Scottish Health Technical Note Sustainable Development Strategy for NHSScotland 2012

Transcription

1 Scottish Health Technical Note Sustainable Development Strategy for NHSScotland 2012 February 2012

2 Contents page 1. Executive summary Introduction Background Context Scope Achievements to date Challenges Implementation Reporting A framework for sustainable development Good Corporate Citizenship - six key areas of action Travel Procurement Facilities management Workforce Community engagement Buildings Requirements for NHSScotland bodies Guidance on implementation of the requirements Establishing or using an appropriate management structure Appointment of a sustainability champion Establishing an Environmental Management System (EMS) Waste management officer Partnerships Sustainable development action plans Using the Good Corporate Citizenship Assessment Model Sustainable development-related reports and tools Appendix 1: National Performance Framework (National Outcomes) Appendix 2: Template for an SD action plan Appendix 3: The three climate change duties of public bodies Appendix 4: Acronyms and abbreviations References... 60

3 Acts and regulations: Publications: Tools: Other useful websites or information sources: Disclaimer The contents of this document are provided by way of general guidance only at the time of its publication. Any party making any use thereof or placing any reliance thereon shall do so only upon exercise of that party s own judgement as to the adequacy of the contents in the particular circumstances of its use and application. No warranty is given as to the accuracy, relevance or completeness of the contents of this document and Health Facilities Scotland, a Division of NHS National Services Scotland, shall have no responsibility for any errors in or omissions therefrom, or any use made of, or reliance placed upon, any of the contents of this document. Version 2.0: February 2012 page 3 of 63

4 Note on Strategic Environmental Assessment (SEA) In drafting the first sustainable development strategy for NHSScotland (published in April 2009), Health Facilities Scotland (HFS) considered the requirements of the Environmental Assessment (Scotland) Act After informal discussion with the SEA Gateway, HFS concluded that the strategy fell outwith the definition of plan, programme or strategy under the 2005 Act, as it formed non-restrictive guidance to NHSScotland bodies on how they could contribute to the delivery of the sustainable development objectives set by the Scottish Government. This remains our conclusion for this updated version of the strategy. Despite the above conclusion, NHSScotland bodies, when developing their own sustainable development action plans, will need to determine whether their individual plans fall within the scope of the 2005 Act and whether the actions they contain are likely to result in significant (positive or negative) environmental effects. Version 2.0: February 2012 page 4 of 63

5 1. Executive summary Our future ability to improve health and to provide healthcare services sustainably to Scotland s population is affected by the management and design decisions we take now. For this reason, today s decision-makers and managers have a significant opportunity, and a responsibility, to take appropriate decisions that consider sustainability fully, and to see that these are followed through consistently. In addition, the resulting actions will need to be monitored and reported simply and effectively. This will assist future reviews of progress to ensure the ongoing relevance of decisions taken and help to drive positive and continuous improvement. This strategy is issued alongside CEL 2 (2012), the 2012 sustainable development policy of the Scottish Government Health and Social Care Directorates (SGHSC). The strategy s purpose is to interpret and provide clear guidance on the requirements of CEL 2 (2012) for NHSScotland bodies. The strategy, along with the Good Corporate Citizenship Assessment Model (GCCAM), provides support and helps to establish a framework for meeting the challenges and requirements set by CEL 2 (2012). Their joint objective is to improve the sustainability of NHSScotland s activities, principally in the context of estates, property and asset management, but also to contribute to the overall purpose and wider strategic objectives of the Scottish Government (SG). This strategy is published as NHSScotland bodies are already responding well to the sustainable development agenda. For example, annual energy use in hospitals has reduced by 40% over the past 20 years. However, during the same period, annual expenditure on energy has doubled 1. Clearly, present rates of resource and energy consumption cannot be sustained, and further fundamental shifts in culture and behaviour are required. Unsustainable practices, whether in NHSScotland or elsewhere, often become visible as a range of negative financial, environmental, social and health impacts. The current austerity measures in all sectors, requiring immediate and ongoing budget savings, emphasise even more the essential need for a sustainable approach to all elements of healthcare service planning, management and delivery. To deal with the main sustainability challenges, NHSScotland will need the cooperation, support and expertise of its staff, other stakeholders and the public. Everyone working for the NHS in Scotland has a responsibility to manage resources effectively and efficiently. Above all, a sustainable NHS requires commitment and leadership from all NHSScotland Chief Executives to enact and enable the principles laid out in CEL 2 (2012). Section 2 of this strategy provides an overview of the background, context and scope of the strategy. It highlights the main challenges, progress, implementation and current reporting requirements for NHSScotland bodies. 1 Source: Annual National Environment Report 2009/10 Version 2.0: February 2012 page 5 of 63

6 The Good Corporate Citizenship Assessment Model for NHSScotland remains integral to the over-arching framework for delivering the policy requirements. Each of the six key areas of GCCAM is summarised in section 3, with brief but relevant facts, benefits and example strategies or activities. Section 4 provides a basic checklist of all mandatory requirements in CEL 2 (2012). Section 5 provides guidance on implementation of these mandatory requirements. It should be noted that each NHSScotland body s Chief Executive will be accountable to the SGHSC for his or her organisation s performance in respect of sustainable development. Version 2.0: February 2012 page 6 of 63

7 2. Introduction 2.1 Background In 2007, the Scottish Government set out its purpose as creating a more successful country, with opportunities for all to flourish through increasing sustainable economic growth. The government s approach to sustainable development is underpinned by five strategic objectives: i.e. a Scotland that is wealthier and fairer; smarter; healthier; safer and stronger, and greener. UK-wide, the stated goal of sustainable development is: to enable all people throughout the world to satisfy their basic needs and enjoy a better quality of life without compromising the quality of life of future generations. 2 For development to be sustainable, the economy, including service delivery, should provide for society s needs. This must be within the ecological limits or capacity of the environment to supply the resources needed, and for the environment to be able to recover. Unsustainable practices or negative impacts often become visible as: rising or unpredictable costs (for example through energy costs and maintenance backlogs); problems with supply (of goods or services); pollution (e.g. from the amount and types of waste discarded), and other types of environmental degradation (e.g. the loss of habitat and species), may have detrimental health and social consequences. The inextricable links between health improvement, healthcare provision and sustainable development are well understood, within which access to, and the condition of, the environment have fundamental roles. A healthy natural environment has a beneficial effect on both mental and physical human health. Conversely, many long-term illnesses are related, at least in part, to environmental triggers and to economic and social factors. Issues of social justice profoundly influence public health concerns, which are central to sustainable development. Social, economic, environmental and health inequalities often coincide, resulting in disadvantaged communities being disproportionately affected by pollution, poor air quality, and limited or no access to safe outdoor green spaces. Chapter 23 of the UK National Ecosystem Assessment provides evidence of the many direct and indirect relationships between the environment and a range of 2 Defra (2005). One future different paths. UK shared framework for sustainable development. Version 2.0: February 2012 page 7 of 63

