Sustainable healthcare

Foreword

As the net zero board lead, I am delighted to introduce our Green Plan, which details how The Christie NHS Foundation Trust will support the NHS to become a net zero health service.

The Trust recognises that the NHS needs to respond to the health emergency that climate change brings, which will need to be embedded into everything we do now and in the future. To ensure we continue providing health and high-quality care for all, now and for future generations.

Professor Chris Harrison, Executive Director/Deputy Chief  Executive

About us

The Christie specialises in cancer treatment, research and education and is one of the largest cancer centres in Europe. Treating more than 60,000 patients a year from across the UK, we became the first UK centre to be officially accredited as a comprehensive cancer centre and are supported by an independent charity.

The Christie employs over 3,000 staff, all of whom are determined to provide the best possible cancer care and patient experience. Some of the developments we have made in the last few years are outlined here. During our last strategy, we have built a state-of-the-art proton therapy centre as well as creating facilities in Macclesfield.

Our experts have been pioneering cancer research breakthroughs for more than 100 years and The Christie is well known for many world-firsts which have advanced cancer treatment on a global scale.

Housing the largest single site early phase clinical trials unit in the UK, we have an excellent reputation as an international leader in research and innovation, which is further strengthened by being a partner in the Manchester Cancer Research Centre (MCRC) and Health Innovation Manchester.

In 2023, we opened the new Paterson building to further our scientific discoveries in partnership with the University of Manchester and Cancer Research UK. A core element of The Christie is education. With its own School of Oncology, the first of its kind in the UK, The Christie educates healthcare professionals from across the country, enhancing the patient experience and promoting developments in cancer care. 

Our partnerships

The Christie places high importance on the establishment of long-term, mutually beneficial partnerships. This is in recognition of the immense value they bring in terms of clinical excellence, academic leadership and commercial benefits. The Christie works with world-leading organisations including Cancer Research UK and the University of Manchester. We also work closely with organisations such as HCA Healthcare to fulfil The Christie Private Care, The Christie Pharmacy Company and The Christie Pathology Partnership. 

Our vision 

The Christie strategy 2023 to 2028 sets out how we will continue to deliver our mission - to care, discover and teach. It has been developed following extensive consultation with staff, patients and public, and our Board of Directors. It sets out a clear vision of how we will transform cancer treatments, care and support, and improve outcomes for our patients.

Our Strategy is focused on 4 main themes:

1. Leading cancer care
2. The Christie experience
3. Local and specialist care
4. Best outcomes 

The refreshed Trust strategy has been built from integrating our clinical strategies (made up from the ambitions of our internationally recognised clinical teams and the future plans of our state-of-the-art clinical services) with our Research and Innovation, Education and Clinical Outcomes strategies which have each been renewed in parallel.

Not only do our plans ensure that the patient is at the heart of everything we do, but they also demonstrate that the key service developments will be undertaken ensuring that the Trust remains operationally, clinically and financially sustainable.

To enable our team to focus upon improving the experience and outcomes of all our oncology patients, our plans not only define the investment we intend to make into facilities and expertise, but also how we wish to work with the health professionals in Manchester and Cheshire to provide a more integrated, caring and personalised experience for our patients.

Climate crisis 

Human-induced climate change is causing dangerous and widespread disruption in nature and affecting the lives of billions of people around the world, despite efforts to reduce the risks. People and ecosystems least able to cope are being hardest hit.

There is a rapidly closing window of opportunity to secure a liveable and sustainable future for all. Without urgent, effective, and equitable mitigation and adaptation actions, climate change increasingly threatens ecosystems, biodiversity, and the livelihoods, health and wellbeing of current and future generations.

The Intergovernmental Panel on Climate Change’s (IPCC) final instalment of their sixth Assessment Report on climate change impacts, adaptation and vulnerability was published on 20 March 2023. The report, which is being described as survival guide for humanity, brings into sharp focus the losses and damages experienced now, and expected to continue into the future, which are hitting the most vulnerable people and ecosystems especially hard.

Climate change is a threat to human well-being and planetary health. The world faces unavoidable multiple climate hazards over the next 2 decades with the 1.5°C warming threshold expected to be crossed this decade.

In 2022, heat records were broken in all continents and 2023 saw the highest global temperatures in over 100,000 years. The Met Office forecasts for 2024 had suggested for the first time that values of 1.5°C or above cannot be ruled out.

The EU’s climate service confirmed in February 2024 that for the first time, global warming had indeed exceeded 1.5°C across an entire year. Even temporarily exceeding 1.5°C will result in additional severe impacts, some of which will be irreversible.

The temperatures in Manchester have also increased with many of the hottest years occurring in the last few decades. A significant moment occurred in July 2022 when the UK Health Security Agency (UKHSA) declared a national state of emergency with a level 4 heat-health alert. The level 4 alert is the highest warning and the first time it had been issued on a national level. At level 4 illness and death can occur among the fit and healthy. Also, that the impacts could go beyond health and social care with potential effects on transport systems, food, water, energy supplies and businesses.

On 19 July, a record temperature of 40.3°C was recorded and verified by the Met Office in Coningsby, England, breaking the previous record set in 2019 of 38.7°C. The same day Greater Manchester temperature reached record high of 37.7°C, with the previous record of 33.9°C from July 25th, 2019.

As climate change has driven such unprecedent severe weather events it can be difficult to make the best decisions because the heat was far more intense and widespread than previous comparable heatwaves. Risks for society will increase, including to infrastructure and low-lying coastal settlements.

The cumulative scientific evidence is unequivocal: Climate change is a threat to human well-being and planetary health. Any further delay in concerted anticipatory action on adaptation and mitigation will miss a brief and rapidly closing window of opportunity to secure a liveable and sustainable future for all.

