The NHS Sustainable Development Unit for England is a team of seven people who provide leadership, support and policy input to ensure the NHS in England is the leading public sector organisation in promoting sustainable development and mitigating climate change.

It was established in April 2008 by the NHS in England under the auspices of the Office of the Strategic Health Authorities and overseen by the 10 Strategic Health Authority Chief Executives. It is hosted at Cambridge by the Strategic Health Authority in the East of England.

Director Dr David Pencheon was previously, Director of the NHS Eastern Region Public Health Observatory from 2001 to 2007. He has worked as joint Director of Public Health, a Public Health Training Programme Director in the East of England, with the NHS R&D programme, and in China in the early 1990s with Save the Children Fund (UK). Prior to that he was clinician in secondary care.

Why is Sustainable Development important for the NHS?

"With 1.3 million staff, the NHS in England is one of the largest employers in the world, the largest in Europe and represents 5 per cent of the UK workforce - it is often the biggest single employer in each of the English regions and is always a significant component of the regional economy.

"It has a very large carbon footprint, and it is a large procurer of goods and services from local, national and international economies. "Every person and organisation has an obligation to mitigate the effects of climate change, arguably the largest health threat that faces us. The ambition of the NHS is to be the most visible and effective public sector exemplar in sustainable development in general and carbon reduction in particular.

"To do this, it needs to operate economically, conscious of its core role in delivering safe and cost-effective health care, whilst simultaneously operating ethically, recognising its broader obligations to the health of the population and the planet as a good corporate citizen."

Don't component parts of the NHS already tackle climate change - why the need for a new unit?

"Yes, some excellent work has been done: in the ten years from 1990 to 2000, the NHS reduced its building energy use by 20 per cent. Since 1999-2000, the percentage of NHS Trusts meeting the highest level of energy efficiency ranking increased from 27 per cent to 53 per cent in 2006-07. However, at the other end of the scale, 27 per cent of Trusts are still rated as unacceptable.

"But energy use - direct emissions - are just one factor and previously, only the carbon dioxide emissions from building energy use in NHS Trusts have been measured and managed: until recently, there was no overall view of the NHS's total carbon footprint.

"Furthermore, the situation isn't static: the NHS is expanding - 100 new hospitals are under construction and new, advanced medical techniques are energy intensive - while the need to combat climate change is becoming ever-more apparent and the targets set for that reduction ever-more stringent.

"So the new Unit marks the determination of the NHS to build on the work we've already done - over half of all NHS Trusts are now registered on the NHS Good Corporate Citizenship Assessment Model, for example - while adding fresh ideas and impetus.

"We plan to support the regional sustainable development networks in the NHS in England to contribute to sustainability and climate change events, run training events, provide downloadable resources.

"As we help coordinate a network of skilled and committed individuals who have delivered in particular areas and in particular parts of the country on sustainability issues we will ensure that evaluated practice where there is an explicit business case is made available so that the effect is multiplied."

Who calculated the NHS's carbon footprint and what did it reveal?

"The Government's Sustainable Development Commission was commissioned to work with the Stockholm Environment Institute at York University to calculate the NHS carbon footprint.

"Based on 2004 figures, the NHS in England is responsible for more than 18 million tonnes of carbon dioxide (MtCO2) each year from heating and lighting its buildings, powering its equipment, procuring goods and services, sending waste to landfill and as a result of patient, staff and visitor travel.

"This is 30 per cent of total public sector emissions in England and 3.2 per cent of total carbon dioxide emissions (2.7 per cent of UK carbon dioxide emissions).

"The 3 main sectors which form the total footprint are: building energy use (heating, hot water and electricity consumption - 22 per cent); travel (patient, visitors and staff - 18 per cent) and procurement (supply chain activities of companies producing goods and services, including waste - 59 per cent).

"Although we are beginning to understand better the national carbon footprint of the health service, every PCT, Trust and service provider, such as GPs, will be different. Each organisation should become much more carbon aware, understand their own carbon footprint and develop realistic plans for reducing it by monitoring progress against baselines.

"The way in which carbon is managed should have the same level of priority as financial management - to which it is closely related - and patient safety. It will be difficult to make progress without a widespread carbon culture throughout all levels of all organisations in the NHS."

What steps is the NHS Sustainable Development Unit taking?

"Armed with the new information, and immediately after our formation in April, we drew up and issued a consultation document - the Draft Carbon Strategy - entitled Saving Carbon, Improving Health and have asked for feedback.

"This document is our vision of how the NHS and everyone in it can play a part in combating climate change. It sets out the case for engagement; it sets out what we can and should do; and it asks for everyone's views and ideas on how the NHS should join with others to meet this challenge.

"This Strategy aims to achieve two core objectives for the NHS in England in fighting climate change:
- Support all our organisations, people, and partners through the creation of a systematic and measurable approach to carbon reduction for the NHS;
- Position NHS organisations as leaders in the public sector, encouraging and challenging others, in a united front against climate change."

