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In the HCT Green Plan we have set out the opportunities we have identified to become more environmentally sustainable over the three years from 2022 to 2025. We will do this by looking at our infrastructure, the equipment and consumables we use, and our behaviours including reducing waste and changing the way in which we deliver our services to reduce travel and other carbon emitting activities.

HCT’s green vision is:

To become one of the most environmentally sustainable community providers in the NHS

As we pursue this, we commit to rapidly reducing our emissions, seeking the fastest trajectory to net zero:

• For emissions we directly control (NHS Carbon Footprint), we will achieve net zero by 2040, with an ambition to reach 80% reduction by 2028.
• For wider emissions we can influence (Carbon Footprint Plus), we will achieve net zero by 2045, with an ambition to reach 80% reduction by 2036.

The Trust has identified the following priorities for the Green Plan period: 

• Target all forms of waste e.g. via LED lighting, heating control/insulation, waste and travel reduction
• Decarbonise heat – as natural gas for heat comprises 49% of our Carbon Footprint, we will aggressively target heat decarbonisation, planning for and commencing replacement of gas boilers with greener alternatives
• Greener supply chain – as our supply chain contributes over 75% of our Carbon Footprint Plus
• Data and decision making – we will implement carbon data analysis and reporting to measure progress, inform decision-making and target effective action
• Sustained engagement and simple communication with staff, patients and partners to support behaviour change

The Green Plan focuses on ten key areas where we can make changes to reduce our carbon footprint and impact on the environment.

 

HCT recognises the importance of digital transformation to enable delivery of more sustainable models of care and reduce travel and use of consumables, such as paper.  The Trust has a good starting point in terms of its digital maturity, for example all services use electronic patient records and we use digital systems for many aspects of administration and healthcare delivery, including use of video conferencing for consultations.  However, there is considerable potential for further digital transformation and the approval by the Board in 2022/23 of our new Digital Strategy gives us an agreed way forward. 

Notable digital transformation delivered during 2023/24 have already been mentioned.  In addition to these, we have started a project which aims to reduce the amount of correspondence and leaflets printed and posted by the Trust. The initial scoping work has identified considerable potential, and this will be taken forward as a priority initiative in 2024/25.

The national NHS Estates 'Net Zero' Delivery Plan aims to address the aspects of the net zero strategy pertinent to estates and facilities activities.  The Trust’s Green Plan closely reflects this, and the national plan has supported us in developing our decarbonisation plan and estates strategy.

It sets out a clear four step investment approach to decarbonising NHS sites:

 

 

HCT's estates and facilities

The following has been delivered by HCT in relation to the four-step approach to decarbonise estates:

• The Trust has made significant process in installing solar PV panels this year, following the installation of panels at five sites between January - March 2023, (Q4, 2022-2023). These are at Bedford Road Health Centre, Danesbury Neurological Centre, Bowling Road Health Centre, Cheshunt Community Hospital and Peace Children’s Centre.  Panels have been installed at a further four sites in 2023/24. These are at Nevells Road Health Centre, Park Drive Health Centre, QVM Community Hospital and Waltham Cross Health Centre.  These solar panels are delivering benefits in terms of reducing the trust’s carbon footprint associated with grid electricity and reducing the trust’s energy costs.
• Rollout of LED lighting across the Trust’s estate.  We now have LED lighting in all 13 of our freehold sites, as well as at our Head Office (leasehold site).
• The Trust has started to implement Building Management Systems (BMS) which will allow for the remote control and monitoring of a building’s main mechanical plant e.g. boilers, ventilation and air conditioning.  Building management systems should mitigate issues with peaks in demand and reduce the overall energy demand.  BMS have now been implemented at Danesbury, Queen Victoria Memorial Hospital (QVM) and Cheshunt Community Hospital sites and at Peace Children’s Centre.
• All the Trust’s utility invoices (electricity, gas & water) are checked and validated with monthly cost and consumption reports provided to estates.
• The Trust has commissioned a Heat Decarbonisation Plan which outlines how we can minimise heat loss from our buildings and how we can reduce our reliance on fossil fuelled heating systems through the installation of low carbon alternatives, such as air source and ground source heat pumps.  Following this, the Trust has developed a business case for the installation of an air source heat pump at one of its sites – to be the first of a programme of installations over coming years.
• For all new build projects, the Trust will adopt the BREEAM (Building Research Establishment Environmental Assessment Method) that sets standards for the environmental performance of buildings through the design, specification, construction and operation phases and can be applied to new developments or refurbishment schemes.

Our Nutrition and Dietetics service continues to promote a real food/food-based approach wherever possible and to support health and care professionals across the system to enhance patients’ food to meet their nutritional needs.  In turn, this minimises use of oral nutritional supplements.  This approach has many benefits; supporting the enjoyment of food by patients and the social side of eating whilst reducing the financial cost of supplements and the associated packaging waste.

We operate a digital meal ordering service in our community hospitals in order to reduce food waste.

The Dental service has continued to progress work to reduce use of nitrous oxide (a greenhouse gas) in the service.  This includes auditing nitrous oxide consumption and purchase of virtual reality glasses which will enable the service to reduce reliance on inhalation sedation.

Through our pharmacy support to Primary Care Networks and our Children and Young People (CYP) Asthma and Wheeze service we are supporting education on appropriate inhaler use and a switchover to lower carbon inhalers.

In addition to our Green Plan, we have developed a Net Zero Carbon Roadmap (NZCR), which provides more detail on the challenges faced and potential options available to reduce and ultimately reach net zero on the ‘Carbon Footprint’ portion of emissions which result directly from Trust activity. The NZCR covers a much longer period and incorporates the NHS’ wider ambitions for net zero.