8 health benefits 3. It includes the telling statistic that if 1% of the sedentary population moved to a healthy pathway, 1063 lives and 1.44 billion could be saved. There are clear messages here for society and public service budgets generally, and a small but important role that NHSScotland can play in improving access to and use of its own outdoor estate. Our future ability to improve health, and to provide healthcare services sustainably to Scotland s population, is affected by the management and design decisions we take today. For this reason, today s decision-makers and managers have a significant opportunity, and a responsibility, to take the right decisions and to see that these are followed through consistently. In addition, the resulting actions will need to be monitored and reported simply and effectively. This will assist future reviews of progress to ensure the ongoing relevance of decisions taken and to help drive positive and continuous improvement. 2.2 Context The scope of the 2012 sustainable development policy - CEL 2 (2012) - issued by the SGHSC to NHSScotland body Chief Executives focuses mainly on estates, property and asset management, although it draws attention to the need for effective consideration of the wider sustainability requirements. This strategy, which interprets and provides guidance on CEL 2 (2012), together with GCCAM, provides a framework for delivery of the policy s requirements. Both the policy and strategy attempt to streamline and rationalise a number of the existing HDLs and CELs that also address sustainability issues. Whilst a more comprehensive review of the monitoring and reporting requirements is required, as highlighted by the consultation process in June 2011, it is hoped that this strategy makes it simpler for NHSScotland bodies to continue to respond effectively to the vital sustainability agenda and to report their progress. As a public body, NHSScotland has a number of important duties which are integral to this strategy, and the policy from which it stems. Firstly, since 2002 NHSScotland has had a legal duty to contribute to the achievement of sustainable development under best value legislation 4. NHSScotland bodies are subject to the Best Value Guidance (updated in March 2011) for two reasons. Firstly, they are non-departmental public bodies sponsored by Scottish Government. Secondly, they have to comply with requirements set out in the Scottish Public Finance Manual. The updated Best Value guidance groups nine relevant characteristics for Public bodies into five specific and two cross-cutting themes. The five generic themes are: Vision and Leadership; Effective Partnerships; Governance and Accountability; Use of Resources; and Performance Management. The two cross-cutting themes which should underpin all activities and delivery of outcomes are: Equality, and Sustainability Version 2.0: February 2012 page 8 of 63

9 The best value requirements above are also consistent with the principles of equity, participation, empowerment and sustainability which underpin the Health Promoting Health Service 5 agenda. In turn, these link with the current policy focus on patient-centred care; a clean and safe environment and clinical excellence driven by the NHS Quality Strategy (2010) 6, which developed from the Better Health Better Care Action Plan (2007) 7 that focussed on improving public health and reducing health inequalities. Secondly, the Climate Change (Scotland) Act 2009 places three main duties on 8 public bodies. More detail on the scope of these duties is available and Appendix 3 of this strategy briefly outlines the duties and key issues, and indicates what NHSScotland is doing and still needs to do. In exercising their functions, NHSScotland bodies must act in the way that is: best calculated to contribute to delivery of the Act's greenhouse gas emissions reduction targets (referred to as mitigation) ; best calculated to deliver any statutory adaptation programme, considered most sustainable. Furthermore, all of NHSScotland s 14 territorial Boards and 8 special Boards are currently considered to be major players with respect to the public body climate change duties 9, owing to their large estate and staff numbers. Finally, under the Nature Conservation (Scotland) Act 2004, it is the duty of every public body and office-holder, in exercising their functions, to further the conservation of biodiversity so far as is consistent with the proper exercise of those functions. For the NHS in Scotland, this means it needs to protect and enhance wildlife species and habitats on its estate. Such actions can and should be consistent with other beneficial healthcare outcomes and opportunities on the estate, and some NHSScotland Boards are contributing to this through principles and initiatives linked to the Green Exercise Partnership. NHSScotland bodies have key (and in many ways, related) roles to play through these various duties, all of which contribute to the delivery of Scottish Government s five strategic objectives - wealthier and fairer; smarter; healthier; safer and stronger, and greener. The Scottish Government has allocated over 11 billion of funding to healthcare in 2011/12, about one third of its budget. The scale of NHSScotland and the challenges it faces are illustrated by the following statistics. NHSScotland: employs around 153,000 staff (June 2011), excluding GPs and dentists, approximately 25% of Scotland s public sector staff; Version 2.0: February 2012 page 9 of 63

10 has an estate comprising over 4.6 million m 2 of building floor area encompassing over 1,000 buildings / sites ranging in size from 40 m 2 to 200,000 m 2 ; had an estimated carbon footprint in 2004 of 2.63 million tonnes of carbon dioxide (MtCO2), representing 3.6% of Scotland s total carbon footprint and 23% of Scotland s public sector emissions. The main emission sources and approximate proportions of the 2004 CO 2 footprint were: buildings (23%); travel (24%), and procurement of goods and services (52%, half of which were from pharmaceuticals and medical equipment). In 2009/10, NHSScotland hospitals: 10 produced some 41,000 tonnes of waste, at a disposal cost of 8.8 million; used 5,809,706 gigajoules (GJ) of energy, at a cost of 64.4 million; used 5.27 million cubic metres (m 3 ) of water, with water and waste water charges of 9.2 million. 2.3 Scope The purpose of this strategy is to establish a clear approach to meeting the requirements of CEL 2 (2012) and to enable all NHSScotland bodies to coordinate their responses and activities within the specific asset management context (including estates, property and land). In addition, the wider sustainability challenges in CEL 2 (2012) and framework for implementation, for both the policy and the strategy, remains that set by the Good Corporate Citizenship Assessment Model. GCCAM focuses on six priority areas of travel; procurement; facilities management; community engagement; workforce, and buildings. Adopting the approach in this strategy will enable NHSScotland bodies to meet CEL 2 (2012) requirements and contribute to the wider strategic objectives of the Scottish Government. 2.4 Achievements to date This second sustainable development strategy for NHSScotland is published as NHSScotland bodies have responded well to the previous strategy 11 by putting in place appropriate governance structures and developing and implementing their preliminary Sustainable Development Action Plans (SDAPs). NHSScotland has lead by example and made good progress on some key 12 aspects of its sustainability performance. Achievements include : by , from a baseline of , NHSScotland hospitals have: reduced annual CO 2 emissions from energy use by 41.4%; 10 Source: Annual National Environment Report 2009/10 11 CEL 15/2009 ( 12 Source: Annual National Environment Report 2009/10 Version 2.0: February 2012 page 10 of 63

