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Environmental and Sustainability Policy

 

Introduction

This policy establishes environmental planning and sustainability standards for the Hurley Clinic Partnership known as the Hurley Group. 

Sustainable healthcare in the NHS is driven through legislative and mandatory requirements, international and UK guidance, and health specific requirements.

NHS England’s values and goals are to create a sustainable health and care system works within the available environmental and social resources, protecting and improving health both now and for future generations. This means working to reduce carbon emissions, minimising waste and pollution, making the best use of scarce resources, building resilience to a changing climate and nurturing community strengths and assets.

Policy and standards alluded to throughout this policy have been extracted from:

  • Public Health England – Sustainable Development Management Plan
  • Health and Safety Executive (HSE) – Safe Management of Healthcare Waste
  • NHSE – How to Produce a Green Plan: A three-year strategy towards net zero

Status

The organisation aims to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage over others, in accordance with the Equality Act 2010. Consideration has been given to the impact this policy might have regarding the individual protected characteristics of those to whom it applies.

This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of our contract of employment.

Green Plans

Overview

The Greener NHS National Programme strategy, Delivering a ‘net zero’ NHS, highlights that, left unabated, climate change will disrupt care due to poor environmental health and will contribute to an increase of major diseases including cardiac problems, asthma and cancer. 

The report sets out trajectories and actions for the entire NHS to reach net zero carbon emissions by 2040 for the emissions it controls directly and 2045 for those it can influence (such as those embedded within the supply chain). 

To support the co-ordination of carbon reduction efforts across the NHS and the translation of this national strategy to the local level, the  NHS Standard Contract sets out the requirement for organisations to develop Green Plans to detail their approaches to reducing their emissions in line with the national trajectories.

These are expected to match the increased net zero ambition and renewed delivery focus with three clear outcomes:

  • Ensure every NHS organisation is supporting the NHS-wide ambition to become the world’s first healthcare system to reach net zero carbon emissions
  • Prioritise interventions that simultaneously improve patient care and community wellbeing while tackling climate change and broader sustainability issues
  • Support organisations to plan and make prudent capital investments while increasing efficiencies

Developing Green Plans 

Green plans provide a structured way for each ICS to set out the carbon reduction initiatives that are already underway and their plans for the subsequent years. 

A three-year timeframe should allow Green Plans to strike an appropriate balance between immediate carbon reductions in some areas alongside the strategic development of capability in others. In all cases, Green Plans should reflect national priorities by aligning with the plans, actions and timescales laid out in Delivering a net zero National Health Service.

In developing a Green Plans, organisations should:  

  • Review progress since the organisation’s last Green Plan (or equivalent) to determine what facets have worked well and which need renewed focus or a different approach 
  • Consider the national targets (and interim 80% carbon reduction goals) for the NHS carbon footprint and carbon footprint plus as well as learning from organisations that are already aiming to exceed these ambitions 
  • Engage widely with internal stakeholders and key partner organisations to inform sustainability priorities and identify areas for productive collaboration 
  • Develop and refine SMART (specific, measurable, achievable, relevant, and time-bound) actions focused on early efforts to directly reduce carbon emissions 
  • Develop systems and processes to measure and report on progress against plans and commitments, annually

Structure of Green Plans 

The shape and structure of Green Plans will vary by organisation depending on local context, work delivered to date and local priorities.  

Introduction

Including number of employees, key services provided, size, configuration, geography and any other pertinent background information to set the context. 

Organisational vision

The organisation’s vision and priorities for carbon reduction and sustainable development reflecting on which environmental, financial and social issues are most important, what specific improvements would most benefit local communities, staff and the organisation, and which specific actions and initiatives will the organisation prioritise over the next three years to lay strong foundations for the longer-term net zero strategy.

Areas of focus

Should align to the main drivers of change and sources of carbon emissions across the NHS.

Workforce and system leadership

Setting out the approach to engaging and developing the workforce and system partners in defining and delivering carbon reduction initiatives and broader sustainability goals. 

