HealthManagement, Volume 18 - Issue 2, 2018

The ripple effect: sustainability in healthcare

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How ‘corporate responsibility’ is impacting on healthcare

Developed by Sussex Community NHS Foundation Trust (SCFT) Care Without Carbon (CWC) is an award-winning healthcare sustainability model, which has impacted positively on reputation.

Sustainability in healthcare

“Sustainability” is a phrase that’s used a lot in the National Health Service (NHS) at the moment, with people interpreting it in different ways. For many it’s simply about money and has become short- hand for doing more with less. This is understandable since it is no secret that budgets are shrinking, demand is rising, and interventions are becoming more expensive. At the same time others equate the word with having an environment conscience or being eco-friendly, which is also reasonable as it’s an issue that’s increasingly in the public eye.

These are narrow interpretations and in reality understanding the concept of sustainability requires a more holistic perspective. It is now widely accepted that for an organisation to be truly sustainable its business model needs to account for and add value to three interrelated capitals: economic capital (the long term economic value of the organisation and its investment practices); environmental capital (in terms of the resources it consumes and the emissions and waste products it produces) and; social capital (the relationship between the organisation and people – i.e. its staff, the community and people working within the supply chain). This idea has become known as the “triple bottom line” approach to business and one that is reflected in NHS policy on sustainability (sustainable development Unit 2018), supported by statutory legislation such as the public services (social Value) act (the national archives 2012), and all NHS providers are expected to put in place board approved Sustainable Development Management Plans (SDMPs) intended to implement these policies. However, in reality most SDMPs that I have read tend to focus primarily on the environmental aspects and financial aspects. Seldom do they articulate a vision for delivering sustainable healthcare that reflects this broader interpretation and gets closer to the core business of the organisation. I think there are several reasons for this including increasing UK and European Union regulation and related statutory drivers and the high management cost of environmental impacts. Additionally, it is relatively straightforward to measure environmental impact inefficiencies and most providers lack the expertise, resources and skills to develop more comprehensive, integrated corporate social responsibility programmes. Finally, there are ever increasing levels of environmental awareness within society with a growing expectation that large organisations adopt a positive and meaningful attitude to environmental management – particularly those spending taxpayers’ money.

Resource challenges and triple bottom line
In light of this it’s perhaps unsurprising that most sustainability strategies in the NHS are really just environmental management or carbon management plans. however, this is exactly how Care Without Carbon’s (CWC: predecessor strategy started life. Called “15 by 15” the strategy aimed to reduce the trust’s main environmental impacts by 15 percent between 2010 and 2015. the strategy was very effective, achieving most of these objectives two years early.

CWC was conceived in response to a challenge from the Trust’s Board: how do we make this agenda more ambitious and meaningful, accelerate the pace of change, embed this programme further into the Trust and make it part of our core business? To address these points, particularly the last one, we needed to articulate the triple bottom line message in a way that would be more clearly understood by an NHS board. Our starting point is to be clear that sustainability is simply another way of saying “resource efficiency”. And if you look at the NHS through the triple bottom line lens you can identify three major resource challenges:
• Dealing with a £30b shortfall in funding to 2020
• Tackling the largest carbon footprint of any public sector organisation in the UK
• Maintaining the health, well-being and productivity of its 1.3m staff.

CWC enables NHS providers to address these challenges through their sustainability work in a systematic and integrated way. This is, in a nutshell, what we believe makes CWC more mature than most sustainability initiatives in the NHS.

Sustainability and reputation

The reputation of any organisation is shaped by more than delivery of the core service it provides. Corporate social responsibility is now a major consideration in the private sector, and the NHS is no exception. In demonstrating that we take our sustainability responsibilities seriously we are also showing that the care we provide extends to the physical environment and to the communities that we serve.

We’ve actually gone out and asked patients if they thought this was something that the NHS should be spending time on, with an overwhelmingly positive response; the majority of people we spoke to felt the NHS should be working to become more sustainable, even if this cost more. Our work with CWC shows our patient community and staff that we have listened to them, and taken action.

We report on our progress on CWC in different ways to ensure we’re communicating the benefits to as many stakeholders as possible – through the Trust’s annual report, through our stand-alone Annual Sustainability Progress Report which we now routinely publish and through our website.

