Black Country ICS has released their Green Plan in line with the NHS Net Zero ambitions which aims to create a greener, more sustainable healthcare system.
The strategy states a commitment to the Greener NHS’s vision through “delivering change where we have direct control, and influencing what we can indirectly control, so that we are responding to climate change, improving health and creating healthier places, people, and futures in the Black Country.”
In order to achieve this, the strategy outlines nine key areas of focus: 1) Supplier procurement, 2) Digital transformation, 3) travel and transport, 4) estates and facilities, 5) Adaptation, 6) Medicines, 7) Food and nutrition, 8) Sustainable models of care, 9) Education and training.
The ICS’s Greener Clinical Care Working Group developed a Sustainable Impact Assessment (SIA) template to “assist purchasers in considering environmental factors when considering swapping products and/or services.” This template has since been formally adopted by the Greener Clinical Care Working Group membership and from April 2022, they have fully adopted the national requirements for procurement.
Regionally, the ICS continues to implement and prioritise a programme aimed at reducing single use clinical plastics; containing to purchase greener alternative for single use items. Similarly, all member organisations will move to 100% recycled paper for necessary desktop printing. By 2024/25, the ICS hopes to only purchase from suppliers who are compliant with the Evergreen NHS Sustainable Supplier Framework and measure actual carbon emission reductions in collaboration with suppliers.
Other priorities in the procurement area include:
- Reviewing Personal Protective Equipment (PPE) and agree ICS wide programme of migration to lower carbon alternatives
- Extend Walking Aids Reuse programme
- Ensure all potential suppliers are required to publicly report emissions and publish a carbon reduction plan aligned to the NHS net zero target
- Set up an education programme for clinical staff on reducing carbon impact of care in collaboration with universities and/or Royal Colleges
The ICS states that they are “committed to harnessing the capabilities of our existing digital technology and utilising innovative solutions to streamline service delivery” whilst improving “the associated use of resources and reducing carbon emissions.”
Examples of actions that have already been delivered in this area include the use of SharePoint, Microsoft Teams and e-consult across all organisations. Remote monitoring technology being implemented and used more widely across the ICS reduces emissions caused by unnecessary travel to hospital and clinics.
Donating old hardware such as mobiles phones and tablets at local community centres has helped to support access to online services and to keep these products in the circular economy.
Going forward, the Digital Lead will work closely with the ICS’s Greener NHS Network to deliver new innovations and technologies that support greener ways of working. These include continuing to reduce paper usage, creating opportunities to work with local authorities to address digital exclusion in the community and rolling out successful initiatives such as the ‘E-Community’ currently underway at Sandwell and West Birmingham – scheduling software which will allow district nurses to plan the most efficient route for home visits thereby reducing carbon emissions associated with travel .
Travel and Transport
The ICS estimates that travel and transport alone contributes to around 14% of the NHS’s total carbon emissions. The Green Travel Working Group aims to collectively reduce emissions by reducing unnecessary journey, enable healthier forms of travel and utilise ultra-low and zero emission vehicles.
Sandwell and West Birmingham Trust and the Royal Wolverhampton Trust have partnered with National Express on a new scheme which provides a free weekly pass to new staff. This is to encourage staff to try their local bus routes at no cost to the trust. On the subject of active travel, the ICS will review a trial for an e-bike pool for the use of community outreach staff. If successful, this scheme will be rolled out across the organisation.
Going forward, the ICS will all look to install EV charging infrastructure at key sites, alongside a Clean Air Action Plan which will explore how the ICS can minimise air pollution and positively influence public health.
Estates and Facilities
In this section, the ICS outlines their immediate prioritises as “using our estate effectively” by maximising the use of of existing estate ahead of renting or utilising more properties.
They will work with third parties to consolidate information, which will then be used to inform their future estates strategy -providing a more nuanced approach to investment in estates upgrades. Alongside this, they will engage with suppliers to create a furniture reuse and recycling program, engage with local authorities as well as regional and national partners to assist with similar programmes.