Are Government carbon reduction targets realistic?

"We set the NHS in England a challenge: to meet and exceed the national target to reduce carbon emissions. We were up for exceeding a 60 percent reduction by 2050 and now, following the Government's latest initiative, we're up for exceeding an 80 per cent reduction if we can.

"The issue is that if people in the health service think we can't exceed the 80 per cent target, then that means it falls to other people, other organisations, to do more than 80 in order to achieve a national average: it pushes the obligation elsewhere.

"We can show where NHS carbon dioxide emissions are coming from and are proposing clear actions for reducing that carbon footprint. It is the organisations and people of the NHS who are responsible for the carbon, so it is up to us to reduce it.

"Having said that, if you've got something like the health service, or any large organisation, and you have such a tremendously ambitious target like 80 per cent, you're probably not going to deliver it by doing what you do today more efficiently tomorrow. We will have to go back to our core objectives - what are we in business for? - and it might be about doing things quite radically different.

"To give an example: in relation to emissions, a lot of people talk about travel - and it's very important - so you can ask 'what are the better ways that people can travel to their follow-up out-patient appointments?' That would be one feasible and necessary approach. But another could be to ask what the health service would look like if we could design a follow-up out-patient approach outside of the existing system? Would it work if we just said: 'sorry, we don't do follow-up out-patients any more: we do them via webcams or only for certain cases but it's no longer just a routine thing.'

"This way of thinking is going to raise hackles - and perhaps this particular hypothetical example would be a step too far for some people to countenance now - but it's unlikely that we're going to reach 80 per cent unless we start thinking quite radically about different ways of doing things. Rather than all people coming to big hospitals for their care, what would a more disseminated service look like?; what if health care professionals did more travelling and patients did less travelling? ... We really have to think about patient pathways in quite radical ways if we are truly going to be a sustainable and low carbon organisation."

Can you give examples of carbon cutting on which you want to build?

"In energy, The Pilgrim Hospital in Boston, Lincolnshire, is replacing its heavy fuel oil boilers with a combination of a biomass boiler burning locally grown sustainable willow and 500KWe Combined Heat and Power. These two systems will provide heat and hot water to the hospital and a gas/oil fired stand-by boiler providing support at peak load and resilience in the event of maintenance. The scheme will deliver savings in excess of £300,000 pa.

"Similarly, Sherwood Forest Hospital Foundation Trust is installing a reverse cycle heat pump that will use geothermal technology. The adjacent reservoir will be used as a heat sink, rejecting heat into the reservoir during the summer and taking heat from the water in winter. When up to full load the system will deliver savings of 1,700 tonnes of CO2 pa.

"In travel, Nottingham University Hospitals NHS Trust has invested in a bus fleet to connect its two hospital sites. The regular 10-minute service has taken 400,000 staff journeys off the road, helping to reduce carbon emissions and congestion, whilst saving the Trust over £180,000 in taxi fares during the project's first year.

"In waste and food management, there are also some very good examples of recycling and sustainability. But overall, we now know the procurement sector accounts for almost 60 per cent of emissions and, within that, the emissions of the supply chain providing pharmaceuticals and medical instruments and equipment that we use represents the biggest opportunity we have for improvement.

"I'm not saying that there hasn't already been some fine work done in this sector because there has. However, as this is the first time the total carbon footprint of the NHS has been calculated, the contribution of the supply chain to the NHS carbon footprint is only beginning to be understood.

"But the point we've already made - and this applies to the entirety of the NHS - is that if we are to reach our targets, it's not only a question of finding today's best practice and replicating it, something which in any case is easier said than done, but also of finding radically new ways of delivering our service."

What are you working on now?

"The consultation period for the Draft Carbon Strategy finished at the end of September and we are now assessing the feedback."

What advice do you have for others engaged in combating climate change?

"Realise that it's a very long journey. Don't expect to solve all issues overnight. Be thick-skinned about your work. If you're too sensitive, you'll get yourself really ground down by thinking that the task is impossible. You've got to be positive.

"Always stick where you can to good scientific evidence - evidence of climate change or evidence like we're now receiving from our consultation. So rather than saying 'I think this, or I think that', look at what the scientific evidence says and look at the surveys, see what ideas people have and what they're up for doing.

"And finally, of all the evidence we need, of all the knowledge required to crack this thing, it's probably just not from cutting edge science - how we sequester carbon or how we develop renewable energy at affordable prices or gizmos that use less energy - the hard technical evidence will probably come of its own because of scientific momentum. The evidence that we really need is around organisations: it's about change and behavioural change. How people behave and how organisations behave. That's where we need really cutting edge evidence. Because that's ultimately what's going to help us turn this thing around."

Corporate Social Responsibility And Emissions Reduction

As the collapse of Lehmann Brothers sent shock waves through the finance industry and pitched markets into a nose-dive across the globe, Goldman Sachs – one of the few remaining investment banks on Wall Street – chose to unveil its latest Corporate Social Responsibility (CSR) project.