Sustainable models of care

Embedding net zero principles across all services is critical. This may include care closer to home, default preferences for lower-carbon interventions and reducing unwarranted variations in care delivery and outcomes that result in unnecessary increases in carbon emissions.

Digital transformation

Focusing on ways to harness existing digital technology and systems to streamline service delivery and supporting functions including the use of telemedicine to deliver some care remotely and using digital systems to reduce the use of paper records, printing and postage.

Travel and transport

Outlining plans to reduce carbon emissions arising from the travel and transport associated with the organisation including increasing levels of public transport, investing in ultra-low emission and zero-emission vehicles for owned and lease vehicles and maximising efficiencies in the transport of goods and services commissioned by the organisation such as patient transport, courier services and deliveries. 

Estates and facilities

Including reducing carbon emissions by improving energy efficiency and reducing energy usage, decarbonising heating and hot water systems, waste reduction and building design and refurbishments. 

Medicines

Identifying the key opportunities to reduce the carbon emissions related to the organisation’s prescribing and use of medicines and medicinal products including medicines optimisation, reducing waste, responsible capture or disposable of waste medicines and considering lower carbon alternative medicines.

The NHS Standard Contract sets out inhalers and anaesthetic gases as two key areas for prompt action in this area and so all Green Plans should cover these two areas of focus.

Supply chain and procurement

The NHS supply chain accounts for approximately 62% of total carbon emissions and is a clear priority area for focus in every Green Plan. Consideration should be given to how organisations may use their individual or collective purchasing power and decisions to reduce carbon embedded in their supply chains. 

Examples may include reducing the use of clinical and non-clinical single-use plastic items, reusing or reprocessing equipment (such as walking aids) where appropriate and considering lower carbon alternative supplies such as recycled paper.

Food and Nutrition

Consideration of ways to reduce overall food waste and ensuring provision of healthier, locally sourced fruit and vegetables.

Adaptation

Provision of a summary of the organisation’s plans to mitigate the risks or effects of climate change and severe weather conditions on its business and functions. 

This may include plans to mitigate the effects of flooding or heatwaves on the organisation’s infrastructure, patients and staff.

Developing a net zero NHS

Overview

The NHS Greener Plan advised that identifying a route to net zero emissions for a complex system is particularly challenging. The targets set are as ambitious as possible, while remaining realistic, and are supported by immediate action and a commitment to continuous monitoring, evaluation, and innovation. 

The aim is to be the world’s first net zero national health service.

Areas of focus

Models of care

The NHS Long Term Plan (LTP) sets out a commitment to deliver care in new ways for the 21st century. This must also include a focus on reducing carbon emissions and will involve using environmental impact as an additional factor in care design. 

Other principles that improve quality of care and patient experience can also help to decarbonise care pathways:

  • Optimising the location of care
  • Earlier and quicker detection, diagnosis, and treatment
  • Embedding the best clinical practice
  • Treating for the long-term
  • Digital technology

Carbon savings will come from reduced presentations in A&E, primary care and outpatients, reduced staff and patient mileage, fewer pharmaceuticals prescribed and less intensive procedures. 

A net zero framework will be developed to help to consider and evaluate the carbon reductions associated with new models of care. 

Workforce

  • Mobilising, informing and upskilling staff to drive and implement the interventions needed to support a Greener NHS.
  • The Greener NHS team is also working with Regional Senior Responsible Officers in each of the seven NHS England and NHS Improvement regions on the delivery of the net zero commitments. 
  • The workforce will be vital to delivering the net zero ambitions. Close working within different levels of the system to spread and scale the things that the team knows work and will embed this commitment in guiding policy and documentation.

Medicines

  • Medicines account for about 25% of emissions within the NHS in England. A small number of medicines account for a substantial proportion of these emissions, particularly anaesthetic gases and nitrous oxide which account for around 2% of NHS emissions, and inhalers which account for around 3%.
  • The NHS is working with patients, clinicians, and industry to reduce emissions by reducing waste, ensuring that the right medicines are available for patients and enabling shared, informed decision making.

