NHS_Notts_County_Carbon_Management_Plan

NHS Nottinghamshire County
Carbon Management Plan
Final version, 10th
June 2010.

NHS Nottinghamshire County Carbon Management Plan Page 2 of 73
Acknowledgements
NHS Nottinghamshire County wishes to acknowledge the assistance of Nottingham Energy Partnership (NEP) in the production of
this document, specifically Jerome Baddley, Sustainable Energy Development Manager and Project Lead, and
Laura Mayhew-Manchon, PCT Carbon Reduction Project Technical Officer and Operational Lead.
Note to readers: Please note that NHS Nottinghamshire County and PCT are used as interchangeable terms throughout this document i.e.: read ‘PCT’ as ‘NHS
Nottinghamshire County’, and viceversa.

Contents
Page
Foreword ................................................................................................................................................................................ 5
1. Introduction ...................................................................................................................................................................... 6
2. Setting the context ............................................................................................................................................................ 6
2.1. Rationale and drivers for change ................................................................................................................................. 7
2.2. NHS Nottinghamshire County baseline carbon footprint ............................................................................................. 8
3. Monitoring, updating and reporting ................................................................................................................................... 9
4. The Carbon Management Plan: Vision and Strategy ............................................................................................................ 9
4.1. Procurement – Commissioning healthcare services ..................................................................................................... 11
4.2. Energy in buildings ...................................................................................................................................................... 13
4.2.1. Energy in buildings policy
4.2.2. Energy in buildings strategy
4.3. Travel, transport and access ........................................................................................................................................ 17
4.3.1. Sustainable travel and transport policy
4.3.2. Sustainable travel and transport strategy
4.4. Waste management ..................................................................................................................................................... 21
4.4.1. Waste management policy
4.4.2. Waste management strategy
4.5. Procurement – Goods and Services ............................................................................................................................... 24
4.5.1. Sustainable procurement policy
4.5.2. Sustainable procurement strategy

(Contents – continued)
Page
4.6. Sustainability and people – Behaviour change in the workforce ................................................................................... 28
4.6.1. Sustainability and people policy
4.6.2. Sustainability and people strategy
5. NHS Nottinghamshire County Carbon Management Action Plan (CMAP) ............................................................................. 31
6. References, useful links and further reading ........................................................................................................................ 51
7. Glossary .............................................................................................................................................................................. 54
8. Appendices
• Appendix A: NHS Nottinghamshire County CRCEFS and Baseline CO2e footprints – April 2010 ......................................... 56
• Appendix B: Protocol for mapping sources of CO2e emissions in-house for footprinting purposes ................................... 61
• Appendix C: Energy andcarbon performance analysis of owned estate, including benchmarks ......................................... 63
• Appendix D: Procuring for Carbon Reduction (P4CR) Flexible Framework ......................................................................... 67
• Appendix E: Representation of different types of healthcare waste and recommended disposal route and end process ... 69
• Appendix F: Flowchart showing how sustainability can be integrated into procurement and associated benefits .............. 70
• Appendix G: Selected graphs from ‘Saving Carbon, Improving Health – Update’ ................................................................ 71
• Appendix H: Key results from the PCT CRP Behaviour change pilot project ........................................................................ 72

Foreword
There is now overwhelming scientific evidence that the climate is changing as a result of carbon dioxide emissions. At a national level, the Government and the
NHS are clear that this presents a serious threat to environmental, health, social and economic wellbeing, and that action needs to be taken now to reduce and
mitigate the harmful effects of climate change on our communities.
Additionally, there is a strong financial incentive for NHS organisations to address climate change, as reducing carbon emissions will save money that can be
redirected into patient care, and will enable the healthcare sector to become more resilient in its use of natural resources and hence in its capacity to deliver
frontline services in years to come.
As a leader of the local NHS and as one of the county’s largest employers, NHS Nottinghamshire County recognises that it has a responsibly to identify and act
to reduce the impact of its own operations, and that it has an important role to play as a leading commissioner of low carbon healthcare.
In recognition of the urgency to act on climate change, NHS Nottinghamshire County, with the support of Nottingham Energy Partnership, has developed this
Carbon Management Plan, which defines the PCT’s long-term vision to reduce its carbon footprint, in line with national requirements, and sets some
challenging targets for achieving effective reduction in carbon emissions across buildings, travel, waste, and procurement practices.
The Plan describes how NHS Nottinghamshire County, by working closely with staff, supply chain and healthcare providers, will play a leading and innovative
role in achieving the shift to a low carbon economy across the PCT’s estate, in the health community and in Nottinghamshire.
The Carbon Management Plan commits NHS Nottinghamshire County to:
• Reducing its own 2007/08 baseline carbon footprint by at least 10% by 2015;
• Delivering carbon reduction through commissioning frameworks;
• Understanding how healthcare delivery must be shaped for a low carbon future;
• Encouraging and enabling NHS staff to take action in their workplace and promoting culture change;
• Consolidating partnership working and making use of leverage within local frameworks including Local Area Agreements and Local Strategic Partnerships;
• Providing reassurance to people living in Nottinghamshire and to partner organisations of NHS Nottinghamshire County’s commitment to tackling
climate change;
• Measuring and monitoring performance on a regular basis, and communicating progress both internally and externally.
I commend the Plan to you and look forward to reporting significant progress in carbon reduction throughout NHS Nottinghamshire County.
Mike Alexander
Director of Finance and Performance, NHS Nottinghamshire County
Chairman, Sustainability Steering Group
21st
April 2010

1. Introduction
NHS Nottinghamshire County’s core carbon footprint has been calculated with assistance from Nottingham Energy Partnership (NEP) as 6,313.45 of CO2e
(Scope I, II and key III emissions) for the baseline year 2007/08. The methodology used was developed by the Department for Environment, Food and Rural
Affairs (DEFRA), and is evidence of the PCT’s commitment to measure and manage the carbon and wider sustainable development impacts from its
operations.
This document describes the strategy and actions required to achieve effective carbon management across NHS Nottinghamshire County in respect of:
• Commissioning of healthcare services;
• Energy use in buildings;
• Travel, transport and access;
• Waste management;
• Procurement of goods and services;
• Facilitating behavioural change in the workforce.
The Plan is divided into two clear sections:
a) Vision and Strategy (Section 4): The strategic element of the Plan, including visual representation of baseline performance, setting targets and
benchmarks, and making recommendations for improvement in each of the above areas over time.
b) Action Plan (Section 5): The ‘live’, operational section of the Plan, for recording and monitoring specific action in each of the key areas of carbon
against the recommendations of Section 4.
Initial priority is being given to actions resulting in both reduced carbon emissions and expenditure associated with energy use across the estate, which
constitute the majority of the PCT’s core CO2e footprint. This is complemented by urgent work to embed sustainability and carbon management as a
contractual obligation with organisations providing healthcare services.

