2007). Buying a better world. Sustainable Public Procurement. Available at: http://www.forumforthefuture.org/files/Buying%20a%20Better%20World.pdf

• Forum for the Future (2007). Sustainable Procurement Toolkit. Available at: http://www.forumforthefuture.org/files/SP_Tool_Guidance.pdf

http://www.nhsconfed.org/Publications/Documents/Taking%20the%20temperature.pdf�



http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/index.htm�

http://www.dh.gov.uk/en/Managingyourorganisation/Estatesandfacilitiesmanagement/Sustainabledevelopment/DH_4119497�

http://www.nottenergy.com/nhscarbonreduction�

http://www.defra.gov.uk/environment/business/reporting/index.htm�

http://www.defra.gov.uk/environment/business/reporting/pdf/20090928-guidelines-ghg-conversion-factors.pdf�

http://www.decc.gov.uk/en/content/cms/publications/lc_trans_plan/lc_trans_plan.aspx�

http://www.defra.gov.uk/sustainable/government/publications/uk-strategy/documents/SecFut_complete.pdf�

http://www.forumforthefuture.org/files/Buying%20a%20Better%20World.pdf�

http://www.forumforthefuture.org/files/SP_Tool_Guidance.pdf�


• The Government’s Buying Standards: How to procure sustainably (aka ‘Buy Sustainable Quick Wins’). Available at: http://www.defra.gov.uk/sustainable/government/advice/public/buying/index.htm

• Global Action Plan’s homepage: http://www.globalactionplan.org.uk/

• The Government’s website on Feed-in-Tariff (FIT):

www.decc.gov.uk/en/content/cms/what_we_do/uk_supply/energy_mix/renewable/policy/feedin_tarriff/feedin_tarriff.aspx

• The Government’s website on Renewable Heat Incentive (RHI):

http://www.decc.gov.uk/en/content/cms/what_we_do/uk_supply/energy_mix/renewable/policy/renewable_heat/incentive/incentive.aspx

• The CRC Energy Efficiency Scheme homepage: http://www.environment-agency.gov.uk/business/topics/pollution/98263.aspx

• UKCIP (2009). UK Climate Impacts Programme – UK Climate Projections (UKCP09) homepage: http://www.ukcip.org.uk/index.php?option=com_content&task=view&id=156&Itemid=287

http://www.defra.gov.uk/sustainable/government/advice/public/buying/index.htm�

http://www.globalactionplan.org.uk/�

http://www.decc.gov.uk/en/content/cms/what_we_do/uk_supply/energy_mix/renewable/policy/feedin_tarriff/feedin_tarriff.aspx�






http://www.decc.gov.uk/en/content/cms/what_we_do/lc_uk/crc/crc.aspx�

http://www.environment-agency.gov.uk/business/topics/pollution/98263.aspx�

http://www.ukcip.org.uk/index.php?option=com_content&task=view&id=156&Itemid=287�


7. Glossary • CIAMS: Commissioners Investment and Asset Management Strategy.

• CMP: NHS Nottinghamshire County’s Carbon Management Plan.

• CMAP: Carbon Management Action Plan (i.e.: section 5. of the NHS Nottinghamshire County CMP).

• CO2e: Carbon dioxide equivalent. The unit of measurement used for the different greenhouse gases that have a climate impact, not just carbon

dioxide, in line with national guidelines.

• CRC EFS: Carbon Reduction Commitment Energy Efficiency Scheme.

• DEC: Department of Energy and Climate Change.

• DEFRA: Department for Environment, Food and Rural Affairs.

• DH: Department of Health.

• EA: Environment Agency. Regulator responsible for environmental regulation (including waste) in England and Wales.

• FITs: Feed-in-Tariffs.

• GAP: Global Action Plan.

• NEP: Nottingham Energy Partnership.

• PCT CRP: The Nottingham and Nottinghamshire PCT Carbon Reduction Project.

• SDC: Sustainable Development Commission.

