Creating a sustainable future for healthcare · sustainable future for healthcare Progress Report...

Creating asustainable futurefor healthcareProgress Report 2019

SCFT nurseries team embrace sustainable childcare

Foreword

The Trust in numbers

Influences on our strategy

Care Without Carbon

Virtuous Circle

Clinical Principles

Our journey so far

Sustainability scorecard

Seven elements of sustainable healthcare

Spotlight on…Circular Economy

Seven elements of sustainable healthcare; Progress to date

Leadership

Buildings

Journeys

Circular Economy

Culture

Wellbeing

Future

Focus on the future

Appendices

Appendix one – Carbon footprint reporting

Appendix two – EEVS certificate

Appendix three – NEF methodology

Appendix four – Carbon and energy usage graphs

Appendix Five - Materiality

Appendix Six – Risks and opportunities

Appendix Seven – Bringing others with us

2 Care Without Carbon Progress Report 2019 3

Foreword

Statement of intent for report

This report chiefly covers the 2018/19 reporting period, with the exception of our wellbeing survey, which was undertaken in May 2019.We also reflect our progress since our inception as a Trust in 2010 and look to the next 12 months and beyond, providing a statement of commitment to our future activities

We are now ten years into our journey to be a more sustainable healthcare provider, and I’m proud that at Sussex Community NHS Foundation Trust we’re seeing a more rounded view of what we mean when we say sustainable healthcare.

As Chief Nurse, it is important to me that we understand that being sustainable applies to all aspects of care delivery; our Care Without Carbon strategy emphasises this message in a way that is not only meaningful, but actionable. Examples of this include how we have integrated our clinical sustainability

principles into the Trust’s new three-year strategy.

These principles are aimed at supporting our staff and patients in numerous ways. For example we’re supporting staff to make best use of resources and technology to improve the efficiency of care delivery, so enhancing the patient experience of our care. We’re educating and empowering staff and patients to understand and manage their own health conditions by focussing on health prevention and promotion through often simple actions such as keeping hydrated. And we’re ensuring joined up pathways of care to minimise wastage and prevent duplication.

The progress outlined in this report is evidence that change is possible, if not always easy. That is the message I would like people to take from the work we have successfully completed to date. Together we can help to mitigate climate change by reducing our impact on the environment. And we can adapt to it, by understanding and readying ourselves for the unavoidable consequences of climate change for our patients, our services and within our buildings -- from the heightening temperatures to the increase in extreme weather events.

We will continue to push ourselves to meet the challenges ahead so that we can continue to deliver excellent patient care in the heart of our communities.

Susan Marshall, Chief Nurse, Sussex Community NHS Foundation Trust

As a Care Without Carbon Envoy, I support the Care Without Carbon team to create a better working life and a greener NHS at Sussex Community. The role chimes with my concern for the natural world and climate change and I’m reassured to work for a Trust that takes their responsibilities so seriously. We are committed to a big reduction of 34% in Trust emissions by 2020 and I’m pleased to be part of delivering that.

We’re all on a learning journey about how our daily choices impact our beautiful, but finite planet. I appreciate how much my colleagues are challenged in their day–to-day jobs

but I think we all know that we do have to step up to the plate to do more. In my role as CWC Envoy I’m asking my colleagues to think how we can increase sustainability in our workplace and in our homes.

The climate crisis is disturbing and we need to talk about it rather than hiding our worries away. If we bring the discussion into the open we’ll have more energy and opportunities to make a positive difference and then move faster towards the outcomes we all want.

Catherine Edminson, Co-ordinator Community of Practice East Grinstead and Care Without Carbon Envoy

Contents

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4 Care Without Carbon

The Trust in numbersSussex Community NHS Foundation Trust is the main NHS community health and care provider across West Sussex, Brighton & Hove and the High Weald, Lewes & Havens area of East Sussex.

We help people to manage and adapt to changes in their health, prevent avoidable admissions and minimise hospital stays through a range of medical, nursing and therapeutic care services.

Through Care Without Carbon we also work closely with other Trusts in our STP region to develop the delivery of sustainable healthcare.

5

Influences on our strategy- 12 monthsof changeAs with the health and care sector, the sustainability landscape is complex, ever changing and growing ever more challenging. This year we have seen some key shifts in the environmental landscape in particular, which have influenced the way we deliver Care Without Carbon.

The severity of the environmental imperative and the need for immediate action has become abundantly clear, and has been reflected at a number of levels:

• Across the globe there has been a sea change in scientific understanding, media coverage and public concern around key sustainability issues such as plastics, climate change and air pollution. Locally within Sussex Community we’ve seen our staff body take on a new appetite for action on sustainability.

• At a regional level within the Sussex and East Surrey (SAES) Sustainability Transformation Partnership (STP) area, there has been a growing understanding of environmental sustainability, with Care Without Carbon becoming a common framework for delivery of sustainable healthcare outcomes across the region.

• The NHS Long Term Plan set out the blueprint for the development of the NHS over the next ten years, and included the introduction of challenging environmental targets. In particular a commitment to meet the Climate Change Act targets of 34% reduction in carbon emissions by 2020 and 51% by 2025, and key goals for travel and air pollution.

• More broadly, more and more public and private sector organisations are making public commitments to act on sustainability, including declaration of a Climate Emergency by governments, local councils and most recently the first NHS Trust (Newcastle upon Tyne Hospitals NHS Foundation Trust).


How we tackle this

Since 2014 we have been working towards a more sustainable model of healthcare through our award-winning programme, Care Without Carbon.

Care Without Carbon is our shorthand for a sustainable NHS – a simple idea that reflects our ambition to ensure that the high quality of care we deliver today is available tomorrow.

To us, being a sustainable organisation simply means “effective management of our essential resources – from people and time, to money and materials.” It means reaching our vision to provide the best possible patient care while at the same time balancing our efforts with three key aims in mind:

• Minimising our negative impact and having a positive impact on the environment and natural resources

• Supporting staff and patient wellbeing to enable a happy, healthy and productive workforce

• Working towards long-term financial sustainability

Our Care Without Carbon programme works across seven key elements to deliver these three key aims (see Figure 3 page 13).

Following its success at Sussex Community, we’ve worked in partnership with other NHS organisations across the Sussex and East Surrey STP, using our Care Without Carbon model as a common framework for achieving sustainable healthcare outcomes across the region.

Figure 1: This is our carbon footprint for 2018/19

Our impact

As a trust, our carbon footprint looks like this:

Committed to more sustainable healthcare

Our Trust’s vision is to provide excellent care at the heart of the community. Delivering this in a complex and changing environment for the health and care sector is a challenge, and our new Three Year Trust Strategy sets out how we intend to achieve this over the next three years.

Key to this is working in partnership locally to ensure the care we provide is high quality, patient centred, proactive and preventative – for now and in the future. This commitment to more sustainable healthcare is reflected by our five strategic goals:

> Population health: improve health and care outcomes for our community

> Quality improvement: foster a continuous improvement culture

> Thrivingstaff:providerewardingworkinglivesandcareers

> Valueandsustainability:improveefficiencyandreducewaste

> Patientexperience:usepatientfeedbacktoimprovewhatwedo

Delivering better care

Health and sustainability go hand in hand. By delivering care in a more sustainable way, and supporting our staff and patients to live more sustainable lifestyles we are enabling better health outcomes in our community. These links are illustrated in our virtuous circle of sustainable healthcare (see Figure 2 page 8).

We are working firstly to minimise the need for healthcare through supporting prevention and self care. Secondly, at the same time as improving health outcomes through our care delivery, we are also working to minimise any negative impacts of our care on the environment and health.

Care Without CarbonHealthcare that cares for people and the planet

2018/19


Figure 2: Care Without Carbon creates a virtuous circle of sustainable healthcare.

Virtuous Circleof sustainable healthcare

Reducing environmental impact

Improving w

ellbeingSaving m

oney

Inve

stin

g in

env

ironmental

impr

ovem

ents

del

ivers

cost savings Healthy lifestyles are

sustainable lifestyles

Preventing ill health saves the NHS money

which can be reinvested in frontline services

Progress Report 2019 9

Clinical Sustainability PrinciplesOur approach to the delivery of sustainable healthcare is intrinsically embedded in what it means to be a care provider. We do not separate being sustainable from being healthy but see them as co-dependent; if we can improve on one then we improve on the other. This is the thinking that underpins our clinical sustainability principles, which are based on those developed by the Centre for Sustainable Healthcare and which form part of the Trust’s Three Year Strategy.

