With staff numbers at well over 1m, the NHS is easily Europe’s largest employer. It’s not surprising that such a huge organisation, the function of which is to provide free healthcare to one of the world’s most populous countries, might not consider its environmental impact to be of primary importance.

It’s understandable that its priorities may not include the close monitoring of its environmental footprint, or providing comprehensive environmental reports. And it is difficult to conceive of an organisation burdened with more managerial, clinical or strategic targets, or one that is under such constant, close and unremitting scrutiny. So it seems slightly shabby to point out that the NHS is an extravagant consumer of resources, and – like everything else about the NHS, its environmental impact is huge.

However, a report entitled Material Health – a Mass Balance and Ecological Footprint Analysis of the NHS in England and Wales, has been published by NHS Estates. The report investigates all the resources consumed by the NHS, provides benchmarks for environmental performance, examines waste production and sets out to place the delivery of health care in the context of sustainability. If nothing else, it demonstrates a new commitment on behalf of the organisation to get a handle on its impact and provide NHS trusts around the country with information that will allow them to make meaningful strategic decisions regarding environmental performance.

Best Foot Forward was commissioned by NHS Estates to carry out the research and publish the report. BFF designs and develops tools to measure and communicate
environmental impacts and sustainability using
methodologies such as resource flow and ecological footprint analysis. It has carried out footprint and resource analyses for Greater London, Scotland and the Isle of Wight, so it seemed qualified to have a look at the lumbering behemoth that is today’s NHS.

The report took a year and a half to produce and BFF worked in conjunction with the Stockholm Environmental Institute – experts in environmental footprinting. It also helped to carry out the huge task of collecting and collating the data. In fact, the NHS already has in place a system called ERIC – Estates Return Information Collection – which facilitated the process, but with the parameters of the report being so wide, and the organisation so massive, BFF had a battle just to maintain the quality and flow of the data.

Priorities and targets

Nicola Jenkin, editor of the report, says: “We were pleasantly surprised with the accuracy and the level of data. We found the NHS very supportive and helpful. They checked the data, helped us to analyse it and, despite serious time constraints, we found that we were able to work closely and constructively with them.”
But surely, an organisation with more pressing priorities and targets would be unable to find the time and resources to be particularly proficient at environmental management? “Well”, says Jenkin, “they try. But because it is so massive and priorities are elsewhere, it is fair to say that the environment can sometimes be sidelined. However, there is some really good best practice coming to the fore, so there are cultural changes taking place. The NHS now realises that reducing its environmental impact will also help it reduce its overall spend as our data demonstrates.”

While the report specifically states that it does not set out to make recommendations, Jenkins says it still has value. “You can’t manage what you can’t measure,” says Jenkin. “It’s the very first time that anything like this has been done on this scale, so we’ve been able to provide a detailed understanding of the environmental impact and the resources being consumed by the NHS. That information is valuable in a way that allows benchmarks to be set and performance can be monitored year on year. We have created what is known as a ‘base case’.”

Wide relevancy

BFF felt that if it provided recommendations, the report would be tied down and people locked out. Those looking at the report may have different roles and agendas, so it wanted to ensure that the report was relevant to as many people as possible. “What it does is to identify its biggest hitters,” says Jenkin. “Previously, it might have been suggested that NHS transport had the biggest environmental impact, but this report has actually shown us that 63% of its impact is with materials and products. So maybe that is where future emphasis should lie.”
The report also develops scenarios, which act as kind of recommendations, and provides specific examples of realistic things that it could do to improve its performance.

The main environmental challenges faced by the NHS, and identified in the report relate to materials and products, but more specifically, waste. “There are anomalies that we couldn’t figure out,” says Jenkin. “And if pressed for a recommendation we would suggest that they examined their procurement policies, especially with regard to paper and tissue. Construction also needs special attention.”

Lorraine Brayford, senior sustainable development policy manager with the NHS, has the job of shifting managers’ focus and encouraging a change of culture within the organisation to make allowances for the environment. “It is only since 2000-2001 that the NHS has been making a serious effort to monitor and improve its environmental impact,” she says. “We have in place a system called NEAT, which covers everything from waste to transport, but also covers social aspects. We recognise that the environment and healthcare are closely linked. For example, pollution can lead to healthcare concerns. So if we are serious about the NHS being a healthcare provider, we really have to work across the board to improve public health.” Brayford admits that in the past the NHS didn’t take its environmental
responsibilities particularly seriously. However, local trusts are hiring environmental managers and calls on her time and expertise are increasing. But interestingly, she makes the point that energy, waste, water, procurement and transport all had to be managed closely anyway. “We didn’t acknowledge that the work we were doing in these sectors is all part and parcel of being environmentally sound.”

A wealth of information

Brayford believes her job has been made easier by the publication of the report. “It has provided us with a wealth of valuable information which allows us to carry the debate forward on the sustainability agenda. It puts detailed information in place of what was previously somewhat anecdotal data,” she says. “It allows us to shape our strategic response. But we have to be careful about making recommendations and setting targets. There are hundreds of targets already in place in the NHS. There is no advantage of drawing up more targets and it would only create a further tier of bureaucracy.” But Brayford will be able to publish some meaningful recommendations on the back of the report and she is optimistic that the NHS of the future will be more proactive in limiting its environmental footprint.
From a much broader perspective, the NHS is now discovering the true value of environmental reporting, as are many other organisations. It makes sound financial sense to analyse environmental impacts.

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