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Sustainability & Carbon Reduction Strategy 

Post Holder Responsible for Policy:
General Manager, Estates Technical Services
Directorate Responsible for Policy:
Facilities Directorate
Contact Details:

Salisbury District Hospital

01722 336262 Ext 2316

Date Written:
7th October 2009
Date Revised:
Approved By:

Approved by Environmental Executive Committee

Ratified by Operational Management Board

Date Approved:

Approved 8th December 2009

Ratified 26th January 2010

Next Due for Revision:
December 2011
Date Policy Becomes Live:
1st February 2010

Version Information

Version No. Author Review Date Description of Changes
General Manager, Estates Technical Services
New Strategy

Table Of Contents

Executive Summary

Executive Summary

The NHS is charged with improving the way it interacts with its local and global environment; it must consider how the decisions on goods and services it procures impact on both its local population and populations of the world. This strategy intends to ensure that Salisbury NHS Foundation Trust continually improves its impact on the above by encouraging all staff to play an active part in environmental stewardship. The strategy sets out actions to improve design of buildings, consider the carbon consequence of procurement decisions, encourages the prudent use of natural resources (oil, gas, water), considers waste management, links with our organisational and development strategy and supports working in partnerships.

The strategy will be used to monitor measure and significantly improve environmental performance by setting out a series of action points and plans following the Good Corporate Citizenship self assessment model and the Department of Health document ‘Saving Carbon Improving Health’. The key headline actions from the strategy are highlighted below:

Key Points

  • A communication plan is to be developed to ensure that this strategy and proposed actions are embedded within the organisation. This plan will ensure the Hospital Operational Management Team, Public Partnership Forum and Staff endorsement of this strategy.

  • The Environmental Executive Committee will review actions and monitor performance against this strategy.

  • The strategy includes a responsibility to support and contribute to the reduction in carbon emissions within everyone’s job description.

  • It is suggested that inline with the stewardship responsibility element included in the appraisal process there is a mechanism to ensure that sustainability and reduction in carbon emissions are discussed on a one to one basis with staff with an obligation on all staff to demonstrate their commitment.

  • It is suggested that all internal business cases must formally consider the impact on the environment thus encouraging ‘sustainable’ decisions.

  • Key Performance Indicators will be identified to monitor and measure performance. A total Trust carbon footprint can not be calculated as yet. KPI’s relating to our carbon emissions will be identified and reported from the Environmental Executive Committee to the OMB.

  • The NHS Sustainable Development Unit (SDU) has set initial targets for the NHS of a 10% reduction of carbon footprint by 2015 from the 2007 baseline.

  • Our Good Corporate Citizen rating will be periodically reviewed to demonstrate continual improvement to achieve a minimum rating of 22% in all areas by 2012.

  • We will support Local Strategic Partnerships and support Regional Sustainable Development networks.

  • The action plan within this strategy will be carried out by many of the existing Trust working groups. These will be reviewed through the Environmental Executive Committee which shall report periodically to the Operational Management Board.

  • This strategy shall be embedded and owned at every level in the organisation, every member of staff shall have direct responsibility for some of the actions required to reduce our impact on the environment.


Sustainability can be defined as ‘Meeting the needs of current generations’ without compromising the ability of future generations to meet their own needs.’ 

In January 2009 the DoH issued the document ‘Saving Carbon Improving Health’ (SCIH), a carbon strategy for the NHS. The aim of the strategy is to significantly reduce the impact the NHS has on the environment.  In conjunction with this document runs the Good Corporate Citizenship (GCC) self assessment model, developed by the Government’s Sustainability Unit to assist organisations in assessing their impact on the environment.

The Salisbury NHS Trust Sustainability Strategy uses both of these tools to develop positive actions to reduce our impact on our local environment and forms part of a world wide commitment to reduction in green house gas emissions.