2. Setting the context
2.1. Rationale and drivers for change
Table 1: Summary of drivers for action to tackle carbon emissions in the NHS (Source: NEP, 2010).
The need to act The reasons why Related mandate
1. The legally binding
Government and
national frameworks
and targets.
There are legally binding UK Government targets to reduce carbon emissions by 80% by 2050
compared to 1990 levels. This is a legal requirement and governance arrangements across all
organisations will need to demonstrate how this is being measured, monitored, and managed.
Furthermore, NHS organisations are audited on their use of natural resources and its impacts.
• Climate Change Act (2009)
• UK 2020 carbon budgets (2009)
• CRC Energy Efficiency Scheme (2010)
• AC 3.1. Use of resources KLOE (09/10)
2. The strength of the
scientific evidence to
act now on climate
change.
The strength of evidence that climate change is happening now due to rising GHG emissions,
that it will lead to serious and dangerous climate change and that it is caused by human
behaviour, is now too strong to ignore. This is destabilising the world’s climate and adversely
affecting the population’s health.
• Intergovernmental Panel on Climate
Change 3rd
report (2008)
• UK Climate Impact Programme (2009)
3. The health co-
benefits now for
patients and
populations, and for the
health system itself.
Taking action now will not only reduce this risk in the long term. Action now will also have
health benefits immediately. Increased levels of active travel, for instance, lead to a reduced
risk of obesity, diabetes, heart disease, and mild mental illness, as well as reducing road traffic
injuries and deaths, and improving air quality. Action will not only benefit the health of the
population now, but also benefit and support changes in the health care system as a whole.
• Saving Carbon, Improving Health: Carbon
Reduction Strategy for England’ (10% by
2015) (2009)
• ‘Taking the temperature’ – Towards an
NHS response to Global Warming (2007)
4. The importance of
cost reductions and
energy resilience.
There are important cost savings to be made, initially in the area of energy efficiency. Energy
prices are highly unpredictable but are much more likely to increase than decrease. All business
plans need to be as resilient as possible to such price and availability fluctuations by sourcing
and using energy wisely. Resources saved by such actions can be reinvested into direct patient
care. Resilience towards the price and availability of energy should be a part of every
organisation’s risk register.
• ENCO2DE targets (2006)
• DH target: 15% energy reduction in NHS
estate by 2010 (2001)
• DH target: 35-55 GJ/m3 in new build and
55-65 GJ per m3 in existing buildings
(2006)
5. The willingness and
commitment of NHS
organisations and staff
to act now.
The results of the 2008 consultation on carbon reduction for the NHS in England showed that
there is a very strong willingness and commitment from NHS organisations and staff to take a
lead. 66% of NHS organisations responded, with 95% strongly supporting the NHS in taking a
lead to act. This commitment and willingness needs to be coordinated and galvanised by
systematic support, guidance and leadership throughout the NHS and from the Department of
Health.
Reduction Strategy for England’ (10% cut
in total footprint by 2015) (2009)
• DH regional Sustainability Networks
• Campaign for Greener Healthcare
• NHS Confederation
6. The need for the NHS
to be a leading public
sector exemplar now.
Finally, there is an important need and opportunity for the NHS to set an example. NHS
organisations can demonstrate to partner organisations and the population that healthy people
depend on a healthy environment. The rapidly increasing risk of adverse effects on health from
climate change is happening on this generation’s watch - it will be this generation’s legacy. See
Appendix G for details on the national NHS carbon targets and trends.
Reduction Strategy for England’ (2009)
• SDC Good Corporate Citizenship Model
• World Class Commissioning, LAAs, NI186

2.2. NHS Nottinghamshire County’s baseline carbon footprint
NHS Nottinghamshire County’s baseline carbon footprint has been calculated by Nottingham Energy Partnership (NEP) using the national methodology for
measuring and reporting greenhouse gas (GHG) emissions, published by the Government in 2009. Full details can be found in Appendix A.
The PCT’s core CO2e footprint has been measured as 6,313.45 tonnes CO2e for the baseline year
2007/08, covering Scope 1, 2 and key 3 emissions, as is depicted on the right. The composition of
the baseline core carbon footprint is broken down as follows:
Scope I and II emissions: 5,969.96 tonnes CO2e
• Energy use in buildings (Scope I and II): 89% of total core footprint in 2007/08.
• Fuel use in leased vehicles (Scope I): 3% emissions of total core footprint in 2007/08.
Scope III emissions: 343.50 tonnes CO2e
• Waste disposal (Scope III): 5% emissions of total core footprint in 2007/08.
• Water (Scope III): Less than 1% emissions of total core footprint in 2007/08.
• Sewage (Scope III): Less than 1% emissions of total core footprint in 2007/08.
You need to identify which activities in your organisation / organisations are responsible for GHG emissions being released into the atmosphere. The
most widely accepted approach is to identify and categorise emissions-releasing activities into three groups (known as scopes). The three scopes are:
▪ Scope 1 (Direct emissions): Activities owned or controlled by your organisation that release emissions straight into the atmosphere. They are direct
emissions. Examples of scope 1 emissions include emissions from combustion in owned or controlled boilers, furnaces, vehicles, and emissions from
chemical production in owned or controlled process equipment.
▪ Scope 2 (Energy indirect): Emissions being released into the atmosphere associated with your consumption of purchased electricity, heat, steam and
cooling. These are indirect emissions that are a consequence of your organisation’s activities but which occur at sources you do not own or control.
▪ Scope 3 (Other indirect): Emissions that are a consequence of your actions, which occur at sources which you do not own or control and which are
not classed as scope 2 emissions. Examples of scope 3 emissions are business travel by means not owned or controlled by your organisation, waste
disposal, or purchased materials or fuels.
Source: Page 10, DEFRA and DECC (2009). Guidance on how to measure and report your greenhouse gas emissions.