• SDU: The NHS Sustainable Development Unit.


8. APPENDICES


APPENDIX A: NHS Nottinghamshire County CRCEFS and Baseline CO2e footprints – April 2010.

1. Legislative / Mandatory Footprint NHS Nottinghamshire County has calculated its footprint under Carbon Reduction Commitment Energy Efficiency Scheme (CRC EFS) following national requirements and guidance from EA and DECC*, and in doing so has also defined areas where this liability may change and potentially increase under the scheme in the future. Between January and December 2008, the PCT had 5 sites with mandatory half hourly meters (HHMs) for which it was liable, which used electricity as follows:

• Standard Court (MPAN: 1100039636378)= 342.93 MWh • Mansfield CH (MPAN 1: 1,180.92 + MPAN 2: 689.87) = 1,870.791 MWh • Ashfield CH (MPAN: 1100039631565) =778.47 MWh • Lings Bar CH (MPAN: 1100039630696) =662.67 MWh • Easthorpe House(MPAN 1100050590240) =32.65 MWh

NHS Nottinghamshire County’s total electricity consumption from its HHMs hence totals 3,655 MWh for the CRCEFS qualification calendar year of 2008. The PCT is required to make an information disclosure to the Environment Agency on the consumption stated above, between 1st April 2010 and 30th September 2010.

2. Operational Footprint

2.1. Core footprint i.e.: Scope 1 and 2 emissions NHS Nottinghamshire County’s baseline carbon footprint has been calculated by Nottingham Energy Partnership (NEP) using methodology recommended by DEFRA for measuring and reporting an organisation’s carbon emissions**. This exercise was commissioned as part of the PCT Carbon Reduction Project, and followed a rigorous and comprehensive data analysis, with internal and external quality assessment. Data gaps and areas identified improvement have been highlighted and are being acted upon by the PCT. Within the PCT’s baseline carbon footprint, Scopes 1 and 2 emissions are equivalent to 5,969.96 tCO2e, for the baseline year of 2007/08. These are made up of 96% of buildings-related emissions and 4% lease car-related emissions.

The energy in buildings data was derived from: o Health centres and clinics: Monthly, manual meter readings for site utility use in the baseline year. These were provided by NCH Estates. o Hospitals: Mixture of monthly, manual meter readings half-hourly, automatic meter readings for site utility use. These were provided by NCH Estates and utility

companies. o LIFTco: Half-hourly, automatic meter readings for site utility use. These were provided by LIFTco team. o HQ: Half-hourly, automatic meter readings for one site’s utility use. There was a marked gap in accurate, continuous utility consumption records for the

remaining HQ sites, due to them being leased, so their data for energy use was based on CIBSE benchmarks. Information was provided by Corporate Services.


The leased transport data was derived from total business mileage allowances for each lease car operating and under contract in the baseline year. These were provided by Finance – Commissioning.

Figure 7: NHS Notts County CO2e footprint by site type (Source: NEP, 2010). Figure 8: NHS Notts County CO2e footprint by fuel source (Source: NEP, 2010).

Table 2: NHS Nottinghamshire County Scope I and II CO2e footprint (2007/08) breakdown. Sites (i.e.: emissions source) Electricity

(tCO2e) Gas & FF (tCO2e)

TOTAL (tCO2e)

Hospitals (3x) 1,551.82 1,561.77 3,113.60 Health Centres (23x) 647.59 663.72 1,311.31

LIFTco (8x) 631.73 389.44 1,021.17 HQs (6x) 186.99 134.54 321.53

Leased cars (163x)

163 vehicles under lease in 2007/08; Fuel breakdown: 33.1% diesel, 66.9% petrol; Total business mileage: 658,622 p.a.; Average business mileage per car: 4,041 m.p.a. Average carbon per mile driven: 0.31 kgCO2e

