In October 2020, the ‘Delivering a Net Zero National Health Service' plan was published. This establishes why the NHS must show leadership and commitment through action in tackling climate change. It specifically explains that all NHS organisations will need to have halved their carbon emissions by 2032 (from a 2019 baseline), and then carried this reduction through to net-zero by 2045, if we are to step away from the current 'Climate Emergency' (as formally declared by the UK Government in May 2019) and halt the globally unfolding environmental crisis.
Our vision at CUH is to demonstrate, through action, our leadership locally, regionally and nationally in the delivery of sustainable healthcare across the community. Our Action 50 Green Plan has been designed to do just this, and it lays out what will be completed in the opening period of our ten-year programme.
Sustainable behaviour change
CUH’s continuing upgrade to the physical infrastructure and delivery systems of energy and water efficiency, waste segregation, travel choices and life-cycle-assessed procurement are all essential aspects of the transition to a secure and more sustainable future. This, however, is only one half of the picture. The essential next step to infrastructure upgrade and process change is to ensure they are used effectively by real people in real situations: our staff, patients and visitors across a large, complex and intense hospital campus.
Few people want to see resources wasted or to cause avoidable damage to our natural environment. The pressures of a busy hospital often mean that the impacts of our day-to-day actions on these issues can easily be overlooked. Requests to power-down, recycle more or catch the bus will struggle to make a real difference on the ground unless they are tailored to individual teams and workspaces. When working in a hospital with over 60 buildings, and over 7,500 occupied rooms, corporate messaging can often only raise awareness of an issue.
Focused engagement for more lasting change will be found at the local workspace or departmental level – working with section managers and their delivery teams. Here the daily run of work processes is completely understood. This means that the options for more sustainable energy, waste, water, transport and purchasing can be tailored to fit with real-world routines and thereby become a natural part of day-to-day life. At this level of direct delivery, the door to new and innovative approaches to sustainable working is also far more likely to open.
The Trust’s Think Green Impact (TGI) programme has proved that small teams are keen to ensure that their work areas and colleagues are really staying on top of energy and water consumption whilst minimising waste and promoting more sustainable travel and purchasing. All that is required is some support, and advice if necessary, with some recognition of achievement along the way. TGI provides exactly this through creating individual team action logs with at least three levels of ambition (Bronze, Silver or Gold tabs) together with detailed guidance, support sessions, newsletters, audits and awards over a six-to-eight month period each year. 2018/19 saw two more teams achieve the top Gold Award with a further two team securing silver and three bronze. The TGI Action Logs allow teams to record what has worked for them and what has been more of a struggle. This has been used to inform a full review of each of the required actions under each of the different tabs.
The engagement of staff with the benefits of environmentally sustainable behaviour has also continued to be delivered:
- through specific contributions in Corporate Induction sessions, New Managers’ Orientation Days, the Estates and Facilities Values Academy and, on invitation to departmental ‘away days’;
- from the work of our Grounds Team and external sponsorship teams in looking after and enhancing our valuable green spaces to bringing together projects to improve the quality of the outdoor environment – everything from hanging baskets to the new J2 Ward garden and the ‘Calm in Chaos’ garden from the Royal Horticultural Society’s designer of the year;
- from Capital Projects and Minor Works directing contractors towards more sustainable solutions, to Hotel Services and Environmental Services engaging with suppliers and service providers to cut and redirect waste for more sustainable outcomes, to, our Quality Assessment Officers engaging with contract cleaning teams on waste segregation;
- from Pharmacy and Clinical Engineering engaging with patients and staff on re-use, to, Addenbrooke’s Abroad channelling redundant equipment into health centres in need in other parts of the world;
- from the Estates Maintenance Team making people aware that they can repair a whole range of ‘consumable’ equipment - from waste bins to water heaters, to, the Environmental Services Porters carefully collecting segregated waste, to, our overnight Porters, Facilities Managers and Security Teams checking that lights are not left on unnecessarily.
All of these direct and indirect engagement actions show that our hospitals are well positioned to establish a wider leadership role in promoting behaviours founded on environmentally sustainable values and all the benefits that they bring.
Sustainable energy and water
The two main energy sources for the Trust are natural gas for heating space and water, and electricity for powering plant, lighting and equipment (with oil available as a backup for both if required). In terms of performance and improvement there are important distinctions between the two. 45% of the energy use on site is electricity but this accounts for 85% of the total energy cost and 60% of the carbon emissions when compared to gas. The carbon intensity and, to an even greater extent, the unit cost of electricity are both significantly more than natural gas. A percentage reduction in electricity consumption is therefore of comparatively greater material impact in terms of cost and carbon.
The Trust, however, like the majority of organisations, is increasingly dependent on electricity and demand can be expected to grow. The greatest immediate pressures are coming from:
- requests for air-conditioning in response to warmer weather conditions and higher electrical equipment and staffing levels per square meter;
- increasing intensity in the use of the hospitals’ services and facilities;
- growth in the deployment of medical imaging and other new equipment that have high electrical power requirements.
In the medium to longer term, the transition to electric vehicles and the electrical heating and cooling of properties with heat pump technologies are both expected to create step-changes in demand for electricity.
On the positive side, the carbon intensity of nationally supplied mains grid electricity continues to fall in response to the increasingly widespread deployment of renewable energy (especially wind and solar photovoltaic). On the negative side, the physical infrastructure required to manage these supplies and the big step-up in the use of electricity for transport, heating and cooling will continue to increase unit costs for several years to come.