Our guiding principles for sustainable healthcare in clinical practice are:

Prevention: minimising the need for healthcare through health promotion, disease prevention and ensuring that the delivery of our care does not negatively impact on the health of our staff or patient community.

What does this look like? With 1 in 20 vehicles on the road on NHS business Trusts are contributing to a rise in ill health due to air pollution. Cutting travel associated with the delivery of healthcare not only reduces this negative impact but also reduces the burden of inactivity on the NHS through promotion of more active travel such as cycling.

Joined up care pathways: streamlining the way we deliver our services to minimise duplication, waste and unnecessary travel.

What does this look like? Patients across Brighton & Hove were encouraged to drop off used inhalers at local pharmacies through the ‘Breathe better, waste less’ campaign. They were offered instruction in how to use an inhaler properly, to reduce waste. 60% of returned inhalers were found to be partially or completely unused, and the project helped to tackle the financial waste to the NHS while helping people get the best from their medicine.

Self-care: taking every opportunity to prevent health problems escalating by educating and empowering our staff and patients to better manage their own health, and supporting this by improving coordination of care within the Trust and through our partners.

What does this look like? The CWC team ran a challenge to encourage staff to drink more water during their working day to support physical and mental health. By ‘walking the talk’ staff also encouraged patients to improve their water intake, vital to keep infections at bay, reducing the need for antibiotics.

Efficient use of resources: preferential use of treatments, technologies and processes with lower environmental impact.

What does this look like? Anaesthetic gases represent 5% of the carbon footprint for all acute NHS organisations.. The most damaging gas is desflurane; sourcing anaesthetic gases with an alternative component to desflurane (such as Sevoflurane which has a carbon footprint 20 times smaller than desflurane) will significantly help to reduce the carbon impact of this medical intervention. It may also be possible to switch to intravenous anaesthetics for some patients which also have a lower carbon footprint.


Our journey fo far

Since our programme launched in 2010, CWC has developed both in terms of its approach and its reach. 2018-19 marks the beginning of a countdown to our 2020 targets and we’ve made a number of key steps forward:

• Increasingly integrating CWC into our clinical services including through the adoption of our clinical sustainability principles into the new Trust’s Three Year Stratgey, (see Future element page 42).

• Strengthening our relationships and broadening our impact within the Surrey and East Sussex STP through successful delivery of an STP-wide waste tender and running a joint Energy Performance Contract procurement across six trusts (see Buildings element: page 22).

• Developing our approach to circular economy and sustainable procurement (see Circular Economy element page 30).

• Growing our reach into our local NHS community by launching Dare to Care at two other local trusts (see Culture element page 34).

How we’re getting there


We focus on three key aims to measure the progress and effectiveness of CWC:

1. financial sustainability (measured in terms of net financial efficiency savings from CWC) 2. environmental impact (measured in terms of total emissions of CO2e) 3. and staff wellbeing (measured by our workplace wellbeing metric).

Our footprint boundary is aligned to the clinical services that the Trust is funded to deliver and which are

delivered in accordance with Trust policies and procedures. In the case of the estate the Trust occupies – most of

which is leased from third parties – this means we account for emissions from energy we consume in the same

way for both our owned and leased assets, ensuring only those emissions relating to the services provided by the

Trust are reported.

See Appendix 2 See Appendix 3

Sustainability scorecard

4.22/10From delivering sustainablehealthcare since 2010. This isagainst an investment of £1.56million since 2010.

6% improvement in wellbeing forstaff engaged in our Dare to Careprogramme

3,199£8.54m

Tackling staff health and wellbeingacross the whole NHS couldsave up to

3.4 mworking days– equivalent to 14,900 extra staff. *

This equates toemploying anadditional

This is similar topowering

348homes for one year.

280band 6 nurses


* https://webarchive.nationalarchives.gov.uk/20130124052412/ http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_108907.pdf

Seven elements of sustainable healthcare

Figure 3: The seven elements of CWC are the work streams through which we are delivering a more sustainable

healthcare system. They work alongside a number of cross cutting areas including quality improvement, digital

innovation and climate change adaptation.

A framework that gives every aspect of the organisation a part to play


Spotlight on…Circular Economy

Looking at the way we dispose of waste is a key part of our work on circular economy, and this year has seen a big shake up in the waste industry – for both healthcare and non-healthcare waste. Here we’re focussing on non-healthcare waste, and these are the key facts:

> For many years the UK and many other countries have relied on China to take and process recycling.

> In 2017 China introduced a ban on imported recycling due to high levels of contamination. The ban was part of a policy called National Sword to help protect the health of local people and the environment.

> China’s decision has created a global shortage of recycling facilities.

> Illegal facilities which burn recycling are springing up opportunistically to take this excess of waste, posing a risk to health through the toxic fumes they create. This has been recently highlighted in the BBC documentary ‘War on Plastic’, which found recognisable waste from UK councils and supermarkets at these facilities.

> In the UK, it’s now not economically viable to recycle a number of materials due to these global shifts in the industry – and we’ve seen a significantly reduced scope of items accepted for recycling.

What has this meant for Sussex Community?

With a new non-healthcare waste contract coming in in 2018, we’ve felt the impact of this global shift relatively quickly.

Recycling through our main bins is now limited to just four key items: plastic bottles, cardboard, paper (not paper towels) and tin/cans.

Although this cuts the number of items staff can put in recycling bins day-to-day, we can be certain that everything is processed correctly.

A global recycling shake up – and what that means for us

The global picture on recycling highlights the problem we face with plastics. Photo by Hermes Rivera on Unsplash

Our recycling figures in the latter part of the year dropped significantly as a direct result of this change.

> As we produce a large volume of the four core recyclable materials, we aim to stabilise our recycling rates over the next six months and then push on to our 2020 target.

> We’re investing in a number of initiatives over the coming year to improve segregation, reduce contamination and open up new opportunities such as food waste recycling. For full details see page our Circular Economy element on page 30.

> We continue to recycle specialist items through other routes including waste electrical equipment, printer cartridges, gypsum and metal. In addition, as all our general waste is sent for energy recovery (with the energy produced being used to heat homes) we’re able to benefit from an extra element of recycling as the bottom ash produced by the energy recovery process is made into aggregate for road building.

And of course, we know that recycling isn’t the be all and end all – this is just one part of our much broader programme to deliver a more circular economy within Sussex Community, which considers not only how we dispose of our waste but also what and how we procure. See page 30 for full details.

15


* Sustainable Development Management Plan

+ + + + + + + + +

75% recycling rate (expressed as a proportion of all non healthcare waste by weight) and maintaining 50% non-infectious healthcare waste (as a proportion of all healthcare waste by weight)

Engage with 100% staff across the Trust on sustainability with measurable benefits.

Maintaining workplace wellbeing above the national average.

Develop an STP wide SDMP that incorporates 2025 carbon reduction targets in line with the Climate Change Act.

Creating and supporting an ethical and resource efficient supply chain.

Informing, empowering and motivating people to achieve sustainable healthcare.

Creating a better working life for our people.

Supporting a strong local health economy to serve our community now and in the future.

Circular Economy Culture Wellbeing Future

Seven Elements of Sustainable Healthcare

Leadership

3 3 + +

Leading the way for sustainable healthcare policy and practice.

Recognised as a leading NHS service provider for sustainable development policy and practice.

34% reduction in CO2e from our buildings.

34% reduction in all measurable travel CO2e.

Providing the workspace for low carbon care delivery with wellbeing in mind.

Maximising the health benefits of our travel while minimising the environmental impacts.

Buildings JourneysKey measure of success

2020 goals

Progress

Key aims

Key to progress: Getting started+ Making progress

towards target++ On track to meet

2020 target+++ 2020 target met3

Procurement accounts for more than 60% of the overall NHS carbon footprint.

Individual actions can collectively make a big difference to reduce our environmental footprint – in and out of work.

Healthy choices are green choices. Actions such as active travel and reducing meat consumption also reduce carbon emissions.

Supporting our local community to reduce its impact on the envi-ronment and adapt to climate change.