202.33

TOTALS 3,018.13 2,749.48 5,969.94


2.2. Scope III emissions The wider, indirect carbon emissions which fall under Scope3 are defined as ‘Discretionary’ by DEFRA, in terms of an organisation reporting performance against them. The PCT has taken a pro-active and forward-thinking approach in its carbon accounting, and has measured as many of these emissions as the existing datasets have permitted for the baseline year. Part of the reason for expanding the extent of its carbon footprint analysis beyond the DEFRA ‘Recommended’ Scopes 1 and 2 is that the PCT is now being audited on its use of natural resources by the Audit Commission Key Lines of Enquiry (KLOE 3.1.) assessment, under which water and transport fuels consumption falls under, and is hence required to measure, manage and improve its usage over time. In terms of water and sewage, the only available dataset for baseline footprint calculations was the ERIC return for 2007/08, which included an aggregate consumption -i.e.: all sites put together- of:

• 43,136 m³ of water (equating to 8.61 tCO2e) less than 1% of total footprint. • 36,234 m³ sewage (equating to 5.40 tCO2e) less than 1% of total footprint.

In terms of waste disposal, the carbon emissions derived from waste, based on the dataset available at the time of producing the CMP. The only available dataset for baseline footprint calculations was the ERIC return for 2007/08. This equated to 285.49 tCO2e (Non-clinical) and 44 tCO2e (clinical) totalling 329.49tCO2e. In terms of procurement, PCT is also working with the local procurement Re:Source Hub to calculate the carbon emissions derived from our direct purchase of goods and services, using the SDU’s P4CR tool, demonstrating best practice locally. Based on expenditure for 2008/09, the carbon emissions derived from our direct supply chain (i.e.: excluding commissioning healthcare services to other NHS organisations) equates 40,129.75 tCO2e.

The DH has welcomed the work of NHS Nottinghamshire County to date on calculating and planning to reduce its carbon footprint, as below: The total baseline footprint in its entirety is represented below, with the inner circle showing the core emissions from the PCT’s own operations i.e.: what the PCT is expected to report progress against, year-on-year. The wider circle represents the wider carbon impact derived from the PCT’s expenditure on goods and services, which can be used for targeting specific areas of expenditure, alongside financial data.

“It is very positive that Nottingham trusts have sought to take this proactive step in looking at their carbon emissions and measures/ways in which it can be reduced/improved”. Lorraine Holme Programme Manager, Sustainable Development Department of Health 12th January 2010


Fig. 9: Proportional representation of the PCT’s full Scope 1, 2 and 3 baseline tCO2e footprint (Source: NEP, 2010).

The PCT is actively working to embed good practice and continuous improvement in its present and future environmental reporting, and as part of this effort, it has highlighted the following areas as a target for data improvement: Energy in buildings use in leased sites (e.g.: HQ): Work with landlords and utility companies to acquire use data on a regular basis and useful format.

Scope III travel: Measure all business mileage in a consistent and regular manner, broken down by travel mode i.e.: grey fleet, bus, rail, air, and to the best

accuracy possible (following data quality pyramid provided).

Water and sewage: Collate actual water consumption and sewage arisings on a site-by-site basis, and monitor them regularly alongside energy use. References and notes on carbon accounting methodology employed on baseline footprinting exercise: *The CRC Energy Efficiency Scheme DECC homepage: www.decc.gov.uk/en/content/cms/what_we_do/lc_uk/crc/crc.aspx **DEFRA and DECC (2009). Guidance on how to measure and report your greenhouse gas emissions. www.defra.gov.uk/environment/business/reporting/index.htm The purpose of the greenhouse gas (GHG) conversion factors is to help organisations such as the PCT convert existing data sources (e.g.: utility consumption data, car mileage, refrigeration and fuel consumption) into CO2 equivalent emissions by applying relevant conversion factors (e.g.: calorific values, emission factors, oxidation factors). Please note that the Defra / DECC Greenhouse Gas (GHG) Conversion Factors for Company Reporting are reviewed and updated on an annual basis, and that the latest factors were published on 30th September 2009, and can be found at: http://www.defra.gov.uk/environment/business/reporting/conversion-factors.htm

