QualityHealthcareEnvironments

Sustainable Development Management Plan2014 – 2018

March 2015

NHS Property Services | Sustainable Development Management Plan | 2

Foreword by Dennis Markey, Chief Operating Officer

I am proud to say that NHS Property Services is working hard to improve our estate to benefit our NHS and other tenants and commissioners. To complement some of the excellent work already in progress, sustainability must be embedded into all areas of the organisation, so that these benefits reach patients and the population into the future.

This Sustainable Development Management Plan (SDMP) will confirm our principles and vision. It sets ambitious but achievable targets which will realise financial and carbon savings, and aligns with the strategic priorities for the business. It will assure our customers, commissioners and partner organisations that relevant legislation is adhered to and that we are taking responsibility for mitigating the impact of our 10% of the NHS estate on the environment.

If you would like to contact us, please email sustainability@property.nhs.uk

Front and back covers: Houghton Primary Care Centre, Tyne & Wear

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Foreword 2

Introduction 5

1.1 An introduction to the company 61.2 Carbon reduction goals 8

Context 9

2.1 National policy drivers 102.2 NHS Carbon Reduction Strategy 11

Areas of focus 12

3.1 Managing energy and carbon 133.2 Designing the built environment 143.3 Ethical procurement 153.4 Low carbon travel and transport 163.5 Water efficiency 173.6 Minimising waste 183.7 Working together 19

Adaptation 20

Communications and engagement 21

Governance 22

References 23

Contents

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Inspection of the assisted Natural Ventilation System, supplying the main public spaces at Houghton Primary Care Centre, Tyne & Wear.

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1Introduction

Climate change is now scientifically recognised as being caused by greenhouse gases generated by increasing human activity with rapidly rising global population. Consequently, international agreements are in place to limit carbon emissions and conserve finite resources for future generations.

Importantly for the NHS, climate change is now regarded as the most serious risk to health and wellbeing [Lancet, 20091] and a major cause of increased public health inequality. The NHS has not only significant potential to make a contribution to reducing climate change but has a clear role in reducing healthcare demand by changing behaviour in favour of wellness.

The NHS is major consumer and contributor to carbon emissions. It is also in a unique position to influence sustainable development. With a £90 billion annual budget and 1.3m employees, the NHS acknowledges its responsibility to encourage the adoption of sustainable development principles in the behaviours of its staff.

The provision of NHS healthcare services is particularly energy intensive. Energy cost was estimated to be £630 million in 2012-13, making energy consumption a major and increasing financial issue for NHS organisations.

The NHS has one of the largest estates in Europe, covering 6,886 hectares of land with 25 million square metres of occupied floor area. NHS Property Services inherited around 10% of the NHS estate, and is working with tenants, key partners and stakeholders to embed sustainable development.

All staff employed by NHS Property Services are expected to work to sustainability principles identified in this document. The NHS Property Services Board via its Sustainability Team will ensure that progress towards targeted objectives is monitored and reported to achieve continuous improvement.

In a recent tenants’ survey 75% of respondents stated they would like to work closely with NHS Property Services to make our buildings more efficient in terms of sustainable development.

75%

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1.1An introduction to the company

NHS Property Services is one of the bodies created as a result of the Health and Social Care Act 2012. We work particularly closely with NHS England and the 211 clinical commissioning groups.

We are a landlord, estates and facilities manager and service provider and have a strong local focus throughout England. We have two main roles:

• Strategic estates management – acting as a landlord, modernising facilities, buying new facilities and selling facilities the NHS no longer needs.

• Dedicated provider of facilities management support services such as cleaning and catering.

We have responsibility for over 3,500 buildings – worth over £3 billion – which were previously owned, leased or managed by primary care trusts and strategic health authorities.

There is a clear mandate to provide a quality service to our tenants and minimise the cost of the NHS estate to those organisations using our facilities. Any savings we make are passed back to the NHS.

Objectives

• Improve the quality of the estate portfolio

• Ensure continuity of the estates service

• Keep buildings safe, warm and clean

• Ensure the NHS estate is managed sustainably

• Use our scale to deliver improvements and efficiencies

• Fill empty buildings by bringing in new tenants

• Make more effective use of the estate

Increasing sustainability should not be a distraction from the company’s core business, but should be embedded in all areas of our business. It is fundamental to the work of optimising the value of NHS assets and making them fit for the future.