NHS Nottinghamshire County will report, measure, monitor and report on its core CO2e footprint on an annual basis, across the above areas of emissions, as
these are the ones which the PCT has the most control over, both in terms of data availability and capacity to action.
The wider carbon impact derived from the PCT’s commissioning and purchase of goods and services has also been measured, in as carbon intensity per
pound spent (tCO2e/£), which will be used for targeting specific areas of spend alongside financial data, as below:
Influence: The PCT’s overall 2008/09 carbon impact
from its commissioning was 293,581 tonnes CO2e. The
single largest area of influence the PCT has is through
contracts with commissioned healthcare services.
Control: The PCT’s 2008/09 procurement footprint, excluding commissioned
healthcare, was 40,129 tonnes CO2e. This includes all emissions from goods and
services through supply chain organisations and from own utility use. The categories are
based on the Government’s Standard Industry Codes (SICs). The inner circle is proportional
and represents the subset of the procurement footprint that is the PCT’s core emissions
from its estate and transport activities.
Duty: The PCT’s core carbon
footprint was 6,313.45 tonnes
CO2e on baseline year 2007-08. This
included a Scope 1+2 footprint
(outlined in bold) of 5,970 tonnes
CO2e, the de minimis level of carbon
reporting, and a Scope 3 footprint
(excluding procurement) of 343.5
tonnes CO2e.

3. Monitoring, updating and reporting
The Action Plan (Section 5. of the CMP) will be reviewed quarterly at meetings of the Sustainability Steering Group. Progress will be reported quarterly to
the Governance Committee, who will include this in their quarterly reports to the Board.
Furthermore, a summary of progress against strategic Key Performance Indicators (KPIs) on the PCT’s use of natural resources and resulting carbon
emissions will be included in the Annual Report, making performance on internal sustainability both available to staff and to the public.
4. The Carbon Management Plan – Vision and Strategy
Carbon emissions, like expenditure, cross all areas of the PCT’s work, from the commissioning of healthcare services to the disposal of waste; from staff
journeys to their workplaces to constructing and maintaining healthcare premises.
Saving carbon saves money that can be better spent on frontline services, reduces the risks associated with rising energy and natural resource costs, and
protects the environment. Saving carbon can improve health within Nottinghamshire through combating climate change, and contributing to protecting
public health nationally and internationally.
As carbon emissions are associated to a greater or lesser extent with all NHS activities, it is essential that the PCT undertakes a carbon management
approach that spans the entire organisation and reaches outward to all areas within its sphere of influence.
• As one of the largest commissioners of healthcare services in the East Midlands, the PCT has a significant sphere of influence through its contracts
with healthcare providers to support best practice in carbon management.
• As a significant procurer of goods and services, the PCT has a large sphere of control over the emissions arising from the supply chain, the
purchasing decisions made and the amount of consumable goods purchased.
• As the operator of a large estate and as manager of leased vehicles, the PCT has a duty to reduce its own operational emissions and thus contribute
to the national government and NHS commitment to combat climate change.
• As one of the largest employers in the county, the PCT has a responsibility to support and invest in the workforce, through whom it can reduce
carbon emissions, costs and vulnerability to rising energy prices.
The PCT’s vision is an integrated approach to carbon management that crosses all areas of influence, control and duty in terms of sustainable use of natural
resources. NHS Nottinghamshire County will lead by example and demand the same high level of commitment from partners.

The PCT’s Carbon Management Plan forms a key part of the PCT’s Board-approved Sustainable Development Strategy and follows the internationally-
accepted definition of sustainable development as “development that meets the needs of the present without compromising the ability of future
generations to meet their own need”. In doing so, NHS Nottinghamshire County has a vision of a clear balance between Carbon, Cost and Care.
‘LOW CARBON VISION’ – NHS NOTTINGHAMSHIRE COUNTY WILL:
1. Influence the commissioning agenda by ensuring that provider organisations actively monitor and reduce their
own carbon emissions, reporting regularly to the PCT, as part of their contractual obligations.
2. Measure, monitor and report on overall CO2e emissions and use of natural resources across all relevant areas
of the PCT’s work, on an annual basis.
3. Make best practice energy and carbon performance (as defined by DH) a critical consideration within all
buildings owned and operated by the PCT. Through estates procurement, lease agreements and ongoing
investment in the estate the PCT will reduce overall electricity, gas and water consumption by at least 10% by
2015. It will further achieve a 25% reduction in kgCO2e emissions from owned estate by 2013.
4. Implement a PCT-wide Sustainable Travel Plan, which will reduce the carbon emissions derived from both
leased car use and business mileage, and deliver important health and wellbeing and cost benefits.
5. Reduce its total waste arising year on year, and by 2015 the PCT will have significantly reduced both the
amount of clinical waste generated and waste sent to landfill each year, and continue to achieve exemplary
recycling rates.
6. Work on the national Flexible Framework for informing and benchmarking progress on sustainable
procurement in public sector organisations, aiming to achieve Level 3 by 2012 and Level 4 or above by 2015.
7. Ensure that all staff are trained, empowered and actively supported to adopt low-carbon and more
sustainable behaviours in their roles and daily activities, and welcome their input and place them at the heart
of decision-making around carbon reduction.
8. Continue to follow national best practice in carbon management as it evolves over the coming years, and the
PCT will aim to share lessons learned and experience with its partners.
‘Carbon management is an
increasingly important issue for
all organisations.
Taking sustainability and
carbon emissions seriously is
an integral part of a high
quality health service’.
SDU ‘Saving Carbon,
Improving Health’. 2009