http://www.decc.gov.uk/en/content/cms/what_we_do/lc_uk/crc/crc.aspx�

http://www.defra.gov.uk/environment/business/reporting/index.htm�

http://www.defra.gov.uk/environment/business/reporting/conversion-factors.htm�


GHG conversion factors used to calculate CO2e emissions in the NHS Nottinghamshire County PCT baseline footprint: Type / Source of CO2e emissions GHG Conversion Factor Source / Reference BUILDINGS – Scope I Electricity

0.54418 kgCO2e per kWh 2007 Grid rolling average for electricity consumed, as featured in DEFRA's GHG conversion factors for company reporting, 2009 (amended on 30/09/09).

Natural gas (gross CV) 0.18396 kgCO2e per kWh 2009 Factors, as featured in DEFRA's GHG conversion factors for company reporting, 2009 (amended on 30/09/09). Coal (gross CV) 0.3392 kgCO2e per kWh

TRANSPORT – Scope I Small petrol car, up to 1.4 litre engine

0.28944 kgCO2 per mile 2009 Factors, as featured in DEFRA's GHG conversion factors for company reporting, 2009 (amended on 30/09/09).

Medium petrol car, from 1.4 - 2.0 litres

0.34246 kgCO2 per mile

Medium petrol car, from 1.4 - 2.0 litres


Small diesel car, up to 1.7 litre or under


Medium diesel car, from 1.7 to 2.0 litre


Large diesel car, over 2.0 litre 0.41167 kgCO2 per mile WATER & SEWAGE – Scope III Water

0.276kgCO2e per m³ 2009 Factors, as featured in DEFRA's GHG conversion factors for company reporting, 2009 (amended on 30/09/09).

Sewage 0.693kgCO2e per m³ WASTE DISPOSAL – Scope III High T° Disposal i.e.: incineration 220 kgCO2e per tonne of waste Provided by North East Waste Consortium to DH, 2010. Does not take into account any energy that

may be reclaimed for electricity generation or heating of steam/hot water for heating or on-site processes.

Landfill Disposal 243.9 kgCO2e per tonne of waste 2009 Factors, as featured in DEFRA's GHG conversion factors for company reporting, 2009. Waste recycling -1,335.60 kgCO2e per tonne of waste From applying DEFRA's GHG conversion (2009) figures for closed loop recycling to a

typical basket of healthcare waste separated out for recycling. Basket comprised of: 45% paper & card, 5% wood, 5% textiles, 15% dense plastic, 5% plastic film, 5% ferrous metal, 5% non-ferrous metal, 15% glass, following DH guidance.

Non-burn treatment (Alternative Treatment)

71.7 kgCO2e per tonne of waste Provided by North East Waste Consortium to DH, 2010. Does not take into account any energy that may be reclaimed for electricity generation or heating of steam/hot water for heating or on-site processes

PROCUREMENT OF GOODS & SERVICES – Scope III Total expenditure on goods and services

kgCO2e per £ spent P4CR: Procuring for Carbon Reduction materials available at: http://www.sdu.nhs.uk/page.php?page_id=159



APPENDIX B: Protocol for mapping sources of CO2e emissions in-house for footprinting purposes. Sc

ope Source of

emissions Typical activities /

causes Typical units for measurement

Ideal unit / KPI

Where is this data saved in our PCT?

Who is/should be the main

contact for this data?