11 reduced annual energy use by 39.9% (a fall from over 9 million GJ per annum in to 5.8 million GJ in ); water consumption in hospitals has reduced from 12 million m 3 in to 5.3 million m 3 in Challenges Despite these achievements, present rates of resource and energy consumption cannot be sustained. Global population levels and demand for resources are increasing, and it is inevitable that future resources will be available at increased cost. despite reducing annual energy use in hospitals over 20 years by 39.9%, rising prices have caused annual energy costs to double in that time; inflationary pressures will increase the future cost of fuels and energy as well as other goods and services which need energy for manufacture and delivery. This will affect food, medicines, equipment and raw materials, effectively squeezing healthcare budgets further; a consequence of this is that supply chains and procurement processes will need regular review to ensure that they remain cost effective. Local supply may have some advantages. Challenges include: implementing plans effectively to mitigate risks from restricted resource availability, and from climate change impacts, which might affect service provision and health outcomes; this may include the ability to deal with disruption to energy supply, flood risk, and heat waves or cold spells where appropriate building temperatures must be maintained; addressing resource implications of demographics and population movements. For example, as we live longer, we will need to provide services for an ageing population. This may lead to transfer of investment to the public health agenda to help people remain healthy, avoiding them falling into ill health in the first place; fully incorporating life cycle costs and value into capital expenditure decisions; managing change in a large and complex organisation such as NHSScotland. To deal with these challenges NHSScotland will need the cooperation, support and expertise of all staff, other stakeholders and the public. Success will also be dependent on the awareness, commitment and leadership of senior staff. Version 2.0: February 2012 page 11 of 63

12 2.6 Implementation Everyone working for the NHS in Scotland has a responsibility to manage resources effectively and efficiently. This is why working to improve the sustainability of NHSScotland s activities will involve action at national, NHS body and site level. Figure 1, from CEL 2 (2012), illustrates this: Figure 1 The framework for implementation of sustainable development policy remains based on the Good Corporate Citizen Assessment Model (GCCAM) which is described in more detail in section 3 of this document. The GCCAM action areas remain the same, and will be those on which NHSScotland bodies should remain focused in terms of maximising their contributions to the achievement of improving sustainable development over the next 5-10 years. SGHSC and HFS have tried to streamline mandatory requirements and concentrate on using existing toolkits when developing this strategy. This is in order to keep the requirements and language as simple and familiar as possible for NHSScotland bodies, to facilitate sharing of information, and to avoid duplication of work. Section 4 of this strategy provides a basic checklist of the mandatory requirements contained in CEL 2 (2012). It indicates further sources of information, and provides a basic template that NHSScotland bodies could use or modify to track their progress on the requirements. Version 2.0: February 2012 page 12 of 63

13 Section 5 provides further specific guidance on implementation of some of the mandatory requirements, indicating useful information and national toolkits that are available. Implementing these requirements, and achieving a more sustainable NHS in Scotland, requires further fundamental shifts in culture and behaviour. It will take time and resources, however the benefits and savings from this investment should significantly outweigh the cost. Sustainable development requires an integrated approach, harmonising environmental, social and economic issues. NHSScotland organisations must provide leadership and commitment from the top. This means ensuring appropriate governance arrangements are in place, supporting behavioural change, and supporting the actions of departments and employees. Sustainable healthcare provision is not an added option or bolt-on when we can afford it. By definition, we cannot afford not to deliver or not to focus on a sustainable NHS. Success can be demonstrated by: fully and effectively integrating sustainable development priorities and considerations from the outset into business as usual practices, ensuring the sustainability of everyday actions in healthcare planning and delivery (it is worth re-emphasising that sustainability cannot be seen or treated as an add-on to our day jobs; it must be integral to everything we do); implementing a culture of continual improvement and best practice (i.e. moving beyond a culture of compliance with minimum standards); protecting and enhancing service delivery through financial savings, e.g. through energy efficiency, waste reduction, careful use of resources and more sustainable asset management; coordinating and fulfilling the organisation s public duties to contribute to the national target to achieve a 42% reduction in greenhouse gas emissions by 2020; to adapt to climate change, and to act sustainably; contributing to community cohesion, e.g. by utilising better, more active and healthier travel options and, where possible, supporting local economies, local employment and skills; capturing and promoting good practice lessons to ensure these can be replicated in other areas; minimising future operational, maintenance and refurbishment costs (this infers that robust life cycle costing and design assessment processes are in place); maximising the value of our built and outdoor estate, and increasing its flexibility of use; maximising the NHSScotland role as a good corporate citizen, thereby contributing to addressing common national and global sustainability challenges. Version 2.0: February 2012 page 13 of 63

14 2.7 Reporting Currently, NHSScotland bodies have a number of management tools to assist them to deliver on national policy requirements, and to report on the required range of issues and activities. The main environmental and asset management or estate-focused tools include: environmental Monitoring and Reporting Tool (emart); Statutory Compliance Audit and Risk Tool (SCART); Property Asset Management System (PAMS); National Performance Framework / HEAT targets / and a range of audits and inspections, including Healthcare Environment Inspectorate (HEI) audits; utilising Corporate GREENCODE to manage and measure environmental performance and environmental legal compliance. NHSScotland bodies also have a current requirement, under CEL 14 (2010), to have registered to use the Good Corporate Citizenship Assessment Model (GCCAM). They must also use its self-assessment test to check their wider sustainability performance. Responses to the consultation draft of this strategy in June 2011 highlighted the need to review the national monitoring and reporting requirements, and wherever possible, to streamline and simplify them. As indicated in the covering letter attached to CEL 2 (2012), SGHSC intends to review reporting arrangements, identify emerging requirements and to monitor the implementation and effectiveness of both CEL 2 (2012) and this strategy. This will require collaboration between NHSScotland bodies, NHS NSS, SG, and other key stakeholders as necessary. In February 2012, the Scottish Government released guidance to assist Scottish public bodies to report on sustainability alongside their annual reports and accounts, commencing with the financial year. It is targeted at all central government bodies in Scotland, including all Health Boards, which produce annual reports and accounts in accordance with HM Treasury s Government Financial Reporting Manual (FReM). It is understood that this guidance ( Public Sector Sustainability Reporting - Guidance on the Preparation of Annual Sustainability Reports ) is to be put on the climate change and public body/duty pages of the Scottish Government website. In advance of a monitoring and reporting review, CEL 2 (2012) has made the reporting requirements as flexible as possible. This is to allow for the different challenges faced by NHSScotland bodies, and to allow them to concentrate on progress through focussing more on effective planning and delivery, rather than on reporting effort. CEL 2 (2012) places two broad mandatory requirements on NHSScotland bodies to monitor and report their performance to the Scottish Government. Requirement 13 means each NHSScotland body must conduct a regular self- Version 2.0: February 2012 page 14 of 63

15 assessment of its sustainable development performance priorities and opportunities using GCCAM. Requirement 14 means each body must submit data directly to SGHSC (or via HFS), as and when required. The details of these are explored further in sections 4 and 5. Version 2.0: February 2012 page 15 of 63