4.1. Procurement – Commissioning of healthcare services
NHS Nottinghamshire County is responsible for ensuring via the commissioning framework that services are continuously
improved, delivered in a sustainable manner, use natural resources efficiently, and develop a holistic model of low carbon
healthcare that is fit for the future.
With an annual budget of circa £1 billion, over 3,000 employees and a responsibility for planning, paying for and overseeing the healthcare of 660,000
people, NHS Nottinghamshire County is one of the largest commissioners of healthcare services in the East Midlands. This gives NHS Nottinghamshire
County an essential role in setting the standards for sustainability in healthcare commissioning.
As a World Class Commissioner, NHS Nottinghamshire County is already required to meet and demonstrate the following competencies:
• Assess business cases according to financial viability, risk, sustainability and alignment with commissioning strategies;
• Make sound financial investments to ensure sustainable development and value for money.
• Monitor provider financial performance, activity and sustainability in accordance with its contractual agreements;
• Actively work with other local commissioners and other partners to influence their actions;
• Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration;
Every year, the Department of Health publishes the standard contract between PCTs and provider organisations delivering NHS funded services. As of 1st
April 2010, the contract’s terms and conditions stipulate under ‘Section 5.2.: National requirements for local definition’ that all providers must show their
own progress on tackling climate change impacts, embedding sustainable development, and performing against carbon reduction management plans. The
clause allows for the format, method and timeframe for delivery of this reporting to be defined locally.
PCTs are the driver of a continuously improving local NHS. They seek innovation, knowledge and
best practice, applying this locally to improve the quality and outcomes of commissioned
services. In partnership with local clinicians, practice based commissioners and providers, they
will specify required quality and outcomes, facilitating supplier and contractor innovation that
delivers the best value. Through open and effective commissioning and decommissioning
decisions, PCTs transform clinical and service configurations, meeting local needs and securing
world class improvements in outcomes and quality.
‘Adding life to years and years to life. World Class Commissioning – Competencies’. DH.

In light of the above, NHS Nottinghamshire County recognises a priority to actively promote and embed carbon management across healthcare services
through its commissioning frameworks, as this is one of the main areas where long-term carbon reduction will be achieved, and to monitor the
performance of its provider organisations against key areas of CO2e emissions.
In light of the requirements of the Climate Change Act, the Department’s Sustainability Strategy “Taking the long time view”, and in line
with the national NHS Strategy: “Saving Carbon, Improving Health”, the Provider shall, as applicable, demonstrate their measured
progress on climate change adaptation, mitigation and sustainable development, including performance against carbon reduction
management plans [format, method and timeframe for delivery to be defined locally].
DH (2010). Terms and Conditions for the provision of community health services – NHS Standard contract for community services (2010/11). Available
at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111203
NHS Nottinghamshire County will work closely with providers of healthcare to:
 Define an appropriate format (i.e.: metrics), method (i.e.: systems) and timeframe (i.e.: frequency) for providers to report
on performance;
 Liaise with and communicate the above arrangements to its provider organisations, to ensure that they are prepared and
equipped with the skills, knowledge and resources needed to monitor and report on their own carbon performance;
 Disseminate knowledge and best practice on carbon management across its providers, promoting a culture of transparency
and lesson-sharing amongst the local healthcare community.

4.2. Energy in buildings
4.2.1.Energy in buildings policy
Energy use and carbon emissions are controllable through a combination of estates investment, procurement and staff behaviour.
The PCT commits to improving energy performance within the owned and leased estate, through cost effective capital investment,
working closely with staff, and actively managing its leasehold arrangements.
Energy use in buildings represents the single largest element of the PCT’s core carbon footprint. With rising energy prices inevitable over the coming years,
this is the area most likely to be at risk of significantly increasing costs. Investment and contracts will be regularly tested and reviewed against the changing
economics of energy prices and in light of any new financial incentives.
At the time of writing, NHS Nottinghamshire County had an estate of 17 owned and 31 directly leased sites, across 63,783 m², spending over £2m on utilities
annually. Energy use in buildings is responsible for over 89% of the PCT’s baseline CO2e footprint. The PCT recognises both the impacts and the
opportunities resulting from the effective management of energy in the buildings it occupies.
NHS Nottinghamshire County expects all employees to contribute to reducing expenditure on energy and cut carbon emissions. The PCT will raise energy
awareness at all levels, ensuring energy management is communicated, integrated and supported throughout the organisation.
Good energy management practice will be actively promoted through internal and external working relationships within the PCT management, through
staff, patient, visitors, local community, partners, and the supply chain.
All NHS buildings need to have a significantly lower carbon impact,
not only in their construction but also in their lifetime use and in their
decommissioning. NHS buildings must be designed to promote
sustainable behaviours in staff, patients and visitors, and they must
be adaptable to support change towards low carbon patient
pathways.
SDU (2009) ‘Saving Carbon, Improving Health’.
All NHS capital developments should be
assessed to ensure options are evaluated
on a whole life cost basis. Low carbon
options include more renewable energy,
passive cooling, ultra-efficient lighting,
sustainable transport and natural
environment.

