NHS Rushcliffe CCG. Sustainable development management plan (SDMP) ( )

Transcription

1 RCCG/GB/15/039 NHS Rushcliffe CCG Sustainable development management plan (SDMP) ( ) Produced by NEP Energy Services Ltd Contact:

2 Contents Executive Summary... 4 Environmental Policy... 7 Review Cycle... 8 Part 1: Sustainable development Management plan Setting the scene Introduction Sustainable Development Climate Change Sustainable Development and the Health & Care System Why the NHS? Rationale and drivers for change Legislative Drivers NHS Policy Drivers Local Drivers Carbon Baseline Performance CCG Baseline Carbon Footprint Good Corporate Citizenship (GCC) Sustainability Vision Sustainability Objectives Sustainable Development Target Carbon Reduction Target UK Carbon Budgets NHS Carbon Reduction Target CCG Carbon Reduction Target Sustainable Commissioning and Procurement Sustainable Development Action Plan (SDAP) Climate Change Adaptation What is Adaptation? Why is Adaptation Important Climate Change Risk Assessment Part 2: Investors in the Environment (iie) Appendix A: Carbon Footprint Methodology Appendix B: Procurement Carbon Factors Appendix C: Commissioning carbon footprint (Supplier Specific) Appendix D: Health Sector Direct and Indirect Impacts of Climate Change

3 Task Name Date Version Prepared by Estelle Nma 12/02/2015 DRAFT Checked by Simon Smeathers 10/03/2015 Draft Approved by Jerome Baddley 10/03/2013 Final Version Control: Version number Purpose / Changes Author Date 3

4 Executive Summary This Sustainable Development Management Strategy (SDMP) has been developed in response to the NHS Carbon Reduction Strategy (2009) and the Sustainable Development Strategy for the Health, Public Health and Social Care System launched in January The strategies reinforced the urgent need for all NHS organisations to take action to reduce carbon emissions arising from their operations and embed sustainability within their strategies and cultures. The NHS, public health and social care system has set an ambitious goal to reduce carbon dioxide equivalent (CO 2 e) emissions across building energy use, travel and procurement of goods and services by 34% by Given the progress already made between 1990 and 2013 there is still a 28% reduction required to align with the Climate Change Act target of a 34% reduction by The SDMP has been developed to set out our vision for becoming a leading green and sustainable organisation, and our key drivers for implementing this vision. It is the framework on which we will effectively respond to the current and emerging environmental, social and economic challenges and risks posed by climate change. This SDMP highlights key areas of focus including: Organisational and workforce development Community engagement Partnerships and networks Adaptation Designing the built environment Sustainable models of care Procurement and supply chain Commissioning Low carbon travel Water Waste Energy and carbon management The CCG s 2013/14 carbon footprint has been used as the baseline on which this SDMP is developed. This baseline encompasses the direct and indirect emissions of healthcare delivery across the entire organisation. The organisation s corporate footprint is tonnes CO 2 e. This produces a per employee carbon footprint of 2.76 tonnes CO 2 e per full time employee per annum. The total organisation-wide carbon influence through contracts for commissioned healthcare services and procurement of non healthcare products and services is 52,926 tco 2 e. The direct and indirect corporate emissions are small in comparison to the impact of the CCGs supply chain through commissioned healthcare and non healthcare goods and services; however the CCG should try to demonstrate corporate leadership in sustainability, alongside encouraging sustainability through its significant leverage in the local healthcare community. To put these figures in context if the CCG were a country with a carbon footprint of 52kt it would put the CCG as about 197th of 198 nation states reporting annual CO 2 e emissions above Kiribati. 4

5 Having established this baseline, the CCG is committed to reducing the carbon emissions from its operations as far as practicable by 18% by 2020 and to supporting local healthcare providers to contribute to the national reduction target. To achieve the 18% reduction by 2020, the CCG needs to reduce its direct emissions in the areas excluding procurement to 71.73tCO 2 e a saving of 15.74tCO 2 e, this entails 2.6% reduction annually. Influencing reductions in emissions from supply chain, while excluded from UK carbon targets, is also included within the national targets advocated by the NHS Sustainable Development Unit. Baselining and evidencing an 18% reduction with quantitative data is more difficult in this area as detailed reliable annual figures on supply chain emissions are not available. From the snapshot of the CCGs leverage on its supply chain, through contract value; to achieve the 18% reduction by 2020 would require driving savings in the region of 180tCO 2 e from non healthcare suppliers and 9,345tCO 2 e from commissioned healthcare providers and suppliers. The table below shows how far the CCG must reduce its CO 2 e emissions for each primary emissions source and the absolute reduction required to meet this target from the baseline emissions. Annual emissions from natural resource use: Baseline Emissions (tco 2 e) Target Emissions Absolute Emissions Reduction Required (tco 2 e) (tco 2 e) Energy Waste Water Travel Total specific procured resources with quantifiable annual impact are worth identifying for particular focus and annual monitoring: Specific key resources Baseline Emissions (tco 2 e) Target Emissions Absolute Emissions Reduction Required (tco 2 e) (tco 2 e) Paper use Data use Unqualified as yet Unqualified as yet Unqualified as yet Total The process of achieving the 18% carbon emissions target from directly controlled resource use (non procurement and commissioning) will need to be monitored closely and reviewed annually by the Board with a rolling programme of actions associated to ensure reductions occur and the changes are sustainable. Total emissions from live contracts represents the full influence of the CCG, contracts over 25k represents the influence of the CCG through its largest individual suppliers. Both analysis methodologies will be been used to identify potential suppliers and contract types for focus. 5

6 Emissions influence from procurement and commissioning contracts represents the most significant level of impact: Area Baseline Emissions (tco 2 e) Live contract value (multi-year) Indicative Target Absolute Emissions Emissions Reduction Required (tco 2 e) (tco 2 e) Procurement 1, Commissioning 51,914 42,569 9,345 Total 52,925 43,399 9, contracts over 25k Procurement Commissioning 38,786 31,805 6,981 Total 39,496 32,387 7,109 The process of achieving the 18% carbon emissions target from non-directly controlled resource use through non healthcare procurement and healthcare commissioning is harder to evidence. Large public sector healthcare providers are required to comply with the DH and government targets, so should be working on achieving the same targets at a corporate level. The CCGs role here will be to support and encourage corporate progress, but also to include requirements in commissioning and service review that ensure that providers approach to emissions reduction penetrates all the way down to the service level, and through service design. To achieve the higher levels of emissions reduction required by the climate change act over time will require work on sustainable models of care, not just the same but more efficient. With non NHS and non healthcare providers the CCG will take a role in supporting and encouraging more consistent approaches to good environmental management and practice through demanding evidence of corporate approaches in commissioning and through systematically identifying key target sectors and contracts for focussed work on improved environmental sustainability. Qualitative and quantitative evidence on actions to drive sustainability through the supply chain through commissioning and procurement activity will be reported, with absolute carbon savings per contract or from providers detailed where possible. An definitive annual report on absolute emissions reductions from procurement towards the 18% target is not likely to be possible, due to the lack of resolution of the data and the fact that not all CCG providers report their own emissions annually, however where emissions savings have been identified from our providers, or through service innovation and redesign, these will be reported and celebrated within the CCGs sustainability report. The included Sustainable Development Action Plan (SDAP) sets out actions we will undertake to achieve our ambitious target of 18% carbon emissions reduction from our 2013/14 baseline in the year Included in this SDMP is the CCG s Environmental policy that demonstrates our commitment to preventing pollution and reducing the environmental impact of our activities, and our compliance with all relevant environmental legislation. 6

