Good data in healthcare sustainability is necessary to drive conservation improvement efforts, increase cost efficiencies and design care strategies that embed environmental considerations.[i] The NHS has set sustainability goals to lower their impact on climate change, laying out their plans on how they are going to get there to future proof a heavily relied upon service. Yet, research to see how well sustainable healthcare initiatives work is limited in part because data collection in grant-funded studies is not carried out long enough. [ii] Consequently, assessing the true long-term impact proves challenging and building evaluation tools to monitor progress is difficult but necessary to measure improvement.
The principal NHS sustainability goal is a commitment to net zero carbon emissions by 2040 for direct emissions and 2045 for indirect emissions.[iii] Net zero can only be realised by measuring the baseline emission factors of current day-to-day operations and from there setting targets that demand specific emission reduction targets and material management improvements are met within a dedicated timeframe. Then, communicate this to stakeholders and ensure there is accountability for reaching these targets across the NHS and provides the opportunity to ask what isn’t working. As a trust/board, the NHS need to provide departments with the tools and resources necessary to ensure teams feel empowered through a better understanding of NHS data to implement solutions, measure impact and effectively deliver their Green Plan. Looking at their sustainability programme more granularly, the HTM 07-01 demands that by 2026, NHS providers must achieve clinical waste segregation targets for clinical, infectious, and offensive waste of 20-20-60.
The unnecessary upgrading of recyclable and general waste to offensive, infectious, and clinical waste streams is a cost and environmental concern as these waste streams require various incineration treatments given the potentially hazardous nature of healthcare waste. Yet in our recent waste audits, we found 59.6% of all disposed materials in offensive and infectious waste had been upgraded.
With in-depth information on the material type and volume commonly incorrectly disposed of, we can promote data driven change and share knowledge across the healthcare industry on how segregation rates can be improved. For instance, patterns in disposal behaviour can be deciphered within different departments and how determinants like bin placement and size affect this. This bespoke data set can ensure the right education is recommended and delivered to the trusts at what needs changing. From your baseline, NuGreen can monitor and measure the change that has been made with a second audit, after an appropriate interval from the educational delivery.
Better data driven decisions like conducting life cycle analysis (LCA) of the materials that make up the waste composition and making decisions to procure items that perform best in LCAS would ensure a more sustainable approach to healthcare purchasing. For example, purchasing reusable materials over disposable ones, even if the initial cost is higher it will exist in the system for longer and there is greater potential for recovery and feeding back into the system it came from.
There is a necessity for a symbiotic and collaborative relationship with the procurement team working in tangent with the finance board as well as staff on the front line to gauge the most used materials to perform these LCAs. Hopefully, this collaboration will pick up on procurement items that are redundant or largely remain unused; only to end up being stored and thrown away or disposed of immediately. Plastic scissors in a wound care pack, when most nurses have reusable, sterile steel scissors to hand, are a prime example. Procurement cannot work in a silo as their purchasing behaviour may not reflect the day-to-day operational needs of the hospital/care they buy for.
NHS are mindful of sustainable procurement as they have created an NHS England Sustainable Procurement team and demand their suppliers fulfil the requirements of the ‘Evergreen Sustainable Supplier Assessment’ with the promise all 80,000 suppliers will work towards decarbonising their own processes. The NHS supplier engagement programme has got the ball rolling by demanding reductions in carbon emissions are shown through carbon transparency reporting. It requires suppliers with contracts worth over £5 million per annum to publish a Carbon Reduction Plan for their UK Scope 1 and 2 emissions and a subset of Scope 3 emissions as a minimum, from April 2023.[iv] By 2030, the organisation will no longer buy from suppliers that aren’t aligned with their commitment of net zero. It’s estimated this will see a reduction of 9,446 ktCO2e a year when fully realised.[v]
Senior leaders should make it clear that these are acceptable methods in how staff collect and analyse data and ensure there is accountability for poor or siloed methodology. In the context of adopting and influencing positive outcomes for sustainable practices such as improved energy efficiency, effective waste management and a clean air framework they should be consistently measured and monitored in the same way. These targets will be bespoke to each trust given the variation in size, state of infrastructure, availability of resources and green priorities yet how they get there should be homogenous and be a recognisable NHS standard.
The NHS uses a carbon footprint model to calculate the greenhouse gas emissions associated with its activities, including energy use, travel, procurement, and waste.[vi] Data used in the model is pulled from a variety of sources including NHS Digital, Public Health England, and the Office for National Statistics. The model acts as a guide to monitor progress to the net zero goal as well as opportunities to spot areas for improvement.