Estates and facilities

  • The NHS estate and its supporting facilities services – including primary care, trust estates and private finance initiatives – comprises 15% of the total carbon emissions profile (NHS Carbon Footprint Plus). Delivering a net zero health service will require work to ensure new buildings are net zero compatible as well as ensuring improvements are made to the existing estate.
  • For the existing estate, a wide range of interventions including air conditioning and cooling, building fabric, LED lighting, space heating, ventilation and hot water could all be rolled out to further reduce carbon emissions. 

Travel and transport

  • Approximately 3.5% (9.5 billion miles) of all road travel in England relates to patients, visitors, staff, and suppliers to the NHS, contributing to around 14% of the system’s total emissions.
  • The travel and transport workstream of Greener NHS is implementing a range of interventions to reduce carbon emissions from travel relating to patients, visitors, staff, and suppliers to the NHS. This includes transitioning the NHS transport fleet to zero-emission vehicles, reducing unnecessary journeys and enabling healthier, active forms of travel such as cycling and walking.
  • The NHS has committed to having a zero emission non-emergency patient transport fleet by 2035, one of the recommendations set out in the report of the Non-Emergency Patient Transport Review, published on 2 August 2021.

Supplies

  • The NHS uses products from more than 80,000 suppliers, encompassing medical equipment, food, business, and office goods. The non-medicines supply chain makes up 42% of the NHS Carbon Footprint Plus. While the NHS does not control these emissions directly, it can use its considerable purchasing power to influence change.
  • Reducing emissions from the supply chain can be done in a range of different ways:
  1. More efficient use of supplies
  2. Low-carbon substitutions and product innovation
  3. Ensuring suppliers are decarbonising their own processes

Food and nutrition

  • It is estimated that food and catering services in the NHS account for approximately 6% the NHS Carbon Footprint Plus. A healthy balanced diet with reduced processed foods high in sugar, salt and fats is also a low-carbon diet.
  • The Greener NHS programme is working closely with the Hospital Food Review and the new National Review of NHS Food Standards. Collaboration with NHS catering leads, dieticians and suppliers will help to provide healthier, locally sourced food to patients, staff and visitors while cutting emissions related to agriculture, transport, storage, and food waste across the supply chain and on the NHS estate.

Sustainable Development Management Plan (SDMP)

Overview 

On a global scale, the Intergovernmental Panel on Climate Change has provided evidence of the scientific, technical and socio-economic aspects of climate change.  

A Sustainable Development Management Plan forms a key part of the organisation’s strategy to ensure services remain fit for purpose now and in the future. It should outline plans to target actions to make a positive difference environmentally, socially, and financially to create an organisation that supports the wellbeing of staff, patients, and wider community. 

To do this Hurley Group sites plan to:

  • Reduce unrenewable resources such as fossil fuels and heavy metals
  • Reduce dependency on substances that persist in nature
  • Reduce the destruction of nature
  • Ensure we are not stopping people meeting their needs 

The process of developing a plan should involve discussions with key stakeholders as well as engaging with the wider staff. This is important to ensure that the plan reflects the needs and motivation of the organisation and empowers staff to contribute and embed sustainability within their work.

Meeting the requirements of a SDMP

A sustainable approach

The PHE document titled Sustainable, Resilient, Healthy People and Places advises that helping to create sustainable, resilient, healthy places and people needs to be approached both by enabling the positives and by reducing the negatives allowing virtuous cycles to constantly improve outcomes.

Why is it important?

The Sustainable Development Management Plan 2015-2020 advises that sustainability matters because it addresses, or contributes to, wider NHS commitments and goals such as quality improvement, resource efficiency and preventative health strategies. 