7 Environmental Policy Rushcliffe CCG recognises that in delivering and commissioning healthcare services, its activities may have adverse impacts on the environment and it is essential that these are minimised and maintained. We recognise that we should lead by example. As such, we are committed to reducing the environmental impact of our activities, and will comply with all relevant environmental legislation. We will expect a commitment to the same principals from our providers and suppliers. As part of the process, we have carried out an assessment of our activities and developed a set of objectives which are contained in the Sustainable Development Management Plan (SDMP). We will, as an integral part of our commitment to ensuring the health and well-being, do its utmost to ensure that its activities do not adversely affect the environment. To this end, it will: Meet or exceed all applicable laws, regulations and other requirements and assist in developing solutions to environmental problems Set challenging environmental targets, monitor and measure progress against these targets, reduce our carbon footprint and produce Sustainability Report annually to demonstrate our performance. Incorporate adaptation to extreme weather events into our business continuity plans. Help to preserve natural resources by developing and implementing strategies to: Reduce the unnecessary and wasteful use of resources including energy and water. Ensure that all purchased durable and non durable products are procured and used to maximum economic and effective value with minimum environmental impacts and maximum social value. Develop strategies and controls to protect the environment. Engage staff and ensure continuing support for environmental improvement. Implement and promote schemes to increase recycling and reduce waste Be aware of and manage where possible through efficient use and procurement the secondary impacts of products and services such as data use. In order to meet the above commitments, we have implemented and will operate an effective and accredited Environmental Management System (iie) and pursue continuous improvement through our review process In order to meet the above requirements through our commissioned services, establish and implement effective policies and practices in sustainable procurement and commissioning We will do all that is reasonably practicable, and considers it essential that all staff should work together and with clients and contractors and the local community positively to enable the CCG to comply with all Statutory Regulations and other guidance relating to energy, the environment and sustainability. This Policy and the obligations and responsibilities required by the Environmental Management System have been communicated to all employees. The Policy is available to the public upon request. The Chief Executive is the environmental champion responsible for implementing this policy within the organisation. Signed: 7

8 (Chief Executive and Environmental Champion) Review Cycle The different sections in this document will be reviewed as follows: SDMP document Action plans Environmental Policy Progress report Investors in the Environment (iie) Sustainability Report (SR) Every 3 years Quarterly Annually Bi-annually Annually Annually 8

9 Part 1: Sustainable development Management plan 1. Setting the scene 1.1 Introduction A Sustainable Development Management Plan (SDMP) is a board approved document that assists organisations to clarify their objectives on sustainable development and set out a plan of action. Sustainable Development and carbon management are corporate responsibilities. Clear governance provides an assurance process that considers requirements, both in terms of the law and to achieve high quality health and care. Demonstrating high quality health and care will be enhanced by embedding sustainable development into management and governance processes. This SDMP describes the national context, strategy, and policy; the commitments made by the NHS and set out how we as a CCG will operate in a sustainable way and sets some clear targets for measuring success over the coming years. This SDMP will help our CCG to: Meet minimum statutory and policy requirements of sustainable development Save money through increased efficiency and resilience Improve the environment in which care is delivered, for both patients and staff Have robust governance arrangements in place to monitor progress Demonstrate a good reputation for sustainability Align sustainable development requirements with the strategic objectives of the organisation Support and encourage providers and suppliers to improve the sustainability of their services. 1.2 Sustainable Development Sustainable development considers how we can live today without causing irreversible change that will threaten the lives and health of future generations development that meets the needs of the present without compromising the ability of future generations to meet their own needs Brundtland Report. In the health and care system, this means working within the available resources to protect and improve health now and for future generations. The case for sustainability in healthcare is clear. Taking action to become more sustainable can lead to cost reductions and immediate health gains. It helps us to develop a health system that is sustainable by reducing inappropriate demand, reducing waste and incentivising more effective use of services and products. Sustaining a modern health service therefore requires a strong link between the three tiers of sustainable development Economics, Environment and Society as depicted in Figure 1 below. 9

10 Figure 1: Sustainable Balance Climate Change Climate change refers to a change in the average state of the climate and is now recognised as potentially the most serious threat to life, our health, and our wellbeing in the 21st Century. 2 The UK Climate Projections (UKCP09) outlines the projected changes in the UK climate at a regional and national level. The projections are presented in 3 different future scenarios; low, medium and high. Under the medium emissions scenario the key impacts of climate change within the East Midlands Region by 2050 are expected to be: The average daily temperature in summer may increase by 2.5 o C The average daily temperature in winter may increase by 2.2 o C Average precipitation in summer may decrease by 16% while winter precipitation may increase by 14% As a result of the warming climate occurrences of extreme weather events will become more frequent. Climate change poses an urgent threat to human health, and the impacts are already being felt around the world. The declaration on climate change, health and wellbeing published at the Doha 1 Smith, L, Diaper, A-M, Wood, N, Taylor, C & Ross, H Sustainability and Transition Management Plan. NHS Midlands and East: MJWebb Associates Ltd. 2 Stern Review on the Economics of Climate Change, 2006, Cambridge: HM Treasury; Cambridge University Press 3 (Accessed: 16/10/2014)

11 Climate Summit in November 2012 provided a reminder that the impact of climate change on health is one of most significant measures of harm associated with our warming planet. Climate change is affecting human health in multiples ways through extreme weather events, food and water insecurity and infectious diseases. Protecting health should therefore be one of the most important motivations for climate action. 1.4 Sustainable Development and the Health & Care System Principle 1 of the Rio Declaration on Environment and Development states that; Human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature 4. In essence, a sustainable health and care system has to be instituted for human beings to live a healthy and productive life in harmony with nature. This sustainable health and care system is achieved by delivering high quality care and improved public health without exhausting natural resources or causing severe ecological damage. The NHS Sustainable Development Unit (SDU) has published the NHS Route map for sustainable health framework that outlines a number of transformational shifts required for a more sustainable health and care system. Creating a sustainable health and care system will require transformation and a new way of thinking. It envisages many shifts such as in the table below Figure 2: Route Map for Sustainable Health framework 5 In the health and care system, sustainable development means working within all the available resources to protect and improve health now and for future generations. In practice this requires us to: Focus on preventative, proactive care; Involve patients in the planning and design of services; /10/2014) 5 (Accessed: 20/10/2014) 11

12 Build resilience whilst protecting and developing community assets and strengths; Make the best use of scarce resources; Improve efficiency and reduce waste; Minimise carbon emissions. Sustainable health and care system can be categorised in three distinct ways: A Sustainable Health Sector: Involves greening the health sector with particular attention to energy, travel, waste, procurement, water, infrastructure adaptation and buildings. This ensures resources used in the health sector are used efficiently and responsibly. Sustainable Health Care: Involves working across the health system, and its partners, to provide health care that delivers on the triple bottom line i.e. simultaneous financial, social and environmental return on investment. It includes adapting delivery, increasing health promotion and more prevention, enhancing corporate social responsibility and developing more sustainable models of care. A Sustainable Health & Well-being way of living: Involves considering the sustainability of everything that impacts on health and well-being (e.g. education, employment, co-benefits of climate change, farming, banking etc). 1.5 Why the NHS? The NHS is the largest single employer in the UK, with approximately 1.3 million staff in England alone. NHS Staff hold a position of unique responsibility and are well respected within their local communities. This position presents them with a significant opportunity to positively influence public attitudes towards sustainable development. In 2008 the NHS Sustainable Development Unit carried out a consultation on carbon reduction within the NHS in England. The results showed there was a very strong willingness and commitment amongst NHS organisations and staff to take a lead in carbon reduction and sustainable development. 66% of NHS organisations responded to the consultation, with 95% of responders strongly supporting the NHS in taking a lead to act 6. A national public survey on sustainability in the NHS (commissioned by the SDU) revealed that 92% of the public have said it is important for the NHS to work in a more sustainable way 7. With 33% saying it should be done even if it will cost the health service money. The public s findings are supported by a survey conducted by RAND Europe 8, with more than 170 NHS leaders who detailed how sustainable practice can save their organisations money. Almost 9 out of every 10 leaders surveyed said they actively engage with sustainability and think it is important. The current 2012 carbon footprint of NHS England published in December 2013 is 25MtCO 2 e 9. This figure shows that there has been a 5.5% reduction in the last 5 years however; a further 4.5% reduction is required to meet the 10% reduction by It is also worth noting that the building energy use carbon footprint has increased by 0.9% since 2007 and will need concerted effort to reduce as patient activity is increasing. The carbon footprint is shown in the figure below depicting the CO 2 e baseline to 2020 with climate change targets. 6 Saving Carbon Improving Health: NHS Carbon Reduction Strategy for England (Accessed: 20/10/2014) 8 (Accessed: 20/10/2014) 9 (Accessed: 20/10/2014) 12

13 Figure 3: NHS England Carbon Footprint Clearly there is a desire both internally and externally for NHS organisations to become more sustainable, as well as there being a significant opportunity for the NHS to have an impact on the wider sustainability and climate change agendas both nationally and globally. 2. Rationale and drivers for change 2.1 Legislative Drivers Climate Change Act 2008 a long-term legally binding framework to reduce carbon emissions, mitigate and adapt to climate change. Legally binding national carbon targets and budgets are introduced, ultimately aiming to achieve at least an 80% reduction on 1990 level carbon emissions by the year Carbon Reduction Commitment Energy Efficiency Scheme (CRC) is a mandatory energy efficiency scheme introduced by government in It acts as a financial and reputational driver for healthcare organisations to instigate further carbon reductions and energy savings. This mandatory carbon emissions reporting and pricing scheme captures energy data from organisations using more than 6,000 MWh of electricity a year (equivalent of 500,000). In the first phase carbon allowances were charged at 12/tonne CO 2. For the second phase beginning in April 2014 allowances could be purchased at 15.60/tonne. The price of allowances is scheduled to increase with each phase and compliance year. Civil Contingencies Act 2004 requires all organisations to prepare for adverse events and incidents (including weather) by undertaking risk assessments, and to ensure Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements. The Social Value (Public Services) Act 2012 in force from 31 January 2013, requires all commissioners of public services to consider taking into account economic, social and environmental value, not just price, when buying goods and services. This means public bodies must look beyond the price of individual contracts and consider what the collective 13