Cutting carbon beyond ‘quick wins’ requires creativity and collaboration. We’ll work with staff, stakeholders and peers to develop new opportunities.

Energy used to heat and power our estate is the largest part of our scope 1 & 2 carbon footprint.

Fossil fuels release Green-house Gases – contribut-ing to climate change and air pollution. Both will affect local health and wellbeing.

By managing demand and taking a more critical, whole-life view of pur-chasing decisions we can reduce waste and deliver cost savings.

Energy costs are likely to increase and become more volatile in the future – which may create an energy security risk.

Fuel is expensive and as natural resources deplete prices will increase.

Through innovation and working in partnership with our peers we can bring efficiency and cost savings.

Engaged and healthy staff are more productive in the workplace and create a workforce that is more resilient to illness and absenteeism.

Increasing productivity helps to improve our cost efficiency. Action on wellbeing delivers CQUIN funding of over £1.25mil-lion.

Prevent avoidable admis-sions and relieve financial pressures on NHS services by planning for extreme weather events such as flooding or heat-waves.

Supporting our workforce to be responsible for sustainable behaviours will strengthen our organisation and the care we deliver, while we tackle the public health risk of climate change.

High quality workspaces support staff health and wellbeing, which in turn will enhance the quality of patient care.

Fewer cars on the road reduces air pollution cre-ating a cleaner environ-ment, while active travel improves mental and physical health and wellbeing.

A responsible procure-ment policy can improve the lives of those at the far end of the supply chain and support local businesses to work with the Trust.

Sustainable lifestyles are healthy lifestyles and staff are empowered to do things differently for a better working life.

Creating a workplace that supports and values people, both in their pro-fessional capacity and in their personal health and wellbeing.

Supporting our staff and local community to live healthier, active lifestyles preventing illness and supporting wider well-being.

Progress Report 2019 1918 Care Without Carbon

NHS service provider for sustainable development policy and practice

Our 2020 goal

leadingRecognised as a

So far

at the CleanMed conference in Netherlands and at COP 24 in Poland.

for sustainability reporting

Excellent

LeadershipLeading the way for sustainable healthcare policy and practice, both internally and externally

RepresentingRatedCWC

internationally

Progress this yearOur leadership within the Trust (governance)

Our sustainability and environment team is responsible for designing, implementing and reporting the CWC programme across the Trust. The team reports on progress directly to the Board twice a year through the Trust’s Executive Lead for Sustainability, Mike Jennings (Chief Financial Officer).

This year we made significant strides in our internal leadership by ensuring sustainability is embedded into the Trust’s New Three Year Strategy. In particular through the Trust’s new strategic goals and the integration of our clinical sustainability principles (see page 9 for more details).

Finally, the NHS Sustainable Development Unit rated our sustainability reporting as ‘Excellent’ for the third year running. We’re proud of this as it gives stakeholders – from patients and staff to our wider community – the confidence that Sussex Community takes its commitments to sustainability seriously and demonstrates the wider value that sustainability delivers within healthcare.

Leadership beyond Trust borders

We’ve continued to work in leading the way for sustainable healthcare outside of the Trust as well, with several key achievements this year including:

> Furthering our international links through representing CWC at the CleanMed conference in the Netherlands and at the Climate and Health Summit at COP 24 in Poland.

> Being awarded Highly Commended at the 2018 Finance for the Future Awards for Communicating Integrated Thinking. Judges said “With limited resources, Sussex Community NHS Foundation Trust has taken the initiative with an innovative approach to improve the well-being of patients and staff while addressing climate change. Their leadership in this area, within their own trust and as their ideas spread more widely, has a game-changing potential for society which is better for patients and better for the planet.”

> Winning in the ‘Our People’ category at the Sustainable Health and Care Awards and receiving Highly Commended for ‘Corporate Approach’.

Final countdownAsweapproachour2020targetdates,ourfocusinthecomingyearwillbeintwokeyareas:

> Firstly, having succeeded in integrating our clinical sustainability principles into the Trust’sTrust’s Three Year Strategy, we will be working to turn these principles into practical action and embed them into the working life of the Trust.

> Secondly, we’ll be gearing up for the update of our CWC strategy once it reaches it’s end date of 2020, identifying and developing key themes for our programme to 2025 and beyond.

Oli Slaughter, sustainability manager for CWC receives the Sustainable Health & Care award for the ‘Our People’ category.


A mandate to take actionOver the last couple of years we’ve seen a step change in the importance being placed on sustainability in the media, within our local community and by our healthcare leaders.

We wanted to understand how this translated for our staff body, so we asked them as part of our annual wellbeing survey this year:

> We asked a question on how important staff felt it was that that the Trust should spend time and energy on creating a greener NHS. The response was overwhelmingly positive, with 88% of staff believing that it is important that we have a strategy for creating a greener NHS. See first graph below.

> Waste and procurement were highlighted as priorities for the Trust to focus on by over 50% of staff. They would like to see us recycle more, and use less through re-use or choosing products from more sustainable suppliers. Other areas of focus included reducing our business miles, and energy use. See second graph below.

> This is leadership from the frontline; staff actively want to see the Trust take action. This empowers the Trust to be bold and set the challenging targets we work to as part of our aim to deliver Care Without Carbon.

Figure 4: Which of the following solutions do you think is most important for SCFT to

focus on? 613 staff responded to this question.

Figure 5: This graph highlights the areas that staff feel it is important we tackle to deliver

more sustainable healthcare with 695 staff responding to this question


Progress this year

> We have achieved a 37% reduction from our buildings carbon footprint against our 2010 baseline, exceeding our 2020 goal.

> During 2018/19 we’ve reduced our CO2e by 324 tonnes

> We have achieved a 36% improvement in per m2 energy efficiency and a 43% improvement in per m2 water efficiency against our 2010/11 base year.

A key priority for us this year has been continuing to lead on the STP-wide Energy Performance Contract (EPC), which aims to achieve significant carbon and financial savings across multiple trusts in the Sussex and East Surrey region.

The project will be funded through the energy savings it achieves and as such there is no upfront cost to the NHS. The project will see the installation of the latest energy generating technology, including low carbon solutions and renewables, as well as energy efficiency improvements made through upgrades and retrofits of time-expired expired plant and equipment.

Outside of our work on the EPC, we’ve undertaken a number of projects within SCFT including:

Conducting energy surveys at a number of Trust-owned sites to assess the potential for carbon savings through the upgrade of existing heating controls and Building Management Systems (BMS). This information will feed into a viability study for a Trust-wide BMS upgrade project.

> Completing the procurement stage of our automated metering (AMR) system renewal. This will renew and expand the previous system to allow us to better monitor and manage energy and water consumption.

> Successfully moving to 100% renewably-backed power for our owned sites from 1st April 2018, alongside some other partner trusts in the STP.

> Deploying our new utilities management software, which we have been building through the year and is already delivering benefits in a number of areas.


reduction in CO2e from our buildings.

34%reduction in Co

2e from our

2010 baselineCO

2e reduced during 2018/19

324 tonnes

BuildingsProviding the workspace for low carbon care delivery with wellbeing in mind.

37%

Goals for 2020 So farExceeding our 2020 goal with a

2017/18 2018/19

Since our base year of 2010/11 the carbon footprint associated with our buildings has reduced year on year.


Final countdownAsweapproachour2020targetdate,ourfocusinthecomingyearwillbeon:

> Continuing to strengthen our energy and water management systems through the installation of our renewed and expanded AMR system and continuing to build our new utilities management software.

> Investigating the opportunity to source “green” gas to complement our 100% REGO (Renewable Energy Guarantees of Origin) backed power.

> Further reducing the carbon impact of our both our owned and leased estate through completing the BMS viability study, assessing potential for solar PV installations at those sites which sit outside of the scope of the EPC project, and engaging with NHS Property Services on opportunities for our leased estate.

> Developing sustainability targets for all Trust new builds, in particular to support the redevelopment of the Brighton General Hospital site.

> Developing a Carbon Roadmap for Sussex Community to show how we will meet the 2025 Climate Change Act carbon targets, understand the impact of the recent IPCC report suggesting more stringent targets, and in the longer term start to explore how and when we will meet our goal to become a carbon neutral trust.