4.2.2.Energy in buildings strategy
This strategy complements the 4.2.1. Energy in Buildings Policy and outlines the main actions the PCT is taking to minimise energy use across the buildings it
operates from, and in doing so, the carbon emissions derived from it.
Energy is increasingly expensive. The rates paid for utility use by the PCT increased significantly from 2007/08 to 2008/09. Electricity rates increased by
52.87%; from 5.98 pence per kWh to 9.14ppkWh. Gas rates increased by 47.61%; from 1.567ppkWh to 2.313ppkWh. Greater energy efficiency will ensure
that, as the cost of energy increases, the total cost of providing energy services such as lighting and heat will not be a drain on the budgets for frontline
services. Resilience towards energy price and supply will form a part of the PCT’s risk register.
Energy cost security can also be increased by installing renewable energy systems. Renewables also represent a potential source of income through the
Government’s Feed-in-Tariffs for electricity and the Renewable Heat Incentive for gas.
The Government’s Office of Gas and Electricity Markets (OFGEM) have generated several scenarios for energy price increases over the coming years, the
worst of which points to a 60% rise by 2016, a situation potentially amplified by the coming impact of ‘peak oil’. All of OFGEMs price scenarios project rising
energy prices. Investment in energy saving and energy generation through capital works and supporting staff will thus represent incrementally increasing
year-on-year financial savings, directly mitigating the financial risk of increased energy prices and reducing carbon footprint.
The PCT will introduce methods of regular reporting and providing feedback to staff on performance for each of our premises, including benchmarking and
other comparisons, as a means of encouraging local reductions in energy consumption. See Appendix C for examples.
NHS Nottinghamshire County will:
 In retrofit / existing buildings: Deliver a 25% reduction in CO2e intensity of its owned estate over 5 years, from 2007/08 emissions.
 In new buildings: Ensure that all new buildings in the estate perform to best practice energy and carbon targets for building type
(currently detailed in EnCO2de). If not already zero carbon by design, all new buildings to have viable plans for zero carbon retrofit post-
occupancy. As a benchmark, all new buildings will be expected to achieve the national BREEAM Excellent standard.
 In leased assets: Enable access to data systems and/or install sub-metering. A minimum ‘C’ rating on Energy Performance Certificates
(EPCs) will be requested of any new leased sites.

Sustainable buildings are those that are designed to reduce energy, resource use and waste, thereby saving money, reducing negative environmental
impacts and benefiting health. The SDU identifies the built environment as an important factor in patient care, and good design is essential to help ensure
that patients, staff and visitors are afforded appropriate facilities.
All buildings occupied by the PCT will aim for best practice energy and carbon performance (as defined by DH, currently detailed in EnCO2de). Through
estates procurement, lease agreements and ongoing investment in the NHS estate the PCT will reduce its overall electricity, gas and water consumption by
at least 10% by 2015. By 2013 the PCT will achieve a 25% reduction in the carbon intensity of its owned estate as measured in kgCO2e/m². By setting a
carbon target per m2, the estate may still grow, however all new buildings will need to meet high standards in energy and carbon performance. This is
consistent with requirements within the Commissioners Investment and Asset Management Strategy (CIAMS) placed on all commissioning PCTs for ongoing
assessment of their buildings in terms of environmental performance.
Furthermore, in buildings with shared occupancy, the PCT will apply the principle of ‘shared pain, shared gain’
between landlord and tenants, in recognition that energy reduction targets can only be achieved with the
co-operation of those operating and using the buildings, and that all parties doing so need to be provided with
the tools, knowledge and awareness to implement energy efficiency and embed low-carbon behaviours into
their use.
In terms of the indoor temperature at PCT sites, the PCT will balance the thermal comfort needs of staff and
patients, with the requirements in national energy regulations, and the requirement to use energy sources such
as gas efficiently and effectively. The PCT will issue clear guidance on both heating and cooling to staff and
other occupants of NHS buildings.
In the 2008 Budget, the Government set out an ambition for all new non-domestic buildings to be zero carbon from 2019, with an earlier target (2018) for
new public sector buildings. In order to support and meet this, the SDU and DH have recognised the need for all new NHS healthcare buildings to be low
carbon by 2015.
The PCT will work towards:
o Sourcing of energy supplies at minimum cost;
o Energy generation, ensuring efficient buildings and effective energy management;
o Leasing arrangements that ensure good energy performance and management;
o Ensuring that all staff recognise their responsibility to reduce energy use.

Buildings that provide healthcare traditionally bring together a wide range of carbon intensive activities and processes. There is a need for all NHS
organisations making capital investment to integrate formal carbon reduction requirements in tender documents and contracts.
Large refurbishment and new build schemes both represent opportunities for the PCT to “design in” future proofing, sustainability and energy saving
measures. Capital developments will be assessed to ensure options are evaluated on a whole life cost basis.
Some climate change is now inevitable over the next 40 years. The healthcare buildings we are now designing need to be fit for a future climate, as well as
rising energy prices and falling carbon emissions.
The PCT will ensure that all new buildings or major refurbishment are designed employing energy use models based on the most up to date climate
projections from the UK Climate Impacts Programme. Good insulation can keep a building cool in summer as well as warm in winter, this will be the first
consideration. There also may be the need to include elements of passive cooling or highly efficient active cooling in design; to ensure that there will not be
the need to later retrofit inefficient cooling capacity. New air conditioning plant will only be installed as a last option, when all other possibilities have been
exhausted.
NHS Nottinghamshire County will continue to meet and wherever possible exceed national NHS targets for buildings energy performance, in particular:
o Primary energy consumption to be reduced across the estate by at least 15%, or 0.15 million tonnes CO2e to be cut by March 2010, on 2001 levels.
o All new buildings, major redevelopments and refurbishments shall meet an energy performance target of 35–55 Gigajoules per one hundred cubic
metres of occupied volume (GJ/100m³).
o All existing facilities shall achieve an energy performance target of 55–65 GJ/100m³.

4.3. Travel, Transport and Access
4.3.1. Sustainable Travel and Transport Policy
NHS Nottinghamshire County recognises that some element of travel is required to carry out day-to-day activities. To ensure that
the approach to travelling is sustainable and to minimise the carbon emissions derived from it, the PCT will implement a PCT-wide
Sustainable Travel Plan, which will realise a wide range of environmental and financial savings. The PCT aims for its Travel Plan to
result in positive health impacts to benefit employees and Nottinghamshire residents.
It is widely accepted that there are two major ways in which an organisation can improve the sustainability of its travel:
• Avoiding travel – i.e.: ‘the greenest mile is the mile not driven’, and
• Travelling differently, where there is no practical alternative to travelling.
The Sustainable Travel Plan will reflect the above, and will provide smart1
targets, deliverable recommendations, practical guidance and real incentives to
enable and encourage staff to minimise the needs to travel, and when it is necessary, to travel more sustainably, both on business and in commuting to
work. The Travel plan will be reviewed and updated annually. The PCT will ensure that good quality data will be recorded on travel claims and leased vehicles
to support and monitor continuing improvement in sustainable travel.
1
Smart: Specific, Measureable, Attainable, Realistic and Time-bound.
10 to win target: Board approved Sustainable Travel Plan for
all NHS bodies by 2010.
Every organisation should routinely and systematically review the
need for staff, patients and visitors to travel; consistently monitor
business mileage; provide incentives for low carbon transport;
and promote care closer to home, telemedicine and home
working opportunities.

