Case studies from the NHS Carbon Reduction

Strategy

Energy use in buildings

The Pilgrim Hospital

The Pilgrim Hospital in Lincolnshire will reduce their estate’s carbon footprint by up to
50% by installing a biomass boiler. The boiler will run on locally-sourced renewable
woodchips and will be up and running by 2009.

The hospital currently produces between 10,000 and 12,000 tonnes of CO2 each year
from heating. The new biomass boiler aims to reduce the CO2 produced from heating
to around 6,000 tonnes.

A combined heat and power plant will further reduce the hospital’s carbon footprint by
generating its own electricity to provide lighting and power for the hospital, as well as
additional heat. The work is being funded through a grant from the Department of
Health’s Energy Efficiency Fund1, following a successful application by United
Lincolnshire Hospital NHS Trust, as well as a £205,000 grant from Lincolnshire
County Council’s LIGHT Project.

1
For more information see Energy Efficiency Fund [Online] Available at:
http://www.dh.gov.uk/en/Managingyourorganisation/Estatesandfacilitiesmanagement/Sustainabledevel
opment/DH_074290 [Accessed 08 January 2009]
Natural Ventilation
Buildings designed with passive ventilation have improved resilience to energy
supply failure and are more energy efficient than mechanically ventilated buildings. In
an acute hospital up to 70% of net floor space could be entirely or partially naturally
ventilated. Concern regarding airborne disease and cross infection appears to be a
major driver for installing fully mechanically ventilated systems in health premises.
Consequently, other public buildings have installed more naturally and passively
ventilated systems.

The UK National Institute of Health Research has found that there may not be as
large a risk as many believe. Modelling, carried out in a 200 bed hospital configured
to current NHS service delivery policy, shows that increased energy performance,
and therefore carbon saving, is achievable whilst saving on energy bills.

Birmingham Heartlands & Solihull NHS Trust

The combined heat and power (CHP) scheme at Birmingham Heartlands & Solihull
NHS Trust enables it to generate its own electricity in a purpose designed energy
centre. The electricity is generated from a gas-powered engine and the heat comes
from hot water. Combining the two is where the carbon savings come from. Rather
than rely on separate boilers to heat water for their central heating systems, the
buildings connected to the energy network exploit the heat the engine generates as it
produces electricity.

This project was part of a £5 million energy efficiency programme that is recording
savings of £688,000 a year and cutting carbon emissions by 1,627 tonnes per year –
the equivalent of a forest of 2,503 trees – as well as reducing other harmful green
house gases such as sulphur dioxide.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
Procurement

Rotherham NHS Foundation Trust

In a pioneering project the Rotherham NHS Foundation Trust is using an innovative
procurement approach, Forward Commitment Procurement (FCP) to harness the
benefits of ultra efficient lighting technology and to significantly improve the efficiency
and functionality of ward lighting. The project forms part of the Trust’s ‘Future Wards’
programme which is a major ward reconfiguration and refurbishment programme that
will run over a seven year period from 2009, with an estimated saving of energy
greater than 50% of conventional lighting system.

“FCP is a practical supply chain management process that is helping us to deliver the
best possible solution for the new wards, not only in terms of energy efficiency and
carbon reduction, but also in terms of patient experience and best value,” Martin
Aizlewood, Energy and Environment Manager, said.

Stork-eco nappies
The Isle of Man real nappy campaign has introduced cloth nappies into the maternity
unit of Noble’s Hospital, Isle of Man. The midwives at the hospital created the
sustainable Stork-eco nappy specifically for the NHS. The not for profit project is
supported by the government and provides interest free loans for cloth nappies in
receipt of income support benefit in the Isle of Man.

The project has showed that introducing cloth nappies into maternity services has
increased the number of parents using cloth nappies at home. By procuring in this
way, the carbon footprint of the hospital has been reduced and it has also influenced
the behaviour and carbon footprint of the parents who continue to use cloth nappies
at home.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
The introduction of the Stork-eco nappy into the Jane Crookall Maternity Unit at
Noble’s Hospital has effectively reduced the unit’s disposable nappy waste and their
total clinical incineration by 99.9% and their total clinical waste by 83% helping to
make long-term financial and environmental savings.