Unit to

measure x

CO2e emissions

factor

= CO2e footprint

Scop

e I

(aka

‘Dire

ct’)

Fuels (on-site combustion) e.g.: gas, oil, coal

Heating, catering (i.e.: boilers, furnaces, turbines)

Gas: kWh, GJ, m3, BTU, £

Oil: gallons, litres, £

Coal: kWh, tonnes, kg, £

kWh kWh See DEFRA, Sept’09*

XXXXX tCO2e

Transport fuels (off-site combustion) e.g.: petrol, diesel, LPG

Owned and leased transport (i.e.: owned fleet, leased & pool cars)

Litres, miles, km, £ spent

Litres of fuel

/ Miles travelled

Litres of fuel / Miles

travelled

XXXXX tCO2e

Fugitive emissions (i.e.: leaks)

Cooling/AC, refrigeration

TBC (e.g.: grams, bar,

PSI, other...)

tonnes tonnes XXXXX tCO2e

Scop

e II

(aka

‘Ene

rgy

Indi

rect

’)

Electricity use (purchased for consumption in-house)

Power, lighting kWh, £ kWh kWh XXXXX tCO2e

Heat, steam use (purchased for consumption in-house)

Power, heating kWh, GJ, £ kWh kWh XXXXX tCO2e


Scop

e Source of emissions

Typical activities / causes

Typical units for measurement

Ideal unit / KPI

Where is this data saved in our PCT?

Who is/should be the main

contact for this data?

Unit to

measure x

CO2Ee emissions

factor

= CO2Ee footprint

Scop

e III

(a

ka‘O

ther

Indi

rect

’)

Waste disposal Recycling, landfill, alternative treatment and incineration

Tonnes, kg, £ Tonnes Tonnes DH 2010 guidance

(CI), based on DEFRA

2009.

XXXXX tCO2e

Water and sewage Hygiene, catering Litres, m3, £ Litres/m³ Litres / m³ XXXXX tCO2e Transport fuels (off-site combustion)

Grey fleet, business mileage, commuting

Litres, miles, km, £ spent

Litres of fuel / Miles travelled

Litres of fuel / Miles travelled

See DEFRA, Sept’09

/

Use P4CR tool.

XXXXX tCO2e

Procurement of goods and services

Production, distribution and consumption of raw +processed materials, commissioning.

Expenditure (£), expenditure codes.

£ spent £ spent XXXXX tCO2e

Figure 10 and 11: NHS organisation data quality pyramids, for footprinting purposes (Source: NEP, 2010).


APPENDIX C: Energy+carbon performance analysis of owned estate, including benchmarks (2007/08 baseline).

Figure 12: Energy intensity (kWh total energy per m2 of Treatable Floor Area (TFA)) of NHS Nottinghamshire County health centres (2007/08), and relevant DH benchmarks. (Source: NEP, 2010).


Figure 13: Carbon intensity (kgCO2e per m2 of TFA) of NHS Nottinghamshire County health centres (2007/08). (Source: NEP, 2010).


Table 3: Breakdown of energy intensity (kWh total energy per m2) of NHS Nottinghamshire County Health Centres and Clinics (07/08)

KWh/m² KWh/m² KWh/m² KWh/m²

TFA Health Centre All Energy Electricity Gas Coal 141.09 Kimberley Health Centre (141.09 m2) 750.4 62.12 688.28 198.22 Calverton Clinic 493.55 64.03 429.52 220.51 Hawtonville Health Centre 144.49 41.27 103.22 250.76 Colwick Vale Surgery (Decant) 165.55 165.55 269.41 Selston Community Unit 257.61 102.71 154.9 302.64 Edwinstowe Health Centre 218.15 59.87 158.28

339 Oates Hill Health Centre 378.71 94.06 284.65 349.81 Ollerton Health Centre 397.82 83.73 314.09 425.93 Oak Tree Lane Health Centre 298.2 90.6 207.6 432.28 Huthwaite Health Centre 382.12 90.08 292.04 439.88 Newark Health Clinic 299.7 68.99 230.71 551.16 Clipstone Health Centre 266.79 90.26 176.53 566.89 East Leake 535.74 127.87 407.87 566.89 Eastwood Clinic 290.43 86.52 203.91 572.68 Kirkby Health Centre 344.28 83.07 261.21 619.85 Daybrook Health Centre 341.33 97.23 244.1 633.84 Bingham Health Centre 350.81 118.94 231.87 636.31 Cotgrave Health Centre 514.38 129.07 385.31 771.27 West Bridgford Health Centre 403.71 63.08 340.63 953.99 Mansfield Woodhouse Health Centre 262.4 109.58 152.82 1013.7 Arnold Health Centre 310.13 68.46 241.67