4.3.2. Sustainable Travel & Transport Strategy
At present, staff, patients and visitors to the NHS travel over 25 billion kilometres a year nationwide, and over 80% of these journeys are made by car.
Furthermore, pollution-related admissions are estimated to cost the NHS between £17 and £60mn each year. In terms of carbon, transport is the fastest
growing source of GHG emissions in the UK, and commuter and business travel constitute nearly 40% of all miles driven by car. The NHS national carbon
footprint is constituted by 18% emissions from healthcare-related travel, representing 5% of all road traffic in England. NHS Nottinghamshire County’s
carbon emissions from leased cars accounted for just over 3% of the total core footprint in 2007/08.
Sustainable travel can be defined as travel behaviours which contribute towards achieving sustainable development objectives, meeting the needs of
today, without compromising the ability of future generations to meet theirs. The PCT understands its potential to influence how staff, visitors and
patients travel to and from NHS sites. Making travel and transport in the PCT sustainable means decreasing carbon emissions from leased vehicles and
business mileage, but also includes accounting for wider environmental, social, health and financial impacts, and presents a unique opportunity to make a
positive contribution to these, including:
NHS organisations need to be exemplar
in leading the population-wide shift from
sedentary travel to more active travel
such as walking, cycling and public
transport.
SDU (2009)
‘Saving Carbon, Improving Health’.
 Produce a Sustainable Travel Plan, as the main strategy and the means for implementing and actively
promoting sustainable travel over time across the whole PCT.
 Review, adequately resource and widely communicate the Plan to the workforce, to ensure that its
targets are met and that its recommendations are successfully implemented.
 Actively work with providers to decarbonise PCT leased vehicles, and explore alternative fuels such as
electric vehicles (EVs).
 Record and monitor all PCT business travel on a continuous basis and in a format compatible with
carbon accounting.
 Provide adequate incentives and resources to staff to maximise the uptake of more sustainable travel
modes and practices.
 Work in partnership with local and regional organisations to promote integrated sustainable travel
measures and share the environmental, financial, social and health benefits to be realised. Figure 1: Hierarchy of CO2 intensity by travel mode
(Source: Buying Solutions).

• Saving money on the cost of providing and maintaining parking spaces, whilst continuing to meet the needs of drivers with a disability.
• Solving problems caused by traffic congestion in and around NHS sites will contribute to improving local air quality and noise.
• Realising savings both in terms of expenditure and CO2e emissions from reducing business travel.
• Assisting with recruitment and retention of the workforce by making staff journeys to/from work easier and cheaper.
• Opportunities to improve staff health, wellbeing and work-life balance derived from more flexible working arrangements.
• Reducing staff downtime spent travelling on business, hence increasing productivity.
• Enhancing the experience of patients and visitors across PCT sites derived from improved access and facilities.
During the summer of 2009, a staff travel survey was carried out across the whole organisation. Over 1 in 4 of staff responded to the survey, equivalent to
27.45% of the workforce, across both the commissioning and the provider side. Key findings from the survey included:
• 91% of staff surveyed use their car as the main mode of transport to get to and from their workplace, often driving alone.
• It takes a quarter of the staff under 15 minutes to reach their place of work.
• One third of staff live within 4 miles of their workplace.
• 62% of staff use their own car for work purposes 3 or more days per week, a large proportion of which involved travelling to meetings.
The results of the survey highlighted a large opportunity to explore opportunities to incentivise more sustainable travel options in-house, such as car
sharing, incentives for public transport, better facilities for cyclists, and greater flexibility in working practices. Moreover, the feedback received made clear
that staff are keen to work to improve the travel and transport options available to them across the PCT.
To maximise this opportunity, and in line with SDU guidance, NHS Nottinghamshire County has committed to produce a Sustainable Travel Plan, as the main
strategy to implement and actively promote sustainable travel and transport across the whole PCT. The Sustainable Travel Plan will:
 Recommend a number of smart targets to remove the need to travel in the first place, minimise single vehicle usage, and promote wide modal shift,
tailor-made around the needs of employees and consistent with the feedback provided in the 2009 staff travel survey.
 Provide practical information to help staff make adequate and more integrated choices when travelling to and from work and on business. The latter
may also be useful for patients and the public when planning to visit NHS premises, enabling them to make more sustainable travel choices too.
 Offer consistent and clear guidance to all staff on procedures to follow with regards to travelling on business, such as parking policies, mileage rates
by travel mode, available incentives and rewards, and data recording requirements.
Some sites may already have site-specific travel plans due to planning and other requirements. The PCT-wide Sustainable Travel Plan will work alongside
these, and could be used in future as a basis for producing own site plans and initiatives.

The Sustainable Travel Plan will be actively promoted to the workforce. Wherever possible, its principles will be communicated to patients, the public,
suppliers and contractors, and we will encourage them to consider making their own travel and transport methods and practices more sustainable.
To maximise success in this area, the PCT will work in partnership with local healthcare organisations, local government, public transport operators and
other relevant agencies to explore, enhance and promote the provision of lower carbon transport through a range of actions including car sharing initiatives,
public transport services, cycling facilities and walking options.
Since the use of fuels in the leased fleet contributes to the core carbon footprint, the PCT will work to maximise the efficiency of our existing and future
leased fleet, aiming to introduce a maximum threshold for carbon emissions in cars, using the national Vehicle Excise Duty (VED) banding. As vehicle fuel
supply is increasingly vulnerable to price volatility, the PCT will also work to minimise its reliance on fossil fuels, by exploring alternatives such as electric
vehicles (EVs).
In order to measure, monitor and manage progress against the Sustainable Travel Plan’s recommendations, the PCT will record relevant data on both its
leased vehicles and on business travel, on a regular basis, and in a format that can be used to calculate the carbon emissions derived from travel (see
Appendix A and B). Doing this is essential to ensure that the PCT meets the requirements of the Audit Commission under the Key Lines of Enquiry (KLOE) 3.1.
Use of Natural Resources assessment, and to successfully identify and account for cashable and non-cashable savings and target areas in travel expenditure
across different travel modes.