Climate crisis and health 

Climate change, caused by human greenhouse gas emissions, is already harming people’s health and driving widespread losses and damages. The health impacts of climate change are happening now and are worsening. They overwhelmingly affect disadvantaged and marginalised communities and exacerbate existing health inequities.

As climate change threatens the foundations of good health, with direct and immediate consequences for our patients, the public and the NHS. The UKHSA and the Office for National Statistics (ONS) estimate that between 17 to 20 July 2022, when temperatures were at their highest, there were 1,012 excess deaths in those aged over 65. These figures demonstrate the possible impact that hot weather can have on the elderly and how quickly such temperatures can lead to adverse health effects vulnerable groups.

Many climate solutions also have benefits for health and wellbeing, and early climate action will bring long-term economic and health gains. The benefits to health far exceed the costs of implementing climate actions. 

Delivering a Net Zero National Health Service Report 

The Delivering a ‘Net Zero’ National Health Service report provides targets to reduce system-wide emissions within direct control (NHS Carbon Footprint) to net zero by 2040, and wider indirect emissions including the supply chain (NHS Carbon Footprint Plus) by 2045. The commitments were enshrined in law with the passing of the Health and Care Act 2022. Looking at the wider scope of the NHS Carbon Footprint Plus, the greatest areas of opportunity – or challenge – for change are in the supply chain, estates and facilities, pharmaceuticals and medical devices, and travel. The report also includes interim targets that are defined as defined equivalent to:

• Reducing NHS Carbon Footprint by at least 47% from 2019/20 levels by 2028-2032.
• Reducing NHS Carbon Footprint Plus by at least 73% from 2019/20 levels by 2036-2038. 

These are the most ambitious targets of any healthcare system in the world to address the impact of the sector and address the climate and health emergency. The Trust is committed to address the climate and health emergency, and we recognise it is our duty to contribute towards the level of ambition set out in report. 

Greater Manchester Green Ambition 

The Green Plan also complements our commitment to the Greater Manchester Five Year Plan for the Environment, which has set out the bold ambition for the city region to be one of the healthiest, cleanest and greenest city-regions and to be carbon neutral by 2038.

The Greater Manchester Five Year Plan for the Environment focuses on the 6 key parts of our daily lives where action is required:

• Our energy supply
• Our transport and travel
• Our homes, workplaces and public buildings
• Our production and consumption of resources
• Our natural environment
• Our resilience and adaptation to climate change

The NHS Greater Manchester, of which The Christie is a member, became the first Integrated Care System (ICS) to declare a climate emergency. This has been supported with the development of an ICS Green Plan that sets out how we will use the power of the system to deliver far-reaching innovation and change, and outlines priorities and targets for delivering net zero carbon emissions.

The challenge set out in this Green Plan will not be easy to deliver, but by working together and building momentum across the system we can deliver change at scale and inspire other systems across the country to do the same. Furthermore, the collaborative work that takes place on the ICS Green Plan will support and enhance the implementation of the Trust Green Plan.

One of the 10 ambitions in Greater Manchester’s ‘Our People, Our Place’ strategy is to ensure the region is at the forefront of action on climate change. The Greater Manchester Combined Authority (GMCA) has formed the Green City Region, tasked with bringing together stakeholders from across the city to ensure Greater Manchester is leading the way on this agenda.

“Young people across Greater Manchester and the rest of the globe have stood up and called for politicians to take urgent action on climate change. I want to say today we are listening. I’m determined that we invest in young people and give you all hope for the future. Greater Manchester wants to be carbon neutral by 2038. Our plan is the UK’s first science-based commitment for a city-region like ours, and one of the first of its kind globally. We have a science-based deadline and a deliverable plan putting us on a path towards it. Achieving our ambition will be very challenging, but it is the right thing to do. We believe this sets us apart from other UK city-regions and puts us at the top table globally. The big challenge is how we use the need to take fossil fuel out of our lives and economy to transform Greater Manchester so it works for everyone. That’s the challenge I have set myself as Mayor, and it’s the challenge that I am setting today.

 Cities and city-regions will make the difference on climate change and, in decarbonising by 2038, Greater Manchester can create a blueprint for every other city in the world. It wouldn’t be the first time. We can change ourselves, and we can inspire change in others. I say this to the people of Greater Manchester: come with us. Tackling a problem on this scale will need us all to work together.”

Andy Burnham, Mayor of Greater Manchester

Sustainable clinical practice 

The provision of healthcare incurs not just financial costs, but also contributes to significant environmental ones, in the form of greenhouse gas emissions, soil degradation, desertification, the decline of life in the oceans, species extinctions, deforestation, and water and air pollution.

This could be viewed as spending ecological capital, which is equally essential to population health. The medical profession can therefore be seen as having a particular responsibility to lead the fight against climate change and wider environmental impacts.

Once the contribution of clinical activity to environmental impact is recognised, the need to create a service which is health promoting as well as skilled in responding to immediate clinical need becomes clear. This can be addressed by considering the 4 principles of sustainable clinical practice.

Furthermore, by adopting sustainable quality improvement into service improvement and considers the ‘triple bottom line’ of social, environmental and financial benefits.

Key legislation and drivers for change

Outline of statutory, regulatory and policy requirements which were considered as part of the Green Plan.

International

Requirement	Description
UN Sustainable Development Goals	The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet, and ensure that by 2030 all people enjoy peace and prosperity. The 17 SDGs recognise that that development must balance social, economic and environmental sustainability.
Climate Change 2023 Synthesis Report Summary for Policymakers	Summarises the state of knowledge of climate change, its widespread impacts and risks, and climate change mitigation and adaptation.
The 2023 Report of the Lancet Countdown on Health and Climate Change	Report tracks the relationship between health and climate change across 5 key domains and 47 indicators, providing the most up-to-date assessment of the links between health and climate change.