Food procurement

London food initiative

The NHS spends around £500 million on food to serve 300 million meals in 1,200
hospitals every year. The London food initiative is a two-year project aimed to
increase the proportion of local and organic food to 10% of the catering provision of
four London NHS hospitals. Ealing General, Lambeth Hospital, St. George's Hospital
and the Royal Brompton Hospital, worked in partnership with the Soil Association to
increase the proportion of locally produced nutritious food served in London
hospitals.
The project evolved after initial encouraging research in 2002 and 2003 by the Soil
Association and funding was secured from the Department of Environment, Food and
Rural Affairs (Defra) under the Rural Enterprise Scheme and the King's Fund.

The Cornwall Food Production Unit

This project, which received almost £2 million from the Objective One European
Agricultural Guidance and Guarantee Fund and DEFRA, as well as NHS and local
LIFT Company investment, offers tasty, healthy food to patients, staff and visitors. At
the same time the project boosts economic sustainability within the region by
sourcing local produce and helping the environment by cutting food miles. The £4.6m
food production unit is an exemplar.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
The development of the CFPU has been led by the Royal Cornwall Hospitals Trust,
as a partnership project for the NHS across Cornwall and is being developed as part
of the LIFT initiative by the county’s LIFTco: Community 1st Cornwall Limited.

Transport

Winchester and Eastleigh Healthcare NHS Trust

Winchester and Eastleigh Healthcare NHS Trust has introduced a patient travel bus
saving 4,000 patient journeys per annum, equating to a reduction of 68,000 miles.
This has been combined with a staff travel plan that has reduced staff car journeys
by 1,540 per week. Based on an estimation of eight miles per journey, this equates to
500,000 miles per annum saved.

This initiative has led to a reduction in the number of cars travelling to the Royal
Hampshire County Hospital site. The incentive to cycle to work will soon increase
when the Trust commences offering staff that cycle to work a free ‘Loan-U-Lock’
security system to better protect them from bike theft. This will work towards the Trust
travel plan to reduce car use and increase sustainable travel modes, thereby
producing a positive effect on the environment and reducing carbon emissions.

Cambridge University Hospitals NHS Foundation Trust

The Cambridge University Hospitals NHS Foundation Trust Travel Plan aims to
encourage and create opportunity for all staff, patients and visitors, to travel to the
Addenbrooke’s Hospital site by means other than car wherever possible, to reduce
traffic onto site, to increase the travel choices so that they are safe, fair and
accessible for all, to encourage healthier behaviour and to reduce carbon emissions.
The travel plan owes its success to some key factors: commitment by the Board,
strong leadership in introducing car park management, ring-fenced income from car
parks, union support, effective communication with staff, patients and visitors and
dedication to behaving as ‘good corporate citizens’ and reducing carbon emissions.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
In 2007, there were over 18,000 return trips made to and from the campus each day.
Changes in the mode of travel are measured annually as part of a one-day, 100%
headcount and traffic survey. To date, Addenbrooke’s travel plan has successfully
reduced the number of staff travelling to the site by single occupancy car journeys
from 50% in 2000 to 34% in 2007. Patients and visitors who travel by car have
decreased from 92% in 2002, to 85% in 2007.

Measuring success in the following ways ensures a good payback on this scheme:
* Reduced need for car parking spaces
* Less air and noise pollution
* Less congestion
* Fairness in the costs of travel
* A healthier, fitter and happier workforce
* Reduction in carbon.

Water

Scrubbing
A study carried out at Gartnavel Hospital and Stobhill Hospital in Glasgow found that
using a certain type of tap for surgical scrubbing could save water, energy and
carbon. The ‘knee on’ version of tap design helped save 5.7 litres of hot water per
scrub compared to the ‘elbow on’ tap. This is approximately 600KJ of energy and 80
grams of carbon dioxide per surgical scrub.

This simple difference of tap types can reduce water and energy use without
producing any negative effects in terms of scrubbing efficiency. It helps to modify
hand-washing behaviour and could help reduce the carbon footprint of surgical
scrubbing across the NHS.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
Building Design

The Lewisham Hospital NHS Trust

The new wing of The Lewisham Hospital NHS Trust contains over 400 beds in single
rooms and units of four beds. The Riverside building provides a high quality, mainly
naturally ventilated, environment despite the pressures of a seven-storey building in
a tight urban environment. It manages to reduce energy costs and cut CO2 emissions
through good design and the use of photovoltaics. Biodiversity and the local
environment have been improved by regenerating a derelict watercourse and
promoting changes to an adjacent park, while stakeholders were successfully
involved at the start in developing the project brief.

The total construction costs were £69 million, for a building of 52,800m3 or about
22000m2. The photovoltaics system cost £79,846, paid for by a grant from the
Energy Savings Trust, and is leading to savings in electricity costs.