NHS Property Services aspires to be a good corporate citizen and an ethical landlord which supports its tenants’ sustainability programmes and therefore we need to collaborate closely with them to support their own SDMPs and energy efficiency goals.

Kirkley Mill Health Centre, Suffolk

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4Regional OfficesCambridge, London, Manchester, Taunton

1Head OfficeSkipton House, London

10The percentageof the total NHS estate

1,946Health centres

683

694Offices

280Hospitals/related buildings

273Land / land with buildings

599Other properties

The company in numbers

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1.2Carbon reduction goals

Much of our initial work is in sourcing the data from the properties that we have inherited from the 161 predecessor organisations to form NHS Property Services on 1st April 2013. We will collect the required data (by the end of May 2015) to calculate an accurate baseline carbon footprint for 2013/14 and then set targets to meet and exceed the reductions required to meet the government’s ambitions – ultimately of an 80% reduction by 2050.

We will also benchmark the energy use across our estate, using the comparison of the large numbers of each type of building we hold to drive building performance towards the very best in class.

We aim to provide a healthy and sustainable environment for healthcare provision, saving money through efficiencies that will directly feed back into patient care in the NHS.

ActionNHS Property Services will set an ambitious target to reduce carbon emissions between 2013 and 2020. Initially this reduction will be set at 34% and will be reviewed in 18 months in line with improving data.

34%

Ongar War Memorial Medical Centre, Essex

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2 Context

All NHS organisations were required to have in place a Sustainable Development Management Plan (SDMP) to support the NHS’s Carbon Reduction Strategy, ‘Saving Carbon, Improving Health’ published in 2009 by the Sustainable Development Unit (SDU)2.

The SDU maintains the Good Corporate Citizenship tool3 as a model for evaluating progress towards embedding sustainability. They monitor progress of all NHS organisations using the tool and have set targets in place.

By 2016Achieving a score of 50% in each area –

“getting there”

By 2020Achieving a score of 75% in each area –

“excellent”

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By nowAchieving a score of 25% in each area –

“getting started”

Colne Health Centre, Lancashire

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2.1National policy drivers

The Climate Change Act 20084 set legally binding targets for reducing UK carbon dioxide (CO2) emissions by at least 80% by 2050, compared to 1990 levels.

It also gave the Government the adaptation reporting power5 – to ask public sector organisations, and statutory undertakers (such as energy and water companies) to report on their assessment of the risks climate change poses to them, and the actions they are going to take in response. The Government has recognised the healthcare system as a key sector in ensuring that the country is adapting to the risks of climate change and has requested a response. NHS Property Services is a member of the working group to report back to the government in March 2015.

The CRC Energy Efficiency Scheme6 requires high energy using organisations to join the scheme and purchase allowances for every tonne of carbon they emit.

Due to the qualifying criteria, NHS Property Services is not a participant of the current phase, but will be required to join when the next phase starts in 2018. Obviously this will have an implication on our energy costs and those of our tenants, so it is important that we minimise the burden through energy efficiency to prevent money being diverted away from healthcare.

Revive Healthy Living Centre, Derby

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2.2NHS Carbon Reduction Strategy

The NHS Carbon Reduction Strategy continues to be updated to follow the progress of all NHS organisations in established sustainable practices within their operations. The Strategy requires specific actions:

• Establishing Board approved sustainable development management plans (SDMP)

• Signing up to the Good Corporate Citizenship tool

• Monitoring / reviewing / reporting carbon footprints

• Actively raising awareness at every level of the organisation

The requirement that all NHS organisations prepare an SDMP now forms part of the Public Health Outcomes Framework, making this information a cornerstone for health and wellbeing boards and their members, including clinical commissioning groups.

The graph (right) confirms that NHS emissions peaked in 2004 and are now on a downward trend but still well short of the required reduction. This means that meeting the Climate Change Act targets of 34% reduction by 2020 and 80% reduction by 2050 will now be an even greater challenge.

1990

1990 1997 2004 2010 2015 2020

0

5

10

15Mt C

O2e

20

25

1995 2000 2005 2010 2015 2020

Year

2025 2030 2035 2040 2045 2050

NHS in England Carbon FootprintCO2e baseline to 2025 with Climate Change targets

Trajectory wedge

NHS in England GHG emissions

NHS in England forecast

2007 baseline

Trajectory to 2020

10% target from 2007

1990 baseline

Climate Change Act Trajectory

34% target from 1990 baseline

50% target from 1990 baseline

64% target from 1990 baseline

80% target from 1990 baseline

NHS England’s projected emissions to 2020 in comparison with the NHS and governmental targets.