The strategy provides brief overviews of the NHS Carbon Reduction Strategy “Saving Carbon Improving Health” and the NHS Good Corporate Citizen Model, explaining the key points and messages for NHS Trusts. It is the NHS Good Corporate Citizen model that provides the basis of this strategy. The self assessments now completed by Salisbury NHS Trust provide us with a series of actions, that, when completed will provide us with a continual improvement in reducing the carbon footprint of our business.  

An action plan has been created for each section of the GCC. These points will be actioned by the identified lead for each of these sections. Success in the action plan will mean the Trust is moving towards being an environmentally responsible company, contributing to the protection of climate change and natural resources.

The purpose of this strategy is to ensure that sustainability and carbon management is embedded into the ethos of the Trust and requirements of both the SCIH and the GCC are met.  The document is intended to develop as improvements in the way the Trust reacts to the environment are made.

This strategy does not consider how Salisbury NHS Foundation Trust will manage the known effects of climate change albeit the Energy Management policy which includes reference to the ‘Heatwave Plan is referred to in this document. This strategy does recognise that action plans will need to be developed with the advice and guidance of our ‘Public Health’ colleagues.

 [1] Dictionary of Environmental Science and Technology – Andrew Porteous.



The NHS is expected to use its huge influence and resources in ways that will benefit the local community and the country as a whole. The massive capacity of the NHS means it has the potential to damage the social, economic and environmental conditions in which the people of this country live.  How the NHS chooses to influence and run its business practices can and does have a significant effect on resources such as transport, water, energy, waste and consumable products such as food and paper.  As an employer the NHS has considerable effect on the lives of its employees and their associated families.  As a commissioner of significant quantities of directly associated activities the NHS affects the lives of the people living around its sites in terms of environmental disturbance and as a corporate neighbour.


The ability to measure and monitor the carbon consequence of our activities is core to the NHS Carbon Reduction Strategy and is vital if we are to demonstrate progress. Although theoretically this could be carried out, there is not a current comprehensive NHS definition. Guidance for the correct calculation methods and conversion factors from energy consumption to carbon emissions is currently in development (as of September 2009) and will be rolled out across the NHS when it is available. Once available, this information should be used to convert all activity and consumption into carbon for all carbon reporting purposes.

Meanwhile using the currently available information we will seek to calculate our operational carbon footprint, providing a datum for continuous improvement and to benchmark against other NHS organisations. Guidance from the SDU states that a ‘top down’ carbon footprint should be generated at a local level. Where data exists and is collected centrally this should be used as a basis for the footprint for example building energy use. Other local data needs consistent conversion to carbon and this should then be categorised and benchmarked. We will monitor and measure carbon emissions from the occupation of buildings, the management of waste streams and business & transport mileage. A large proportion of our procurement activity and the commuter mileage associated with the Trust activity cannot yet be measured.

See appendix A for a detailed breakdown of current metrics and measures from the SDU.



The Government gives six key reasons for all Trusts to adopt the parameters of the SCIH document:

1. The new legally binding Government framework and national targets to reduce carbon emissions by 80%   by 2050 compared to 1990 levels phased in as;

  • 10% by 2015 from 2007 baseline.
  • 26% by 2020 from 1990 baseline.
  • 64% by 2030 from 1990 baseline.
  • 80% by 2050 from 1990 baseline.

2. The health co-benefits now for patients and populations, and for the health system itself.
3. The importance of cost reductions and energy resilience.
4. The strength of the scientific evidence to act now on climate change.
5. The willingness and commitment of NHS organisations and staff to act now.
6. The need for the NHS to be a leading public sector exemplar now.

There are ten key areas described within the NHS Carbon strategy, these are explained below:

§  Energy & Carbon Management

Carbon reduction can only be achieved if staff know what they are working towards; consequently information must be published and understood.  Such things as comfort cooling and air handling must be viewed as unnecessary (unless clinically essential) and phased out of building projects.  The use of solar panels, photo-voltaic cells, free cooling etc needs to be assessed when developing buildings. Refer to Salisbury NHS Energy Policy for details.

