How a hospital is reducing its carbon footprint

Green Wing

At almost any hospital it’s not difficult to find overheated buildings or lights left on in empty rooms, but now the NHS in England has called for help in tackling its carbon footprint and to stamp out the waste

by Andrew Cole

It has been an age-old issue but in the last few years there have been signs the NHS is at last beginning to get to grips with the problem of carbon emissions. Perhaps the biggest spur to action has come from EU and government legislation on the issue. Latest mandatory Department of Health targets require all health trusts to cut CO2 emissions by 10 per cent by 2015, for instance. And by 2050 the Climate Change Act obliges the NHS to slash its total carbon footprint by a staggering 80 per cent. It all means, as one estates manager put it, that a carbon policy is no longer a “nice thing to have” for trusts but “a must”.

The NHS is working to trim its carbon footprint

Many trusts are pursuing this at an individual level but a growing number are working more strategically. Over half of all England’s trusts, for instance, have signed up to the Sustainable Development Commission’s good corporate citizen assessment model. And a significant minority are now members of the NHS carbon management programme, run by the Carbon Trust.

The Carbon Trust works across all public sector organisations in England, Scotland and Wales. Its NHS scheme, launched in 2006, has 48 member trusts, mainly representing the medium and large-scale acute hospitals responsible for the biggest emissions and therefore ripe for the biggest savings. Trusts have to make a substantial commitment in terms of time and money. Not only does the Carbon Trust demand active support at board level, it expects a project leader to be appointed who will devote at least two days a week to the project for its first 10 months. Initial capital investment may also be needed to replace existing infrastructure with more energy efficient models.

In return trusts receive expert support to make a systematic analysis of their total carbon footprint. The Carbon Trust also helps them to assess where the biggest, most achievable savings are and provides the tools to draw up a structured action plan to achieve them. As Carbon Trust project manager Tom Cumberlege puts it: “We aim to identify the biggest emission impact in the quickest space of time.”

Good behaviour

So far the biggest savings have tended to be around heating and lighting, hardly surprising given that NHS buildings alone are responsible for 3.7 million tonnes of carbon dioxide a year. But the Carbon Trust also encourages trusts to consider how purchasing, transport and waste management contribute to the overall bill.

Cumberlege calculates the average hospital trust within the carbon programme stands to save around £470,000 a year, which translates into a total saving from the 48 trusts of over £20 million and a reduction in the carbon footprint of 185,000 tonnes. When University College London Hospitals Trust signed up to the programme in 2006 it was starting from “a very low base”, admits director of facilities Trevor Payne. The Carbon Trust helped to focus their efforts. “Just having a timescale and a focus helped to concentrate our minds,” he says. “We also had quite a motivational support team that helped us produce a carbon management action plan.”

Above all, the trust was able to ask the “dumb questions” that otherwise didn’t get asked because familiar problems tend to get ignored. And having asked the questions, they pursued the answers. “The NHS is quite a slow moving beast and this helped to speed us up.” Calculating exactly what the trust’s carbon footprint was and then drawing up the initial action plan took a year but the trust is now starting to reap the benefits and expects to make annual savings of at least £300,000.

The changes include a revamp of the building management system to ensure lights are switched off and temperatures reduced where appropriate. In addition a lighting control scheme will automatically switch off lights in areas that are not in use. Payne and his team also examined the supply chain to see how they could procure more sustainably and reduce the transport bill. And they are actively pursuing ways of disposing waste more economically. One scheme, for instance, involves taking on the shredding of confidential material before putting out to recycling rather than contracting out the entire process.

But the biggest challenge, he says, is not technical but cultural — involving and energising staff themselves. UCLH has appointed 40 “energy champions” to try to spread the message. It is, he says, a never-ending process. He has already placed energy awareness leaflets in everyone’s pay slip but knows that to keep the message fresh he will need constantly to repeat the exercise. His team is also working on ways of translating the technical jargon into language everyone understands — “we want people to be able to visualise what a cubic metre of carbon looks like, for instance”.