Source: Sustainable Development Unit

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3 Areas of focus

Morpeth NHS Centre, Northumberland

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3.1 Managing energy and carbon

NHS Property Services is expected to provide low carbon, high quality healthcare environments which are not only sustainable but resilient to the future climate change consequences of potential energy shortages.

Where are we?

NHS Property Services is rolling out a programme to upgrade our gas and electricity meters so that they can be automatically read. This provides accurate data for analysis and eliminates estimated readings, improving budgeting.

The two most effective ways to reduce the impact of rising utilities costs will be to use less energy and to generate it ourselves. Technologies for self-generation are rapidly evolving, so we will continually monitor opportunities and apply them wherever possible.

We will prioritise sites that offer the best opportunity for renewable investment by developing a league table based on utility benchmarking and property type.

How do we measure success?

• CIBSE benchmarks7

• Ratings from our Display Energy Certificates8

Our pledge:Install renewable generation to reduce the carbon intensity of the electricity used across our estate by 30% by April 2018; and reduce our own energy consumption by 30% by April 2018.

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3.2Designing the built environment

The built environment has a significant impact on health and sustainability not only in carbon emissions but influencing the behaviour of people, by making sustainable choices more convenient, such as staircases being more visible.

Where are we?

All new buildings and major refurbishments are assessed for sustainability using the BREEAM model9. This offers a good rating of the design, with the SDU urging that ‘Outstanding’ should be the aim. As a minimum we are expected to achieve ‘Excellent’ on new build projects and ‘Very good’ on refurbishment projects.

BREEAM assesses the design of building projects but often there is a ‘performance gap’ between the designed energy efficiency and the actual performance in use. This is where we intend to work more closely with our tenants to close the gap. The Government Soft Landings model10 offers a tool to manage this process and ensure that the good intentions in the design are realised by our tenants and patients using the buildings.

Alternatives to traditional procurement models will be considered, such as Energy Performance Contracts (EPCs). The RE:FIT11 scheme is one such example that has been used successfully by public bodies.

How do we measure success?

• Ratings from BREEAM assessments

• Buildings’ Energy Performance Certificates and Display Energy Certificates12

• Government Soft Landings

Our pledge:All new builds to be rated BREEAM Outstanding by April 2016; to eliminate the ‘performance gap’ between the design efficiency of buildings and the actual in-use performance; to improve all buildings with EPC ratings of F and G so that E is our minimum rating. All this will ensure that our buildings are pleasant places to work and visit, improving the wellbeing of staff, patients and visitors.

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3.3Ethical procurement

Analysis by the SDU on the carbon footprint of the NHS shows that procurement is responsible for around 60% of the total. NHS Property Services needs to implement innovative and sustainable low carbon procurement principles. To do so involves working in partnership with suppliers, whilst using our greater national buying influence.

Where are we?

We are working to ensure all new contracts and tenders consider sustainability, and that prospective contractors have sustainability policies and procedures in place.

The Government Buying Standards13 – mandatory for central government and encouraged for all of the public sector – requires that the life cycle is considered when procuring goods. This may require a change in emphasis by the procurement team to enable reaping benefits over a longer timescale. Carbon ‘hotspots’ within our purchasing will be identified as priority areas to tackle.

Another consideration is the Public Services (Social Value) Act 201214 which requires that “economic, social and environmental wellbeing” are considered during procurement.

How do we measure success?

• Good Corporate Citizenship model15

• SDU’s P4CR toolkit16

Our pledge:To be an ethical procurer, achieving ‘P4CR level 4’ by April 2016.

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3.4 Low carbon travel and transport

Travel is responsible for approximately 17% of the NHS’s carbon footprint and significantly transport is a key area where the NHS can achieve a demonstrable impact on the nation’s health.

Where are we?

We are currently piloting a travel bureau to allow staff to book travel, this will help us monitor the amount of CO2 used for business travel. A review of our commercial vehicles and lease cars is being undertaken, with a view to reduce the number of vehicles, improve the efficiency of the service and introduce more sustainable vehicles.