§  Procurement & Food

When departments consider the purchase of goods or services the involvement of our Procurement team will ensure that the sustainable guidance is used in the selection of items.  The guidance will be drawn from the action plan and goals created by Procurement in their action plan created via the GCC model.  Procurement will also be working with contractors and service providers to achieve packaging minimisation and sustainable partnerships where practical.

§  Travel & Transport

Staff will require access to alternative travel options and be encouraged to find alternatives to onsite parking and car use.  The Trust must ensure that the Travel Plan is active, viable and influential when recruiting staff or making decisions about current staff travel plans.  Partnerships with transport providers will ensure that the Trust concerns and needs are considered when local travel plans are developed.

§  Water

Water needs to be managed as a precious resource.  As with energy, staff need to know how much water is being consumed and have achievable targets to reduce consumption by. Water efficient technology needs to be installed into new builds or refurbishments and routine use of bottled water should be reduced to an absolute minimum. 

§  Waste

Year on year (across the NHS) waste volumes and costs rise and effective use of waste recycling systems has to be employed by all site users.   In the initial instance reduction in creation of waste is paramount; reduction in paper printing and disposal, increased use of electronic correspondence, reduction in the amount of disposable items being used.  Any items considered to be ‘end use’ should be selectively disposed of via a re-use route where possible. 

§  Designing the Built Environment

New buildings must be designed taking into account the need to build in sustainable features such as grey water harvesting and PV (photo voltaic)-cells / solar panels etc.  New buildings must maximise natural light and ventilation as well as shape design and orientation to maximise solar radiation. The built environment must take into account the need to provide patients with access to natural environments and green spaces.   

§  Organisational & Workforce Development

The workforce needs to be educated in ways to minimise carbon production.  Staff need to understand how they can contribute to energy and carbon saving practices.  Consideration needs to be given to incorporating sustainability information into training programmes provided both in-house and by educational institutions.  The Trust needs to work in partnership with training providers to ensure this is evolved.  Staff need to be provided with information on low carbon options and ways in which they can help reduce the site carbon footprint.

§  Partnerships & Networks

To maximise the benefits of the Carbon Strategy the Trust must be active in working with local partnerships and formulating plans that incorporate the local population.  The Trust needs to be involved in local planning initiatives to influence decisions that affect our services, staff and visitors. Core to the NHS Carbon Strategy are virtuous circles, the concept and belief is that NHS organisations can reduce environmental impact and subsequently can improve the health of their respective populations. The diagram over is an example:

§  Governance

Sustainable practices are corporate responsibilities and thus require sound governance arrangements. This strategy is to be implemented via a Sustainable Committee led by an Executive lead and shall report periodically to the Hospital Management Team. To ensure sustainable options are considered when developing our service all business cases need to contain an indication of how any changes will take into consideration sustainable practices.  Sustainable performance indicators need to form part of the annual Trust report. The Governance arrangements for this strategy are considered within the action plans.

§  Finance

The Trust must develop carbon literacy and embed carbon reduction into its financial plans.  In spring 2010 the Carbon Reduction Commitment scheme (CRC) will require all organisations to buy carbon credits.

The NHS carbon strategy provides NHS Trusts with guidance on what to consider when embarking on a commitment to reduce carbon emissions. However, organisations need to understand the impact of their current activities, when undertaken, the Good Corporate Citizen Self Assessment Model provides organisations with a gap analysis between best and current practice.



The intention of the GCC self assessment model is to influence business practice. The GCC suggests that NHS organisations will benefit from a healthier local population, have better staff morale and patients will recover more quickly and some financial savings can be made.

The model is divided into six sections:

 5.1 Transport

Sustainable transport in the main is about ensuring CO2 emissions are minimised by encouraging the use of other means of transport such as walking, cycling and public transport.  Transport needs to be managed in a way that benefits the local community, supports local economy and protects the environment.