A procurement strategy will be developed at an ICS level that will priorities reuse with a motto of “new is a last resort.” Other recycling and waste management efforts will include free cycle schemes and exchanges – collaborating with local small and medium enterprises (SMEs, voluntary organisations and social enterprises to support capacity building.
The ICS have placed Public Health England’s Single Adverse Weather and Health Plan at the centre of their adaptation priorities, meaning they will ensure their estates teams follow the Emergency Preparedness Resilience and Response (EPRR) Framework to embed emergency planning. This will “maintain continuity of key services in the event of disruption from severe weather” and will mean that they can prioritise, identify and implement adaptation actions.
The ICS will look to increase green spaces and local biodiversity across the region. For example, Russells Hall Hospital currently maintains a wide variety of green spaces across the site which the ICS would like to apply to other organisations in the area.
The strategy wants to ensure staff and patients have easy access to green spaces and will be exploring the option of “engaging with the NHS Forest and other National initiatives” going forward.
The ICS has prioritised both inhalers and anaesthetic gases through the establishment of two specific working groups, which aims to optimise prescribing, substitute high-carbon products for low-carbon alternatives and improve production and waste processes. “We intend to move to lower carbon inhalers without compromising patient care and are committed to reaching the national target” the strategy writes.
They are actively working to reduce the use of desflurane and nitrous oxide, as well as exploring innovative solutions to reduce anaesthetic gas emissions. This includes using scavenging technologies which work by collecting residual nitrous oxide from exhaled air and destroying the gas.
Going forward, the ICS will collaborate int he procurement of technologies to enable consistent training, data collection, ease of maintenance and utilise successful innovation trials.
Food and Nutrition
Both the Dudley Group and Sandwell & West Birmingham Trust have implemented a digital meal ordering system to facilitate accurate meal planning and reduce food waste. The ICS would like to roll out similar systems across the region in the near future.
Over the next three years, the ICS aspires to establish a working group for food and nutrition, utilising the “social value element” of procurement decisions around catering to enable local businesses and produce to be considered.
It is the trust’s vision that the group would be able to identify best practice from across the ICS and beyond, which will allow the ICS to develop targeted initiatives to tackle food waste and improve nutrition
Sustainable models of care
This part of the strategy highlights the ICS’s desire to proactively embed net zero principles into all of its clinical services. In practical terms, this involves:
- Working with clinicians locally to consider pathways/specialties that could be decarbonised, share best practice and put into practice the Sustainability Impact Assessment (SIA).
- Utilise local academic health science network to support the adoption and spread of clinical carbon reduction innovations.
- Continue to use the Elective Care Plan which has (thus far) facilitated 25% of patients to undergo virtual consultations. This will improve personalised care and reduce associated travel emissions.
- Place digital at the forefront, enabling greater outpatient follow up through online platforms instead of hospital visits. The ICS’s digital programme has been formed to increase virtual attendance rates and gather evidence to identify future opportunities to replace face to face attendances with virtual ones.
Looking ahead, the ICS plans to upscale initiatives that work at an organisational level, ensuring that working groups feel “empowered to make the changes needed to deliver sustainable models of care.”
Education and training
Developing a system wide awareness, training and education plan to reduce the ICS workforce’s carbon impact is a central goal of the strategy. This will involve a three step process:
- Climate awareness training for all staff
- Targeted training for specific departments
- Investment in specific staff
The development of dedicated green teams across many of the ICS’s organisations with an aim of “enabling staff, patients and visitors to provide regular feedback and suggestions to improve sustainability performances as well as communicate local successes across Trusts.”
Black Country’s ICS Greener NHS Network will formally review and update the current Green Plan on an annual basis, considering the progress they have made and the ability to accelerate agreed actions. They will also look to introduce new initiatives generated by staff or partner organisations, alongside advancements in technology and other enablers of innovation.