Is sustainability within the UK health and social care sector a reality or pipe dream?



The rise of short-haul flights and the requisite need for planes and engines means that there is expected to be demand for 45, 000 new engines over the next two decades, at a cost of £351.5bn. General Electric’s new engine, called Leap, which is expected to enter service in 2016, can compress air at 20 times atmospheric pressure and burn fuel at temperatures high enough to melt metal. What’s the upshot?  It can conserve 15% less fuel, run at higher temperatures and for longer. In other words, it’s about efficiencies.

A recent report, ‘The Delivering Waste Efficiencies in the North East’, highlights a number of areas where 12 local authorities in the North East of England could make £9m in efficiency savings in the delivery of waste services. Strategies included partnerships and more closely together in areas such as procurement and route optimisation.

The two examples above illustrate that in every sector, the need for efficiencies is crucial to the way organisations function and gain competitive advantage. Those who cannot, will lose market share, run up deficits, and operate in a manner that is financially, socially and environmentally unsustainable. Indeed, terms such as circular, low-carbon and green economies are becoming common. Even though it has to be said, they can mean different things to different people.

The UK health and social care sector is no different in the need to operate more efficiently. It is currently faced with significant financial, socio-demographic, logistical and legislative challenges, and these will become increasing challenges in the future. According to the King’s Fund, over the next fifty years, the sector could become one of the largest in the economy. The Office for Budget Responsibility arguing that by 2062, it could account for around £1trillion of a total spend of £4.8 trillion.

The National Health Service (NHS), is one of the largest organisations in the world, employing around 2 million staff and delivering an array of services to a population of over 50 million people. These services are delivered from hundreds of thousands of sites, to a public that expects choice and quality, whether it’s at their acute site or local GP. Procurement of pharmaceuticals and medical instruments comprises 72% of the carbon emissions within the sector. There are a number of corporate, financial and environmental drivers for the NHS to engage with the sustainability agenda. For example, the Public Services (Social Value) Act (2012) requires all commissioners of public services to take into account economic, social and environmental value, not just price, when buying goods and services, while the Climate Change Act calls for reduction in carbon emissions.

Is enhanced sustainability within the sector a reality or a pipe dream? The answer is, it’s a reality. Indeed, there are a number of examples of good practice across the UK. For example, use of a combined heat and power (CHP) system by Birmingham Heartlands and Solihull NHS Trust enabled generation of its own electricity and savings of £688,000 annually and reduction of its carbon emissions by 1,627 tonnes. Through a waste minimisation project called Waste it Not (WIN), the Cornwall NHS Hospitals Trust was able to identify savings of £53,000 and cost avoidance of £200,000 in waste treatment and disposal costs in only its first two years.

However, for sustainability to become truly embedded and long-term, there is a need for various factors to be put in place. First, there is a need for a greater evidence-base on which to make decisions. The Healthcare Waste and Resources Research Group at the University of Northampton has promoted this, for several years. Second, sustainable resource consumption has to be incorporated within the overarching strategic plans of sites and there has to be commitment from senior management in the form of resources (i.e. finance and personnel). Third, implementation of low carbon technologies should be seen as an investment, which while it may not always realise significant short term financial savings, can with time achieve these. Pressure to reduce costs and meet health services targets means that too often environmental management decisions within the sector tend to be made looking at short-term gain, on small-scale project basis, rather than long-term. This therefore leads to hesitancy in investment and limitations in success. Fourth, there should be more partnership building, looking at ways say in which healthcare facilities, as energy intensive organisations can work with others in the community. For example, the Gundersen Lutheran Health System in La Crosse, Wisconsin, USA uses biogas discharged from the nearby City Brewing Company’s waste treatment process and turns it into electricity. Fifth, staff engagement is crucial if there is to be buy in and behaviour change in terms of resource consumption. Sixth, rather than reinventing the wheel, it should learn from other sectors.

Given its size and reach, any improvements in the sector can have significant impacts across the UK society and economy. Indeed, improved sustainability can lead not only to environmental compliance, but also to costs savings, sustainable resource management, and public health benefits. For example, reduction in travel and transport would lead to benefits such as reduced toxic air pollution and traffic noise, improved patient experience and increased levels of physical activity. The challenge is making it a reality.

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