> Continuing to lead-on the development of the STP-wide EPC project, aiming to complete procurement for all six trusts during 2020.

Chailey Clinical Services are one of the sites that we own and where we can make changes to improve the carbon footprint of the site.


Progress this yearWhile travel is an essential element of the delivery of care to our communities, it can have a significant impact on our health and environment. We’re working hard to travel less when possible, and as efficiently as possible when it is unavoidable. This year:

> Although our carbon emissions associated with travel and transport increased this year by 46 tonnes CO2e, this is due to an increase in grey mileage claims (see below). Even with this increase we have still seen a 24% reduction in CO2e.

> Our grey fleet mileage 2018/19 has gone up to 4.09 million miles. The increase on last year is due to an increase in operational activity and we are working on ways we can reduce this.

> We have increased our low emission pool car fleet to 35 since the base year, operated from 15 different locations Trust-wide.

> We are also increasing our electric pool bikes with the Hospital at Home team the latest team to adopt an electric pool bicycle for business journeys in the Brighton and Hove area (see case study).

> We have reduced tailpipe emissions by 28.5% to 108.00g CO2e/km for Trust fleet.

We’ve introduced a new travel booking system which enables staff to book tickets in advance and without incurring a personal cost. This system provides for the first time an overview of multiple travel mode journeys, providing the Trust with valuable insight into travel patterns and costs.

Reducing our grey fleet mileage is a priority and a key piece of work for this year has been to review our Business Travel Plan. This sets out our targets, objectives and action plans for the next five years as well as including bespoke workplace travel plans for five key sites: hospitals in Crawley, Horsham, Brighton and Bognor, along with Chailey Clinical Services.

Our 2024 targets are to:

> Increase the percentage of Trust-operated vehicles using low emission engine technologies to 90%

> Reduce total Trust mileage by 1 million miles

> Reduce grey fleet mileage by ½ million miles

> Increase annual business cycle mileage to 20K

> Increase active travel commuting by 10%

Final countdownAs we approach our 2020 target dates, our focus in the coming year will be on:

> Carrying out detailed analysis of business mileage claims to establish the proportions that relate to core business (patient care) as opposed to other purposes. This will inform our strategy on targeting functions where mileage may not be essential i.e. where travel can either be avoided or reduced.

> Increasing the electric charging network across key Trust sites in readiness for the increase in electric fleet vehicles planned for 2020-2022.

> Continuing to work with colleagues to establish suitable locations for electric pool bicycles including Children’s services in Brighton and Hove.

> Introducing a second Cycle To Work Scheme provider that can offer bicycles in the range £1001 - £2000; this will ensure that staff wishing to obtain their own electric bicycles can now have more choice and still take advantage of the schemes’ tax free status.


reduction in CO2e from our travel

34% reduction in our CO2e from

our 2010 baseline

This is an increase of

CO2e during 2018/19

46tonnes

JourneysMaximising the health benefits of our travel while minimising the environmental impacts.

24% Goals So far

Lordson Simpson is a CWC envoy who commutes by bike


Case StudyPatient Care …without carbonAs a community trust one of the biggest challenges we hear from staff when we talk about active travel is ‘I couldn’t do my patient visits on a bike.’ But the Hospital at Home team have with a very different message.

Hospital at Home, led by Marcello Rossi, have embraced an e-bike as a key member of their team!

Clare Maloney a senior nurse on the team is so passionate about creating a greener NHS she is one of our Care Without Carbon Envoys.

During the summer of 2018 she introduced the team to the idea of using an electric pool bike and with agreement from Jim Thomas, Head of Logistics their team borrowed the Trust’s pool bicycle for a month long trial, enabling all the team to have a go at using it for their patient visits – and they loved it.

The trial was so successful – the team averaged around 30 miles a day on it –Jim supported them by sourcing 50% of the funding for a new bike of their own from Brighton & Hove City Council’s local air quality fund. The team then applied for the remaining funding via the Trust’s wellbeing fund.

Hospital at Home covers a huge area, from Portslade to Newhaven and out to Uckfield, so not all patient visits are possible by bike, although Clare did Brighton to Newhaven and said, “It was fantastic. I did all my visits in exactly the same time, and did my workout for the day into the bargain. “

Marcello agrees, “I did 5 patient visits on the bike in less time than with the car. Around Brighton and Hove traffic is so bad, the bike is actually faster, it makes it so easy. I feel like it is a free gym, I’m training for free just by doing my job. “

The team are so enthusiastic about the e-bike that they are getting other teams in their building interested too. Clare said, “We let the team upstairs try it, and I think they are going to ask to use the pool e-bike next as they could see how great it was.”

Rebecca Rose is a speech and language therapist and CWC Envoy who has retrofitted her bike to become an e-bike which she uses to commute to work.


Progress this yearHaving set the groundwork for our circular economy programme last year, our recent focus has been on integrating our leaning into procurement projects and processes. We’ve made some great progress this year:

> Through close collaboration with the Trust’s procurement department, we have integrated sustainability criteria into a number of key tenders, with a total value in excess of £8 million pounds.

> Working with clinical teams to integrate sustainability principles into their day-to-day purchasing decisions e.g. through our Hospital at Home Dressings Project (see case study).

> We’ve completed a carbon hotspot analysis of our supply chain to identify key product areas for focus next year: paper products, pharmaceuticals, medical devices and IT equipment and infrastructure.

> We’ve also updated our 2020 targets for circular economy, and no longer intend to target a 34% reduction in CO2e from waste and procurement. This is due to lack of reliable footprinting methodology. Our intention is to develop a new metric and target to 2025.

Of all the seven elements of CWC, this is perhaps the most difficult to navigate due to the sheer scale of the issue.

Delivering healthcare in the NHS requires the purchase and use of an enormous number of products and services. The impact of procurement on the environment reflects this scale, with supply chain making up around 72% of the carbon footprint of the NHS. At Sussex Community, although we don’t include procurement as part of our main carbon footprint (see Appendix), we estimate that our supply chain impact is around 20,000tCO2e based on spend data.

By working towards a ‘Circular Economy’ for the products and services we use, we can ensure that the vast amount of material, water and energy used to create them is not simply lost at the end of the product’s life, but can be used again and again.

To make this a reality we will:

> Create a culture of reuse and repair rather than disposal;

> Prioritise products that can easily be reused, repaired or recycled – and that have a lower impact on the environment;

> Work with suppliers to improve the sustainability of the products and services we buy, and of our disposal mechanisms.

Figure 6: procurement as % of carbon footprint across the NHS as provided by the NHS Sustaianble Development Unit


Circular EconomyCreating and supporting an ethicaland circular supply chain.

recycling rate (expressed as a proportion of all non-healthcare waste by weight)

non-infectious healthcare waste (as a proportion of all bagged healthcare waste by weight)

75% 75% non-healthcare wasteto landfill

recycling rate1

Sustainability criteria integrated into tenders valuing in excess of

1 Recycled waste expressed as a proportion of all non-healthcare waste by weight2 Non-infectious healthcare waste as a proportion of all bagged healthcare waste by weight

non-infectious healthcare waste2

63% £8 m

59% ZeroOur 2020 goals So far

Travel

Building Energy

Procurement

72%

13%

15%


Case StudyHospital at Home dressings projectThis clinical team was keen to reduce their environmental impact and identified the significant plastic waste associated with the dressing pack they routinely used.

The only needed one or two of the nine items included and the rest, including the packaging, had to be thrown away unused; using at least 30 packs a day, this waste built up quickly.

The CWC team worked with them to rewrite the Antiseptic Non-Touch Technique Policy (ANTT) with support from the Infection Control team so a less wasteful alternative of singular items could be used in future.


Final Countdown (Next 12 months)

As we approach our 2020 target dates, our focus for the coming year will be on:

> Bringing our recycling figure back in line with our 2020 targets through: rolling out new recycling bins and other infrastructure; delivering a staff engagement campaign around waste; working closely with our new recycling contractors; and introducing a food waste collection.

> Continuing to integrate circular economy principles across the Trust, through embedding sustainability criteria into key tenders and contracts, and developing our work with clinical teams. We’ll use our newly identified hotspot areas to help focus this work.

> Tackling the use of single-use plastic through the development of a new programme for plastic reduction across the Trust.