The main benefit from this building is improved patient experience. There is also a
benefit in providing attractive working conditions to attract and retain skills.

Kentish Town
Camden PCT has commissioned a new primary care building which is leading the
way in the development of the NHS estate. This LIFT* initiative has been designed to
a sustainable construction and it will be sustainable for its whole life operational use.

This healthcare development has carbon savings at its heart. The design makes the
most of natural light and ventilation, reducing the need for artificial light, heating and
air-conditioning. The building materials were also chosen to reduce the reliance on
heating and cooling, high thermal mass building materials and solar reflective glass
were among the materials used.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
*Local Improvement Finance Trust (LIFT) is a vehicle for improving and developing
frontline primary and community care facilities. It allows PCTs to invest in new
premises in new locations and it is providing patients with modern integrated health
services in high quality, fit for purpose primary care premises. For more information:
www.dh.gov.uk.
[http://www.dh.gov.uk/en/Procurementandproposals/Publicprivatepartnership/NHSLI
FT/index.htm]

Plowright Surgery
The Plowright Surgery in Norfolk is a GP surgery built for a list size of 5,200 patients.
The surgery sets a new benchmark for surgeries and uses just 54 kWh of electricity
and 90 kWh of gas per m2 per year. This energy use is far lower than the
Department of Health’s standard for new buildings.
The design of the building ensures effective use of natural light and ventilations,
avoiding the use of air-conditioning and reducing the energy consumption.
The building was funded by Norfolk LIFT and the NHS Local Improvement Finance
and fell with in the lowest quartile of the funding criteria (at £1,706/M2), proving that
low carbon does not have to cost more. The CO2 of the building are only 31 tonnes
per year.

Staff Engagement

Earth Beat, Derby Hospital Foundation Trust

Derby Hospitals Foundation Trust has made great strides in involving its staff in
lowering the hospitals’ carbon impact. Over the last four years, this has helped the
Trust reduce its energy consumption and saved £628,000. Their Earth Beat
magazine supplement 'keeping you informed on green issues', provides staff with up-
to-date information on developments within the hospital on energy saving,
cycle2work schemes and recycling.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
The Trust’s ‘environmental champions’, volunteer members of staff, feed back issues
from ward and department level, creating an interactive framework across the Trust.
This helps to foster ideas sharing and raise awareness of carbon and sustainability
issues.

Sustainable development partnerships

Chesterfield Royal NHS Foundation Trust

The Chesterfield Royal Hospital NHS Foundation Trust believes that it has the
responsibility to take forward the corporate citizenship and sustainability agendas on
behalf of the community it serves. The corporate citizenship committee, which has
joint board of directors and Council of Governors backing, meet on a quarterly basis
and are responsible for setting objectives and recommending targets under the NHS
‘good corporate citizenship assessment model’ and for monitoring progress and
performance against these. Their success so far includes planting 200 trees in
partnership behind the education centre, to help the environment. The hospital has
also recently entered into partnership with Calow firm Polar Windows, which has cut
the trusts emissions by more than 50 tonnes a year through a window replacement
programme and ventilation.

Good Corporate Citizen

NHS North West

The North West SHA has incorporated ‘Good Corporate Citizen’ guidance into new
internal policies, including transport, procurement and employment. All Trusts and
PCTs in the North West have identified sustainable development leads. Progress in
implementing Sustainable Development Plans for PCTs and Trusts is included in the
public health indicators for performance improvement and is linked to work currently

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
being undertaken to align Local Delivery Plan and Local Area Agreement
performance frameworks.

The SHA has also developed a draft travel policy promoting the use of teleworking,
sustainable transport options and lease car policy which is undergoing consultation
with staff representatives.

Knowsley PCT has been recognised for their Sustainable Development Plan and was
a runner-up in the Public Sector Environmental Progress section of the Groundwork
Merseyside 2006 Awards.

Future proofing

West Midlands Cancer Intelligence Unit

The West Midlands Cancer Intelligence Unit has pioneered the use of cancer registry
data along with GIS (Geographical Information Systems) to calculate the carbon
emissions associated with treating breast cancer. Data comparisons from 1999 and
2004 showed that there has been a 214% increase in total car miles travelled which
equates to over 400 tonnes of carbon associated with radiotherapy treatment in the
West Midlands. Considering patient and visitor mileage, and therefore carbon, will
prove to be a useful tool in designing low carbon patient pathways.

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.