5.2 Procurement

To have ‘sustainable purchasing’, goods and services should be secured in a way that minimises negative impacts on the environment and society for the full product life cycle.  It is estimated by the Department of Health that in 2004 60% of the total carbon emissions from NHS activities relates to procurement of goods and services these were broken down as shown below.

Analysis of the carbon footprint attributable to procurement indicates that pharmaceuticals have a significant contribution to the footprint. Although this may only be influenced at industry and national level it maybe appropriate for NHS Trust’s to consider reducing any drug wastage for example, re-using patients own drugs whilst in hospital and recycling unused drugs from wards.

5.3 Facilities Management

22% of the total carbon emissions from NHS activity relates to building energy use.   This element of the Good Corporate Citizen assessment includes activities such as, energy consumption, waste management, and use of utilities. The NHS produces circa 600,000 tonnes of waste each year and consumes nearly 50 billion litres of water.  By employing a sustainable facilities approach these figures can be reduced.

5.4 Employment & Skills

The Improving Working Lives (IWL) initiative has ensured NHS organisations are acting in a responsible manner towards their staff.  Sustainable HR practices help to improve the mental and physical health which can in turn have a residual effect upon the family and friends of employees.

5.5 Community Engagement

NHS organisations are an important part of the local community.  Through involvement with Local Strategic Partnerships (LSPs) and planning processes, NHS sites can help improve the health of local people, promote social cohesion and tackle health inequalities.  Local Authorities must develop Local Area Agreements (LAAs) which now include two new indicators:

a)    To reduce CO2 emissions from their own operations

b)    To reduce CO2 emissions from the Local Authority area (including hospitals)

By involving patients and local residents in decisions about how services are delivered, decisions can be made that best benefit the local community. NHS organisations need to work in tandem with local government, public services and community based organisations to find new and beneficial ways to deliver healthcare.

5.6 New Buildings

The Sustainable Development Commission suggests that, constructing sustainable buildings provides healing environments and healthier workplaces.  By utilising local contracts, services and people, jobs and economies are created and supported, providing a better standard of living within the area.  By involving the community and looking for local resources the impact of the building can be less invasive and more locally supported.   Incorporating green spaces and producing a ‘healing environment’ has been shown to reduce patient recovery times by providing pleasant outlooks and calm spaces.

5.7 Self-assessment Stage

Salisbury NHS Foundation Trust have undertaken the Good Corporate Citizen self assessment. A summary of the current results are detailed below. The full current assessment score detail for the Trust is attached (Appendix B).


The self assessment scores indicate that Salisbury NHS Foundation Trust is behind others Trusts in the “Buildings” and “Community engagement” sections. While this might be an interesting comparison it must be noted that the GCC assessment is designed to allow an organisation to show its own development and provide guidance on where area might be improved.

The Good Corporate Citizen assessment tool prompts the Trust with action and initiatives to improve performance.  The recommendations for overall improvement are suggested by the GCC as being:

By 2012, the Trust should be "Getting there" in at least two questions in each area of the test - or achieve a minimum of 22% in each area of the results.

By 2015, the Trust should be "Getting there" in at least four questions in each area of the test, and "Excellent" in at least two questions in each area - or achieve a minimum of 56% in each area of the results.

By 2020, the Trust should be "Excellent" in all areas of the test - or achieve a minimum of 78% in each area of the results.

“Getting there” refers to a score of 4 or more out of 9 (>44%)

“Excellent” refers to a score of 7 or ore out of 9 (>78%)

5.8 Action Plan

The recommendations outlined above and the discussions with the initial GCC assessment group have developed the following action plans.

Each area within the GCC assessment has an assigned working group or lead/s currently in the Trust. The groups will review all of the elements within their section and shall develop a robust and achievable plan for meeting the improvement targets above. This will ensure that a constantly improving sustainability strategy exists that is embedded within the Trust activities.