4.4. Waste Management
4.4.1. Waste Management Policy
NHS Nottinghamshire County recognises the significant environmental, health and financial impacts associated with waste
generation and disposal. The PCT commits to minimising these by applying an integrated and holistic approach to the way it
manages its waste, guided by the principles of the waste hierarchy and achieved through working closely with staff. The PCT will
equip itself with the necessary resources to manage waste sustainably and cost-effectively, meeting or exceeding current and
future national requirements and legislation.
The PCT will demonstrate continuous improvement in its waste practices in terms of quantity, cost, and resulting carbon emissions, by meeting a number of
appropriate and quantitative targets, by working closely with waste contractors to monitor and target performance across each waste stream, and by
actively promoting a culture of awareness and best-practice accross NHS sites.
The PCT’s waste management approach is based on the principle that the preferred priority of action on waste is to follow the following hierarchy:
Every organisation should monitor, report and set targets on
its management of domestic and clinical waste.
In a low carbon NHS, waste is minimised, and
managed to consistently comply with legislation,
and is recycled or composted routinely.
PREVENT  REDUCE  RE-USE  RECYCLE  RECOVER  DISPOSE
Figure 2: NHS Nottinghamshire County Green Champions
on a visit to Wastecycle’s recycling plant in Colwick, Notts.

4.4.2. Waste Management Strategy
W
1 in every 100 tonnes of domestic waste generated in the UK comes from the NHS. The NHS produces an average of 250,000 tonnes of waste a year, with a
cost of £71.2 million. Waste is an important area of expenditure, and a key contributor to the PCT’s environmental impacts.
As a producer of both domestic and clinical waste, NHS Nottinghamshire County is legally responsible for complying with national waste regulations, and
taking reasonable steps to dispose of waste adequately and effectively. Given the nature of healthcare services, there is a health and safety risk associated
with the waste the PCT generates, which places the PCT under a duty of care to put effective measures in place, across all premises, to ensure correct
segregation and disposal of waste. See Appendix E for a full list of healthcare waste types and their disposal routes and segregation procedures.
 Minimise the production of total waste derived from its activities across the whole PCT, by meeting the following targets:
• Reduction in the total weight of waste arising across all streams, year on year.
• Reduction in the % of total waste sent to landfill, year on year.
• Reduction in the total weight of clinical waste disposal, year on year.
• Increase levels of in-house recycling across NHS sites by at least 35% by 2015.
• Maintain its exemplary overall domestic waste recycling rate of over 80%. (i.e.: segregated in-house + recovered by contractors).
• Falling CO2e emissions derived from total waste disposal, year on year.
 Regularly monitor and report progress against the above targets, alongside financial expenditure on waste disposal.
 Actively manage all corporate waste contracts and work closely with both domestic and clinical waste contractors to realise environmental
and financial savings, ensure compliance, and maximise VFM over time.
 Meet –and wherever possible, exceed– all current and forthcoming legislative requirements governing the safe and correct handling, storage,
treatment and disposal of all waste from its operations.

The PCT believes that by employing an environmentally sustainable and integrated approach to managing its waste, it will also realise important financial
benefits, both by reducing waste collection costs and by minimising additional costs that certain waste streams present, such as landfill tax and incineration
charges.
Following the waste hierarchy (see Fig.3), the most favoured option is often so in terms of cost, carbon, and ease of implementation. Preventing waste being
disposed of in the first place, utilising resources efficiently, and re-using materials, will clearly make financial and carbon savings.
Moreover, given that recycling waste is cheaper as a process than incinerating it or sending it to landfill, and that it has a positive carbon footprint under the
national DEFRA carbon accounting methodology, maximising the amount of waste being recycled is a high priority.
Research nationally indicates that 40-50% of waste placed in clinical waste containers at healthcare sites is actually domestic waste. An NHS Purchasing and
Supply Agency (PASA)-funded project2
which looked at waste practices across a number of the PCT’s sites reflected this, and highlighted that there is a great
opportunity to improve waste segregation in the clinical waste stream across the PCT, for compliance, cost and carbon purposes.
To achieve the PCT’s targets for waste disposal, it is paramount that the following is in place:
 Continuous, accurate records of waste generated, broken down site-by-site, by waste
stream type, and by weight. The PCT will continue to work with its waste contractors to
ensure access to this information by directorates and staff members in the PCT, and
will report on progress against KPIs that reflect waste quantities, carbon emissions and
cost over time.
 Regular communications, active awareness-raising and visible and clear guidance on waste
segregation and practices. Anyone who disposes of waste at any NHS premise has a
personal responsibility to abide both by legislation and by the PCT’s commitment to
sustainable waste management. To ensure that this met, NHS Nottinghamshire County
commits to providing the appropriate training to relevant staff on safe waste procedures,
and providing up-to-date resources and guidance to all staff, visitors and the public to enable
them to follow the principles of its waste policy and strategy.
2
‘Lean Management Principles’ project, led by the EM Re:Source Hub, 2009/10.
Recycling all the waste paper, cardboard, magazines and newspapers produced
by the NHS as a whole could save up to 42,000 tCO2e. This is equivalent to the
carbon savings made by taking 17,000 cars off the road for a year.
NHS Confederation & NEF.
Figure 3: The waste hierarchy.