The Net Zero Roadmap supports our Trust capital planning as the roadmap identifies the scale of the capital investment required and provides a view of the profile of capital spend over time to achieve the required Net Zero trajectory.

We recognise the contribution that commissioning, procurement and commercial services can have in delivering sustainability and social value, and our duty under the Public Services Value Act.  Our Hertfordshire and West Essex Procurement service, which supports HCT and other providers in the system, has embedded a minimum 10% social value weighting into all tenders in line with requirements across the NHS. In many cases, this social value weighting will include sustainability benefit.

The Procurement service has also implemented a requirement that suppliers bidding for contracts of greater than £5m per annum have a carbon reduction plan.

All the areas of focus described above will support us to deliver more sustainable services in the future.  As a community provider, HCT is at the forefront of sustainable care delivery within the local healthcare system, with care delivered in patients’ homes, at educational settings or as close to patients’ home as possible thereby avoiding/reducing patient or service user travel.  The Trust also provides primary and secondary prevention through its services, promoting health and preventing exacerbations.  Examples include:

• The National Child Measurement Programme and advice provided via Public Health Nursing e.g. to encourage breast feeding and prevent obesity by encouraging healthy eating, healthy weight and physical exercise.
• Vaccination programmes delivered by our Community and School Aged Immunisation Service
• Many of our services have a focus on preventing deterioration and exacerbations and supporting rehabilitation; to take just a few examples our frailty, diabetes, dental and children’s asthma and wheeze services.

This year HCT has significantly expanded its Hospital at Home service and this is making a valuable contribution to more sustainable care delivery, with acute-level care provided for patients in their own homes, avoiding the need for hospital admission and supporting earlier discharge.

The HCT Quality Wheel is embedded as a tool our services use to review and improve quality.  We use the ‘green spoke’ within our Quality Wheeil to prompt services to regularly review their progress on sustainability and to plan continuous improvements.  This is further supported by e-learning on ‘building a net zero NHS’ and ‘environmental sustainability in quality improvement’, and by our Green Champions Network.

HCT has a cycle-to-work scheme and a compliant lease car scheme in place to support reduction in emissions associated with staff travel. Coming out of the COVID pandemic, we have implemented a hybrid home/office-based working model for our non-clinical staff and our clinical staff continue to use a mix of video conferencing, telephone and in-person contacts for patient consultations and staff meetings to ensure that patient and staff needs are met whilst reducing travel where possible.

During 2023/24, we undertook our first staff travel survey to develop our green travel plan. We received over 500 responses, giving a strong understanding of staff travel patterns, behaviours and plans.  The data shows that many staff are adopting hybrid working, where this is compatible with their work duties, but most staff are highly dependent on cars for travel.  This emphasises the importance of the Trust supporting a switch from petrol/diesel cars to greener electric or hybrid vehicles through installation of electric vehicle charging points.  We hope to progress work in this area in the coming year.

Our Estates and Facilities team have rolled out suitable dual segregation waste receptacles for promoting sound segregation of waste within our Staff ‘Rest and Refresh’ areas.

The Trust continues to deliver and improve on waste hierarchy initiatives and the Trust’s soft Facilities Management Manager has shared the new national NHS Clinical Waste Strategy with the Green Steering Group and Champions Network to ensure visibility and provide assurance on the Trust’s ability to implement this.

Our Infection Prevention and Control team have been working with clinical services to reduce use of personal protective equipment (PPE), where it is not required.

The Trust has a walking aids re-use programme.

 

Non-clinical waste data

As an organisation we are committed to diverting waste from landfill and during 2023-2024 the Trust diverted 100% of this waste stream from landfill by utilising recycling and energy for waste (EfW) routes.

This form of disposal has resulted in 1.20 kilograms of CO2 being saved in the year.

 

Clinical waste data

All clinical waste produced within the organisation is processed at facilities that commit to zero to landfill.  Non-infectious waste undertakes an alternative treatment process which shreds and disinfects the waste, compacts and bales it as solid recovered fuel (SRF).  Infectious waste is sent for incineration and used as energy from waste (EfW). All residual ash and lime produced by this process is also recycled and used within 3rd party industries.

68.7 tonnes of clinical waste have been processed this year of which:

• 31% used as EfW
• 68% solid fuel recovered
• 1% recycled ash/lime

HCT has clear leadership and governance in place for environmental sustainability and net zero. There is overall leadership and HCT’s combined Green Steering and Green Champions Group which meets monthly and oversees implementation of the Green Plan.

The Board is well-sighted, engaged and supportive, with the HCT Net Zero Roadmap.

Green Champions Network

We have an active and growing Green Champions Network which meets virtually monthly and includes a champion for most Trust services.  These champions promote green action and behaviours at a service-level and share successes and learning.  

We have engaged with all staff through:

• A programme of communications and engagement activity, which has included focusing a number of the Trust’s all-staff ‘Team Conversation’ meetings on green topics this year and regular articles in our staff bulletin.
• Introduction of the Green Award in our Leading Lights annual staff awards
• Promotion of the ‘e-learning for healthcare’ Net Zero modules on our My Learning Zone staff training platform.
• Use of the ‘green spoke’ of the Quality Wheel to prompt services to regularly review how they are doing on sustainability and plan continuous improvements.

The Trust is engaged with green work at a system, regional and national level and regularly attends the Integrated Care System (ICS) Green group and regional/national webinars and networks to enable partnership working and sharing of best practice.