14 benefit is to a community when a public body chooses to award a contract. It is primarily concerned with ensuring 'impacts', both positive and negative, are measured and accounted for. For the NHS, it reflects a more balanced approach when assessing outcomes, taking into account the wider benefits to the patient, the public and the community. HM Treasury Sustainability Reporting Framework the Government Financial Reporting Manual (FReM), the basis for NHS annual financial reporting, includes mandatory sustainability reporting. A sustainability template, to be included in NHS organisations annual reports, is available on the SDU website and may be adopted by the NHS Commissioning Board. The EU Energy Performance in Building Directive Recast - has translated into UK legislation requirements for publically displayed energy certificates in all public buildings over 500m 2. This will include buildings over 250m 2 by This includes all buildings used to deliver NHS services. Certain air conditioning units will become outlawed and unmaintainable by 2015 due to the polluting refrigerants they use. There are now legal requirements for regular maintenance and testing of heating and cooling systems. EU Directive on Public Procurement - A new EU Directive on public procurement was agreed in 2013 setting new rules for public bodies when purchasing goods and services, including clinical services. It includes a number of positive drivers for sustainable development. For example, a provision that a greater emphasis is put on considering environmental and social issues in public procurement. 2.2 NHS Policy Drivers NHS Carbon Reduction Strategy Saving Carbon, Improving Health - sets an ambition for the NHS to help drive change towards a low carbon society; setting a pledge for the NHS to become one of the leading sustainable and low carbon organisations by aligning NHS targets in accordance with the Climate Change Act. Furthermore, this strategy set an interim target for all NHS organisations to reduce emissions by 10% by NHS Constitution The NHS Constitution establishes seven key principles to guide NHS organizations. Principle six from the constitution states: The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves 10. Care Quality Commission (CQC) - responsible for ensuring high quality systems of care and safeguarding the rights of patients. The CQC judges that to be high quality, care must: Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people who use it Help to prevent illness, and promote healthy, independent living Be available to those who need it when they need it Represent good use of resources 10 (Accessed: 22/10/14) 14

15 All of these characteristics are inherent to a sustainable health service. The CQC, as part of its strategic planning, is considering how it makes environmental and public health an appropriate and meaningful part of its assessment criteria. Public Health Outcomes Framework The Outcome Framework for public health at national and local levels consists of five domains. The Health Protection and Resilience domain includes the indicator: Public sector organisations with board-approved sustainable development management plan 2.3 Local Drivers The Sustainable Communities Act 2007 (SCA) provides an opportunity for local people to ask central government via local government to remove legislative or other barriers that prevent them from improving the economic, social and environmental well-being of their area. The principal aim of this Act is to promote the sustainability of local communities by encouraging the improvement of the economic, social and environmental well-being of the area. The Local Government Act (2000) introduces a duty for local authorities to develop sustainable community strategies to promote or improve the social, economic and environmental well-being of their areas and contribute to the achievement of sustainable development in the UK. Nottinghamshire County Council has produced the sustainable communities strategy for The ambition of this vision will be achieved by focusing on the following areas: Economic success: - to create a mixed and vibrant economy, supported by an educated, skilled and flexible workforce and improved infrastructure Better quality of life: - committed to improving the lives of everyone in Nottinghamshire and will provide the leadership to ensure that this happens High quality environment: - to create sustainable communities which are able to access a wide choice of housing, leisure, sporting and cultural opportunities, and which are located in high quality environments in urban, suburban and rural settings Fair and sustainable communities: - to ensure full inclusion for all citizens by creating safe and healthy communities and a more prosperous county Obviously, the CCG has a huge role to play in developing sustainable communities within the County, particularly in respect to developing a healthy society where the vulnerable are supported and residents are empowered to make choices which improve their health and quality of life. 3. Carbon Baseline Performance 3.1 CCG Baseline Carbon Footprint NEP Energy Services Ltd was commissioned to produce an organisation-wide carbon footprint analysis to establish NHS Rushcliffe CCG baseline performance. This assessment encompasses energy in buildings; travel; waste and water; printing paper; procurement; data transmitted and commissioned services. The carbon baseline uses metrics from the financial year 2013/14. For the purposes of this SDMP, by procurement activity we mean non healthcare procurement and by commissioning activity we mean healthcare related commissioning and procurement (Accessed: 04/03/2015) 15

16 The organisation s corporate footprint is tonnes CO 2 e. This produces a per employee carbon footprint of 2.76 tonnes CO 2 e per full time employee per annum. The total organisation-wide carbon influence, including commissioned healthcare services and non healthcare related procurement is 53,022 tco 2 e. The direct and indirect corporate emissions are small in comparison to the impact of the CCGs supply chain through commissioned healthcare services and procured non healthcare goods; however the CCG should demonstrate corporate leadership in sustainability, alongside encouraging sustainability in through its significant leverage through the local healthcare community. The largest component of the organisation s emissions is indirect, from the supply chain; predominantly the commissioned healthcare services. This is expected from a CCG, as this forms the majority of the work carried out. It accounted for 98% of the total emissions, followed by the non healthcare procurement emissions accounting for 1.9%. Corporate footprint Source tco 2 e % Electricity % Gas % Water % Waste % Travel % Total The corporate CO 2 e footprint has been measured as tonnes CO 2 e covering Scope 3 emissions only. All emissions have been classed as scope 3 because the CCG does not own or control any of the properties they occupy or own or lease any vehicles. The CCG occupies Easthorpe House. This equates to approximately 2.76 tonnes per full-time employee. The composition of the corporate carbon footprint is broken down as follows: Gas use: tonnes CO 2 e, 57.8% of total corporate emissions Electricity use: tonnes CO 2 e, 34.4% of total corporate footprint. Travel: 6.39 tonnes CO 2 e, 7.3% of total corporate footprint Waste disposal: 0.16 tonnes CO 2 e, <1% emissions of total corporate footprint Water: 0.31 tonnes CO 2 e, 0.4% emissions of total corporate footprint Energy in Buildings The total environmental impact of Energy in Buildings is tonnes CO 2 e 16

17 To evaluate the carbon intensity of the organisation, usage has been benchmarked against CIBSE benchmark (typical practice for offices) by comparing the carbon emitted per m 2 from the building. This shows NHS Rushcliffe CCG is 9% less carbon intensive than CIBSE benchmark typical practice for Offices. The energy data was provided by the CCG which was taken directly from the meters. KgCO 2 e/m 2 from energy Typical Practice for offices Electricity Gas CIBSE Benchmark* NHS Rushcliffe CCG Waste Waste type Weight (t) tco 2 e Recycled waste Landfill waste Totals The recycling figure for the organisation is up to 85%; this comprises onsite recycling, recycling and energy recovery by the general waste contractors. The environmental impact arising from disposal of waste is 0.16 tco 2 e accounting for 0.2% of the organisation s corporate emissions. The waste generated across the organisation equates to 105kg per employee, approximately 1¼ times the weight of an average person. Travel The CCG currently only has good data for mileage form staff mileage claims. Taxi, train and other public transport data are not currently available. This is intended to be addressed in future to support the CCG in evidencing progress towards more sustainable travel options. Mode of travel Mileage (Km) Cost Direct tco 2 e Well To Tank, indirect tco 2 e Total tco 2 e 17