1052.93 Beeston Clinic 171.85 22.09 149.76 1218.63 Hucknall Health Centre 214.5 75.66 138.84 1689.7 Mansfield Health Centre (1,689.7 m2) 454.22 81.7 372.52

14217.37 TOTALS 8246.87 1910.99 5938.46 231.87


Table 4: Breakdown of carbon intensity (kgCO2e/m2) for NHS Nottinghamshire County Health Centres and Clinics (07/08)

kgCO₂e/m² kgCO₂e/m² kgCO₂e/m² kgCO₂e/m²

TFA Health Centre All Energy Electricity Gas Coal

141.09 Kimberley Health Centre (141.09 m2) 161.00 34.00 127.00

198.22 Calverton Clinic 114.00 35.00 79.00

220.51 Hawtonville Health Centre 41.00 22.00 19.00

250.76 Colwick Vale Surgery (Decant) 90.00 90.00

269.41 Selston Community Unit 84.00 56.00 28.00

302.64 Edwinstowe Health Centre 61.50 32.50 29.00

339 Oates Hill Health Centre 103.00 51.00 52.00

349.81 Ollerton Health Centre 103.56 45.56 58.00

425.93 Oak Tree Lane Health Centre 87.00 49.00 38.00

432.28 Huthwaite Health Centre 103.00 49.00 54.00

439.88 Newark Health Clinic 79.98 37.54 42.44

551.16 Clipstone Health Centre 81.00 49.00 32.00

566.89 East Leake 144.59 69.59 75.00

566.89 Eastwood Clinic 85.00 47.00 38.00

572.68 Kirkby Health Centre 93.26 45.21 48.05

619.85 Daybrook Health Centre 98.00 53.00 45.00

633.84 Bingham Health Centre 147.72 64.72 83.00

636.31 Cotgrave Health Centre 141.00 70.00 71.00

771.27 West Bridgford Health Centre 97.00 34.00 63.00

953.99 Mansfield Woodhouse Health Centre 87.63 59.63 28.00

1013.7 Arnold Health Centre 81.00 37.00 44.00

1052.93 Beeston Clinic 40.00 12.00 28.00

1218.63 Hucknall Health Centre 67.00 41.00 26.00

1689.7 Mansfield Health Centre (1,689.7 m2) 113.00 44.00 69.00

14217.37 TOTALS 2304.24 1037.75 1093.49 83.00


APPENDIX D: Procuring for Carbon Reduction (P4CR) Flexible Framework. Stage Foundation (Level 1) Embed (Level 2) Practice (Level 3) Enhance (Level 4) Lead (Level 5)

Policy & Communication

A strong business case for addressing carbon reduction through procurement exists and is endorsed by senior

management. The business case has been

communicated to key procurement staff.

Key stakeholders, internal and external identified.

Policy on P4CR is documented, integrated

within procurement processes and it has been

communicated to all procurement staff and key

stakeholders.

Strategy and action plans are documented and identify how

policy will be delivered. Strategy endorsed by senior

management and communicated internally and to all key

stakeholders.

Organisation reports internally on activity and performance that supports policy and strategy on P4CR. Processes established for responding to enquiries and

challenges from external interested parties.

Organisation recognised as a leader by peers and other stakeholders in

P4CR. Reports externally on activity and performance. Case studies are

developed to promote continual improvements. Feedback sought from

external stakeholders on the organisation’s policy, practice and

performance.

People

Named senior level champion for development

and implementation of P4CR activity. Initial awareness raising activity has been

undertaken with key procurement staff.

