Sussex Community NHS Trust

Integrated sustainable healthcare - the business case

Through financial leadership, Sussex Community NHS Trust is setting the benchmark for delivering integrated sustainable healthcare. Their Sustainable Development Management Plan (SDMP) aims to reduce the environmental impact of the Trust’s operations and associated costs and, at the same time, enhance the quality of care it delivers.

The business

Sussex Community NHS Trust is the main provider of community NHS healthcare services across Brighton and Hove and Sussex. The Trust’s expert teams provide essential medical, nursing and therapeutic care to over 8,000 adults, children and families a day.

Under the NHS Carbon Reduction Strategy (2009) and its Sustainable Development Strategy (2014), NHS Trusts are required to design and implement board-approved SDMPs and take action to reduce CO2 emissions and pursue
sustainable development as a strategic goal.

The idea

In 2010, the Trust’s first plan called ‘15 by 15’, aimed to reduce all key environmental impacts from the Trust’s operations by 15% by 2015. This included a zero landfill commitment. 

"The Trust has invested nearly £1m in sustainability in one way or another since 2010 and every penny of this has had a solid business case to back it up."

The strategy was designed to deliver quick wins, demonstrate the value of investing in sustainability solutions and, create a platform to build a more ambitious long-term strategy. The work programme that followed delivered significant results, meeting the 15% targets a year ahead of schedule. These tangible successes paved the way for the Trust to develop a more ambitious strategy, which they called Care Without Carbon (CWC).

The innovation

In February 2014, the board approved the Care Without Carbon (CWC) strategy. It set more challenging sustainability 
targets to 2020 (34% reduction in absolute CO2 emissions), with the Trust aiming to be the first carbon-neutral healthcare NHS provider.

At the heart of the strategy is a unique seven-step management framework, to be led by the Trust’s Director of Finance:

  1. Buildings – reducing the environmental impact of the Trust’s estate.
  2. Journeys – minimising the environmental and health impact of travel.
  3. Procurement – creating an ethical and resource efficient supply chain.
  4. Culture – informing, motivating and empowering people to achieve sustainable healthcare.
  5. Wellbeing – enhancing the wellbeing of the Trust’s workforce.
  6. Adaptation – ensuring the Trust’s infrastructure and operations are resilient to climate change.
  7. Governance and transformation – embedding sustainability in corporate governance structures and the Trust’s transformation agenda.

One of the key factors to making the project a success was gaining the engagement of the Trust’s staff. By showing the link between patient care and staff wellbeing, the Trust’s finance and sustainability team was able to get staff buy in.

Finance function leadership

Support from the Trust’s finance department has been fundamental to the success of the Care Without Carbon strategy. The Trust’s Director of Finance and Deputy Chief Executive, Jonathan Reid, is the executive sponsor for the programme and represents the delivery team at the Trust board, ensuring it is a mainstream issue for the Trust.

‘The finance team was fundamental in allowing Care Without Carbon to develop into the successful programme it is today,’ says Will Clark, who heads up the Trust’s sustainability team. ‘They have provided direct support to enable us to build robust business cases for investment in sustainability projects, helping us to earn credibility in the organisation. The Trust has invested nearly £1m in sustainability in one way or another since 2010 and every penny of this has had a solid business case to back it up.’

Although the programme is cash positive overall, many aspects of its delivery have required upfront investment. This has involved the development of robust business cases that take into account a range of environmental and social benefits, in addition to the potential financial return. For instance, the decision was made to invest in a 50kW photovoltaic system at Brighton General Hospital.This project delivered a simple payback of nine years but offered long-term carbon-savings. The finance team helped to quantify and highlight the environmental benefits of investment in renewable energy technology to Trust staff and the wider community.

‘The finance team also provides a more critical role, where they challenge us to come up with new ideas, opportunities
and projects that enable us to meet both our financial and environmental sustainability goals – reducing carbon and
contributing to cost improvement across the Trust,’ explains Clark.

‘More recently they have directly supported the development of an Integrated Performance Reporting approach, in which all aspects of sustainability are integrated into a single monthly report. This is work in progress because of the complexity of the data that needs to feed into it but achieving it will not be possible without the support of the finance team, which oversees performance reporting at the Trust.’

Positive long-term impact

‘The Trust reports that it has achieved a 16% improvement in energy efficiency and a 55% improvement in water efficiency since 2010/11, with associated cost savings. It has also introduced a low-emission car pool scheme with a 38% return on investment; worked with clinical services to bring in the Trust’s first electric bike; and given advice to hundreds of Trust staff about how to travel more efficiently. As a result, business mileage has dropped by 500,000 miles since 2010/11 and fleet vehicle emissions are down 18%.

February 2015 also saw the launch of ‘Dare to Care’, an engagement programme aimed at staff across the Trust, asking them to build simple actions into their daily routine that help the environment, the NHS and their own wellbeing. In the first six months, over 500 staff signed up to the programme, and the long-term target is to get every member of staff involved in the campaign and extend it into the wider community.

"The finance team provides a more critical role, where they challenge us to come up with new ideas, opportunities and projects that enable us to meet both our financial and environmental sustainability goals."

Lessons from the case study

‘The key to successfully achieving a plan like this is to keep it simple,’ says Will Clark at the Trust. ‘Sustainability can be a bit of an abstract buzzword and can mean different things to different people. So you need to be absolutely clear what you’re trying to achieve and find ways of communicating this in language people understand and importantly, is meaningful to them.

‘This was what we tried to do by creating Care Without Carbon – it’s a mission statement and does what it says on
the tin. In terms of engagement and involving people it’s also critical that you’re able to articulate why sustainability, however you define it, is relevant to them and can actually support what they are trying to do in the organisation.

‘In healthcare it’s about showing that taking action to become more sustainable will actually support health and wellbeing, which is our core business. But the same principle applies in any organisation – to identify and articulate the link between sustainability and the primary ambition or function of the organisation.’

What the judges said

It was clear that the leadership from the Finance Director and his team in driving the project was key to its success. THe judges particularly liked how they used the link between improved environmental performance and improved care outcomes for patients to get staff buy-in for the programme within the Trust.