The good news is that growing awareness and concern about climate change means the trust is pushing at an open door. “Five or 10 years ago it felt like a really uphill battle to get people to separate glass from plastic and domestic waste,” he says. “Now most people at least understand the issue.”

Bad habits

For Cumberlege the key to success is involving staff. One of the first things the trust offers member trusts is a facilitated workshop where staff from every discipline are invited to identify the problems as they see them. “We want to create a culture where staff are continually questioning bad carbon habits and know their ideas will be taken seriously.

“The challenge is: how can we make sure this is not seen simply as a matter for the estates team and actually becomes intrinsic to people’s decisions within the trust? Given all the other priorities, how can we really embed carbon management within the organisation?”

The truth is many trusts are still not giving carbon management top priority. At Tameside Hospital Trust, for instance, capital project engineer Gareth Llewellyn is responsible for energy consumption but has focused almost exclusively on capital projects in recent years.

Until this year, he says, the energy budget was more hypothetical than real. This year he was able to spend a “few thousand” on an intelligent metering system as well as lighting and BMS schemes in particular buildings.

But, he says, these initiatives are dwarfed by the scale of the problem. “Lighting control within the entire trust is almost non-existent. There are huge savings we could make relatively quickly and relatively easily.” It’s a similar story with heating. “There are a number of areas at the moment where we’re heating on the one hand and then cooling down on the other.

“I don’t think there’s any lack of will,” he adds. “It’s purely down to a lack of time and manpower.”

Of course, cutting carbon bills in a hospital environment is not as simple a process as, say, in a factory. And ironically, gas and oil prices — the very things that brought the issue of energy management to boards’ attention in the first place — are now plummeting, making it more difficult for trusts in the carbon management scheme to achieve the level of savings originally pledged. Payne says he tries to concentrate on the things he can control — that is, consumption rather than cost. “The other difficulty is that we’re now treating more patients than ever before so savings can be eroded simply because we’re doing more.”

Despite this Cumberlege is optimistic about the future. The number of trusts joining the programme has increased each year and now includes mental health and primary care trusts as well as big hospital trusts. Even in the time the programme has been operating he has observed a change. In particular, he says, a growing number of clinicians are speaking up about the health impact of climate change.

“I do feel that it’s gathering pace.”

Wrightington, Wigan and Leigh

In the last four years, Wrightington, Wigan and Leigh NHS Trust (WWL) has seen energy bills have rocket from £1 million a year to over £3 millon, making them prime candidates to be founder members of the NHS carbon management scheme. Working in close conjunction with WWL, the Carbon Trust identified a range of measures to cut costs and emissions. An implementation plan was drawn up in March 2007 and the actions taken are already having an impact. The measures taken include installing a boiler flue economiser at the trust’s biggest site, the Royal Albert Edward Infirmary in Wigan, which is expected to cut consumption by 20-30 per cent, putting in lighting controls and movement sensors, replacing a coal-fired boiler with a low temperature alternative and introducing more efficient cooling systems in the refrigeration plant.

Over the course of the five-year programme the trust expects to save £380,000 on its expanding energy bill and cut carbon dioxide emissions — currently around 17,000 tonnes a year — by almost a quarter.

One lesson is that you have to be prepared to spend in order to make worthwhile savings, says energy environmental manager Mark Hogan. But perhaps the biggest challenge is engaging staff. He has plastered wards and offices with posters and stickers pointing out that failing to switch off computers and other electronic items wastes the trust £18,000 a year — the equivalent of five defibrillators — and not turning off lights loses £76,000, which could buy 65 hospital beds. Continuing to hammer home the message is critical to long-term success, he says. “If you start to relax that’s when everyone starts to get lazy. I’m here to make sure we stay on top of this. Some people might not think energy is very relevant to patient care but if we can save money on energy bills, that’s more money for patient equipment. That’s the bigger picture.”

Andrew Cole is a freelance journalist specialising in healthcare issues.