National

Requirement	Description
Climate Change Act (2008)	Established powers for the government to ensure that organisations in key sectors are aware of and prepared for the impact of a changing climate. Commits the UK government by law to reducing greenhouse gas emissions by at least 100% of 1990 levels (net zero) by 2050.
Environment Act (2021)	Includes provisions to establish a post-Brexit set of statutory environmental principles, a new environmental watchdog and provisions relating to waste, air, water and biodiversity.
Health and Care Act (2022)	The legislation states that NHS organisations must be compliant with the UK’s Climate Change Act 2008 and the Environment Act 2021. The NHS must also “adapt to any current or predicted impacts of climate change” as identified in the climate change reports that the government is required to put before parliament at least every 5 years.
UK Health Security Agency report on Health Effects of Climate Change in the UK	This report provides an authoritative summary of the scientific evidence on the health effects of climate change, potential implications for public health, and gaps in evidence.
UK Climate Risk Independent Assessment (CCRA3) -Health and Social Care Sector Briefing (2021)	The UK Climate Risk Independent Assessment (CCRA3) was developed at a UK-wide scale involving scientists, economists, and stakeholders from across the United Kingdom. This briefing summarises how health and social care have been assessed and what types of action to adapt to climate change risks and opportunities would be beneficial in the next 5 years.
NHS Standard Contract Service Conditions	NHS Standard Contract Service Conditions are updated on an annual basis and include obligations that the Provider must take all reasonable steps to minimise its adverse impact on the environment.
NHS clinical waste strategy	The NHS clinical waste strategy aims to improve waste management practices amongst NHS trusts, NHS foundation trusts and primary care to make them more efficient and sustainable in order to save on cost, improve hospital function, and reduce the impact on the environment in line with NHS net zero carbon commitments.
Net Zero travel and transport strategy	This strategy outlines how the NHS will have fully decarbonised its fleet by 2035, with its ambulances following in 2040.
NHS Estates ‘Net Zero’ Carbon Delivery Plan	This delivery plan aims to address the aspects of the net zero strategy pertinent to estates and facilities activities. It sets out a clear, sequential 4-step investment approach to decarbonising NHS sites
Estates Net Zero Carbon Delivery Plan - Technical Annex	This Technical Annex has been produced to support the Estates Net Zero Carbon Delivery Plan and details the interventions, activities and target dates required to achieve the 11 strategic actions within the Estates Delivery Plan.
NHS Net Zero Building Standard	The NHS Net Zero Building Standard provides technical guidance to support the development of sustainable, resilient, and energy efficient buildings that meet the needs of patients now and in the future.

Local

Requirement	Description
GMCA 5-Year Environment Plan for Greater Manchester 2019 to 2024	Sets out the aim and priorities for Greater Manchester to be a carbon neutral city region by 2038.
Greater Manchester Transport Strategy 2040	Sets out Greater Manchester’s long-term ambition for transport.
Manchester Climate Change Framework 2020 to 2025	Manchester’s high-level strategy for tackling climate change.
The NHS Greater Manchester Integrated Care Green Plan 2022 to 2025	The Green Plan from NHS Greater Manchester Integrated Care has at its heart a commitment to achieve a net zero carbon footprint by 2038, in collaboration with partners as part of the Greater Manchester Combined Authority Environment Plan. By 2045, this net zero commitment will also include the carbon impact of goods and services in line with a national NHS target.

Trust carbon footprint

2019/20 is the base year from which trajectories to Net Zero were defined in the Delivering a Net Zero NHS report, and therefore NHS England defined the required average contributions from NHS trusts. The carbon footprint plus data provided is to be used for baselining, identifying emissions hotspots, and understanding contributions to the national emissions set out in the Delivering a Net Zero NHS report. 

NHS Carbon Footprint (2022/23)

Data provided by NHS England shows Trust contributions to the NHS Carbon Footprint up to financial year 2021/22. Furthermore this does not represent the most complete and accurate data set, as currently data for the Carbon Footprint Plus is incomplete. This Green Plan aims to address this gap going forward and also develop internal reporting process to ensure most up-to-date data is available. 

Green success 

This Trust has had early success in our journey towards net zero and aims to build upon these success stories going forward.

Sustainability nurses

Angela Hayes, palliative care clinical nurse specialist, and Alexandra Langstaff, ward sister, were jointly named as Sustainability Nurse of the Year at the British Journal of Nursing Awards 2024.

Angela and Alexandra are keen to promote greener nursing practices as part of The Christie’s ongoing drive to increase our sustainability.

Innovation

Dr Robert Chuter (Principal Clinical Scientist) successfully applied for NIHR (National Institute for Health and Care Research) funding to implement an innovative research project that looked at modelling the carbon footprint of radiotherapy pathway.

To improve environmental sustainability within radiotherapy, foundational works for others to develop upon are necessary. The radiotherapy pathway incudes everything that happens to the patient from diagnosis to follow up. Whilst fully understanding the carbon footprint of the radiotherapy pathway will take time and the efforts of many, it is important to begin assessing this UK-wide service.

This innovative research aims to support improving efficiency whilst also reducing costs in the radiotherapy pathway. This study builds on a project funded by a Greener NHS North West innovation fund.

Public Sector Decarbonisation Scheme

The Trust working with our energy partner Vital Energi successfully applied for £7.9m of grant funding through the Public Sector Decarbonisation Scheme. This was to support the installation of a self-funding fully integrated energy solution comprising a unique blend of renewable technologies.

• 280kW Solar PV System
• 2MWh Battery Energy Storage System
• 700kW Heat Pump System
• Replace Boiler / New high efficiency CHP
• 3000 LED Lighting upgrade
• De-steam improvements (LTHW)
• Site wide energy saving measures
• BEMS Optimisation
• Energy infrastructure upgrades

We forecast savings of £500k on energy bills in the first year with ongoing energy savings of £1.8m per year guaranteed. The savings in terms of carbon emissions is 1250 tonnes of carbon dioxide equivalent per year.