Adapting to climate change

The government’s latest Climate Change Risk Assessment lays out the risks of climate change to the UK which are extreme heat, flooding, drought, pests, and diseases. Even if we meet the ambitious Climate Change Act’s targets for reducing carbon emissions, we need to plan adaptation strategies to ensure we are an organisation that is resilient to a changing climate. This is due to temperatures already above pre-industrial levels and time lags in the climate system.

At Hurley Group we are committed to the following:

  • Adding climate change to the organisation’s risk register
  • Reviewing Business Continuity Plans for water/power shortages and supply chain failure to reduce the impact on our service delivery 
  • Assessing the flood risk to sites based on current and future projected climate conditions

Managing carbon and greenhouse gases

The US Environmental Protection Agency advises that greenhouse gases (GHG) produced by human activities have caused an overall warming influence on the Earth’s climate. The largest contributor to warming has been carbon dioxide.

As a socially responsible organisation, Hurley Group recognises the need to reduce carbon emissions and to contribute to the national effort to tackle climate change. 

Hurley Group is committed to the following:

  • Setting targets in line with the Climate Change Act 2008 and NHS Carbon Reduction Strategy 2009 for the complete carbon footprint
  • Working to influence staff, visitors, and patients in reducing their individual carbon footprints through behaviour change campaigns
  • Decarbonising our electricity supply by moving towards a green energy supplier
  • Calculating our carbon reduction calculations and developing our trajectory to achieve the requirements of the NHS Strategy

By reducing our emissions of greenhouse gases, the organisation can reduce the magnitude of climate change. This can be achieved through the use of more efficient and low carbon technologies or changing behaviours and the way things are done. Whilst it is important to tackle carbon emissions, as health organisations it is important to also prepare for an already changing climate. Heatwaves will increase in regularity and are known to increase mortality rates significantly, with the elderly and people with pre-existing illnesses being at most risk. 

Climate change will also increase the risk of river and coastal flooding. The direct effects on human health, such as drowning, are expected to be rare in the UK due to effective emergency services and expanding flood defences. However, preparation for increased flooding will be necessary to minimise such risk. Flooding will also increase the risk of an outbreak of infectious diseases. In addition, flooding is known to have an important impact on the mental health of communities due to the negative impact that it can have on their livelihoods and property. 

Extreme weather events also have the potential to disrupt supply chains to healthcare services which can subsequently have a negative impact on provision to communities. This may include a lack of access to essential medicines and equipment and the potential disruption of utilities supplies. 

The associated health risks include a rise in:

  • Cardiovascular diseases 
  • Respiratory illnesses 
  • Infectious diseases 

Biodiversity and water 

Biodiversity is the variety of fauna and flora in an ecosystem or the community for instance. Water and biodiversity have strong links. Water, as a resource, is essential for life. It is vital to our way of living, essential for agricultural production as well as in maintaining the natural ecosystems upon which we, and all life, depend.

The combination of a decreasing rainfall, an increasing population and  increasing commercial demand is placing pressure upon this vital resource. 

At Hurley Group, we are committed to the following:

  • Ensuring efficient use of water by measuring and monitoring its usage
  • Ensuring that there is a quick operational response to leaks 
  • Installing an Automated Meter Reading (AMR) on our main water meters to capture detailed consumption data and allow active monitoring
  • Utilising water efficient technology such as automatic taps when replacements are required, wherever possible
  • Phasing out bottle fed water coolers for mains fed water coolers when possible
  • Raising awareness of staff to the environmental and financial impacts of water use
  • Encouraging staff not to waste water and turn taps off when not in use

Energy

Building energy use contributes to a considerable percentage of the total health and care system carbon footprint and offers many opportunities for carbon savings and efficiency.

Measures can be taken on both demand and supply. Energy prices are set to rise well above inflation for years to come so there is a strong business case to invest in energy efficiency measures.  

Demand led measures

This means reducing consumption by addressing energy wastage or using more energy efficient technology. These measures can tackle the energy used for space and hot water heating, air-conditioning, ventilation, lighting, and powering equipment. 
 

