Can the NHS ever be green?

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The government has announced tough new targets to cut the health service's carbon dioxide emissions. How can nurses help make the NHS greener, asks Richard Staines

The NHS is Europe's largest employer – and the largest public sector contributor to climate change in England. The government estimates that it is responsible for 3% of the country's total CO2 emissions, which are thought to contribute heavily to global warming.

For an organisation set up to improve the nation's well-being, it is some paradox that it may be contributing untold damage to people's future health.

In light of this, the government has decided to launch a carbon reduction strategy for the NHS, aimed at cutting CO2 emissions by 26% by 2020, and by 60% by 2050.

This is not going to be easy, as many factors are driving the NHS towards an increase in its greenhouse gas output.

Government targets to treat more patients and increase activity could result in more CO2 being released into the atmosphere, according to the Department of Health's Sustainable Development Unit (SDU) – set up in April to oversee a consultation on reducing the NHS carbon footprint.

What's more, it adds, a predicted increase in NHS-related travel from staff and patients, more buildings, and energy-intensive care using technology, such as linear scanners, will also increase the health service's carbon footprint.

Although the government's policy of treating more patients closer to their homes and improved building regulations will offset this, there is much to be done if the health service is to hit its carbon commitments.

SDU director David Pencheon says the government has competing policies as the continual drive to save money may well increase CO2 emissions – the cheapest options not always being the greenest.

'If we do find a policy detrimental in terms of carbon emissions we will be very active in helping the DH shape policies,' he says.

'We will also promote better research around the carbon issue.'

But while politicians and civil servants try to influence policy at the top of organisations, nurses at the frontline of care can have a huge impact on their employer's carbon footprint.

The first publication of the SDU is its draft NHS Carbon Reduction Strategy for England. As well as calculating the NHS' carbon footprint, it also provides a telling analysis on where the organisation is producing the most carbon pollution.

Energy use from buildings accounts for 22% of all CO2 emissions in the NHS. Further calculations reveal that 12% of the carbon footprint comes from electricity usage. When analysed by sector, it was found that acute hospitals account for nearly two-thirds of building energy usage.

So what can nurses do at a grassroots-level to improve this situation?

Gina Shaw, who is clinical support nurse at Royal Liverpool Children's NHS Trust, has become the hospital's environment champion (see box). She says there are huge savings to be made by simply switching off lights and computer terminals when they're not in use. In the last two years alone, she has led initiatives that have not only helped reduce CO2 emissions but also saved the trust £50,000 in electricity bills.

She says: 'We put up some posters from the Carbon Trust. They give out information such as if a photocopier is left on standby overnight, it wastes as much energy as it takes to make 30 cups of tea.'

The savings allowed the trust to apply for an NHS energy grant – which it spent on replacing every conventional light bulb with a low-energy, long-life bulb.

Another way for nurses to be greener, says Mike Travis, RCN steward at Alder Hey, is to dispose of waste correctly. 'Staff need to make sure that when they are at work, they use black bags only for general waste. Lots of people put general waste in yellow clinical bags, which costs a fortune to be incinerated compared with black ones.'

He adds that many staff are over-reliant on cars and could use public transport instead. 'A while back we were looking at car parking and found that 40% of our staff lived within a mile and a half and yet still drive to work,' he points out.

However, Carolyn Taylor, a health visitor from South Tyneside NHS PCT, who sits on the national mileage allowance review – a body which is currently updating mileage allowance, as stipulated under Agenda for Change – says many staff have no choice but to use cars.

'Our trust is out of town on an industrial estate,' she says. 'How do you get there if there is no public transport route? If hospitals are built outside town centres, authorities need to put more investment in public transport and organisations need to sign up to travel plans,' she adds.

The SDU estimates that overall, travel is responsible for 18% of the health service's carbon footprint – with staff travel contributing 4%, patient travel contributing 8%, NHS fleet cars contributing 4%, and visitors' travel contributing 2% to the overall carbon output.

However, there are some simple ways that the NHS can reduce this. Nursing unions are in talks over a new mileage allowance scheme that would encourage staff to swap their cars for bicycles. Talks have already produced an interim increase in the cycle allowance rate, up from an average of 6.2p at most trusts to 10p.

Kim Sunley, RCN senior employment relations adviser, says: 'There is a lot of discussion about mileage at the moment and the second stage of the consultation is going to be about giving allowances for green transport. It will be about employers giving incentives.'

For those who are unwilling to give up four-wheeled transport, there is also the option of buying an electric car, says Greenpeace spokesperson Ben Stewart.

He says: 'It makes cost sense to go for an electric car because it is cheap to tax and cheap to run. The government's energy strategy requires a huge uptake of electric cars. If it is recharged on renewable energy, you have got a pollution-free car. This will also help reduce respiratory diseases in cities, which are due in part to the pollution from motor vehicles.'=

Car pools are another way nurses can help to reduce CO2 emissions. More people in a car reduces the number of journeys and also saves on petrol bills.

Deborah Fox, who is director of the public sector programme at sustainable development organisation Forum for the Future, explains: 'It is not about demonising people for travelling to work in a car. It is about looking at ways to support staff to have a car pool.'

Dr Pencheon says there will be financial incentives to encourage organisations to be more energy-efficient next year when the climate change bill, currently before parliament, becomes law. However, he warns that, equally, organisations will find themselves being punished if they are not energy-efficient.

'[Every organisation] will have carbon allowances and if you are using more than your allowance, you will have to pay, which would have a direct impact on patient care,' he says.

The SDU's draft strategy shows that procurement is even more energy-intensive than lighting and heating hospitals.

It accounts for a massive 59% of the NHS' carbon footprint. In total 21% of the NHS' emissions come from procuring pharmaceuticals and 9% from procuring medical equipment. Paper products are responsible for 5% of the NHS carbon footprint and 2% is caused by procurement of food and catering services.

The strategy recommends first and foremost that the NHS should reduce its overall consumption of goods.

Ordering multi-purpose printing devices incorporating scanning, printing and fax functions is one possible way of saving energy.

The draft carbon strategy estimates the NHS could save £25m per year by replacing half its old machines with multi-function devices.

Other recommendations include using electronic records to cut back on paper. And whole-life costing can also be used to calculate the impact of a procurement decision over the lifetime of a device.

Forum for the Future has created a tool to help public sector organisations make eco-friendly procurement choices. It uses a simple spreadsheet that calculates costs, such as electricity and water, over the entire lifetime of the product. As well as saving the environment, Forum for the Future says this approach saves money in the long term.

However, it adds that the current drive towards financial stability is resulting in organisations basing choices simply along the lines of unit cost.

Ms Fox says: 'In the public sector there is often an approach to spending money that price is king. As a result many people are simply looking for the cheapest unit cost.'

Forum for the Future also recommends hospitals review their catering services, which are major sources of CO2. Energy-intensive fast foods should be avoided and where possible, locally sourced produce should be used. This will cut down on the hidden CO2 released to transport food around the country in trucks.

Although the NHS has a long way to go before it reduces its environmental impact, there is much that staff can be doing to cut the damage it causes. And nurses are in a good position to take the lead, says Ms Fox. 'It is all about taking leadership rather than taking the easy option,' she says. 'It is for the people working in the NHS to come up with the answers. It is up to them to ask "what am I waiting for?"'