NHS Forest Awards 2023

The Christie gardener, Phill Walker’s work on Trust green space has been recognised in the NHS Forest Awards 2023. Recognition was given for projects to support biodiversity and for innovative development of green space on a healthcare site, including:

• Outdoor education spaces for children
• Living walls
• Permeable concrete
• Native planting
• Birdhouses, bat boxes, and bug hotels
• Reuse of materials on site
• Pop-up gardens
• Use of organic mulch and compost

These combined efforts have not only transformed the site into a lush and vibrant landscape but have also created a haven for native flora and fauna. The Trust green space now stands as a testament to the commitment to biodiversity conservation and sustainable environmental practices, serving as a model for similar projects aiming to harmonise human development with nature. 

Green Travel Plan

The Trust has achieved a 12% model swing towards sustainable travel from 2013 baseline (46% of staff using sustainable travel in 2022). This has been achieved through an award-winning Green Travel Plan, staff benefits and investment in cycling infrastructure. This has helped the Trust achieve Transport for Greater Manchester’s Platinum Accreditation, the highest rating possible for travel management.

Areas of focus

This Green Plan is aligned to the main drivers of change and sources of carbon emissions across Trust activities. The aim is to further develop actions completed in the previous Green Plan and to also incorporate new ideas. A full detailed list of the actions can be found below in appendix 1. 

• Assurance and governance
• Workforce and system leadership
• Clinical transformation Digital transformation
• Travel and transport
• Estates and facilities
• Medicines
• Supply chain and procurement
• Food and nutrition
• Adaptation
• Green space and biodiversity

Assurance and governance

The Green Plan is approved by the Trust Management Board and Board of Directors. This is to ensure that it is embedded and aligned with the strategic direction of the organisation.

The Green Plan is led by a designated board-level net zero lead who chairs the Trust Net Zero and Climate Adaptation Committee. This is a senior strategic and advisory committee that meets quarterly with responsibility for delivering of Green Plan and ensuring relevant legislative and NHS England guidance compliance. The Senior Management Committee meetings are reported to Trust Net Zero and Adaptation Committee meeting by exception. Any items of specific concern or those which require Board approval will be the subject of a separate report.

The Sustainable Development Committee meets monthly and consists of stakeholders from across the organisation. This group provides operational leadership, coordination and guidance to the Trust for integration of sustainability principles and practices throughout the Trust’s core activities. The committee meetings are reported to the Trust Net Zero and Climate Adaptation Committee. Additional working groups are set up when required and will also report to Trust Net Zero and Climate Adaptation Committee.

Where we are

• Net Zero Board Lead
• Sustainability Manager
• Governance structure in place
• Sustainability annual report with qualitative progress data

Where we are going

• Publish sustainability annual report with quantitative progress data.
• Monthly greenhouse gas emission for waste, business travel and medical gases reported in tonnes.

Workforce and system leadership

This area looks at how the Trust approaches engaging, educating and developing our workforce and system partners in defining and delivering carbon reduction initiatives and broader sustainability goals. Furthermore, how sustainability will be incorporated into decision making processes.

Where we are

• Net Zero Board Lead
• Sustainability Manager
• Governance structure in place
• Sustainability annual report with qualitative progress data

Where we are going

• Net Zero and Adaptation policy
• Sustainable Impact Assessment for business cases and policy.
• Provision of leadership development and education series.
• Repackage relevant benefits as green benefits and update recruitment materials.
• Job documentation and appraisal guidance to reference net zero target and/ or healthcare emergency.
• Introduce signposting to wellbeing advice and support linked to eco-anxiety.

Clinical transformation

The NHS Long Term Plan set out a commitment to deliver a new service model for the 21st century. If the NHS is to reach net zero emissions, that new service model must include a focus on sustainability and reduced emissions. This will require a focus on the ‘triple bottom line’ of environmental, finance and social pillars in clinical pathway design and improvement.

Where we are

• Estimating the carbon footprint of external beam radiotherapy.
• Participated in Centre of Sustainable Healthcare’s Green Team Competition.
• Bloods Closer to Home (BCTH) to reduce travel for patients and transport organised by the Trust).
• All clinic outcome forms are now to be done via the e-outcome form reducing paper.
• Treatment closer to home through our 3 radiotherapy centres.

Where we are going

• Facilitate Sustainable Quality Improvement (SusQI) training for leads across the Trust.
• Incorporate SusQI into implementation plan for NHS IMPACT.
• Measuring the carbon footprint of a move to hypofractionation in radiotherapy
• Estimating the carbon footprint of proton beam therapy.
• Measure carbon footprint of MR-Linac in collaboration with the manufacturer.
• Measure carbon footprint of nuclear medicine with a specific aim on PET and SPECT.

Digital transformation

The direct alignments between the digital transformation agenda and a net zero NHS are clear. This Trust seeks to focus on ways to harness existing digital technology and systems to streamline service delivery and supporting functions while improving the associated use of resources and reducing carbon emissions.

Where we are

• Recycling/reselling/ donating ICT resources - ensure no IT waste is sent to landfill.
• All new IT procured meets or exceeds current government buying standards.

Where we are going

• Reduce energy consumption including moving to Cloud and low CO2 data centres.
• Digital First Travel Policy - eLearning and online learning
• Power saving initiatives.
• Improved digital communications removing the need for paper.

Travel and transport

NHS England has developed an NHS Net Zero Travel and Transport Strategy that describes the interventions and modelling underpinning the commitments that the NHS will have fully decarbonised its fleet by 2035, with its ambulances following in 2040.

The Trust recognises its role in its delivery and as an anchor institution is committed to taking ambitious action to tackle the twin challenges of climate change and air pollution. Through adopting the transport hierarchy in the delivery of services. Actions to cut carbon emissions can also reduce air pollution which leads to direct improvements to health while also addressing health inequality.