In addition to our work on sustainable procurement, we have also made progress within our waste management programme:

> We completed our STP-wide waste services tender, generating four trusts implementing new non-healthcare waste contracts, with significant financial savings. These contracts included ambitious recycling and landfill targets.

> As a result of significant changes in the global recycling industry this year (see Spotlight on section on page 14), our Trust recycling rate for 18/19 is lagging behind target at 63% and is at risk of further reducing next year. It’s a key focus of our action plan for next year.

> Our proportion of non-infectious ‘offensive’ healthcare waste has increased by 4% from last year to 59%. As of 19/20 we will be updating our 2020 target for offensive waste to 60% on the basis of new information around expected proportions of healthcare waste.

> Since launching our internal reuse network ‘Warp It’ in early 2018, we have further broadened the scope to allow for the re-use of unused clinical consumable items. This year we have managed to save in excess of £5,000 from the reuse of internal equipment.

As a trust we procure a lot of supplies. These things need to be disposed of and we are working on a whole life evaluation of what we buy to ensure we are making the most sustainable choices.


Progress this yearWe created our staff engagement programme, Dare to Care, to enable staff to get more involved with Care Without Carbon and support its delivery.

> 1,600 members of staff have signed up since launch.

> Over 6,800 dares (32% of the workforce) have been taken – a dare is a small action to support wellbeing, environmental improvement and financial savings.

We are continuing to develop our reach beyond our own Trust, extending our staff engagement programme to two other Trusts in our STP region, SPFT and SASH. Engagement in the first six months of these programmes has been positive.

> Over 500 people outside of Sussex Community have signed up to the programme.

> Collectively they have pledged to take over 2,300 dares.

> This is a 30% increase in the past 12 months and includes our STP partners, Foundation Trust members and the wider community.

Outside of Dare to Care, our CWC Envoy programme completed its first year. Envoys delivered projects to support the wider CWC programme, cutting waste, reducing carbon and boosting staff wellbeing. For example an HIV nurse in Crawley delivered research into hydration levels for ward based staff which is being used to develop wellbeing initiatives targeting improved hydration.

We’ve also built on attendance at staff events to talk with staff away from the pressures of day to day work about CWC and the ways they can support more sustainable healthcare. We developed a sustainability training programme which we have delivered to staff this year, and plan to build on this over the next 12 months.

Our digital engagement continues to develop:

> CWC has an active Twitter following (grown by 20%).

> The growth on social media has increased engagement with the CWC website with around a 15% increase in traffic over the past 12 months.


staff across the Trust on sustainability with measurable benefits.

Engage with

Our goal

100%

CultureInforming, empowering and motivating people to achieve sustainable healthcare.

engaged more widely with CWC

50%of staff engagedwith Dare to Care

32%

So far



> Developing our Envoy programme in 2019/20, this time with a fresh focus to enable more staff to get involved. The new structure for the programme will ensure that sustainable thinking is built into team meetings, extending the reach of CWC into the organisation and normalising it as a topic of conversation.

> Supporting our waste and circular economy programme with a focus on waste communications and a new dare on plastic use.

> Delivering an STP wide campaign around air pollution, promoting active travel and more mindful use of cars to try and reduce localised air pollution around our sites. This will include a joint challenge for staff at Trusts signed up to Dare to Care and a new dare for all Trusts in our STP region to grow participation in the programme.

> Working with our HR teams to build a segment on CWC into the statutory training sessions which will ensure we can meet our goal of reaching 100% of staff.

> Working to deliver Dare to Care at other trusts and in particular we hope to develop an Envoy programme for at least one more Trust in the STP region.

> Our aim is to grow our social media interactions by 10% through the use of more interactive media such as micro-films and gifs.

CWC Envoys Giving staff a voiceWe asked our Envoys to share why working differently to create a better environment for ourselves and our patients mattered to them…

“I took the opportunity to become an Envoy when I saw that not everything I normally do, such as switching off lights and recycling, was being done by my colleagues. This was not being done on purpose, it just wasn’t being thought about. Now I work with a team of people who think and act to reduce their environmental footprint and also take more care of themselves.” Glenys Tupper, Health Visitor

“I felt I would be able to make a difference as an Envoy working in the Fleet Department as the difference could be dramatic by encouraging our drivers into hybrid/full electric vehicles. We are getting there slowly.” Neil Cooper, Acting Travel Coordinator

“Being an Envoy I would like to learn and explore more efficient and eco-friendly ways of providing care. As a clinical Occupational Therapist, I can see the amount of ‘bad practice’ in terms of carbon emissions i.e. leaving computers on, heating on and windows opened in the teams I have worked in. I am hoping to make an impact by providing Care Without Carbon.” Lordson Simpson, Senior Occupational Therapist

“I’m trying to reduce my environmental impact at home, so hopefully I can encourage others to consider this while we’re at work.” Robert West, Security Risk Officer

Meet some CWC Envoys. Left to right Rebecca Rose, Maureen Downes, Glenys Tupper and Neil Cooper.

Maintaining workplace wellbeing above the national average of

5/10 is the average score forworkforce wellbeing

WellbeingCreating a better working life for our people.

4.22/10 So farGoals for 2020


We developed a new wellbeing metric in partnership with the New Economics Foundation three years ago. This enabled us to meaningfully measure the impact of our programme on people and social sustainability and of identifying areas for future focus. We achieved the best response rate ever to the wellbeing survey in 2019, doubling participation compared to the previous year to over 700 people.

Our overall wellbeing score remains similar to last year, at 4.22/10, giving us some way to go to reach our target score of 5 in line with the national average.

The overall score is broken down into its eight indicators below.

Physical health score increased again this year to 6.32 and remains well above the national average.

The reported score for stress and anxiety improved this year but remains much lower than all the other areas. A 2018 Health and Safety Executive report shows that those working in human health and social work have around 60% higher prevalence of stress, depression and anxiety than the average across all industries. This suggests that although this is and should be a key focus area for our wellbeing programme, our Trust score is likely to be similar to others in the sector.

Finally, analysis of the wellbeing of staff engaged in CWC showed a 6% higher score than those that weren’t.

Key wellbeing projects this year included:

> Successfully launching the Step Up Challenge across three Trusts simultaneously. Overall, 65 teams walked a grand total of 67,170 miles – bringing teams together and raising awareness of wellbeing and sustainable healthcare. (see case study).

> Running our third Wellbeing Festival offering staff wellbeing info, activities and support at sites across the patch.

> Strengthening our relationship with Brighton & Hove City Council by delivering several joint events to staff to promote cycling and more active travel choices.

> Working closely with the Quality Improvement team to deep dive into our wellbeing data and used this to influence the Trust’s Health and Wellbeing Action plan for 18/19.

Progress this year


41Progress Report 2019

This poster is printed on 100% recycled paper using vegetable inks and a waterless printing process

We are taking on the challenge to create a better working life and a greener NHS through Care Without Carbon. Find out more at www.carewithoutcarbon.org

Walking is a stress busting, health boosting, calorie burner.

Email [email protected] to sign up and get your challenge chart and toolkit.

DID YOU KNOW... CHALLENGEWALK ONE OF THREE VIRTUAL ROUTES IN JUST 12 WEEKS

Take the Step Up Challenge and create a positive walking habit.

Choose from these three routes:

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It can help to cut carbon and air pollution.

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H



> Delivering and enabling wellbeing initiatives towards achieving our goal of 5 for the wellbeing score. Emphasis will be on improving scores for stress which is a leading cause for sickness absence.

> Restructuring the Wellbeing Festival to reach more clinical staff.

> Developing a cross-STP campaign on air pollution. Air pollution demonstrates that health is intrinsically impacted by our environment, and supports our aim to raise clinical awareness of why sustainable healthcare matters.

> Forging a stronger relationship with national charities and campaigns focused on active travel such as Love to Ride and Living Streets.

> Continuing to support the work of the Trust’s Health and Wellbeing Group, using our data from the wellbeing survey to deliver more targeted interventions.

Case Study: Three local trusts take on the Step Up ChallengeThe Step Up Challenge is popular at Sussex Community NHS Foundation Trust, drawing teams together in a competition to up their daily steps and walk a chosen route.

This year we decided to up the ante and run the challenge across three trusts within the SAES STP simultaneously to create a bigger sense of competition.