18 Car 27,826 7, Total Expenditure for all travel and transport is 15,227 The total environmental impact of car travel is 6.39 tco 2 e which accounted for 7.3% of the organisation s corporate emissions. Water The environmental impact of water supply and treatment has been assessed from building meter readings and represents a very small proportion of the corporate carbon footprint (0.31tCO 2 e 0.4%). Whilst only a small component, water costs are rising and sustainability of water supply is an increasingly important issue. We recognise the need to minimise wastage of this critical natural resource to manage costs and as an area of corporate social responsibility, and will continue to monitor this in the future. The water data was provided by the CCG which was taken directly from the meters. Organisation wide Footprint Paper Paper represents a significant proportion the organisations resource use footprint. The environmental impact of paper is significant because the pulp and paper production is one of the most resource-intensive and highly polluting of all manufacturing industries. Total emissions as a result of printing paper usage are 1.09 tco 2 e, meaning that the impact of this resource alone is greater than the sum of the impacts from our waste and water use. The paper data was provided by the CCG. Procurement and commissioning foot printing methodology For the purposes of this SDMP, by procurement activity we mean non healthcare procurement and by commissioning activity we mean healthcare related commissioning and procurement. Carbon foot printing procurement and commissioning activity is a far less precise and accurate process than that for direct corporate emissions. Without detailed emissions data from actual suppliers, procurement footprinting is a hotspot identification activity only. Factors convert from spent to tonnes carbon on industry averages and the most recent publically available factor sets are not regularly updated. Some of the CCGs providers, particularly larger healthcare providers, however do publish annual data in their own SDMPs and sustainability reports. Where possible we have used the data available from actual suppliers in the commissioning footprint to replace generic factors. These factors have been generated by dividing each organisations reported carbon footprint by its turnover from balance sheets. Footprinting methodologies in each case have been checked for consistency of approach and scope. The footprint however has been created from the CCGs live contract values (2013/14) and doesn t necessarily represent an annual figure, rather the baseline represents the CCGs total influence on emissions through its supply chain. 18

19 We have further analysed the annual expenditure on items over 25k from the 2013/14 data to drill down into more detail on larger areas of expenditure with significant individual providers. This work will be used to target action to work with providers on improving the sustainability of key services and contracts. Emissions based on live contract value: Area spent tco 2 e Procurement 5,437,726 1,012 Commissioning 152,688,911 51,914 Totals 158,126,637 52,926 Commissioned services: Provider Contract Value Emissions kg CO 2 e per turnover Tonnes CO 2 e Data source % of CCG Total contract value NOTTINGHAM UNIVERSITY Sustainability 33.7% HOSPITALS NHS TRUST 53,619,326 19,249 report NOTTINGHAMSHIRE COUNTY 0.34 Benchmarks 11.8% COUNCIL 19,310,868 6,566 NOTTINGHAMSHIRE HEALTHCARE Sustainability 11.5% NHS TRUST 18,838,956 2,121 report CIRCLE NOTTINGHAM LTD 0.34 Benchmarks 4.9% 7,970,962 2,710 SHERWOOD FOREST HOSPITALS 0.34 Benchmarks 3.2% NHS FOUNDATION TRUST 5,230,816 1,778 Services commissioned through 0.34 Benchmarks 2.6% NHS NOTTINGHAM CITY CCG 4,243,098 1,443 AMG NURSING & CARE SERVICES 0.34 Benchmarks 1.7% 2,793, EAST MIDLANDS AMBULANCE Sustainability 1.4% SERVICE NHS TRUST 2,268, report TOTAL 114,276,466 35, % The above contractor list represents 70.8% of the CCGs live contract value. As a default emissions from specific contracts have been calculated using the DEFRA 2009 benchmark emissions factor for the health and social care sector of 0.34kg/ spent. Where available this calculation has been improved using the specific years reported emissions of each organisation divided by the organisation gross revenue income in that year. In each case the total emissions include all scope 1,2 and 3 emissions from direct resource use and procurement. Over time the CCG will aim to increase the number of its providers publically reporting their actual annual emissions, the CCGs reported impacts will be updated annually accordingly. While the specific contracts above show a clear group of providers that make up the large part of the CCGs supply chain, there is also a large cohort of specific contract types throughout the full contract list that could be viewed as single area of focus for work. For example the total commissioned work from care homes. 19

20 While each individual payment to an individual care home falls under 25k and individual care homes can have a contract worth around 500k. The aggregate value of contracts with care homes, nursing homes and residential care would places this group of contracts in the top 10 on value. The CCG will evaluate showing areas such as care homes as a single entry to reflect the significant aggregate impact from this type of contract. Procurement: The procurement carbon factors used for this assessment were taken from the DEFRA 2009 Standard Industry Codes (SIC) supply chain carbon factors. Financial data from energy, travel, waste and water are excluded from this approach to prevent double accounting, however all other expenditure is assessed to calculate supply chain emissions from extraction, processing, manufacturing, packaging and transportation of the goods and services purchased. See Appendix B for the carbon factors used. Total procurement emissions split by the SIC descriptions are 1,012 tco 2 e. The highest contributors are Computer services (45.25%), Legal, consulting and other business activities (28.22%), Rent (12.46%) and Stationery (6.65%) Sic Description Spend tco 2 e % of CO 2 e emissions Computer services 2,289, % Legal, consultancy, other business activities 1,679, % Rent 1,051, % Stationery 86, % Banking and finance 234, % Printing matter and related services 52, % Travel and transport (excluding car travel) 10, % Education 23, % Hotels, catering, and hospitality 6, % Communications 3, % Postage % Total 5,437,726 1,012 20

21 Detailed analysis of spend over 25k: Further to the contract values provided, the CCG published detailed analysis on all direct spend in this amounted to 4,425,973 in procured non-healthcare goods and services with carbon emissions of 710 tco 2 e and 124,606,600 in commissioned healthcare services with carbon emissions of 38,786 tco 2 e, 81.6% of the total contract value held by the CCG A further detailed analysis of this spend has been carried out in order to identify carbon hotspots areas in more resolution. Where possible supplier reported carbon emissions for the same period have been used. For this reason the footprint for the detailed analysis shows as lower than the footprint in the overview. With the dataset for spend over 25K, the total spent on commissioning and procurement is 129, with total carbon emissions of 39,496 tco 2 e. The top six suppliers have been identified following this analysis. The total spent with these 6 suppliers accounted for 83% of the total spent. The most carbon intensive area is acute commissioning, accounting for over 42% of total carbon emissions as a result of commissioned activities. Three out of the six most significant suppliers have published their organisational footprint in their annual report and their total turnover. With the information provided, we have calculated the carbon intensity of those suppliers on the basis of tco 2 e/ K spent, this is given in appendix C. 21

22 Supplier Spend % of total tco 2 e over 25K spend NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 53,027, % 19,059 NOTTINGHAMSHIRE HEALTHCARE NHS TRUST 18,627, % 2,097 NOTTINGHAMSHIRE COUNTY COUNCIL 17,329, % 5,892 CIRCLE NOTTINGHAM LTD 5,303, % 1,803 SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST 4,754, % 1,617 Services commissioned through NHS NOTTINGHAM CITY CCG 4,217, % 1,434 Total 103,260,256 83% 31,903 A further breakdown is shown below indicated the expense areas in these top 6 suppliers. The most carbon intensive area is acute commissioning. Supplier 22 Spend % of total spend tco 2 e NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 53,027, % 19,059 ACUTE COMMISSIONING 52,498, % CHC ADULT FULLY FUNDED 26, % CHC ADULT JOINT FUNDED 134, % CHC CHILDREN 278, % OXYGEN 34, % RECHARGES 54, % NOTTINGHAMSHIRE HEALTHCARE NHS TRUST 18,627, % 2,097 CEO/ BOARD OFFICE % CHC ADULT FULLY FUNDED 3, % CLINICAL ASSESSMENT AND TREATMENT CENTRES 42, % COMMUNITY SERVICES 9,382, % MENTAL HEALTH CONTRACTS 9,043, % MENTAL HEALTH SERVICES - OTHER 154, % NOTTINGHAMSHIRE COUNTY COUNCIL 17,329, % 5,892 CHC ADULT FULLY FUNDED 225, % CHC ADULT JOINT FUNDED 10,463, % CHC CHILDREN 859, % COMMUNITY SERVICES 329, % FUNDED NURSING CARE 4,825, % PROGRAMME PROJECTS 626, % CIRCLE NOTTINGHAM LTD 5,303, % 1,803 CLINICAL ASSESSMENT AND TREATMENT CENTRES 5,303, % SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST 4,754, % 1,617 ACUTE COMMISSIONING 2,676, % NON RECURRENT PROGRAMMES 33, % PROGRAMME PROJECTS 245, % RECHARGES 1,800, %