We will:

• Develop a national travel plan by July 2015

• Encourage our staff to choose low emission travel choices through reviewing business mileage rates, promoting cycling incentives and car sharing

• Improve the facilities to encourage more virtual meetings

• Ensure all new NHS Property Services premises have good access to cycle routes, public transport and electric vehicle recharging networks

• Take opportunities to introduce electric vehicle pool cars and commercial vehicles

• Robust systems for collecting data on all our travel carbon emissions, including our grey fleet

How do we measure success?

• Source all data to measure organisation’s travel carbon footprint and target a reduction

• Good Corporate Citizenship model

Our pledge:To enable staff, patients and visitors to access our sites in the healthiest way that suits them, encouraging active travel for all. Introduce electric vehicles into our fleet and where they are not feasible ensure we use low-emission vehicles to target an overall reduction of 40% in carbon emissions from our vehicles by April 2016.

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3.5Water efficiency

Water is an increasingly expensive natural resource that needs to be managed effectively to prevent unnecessary waste. The NHS in England consumes an estimated 38.8 million cubic metres of water at an approximate cost of £145 million p.a.17. We will work with our tenants to provide water efficient technology within sites and monitor and respond to waste which costs money that could otherwise be spent on healthcare.

Where are we?

NHS Property Services is currently procuring a bureau service to manage the many accounts we have across the country, and this will help to identify those premises where usage is higher than average.

We will:

• Reduce water consumption in existing premises using efficiency measures

• Rapidly respond operationally to reported leaks and faulty equipment

• Design water-efficient technology into new building developments

• Audit water usage consumption and implement billing checks

How do we measure success?

• Establish the baseline by early 2015/16 so that we can set reduction targets for consumption across our estate

Our pledge:We will make more use of rainwater harvesting and reuse of greywater along with other water-saving measures to reduce the water use across our estate by 15% by April 2018.

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3.6Minimising wasteWaste generates carbon and costs the NHS approximately £75m annually. There is a need for all NHS organisations to minimise the creation of waste by monitoring its generation and target reduction. Contracts with waste management companies need robust records of quantities collected and disposal destinations.

Where are we?

• A review is currently being undertaken to consolidate contracts and improve efficiency

• We are currently compiling a database of all waste contracts, including weights and waste stream to ensure we have accurate data

Robust waste management practices will be adopted covering the production, collection, transportation, processing, recycling and disposal of all waste material with stringent waste monitoring in place. The waste hierarchy will also be used to fully engage all building users on the importance of diverting waste from landfill and driving down volumes of waste.

The biggest impact from waste in our estate will come from our tenants. We will work closely with them to provide the collections they need and the facilities to enable efficient and effective segregation, reduction and storage of their waste.

How do we measure success?

• Tenants are compliant with current legislation

• Benchmark our current recycling and target improvement

• Efficiencies through procurement of waste contracts

Our pledge:All NHS Property Services sites will have waste recycling facilities by April 2016; where tenants occupy our buildings, we will provide the facilities to encourage them to recycle. We will establish our baseline and increase recycling by 10% in the first year. All capital projects will have a Site Waste Management Plan to ensure that all construction waste is recycled in accordance with legislation and to reduce landfill. Furniture and office equipment will be reused or recycled wherever possible.

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3.7Working together

To fully leverage the potential for reducing the impact on the environment we will have to work closely with our tenants, local communities and other stakeholders. Our goals are closely aligned to those of our tenants so we will work together to the benefit of patients, communities and the public purse.

Where are we?

Many close working partnerships existed from previous working arrangements within former PCTs. It is important to continue expanding on this and replicate examples of best practice across our regions.

Our buildings will not be operated efficiently if the design and management is done in isolation to the operations within the building. Savings are not always transparent which can create barriers to the implementation of improvements. For example, the tradition view of financial payback of investment towards energy efficient equipment isn’t appropriate if the investment is made by the landlord but the energy savings are realised by the tenant.

This relationship can be effectively managed by adopting the work of the Better Building Partnership on Green Leases18. This sets out how landlords and tenants can work together to provide each other with what is necessary to manage buildings efficiently.

It is proposed that working groups be created to allow tenants / collaborative networks to influence the action plans and voice their concerns about energy wastage and costs to estate managers.

How do we measure success?

• Stakeholder research

Our pledge:To become a trusted source of sustainable development success, support and advice.

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4 Adaptation

Planning for climate change involves preparation for extreme events, strategic planning for longer term expected changes and building resilience to increased variability in weather patterns with a view both of emergency preparation and resilience across the organisation, partnerships and community.