16 3. A framework for sustainable development 3.1 Good Corporate Citizenship - six key areas of action The Good Corporate Citizenship Assessment Model for NHSScotland sets out six key areas of action. Utilising the GCCAM tool, and implementing Sustainable Development Action Plans, will help NHSScotland bodies to achieve enhanced sustainability outcomes, improve environmental performance, and make important and direct contributions to the strategic objectives of the Scottish Government. In this section, each of the six GCCAM areas is summarised with brief but relevant facts, an indication of benefits, and example activities that can assist NHSScotland bodies and managers to address cross-cutting challenges and opportunities such as greenhouse gas emissions, waste, and community benefits: Travel including journeys to, from, around and between sites by patients, staff and visitors; Procurement including equipment and food, and sustainable building materials; Facilities management including soft FM (catering, domestic, cleaning, laundry, portering, telecommunications and security services) and hard FM (planned, preventive and reactive building fabric and building services maintenance (mechanical, electrical, public health and fire safety), and biodiversity and land management; Workforce including staff training, retention and recruitment; Community engagement including health inequality and community consultation; and working with community partners on decision making; Buildings the design, refurbishment and construction of NHSScotland sites. The actions below are recognised good practice and are rooted in existing legal and policy requirements. In some cases, the actions mentioned here are already being delivered by NHSScotland bodies. This section is not intended to be a comprehensive guide covering all practical issues on the ground; rather, it is an indication of where to start. It should reassure staff already undertaking such actions, and energise others who wish to do more. Further references, and a more detailed list of activities and outcomes, can be found under the same topic headings on GCCAM s website - As compliance with mandatory requirements and implementation of performance improvements is not yet comprehensive or consistent across all NHSScotland bodies, a coordinated and sustained effort is needed to ensure greater emphasis on their delivery. A greater focus on delivery will enhance Version 2.0: February 2012 page 16 of 63

17 NHSScotland s contribution to the national outcomes sought under the Scottish Government s National Performance Framework (please see Appendix 1). 3.2 Travel: Travel choices have a wide range of impacts on the environment and quality of life. Active, green travel choices have clear health benefits. NHSScotland s travel policies can influence the behaviour of staff, patients, visitors and suppliers, reduce single-occupancy car travel and help reduce social exclusion. The Scottish Government aims to achieve almost complete decarbonisation of road transport by 2050, as outlined in the Climate Change Delivery Plan 13. As a public body, NHSScotland has a responsibility to support the Scottish Government in achieving this target 14. This means: implementing green Travel Plans, (wherever possible in collaboration with Local Authorities) in order to promote more sustainable travel choices; encouraging people to make active and sustainable travel choices where possible, such as walking and cycling, thereby contributing to health improvement and being consistent with the concept of a Health Promoting Health Service 15 ; ensuring that health services can be accessed by good quality footpaths and cycle routes, and effective public transport systems, and encouraging their use ahead of private vehicles, and especially to reduce singleoccupancy vehicle journeys; making sure that accidents, noise, pollution, congestion and CO 2 emissions are minimised through effective travel planning; providing facilities and working arrangements that reduce the need for travel and distances travelled, including tele- and video-conferencing and other IT solutions, and managing travel in ways that benefits communities, supports local economies and helps protect the environment. Some NHSScotland bodies may face particular challenges and require imaginative solutions to rationalise the requirement for decarbonisation of transport with the increasing needs of service provision where patients and staff 13 Scottish Government Climate Change Delivery Plan - Meeting Scotland s Statutory Climate Change Targets, June Low Carbon Scotland: Meeting the Emissions Reduction Targets Version 2.0: February 2012 page 17 of 63

18 need to access acute or specialist healthcare services in remote community settings. Facts in 2008, 274 people were killed and 2532 people were seriously injured in road accidents in Scotland. travel, including patient and staff transport, accounted for 24% of the NHSScotland carbon footprint in in 2007, there were 24 million face-to-face appointments with NHSScotland GPs and practice nurses. in 2003, 64% of men and 57% of women were found to be overweight in Scotland. in 2005, only 50% of men and 35% of women in Scotland achieved the recommended levels of physical activity. Potential benefits of action include tackling obesity, heart disease and mental health problems through active travel; saving money that can be redeployed to frontline healthcare services by reducing transport costs and increasing value for money; meeting legally-binding government carbon dioxide reduction targets; reducing health risks and the pressure they put on the health service by decreasing road accidents, stress, noise and air pollution; enhancing reputation with staff, patients, visitors and the wider community; supporting co-ordination of the provision of transport solutions in Scotland in both rural and urban environments. Version 2.0: February 2012 page 18 of 63

19 Example actions compile, understand and utilise carbon footprint data (including business travel, fleet travel, leased vehicles and impact of delivery of goods and services). Determine which travel is essential. Set, monitor and report performance on target(s) to stakeholders; promote a travel hierarchy, and reduce the need to travel promote healthy and lowcarbon options: zero travel, walk, cycle, public transport and car sharing. Is the travel required? Could webinars, tele- or video-conferencing be used? This may involve implementing changes following travel / satisfaction survey(s), policy intervention, and development of possible incentives. plan layouts and services with travel in mind decisions on site selection for services to consider impact on travel. Make sites easy and safe to access on foot / by bicycle, and for those with mobility issues; consider features such as well-lit, and secure, cycle storage within sight of main entrances, and provision of changing areas / showers. consider health inequalities work with partnerships to shape availability of public transport to coincide with visiting hours. Consider accessibility for marginalised communities, and socially excluded groups. This will include work with Community Planning Partnerships. publish information consult with regional travel partnerships and travel providers to provide tailored information on website(s) and at site entrances for active and public travel options. e.g. bus routes and timetables at all sites, with live displays showing arrival of next services at large sites (using energy efficient information screens). use fiscal incentives such as a cycle to work scheme; assist with public transport season tickets; become a cycle-friendly employer 16. support fuel-efficient driving - provide information, logistics, route choice and scheduling guidance, training and consider in-vehicle technologies. improve the efficiency of all vehicles ensure procurement criteria include fuel efficiency, life cycle environmental impact, local air quality, reliability, cost of maintenance, and depreciation. Lead by example with executive, lease and fleet vehicles having low CO 2 emissions. Consider pilot projects for novel options, such as hybrid vehicles; leading by example reduce the impact of travel of senior management, e.g. reducing flights Version 2.0: February 2012 page 19 of 63

20 3.3 Procurement Decisions about how the NHSScotland budget is spent can have a huge impact on its contribution to sustainable development. Procurement criteria: influence the way that suppliers think about their environmental impacts, and the fairness of the supply chains; can support the local economy, with knock-on benefits for the health and wellbeing of the communities we serve. There are valuable lessons and opportunities for all NHSScotland bodies in applying the principles of the Scottish Sustainable Procurement Action Plan 17 (2009) which contains best practice procurement actions. NHS NSS National Procurement is a centre of excellence and a lead for sustainable procurement in NHSScotland. This means: buying only what is needed, and seeking innovative products and services which maximise opportunities for re-use and recycling; which maximise positive environmental and social impacts and minimise negative ones; understanding demand to ensure most efficient delivery of outcomes; specifying environmental and social standards through the procurement process, to influence supply chains and drive innovation; basing procurement decisions on the whole life cycle rather than shortterm cost and benefit considerations; providing business opportunities and supporting skills development amongst supplier communities; ensuring procurement supports and facilitates a reduction in resource use, CO 2 emissions and waste Version 2.0: February 2012 page 20 of 63