23 Services commissioned through NHS NOTTINGHAM CITY CCG 4,217, % 1,434 CHC ADULT FULLY FUNDED 37, % CLINICAL ASSESSMENT AND TREATMENT CENTRES 3,183, % NON RECURRENT PROGRAMMES 68, % OUT OF HOURS 928, % Total with top 6 suppliers 103,260,256 83% 31,903 Total 124,606, % 38, Good Corporate Citizenship (GCC) The current version of the Good Corporate Citizenship (GCC) assessment tool has been developed by the NHS Sustainable Development Unit (SDU) as a methodology for NHS organisations to measure and monitor their progress towards sustainable development. The tool provides organisations with the means to monitor progress on the less easily quantifiable aspects of sustainable development in financial, social and environmental terms. Using the GCC tool is one of the four corporate requirements of the NHS Carbon Reduction Strategy. The GCC tool encourages users to assess their performance over 8 sections and scores progress in three categories; getting started, getting there, excellent. The GCC tool is designed to be used annually for monitoring and reporting on progress. The results of each assessment are made public and can be viewed by other registered users of the tool. The Areas Assessed Under the GCC Tool Travel Procurement Facilities Management Workforce Community Engagement Buildings Models of Care Adaptation In the coming years the CCG plans to use the GCC tool in conjunction with the carbon footprint established above as the key metrics by which it will measure the impacts from the implementation of this plan and by extension its progress towards sustainable development. 4. Sustainability Vision The CCG has adopted the vision for sustainability as published in the NHS Sustainable Development Strategy 12 : A sustainable health and care system works within the available environmental and social resources protecting and improving health now and for future generations. This means working to reduce carbon emissions, minimising waste & pollution, making the best use of scarce resources, building resilience to a changing climate and nurturing community strengths and assets. 12 NHS SDU (2014): Sustainable, Resilient, Healthy People and Places: A Sustainable Development Strategy for the NHS, Public Health and Social Care System. Available at: (Accessed: 15/12/2014) 23

24 4.1 Sustainability Objectives The CCG has identified the following key areas of sustainability as being relevant to its operations. Leadership, engagement and development Healthy, sustainable and resilient communities Sustainable clinical and care models Procurement Carbon Management NHS Rushcliffe CCG has developed the following aims for each of the key focus areas identified above. Key Topic Areas of Sustainability Corporate vision and for sustainable development Leadership, engagement and development Healthy, sustainable and resilient communities Sustainable clinical and care models Commissioning and Procurement Specific Areas of Organisational Aims Focus for CCG Put in place governance processes to ensure that sustainability is embedded throughout all levels of the organization and within all relevant policies and procedures. Organisational and workforce development Community engagement Partnerships and networks Ensure that staff at all levels are aware of the sustainability agenda and how it applies to their roles and support staff with the appropriate skills and understanding to fully integrate sustainability throughout the organisation. Engage with patients, service users and local communities in a clear and transparent way to develop services which fit their needs and which can be delivered in a sustainable manner. The CCG will develop its position as regional leader in sustainable development practices and expertise and encourage collaboration with other public sector bodies within the region to work together to tackle local sustainability issues. Adaptation The CCG will work to understand the health and wellbeing implications of current and predicted future climate change in the region and will develop plans to adapt its services to meet this change. Designing the built environment Sustainable models of care Procurement and supply chain Ensure that new developments are designed with sustainability and energy efficiency in mind and to promote health, wellbeing and resilience to climate change throughout their operation. Investigate opportunities for different methods of delivering care including designing services around end users and focusing on prevention and health improvement. Embed the principles of sustainable procurement, whole life cycle and responsible sourcing approach, in the specifications and procurement of goods and services. Commissioning Ensure that Sustainability and social value is optimised in the commissioning cycle, built into the process from the outset and then embedded into all subsequent stages 24

25 Carbon Management Low carbon travel Promote the uptake of low carbon travel alternatives for all travel associated with the CCG s operations, including staff and visitor commuting. Water Ensure the efficient use of water as a precious natural resource across the CCG s estate. Waste Reduce the quantity of waste produced from the CCG s operations and identify sustainable disposal methods for all waste streams. Energy and carbon management The CCG aims to become a leader locally, in the provision of energy efficient, low carbon public services and to reduce carbon emissions from its services in line with national targets. 5. Sustainable Development Target The NHS Good Corporate Citizenship assessment tool is recognised as an excellent method for assessing the less easily measured aspects of becoming a sustainable organisation. The CCG will use this methodology to monitor and record its progress towards becoming a sustainable organisation alongside the carbon reduction target established in the previous section. Within the next year Rushcliffe CCG commits to using the GCC assessment tool to monitor its sustainability progress and this assessment will be reviewed annually. The CCG will write an internal procedure for attachment to this SDMP to ensure that the GCC assessment tool is completed as fully and accurately as possible and reviewed on an annual basis. The CCG will report the results from the GCC assessment in its annual sustainability reports and will endeavour to benchmark its progress against other CCG organisations. 6. Carbon Reduction Target 6.1 UK Carbon Budgets To ensure that regular progress is made towards the 2050 target the Climate Change Act establishes a system of five-yearly carbon budgets. These budgets are published by the Committee on Climate change. The first four carbon budgets, leading to 2027, have been set in law. The UK is currently in the second carbon budget period ( ). Meeting the fourth carbon budget ( ) will require that emissions be reduced by 50% on 1990 levels in Budget Carbon Budget Level % Reduction Below 1990 Base Year 1 st Carbon budget ( ) 3,018 MtCO 2 e 23% 2 nd Carbon budget ( ) 2,782 MtCO 2 e 29% 3 rd Carbon budget ( ) 2,544 MtCO 2 e 35% by th Carbon budget ( ) 1,950 MtCO 2 e 50% by

26 6.2 NHS Carbon Reduction Target In the NHS Carbon Reduction Strategy (2009) the NHS SDU plots the carbon reduction trajectory required for the NHS to meet the targets set out in the Governments Climate Change Act (2008). The Act sets legally binding targets for the UK to meet and the NHS will play a vital role in helping the country to achieve these targets. This trajectory is shown in figure below. Figure 4: NHS England CO2 Emissions from 1990 to 2020 with Climate Change Act Targets Given the progress already made between 1990 and 2013 there is still a 28% reduction required to align with the Climate Change Act target of a 34% reduction by The baseline period for the CCG is 2013/14; this has been used as the baseline period for its emissions target. 6.3 CCG Carbon Reduction Target Taking in to account the national and NHS specific carbon reduction targets described above NHS Rushcliffe CCG has established the following carbon reduction target for its operations: NHS Rushcliffe CCG commits to reducing the direct CO 2 e emissions from its operations by 18% by 2020 against the 2013/14, this is lower than the baseline NHS Target in recognition that the CCG currently occupies a grade 2 listed building The aim of this SDMP and the included action plan is to help the CCG to meet this target and in the course to become a more sustainable and efficient organisation. In order to project the absolute carbon emissions reductions needed to meet the target a Business as Usual (BAU) emissions scenario has been developed. The reduced emissions scenario has then been plotted as a linear pathway from 2013/14. The UK is committed to legally binding greenhouse gas emissions reduction targets of 34% by 2020 and the decarbonisation of electricity generation will 13 NHS SDU (2014): Sustainable, Resilient, Healthy People & Places: Module, Carbon Hotspots. Available at: (Accessed: 03/12/ 2014) 26

27 tco 2 e form a major part of this reduction. The UK has projected future grid carbon intensity which has been factored in this scenario, as a result, reductions in BAU emissions Carbon Reduction Target Target BAU / / / / / / / /21 Figure 5: NHS Rushcliffe CCG 2020 Carbon Reduction Target The graph above demonstrates the carbon emissions reductions which are required to take the CCG from a BAU scenario to one in which the 2020 target is achieved. The table below shows the levels to which the CCG must reduce its CO 2 e emissions for each of its primary emissions sources and the absolute reduction required to meet this target from the baseline. To visibly demonstrate its commitment to corporate sustainability the CCG will maintain a membership of the local Investors in the Environment network run by NEP. The network forms the core of the Local Enterprise Partnership s Low Carbon Hub and supports members in reducing emissions. The network also facilitates collaboration between procurers and suppliers to drive down carbon emissions in products and services. 27

28 7. Sustainable Commissioning and Procurement Rushcliffe CCG commits to working with its suppliers and providers to encourage and support them to report annually to NHS standards and reduce their emissions in line with the national NHS targets. Commissioning for Sustainable Development is the process by which commissioners improve both the sustainability of an organisation, and the way it provides services and interacts with people in the community 14. It is about striking the right balance between the three key areas of financial, social and environmental sustainability when making commissioning decisions. Commissioning for Sustainable Development: Saves money Saves resources, and Benefits staff and patients The CCG will use commissioning processes including service design, business case assessment, service specifications, service review, tendering, contracting and contract management to increase sustainability at the same time as improving quality. Good quality healthcare, delivered by sustainable providers, at the right time and in the right place to the right person, reduces the use of resources, carbon and improves sustainability. The CCG will evidence annually through its sustainability report, progress in increasing the level of carbon reporting in its supply chain. The CCG will also evidence specific work undertaken with suppliers and providers to reduce those impacts. 14 Sustainable Development Unit and Royal College of General Practitioners A Guide to Sustainable Development for Clinical Commissioning Groups. Cambridge: SDU (Accessed: 15/12/2014) 28