Where we are

• Award winning Green Travel Plan.
• Annual staff travel survey (average response rate 41% since 2013).
• A 12% model swing towards sustainable travel from 2013 baseline (46% of staff using sustainable travel in 2022).
• 12 electrical vehicle charge points in staff car park.
• Annual Modal Shift Report.
• Car park eligibility process.

Where we are going

• Revised Green Travel Plan in line with NHS Net Zero Travel and Transport Strategy.
• Fleet management centralised.
• Air Quality Risk Assessment.
• Electric vehicle infrastructure strategy.

Estates and facilities

The Trust estates and facilities team has a critical role to play in achieving net zero as it is an area where the NHS can take direct action needed to help reduce carbon footprint and also a proportion of the carbon footprint Plus. Estates and facilities Interventions have been identified in the NHS Estates Net Zero Carbon Delivery Plan 4-step approach to decarbonise the NHS estate by 2040.

Furthermore, the NHS’s clinical waste strategy published in March 2023 sets out NHS England’s ambition to transform the management of clinical waste by eliminating, reusing and processing it in the most cost-effective and sustainable way.

Where we are

Estates decarbonisation schemes

The Christie put £6.9 million towards decarbonisation and also received a grant of £8 million from the government. This led to the development of the following schemes:

• Solar power system
• Battery energy storage system
• Heat pump system
• LED lighting upgrade
• Other energy infrastructure upgrades including;
  • New higher efficiency combined heat and power
  • Steam System Improvements

The schemes will deliver circa 1 tonne of carbon emission savings and circa £500k annually in energy cost savings.

Where we are going

• Aim to deliver of NHS waste strategy targets.
• Implementation of reusable sharp containers across the Trust.
• Trust-wide waste training.
• Improve energy metering (gas and electric) across site where feasible and develop a sub-metering strategy.
• Where financially feasible return to the policy of purchasing electricity which is from 100% renewable sources.
• Development of a decarbonisation plan and strategy.
• Where possible new roofing projects to have additional insulation installed to decrease heat loss.
• Incorporate sustainability into handover process to communicate and induct staff into the new building or area.
• Deliver our first redevelopment heated solely by electricity.

Medicines

Medicines account for 25% of emissions within the NHS carbon footprint plus primarily within the manufacturing and freight inherent in the supply chain. Interventions that should be considered include optimising prescribing, substituting high carbon products for low-carbon alternatives, and improvements in production and waste processes.

Where we are

• Decommissioning of the nitrous oxide manifolds across site.
• The proportion of desflurane to all volatile gases used in surgery to 2% or less by volume.

Where we are going

• System wide campaign to encourage patient to bring own medicines into hospital on admission.
• Campaign to encourage patients to be discharged with their controlled drugs.
• Reduction in paper pharmacy documents.
• Reduction in plastics wastage supplied by sponsors in study kits.

Supply chain and procurement

The Trust uses a network of suppliers to produce and deliver the goods and services needed to deliver healthcare. The emissions associated with the supply chain account for the largest proportion of the overall NHS Carbon Footprint Plus. Whilst we don’t have direct control over these emissions, we have significant influence and purchasing power.

Where we are

• All tenders include minimum 10% net zero and social value.
• All tenders require a copy of company’s Environmental / Sustainability Certificate (ISO 14001 or equivalent).
• All tenders require company’s CSR (Corporate social responsibility) policy.
• Optional questions added to tenders:
  • Policy towards reducing the amount of single use plastics.
  • Plans to reduce your carbon output, in line with the NHS targets for decarbonisation.
  • Plans to reduce the amount of plastic packaging and future plans to utilise recycled packaging.
  • Carbon footprint of the product throughout the whole life cycle, including the manufacturing, use and disposal of the product.

Where we are going

• Develop standard Sustainability Specific Key Performance Indicators.
• Understand carbon footprint of “Gold” suppliers (contracts over £500,000).
• Obtain and monitor Carbon Reduction plans.
• Ensure suppliers are complaint with the Evergreen Assessment.

Food and nutrition

The nutritional quality of food served to patients has a direct impact on their health and recovery. A well-balanced plate is also a low carbon plate, consisting of minimally-processed foods and seasonal, ideally locally-sourced, fruit and vegetables.

Improving the quality of the food served within hospitals has the potential to significantly benefit the patient experience and recovery rates, as well as improve staff health and wellbeing.

Where we are

• Identified opportunities to make menu options healthier and lower carbon by increasing the proportion of fruit, vegetables, beans, pulses or other low carbon ingredients/proteins.
• Tackling obesity by empowering adults and children to live healthier lives by preventing advertising on site of unhealthy food advertising and encouraging healthier alternatives.
• Plastic bottled water phased out of restaurant.

Where we are going

• Electronic Menu book being explored for patients.
• Adapt menus for patient meals to use more seasonal produce.
• Review suppliers to meet GBSF Standards.
• Review how waste is processed on site.

Adaptation

Climate change adaptation seeks to manage this risk to services, adapting or designing buildings and processes to ensure continuity of care, in a rapidly changing global climate.

Adaptation measures will complement the existing Emergency Preparedness, Resilience and Response (EPRR) measures which are developed to react to individual incidents when they occur. The Met Office has published a “Manchester Climate Pack” predicting likely climate impacts for Manchester.

The Climate Change Act 2008 established under section 56 that a 5-yearly cycle of Climate Change Risk Assessments (CCRA) and the UK National Adaptation Programme.

• The third Climate Change Risk Assessment (CCRA3) was published June 2021. Chapter 5 covers Health, Communities and the Built Environment.
• The Third Health and Social Care Adaptation Report was published by the NHS and the UK Health Security Agency in December 2021 as part of that process.

The Health and Care act 2022 legislated that Trust must adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.