21 FActs NHSScotland spends about 1.5 billion a year on goods and services; goods and services procured by NHSScotland accounted for 52% of its CO 2 in 2004; about half of the procurement CO2 was from pharmaceuticals and medical equipment; NHSScotland activities were estimated to account for 3.6% of Scotland s total carbon 18 footprint and 23% of Scotland s public sector emissions in Potential benefits of action include securing Best Value through inclusion of tailored sustainability criteria and weightings in procurement decisions; protecting the environment by reducing demand for natural resources, producing less waste and minimising transportation effort (this includes requiring our suppliers to reduce their impact on the environment); promoting fairness and good working conditions through supply chains; reducing costs through demand management, and by challenging wasteful practices; meeting government carbon dioxide reduction targets; supporting a strong and sustainable local economy, by involving local suppliers in procurement opportunities; health benefits realised e.g. from specifying fresh, seasonal produce in NHSScotland facilities and catering, and enhanced skills for staff involved in procuring goods and services. 18 Health Facilities Scotland, Carbon Footprint of NHSScotland ( ) Version 2.0: February 2012 page 21 of 63

22 Example actions all NHSScotland bodies should ensure the integration of sustainability considerations into procurement policy, strategy and action plans. This should be supported by guidance and training for staff; develop objectives and monitor indicators for social and performance benefits from a more sustainable supply chain e.g. fair competition for contracts is ensured and the spend on local suppliers monitored; document sustainable procurement performance to build corporate knowledge and ensure future procurement decisions learn from previous lessons and good practice; review Standing Financial Instructions and consider a requirement for assessment of lifecycle costing, with justification to and sign-off by senior management required where deviation from lowest lifecycle costs is selected as the preferred option; provide healthy menus ensure that menus and retail outlets reflect 5-a-day advice for fruit and vegetables. Carbon footprint of goods (including food) and services is monitored and minimised, build menus around availability and seasonal produce, and to encourage a range of healthy options. Consider targeting the Healthy Living Award 19. This may go beyond compliance with NHS QIS 20 Clinical Standards for Food, Fluid and Nutritional Care in Hospitals, which are minimum standards for all hospital in-patients; engage with suppliers to reduce packaging, and encourage or require take-back ; monitor and increase the content of recycled and recyclable materials in purchases; review options other than purchasing new, wherever repair, sharing with other departments or purchase of services rather than products are appropriate, and monitor carbon footprint from suppliers and use the buying power of the NHS to create a more sustainable supply chain by challenging suppliers to offer more sustainable goods and services, and by specifying the Best Practicable Environmental Option NHS Quality Improvement Scotland is now NHS Healthcare Improvement Scotland 21 The BPEO is the option that offers the greatest positive sustainability outcomes while meeting fitness for purpose and budget requirements as a minimum standard. IEMA, the Institute of Environmental Management & Assessment can provide guidance. Version 2.0: February 2012 page 22 of 63

23 3.4 Facilities management Facilities management is the integration of processes within an organisation to maintain and develop the agreed services which support and improve the effectiveness of its primary activities. 22 Facilities management (FM) plays a key role in ensuring that the care delivered by NHSScotland is safe and of high quality. FM may include: catering; cleaning; domestic; portering; telecommunications; building services maintenance (mechanical, electrical, public health and fire prevention); security and transport services, biodiversity and land management. It also involves improving building performance (fabric and systems, including energy saving measures). Delivering effective FM may involve the integration of the planning and management of a wide range of services both hard (e.g. building fabric) and soft (e.g. catering, cleaning, security, mailroom, and health & safety) to achieve better quality and economies of scale. This will require co-ordination between Estates / FM and Capital teams where these teams are separately managed. NHSScotland bodies are required to have an effective Environmental Management System (EMS) in place at their sites. Corporate GREENCODE assists bodies in legal and policy compliance, and also helps them monitor, report, and improve their environmental performance. Corporate GREENCODE therefore has a central relevance to FM, asset management and overall sustainability of all NHSScotland bodies. This means: complying with environmental and other appropriate legislation; making highly efficient use of resources, such as energy, water, land and goods and services; and minimising waste; considering climate change risks, and implementing adaptation and mitigation strategies; protecting green space and biodiversity on the healthcare estate; supporting local communities and economies wherever possible. 22 Source: BIFM, British Institute of Facilities Management Version 2.0: February 2012 page 23 of 63

24 Facts NHSScotland was responsible for emitting over 410,000 tonnes of CO 2 during the year ; the total NHSScotland energy bill was 66.4 million for the year ; the total NHSScotland water bill was 4.2 million for the year ; the total NHSScotland waste bill was 8.8 million for the year ; building energy use, including heating and lighting, accounted for 23% of the overall NHSScotland carbon footprint in 2004; in 2009, NHSScotland owned 2900 hectares of land, supporting its services. However, there are no uniformly available data on the type or quality of that land indicating how it could be used for wider healthcare and biodiversity benefits. climate change risk assessment and adaptation work is at an early stage in most NHSScotland bodies, and reporting data on these areas has not yet been sought or collated. Potential benefits of action include saving money by reducing energy use and waste and, in the longer term, redeploying savings to frontline healthcare services; reducing patient recovery times and improving health by protecting biodiversity and promoting green space and the outdoor estate as a healthcare facility and health promoting health service opportunity; meeting national CO 2 reduction targets; reducing health risks by using fewer chemicals and toxic products; enhancing reputation with staff, patients, visitors and the wider community; meeting the biodiversity duty requirements of the Nature Conservation (Scotland) Act Support is available from Scottish Natural Heritage, including guidance: Version 2.0: February 2012 page 24 of 63

25 Example actions continue to develop, implement and review energy and carbon management programmes for buildings and plant to reduce CO 2 emissions. Continue to consider sub-metering programmes and invest to save initiatives; conduct regular audits linked to the effective EMS (Corporate GREENCODE) to identify and benchmark usage and problems covering issues such as energy, water, waste and legal compliance, e.g. identify the true cost of waste segregation issues; maintenance, cleaning, clinical, and other site staff should be encouraged and incentivised where possible to report issues and problems; calculate site environmental performance including: carbon footprints, energy and water consumption and waste arisings. Regularly publish performance data locally, perhaps in conjunction with awareness raising programmes, and monitor the effect of initiatives; set and monitor targets for waste, energy and water usage reduction and minimisation in addition to management indicators (such as waste recycling rates and segregation). Report results back to staff at operational and senior level. This can be through implementation of an effective EMS using Corporate GREENCODE; identify types of materials and equipment that might constructively be re-used either within or out-with the organisation in preference to recycling; identify benefits / performance of water-efficient fittings and equipment (low-flush toilets, aerated and auto-stop taps, PIR 24 initiation, etc.) into maintenance and replacement programmes; in accordance with Green Exercise Partnership (GEP) principles, consider how to make use of the estate as an attractive outdoor space suitable for promoting physical activity by patients, staff and visitors, as well as for other therapeutic and wildlife benefits; protect and enhance green space and biodiversity (implementing the Biodiversity Duty as set out in the Nature Conservation (Scotland) Act 2004) and manage access positively to comply with Section 1 of the Land Reform (Scotland) Act 2003; improve data on the extent and condition of NHSScotland land, and its opportunities. Boards are already responding to this opportunity through GEP funding applications on a number of sites. Note: case studies and further guidance may be available from the GCCAM website Passive infra-red sensors (PIRs) are commonly used to control lighting and save energy. Version 2.0: February 2012 page 25 of 63