Enhancing our reputation through CWC wasn’t an explicit aim when we started the programme but has become increasingly important over its life. When the work started in 2010 sustainability was a very new concept in the NHS and a completely new one for SCFT. i needed to make the case for the Trust to embrace and invest in it and the Board wanted assurance that the approach I was proposing represented best practice.

I therefore decided to seek external recognition and in 2011 the programme was awarded the health service Journal’s good Corporate Citizenship award – the first of several high profile awards it has received. the 2011 award served both as confirmation that the programme was hitting a national benchmark but also gave a reputational boost to the Trust, which had only been formed the previous year. This was clearly regarded by the Board to be a tangible benefit of adopting a proactive approach to sustainability, alongside the cost savings and other outputs we were identifying and delivering.

By the time CWC was developed in 2013 it had become clear to me that sustainability was something that we needed to actively market in order to raise awareness, generate interest and encourage engagement. This was the fundamental reason for developing the brand and as recognition of CWC has grown (it is now known internationally as a leading example of sustainability best practice in healthcare) this has only served to reinforce the rust’s commitment to supporting and promoting the programme. For instance, it used CWC in its recent recruitment campaign as a means of highlighting its ethical and forward-thinking attitude as an employer.

Public demand

Our experience is that people do want to see the NHS take a positive stance in tackling climate change. there has been increasing coverage of the impact of air pollution on health for example. It does help to raise the profile of the issue in the public mind and as a response to this trusts will have to show they are doing their bit towards solving the problem.

I would say all media, not just social media, has helped to mainstream this important call to action. What we try to demonstrate with CWC, is the link between sustainable behaviours and healthy behaviours, so people can see that our work is addressing more than one agenda (a sustainable lifestyle is a healthy lifestyle and vice versa). After all, at the end of the day we are here to help keep people healthy.

There is a growing demand across the NHS on all aspects of its services. Sustainability is not as high on that list as, say, clinical risk or quality improvement, but there is a risk that people will expect more than a Trust can deliver. We have to manage our services to deliver the best outcome for patients, and patient care will always be at the heart of our decision-making.

One area we want to start to tackle is the public health relationship with sustainability. For example, many of the techniques we use to engage staff in more sustainable, healthier behaviours to promote and enhance well-being in the workplace are equally applicable to patients and the wider community. We would like to start working with some key patient groups, for instance pre-diabetic patients – to demonstrate the impact that simple lifestyle changes can make, to their own health of course, but also in terms of environmental improvement. there are some important public health challenges that are intrinsically related to environmental quality – air pollution caused by motorised transport and respiratory disorders is a great example.

Delivering a clear message

When approaching the development of a good sustainability reputation, it’s important to be very clear with your communication strategy and use language people can understand. be clear what you mean by sustainability and why the organisation takes it seriously. Most people can see through “green wash” so the messaging needs to be sincere and consistent.

Also, use every opportunity to talk to staff, patients etc to find out w hat t heir interests are, enable them to get involved and to make suggestions.

Finally, don’t overpromise and make sure you can measure and report on progress and evidence successes. Don’t be afraid to talk about things that haven’t gone so well or areas where you recognise you need to take more action.

Key Points

  • Sustainability is interpreted differently throughout NHS
  • Understanding sustainability needs a more holistic approach
  • CWC confirmed there is a growing public demand for activity that supports sustain- ability – especially from taxpayer-funded organisations
  • CWC was directed by board to reduce main environmental impacts with an ambitious and accelerated pace while making programme part of Trust’s core business
  • Reputation enhancement was not aim of CWC but became an intrinsic part of initiative with the programme garnering accolades
  • All media, not solely social media, have played a key role
  • When it comes to delivering a message on an organisation's sustainability activity, a clear and sincere message is necessary


Sustainable Development Unit (2018) Policy and Strategy. Available from (2012) Public Services

(Social Value) Act 2012. Available from

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Sustainability, NHS, corporate responsibility, European Public Health Association, healthcare reputation, Sustainability in healthcare, Will Clark, Sussex Community NHS Foundation Trust, Sussex Community NHS Foundation Trust (SCFT) Care Without Carbon (CWC), Care Without Carbon, CWC, healthcare sustainability model, Corporate social responsibility Developed by Sussex Community NHS Foundation Trust (SCFT) Care Without Carbon (CWC) is an award-winning healthcare sustainability model, which has impacted positively on reputation.

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