All procurement staff have received personal

development activity on procuring for carbon

reduction, policy and good practice. P4CR is

specifically identified within employee induction

programmes for procurement staff.

Responsibilities around carbon reduction are defined and personal objectives set for

procurement staff. Key procurement staff have

undertaken detailed training on managing carbon reduction

through procurement as part of a structured personal development

process.

Procurement staff to engage with clinical and patient groups on procurement related carbon

reduction issues at an organisational level. The

principal objective of engagement is to raise broad

awareness, build understanding of needs and expectations and

identify opportunities.

The knowledge and capability to procure for carbon reduction is a specific element of the role profile

and competencies for all key procurement staff.

Procurement Process

High carbon impact categories / suppliers are

identified through application of carbon intensity

modelling.

Consideration of carbon is a feature of the procurement process. Prioritisation of

categories/suppliers undertaken based on

carbon intensity modelling, levels of influence, profile and stakeholder views.

Carbon reduction strategies are developed to address the

identified priority categories/suppliers

incorporating techniques such as demand management, whole-

life costing, substitution, innovation and supply chain

engagement.

Baseline carbon emission measurements and

assessments are undertaken for priority categories/suppliers to

support future benefits tracking.

Carbon emissions measurement and assessments are undertaken for

priority categories/suppliers at regular intervals to track benefits and the

effectiveness of different strategies and techniques. Data collected on

carbon reduction is robust and objective, and used to support best

practice case study material.

Engaging Suppliers

Initial communication has been conducted with

suppliers/trade associations around carbon reduction

strategy and future aspirations.

Two way dialogue is established with some key

suppliers/trade associations to increase awareness and

inform category prioritisation process.

Dialogue aims to establish carbon-awareness levels,

and the position/maturity of key market sectors in carbon management.

Structured supplier engagement process in place to address priority categories/suppliers.

Specific programmes identified with suppliers to address carbon

reduction in priority areas.

Organisation has in place approaches to recognise high performing

suppliers or sectors which form the basis for best practice carbon

reduction case studies.

Measuring & Results

Organisation regularly reviews implementation

progress against requirements of this

framework.

Process indicators are adopted to monitor aspects

of the organisation’s approach to carbon reduction through

procurement.

Process indicators are reported on regularly to inform internal

audiences and key stakeholders. Plans are in place for the

collection and verification of carbon emissions data from priority categories/suppliers.

Data is available to support carbon emission baselines for priority categories/suppliers.

Comparisons of results with peer organisations are undertaken

and information is used to generate and share best

practice examples.

Ongoing carbon data collection and measurement is undertaken to

monitor progress against baselines for priority categories/suppliers.

Benefits are reported and compared against predicted benefits identified in

the business case.


Procuring for Carbon Reduction: Supporting Materials Reference Matrix. Stage Foundation (Level 1) Embed (Level 2) Practice (Level 3) Enhance (Level 4) Lead (Level 5) Policy & Communication Stakeholder Identification Template* P4CR Roadmap* ACCA reporting

awards*

People

DH Sustainable Procurement E-Learning Module 2.2 – Environmental Issues in Procurement (note that materials for class based training are also freely available) P4CR Roadmap*

DH Sustainable Procurement E-Learning Module 2.2 – Environmental Issues in Procurement (note that materials for class based training are also freely available) P4CR Roadmap*

Procurement Process

NHS SCO2EPE tool* Forum for the Future ‘Sustainable Procurement Toolkit’ 2009 Defra/DECC Greenhouse Gas (GHG) Conversion Factors for Company Reporting (30 September 2009) NHS Carbon Reduction Strategy for England, Saving Carbon, Improving Health PAS 2050: 2008 – Specification for the assessment of the life cycle greenhouse gas emissions of goods and services ISO 15686-5: 2008 Buildings and constructed assets. Service life planning. Life cycle costing ISO 14040: 2006 Environmental Management – Life Cycle Assessment (LCA) – Principles and Framework

NHS SCO2EPE tool* Environmental issues in purchasing (joint guidance of OGC and Defra) Buy green and make a difference – how to address environmental issues in procurement (OGC) Commission interpretive communication on the community law applicable to public procurement and the possibilities for integrating environmental considerations into public procurement.