Neighbouring trusts Sussex Community, Sussex Partnership and Surrey and Sussex Healthcare Trusts took part, with the challenge launching in January to capitalise on healthy, post-Christmas ambitions.

Every team or individual that signed up had 12 weeks to complete a virtual route:

> Southdowns Way and back - 224 miles (for 1 to 3 people) > Land’s End to John O’Groats - 898 miles (for 3 to 5 people) > UK Coast - 1,848 miles (for 5 to 8 people)

Brighton and Hove City Council provided pedometers for participants if needed, although most people used an app on their phones or a fitbit.

Any walking, anywhere counted which was great for ward based staff that could rack up many steps while at work! Teams got together and began to walk at lunch times, and some teams used it to train for a charity run.

In total 65 teams across all three Trusts walked a grand total of 67, 170 miles.

The challenge brought teams together and created an appetite for walking that has persisted beyond the challenge. We saw a fun sense of competition develop between Trusts while raising awareness of wellbeing and sustainable healthcare.

“The team has commented how much they enjoyed the challenge, thank you for letting us be part of it. “ Katherine Appleton, Podiatrist, SCFT

“We have gained from this challenge an awareness of making sure we get up and move more often during the working day. That is not always easy to do, but with the support of our line managers we are making changes to the way we work.” Tracey Pascoe, IT Project Support Officer, Sussex Partnership


Progress this yearSussex Community is part of an increasingly interconnected health and care system. As a system we are seeking to meet the needs of an ever increasing ageing population with more complex conditions, move towards a more preventative model of care and make the best use of technology in the most effective and efficient way possible.

We are working in two key areas to support this transformational change.

Firstly finding ways of integrating sustainability into the clinical design and decision-making process:

> Following on from the work of our Darzi Fellow, we have produced a set of clinical sustainability principles based on those developed by the Centre for Sustainable Healthcare.

> These have now been integrated into the Trust’s Three Year Strategy and support the ‘Our Community Way’ Quality Improvement programme.

Secondly we are leading delivery of a number of sustainability programmes across the STP. In particular:

> Supporting a number of trusts in the STP region to develop sustainability programmes using the Care Without Carbon framework, with a focus on targets in line with the new NHS Long Term Plan, notably 51% reduction in carbon emissions by 2025.

> Leading a regional EPC procurement, delivering energy, carbon and cost savings across the STP area (see Buildings section for more info).

> Delivering a joint waste tender for healthcare and non-healthcare waste (see Circular Economy section for more info).

> Launching our staff engagement programme, Dare to Care, at SASH and SPFT, culminating in a regional Step Up Challenge with staff from across the three Trusts competing with each other in a walking challenge.

> Running our Envoy programme (see Culture section for more info).

> Developing our approach to aid delivering sustainability training at a number of events across the Trust.

> Leading an STP-wide sustainability group to share best practice and develop joint working projects across the region.


> Developing our work around climate change adaptation in particular, using new UK CIP data to undertake a climate change risk assessment for Sussex Community and other local trusts to understand how our area will be affected by climate change over the next five to ten years.

> Supporting our partner STP trusts to publically commit to the Climate Change Act targets in line with the NHS Long Term Plan – 51% reduction in carbon emissions by 2025 – and work towards an STP-wide SDMP that reflects this.


that incorporates 2025 carbon reduction targets in line with the Climate Change Act.

Develop an

and integrated them into the Trust’s three-year strategy.

We have developed our CWC is embedded into our

FutureSupporting a strong local health economy to serve our community now and in the future.

clinical sustainability principles

STPpartnership.

So farOur goal

STP wide Sustainable Development Management Plan


Partnerships forsustainable progressThe most effective approach to tackling this climate emergency is to work together, maximising our impact and the benefits for Trusts. The Care Without Carbon team now support almost all Trusts in our STP region on their journey to become more sustainable healthcare providers.

“I am proud of the energy and enthusiasm that staff at Sussex Partnership are demonstrating in support of our aims to become a greener mental healthcare provider since we embarked on our Care Without Carbon strategy. Frontline initiatives such as the greening of the medication round, to reduce plastic waste are inspiring change, not just across our Trust but also across our wider healthcare network, sharing best practice and ideas.

As an NHS organisation serving a large county, we have an important role to play within our local communities of adopting and embedding approaches that support this hugely important agenda. It's one that's important to all of us and for our future.”

Sam Allen, Chief Executive, Sussex Partnership NHS Foundation Trust

“At SASH we take our responsibility for tackling our impact on the environment extremely seriously. Care Without Carbon helps us deliver comprehensive and integrated plans with the urgency and pace this work needs. We are delighted to be doing this in collaboration with partners across Sussex; this brings financial savings which will help us to do more in the future.”

Ian Mackenzie, Director of Information and Facilities, Surrey and Sussex Healthcare Trust

“We’ve been working with the CWC team for some years now; because we see the importance in Trusts coming together to deliver the best possible solutions. There is no one size fits all when it comes to sustainable healthcare, but there are principles and approaches that can be applied and adapted across all healthcare organisations so that we are working together to the same end; to reduce our impact on the environment, make savings and ultimately ensure the health our communities. We have set ourselves a challenging target to reduce our carbon footprint by 34% by 2020 and we’ll continue to work towards delivering on it.”

Mark Paice, General Manager, Estates, East Sussex Healthcare Trust

We are working with our Partner NHS Trusts across many locations in Surrey and Sussex.

47

Greener hospitals,healthier communities

Progress Report 2019

The UK Health Alliance on Climate Change (UKHACC) advocates on behalf of over 650,000 health professionals for responses to climate change which protect and promote public health. Our members include many Royal Colleges of Medicine, the Royal College of Nursing, the British Medical Association, the British Medical Journal and The Lancet.

Climate change is the greatest health threat of the 21st century, but action on the climate crisis could bring major co-benefits to health.

Many of the drivers of climate change – fossil fuel combustion, unhealthy diets and overreliance on motorized transport – harm our health directly, through air pollution, high saturated fat intake and physical inactivity. By responding to these we can simultaneously reduce our contribution to climate change, realise huge public health benefits and reduce pressure on the NHS.

As trusted professionals, scientists and guardians of public health, health professionals have a vital role to play in raising awareness of climate change, examining the impact of their own practice and promoting personal, institutional and governmental responses to the current crisis.

To be successful, we must embed actions mitigating climate change – and the principles of sustainable development – in policies across all sectors and into everything that we do from our commutes to our clinics. It’s fantastic that Care Without Carbon’s sustainability goals apply to so many elements of what makes a healthcare system work, from transport and buildings to staff wellbeing and culture.

This is about making healthcare better for everyone; not just making savings whether they be financial or carbon. A very simple example is the Hospital@Home team at Sussex Community, who found that using an e-bike in a busy city for their patient visits was actually faster than by car, meaning they could see more patients in their working day.

On the pathway to net-zero emissions before 2050, we hope that more NHS trusts will replicate the efforts of Sussex Community NHS Foundation Trust to reduce their contribution to climate change, and to mitigate its current and future health impacts.

The UKHACC provides a voice for health professionals across the UK.

“Re-thinking the way that we travel – both as individuals, and as members of organisations like Sussex Community NHS Foundation Trust – is one of the best

examples of how changes to our behaviour and attitudes in response to climate change can have enormous environmental, health, and financial co-benefits. Exercise is a ‘miracle cure’ for many long term health conditions – which account for up to 70% of the entire NHS budget – so the opportunity to improve health through active travel (e.g. walking or cycling), at the same time as tackling the climate crisis, is an opportunity we can’t pass up.”

Mrs Scarlett McNally, Consultant Orthopaedic Surgeon, Eastbourne District General Hospital, and Council Member of the UKHACC.

“CWC has brought the Trust on a journey. We have travelled a good way towards creating a greener, more sustainable NHS, and have already achieved our 2020 target of reducing our carbon footprint by 34%, which we’re very proud of.

However, the steepest part of our journey still lies ahead. This year has seen the threat of climate change rise up the global agenda further than ever before as we move into an era of ‘climate emergency’. As a Trust we must respond to this, redoubling our efforts and commitments to ensure we continue to find pioneering and innovative ways to deliver more sustainable healthcare both within our own Trust and beyond.