In practise, this can mean improving building insulation, using efficient lighting (such as LED) or optimising controls on heating systems. 

Supply led measures

Another way to reduce carbon emissions is to use cleaner energy sources. For instance, natural gas has a much lower carbon footprint per kWh when compared to electricity or other fossil fuels.  

Combined Heat & Power (CHP) takes advantage of this by producing electricity while using the heat losses for heating, a process 30% more efficient than using grid electricity. 

Finally, renewable energy sources, such as wind, solar and anaerobic digestion, have extremely low carbon emissions. 

At Hurley Group, we are committed to the following:

  • Maximising the efficiency of our operations to ensure that our energy consumption is minimised
  • Regularly reviewing the potential options for ensuring that we are supplied by cleaner and more sustainable forms of energy
  • Monitoring energy use and implementing energy/carbon saving targets to improve performance
  • Promoting responsible energy use through staff awareness projects and training
  • Rationalising our estate to ensure buildings are used to their maximum efficiency
  • Engaging with our staff to encourage energy saving behaviours through a ‘Switch It Off’ campaign
  • Replacing traditional lighting for energy efficient LED versions when replacement is required
  • Ensuring that boilers, air conditioning systems have service plans commensurate with the recommended guidance
  • Ensuring that all roof spaces are appropriately lagged and considered utilising suitable roof space for the installation of solar panels to generate onsite energy 

Using resources sustainably, waste and recycling

The UK-wide policies on waste are built on an EU concept known as the waste hierarchy. 

The waste hierarchy outlines a preferred order for waste management: prevention, reuse, recycling, and energy recovery, with disposal as a last resort. This strategic approach promotes environmentally friendly practices, ensuring efficient resource use and reducing environmental impact. 

At Hurley Group, we are committed to the following:

  • Always using the waste hierarchy
  • Aiming for ‘zero landfill’
  • Using local waste management solutions when possible
  • Monitoring, reporting, and setting targets for our management of waste
  • Minimising the creation of waste
  • Ensuring we have robust systems for recycling wherever possible

At Hurley Group our sites have:

  • Embedded sustainability principles and environmental considerations in the selection criteria and specifications of our waste management contracts
  • Implemented and reviewed our Infection Prevention Control Policy
  • Raised an IPC statement as per the Infection Prevention and Control (IPC) Annual Statement. [Detailed findings will be added to the practice websites]
  • Promoted mandatory clinical waste training for all our staff
  • Segregated and recycled batteries, electrical and electronic items, and printer cartridges and in accordance with The Waste Electrical and Electronic Equipment Regulations 2013
  • Arranged a confidential waste collection service that is removed from the organisation. They will collect any shredding and waste within the confidential waste bins as per the Confidentiality Policy. All waste is signed for and receipts retained
  • Put in place processes for general and other waste such as non-confidential office or food waste. These are to be segregated and placed into the relevant bins, dependent on whether recycling or non-recycling

At Hurley Group, we will: 

  • Further develop our work on clinical waste segregation
  • Consider waste prevention and minimisation measures such as the possibility of using reusable sharps containers
  • Consider the use of hand dryers over paper towels where appropriate 
  • Consider the whole-life cycle of a product, including its final disposal, in our decision-making process for the standardisation of clinical and non-clinical products, most particularly when choosing disposable products over reusable alternatives
  • Where possible, take all measures to ensure that appropriate recycling occurs 

Purchasing and resources

Achieving sustainable purchasing

Hurley Group is committed to achieving value for money and delivering economic, environmental, and social benefits through sustainable purchasing activities. Our ambition is to ensure that sustainable purchasing is being consistently undertaken across the organisation. Through encouraging staff, suppliers, and contractors to follow more sustainable purchasing practices, this can be achieved. 

As part of an improved process that questions the need to spend, cuts out waste and seeks innovative solutions, we will reduce rather than add to organisation spending costs in both the short and long term. 