Hierarchy of Interventions – slide deck* PAS 2050: 2008 – Specification for the assessment of the life cycle greenhouse gas emissions of goods and services ISO 14040: 2006 Environmental Management – Life Cycle Assessment (LCA) – Principles and Framework

Engaging Suppliers

‘Meet the buyer’ events.

Defra Supplier engagement programme

Measuring & Results Excel based - P4CR Self Assessment tool*

* All available as document downloads at http://www.sdu.nhs.uk/page.php?page_id=159



APPENDIX E: Representation of different types of healthcare waste and recommended disposal route and end process (Source: DH, HTM 07-01, 2006).


APPENDIX F: Flowchart showing how sustainability can be integrated into procurement and associated benefits. (Source: ‘Securing the Future’, 2005).


APPENDIX G: Selected graphs from ‘Saving Carbon, Improving Health - Update’ (SDU, 2010), including national NHS CO2e footprint against national trajectories and targets, 8 key areas for national NHS carbon reduction, and the ‘virtuous circle’ of sustainable healthcare.


APPENDIX H: Key results from the PCT CRP Behaviour change pilot project (Source: Global Action Plan, 2010). A pilot project on environmental behaviour change was undertaken in conjunction with Global Action Plan at 5 sites across NHS Nottingham City and NHS Nottinghamshire County. This was part of the PCT’s joint Carbon Reduction Project being run by Nottingham Energy Partnership. This pilot project was run during 2009 and included (1) recruiting volunteers at the sites to act as environmental “Green Champions”, who provide advice and engaging colleagues on environmental/sustainability issues, (2) training for those Champions, (3) auditing typical environmental behaviour and (4) supporting Champions to engage and communicate to colleagues. A number of excellent initiatives and engagement 3-d displays were produced by the volunteer Champions to engage their colleagues; these included:

• “Hit the Switch” (lighting), “Recycling” (promoting recycling), “Cup Tree” and “Paper Usage” (waste awareness and resource use).

In addition to the above work on the displays, a number of other events/initiatives were also undertaken including: • A visit to Wastecycle’s materials recycling facility • Installation of green notice boards • Suggestion boxes • A Green Week event

Global Action Plan worked with sites to obtain indicators of environmental behaviour of their staff. Examples of these audit findings include:

• Lings Bar Hospital initially had 9 % of recyclable paper and card in general waste, falling to 0%. • Birch House initially had 7% plastic cups in general waste, falling to 0%. • Lings Bar reduced lights left on from 21% to 1% following their Hit the Switch campaign.

In addition to the successes of the project, there were many challenges. The largest problem appeared to be a lack of time availability by Champions. Feedback from everyone in the project was asked for and this generated a number of useful suggestions for any further project work on sustainability including:

• Ensure that any future project supplies Champions with more ready-to-use resources such as display templates. • Ensure Champions have appropriate incentives (such as a reward or being a Green Champion counting towards their job targets or personal development

plan). • Ensure both organisations have a central coordinator throughout the project. • Ensure initial planning involves a wider range of key stakeholders to engage them, ensure buy in and support, and understand their ideas, identify existing

or planned environmental projects, as well as any relevant events, groups, linkages and networks at the PCT level. Additionally, create a greater level of coordination of sustainability projects with existing national strategies, targets, any environmental management systems, and the NHS Sustainable Development Unit.

• More emphasis of getting GPs on-board. • Consider 1 environmental theme every two months (or longer) to make timeline more manageable for Champions. • Site managers to receive a sustainability checklist / log book.

NHS_Notts_County_Carbon_Management_Plan

Documents

waste management strategy

waste management policy

sustainable procurement

sustainable travel

transport strategy

buildings strategy

transport policy

buildings policy