Where we are

• Climate Change Risk Assessment
• Flood Risk Assessment
• Major Incident Plan
• Heatwave Plan

Where we are going

• Review Heatwave Plan in line with latest UK Climate Projections
• Review flood risk assessment in line with latest UK Climate Projections
• Review Major Incident Plan in line with latest UK Climate Projections
• Climate Adaptation Plan

Green space and biodiversity

The benefits of access to nature and green space for mental and physical health include positive outcomes for heart rates and blood pressure, stress levels, mood and self-esteem, obesity, type 2 diabetes, post-operative recovery, birth weight, children’s cognitive development and cardiovascular disease.

When people have more access to green space where they live, income-related health inequalities are less marked. In England alone, it has been calculated that the NHS could save an estimated £2.1 billion every year in treatment costs if everyone had access to good quality green space.

Where we are

• Wildflower gardens
• Fruit trees and vegetables
• Bug hotels
• Outdoor education spaces for children
• Living walls
• Permeable concrete
• Indigenous plant species prioritised in landscaping
• Reuse of materials on site
• Birdhouses and bat boxes
• Tree registers

Where we are going

• Biodiversity strategy to maintain and further develop green spaces onsite.

Communication plan

The success of the plan requires engaging and accessible communications with all stakeholders. Achieving net zero and adapting to the impacts of climate change will require collaboration with all stakeholders as all skills on knowledge will be required to build a truly sustainable healthcare service.

Our main focus will be to use existing communications channels to promote our work, encouraging staff and others to consider green issues in all they do. Key channels of communications include our intranet HIVE, internal newsletter Chinwag and the monthly Team Briefing. All communications activity will link in with work carried out by our Organisational Development team.

Externally, we will also use existing channels to promote our best practice work in the area. This includes media relations for any projects of particular significance, social media and The Christie’s website. The Trust’s communications team will lead on all communications activity.

Tracking progress

To support the delivery of the Green Plan a range of reports and data collections will be used to monitor progress. These are both internal and external reporting methods to ensure good governance and transparency.

The reports will utilise a combination of qualitive and quantitative data. The reporting methods may be subject to change throughout the delivery Green Plan to ensure compliance with local, regional and national requirements.

Monthly

• Waste tonnage/emissions
• Medical gas emissions
• Fleet mileage/emissions
• Business travel emissions

Quarterly

• Greener NHS Data Collection
• Quarterly dashboard report to Net Zero and Climate Adaptation Committee
• Presentation to Development and sustainability committee

6-monthly

• Written report to the Trust Audit Committee

Annually

• Trust Annual report
• Trust Sustainability Report
• NHS Fleet Data Collection
• Greener NHS Green Plan
• Support Tool
• Estates Returns Information Collection
• NHS Premises Assurance Model
• Annual staff travel survey modal shift report

Challenges and risks

Introduction

There are a number of challenges and risks that the organisation faces in ensuring implementation of the Green Plan and the underpinning work programme. The risk assessment of the plan is currently scored at 9. We have identified 7 key risks that we must work together with key stakeholders both within and outside of the Trust to overcome in the next year.

Organisational vision

Although significant progress has been made in the last Green Plan, sustainability is still not fully embedded into the organisational culture as evidenced by no formal consideration for sustainability in business cases. This could be addressed by ensuring that there is a sustainable impact assessment for business cases, procedures and policies.

Workforce and system leadership

Due to the scope of the work involved with responding to the climate crisis, it is anticipated that additional staff resources will be needed. Training is also required to ensure that all staff understand the commitments around delivering a net zero service and how climate change will impact the service we provide at this Trust.

Particular attention needs to be focused on raising awareness around the urgency of the climate crisis. Training will help to embed sustainability into operations and governance, create sustainable improvements and change culture. Through education we will be able to support adaptation and also incorporating the ‘triple bottom line’ into care pathways.

Finance

Budget constraints and access to financial capital is limited, if the Trust is to reach the NHS net zero targets, we will require significant access to capital. The cost to achieve net zero is not included here as there is no reliable way of doing this at present.

In addition, there currently is no sustainability budget that reflects the requirements of delivering the Green Plan annual work programme.

Adaptation

Climate change is already happening. There is a clear and immediate need for the reducing our carbon emissions to net zero, and to adapt to the impacts of climate change that can’t be avoided. Building resilience into the system as it protects and promotes the health of populations now and in the future.

To meet our obligations to adapt the premises and the manner in which services are delivered to reduce risks associated with climate change and severe weather an adaptation plan needs developed.

In addition, emergency planning policy and procedures need updating in line with the latest climate science.

Carbon Footprint Plus

The Trust currently does not have a process in place to report the carbon footprint plus, carbon budget and trajectories. Current challenges are the volume of data that needs collecting and categorised to produce a footprint.

Conclusion

We have seen a significant increase in levels of interest and engagement, as public consciousness grows. The frequency of staff enquiries has grown as they see opportunities in their own work areas.

This will only intensify, as people will come to expect large public sector organisations like ours to be leading from the front on sustainability and climate change. This will undoubtedly present challenges, but we will continue to find innovative ways of engaging staff with this agenda.

Embedding sustainability into the core values of our organisation is vital to ensure sustainable healthcare and support the Trust to continue to deliver exceptional care in a time when the climate crisis is escalating. There may be many challenges but there are also opportunities to create a better healthcare model for patients through a service that delivers socially, financially and environmentally.