29 8. Sustainable Development Action Plan (SDAP) The CCG has developed a sustainable development action plan that sets out priorities and actions for delivering the organisation s sustainability objectives. This action plan will assist the CCG towards becoming a good corporate citizen, making a significant contribution to the health and sustainability of the communities it serves. High Medium Low Completed SDMP Objective Action Reasons for Action Action Owner Area of focus: 1. Overall Corporate Vision and for Sustainable Development Put in place governance processes to ensure that sustainability is embedded throughout all levels of the organisation and within all relevant policies and procedures. 1.1 Embed sustainable development into Business Plans, Board Assurance Frameworks, commissioning frameworks, annual reporting requirements To ensure that the CCG embeds sustainability into its policies and procedures and accountability is clear Metrics to measure performance TO BE COMPLETED Timeframe March 2016 Priority Medium Progress/ Comment 29

30 1.2 Sign up and commitment to regularly completing the Good Corporate Citizenship (GCC) Assessment Model To demonstrate commitment and ensure progress can be tracked Complete the GCC assessment model annually. Achieve a score of at least 50% in each topic area by 2016 Annual Medium Area of focus: 2. Leadership, engagement and development Leadership: 2.1 Nominate a board level Ensure that leaders executive and at all levels have operational leads for engaged widely and sustainability developed a narrative for sustainable on SD development that aligns visions, priorities and delivery 2.2 Share success stories and develop a clear organisational vision statement for sustainability with staff To ensure senior management is fully engaged and committed to the sustainability visions and benefits of focus TO BE COMPLETED Nominated leads TO BE COMPLETED March 2015 Annual Medium Completed. Vicky Bailey, Chief Officer is lead for Sustainability 2.3 Report progress on sustainability in the organisation s annual report. To demonstrate compliance to the SDU mandate Use Sustainability Reporting Template Annual Medium 30

31 2.4 Maintain Investors in the Environment (iie) accreditation 2.5 Integrate leadership programmes in organisational development plan to promote sustainable leadership competencies To demonstrate clear commitment to improving the environment To promote Sustainable leadership competences from SDU website Present progress to Management and Staff biannually Workforce section of the Good Corporate Citizen (GCC) assessment model Annual March 2016 Medium High Staff development: Ensure that all staff are aware of the benefits of acting sustainably and have the competencies and skills to implement sustainability initiatives 2.6 Introduce SD as part of the induction programme for all staff 2.7 Raise awareness amongst key staff on commissioning, environmental awareness, waste and carbon and energy management and sustainable procurement 2.8 Communications campaign to increase awareness on how individuals and the To embed sustainability as a corporate requirement from day one To ensure that opportunities for reduction in carbon emissions are optimised and SD is embedded at key levels of the organisation To ensure accountability and joint CCG/staff % of staff who have received training on sustainability Workforce section of the Good Corporate Citizen (GCC) assessment model Campaign communicat ed June 2015 June 2015 Oct 2015 High Medium Medium 31

32 Role of partnerships / Networks: Organisations can consolidate partnership and make use of its leverage within local frameworks organisation can help contribute towards the reduction of carbon emissions 2.9 Work with our HR to include sustainability in job roles and responsibilities 2.10 Introduce a Green suggestions system to encourage staff to feed in sustainable ideas for consideration 2.11 Hold annual sustainability awards to recognize the most environmentally and socially sustainable team/ department 2.12 Apply for national sustainability awards 2.13 Encourage development of SD in Local Strategic Partnerships and publicise the CCG s Plan e.g. Continue to attend Nottinghamshire Community Sustainable Network responsibility is in place and to monitor progress To embed sustainability as a corporate requirement from day one For staff engagement For staff engagement and encouragement For recognition on the achievements To engage, encourage and learn from key partners Inclusion in contracts Implementat ion of system as part of campaign June 2015 Oct 2015 High Low Awards Annual Low Partnership and Planning section in Community engagement section of the Good Corporate Citizen (GCC) When appro priate Ongoing Low Low 32

33 2.14 Review potential for improved SD interaction with local bodies/ partners including economic forums To act as exemplar and share with good practice Area of Focus: 3. Healthy, Sustainable and Resilient Communities Risk Assessment: Assessing climate change risks to the organisation is an important first step in developing an adaptation plan E.g. Current and future risks to the organisation from changing times and climates are understood and minimised 3.1 Ensure that sustainability is included in the CCG business continuity plan and addressed as a regular issue at board meeting 3.2 Identify risks and opportunities to health and wellbeing in the TO BE COMPLETED TO BE COMPLETED local area, e.g. by using UKCIP climate projections tools 3.3 Consider the use of Climate Ready BACLIAT TO BE COMPLETED with Helen Ross assessment model Partnership and Planning section in Community engagement section of the Good Corporate Citizen (GCC) assessment model Risk Assessment in Adaptation section of the Good Corporate Citizen (GCC) assessment model Organisation al Risk register Environment Agency/UK Dec March 2016 Oct 2015 Oct 2015 Low Low Medium Medium 33

34 Adaptation planning: Communities, services and infrastructures should be prepared and resilient to weather events and other crises E.g. Develop an organisational adaptation plan that links to business continuity and emergency planning processes tool to complement the process of assessing risks and opportunities associated with climate change locally 3.4 Engage with NHS Property Services to ensure assessment of the risks to continuity and assets (buildings, emergency services, vehicles and the supply chain for fuel, food and key products) 3.5 Involve business continuity and emergency planning colleagues in developing an Adaptation Plan as a corporate component of the SDMP. The adaptation plan should link to heat wave and cold weather plans, flooding, emergency preparedness and business continuity plans 3.6 Work with the local Health and Wellbeing Board to help mainstream climate change adaptation This will help the CCG fully understand and manage the risks associated with climate change and how adaptation can be built into organisational processes. Adapting to climate change and particularly the health and with Helen Ross Climate impact Project (UKCIP) Tools Adaptation section of the Good Corporate Citizen (GCC) assessment model Adaptation section of the Good Corporate Citizen (GCC) assessment model Adaptation section of the Good Corporate March 2015 March 2016 March 2016 High High High 34

35 and resilience planning across the health and social care sector 3.7 Engage local communities in resilience planning for climate change adaptation social care impacts requires a cross sector approach from public, private and voluntary sector organisations. Achieving this type of approach at a regional level is paramount to the success of adaptation planning. The Health and Wellbeing Boards could provide a helpful focus for local level resilience planning across health and social care via the statutory health and wellbeing strategies. A broad approach to understanding social vulnerability is required which considers a range Citizen (GCC) assessment model March 2017 High 35

36 Designing the built environment: Built environments can be designed to encourage sustainable development and resilience to a changing climate in every aspect of their operation. e.g. The entire environment in which 3.8 Report adaptation plan progress in the CCG s annual report 3.9 Influence NHS Property Services and providers to consider opportunities for improved access and increased green space in health and care organisation grounds 3.10 Engage with NHS Property Services and providers to gain of factors including, but not limited to, age, economic deprivation, social isolation and health. Many people labelled as vulnerable, including older people, can contribute significantly to resilience planning. This will ensure organisational accountability for progressing planned adaptation actions. Inclusion in Sustainability Report Environment Agency/ UK Climate March 2016 March 2016 March 2016 High Low Low 36

37 our organisation delivers care will be low carbon, promote wellness and be resilient to changes in climate. assurance on risk assessments carried out on buildings to ensure they are resilient to projected changes in climate and weather extremes 3.11 Influence NHS Property Services and providers to refurbish buildings to reduce their carbon impact beyond regulatory minima impact Project (UKCIP) Tools Buildings section of the Good Corporate Citizen (GCC) assessment model Dec 2016 Low Area of Focus: 4. Sustainable clinical and care models Service Redesign: The 4.1 Include environmental design of more and social sustainability integrated care assessments on services provides a business case and great opportunity for service redesign developing services in templates a way that also delivers 4.2 Review models of care wider societal and and patient pathways environmental benefits taking into account the e.g. Transformation of use of resources and our Service delivers carbon footprint, to improved health identify where outcomes coupled with resources are used and social and can be reduced environmental benefits 4.3 Consider most appropriate service locations to minimise Oct 2015 Dec 2015 Dec 2015 Medium Medium Low 37