26 3.5 Workforce In many parts of the country NHSScotland is the largest local employer. Employment is a key determinant of health and social cohesion. Employers can make a big difference to the wellbeing of the communities they serve through their approach to recruitment, learning and skills development, management, career progression, working conditions and equal opportunities. Employers can also promote sustainable development through the learning opportunities they provide, and the examples they set. This means: understanding and responding to local employment conditions and needs; proactively building a skilled local workforce; building partnerships with education, training and skills providers, and voluntary organisations that help specific groups of people find employment; promoting the health and wellbeing of employees through enlightened HR policies; providing opportunities for employees to practice sustainable development. Facts NHSScotland currently employs 153,000 people, equivalent to 25% of public sector employees in Scotland; 70% of NHSScotland s expenditure is on staff; NHSScotland s workforce age profile reflects an ageing population; there are 840,000 individuals in Scotland living in relative poverty. However poverty and deprivation are not distributed evenly throughout Scotland, with Glasgow having the highest incidence of both; in 2005/2006 depression and other mental health conditions were the fifth most common group of conditions reported in GP consultations in Scotland; through the Corporate Greencode User Group, NHSScotland is developing a pool of skilled environmental managers able to review their peers environmental management and compliance arrangements with recognised standards. This transferable expertise is appropriate to all NHSScotland bodies. Version 2.0: February 2012 page 26 of 63

27 Potential benefits of action include meeting your organisation s workforce requirements by developing in the local population the skills you will need in the future; improving the health of the local community and reducing health inequalities by providing work opportunities for local people at all levels of the organisation; helping to move from treatment to prevention by increasing employment levels, one of the key determinants of health; reducing financial and environmental costs by developing a local workforce, local networks and minimising negative travel impacts, and increased job satisfaction, career progression and empowerment of workforce. Example actions invest in facilities that enable flexible working practices, e.g. secure server access to IT systems from home, creche facilities, rooms or clinics that can support different uses / users; build on existing good practice to strengthen employment diversity and equality, for example with targets set to provide opportunities for the long-term unemployed, both directly and through the letting of contracts; consider capital project requirements for local labour, and disability access; recruitment and training policies to contain structured training, facilities and career development approaches for all staff, and improve recruitment, retention and productivity by providing a healthy workplace (reference sustainable design objectives) green spaces, good indoor air quality, daylight, opportunities for active travel, etc. (linking with management of healthcare estate and buildings section below). Note: case studies and further guidance may be available from the GCCAM website Community engagement NHSScotland bodies play a central role in any community and can make significant contributions to health. This goes beyond the obvious clinical functions and benefits. NHSScotland bodies can help local people make better informed decisions about healthier and more sustainable lifestyles, integral to their role in being a health promoting health service. By understanding the needs of the local population, NHSScotland bodies can understand how to influence people s behaviours in relation to health and sustainable development. Version 2.0: February 2012 page 27 of 63

28 This means: listening to, understanding and involving the local community in decisionmaking and scrutiny processes; involving members of the local community in the planning and delivery of healthcare services. This should include consideration of communities of interest e.g. those with specific health or communication needs; working positively with key stakeholders to ensure local decisions (e.g. on planning or transport) consider and ensure healthier travel options leading to more sustainable outcomes; supporting a strong and sustainable local economy, by involving local suppliers in appropriate procurement opportunities; promoting healthy, sustainable food and nutrition; engaging local people in the design and use of the outdoor healthcare estate, and promoting access to it. Maximise benefits of green exercise partnership opportunities and similar initiatives for local people and wildlife; sharing service provision / delivery with other partners to meet local community needs. Facts in 2005/2006, depression and other mental health conditions were the fifth most common group of conditions reported in GP consultations in Scotland; there are 840,000 individuals (approximately 1 in 6 of the population) in Scotland living in relative poverty. However poverty and deprivation are not distributed evenly throughout Scotland, with Glasgow having the highest level of both. Potential benefits of action include tackling health inequalities and promoting social cohesion; empowering the local community to adopt healthier, more sustainable lifestyles; more effective service development and delivery - based on evidence of need; reducing waiting times and the financial burden on the NHSScotland resources by helping to move from treatment to prevention; enhancing reputation with staff, patients, visitors and the wider community. Version 2.0: February 2012 page 28 of 63

29 Example actions Identify local sources of goods and services, and monitor and report on expenditure within the local community; Build on existing good practice within NHSScotland to improve, expand and devise new civic participation schemes. Seek to include the involvement of poorer communities as well as better off communities. Community engagement delivers shared facilities that promote better health as well as healthcare; Align strategies and share resources with and between Local Authorities and other support partners such as Registered Social Landlords; Ensure patient and community focus with public representation optimised in community consultation, evaluation and decision-making processes. This includes involving communities in the planning, operation and maintenance of facilities and services; Encourage staff involvement in local community and environmental initiatives, and participate in networks active in sustainable development; Align strategies by developing links between outreach projects and programmes, care in the community, and the sustainable development strategy. Work in partnership with other agencies to tackle inequality; Share ideas and performance with other organisations; Set a leading example in sharing assets and resources with the local community; Seek new opportunities to work in partnership with a range of volunteer involving organisations to take forward actions on sustainable development and further develop community engagement. Volunteer Development Scotland 25 may be a useful source of guidance. Note: case studies and further guidance may be available from the Good Corporate Citizenship website ( 3.7 Buildings NHSScotland s asset base was valued at 4.9 billion in Decisions about the planning, design and construction of new buildings (and the refurbishment of existing ones) are important to a more sustainable health service in Scotland. In short, sustainable buildings are likely to be more pleasant to be in, and be better for health and healthcare outcomes, for patients, staff and visitors. They minimise running costs and future maintenance and refurbishment costs. What all NHSScotland bodies need to do is determine the processes, features and design issues that maximise the above to meet best the local context and community needs Version 2.0: February 2012 page 29 of 63