Appendix 1

Area	Action	Division	Lead	Timeframe	Reporting Measures
Assurance and governance	Publish sustainability annual report with quantitative progress data, covering as a minimum greenhouse gas emission in tonnes, emissions reduction projections and an overview of the Green Plan progress to deliver those reductions.	Net Zero and Climate Adaptation Committee	Executive Director/Deputy Chief Executive Officer	Mar-25	Sustainability Annual Report published Greenhouse Gas Equivalencies
Assurance and governance	Quarterly dashboard report covering as a minimum greenhouse gas emission in tonnes for waste, business travel and medical gases, progress against Greener NHS deliverables and Green Plan progress.	Net Zero and Climate Adaptation Committee	Sustainability Manager	Mar-25	Greenhouse Gas Equivalencies Quarterly reports produced
Workforce and system leadership	Develop Net Zero and Adaptation Policy	Net Zero and Climate Adaptation Committee	Sustainability Manager	Mar-25	Policy in place
Workforce and system leadership	Sustainable Impact Assessment for business cases, policies and procedures	Finance & Business Development/Quality and Standards	Director of Finance & Business Development	Mar-25	Launch of Sustainable Impact Assessment
Workforce and system leadership	Aim for 20% of staff to have completed ‘Building a net zero NHS’ via the Electronic Staff Record (ESR)	Estates and Facilities	Sustainability Manager	Mar-27	Electronic Staff Record (ESR)
Workforce and system leadership	Investigate specialist support linked for eco-anxiety and included in tender for new Employee Assistance Programme	Workforce	Head of Engagement & Organisational Development	Mar-25	Support available to staff
Workforce and system leadership	Update recruitment materials, job documentation and appraisal guidance documentation to reference net zero target and/or healthcare emergency (link to Trust behaviour of 'We care for each other and our environment')	Workforce	Head of Engagement & Organisational Development/Head of Workforce Transformation and Systems	Mar-25	Documents updated to include net zero and climate healthcare emergency
Workforce and system leadership	Provision of leadership development and education series linked to green agenda	Workforce	Head of Engagement & Organisational Development/Head of Workforce Education & Development	Mar-25	Training delivered Certification
Workforce and system leadership	Seek to make best use of sustainability apprenticeship within a centralised role to best promote sustainability within the organisation	Clinical Support and Specialist Surgery	Divisional Director	Mar-26	Apprenticeship recruitment figures
Sustainable models of care	Remote consultations embedding the use of video consultations and/or more telephone consultations where appropriate to futureproof the level of service we can offer.	Clinical Networked Services	Divisional Transformation Lead	Mar-25	Patient travel Patient Transport
Sustainable models of care	Expand Oral Chemo Clinic live remote consultations releasing patients on oral chemo from face-to-face Consultant follow up appointments (not complex patients).	Clinical Networked Services	Senior Sister SACT+ SACT Deputy Service Manager	Apr-25	Patient travel Patient Transport
Sustainable models of care	Measure the carbon footprint of a move to hypofractionation (less treatments for same outcome, meaning less travel), the patient benefit and the resource implications of further implementation too.	Radiotherapy	Radiotherapy Physics - Principal Clinical Scientist	Mar-26	Carbon Footprint (CO2e)
Sustainable models of care	Carbon footprinting of proton beam therapy, MR-Linac, and PET/SPECT	Radiotherapy	Radiotherapy Physics - Principal Clinical Scientist	Mar-26	Carbon Footprint (CO2e)
Sustainable models of care	Promote and facilitate Sustainable Quality Improvement training for leads across the Trust. Identify leads and provide additional support to eLearning packages to identify and carry out projects.	Quality and Standards	Clinical Audit Manager	Mar-26	Number of SusQI projects registered and completed Monitor uptake of ESR modules QI scores reported and commentary on SusQI Promote examples of projects delivering SusQI via quarterly and annual QICA reporting, Quality Improvement and Clinical Audit (QICA) Awards and publications
Sustainable models of care	Incorporate SusQI into implementation plan for NHS IMPACT	Quality and Standards	Clinical Audit Manager	Mar-25	Quality Plan and monitoring
Digital transformation	Move to Cloud to reduce energy consumption	Digital	Head of Digital Service Delivery	Mar-27	Reduction in on-premises server infrastructure.
Digital transformation	Digital First Travel Policy - eLearning and on line learning	Digital	Digital Lead Clinical Implementer	Mar-25	Travel Expenses Grey fleet mileage and spend Grey fleet emission (tonnes) Trust fleet mileage and spend
Digital transformation	Power Saving Initiatives - Reduction in Network equipment energy consumption	Digital	Head of Digital Service Delivery	Mar-26	Reduction in POE network switches across the Trust.
Digital transformation	Improved digital communication removing the need for paper	Digital	Digital Lead Clinical Implementer	Mar-25	tbc
Digital transformation	Remove physical phones where they are no longer needed	Digital	Head of Digital Service Delivery	Mar-26	Procurement Spend
Digital transformation	Implementation of eConsent and eReferral	Digital	Head of Digital Portfolio	Mar-25	Printing and postal costs.
Digital transformation	Replace infrastructure to a new, power efficient data centre	Digital	Head of Digital Service Delivery	Mar-25	90% of our server infrastructure moved to the new Patterson Datacentre/Cloud.
Digital transformation	Replaced mechanical hard drives for our main storage with Solid state drives	Digital	Head of Digital Service Delivery	Mar-26	Procurement Spend
Supply chain and procurement	Develop standard Sustainability Specific Key Performance Indicators	Procurement	Deputy Head of Procurement	Mar-25	Inserted into KPIs of all new contracts
Supply chain and procurement	Understand carbon footprint of "Gold" suppliers, whose total contract value is over £500,000	Procurement	Deputy Head of Procurement	Mar-25	Included in annual reports
Supply chain and procurement	Obtain and monitor Carbon Reduction plans	Procurement	Deputy Head of Procurement	Mar-25	Updated procurement process documentation