38 patient and staff travel and facilitate access, including use of mobile technology or telephone clinics. Area of Focus: 5. Commissioning and procurement Procurement carbon 8.1 Embed sustainability in emissions: Embed the the CCG procurement principles of sustainable policy and apply the procurement, whole life principals of the Social cycle and responsible Value Act 2012 when sourcing approach, in the procuring specifications and procurement of goods and services. 8.2 Review existing impacts of goods and services and identify 2 areas annually to Procuring more sustainably optimises resource use throughout the organisation and saves on both disposal and procurement costs. Considering the Social Value Act 2012 when procuring will create a more sustainable supply chain which will improve resource efficiency thereby reducing future procurement costs Targeting the areas of highest spend will provide the Oct 2015 Oct 2015 High Medium 38

39 target for carbon reduction through carrying out whole lifecycle approach of the identified areas 8.3 Communicate sustainable procurement policy and long term plan to all relevant personnel including suppliers; specification writers; contract managers and stores departments 8.4 Conduct 3 yearly review and conduct assessment of procurement and commissioning 8.5 Proactively work with supply chain to support innovation and low carbon services e.g. encourage supply chain to engage with universities and to work with Low Carbon Hub (LEP) greatest opportunity for cost and efficiency savings. This ensures that they are given sufficient time to adapt to any changes to current practices and provide a specification against which they can develop their services This reviews the progress so far and highlights achievements made and prioritise target areas for the next 3 years Oct 2015 March Medium Low Medium 39

40 8.6 Engage with Low Carbon Hub (LEP)to identify how the CCG can support growth in the low carbon economy through sustainable public procurement 8.7 Promote and publicise sustainable procurement projects undertaken by the CCG through case studies at the Low Carbon Hub 8.8 Encourage/require suppliers to develop their own SDMP or have an EMS accreditation, such as investors in the Environment (iie) 8.9 Maintain up to date contracts database for procurement and commissioning featuring expiry dates and potential for extension; publicise this database and make it visible to the potential suppliers 8.10 Favour local businesses where possible within Oct March 2018 Medium Medium High 2016 Medium?? Does this mean with carbon footprint?? Medium 40

41 Commissioning: Ensure that Sustainability and social value is optimised in the commissioning cycle, built into the process from the outset and then embedded into all subsequent stages procurement regulations 8.11 Favour more environmentally friendly products on a Life cycle cost and impact basis, when choosing between comparable products 8.12 Integrate environmental impact to the evaluation principles used within the research evaluation and development principles ensuring this covers health, financial, social and environmental impacts 8.13 Ensure that sustainable commissioning is embedded into all contract/tender processes and is given a green weighting 8.14 Develop clear procedures on how the organisation complies with the Public Services (Social Value) Act Review commissioning processes such as service design and To enable the carbon cost of operations to be identifies and commitment to SD embedded To ensure that the CCG achieving sustainable Oct 2015 March 2016 Oct 2015 March 2016 Medium High High High High 41

42 Area of Focus: 6. Carbon hotspots Low carbon travel, transport and access: The emphasis is on providing low carbon service specifications to ensure proposals consider opportunities to improve sustainability at the same time as quality e.g. identify 2 services for deep-dive sustainability work and put aside funds to undertake full environmental impact review in partnership with providers 8.16 Include a sustainability/carbon impact assessment on business case templates 8.17 Outline how the organisation will enable small and medium-sized enterprises (SMEs), social enterprises and other enterprise models to participate in public service commissioning requirements 6.1 Assess environmental impacts in business cases for proposed new models of care targets March 2016 March 2016 March 2016 High Medium Medium 42

43 models of care by focussing on care closer to home, telemedicine, videoconferencing for meetings etc. 6.2 Review recurring business mileage expenditure and review recording and monitoring of travel 6.3 Reduce the level of carbon emissions from car usage by continuing to drive forward mobile technology solutions, enabling and encouraging teleconferencing e.g. using providers that have embedded sustainability in their business such as Questmark 6.4 Develop an active travel plan that promotes the use of public transport, cycling and walking e.g. engaging with Sustainable Travel Cooperative to assist in the development of the travel plan 6.5 Reduce the level of carbon emissions as a result of taxi travel or delivery by using low carbon taxi and courier organisation To identify costs and carbon impact To achieve carbon reduction and potential financial savings To achieve carbon reduction across the CCG s travel activities To achieve carbon reduction across the CCG s travel activities June 2015 Ongoing June 2015 March 2016 High High High High 43

44 Utilities: Ensure the efficient use of utilities and energy by measuring and monitoring its usage e.g. Reduce carbon emissions at least 2% this year Waste: Monitor, report and set targets on management of domestic (and where applicable clinical waste), including reduction and appropriate disposal of waste in medicines, 6.6 Develop a car share scheme for staff 6.7 Gain assurance from NHS Property Services and CHP to: i. ensure measuring and monitoring of utility and energy usage for the CCG ii. heating and airconditioning is environmentally is maintained to ensure best use of energy 6.8 Run a staff energy awareness campaign 6.9 Avoid the routine purchasing of bottled water unless clinically required 6.10 Provide recycling facilities in public areas and offices 6.11 Work with suppliers to reduce the amount of packaging products come in. To achieve carbon reduction across the CCG s travel activities To identify trends, anomalies and opportunities for reduction To capture opportunities from staff engagement 44 June 2015 March 2016 Oct 2015 March 2015 Ongoing Reduce availability of On- Low Medium High Low Low Low Low Achieved

45 food and ICT. Paper: printed papers for meetings 6.13 Reuse blank side of paper for scrap/note paper 6.14 Reduce the waste paper by continuing to drive forward mobile technology solutions, enabling and encouraging teleconferencing and paperless meetings 6.15 Ensure that all paper used by the organisation are 100% recycled paper or FSC paper To reduce the impact of these resources going Oct 2015 Ongoing Oct 2015 Low Low Medium 45

46 9. Climate Change Adaptation 9.1 What is Adaptation? Adaptation means responding to both the projected and current impacts of climate change and adverse weather events. Past and current global greenhouse gas emissions mean that the world is already committed to some level of future climate change, adaptation is required to address the resulting consequences. Adaptation for the health and care system is two-fold 15 : Climate change could negatively impact the physical and mental health and wellbeing of the UK population. The health and care system needs to be prepared for different volumes and patterns of demand. Climate change could impact the operational delivery of the health and care system. The system infrastructure (e.g. buildings, communications, emergency service vehicles, models of care) and supply chain (e.g. fuel, food, and care supplies) need to be prepared for and resilient to weather events and other crises. 9.2 Why is Adaptation Important The impacts of climate change are already being felt in the UK and these impacts will increase in the future. These impacts pose challenges to the CCG as it strives to fulfil its mission of commissioning health care services. It is vital the CCG anticipate and plan for future changes in climate and incorporate considerations of climate change into its operations to ensure they remain effective under future climatic conditions. Adaptation should therefore be addressed alongside mitigation actions to reduce carbon emissions in a twin-track approach to addressing climate change. Effective adaptation encourages better use of resources; can save money and can deliver wider health benefits too. For instance developing green spaces and infrastructure to help prevent overheating can help prevent flooding, save energy and promote biodiversity. It can also encourage people to go outdoors, be more active and promote mental well-being. 9.3 Climate Change Risk Assessment The Climate Change Risk Assessment for the Health Sector (2012) has analysed the risks and impacts of climate change on public health. The document identified over 40 direct and indirect risks for the Health Sector 16. These risks are broadly grouped into three thematic areas; population health and wellbeing, healthcare services, facilities and infrastructure and environmental health. From this original list the document identifies 9 risks which are the most significant to the health sector: Temperature mortality (heat) 15 NHS SDU (2014): Adaptation to Climate Change, Planning Guidance for Health and Social Care Organisations. Available at: (Accessed: 20/01/2015). 16 Hames, D. and Vardoulakis, S. (2012): Climate Change Risk Assessment for the Health Sector. Available at: (Accessed: 20/01/2015). 46