Each day, the Trust consumes the gas and electricity equivalent of approximately 5700 average homes – the equivalent of a small town. However, considering that the Trust runs a 24/7 major acute hospital with up to 24,000 patients, staff and visitors coming to site every day, this is not such a surprising figure.
The existing infrastructure is continuously assessed against the efficiency levels at which it can deliver and the demands of future development or expansion to meet the ongoing and longer term needs of safe, kind and excellent healthcare for its patients. The main options for improvement are in new or upgraded technology and alternative forms of delivery (e.g. low-pressure hot water against steam, or direct against alternating current).
Water consumption across the site remains relatively stable at approximately 35,000 m3 per month. For operational and safety reasons, much of the water is treated, with tank storage and a carefully managed pipe flushing regime. The water has many purposes: from washing, flushing and cleaning to drinking and food preparation, to research and testing, to running boilers and providing hydro-therapy and swimming facilities. Due to hospital regulatory issues, methods of reducing water consumption on campus can be constrained: especially in relation to the very necessary priority of infection control.
The quality of billing has improved significantly through the services of our new ‘retailer’, Pennon Water Services. This contract has provided us with a site-wide water efficiency survey. The survey findings were very positive, supporting the ongoing benefits of the pressurisation control units installed in 2011 and the report did not identify any leakage losses in supplies across the main campus.
Sustainable procurement and waste management
For the Trust to achieve a more circular local flow of goods and materials, that saves it both money and resources (whilst also contributing to the wider sustainability of its supply chains), it is essential that procurement works hand-in-hand with waste management. Almost all of the products we buy, we also subsequently throw away. Linear supply chains mean that we are, in effect, buying our own waste. We continue to make progress in identifying the more circular relationships between purchasing and waste management through the combined endeavours of our Environmental Services, Procurement and Sustainability teams. Good working links to identify ‘circularity’ benefits have continued to develop through the Clinical Consumables Evaluation Group, assessment of tender specifications and Pre-Acceptance Waste Audits; and, more opportunistically through periodic staff communications relating to waste segregation, collection and disposal queries (including links with the team-based Think Green Impact behaviour change programme).
The commercial relationships between supply chains and recycling or re-use infrastructure, however, remain and are typically beyond the Trust’s direct control or effective sphere of influence. We have however made some material steps to reduce the deployment of plastic single-use items through working with our on-site retail partner, Compass, to remove polystyrene food containers and plastic cutlery from the supply chain. A detailed review of single-use of cups has however proved more challenging and we have yet to find a practically viable and genuinely recyclable alternative for disposable hot beverage cups – the focus remains on promoting the take-up of re-usable cups as the long-term optimal solution.
Performance across the Trust’s three main collated waste streams continues to improve. The balance between the necessary on-site incineration of clinical waste and the recycling and landfill of domestic waste continues to shift away from landfill.
As an acute hospital campus there are waste types which is often hazardous or contaminated. This means it is bound by tight regulations as to how it can be disposed of: re-use and recycling are not available disposal routes for these types of waste. The Trust incinerates all clinical and offensive waste on site in what is, essentially, total destruction - with the exception of the recovery of heat from the burning process that is then used to warm the premises.
As with other aspects of sustainability, we depend upon staff, patients and visitors to use the sustainability infrastructure that the Trust puts in place as effectively and responsibly as possible. For waste management this essentially means users putting items in the correct bin when they have finished with them. The potential for bagged waste to hide mistakes and errors in this sorting (or segregation) at source are both perennial and significant in terms of safety and sustainability. The Environmental Services and Sustainability Teams continue to actively promote safe, sound and sustainable segregation with plans in train to rebrand the current communications media set and introduce an essential on-line training module for all staff.
We have a long track record of successfully enabling more sustainable modes of travel for work. Since 1993 the percentage of staff traveling to work by car has halved. This has been an outstanding and very necessary achievement as the total number of staff coming to work at CUH each day has grown from around 4,000 journeys to over 10,000 for the same period.
Managing the transport impacts of the new wider campus developments has been a challenge shared between the Trust, other CBC existing occupants, the newly arriving occupants, the landowners, the relevant local authorities with a combined lead through the Greater Cambridge Partnership (GCP) and commercial partners from public transport to cycle-share companies. GCP have prioritised the role of the Biomedical Campus in transport planning improvements for the wider area, including the delivery a full needs-based survey.
Without the determination to deliver a major step-change in commuting modes, the number of cars coming to site would have created extreme congestion on the campus and its local feeder roads during peak times as well as creating issues of air pollution and excessive carbon emissions.
The Trust implemented and successfully concluded in 2019 a major reapplication and restructuring process for all existing staff eligible to park on-site. This saw a further 1000 members of staff potentially making the peak-period transition to the more sustainable commuting options of park-and-ride (P&R), cycling, public transport and car-sharing. Each modal shift is supported through a range of measures delivered either directly by the Trust or by effective shared-working with a range of campus, local authority and commercial partners.
Travel on Trust business is another important area where there is real potential to take direct steps to reduce carbon emissions, improve air quality and cut costs. CUH presently operates a fleet of 12 lease cars. Miles traveled in these types of vehicles can be controlled in terms of fuel economy and emissions in a way that staff-owned ‘greyfleet’ vehicles cannot. In most circumstances it also marginally lower cost per mile to deploy frequent and regularly used lease cars over the greyfleet option.