The Sustainable Development Assessment Tool (SDAT), is a self-assessment diagnostic tool that helps NHS organisations to measure their sustainability performance across a range of domains implicated in corporate activities from travel and logistics to buildings and utilities as well the longevity of care models and social value. The tool provides a scorecard with a report that highlights the strengths and weaknesses of each organisation and suggests actions for improvement.[vii] With this tool to hand, trusts can benchmark their performance against other trusts as well as national standards. Good data is a key component of the model, as it provides evidence-based insights and feedback on the progress and impact of the sustainability actions currently being taken[viii]. Devon Partnership NHS Trust reported, “This (the SDAT tool) is very useful for helping us to identify where we need to change our behaviour and how to do it.”[ix]
The images below demonstrate what a scorecard looks like and how this is visually benchmarked on a graph.
The NHS has achieved significant success with its conservation initiatives, as shown by the data in its annual sustainability reports. For example, in 2020-21, the NHS reduced its total CO2e emissions by 28% from the previous year, increased its green energy consumption by 35% since 2018-19, and saved an estimated 57,000 tonnes of CO2e by using digital services such as the NHS App and remote collaboration tools. [x] These achievements demonstrate how ‘good’ data can help the NHS to become more sustainable and resilient in the face of climate change.
The Clinical Sustainability Assessment Tool (CSAT) is an instrument the NHS would benefit from implementing as a way of measuring organisational capacity to promote sustainability within a healthcare setting.[xi] After getting 64 clinicians to brainstorm factors leading to sustained clinical practices, the ideas were mapped into a tool compromised of seven domains. These domains were as follows; engaged staff and leadership, engaged stakeholders, organisational readiness, workflow integration, implementation, and training, monitoring and evaluation and outcomes and effectiveness.[xii] By measuring the scope of a programme through these seven lenses, it’s easy to see what improvements need to be made and where. This tool is easy to use, short, requires little training, and can be used by a variety of people from researchers and evaluators, to frontline clinical staff.
In summary, measuring sustainability in healthcare requires continuous, long-term monitoring and evaluation of appropriate indicators with the extraction of good data. By using measuring tools such as the CSAT, healthcare systems can have a better holistic understanding of their strengths and weaknesses before adopting the apt changes to achieve greater sustainability.
[i] Health Foundation (2021) How better use of data can help address key challenges facing the NHS. Available at: https://www.health.org.uk/publications/long-reads/how-better-use-of-data-can-help-address-key-challenges-facing-the-nhs (Accessed: 16 Augus 2023).
[ii] Proctor E, Luke D, Calhoun A, McMillen C, Brownson R, McCrary S, et al. Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support. Implement Sci. 2015;10(1):88. https://doi.org/10.1186/s13012-015-0274-5.
- [iii] NHS England. Delivering a net zero NHS, Greener NHS. Available at: https://www.england.nhs.uk/greenernhs/(Accessed: 21 August 2023).
[iv] NHS England. Delivering a net zero NHS, Greener NHS.
[v] NHS England. Delivering a net zero NHS, Greener NHS.
[vi] NHS England (2022) NHS Sustainability Annual Report 2021-22, NHS Digital. Available at: https://digital.nhs.uk/about-nhs-digital/corporate-information-and-documents/sustainability/sustainability-reports/sustainability-annual-report-2021-22 (Accessed: 21 August 2023).
[vii] NHS England (2022) NHS Sustainability Annual Report 2021-22.
[viii] NHS England (2022) NHS Sustainability Annual Report 2021-22.
[ix] Devon Partnership NHS Trust (2019) Devon Partnership NHS Trust: Sustainable Development Management Plan (2019-2022), Devon Partnership NHS Trust . Available at: https://www.dpt.nhs.uk/resources/corporate-information/sustainable-development (Accessed: 17 August 2023).
[x] NHS England (2022) NHS Sustainability Annual Report 2021-22.
[xi] Malone, S., Prewitt, K., Hackett, R. et al. The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare. Implement Sci Commun 2, 77 (2021). https://doi.org/10.1186/s43058-021-00181-2
[xii] Malone, S., Prewitt, K., Hackett, R. et al. The Clinical Sustainability Assessment Tool: measuring organizational capacity to promote sustainability in healthcare. Implement Sci Commun 2, 77 (2021). https://doi.org/10.1186/s43058-021-00181-2
Written By Charlie Dawson