Our sustainable purchasing objectives 

Collaborating with stakeholders and suppliers, where relevant Hurley Group will: 

  • Reduce carbon within contracts, reduce energy usage, fuel usage and waste
  • Reduce other emissions that may be used in manufacturing/production 
  • Improve supply chain management including working with SMEs, the voluntary sector, and local suppliers 

The three principles of sustainable development

Environmental

Seeking to minimise any negative environmental impacts of goods and services purchased across their life cycle from raw material extraction to end of life. 

Social

Managing and monitoring supply chains to ensure that fair contract prices and terms are applied, and that ethical, human rights and employment standards are always met. 

Economic 

The economic principle relates not only to obtaining value for money across the whole life of the product or service but also ensuring, as far as is possible, that local businesses can benefit from our purchases.

Workforce health and wellbeing 

The health and wellbeing of the organisation’s staff is an important priority, supporting staff to be healthy and productive is fundamental to the organisation’s ability to deliver priorities and objectives. 

Hurley group is committed to:

  • Improving staff satisfaction levels, reducing sickness absence rates, and minimising work related stress
  • Bringing together partners and members of the organisations who are committed to maintaining, enhancing, and protecting the health and wellbeing of staff. This includes support to both staff at work and those absent through ill health
  • Providing and contributing to specialist training, guidance, and expert advice in a wide range of health-related subjects
  • As Good Citizens, supporting local businesses, charitable causes and apprenticeships
  • Valuing and respecting every person for who they are, be it staff or patients. This means promoting diversity and inclusion and eliminating bullying and harassment towards staff and between our staff

Hurley Group sites will:

  • Actively embed health and wellbeing into our culture and values
  • Utilise tools such as our sickness planner SMI to actively manage sickness absences 
  • Continue to actively promote our equality and diversity group

Enabling sustainable travel and logistics

The organisation is committed to supporting the reduction of local congestion and pollution concerns as well as supporting our patients, staff and community’s health and wellbeing.  

Modes of transport and travel have a very wide range of different carbon footprints. Travel and transport encompass a range of activities from staff commuting to work, business travel, the transport of patients and the shipping of goods required for the organisation to function.

At Hurley Group, we are committed to the following:

  • Encouraging staff, patients, and visitors to walk, cycle, car share or use public transport whenever possible
  • Providing appropriate bicycle storage facilities to encourage staff to adopt healthy modes of transportation 
  • Improving the energy efficiency of any organisation vehicles
  • Minimising travel through the provision of healthcare in locations that are accessible to patients, staff and visitors and exploiting the potential of telehealth technologies

Hurley Group sites:

  • Operate the Cycle to Work scheme, encouraging staff to commute to work by bike
  • Actively encourage our staff to adopt more sustainable transport modes for commuting to work, such as walking, cycling, or using public transport 
  • Maximise the use of technology (such as audio, video, and web conferencing) to minimise the need for business travel
  • Work with suppliers to optimise the logistics of shipping goods
  • Explore the feasibility of purchasing/leasing low carbon practice vehicle technologies such as electric cars

Built environment

The built and natural environment are major determinants of health and wellbeing. The design of the built environment and access to the natural spaces impacts on health and wellbeing. 

When making improvements to our facilities, the organisation aims to ensure that we are designing the best possible environments to support good physical and mental health for our staff to work in whilst ensuring that they are sympathetic to the natural environment.

At Hurley Group, we are committed to the following:

  • Establishing an appropriate estates strategy ensuring longer term performance, cost benefits will be considered, designed in, and measured across the asset’s whole life cycle

Summary

At Hurley Group, we are committed to sustainable development. As a guiding principle within our work, our goal is to meet the needs of the present without compromising the ability of future generations to meet their own needs and concern for the environment is an integral and fundamental part of this commitment. 

By challenging and adapting our operational processes, this organisation will always aim to reduce the impact on the environment.