30 Although this section is entitled Buildings for consistency with Good Corporate Citizenship, actions here should focus beyond a given building to its site and the wider hard and soft landscape. There may be valuable and simultaneous opportunities for integrating outdoor health promotion with green prescription, wildlife enhancement, sustainable urban drainage schemes (SUDS) and carbon reduction measures. Asset rationalisation, leading to the disposal of underutilised or redundant healthcare sites (buildings, facilities and land), may have budgetary advantages. However, the impacts on the local community should be carefully considered (e.g. voiding property can create holes in the community fabric, risking inappropriate development taking its place or attracting anti-social behaviour). Clearly others, e.g. local authority planning departments, have responsibilities here too and, where possible, NHSScotland should work with local communities and other partners to secure a viable future when vacating sites or premises. Health and healthcare needs will change as demographics and treatments change and as NHSScotland moves to more sustainable delivery of services. It will normally be more sustainable to refurbish buildings than to build new ones. In any decision-making, flexibility and life cycle considerations must be built in to allow long-term occupancy, or sustainable deconstruction and re-use of resources. There are several resources available to assist NHSScotland bodies in evidencing decisions, including the design quality policy and design assessment process in the Scottish Capital Investment Manual (SCIM). Many of the issues and opportunities that follow, and those discussed in section 3.4 on FM, have key relevance to sustainable asset planning and management. This means: seeking to maximise the value of the NHSScotland sites (while respecting other sustainability considerations); considering if all buildings in all locations are needed, and/or if they might accommodate additional activities, either from within the service, or by partner organisations; plan new/altered buildings flexibly such that spaces can be shared and used between services (both within the NHSScotland body and partner organisations); consider if a new building is always needed for services new to an area, or if services can be provided from a partner s venue or by re-using other existing buildings; including climate change adaptation and mitigation requirements as part of good design; listening to the views of the local community on their needs from healthcare buildings (and other buildings occupied by NHSScotland bodies); working with design teams and contractors to ensure sustainable development objectives are properly specified, understood and delivered; using building projects to trigger improvement in other areas, like boosting people's physical and mental wellbeing and morale, aiding patient recovery, Version 2.0: February 2012 page 30 of 63

31 promoting active travel, cutting carbon, providing a haven for wildlife by protecting, managing and enhancing natural areas, and encourage their use; maximising sustainability performance through all phases of a building s lifetime - planning, design, construction, operation and decommissioning; supporting a strong and sustainable local economy by involving local suppliers in building projects. The environmental performance of a building cannot compensate for a development where materials or provision of rooms have been over-specified, or for power used in heating empty rooms. However, this does not mean that the minimum area possible should be built. Flexibility to improve occupancy may need an increase in circulation spaces, allowing options for accessing rooms and creative thinking on how circulation spaces may be designed for multiple uses. Facts Building energy use, including heating and lighting, accounts for some 23% of the overall NHSScotland carbon footprint. NHSScotland hospitals have reduced annual energy consumption by around 40% over the past 20 years. However, during the same period, annual energy costs have doubled. Potential benefits of action include More efficient buildings, with lower running costs, mean less money spent on bills, effectively increasing the resource available for frontline healthcare services; Meeting increasing environmental legal requirements, including the legally-binding government carbon dioxide reduction targets; Buildings that reduce the risk to service disruption from future climate change and energy supply issues; Buildings that exemplify sustainability to their users, promoting awareness and confidence; Improved quality of the indoor and outdoor environment reducing patient recovery times, and providing better environments for staff and visitors; Protecting the environment and improving health for example by reducing waste and encouraging physical activity, perhaps through shared community facilities. Version 2.0: February 2012 page 31 of 63

32 Example actions Senior level commitment is required to implement sustainability principles. For building projects this could involve a formal requirement for senior management to sign off any deviation from lowest lifecycle costs; Improve linkages between building design team and building users and consider how management processes will ensure vision and design concepts move from concept design to delivery. (See also the community engagement section of this strategy); Focus on the influence of building design on health e.g. daylight, views, air quality, and toxic chemical reduction in buildings; Consider integration of requirements to provide capital works procedures that meet the objectives of asset management strategies, the Scottish Capital Investment Manual, and Design Quality Policy for NHSScotland; Risk assess for climate change adaptation and energy supply so that existing and future healthcare buildings can withstand and operate comfortably in the changing climate; Monitor and report on the Building Research Establishment Environmental Assessment Method (BREEAM) scores obtained by all development and refurbishment projects with a value over 2million; Recognise that low carbon design is more cost-effective. Highly efficient buildings need less plant (and space for it), sometimes resulting in lower capital costs. Reducing energy losses by first focussing on high levels of insulation and air-tightness before considering introduction of new plant, and maximising natural lighting and ventilation also reduces costs. Designing for deconstruction reduces future costs; Take a site-wide approach to the supply of heat, cooling and power not just one building at a time; Adopt a similar broad approach to masterplanning - materials can be wasted, and costs can increase through piecemeal development, moved roads/services, and demolished recent works; Revisit your design action plan to ensure consistency with the sustainable development action plan the aims and benefits of both are closely aligned; Develop and implement strategies that minimise the immediate impact of construction projects on the environment and neighbours including site waste management plans (SWMPs) and contractor EMS certification. Increase use of prefabrication and off-site manufacture to minimise waste and improve quality management. Version 2.0: February 2012 page 32 of 63

33 4. Requirements for NHSScotland bodies CEL 2 (2012) sets out 14 mandatory requirements. The requirements are shown below in a checklist format intended to support internal monitoring and reporting within NHSScotland bodies. Due to its simple nature, this template can not, on its own, be used to represent the true sustainability performance of an NHSScotland body. Further guidance on reporting can be found in section 5.9. Mandatory Requirement Guidance Available Current Status / and deadline Lead / Responsible Person Governance-related requirements 1. Each NHSScotland body must implement a strong management structure as a means of ensuring the effective delivery of its strategic Sustainable Development Policy Statement and supporting Sustainable Development Action Plan (see 5) Section 5.1. Elements of section 5.5 on partnerships may be helpful. 2. Each NHSScotland body must appoint a member of its board to act as Champion for Sustainability at a strategic level to assist in articulating and promoting its sustainability priorities. Each NHSScotland body Chief Executive will be accountable to the Scottish Government Health and Social Care Directorates for the NHSScotland body s performance in respect of sustainable development. 3. Each NHSScotland body must appoint an Environmental Management Representative (EMR) with organisation-wide responsibility for the implementation of an effective Environmental Management System (EMS) to measure, and through which it can continually aim to improve, environmental performance, consistent with the European Union's and the Scottish Government s commitment to sustainable development. Corporate GREENCODE is the exemplar tool towards achieving these goals and NHSScotland bodies are expected to utilise Corporate GREENCODE unless given SGHSC approval of an equivalent alternative. Section 5.2 Corporate GREENCODE Tool (Section 5.3) Version 2.0: February 2012 page 33 of 63

34 Mandatory Requirement Guidance Available Current Status / and deadline Lead / Responsible Person Governance-related requirements (continued) 4. Each NHSScotland body must appoint a senior staff member as Waste Management Officer (WMO) as a single point of contact, with responsibility for all aspects of waste management within the organisation consistent with the Scottish Government s commitments towards zero waste. The WMO will report to the Chief Executive through formal channels (see 1). [CEL 8 (2007) - Waste Management in NHSScotland Action Plan: 2007 refers] Planning-related requirements 5. Each NHSScotland body must have a Sustainable Development Action Plan (SDAP), which sets out the organisation s contribution to the Scottish Government s sustainable development aims and objectives in the context of the key strands of activity indentified by this Policy (CEL ). The Sustainable Development Action Plan should be consistent with, and supportive of, the organisation-wide strategic Sustainable Development Policy Statement, and should include actions to ensure an integrated approach is taken to core business, guided by the key strands. 6. The SDAP must undergo a review process with actions monitored, evaluated and updated, using past progress as a context for the renewed actions the organisation will take to continually improve its performance. The review process will be assisted through self-assessment using the GCCAM toolkit (see 13). 7. The SDAP must include an assessment of the impacts of climate change and a suitable adaptation strategy in compliance with public sector duties. Section The SDAP must include appropriate actions to contribute to the overall NHSScotland H.E.A.T. (Health; Efficiency; Access; Treatment) Targets. Section 5.6 and elements of section 5.5 on partnerships may be helpful. Appendix 2 of this document Section 5.6 and GCCAM toolkit Appendix 3, and Adaptation Scotland s public sector workbook 26 Section Version 2.0: February 2012 page 34 of 63