Our focus beyond 2020 is to ensure that we rise to the scale of the challenge within Sussex Community - and importantly that we support others to do the same.

As a minimum we’ll be targeting a 51% reduction in our carbon footprint in line with the global Climate Change Act and the NHS Long Term Plan, but ensuring also that our targets are in line with our overall ambition to be a carbon neutral healthcare provider.

In order to achieve these ambitious targets, we’ll be focussing more and more on integrating sustainability principles and practice into our clinical services and the delivery of healthcare.”


Susie Vernon, our Associate Director Sustainability has been with Care Without Carbon since its inception, she tells us where she sees the programme heading…

Why does this matter? We asked the UK Health Alliance on Climate Change to share their view on the responsibility of healthcare professionals to tackle the challenge of climate change.

Focus on the future


Appendix One

The Greenhouse House Gas (GHG) Protocol sets out two distinct approaches to

setting accounting boundaries:

Equity Share Approach. Where accounting for emissions is undertaken

according to the share in the company in terms of economic interest. Control

Approach. Where an organisation accounts for 100% of emissions from

operations over which it has control. Control is defined in either financial or

operational terms. In addition, it introduces three scopes, as follows:

> Scope 1: Direct GHG Emissions. These occur from sources owned or

controlled by the organisation.

> Scope2:Energy Indirect Emissions. These occur as a result of energy

consumed that is supplied by another party.

> Scope 3: Other indirect GHG Emissions. All other emissions that occur as a

consequence of organisational activity but which are not owned or controlled

by the organisation.

The approach adopted by SCFT is to report on emissions from the activities

over which it exerts operational control. In other words, the accounting

boundary is drawn around the clinical services that the Trust is commissioned to

deliver and which are therefore delivered in accordance with Trust policies and

procedures.

This approach aligns the Trust’s GHG reporting with other national NHS

reporting processes and standards, notably the annual Estates Return

Information Collection (ERIC).

In the case of the estate the Trust occupies – most of which is leased from third

parties – this means we account for emissions from energy we consume in the

same way for both our owned and leased assets, ensuring only those emissions

relating to the services provided by the Trust are reported.

The diagram on page 49 summarises the emission sources covered by our

current GHG reporting boundary broken down according to their scope.

Emissions associated with procurement and waste (scope 3) are not currently

included in our carbon footprint due to a lack of reliable footprinting

methodology in these areas. We recognise, however, that procurement in

particular would make up a significant proportion of our Trust footprint, if it

were included. As such, one of our key priorities is to find an accurate way of

measuring and reporting against this area in the future. For further information

please see our Circular Economy section, page 30.

¹ http://www.ghgprotocol.org/

Our carbon footprint reporting boundary

Progress Report 2019 – Appendices 49

Other points to note:

All information included in our sustainability reporting corresponds to the standard public sector financial year of 1st April to 31st March.

Our emissions are reported in absolute terms (i.e. total emissions) without any degree day adjustment (correcting for weather variation).

Where the Trust undergoes strategic structural change, e.g. operational growth through the acquisition of new services, this has implications on our reporting boundary. In the case of significant changes, the boundary is adjusted to take account of the new operational structure and a baseline adjustment is also undertaken to ensure consistency in reporting.

¹ CO₂e refers to six greenhouse gases: Carbon dioxide; Hydrofluorocarbons; Methane; Nitrous oxide;

Perfluorocarbons and Sulphur hexafluoride. This is important as some of the gases have a greater warming effect than CO₂. Using CO₂e allows all six greenhouse gases to be measured on a like-for-like basis. The NHS measures its carbon footprint in CO₂e which is in line with national and international conventions.

Business travel

Fleet

Occupied estateOccupied estate

Business travel

Other travel

Supply chain

Direct fuel usePersonal vehicles

Owned and leased vehicles

Water & sewerage

Electricity

Waste disposal

Key:

Natural gas

Scope 1 Scope 3

Reporting boundaryScope 2

Fugitive emissions

Rail

Staff commuting

Procurement emissions

Air

Patient travel

Other

Petrol

Petrol

Supply

Treatment

Purchased electricity

Recycling

Energy recovery

Transmission & distribution

Landfill

Incineration

Gas oilDiesel

Diesel

Hybrid

Hybrid

50 Care Without Carbon Progress Report 2019 – Appendices 51

Appendix Three

In 2015/16 NEF Consulting worked with us to develop a unique measure of

wellbeing for NHS staff and to measure the impact of our Dare to Care (Dare)

campaign.

A wellbeing survey was developed which was made open to both those who

engaged with the campaign and those that did not, helping to establish a clear

picture of the impact this work.

Responses from the staff wellbeing questionnaire (made available online

and in paper format) were compiled and converted into numerical format for

statistical analysis.

Z-Scores are calculated for each response and averages are taken. The averages

are converted to a standardised 0-10 scale and compared against national

benchmarks for each of the eight wellbeing indicators.

Staff that took part in the campaign were asked to assess to extent to which

they perceived their wellbeing had changed before and after participating in

Dare and how much they thought Dare had contributed to this change.

Scores were then totalled and averaged as per the above methodology to

produce before and after scores for darers (staff that actively participated in

the campaign).

The difference between these scores provides a ‘distance travelled’ score (or

total change) from participating in the campaign. All outcomes are weighted

equally.

Staff wellbeing metric - methodology

b) Baseline adjustments

None

Appendix Two

a) Certificate of carbon footprint verification

For the ninth year running we have commissioned an external independent verification of our carbon footprint data. For this reporting year the verification exercise was undertaken by EEVS Insight Ltd.

Carbon footprint verifications and baseline adjustments

EEVS operates a certified Quality Management System for analytical measurement and verification services

FS-591998

Certificate of Carbon Footprint Verification 2018/19

This certificate is to certify that

Sussex Community NHS Foundation Trust has been assessed and judged to meet the principles for reporting Carbon Footprint under the guidelines of the Greenhouse Gas Protocol Corporate Accounting and Reporting Standard for the 2018/19 emissions inventory.

The scope of this Greenhouse Gas Protocol covers:

The accounting and reporting of greenhouse gas emissions covered by the Kyoto Protocol for emissions from purchased electricity and heat. Additionally, the optional reporting of emissions from indirect sources including transport and water.

Signed on behalf of EEVS Insight:

………………………………………………. ……………………………………………….

Hilary Wood Ian Jeffries

Director Managing Director

Date of Issue: 8th October 2019

Issued by:

EEVS Insight Ltd

25 Lavington Street London SE1 0NZ

52 Care Without Carbon Progress Report 2019 53Progress Report 2018– Appendices

Appendix Foura) SCFT carbon emissions reduction since 2010

Resource data, emissions, targets and KPIs

Care Without Carbon

c) Absolute KPI values since 2010

This table presents absolute annual values for each of our environmental KPIs since 2010.

Source Base year2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017

2017-2018

2018-2019

Electricity consump-tion (kWh)

6,983,633 6,479,400 6,610,597 6,330,530 5,782,802 5,681,670 5,871,349 5,699,090 5,395,859

Gas con-sumption (kWh)

16,880,831 13,789,943 14,280,176 13,847,054 12,648,412 12,423,819 12,093,646 12,798,015 11,966,481

Oil con-sumption (kWh)

62,913 35,648 34,946 34,648 34,496 30,389 31,332 32,671 31,359

Water con-sumption (m3)

98,268 91,131 75,554 72,624 72,029 69,134 72,808 67,144 57,316

Wastewater consump-tion (m3)

93,354 86,575 71,776 68,993 68,425 65,675 69,150 63,507 54,440

Trust fleet mileage (miles)

1,204,495 1,133,311 11,18,811 1,147,138 1,301,726 1,484,319 1,501,225 1,495,742 1,439,338

Grey fleet mileage (miles)

4,693,757 4,957,344 5,132,489 5,244,313 4,889,445 4,541,732 3,838,094 3,850,603 4,085,883

b) Progress for 2018/19 against our 2020 targets & key performance indicators (KPIs)This Environmental Performance Dashboard summarises the progress we have made against our

2020 environmental targets.