Travel and transport	Incorporate and implement NHS Net Zero Travel and Transport Strategy actions into Trust Green Travel Plan	Estates and Facilities	Sustainability Manager	Mar-25	Green Travel Plan Updated Annual staff travel survey Grey fleet mileage and spend Grey fleet emission (tonnes) Trust fleet mileage and spend
Travel and transport	Air Quality Risk Assessment	Estates and Facilities	Sustainability Manager	Mar-26	Risk Assessment
Estates and facilities	Develop EV infrastructure plan by identifying local/regional grid capacity and working with local network operators and authority to plan for increased capacity where necessary	Estates and Facilities	Estates Officer - Specialist/Sustainability Manager/Operational Estates Manager/Capital team	Mar-26	Strategy produced
Estates and facilities	Achieve NHS clinical waste strategy clinical waste segregation targets of 20:20:60 HTI (High temperature incineration) AT (alternative treatment) and OW (offensive waste)	Estates and facilities	Waste Minimisation Officer/ Site Services Manager	Mar-26	Waste Tonnage Scorecard
Estates and facilities	Implementation of reusable sharp containers across the trust replacing 95% of single use plastic sharp containers. Procurement and business case required	Estates and facilities	Waste Minimisation Officer/ Site Services Manager	Mar-25	Procurement Process and waste CO2 figures
Estates and facilities	Trust wide waste training via ESR mandatory training so all clinical and nonclinical staff are fully aware of waste segregation to maintain waste compliance and waste reduction	Estates and facilities	Waste Minimisation Officer/ Site Services Manager	Mar-25	ESR training records
Estates and facilities	Trust improves Energy Metering (Gas & Electric) across site where feasible and develop a sub-metering strategy including new building developments.	Estates and facilities	Operational Estates Manager/Capital team	Mar-25	Project Scoping documents, design briefs
Estates and facilities	Where financially feasible return to the policy of purchasing electricity which is from 100% renewable sources	Estates and facilities	Procurement Team/Energy manager	Mar-25	Future Bills
Estates and facilities	Where possible new roofing projects to have additional insulation installed to decrease heat loss	Estates and facilities	Operational Estates Manager	Mar-25	Scoping documents and design briefs
Estates and facilities	Heat Decarbonisation Plan and working with funding partners to produce viable bids for future consideration	Estates and facilities	Director of Capital/Head of Estates and Facilities/Operational Estates Manager/Energy manager	Mar-25	Scoping Documents, Completed applications for additional funding
Medicines	Decommissioning of nitrous manifolds	Estates and facilities	Technical Manager for Hard Facility Services	Mar-25	Nitrous manifolds decommissioned
Medicines	Implementation of NHS Guidance on Desflurane decommissioning and clinical use	Clinical Support and Specialist Surgery	Anaesthetic Consultants	Mar-25	Greener NHS Dashboard
Adaptation	Climate Adaptation Plan	Risk and quality governance committee	Sustainability Manager/Head of Emergency Preparedness	Mar-26	Climate Adaptation Plan in place
Adaptation	Creation of Adverse Severe Weather Plan in line with latest UK Climate Projections and UKHSA Guidelines	Emergency Preparedness Team & EPRR Committee	Head of Emergency Preparedness, Sustainability Manager, Head of Estates and Facilities	Apr-25	EPRR Committee
Adaptation	Review flood risk assessment in line with latest UK Climate Projections	Emergency Preparedness Team & EPRR Committee	Head of Emergency Preparedness, Sustainability Manager	Apr-25	EPRR Committee
Adaptation	Review Major Incident Plan in line with latest UK Climate Projections	Emergency Preparedness Team & EPRR Committee	Head of Emergency Preparedness	Apr-25	EPRR Committee
Green Space and Biodiversity	Biodiversity Strategy	Estates and Facilities	Technical Manager for Hard Facility Services/Sustainability Manager	Mar-26	Strategy in place
Medicines	System wide campaign to encourage patient to bring own medicines into hospital on admission	Clinical Pharmacy / GM Pharmacy	Chief Technician / Head of Strategic Pharmacy Transformation	Mar-25	Quantity and value of supply from Pharmacy on admission and discharge across GM
Medicines	Encouraging the minimisation of medicine and related waste by promoting optimal prescribing of medicines	Pharmacy	Director of Pharmacy	Mar-27	Reduction in medicine wastage
Medicines	Reduction in paper related to clinical trial pharmacy documentation	Pharmacy Clinical Trials / Research & Innovation / Digital	Senior Clinical Trials Pharmacist	Mar-25	Reduction in paper purchased by clinical trials.
Medicines	Reduction in paper kardexes for inpatients and rewritten kardexes with the introduction of Better Care EPMA system in Trust.  Reduction in other associated charts too i.e. Insulin	Pharmacy / Digital	Electronic Prescribing and Medicines Administration Pharmacy Technician	Mar-26	Reduction in paper charts across Trust
Medicines	Reduction in paper related to aseptic pharmacy documentation	Pharmacy Aseptics / Digital	Lead Aseptic Pharmacist	Mar-27	Reduction in paper purchased by asceptics
Medicines	Reduction in plastics wastage supplied by sponsors in study kits	Pharmacy Clinical Trials / Research & Innovation	Senior Clinical Trials Pharmacist	Mar-27	Reduction of plastic kits through work done on Research & Innovation workstream
Food and nutrition	Electronic Menu book being explored for patients	Estates and facilities	Catering Manager	Mar-25	Digital menu book in place
Food and nutrition	Adapt menus for patient meals to use more seasonal produce	Estates and facilities	Catering Manager	Mar-25	Review menus and cycles
Food and nutrition	Review suppliers to meet Government Buying Standards for Food (GBSF) Standards	Estates and facilities	Catering Manager	Mar-25	Liaise with NHS Supply Chain
Food and nutrition	Review how waste is processed on site	Estates and facilities	Catering Manager	Mar-25	Explore possibilities of Dehydration compactor to reduce waste weight.
Supply chain and procurement	Ensure suppliers are complaint with the Evergreen Assessment	Procurement	Deputy Head of Procurement	Mar-25	Review the possibility of including Evergreen Assessment as a criteria in all tenders