35 Mandatory Requirement Guidance Available Current Status / and deadline Lead / Responsible Person Planning-related requirements (continued) 9. The SDAP will be consistent with each NHSScotland body s Property and Asset Management Strategy (PAMS). A PAMS is required for business case approval through the SGHSC Capital Investment Group process. 10. The SDAP must be signed off annually by the Chief Executive and the Sustainable Development Champion. 11. Each NHSScotland body must submit a copy of its Sustainable Development Action Plan annually to SGHSC Capital and Facilities Division by 31 October each year, regardless of the frequency of review (see 6). 12. All NHSScotland bodies engaged in the procurement of both new-build and refurbishment of healthcare buildings must carry out independent sustainability accreditation for projects. This is a requirement of the Scottish Capital Investment Manual (SCIM) business case approval process. SGHSC (Capital and Facilities Division) website 27 Section 5.6 Section 5.6 Section 5.7 SGHSC web sites 28 Monitoring, evaluation and reporting requirements 13. Each NHSScotland body must conduct a self-assessment using the GCCAM toolkit to help understand, monitor and evaluate its progress on its own sustainable development priority issues and opportunities. [CEL 14 (2010) refers] 14. Each NHSScotland body must submit data to SGHSC Capital and Facilities Division and Health Facilities Scotland as and when required in order to meet SGHSC and wider Scottish Government reporting requirements. Section 5.8 Section and Version 2.0: February 2012 page 35 of 63

36 5. Guidance on implementation of the requirements The following section provides guidance on implementing the mandatory requirements of CEL 2 (2012), outlined in the previous section. The GCCAM website contains a number of reference materials that may be helpful, Governance-related requirements 5.1 Establishing or using an appropriate management structure Each NHSScotland body is advised to implement a strong management structure as a means of ensuring the effective delivery of its body-wide Sustainable Development Policy Statement and supporting Sustainable Development Action Plan objectives. Additionally, each NHSScotland body will have to decide whether its corporate-wide and site-based governance arrangements for delivering sustainability are in place and working effectively. What needs to be done? Given the variation between NHSScotland bodies (e.g. size, geography, and structure) it is neither reasonable nor sensible to propose a one size fits all prescriptive governance structure for sustainability. Instead, what follows is an attempt to explore or describe the characteristics of effective governance needed to achieve more sustainable outcomes. Accordingly, NHSScotland bodies should develop appropriate management structures that: place emphasis on outcomes and deliverables; ensure legal compliance as a minimum standard (e.g., on environmental legal requirements guidance is available through Corporate GREENCODE); ensure coordination between different working groups and avoidance of duplication (both internal and external to the NHSScotland body, as many similar challenges will also be faced by other NHSScotland bodies); ensure a comprehensive coverage of the breadth of sustainable development issues. However, it is probably desirable (if not essential) that these are prioritised according to local circumstances to ensure manageable numbers are addressed at any one time or action cycle; ensure that the management structure includes key roles such as a Champion for Sustainability and an Environmental Management Representative, and that the functions of these key roles are widely communicated. While the governance arrangements may be achieved through existing management structures, there is a clear need to co-ordinate actions within and across each NHSScotland body on the six GCCAM priority areas to ensure more sustainable outcomes. This will require representation and engagement from various divisions or departments, which may cut across existing Version 2.0: February 2012 page 36 of 63

37 management structures. Some organisations may require new structures or specific roles to achieve these outcomes. Each NHSScotland body should consider the best options on; raising awareness and encouraging all staff to deliver on wider sustainability opportunities for their NHSScotland Board; how to co-ordinate and communicate the work of specialist sub-groups (e.g. for travel or energy or CO 2 reduction) to those charged with developing the Sustainable Development Action Plan and Environmental Management Systems. Coordination needs to include approaches at both strategic and site-specific levels; how to instil an integrated approach, avoiding the creation of silos and rigid separation of roles; the strategic review and management of staff structures to deliver sustainability goals. For instance, should there be one management steering group for all sustainability issues, supported by site teams delivering a broad range of sustainability improvements, rather than separate teams for the EMS, carbon management, travel, etc.? how to conduct site-based assessments of legal compliance and sustainability issues, to identify opportunities for improvement; how frontline, facilities and estates staff can be supported to deliver the challenging improvements required for more sustainable outcomes; how to share best practice more effectively between sites, and between other NHSScotland bodies; how to ensure focus on a broad range of sustainability issues (i.e. ensuring that focus is not limited solely to one area, e.g. carbon reduction); whether ring-fenced funding is required to deliver mandated objectives. Note: HFS has a role to facilitate best practice, training, professional development and networking on sustainability. This may include development of guidance on the required competencies, measurables and resources, as well as development of bespoke tools, and training for champions and Environmental Management Representatives (EMRs) once they are in place. The Corporate GREENCODE User Group (a valuable peer network), and the Corporate GREENCODE web-based toolkit, are practical examples where expertise is being developed in NHSScotland. This presents specific training opportunities which are intended to be rolled out more widely to all NHSScotland bodies. Who needs to be involved? It is up to individual NHSScotland bodies to decide the most appropriate governance structure to meet legislative and policy requirements. NHS Greater Glasgow & Clyde has found it helpful to create a high-level Sustainability Planning and Implementation Group that includes the sustainability champion and senior management representatives from several divisions. This group coordinates actions within the Board to deliver the six key strands of activity identified in GCCAM, which assists the group to identify Version 2.0: February 2012 page 37 of 63

38 resources, and decide accountability for actions within their SD Action Plan. This model might be appropriate for other NHSScotland bodies. Figure 2 below shows some of the strategic drivers, action plans, and review functions at national and local levels. Figure 2: Governance, action planning and management review framework 5.2 Appointment of a sustainability champion NHSScotland bodies sustainability champions / managers have a crucial role to facilitate the delivery of improved sustainable development within and across all departments, and for reporting performance. However, they cannot be expected to deliver all the sustainable development objectives outlined in this strategy single-handedly; that responsibility must be shared by all staff. Clarity and co-ordination of various roles and responsibilities within each NHSScotland body is essential for successful implementation of CEL 2 (2012). Influencing the effectiveness of the organisation s governance and management structures will be a vital task for the champions, as they are central to the delivery of sustainable development outcomes (see 5.1). Responsibility for the performance of individual departments normally rests with the existing line management structures, and ultimately with the NHSScotland body s Chief Executive. What needs to be done? Appoint a sustainability champion (and consider appointing a deputy to the role). This is likely to be an appointment added to an existing role, rather than a new member of staff. It is expected that the Version 2.0: February 2012 page 38 of 63