Indicator KPI2020

targetBase year

value

2020 target value

2018-19 target value

2018-2019 value

% change from

2017/18

Carbon footprinttonnes CO2e

34% 8,562 5,651 5,974 5,363 -10.9%

Energy efficiency kgCO2e/m2 34% 59.3 39.1 41.3 37.9 -17.6%

Water efficiency m3/m2 34% 1.36 0.90 0.95 0.78 13.5%

Trust vehicle emissions

gCO2e/km 34% 151 99.6 105.3 107.6 -0.4%

Grey fleet mileage1 miles claimed

34% 4,693,757 3,097,880 3,275,199 4,085,883 -6.1%

General waste recycled

% recycled 75% 50% 75% 73% 63% 1.6%

Infection waste reduction

% offensive

75% 0% 75% 65% 59% 5.4%

¹ Grey fleet mileage refers to Trust staff using their own vehicles for business travel.

² Whilst still on target ove`rall, we are aware of increased water consumption at one of our KPI sites and investigation into this is ongoing – this one site represents a total of 75% of the reported decrease in efficiency.

Emission Source (tCO2e)

Base year

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017

2017-2018

2018-2019

2019-2020

Fossil fuel 3,143 2,564 2,654 2,558 2,349 2,300 2,234 2,366 2,210 -

Trust vehicles 296 271 259 254 257 273 266 261 249 -

Electricity (incl. T&D losses)

3,430 3,179 3,281 3,061 3,108 2,843 2,638 2,191 1,657 -

Water & wastewater

100 93 77 74 73 70 74 68 58 -

Business mileage 1,593 1,722 1,825 1,493 1,396 1,261 1,155 1,130 1,188 -

CWC 2020 target 8,562 8,239 7,915 7,592 7,268 6,945 6,621 6,298 5,974 -

TOTAL 8,562 7,829 8,096 7,440 7,183 6,747 6,367 6,016 5,362 -

Actual savings against baseline

9% 5% 13% 16% 21% 26% 30% 37% -

54 Care Without Carbon Progress Report 2019 – Appendices 55

Appendix FiveDeveloping strong metrics has been key to the development of the CWC

programme. By addressing materiality we are better able to identify priorities

for action, and importantly, communicate the impact of our work at all levels in

a meaningful way. Some key examples include:

> Our sustainability scorecard - this was developed to track progress against our three key aims (see page 12).

> Our carbon footprint - this highlights the environmental impact of our buildings and journeys, with targets and action plans developed to address these areas.

> Our wellbeing metric - we developed this to give a better understanding of the wellbeing of our workforce and highlight key areas for action.

> Our circular economy work stream - work by the Sustainable Development.

Unit highlights procurement as the key contributor to the NHS carbon

footprint nationally. We are working on developing an accurate methodology

for measuring this within our Trust. In the meantime, our focus in this area is

determined by using existing metrics including: analysis of Trust procurement

data, working with known and local suppliers where our influence is greatest.

Materiality

d) Progress since 2010 against our 2020 targets & KPIs This table shows our progression from the 2010 baseline in meeting the 2020 targets set against

each of our environmental KPIs.

TargetBase year

2011-2012

2012-2013

2013-2014

2014-2015

2015-2016

2016-2017

2017-2018

2018-2019

2019-2020

Energy efficiency (kgCO2e/m2)

59.3 49.0 53.1 40.9 49.8 51.1 48 46 38

Target 34% 57.0 54.8 52.6 50.3 48.1 45.9 43.6 41.4

Difference -14.1% -3.1% -22.2% -1.1% 6.2% 4.7% 5.5% -8.2%

Water efficiency (m3/m2)

1.4 1.4 0.9 0.7 0.6 0.7 0.9 0.7 1.0

Target 34% 1.31 1.26 1.21 1.15 1.10 1.05 1.00 0.95

Difference 5.5% -32.4% -46.1% -47.2% -32.9% -17.3% -31.0% 5.4%

Trust emissions (gCO2/km)

151 147.1 142.3 136.2 122.6 114.4 110.0 108.0 108.0

Target 34% 145.3 139.6 133.9 128.2 122.5 116.8 111.1 105.4

Difference 1.2% 1.9% 1.7% -4.4% -6.6% -5.8% -2.8% 2.5%

Grey fleet mileage (miles claimed)

4,693,757 4,957,344 5,132,489 5,244,313 4,889,445 4,541,732 3,838,094 3,850,603 4,085,885

Target 34% 4,516,437 4,339,118 4,161,798 3,984,478 3,807,158 3,629,839 3,452,519 3,275,199

Difference 9.8% 18.3% 26.0% 22.7% 19.3% 5.7% 11.5% 24.8%

General waste recycled (% recycled)

50% N/A 54% 62% 65% 62% 66% 64% 63%

Target 75% 53% 56% 58% 61% 65% 68% 70% 73%

Difference -2.1% 5.7% 5.7% -4.5% -2.2% -8.6% -13.1%

Clinical & offensive waste (% offensive)

0% N/A 35% 36% 40% 54% 57% 56% 59%

Target 75% 8% 17% 25% 33% 35% 45% 55% 65%

Difference 109.5% 44.6% 19.7% 55.5% 26.7% 1.8% -9.2%


Appendix SixRisks & Opportunities

Mitigation measures Opportunities and benefits

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The Trust’s Journeying Group and Business Travel Plan aims to

target reduction in business mileage, move towards cleaner

vehicle technology and incentivise active travel.

Procurement Policy ensures we rationalise and consolidate

orders for fewer deliveries.

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Appendix SevenBringing Others With Us

We believe that change happens when people make it happen. Care Without Carbon as a strategy alone cannot deliver sustainable healthcare; it is a key part of our work to bring people along with us to deliver on the goals set out in the strategy. We also want stakeholders to help us shape the goals as we progress.

Our BoardThe Trust’s direction is driven by the Board and senior managers, and we ensure that our sustainability goals reflect the wider strategic aims of the Trust. Twice each year we present to the Board, in part to demonstrate accountability for the goals we set, but also to gain their insight and support as we progress. It was a positive indictment of CWC that our clinical sustainability principles were incorporated into the new Three Year Trust Strategy.

SCFT StaffNow in its 5th year the staff engagement programme Dare to Care, created specifically to talk to staff about CWC, continues to develop and evolve. The programme has served as a narrative thread throughout our journey towards more sustainable healthcare, as well as prompting behaviour change to reduce impact on the environment and boost wellbeing.

The Envoy programme in 18/19 saw staff develop and deliver their own projects around sustainability, and waste featured strongly as a concern and opportunity for staff to take action.

Staff are making contact with the CWC team to share ideas and source solutions to environmental issues they have identified, which we use to shape future dares and projects for case studies.

The wider healthcare networkOur goal is to facilitate a sustainable healthcare system; and Trusts are coming together to deliver CWC with our guidance and support, making CWC the defining framework for sustainable healthcare across our STP region.

Our work with other Trusts affords us the opportunity to explore new ways of working and communicating about sustainable healthcare so we can collectively reduce our impact on the environment.

In addition to regular STP-wide meetings for specific projects such as the EPC, we chair a quarterly meeting with STP Trusts on sustainability to keep a dialogue open on opportunities to work together, and we co-chair a regional waste group, sharing best practice and developing joint working opportunities.

Our membership of Health Care Without Harm (HCWH), Europe continues, and we maintain and active role in the global conversation on the links between health and climate and the role that healthcare organisations can play in addressing this, participating in the HCWH conference in Poland in 2019.

Patients and communitiesWhen we created CWC we did so with a view to ultimately including patients and our wider community in the programme. For this reason the website was designed to be external from the start, and there is an option for anyone, not just staff to make a pledge to reduce their impact on the environment. In addition we are seeing an increase in followers on social media, in particular Twitter.

For us the ultimate message is that #selfcare is #sustainablehealthcare and our ambition is to reach everyone and see this reach translate into actions that improve health in mind and body.

Our partnerships with the wider community and nationally continue to develop, with Living Streets supporting our promotion of walking for example. We also sit on the active travel panel set up by Brighton & Hove City Council.

At the HCWH conference. L-R: Susie Vernon, Sussex Community NHS Foundation Trust, Cathy van Beek, Chair of the EHCC, Rick Lomax, NHS SDU, Wouter van Wijhe,Radboudumc

Susie Vernon, Associate Director Sustainability, Sussex Community NHS Foundation Trust

[email protected] | 01273 696011

This publication is printed on 100% recycled paper

@carewithoutCO2

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