Leicester, Leicestershire and Rutland (LLR) integrated care system has published their green plan – a system-wide strategy committed to sustainability in alignment with the NHS’s long term environmental ambitions.
The green plan has emerged from regional and national Net Zero targets, and sets out a collective vision and action plan for the ICS to embark on over the next three years. The plan will focus on the following key areas:
- Prioritising interventions which improves patient care and community wellbeing while tackling climate change and broader sustainable issues across LLR
- Supporting the NHS-wide ambition to become the world’s first healthcare system to reach net zero carbon emissions
- Collaborative efforts by ICS members and LLR partners to achieve desired outcomes in a cost-effective and efficient manner
Workforce and system leadership
The ICS is expected to draw on their experiences piloting Carbon Literacy and other green plan related resources, in order to train staff on the impacts of emissions, carbon costs and how they can collectively reduce their carbon footprint on a daily basis.
The initial target groups will include leadership teams, procurement teams and greener NHS programme staff , such as ICS sustainability and adaptation leads.
In terms of leadership, the board will embed sustainability and net zero plans into business cases and a dedicated Greener Lead Director will be appointed for every primary care network.
Sustainable models of care
The plan states that the ICS’s vision is to “appropriately use technology to deliver sustainable healthcare that is future-proofed and meets the needs of the communities that we serve within LLR.”
The section stipulates that this work will benefit the most from an integrated approach across the ICS, as it aims to tackle various challenges such as health inequalities.
Sustainable models of care include telemedicine and virtual consultations; provision of care closer to home; preventative care; and integration of lower carbon interventions.
The plan has the opportunity to build on ‘Health Infrastructure Plan Blueprint for Digitally Advanced Hospitals’ which focuses on the following key themes:
- Digitally empowered patients
- Digitally enabled staff
- Interoperable and intelligent systems
- Hospitals without walls supporting integrate care
- Smart buildings
LLR recognises the need to engage all key stakeholders at an ICS level, to define needs and ensure interconnectivity and interoperability.
The plan highlights a commitment to consider health inequalities within digital transformation actions, with designs to improve digital literacy among patients and fully explore remote monitoring and telemedicine pathways.
Going forward, the ICS will review the carbon footprint of digital systems and associated waste, creating a plan to reduce the impact of digital systems to support the net zero targets.
Travel and transport
The document notes that travel and transport play a huge role in addressing sustainability challenges across LLR; as such there have been ongoing actions across the region to facilitate more sustainable modes of transport.
For example, Leicester Royal Infirmary and Glenfield Hospitals have improved cycle storage to encourage greener modes of transport. There are plans for a new park and ride, and electric buses were introduced in 2022 along with PlusBus ticketing and a ‘park and stride’ scheme alleviate parking issues.
Long-term plans also include further investment into Santander Cycles docking stations, increasing the frequency of the Hospital Hopper, expanding inclusive hours for Park and Ride and introducing a car park management system that encourages flexile transport decision-making.
Estates and facilities
The plan highlights that changes are underway across LLR ICS to provide opportunities to improve patient pathways, increase efficiency in travel and to integrate green energy solutions.
University Hospitals Leicester (UHL) and Leicester Partnership Trust (LPT) will implement, where possible, a programme across estates and facilities that will “positively impact energy use and carbon emissions, waste and water management, air emissions, biodiversity and greening.”
This will involve:
- Rationalisation of estate to streamline service and matching clinical need across LLR
- All new buildings will aim to achieve net zero with low embodied and operational carbon
- The use of refrigeration systems with low global warming potential
- Working with partners to identify potential green corridors and spaces from NHS to adjacent sites
- Integration of Estates and Sustainable Travel Strategies across LLR – where possible, making facilities ready for electric vehicles
- Ensuring all energy and water consumption is well used
- A Primary Care Estates Strategy (PCES) will support collaboration with all ICS partners to adopt a combined public estate approach – ensuring primary care needs are recognised and acted upon as part of the wider financial landscape
Approximately 25 percent of emissions are attributed to medicines within the NHS. The plan states that “it is vital that we take a collaborative approach” to “drive forward green initiatives related to inhalers, anaesthetics and the recycling of medical devices.”
A dedicated green medicines optimisation sub-group will identify and share the best practices, involving stakeholders across LLR ICS.
The ICS will be promoting the Take AIR scheme and the safe disposal of inhalers by returning them to local pharmacies. Switching pressurised metered dose inhalers (pmDIs) to lower carbon footprint inhalers where appropriate is to be encouraged.
Anaesthetic gases will also be reviewed at UHL to reduce the use of desflurane in surgery to less than 5 percent of its total volatile anaesthetic gas use by April 2023 (as per the 2022/2023 NHS Standard Contract).
UHL and other stakeholders will assess the potential to reduce unnecessary emissions of nitrous oxide into the atmosphere.
On medicines logistic, storage and waste, the strategy shares how UHL Pharmacy Department has created a Sustainability Interest Group to discuss waste and carbon reduction opportunities and increase staff awareness.
A dedicated polypharmacy medicines optimisation team will work to implement sustainable prescribing methods by preventing overprescribing – which can lead to premature deaths and preventable hospital admissions. The team will support primary care services to identify and prioritise patients with polypharmacy and improve the quality of discharge medication letters, information and involvement.
An established Care Home Pharmacy Team continues to address medicine waste within care settings, helping to streamline processes and review oral supplements of patients to reduce waste.
Supply chain and procurement
LLR ICS has aligned itself with the National Procurement Policy Note which asks all authorities to consider the following national priority outcomes:
- Creating new businesses, new jobs and new skills
- Tackling climate change and reducing waste, and
- Improving supplier diversity, innovation and resilience
UHL has already made progress on these objectives and going forward they will develop a roadmap to embed sustainability and carbon reduction across broader decision making.
Food and nutrition
At a trust level, the plan will focus on reducing single use plastic, exploring sustainable procurement, healthy food choices, waste minimisation and recycling of packaging.
Key aspects to be reviewed and integrated into the plan include low carbon menu selection, enhanced food waste management, substitution of sustainable cutlery and disposable meal items.
The plan notes: “It will also be important to better understand the carbon footprint associated with Food and Nutrition to identify priority items and set targeted action plans.”
Opportunities include the use of reverse vending machines (RVMs) that offer a range of initiatives to encourage recycling, collaboration of food waste collection and a focus on healthy and sustainable meal options to reduce carbon footprints.
Looking ahead, the ICS will collaborate with the Council’s Sustainable Food Partnership to promote healthy diets and look for opportunities across the LLR for food waste management; including composting, food banks and donations to homeless shelters.
The ICS has identified that mitigation and adaption actions will be required in order to tackle the impacts of global warming.
The plan states that “the former (mitigation) is taking steps to reduce greenhouse gas emissions to minimise more severe climate impacts. The latter (adaption) is the operational changes required to ensure resilience in the face of impacts brought about by anticipated climate change.”
An adaptation lead will be appointed to consider plans to mitigate the risks and effects of climate change and severe weather conditions such as floods and heatwaves, and the risks these pose to patients and staff.
By establishing a clear process of assessment and reviewing, LLR ICS will aim to ensure that operations remain resilient and continue to provide the highest standards of health care across the region.
For further information on the LLR ICS Green Plan, please click here.