The bank’s decision to press ahead with publicity for its ‘10,000 Women’ scheme, which aims to give business and management training to women in developing countries, prompted the Financial Times to ask what will happen to CSR commitments in our gloomy economic climate.

“I suspect there are lots of …managers in the private sector who grumblingly tolerated CSR programmes during the boom and would now love to get rid of them,” said the FT’s Adam Jones. “But that would be a pretty dumb move at a time when the public mood is for more accountability and regulation, not less,” he concluded.

For many companies CSR is a natural home for emissions reduction efforts, but there are differing views on whether this is the best approach in all cases. On one hand many companies have a well-established approach to CSR in place, led by a director and supported by policies and good communications across the company.

On the other it could be argued that emissions reduction is too big and important an issue, requiring a sharper strategic focus than would be achieved by situating it alongside a diverse collection of other issues. The recent crisis in the markets and latent hostility felt by some towards CSR may add weight to this view.

Scope, drivers, insights

An important aspect of CSR is the diverse range of issues within its scope, but they tend to divide into four main aspects of a company’s conduct – business, social, animal welfare, and environmental. The environmental aspect itself is broad, taking in use of scarce natural resources; dangerous or hazardous substances; impacts on biodiversity, habitats and ecosystems; disposal of waste products; and genetic engineering, in addition to emissions and energy use.

According to ‘Effective CSR Implementation’, a useful briefing by the Chartered Institute of Purchasing & Supply (CIPS), the diversity of CSR can create problems. “…some aspects of CSR have developed more rapidly than others, for example environmental awareness started to gather momentum in the mid-1980s, whilst others, such as supplier diversity, have emerged more recently…This fragmentation has often led to confusion and difficulty in terms of practical application in the workplace,” says CIPS.

As with carbon emissions reduction, there are many possible drivers for CSR. Although the CIPS research is aimed primarily at procurement professionals its summary of these drivers could apply quite generally. They include growing expectations and scrutiny from stakeholders – particularly investors and consumers; more stringent legislative requirements and reporting standards; competitive pressure and the globalisation of markets and trade; and increasing reliance on external suppliers and supply chains.

How comfortably carbon reduction sits alongside existing CSR activities will depend on the scope and objectives of those activities, suggests Matt Gitsham, Principal Researcher at the Ashridge Centre for Business and Society. “If a company’s CSR approach is mainly focused on community philanthropy for example, it may not fit as well. Some CSR activities are more focused on building relationships outside the company rather than changing what goes on within it. Some organisations have only paid lip service to CSR, and an issue like carbon reduction which requires a serious strategic response won’t fit very well with that,” he observes.

For companies with experience of a more full-blooded commitment to CSR, there will be valuable insights that can help a carbon reduction strategy. In ‘Making CSR Happen: the contribution of people management’, the Chartered Institute of Personnel and Development (CIPD) analysed how companies in a range of sectors achieved commitment to CSR across their organisations. “A common theme across all the case studies was the support of the board or the chief executive. Although this was essential, it was not a sufficient condition for success,” CIPD found. “Involving employees in the process was needed to ensure staff commitment, and all the companies viewed this as important for effective implementation,” it concluded.

Certainty in uncertain times

“I would be wary of treating carbon reduction completely separately,” says Claire Boasson, Adviser, Climate and Environment at Caisse des Depots, which acts as the investment bank for the French government. “Any action taken is stronger if it is a mainstream part of the business, so it makes sense to integrate carbon reduction within a broader environmental strategy. But the details will depend on what sector a company is in and its structure – whether it is national or global,” she says.

Because Caisse des Depots (CdD) invests the savings of millions of French citizens in public projects on behalf of the government it is expected to place a high value on public interest issues. The need to tackle carbon emissions has been a valuable tool in developing the environmental aspects of CdD’s approach to CSR, suggests Boasson. “For most of the 20th Century we were only concerned with a combination of the social and financial performance of our investments,” she reflects.

CdD’s efforts to tackle the emissions in its own operations have improved its understanding of the environmental aspects of the projects it invests in. “I think this would apply to many in the financial sector – when you look at your own operations you realise how difficult it is for others,” she says.

As co-chair of the Climate Change Working Group for the United Nations Environment Programme Finance Initiative, Boasson is well-placed to gauge the effects of the collapse of institutions like Lehmann Brothers on CSR commitments, particularly in the finance sector. “It’s true that some of the large financial institutions we were talking to have gone out of the door, but these are difficult times,” she says.

“What this crisis has shown us is that the combination of pure maths and finance is dangerous. We need to re-establish the link between finance and economics, and we are definitely making progress in understanding the economic dimensions of environmental issues.”

Key Questions:

• How can CSR help us to meet stakeholder expectations?
• How could CSR support emissions reduction, or vice versa?
• How can emissions reduction become part of our mainstream operations?