Board ownership of the sustainability agenda
Boards are leading this work with increasing determination and diligence, and with a high level of commitment, as shown in our survey results. While sustainability is a priority for trust leaders in the year ahead, they also recognise the knowledge and expertise gap that some trusts have in this field and are keen to develop it.
Ahead of submitting their green plans, trust leaders should consider
- whether there is sufficient experience in this area on the trust board, and if not, consider how they can boost the level expertise at a senior level within the trust
- work towards ensuring tackling climate change and improving sustainability is owned across the trust leadership. It needs to become 'business as usual' within organisations, rather than a project done by some.
System working: major changes must happen at scale
The COVID-19 pandemic has illustrated the need to be prepare for future risks to population health and operations. The NHS continues to face significant pressure as it recovers services from the pandemic and manages high levels of unmet need. In order to fit sustainability work into the wider priorities of the trust sector, it will need to be embedded as part of wider organisational transformation taking place as part of increased integration. The examples in this report illustrate the importance of embedding sustainable change into the 'day-to-day' business.
Sustainability is best addressed as a common purpose which brings together thriving places, ICBs and ICPs. A number of trusts are encountering barriers that can only be addressed by working with local schools and housing bodies, transport planners, and those involved in leading economic resilience work within local authorities. To build on cross-government prioritisation of these issues, and reinforce the NHS' commitment to this, there is a need for stronger co-ordination on this agenda.
ICBs and ICPs should consider
- how ICSs can embed sustainability into their strategies and plans, and how all organisations represented on integrated care boards can have a role and a voice in making changes happen across their patch
- how digital transformation can begin to alter where we work and how care is provided in a way that enables the urgent ambitions to improve energy use and efficiency and reduce emissions.
Support from the national bodies
There is further work to be done nationally to help the NHS to move faster and further. The priority given by local systems and trusts to this agenda must be matched by leadership from NHS England and NHS Improvement and the Department of Health and Social Care. At a time of significant operational pressure, it is easy for national leaders to focus on the most politically pressing issues such as waiting lists and operational performance, but ultimately environmental sustainability can be embedded into wider efforts to put the service on a sustainable footing and reduce health inequalities.
National leadership on securing a more sustainable supply chain should support local efforts by trusts to procure more sustainably, to create larger-scale change and give the agenda more weight. However, the work of NHS Supply Chain to alter catalogues and to change transport models should not defray a need to purchase locally, where such sourcing is possible and offers social value. The NHS is a large landowner and this offers an opportunity to use its estate to the benefit of the climate. However, where ownership of land and buildings are held outside trusts, by NHS Property Services and under PFI contracts, there is a need through policy and dialogue with investors to reset expectations around the pace of change to adapt NHS buildings to meet the ambitions for a greener NHS. Investors in large PFI estate should also consider taking a lead in addressing any perceived conflict between commercial returns and environmental sustainability, and national action may be needed to ensure that this happens rapidly in the next eighteen months. PFI estate cannot delay the wider NHS ambitions that trusts are submitting in their forthcoming plans.
National bodies will need to examine
- which supplier relationships need a clear service-wide steer about the pace and direction of change needed to support large-scale improvements in the sustainability of supply chains
- how best to ensure a standardised approach to accounting for carbon impact is reported routinely at local, regional and national level to improve transparency and aid understanding
- how they can ensure trusts' access to capital is front-loaded and phased to support major changes in carbon emissions nationally by 2030 to enable significant changes to equipment, energy and estate.