47 Temperature morbidity (heat) Temperature mortality (cold) Temperature morbidity (cold) Summer air pollution mortality/morbidity (ozone) Extreme weather event mortality (flooding and storms) Effects of floods/storms on mental health Sunlight/UV exposure Extreme weather event injuries (flooding and storms) The risk assessment also identified a number of climate change risks to other sectors which may be applicable to the health sector. These include: Urban heat island effect Overheating of buildings Effectiveness of green space Demand for heating Loss of staff hours due to high internal temperatures Cooling demand Population affected by a supply demand deficiency of water The organisation will use the risks identified in the UK Climate Change Risk Assessment (2012) as the basis for its adaptation activities and around which the organisation will develop its adaptation action plan, this is given in appendix D. Under the Civil Contingencies Act (amendments), the CCG is designated as Category 2 Responder to emergency situations. The Act requires the CCG to co-operate and share relevant information with other Category 1 and 2 Responders. We will develop a climate change adaptation action plan that will help us deal with incidents that affects our organisation. However there also exists substantial overlap between adapting to climate change and preparing for emergency scenarios as required under the Civil Contingencies Act For example the overheating of buildings and potential loss of staff hours due to overheating represents a significant business continuity issue and as such should be addressed under the EPRR plan. Where such overlaps occur the CCG will include the risks posed by climate change in its EPRR plan paragraph b (Accessed: 02/02/2015) 47

48 Part 2: Investors in the Environment (iie) Investors in the Environment (iie) is an Environmental Management System (EMS) accreditation scheme which offers support and promotion for organisations. It is designed to help the organisation save money by reducing waste and being more resource efficient. Scope of the Environmental Management System This section describes the Environmental Management System (EMS) implemented by the CCG from March 2015 and maintained thereafter. The scope of the EMS includes all activities that the CCG has direct control over. This includes: day to day business activities; and staff business travel. Environmental Policy The environmental policy which the organisation is committed to is given here. Resource Use The CCG has examined its activities and services to determine its impact on the environment and where possible the impact has been measured. The resource use and carbon footprint monitoring baseline has been set to 2013/14. The CCG occupies Easthorpe House. The CCG is a tenant and therefore does not have access to the meters. However, the meter readings will be obtained from the Landlords (NHS Property Services) on a quarterly basis. Electricity usage is for lighting, powering of electrical equipment and air conditioning. Gas is used for space heating. Water use is for domestic purposes only i.e. toilets, sinks, drinks and washing up etc. Readings for these resources will be obtained from the landlords on a quarterly basis. There is a recycling system in place. The weights of general and recycling waste will be obtained from waste contractors on a quarterly basis. The CCG uses a high volume of paper in carrying out its day to day activities, and this is monitored by the number of reams bought. This will be obtained from the finance team every quarter. The CCG business travel comprises of travel for meetings and conferences. The vast majority of travel was from grey fleet (use of private vehicles).the CCG will adopt and implement a travel plan that will be made available to all staff and visitors. This will ensure that all staff consider the environment when making decisions on business travel modes. Staff are encouraged to use teleconferencing for meetings wherever practicable. Targets NHS organisations have an obligation to reduce it carbon emissions by 28% in 2020 against 2013/14 figures to align with the Climate Change Act target of a 34% reduction by NHS Rushcliffe CCG commits to reducing the direct CO2e emissions from its operations by 18% by 2020 against the 2013/14; this is lower than the baseline NHS Target in recognition that the CCG currently occupies a grade 2 listed building. 18 NHS SDU (2014): Sustainable, Resilient, Healthy People & Places: Module, Carbon Hotspots. Available at: (Accessed: 03/12/ 2014) 48

49 To meet the above target, we are committed to reduce our environmental impact by at least 2.6% annually wherever practicable, however this is not always possible when using shared facilities. Action Plan: In order to meet the requirements of iie and meet the climate change Act target, the CCG has set an action plan on how to reduce the organisation s impact on the environment. These are given in the SDAP section above. The actions will be reviewed quarterly and update on the progress will be reported biannually to management team and the staff. As part of the iie accreditation, a further three essential actions are required. The CCG s essential actions are: Adaptation plan policy; Sustainable procurement policy and use of FSC or 100% recycled paper. Further details on these actions are also given in the SDAP. Monitor and report progress As part of our commitment for continual environmental improvement, we will monitor and report on our environmental performance annually in our organisation s Sustainability Report. This report will show our carbon footprint and steps taken so far to reduce our impact in the environment and the organisation s future plans. It will also show our performance against our baseline year. This report will be made available to the public through our annual report. Below is a summary of our organisation s carbon footprint baseline (2013/14) measured per full time employee. Source Usage tco 2 e Usage/FTE tco 2 e/fte Electricity (kwh) 53, , Gas (kwh) 238, , Water (m3) General Waste (tonnes) Recycling Waste(tonnes) Travel (Km) 27, Paper (tonnes) Total

50 Appendix A: Carbon Footprint Methodology The methodological approach used for this carbon accounting report is consistent with UK best practice as outlined by the recommendations of Environmental Reporting Guidelines: Including mandatory greenhouse gas emissions reporting guidance (2013). This adopts the key principles of the international GHG Protocol, enabling a transparent and consistent comparison with other organisational carbon footprints from around the world. Where this report commonly refers to carbon emissions, this should be understood as the broader definition of greenhouse gas emissions as the reporting process takes into account 6 key gases which contribute to climate change 19. With differing greenhouse gas potentials and therefore contribution to climate change, the impact of these gases are standardised through units of kg of carbon dioxide equivalent (kgco2e), which will be used throughout the accounting process. To differentiate the various carbon emitting elements and to help plan future carbon management initiatives, the areas analysed are categorised by Scope which describes how much control and influence an organisation has to reduce their emissions. Scope 1 (Direct emissions): Activities owned or controlled by your organisation that release emissions straight into the atmosphere. They are direct emissions. Examples of Scope 1 emissions include emissions from combustion in owned or controlled boilers, furnaces, vehicles, and emissions from chemical production in owned or controlled process equipment. Scope 2 (Energy indirect): Emissions being released into the atmosphere associated with your consumption of purchased electricity, heat, steam and cooling. These are indirect emissions that are a consequence of your organisation s activities but which occur at sources you do not own or control. BEST PRACTICE Scope 3 (Other indirect): Emissions that are a consequence of your actions, which occur at sources which you do not own or control and which are not classed as Scope 2 emissions. Examples of scope 3 emissions are business travel by means not owned or controlled by your organisation, waste disposal, or purchased materials or fuel 20. Source: Adapted from Page 36, DEFRA and DECC (2013). Guidance on how to measure and report your greenhouse gas emissions. Page 22 of Carbon Dioxide, Nitrous Oxide, Methane, Hydrofluorocarbons, Perfluorocarbons, Sulphur Hexafluoride 20 Also encompassed within the scope 3 classification are those indirect emissions relating to the extraction and processing of natural resources prior to the consumption of fuel. Therefore all scope 1 and 2 emissions have additional scope3 emissions associated which are included within the accounting process. 50

51 What s included? Scope Scope 3 Scope 3 Scope 3 Scope 3 Scope 3 Scope 3 Area of Emissions Electricity Gas for heating Waste Water Business Travel Paper The CCG does not have operational control of the building including the operation of the boiler system as the building premises is landlord operated and is shared by other tenants. For this reason all the CCG s emissions are classed as indirect emissions (Scope 3), and signifies an area where we can influence more efficient technologies and better management. Area of Emissions Description Emissions Factor* Electricity UK Grid Electricity KgCO 2 e per kwh Gas Gas KgCO 2 e per kwh Waste disposal Open/Closed Loop Recycling (various materials) 21 kgco 2 e per tonne Commercial and Industrial Waste: Landfill 199 kgco 2 e per tonne WEEE 21 kgco 2 e per tonne Water Water Supply 2010/ kgco 2 e per m 3 Water Treatment 2010/ kgco 2 e per m 3 Paper Primary material production KgCO 2 e per tonne Travel Car Kg CO 2 e per Km Taxi Train KgCO 2 e per Km KgCO 2 e per Km *Factors are inclusive of the Well To Tank (WTT) factors scope 3 emissions of extraction, refining and transportation of primary fuels to an organisation s site (or asset), prior to their combustion. 51

52 Appendix B: Procurement Carbon Factors SIC description Emission factor, KgCO 2 e/ spend Banking and finance 0.15 Communications 0.48 Computer services 0.2 Education 0.23 Hotels, catering, and hospitality 0.49 Legal, consultancy, other business 0.17 activities Postage 0.41 Printing matter and related services 0.36 Rent 0.12 Travel and transport 0.98 Stationery 0.78 Appendix C: Commissioning carbon footprint (Supplier Specific) Supplier tco 2 e/ K NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 0.36 NOTTINGHAMSHIRE HEALTHCARE NHS TRUST -Mental health 0.11 services EAST MIDLANDS AMBULANCE SERVICE NHS TRUST 0.17 Others

53 Appendix D: Health Sector Direct and Indirect Impacts of Climate Change 53

54 54