The initial action plan requires that by 2012, the Trust should achieve a score of 4 or more out of 9 (>44%) in at least two questions in each area of the test - or achieve a minimum of 22% in each area of the results. Appendix C.

Once action has been completed by a working group they will report the revision to the EEC. The progress of these groups will be monitored by the EEC and change will be made to the GCC assessment and reported in the EEC report to the OMB.



6.1 Targets

Advice from the SDU and the Carbon Trust states that, “In setting targets for carbon reduction, it is important both that NHS Trusts consider all emissions sources and that Trusts first target the largest reductions which are also easiest to measure and influence. The 10% SDU target covers all emissions sources - buildings, transport, waste and procurement. To reduce emissions in line with this target action is needed in all areas of the footprint. To demonstrate progress, this action should be supported with stretching targets for the footprint we can measure i.e. from buildings and own transport. Previous experience from the Carbon Trust suggests that an absolute emissions reduction, for these areas, of between 20 and 25% over a 5 year period is readily achievable. Targets in this range are in line with the Climate Change Act targets and sufficient to set Trusts on a course to meet vital long term carbon reduction targets.”

6.2 Reporting

The following are NHS SDU Proposals for reporting at National, Regional and Local Levels, taken from the Carbon Footprint Monitoring 10% target paper released on 14 April 2009. Any updated information will be included and acted on accordingly.

§  National Level (NHS SDU)

Reporting mechanism at a national level via the NHS SDU is bi-annual progress reports on overall NHS England consumption emissions published in June 2010, 2012, 2014, 2016.

§  Regional Level (SHA)

The NHS carbon reduction strategy recommended that "every SHA Board should receive at least annually a report about progress in meeting the requirements of this strategy in their region". These annual reports should therefore expect to include a section on actions in all areas of the carbon footprint and progress for meeting carbon targets for building energy use and transport.

§  Local Level (NHS Trust)

Each NHS Trust is expected to include their Carbon Management Plan within their board level Sustainable Development Management Plan. It is expected that annual reports will be made to the Trust Board reporting datasets collected and assessed progress in reducing emissions building energy use as well as actions in all areas of the carbon footprint, including staff involvement across the Trust.



This part of the strategy is to consider the fact that climate change is happening now and is one of the greatest threats to our health and well being. NHS organisations need to understand what the threats to the health of our communities are as a result of a changing climate and differing weather patterns. This strategy recognises that work needs to be undertaken to ascertain what the likely threats are and to develop contingency plans to mitigate any risks. This strategy shall dovetail into the Trust’s Business Continuity strategy / plans. It is suggested that our Emergency Planning Officer considers this impact via the Emergency Planning Group.


A communication plan is to be developed to Inform and raise awareness amongst staff, partner organisations and the public about the Trust’s Sustainability and Reduction Strategy The plan shall be regularly reviewed by the EEC and will

  • Define the principal areas that the Trust is focusing on ( carbon management, procurement, transport and travel, waste)

  • Establish a clear shared understanding of the Trust’s  Sustainability  and Carbon Reduction Strategy and its objectives and generate enthusiasm and ownership among individuals/staff groups

  • Ensure accurate information and guidance are provided at the right time

  • Inform and raise awareness amongst audiences about the Trusts objectives and targets in all areas, key stages and timescales as and when appropriate

  • Seek the views of staff, external stakeholders through questionnaires, surveys on what the Trust/ individuals can do to help meet objectives.

  • Use  champions/ representatives to deliver key messages in  work areas.

  • Set out clear benefits for the local community and staff of the strategy and what it means for them

  • Create publicity/staff awareness campaigns and campaign materials 


  • Establish and maintain an overarching theme/strapline for the carbon reduction process

Included as appendix D



An equality impact assessment has been carried out in relation to this strategy. This is included in appendix E.






 Carbon Footprinting Metrics and Measures


 Good Citizen Assessment 20th August 2009



 GCC Action Plan



 Communication Plan



 Equality Impact Assessment










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