It is recognised that new technologies should be installed, and adaptations should be undertaken where premises are at risk of being affected by significant environmental impacts. NHS Property Services, as part of the business continuity framework and planning process, will minimise the disruption to services and building closures by managing the environmental risk. NHS Property Services will undertake the necessary measures to prepare and react to extreme events to ensure our buildings are resilient and fit for the future.

The SDU has produced the Sustainable Development Strategy19 document launched in January 2014 with one of the areas of focus being Healthy, Sustainable and Resilient Communities. NHS Property Services will work with all key organisations to mitigate risk and manage environmental impacts for the benefit of local communities and continued access to services.

Our pledge:We will install new and innovative technology to mitigate the risk of environmental impacts.

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5 Communications and engagement

To succeed in significantly increasing the estate’s sustainability, staff and tenants will need to feel motivated to change the way they work.

Motivate sustainable developmentSuch behaviour change would result from a creative and integrated social marketing campaign. This would put into place the conclusions of existing or if necessary new research into what motivates relevant audiences to behave more sustainably in relation to the use of healthcare premises, and what interventions might achieve that.

Communications principlesThe research and campaign would be on the basis of the following draft principles:

• Motivating staff and tenants to take actions locally in their buildings, supported by the national campaign and tenants’ own SDMPs.

• Using positive behaviour change thinking to modify social norms.

• Confirming the belief that sustainability is efficiency.

• Using the positive emotions of audiences to create healing environments.

• Communications to be integrated and complementary with associated sustainability initiatives in the NHS and the commercial property sector.

• Active engagement activities with staff and other stakeholders.

• Acting on the mandate that 75% of tenants want to work closely with us to make buildings more efficient in terms of sustainable development.

Actions:1 Review existing research –

or if necessary commission new social marketing research to understand what communications interventions will be effective.

2 Develop a communications and engagement strategy and social marketing campaign to act on the research conclusions.

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6 Governance

NHS Property Services needs to show commitment by documenting sustainability in its operations and progress towards objectives.

The SDMP will establish Board-approved principles and set action plans. As the company matures and its relationship with its tenants develops the SDMP will evolve within this framework.

Reporting Sustainability will be reported to the Board on a quarterly basis, with progress against actions and targets communicated as part of the Performance Report. This will be led by the CSR and sustainability team who are responsible for the development, implementation, review, performance management and distribution of this policy which will be revisited annually or when significant changes make earlier review necessary.

Our pledge:We will document sustainability in our operations and progress towards our pledges.

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1 “Climate Change is the biggest global health threat of the 21st century”, Lancet front cover, vol. 373, no.9676

2 www.sduhealth.org.uk/delivery/plan.aspx

3 www.sduhealth.org.uk/gcc

4 www.legislation.gov.uk/ukpga/2008/27/contents

5 www.gov.uk/government/policies/adapting-to-climate-change/supporting-pages/adaptation-reporting-power

6 www.gov.uk/government/policies/reducing-demand-for-energy-from-industry-businesses-and-the-public-sector--2/supporting-pages/crc-energy-efficiency-scheme

7 www.cibse.org/knowledge/cibse-tm/tm46-energy-benchmarks

8 www.gov.uk/government/publications/display-energy-certificates-and-advisory-reports-for-public-buildings

9 www.breeam.org/about.jsp?id=66

11 www.refit.org.uk

12 www.gov.uk/government/policies/improving-the-energy-efficiency-of-buildings-and-using-planning-to-protect-the-environment/supporting-pages/energy-performance-of-buildings

13 www.gov.uk/government/collections/sustainable-procurement-the-government-buying-standards-gbs

14 www.gov.uk/government/publications/procurement-policy-note-10-12-the-public-services-social-value-act-2012

15 www.sduhealth.org.uk/gcc/about.aspx

16 www.sduhealth.org.uk/areas-of-focus/commissioning-and-procurement/procurement.aspx

17 From ‘Health Technical Memorandum 07-04: Water management and water efficiency – best practice advice for the healthcare sector’, www.gov.uk/government/publications/water-management-and-water-efficiency-best-practice-advice-for-the-healthcare-sector

18 www.betterbuildingspartnership.co.uk/working-groups/green-leases

19 www.sduhealth.org.uk/policy-strategy/engagement-resources.aspx

References

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