4.5. Procurement – Goods and Services
4.5.1. Sustainable Procurement Policy
NHS Nottinghamshire County is committed to identifying and reducing, on a cost-effective basis, the carbon footprint and wider
sustainable development impacts associated with the goods and services it buys. The PCT will work with its suppliers and providers
to enhance sustainability in contracts, and will actively encourage them to reduce the impacts of the goods and services they
provide the PCT with, and in doing so help mitigate both cost and resource vulnerability risks across the supply chain.
The public sector has a duty to spend public money in the long-term public interest – in ways that avoid undermining people’s health, opportunities and the
environment. Sustainable procurement involves taking action at each and all stages of the procurement process. Simply requiring suppliers to respond to an
environmental questionnaire at prequalification will not deliver more sustainable outcomes. This action should be part of a package of measures planned
and implemented throughout needs analysis, prequalification, specification, evaluation and supplier development and engagement.
With a strong national drive towards increasingly better procurement, and a pressing need to achieve VFM, delivering more with less, the case is clear for
embedding sustainability into procurement practices, alongside commissioning. The costs for natural resources are increasingly volatile and generally rising,
reflecting the constraints of our natural environment to support the consumption patterns of the 20th century. This is particularly critical for fuel and energy
resources, represented through supply chains in terms of carbon. It is essential that carbon features not just in the PCT’s risk registers and performance
frameworks, but also in those of its supply chains. Identifying areas where carbon savings enhance impact of cost savings is a priority for the PCT.
NHS Nottinghamshire County will work closely with its staff and in partnership with its suppliers so that PCT procurement activities reflect best practice in
sustainability. The PCT will also implement a programme of measures designed to improve its sustainable procurement capability over time.
The NHS has a responsibility, as the largest employer and
public sector emitter of carbon, to take this issue seriously. It
has a unique status, given its size and procurement
budgets, to lead the change and drive the creation of low
carbon markets. Substitution, innovation and effective
engagement with suppliers will all become significant
elements of carbon reduction strategies.
SDU (2010). P4CR Executive Summary.
Figure 4: Hierarchy of choices for sustainable and low-
carbon procurement (Source: SDU, P4CR, 2010).

4.5.2. Sustainable Procurement Strategy
Nationally, procurement of goods and services in the NHS costs
over £20billion per annum and constitutes over 60% (11mn tCO2e)
of its total carbon footprint. Regionally, the NHS in the East
Midlands spends around £1.5 billion annually on the procurement
of goods and services. In the PCT, purchasing goods and services,
excluding commissioning healthcare, accounted for over £66
million and emitted 40,129 tonnes CO2e in 2008/09.
Procuring goods and services does not just represent high cost and
high carbon implications for the PCT. From 2009/10, the Audit
Commission’s Key Lines of Enquiry (KLOE) assessment includes
several clauses requiring that the principles of sustainable
procurement are embedded into NHS organisations buying
activities, and that evidence of this is provided on an annual basis.
 Work towards the decarbonisation of its supply chain and actively promote this amongst staff, suppliers and partners.
 Use existing toolkits and resources to enable the PCT to review its own procurement practices as a whole and in specific purchasing areas, to
prioritise those of both high financial and environmental risk, and develop appropriate measures to address them effectively.
 Provide procurement staff with the tools, knowledge and skills to enable them to embed sustainability into all steps of buying decision-making,
and into day-to-day procurement practices.
 Measure PCT progress on procuring sustainably using the national Flexible Framework, and aim to achieve Level 3 by 2012 and Level 4 or above by
2015.
 Routinely require all suppliers to disclose their own approach to sustainable development and carbon management, and to report on progress
on a regular basis throughout the length of the PCT’s contracts with them.
 Maximise existing and new opportunities to set high environmental standards in pre-qualifications, tender specifications, contracts, and SLAs.
Key aspects of the Audit Commission’s KLOE
relating specifically to sustainable procurement:
1.2 Does the organisation have a sound understanding of its costs and performance and
achieve efficiencies in its activities?
- Understanding costs, including whole life, transaction and unit costs, the main
factors that influence these and how they link to performance.
2.1 Does the organisation commission and procure quality services and supplies tailored
to local needs, to deliver sustainable outcomes and value for money?
- Reviews competitiveness of services and achieves value for money, while meeting
wider social, economic and environmental objectives.
3.1 Is the organisation making effective use of natural resources?
- Note: To achieve Level 3 ‘Performing Well’, our PCT needs to demonstrate that it
‘considers the environmental impact of its suppliers of goods and services within its
procurement decisions and is working with them to achieve improvements’.

Sustainable procurement is defined as “a process whereby organisations meet their needs for goods, services, works and utilities in a way that achieves
value for money on a whole life basis in terms of generating benefits not only to the organisation, but also to society and the economy, whilst minimising
damage to the environment. It demonstrates that procurement’s contribution to a sustainable society is far beyond the financial” (SDC ‘Procuring the
Future’, 2006).
A sustainable approach to our procurement will therefore help us deliver long-term value for money, together with protecting our reputation, future-
proofing our supply chains and investments, and therefore making them viable in the long-term. By considering the financial, social and environmental
impacts of what the PCT buys throughout the whole lifecycle –from raw materials to disposal / end of life, not just the impacts related directly to product
ownership or service delivery– the PCT will be able to make more informed and realistic decisions towards purchasing. Sustainable procurement will also
support the PCT in achieving true Quality, Innovation, Prevention and Productivity (QIPP).
Forum for the Future in their ‘Buying a Better World: Sustainable Public Procurement’ guide identifies two basic principles that underpin sustainable
procurement and should be integral to the sourcing process of goods and services:
1. Upstream thinking: The ability to influence cost, performance and sustainability declines as the procurement process progresses. To maximise
opportunities for sustainability and carbon reduction, it should be considered from the very outset:
2. Life cycle thinking: As with costs, sustainability impacts are created throughout the whole product lifecycle. The impact and cost of resource use and
should be considered across all stages of production, transport and disposal of the goods and services.
Nationally, it is recognised that the NHS does not have direct control over absolutely all the actions of its supply chains, and while the overall expenditure of
the NHS is large, the scope for improvement and influence is not uniform across all of the products and services procured.
Recognising this, and given the size of the challenge all NHS organisations face in meeting national carbon reduction targets, it is recommended by the DH
and the SDU that NHS organisations use resources available to enable them to understand the carbon impacts of what they buy, use and waste, and to start
tackling their carbon emissions immediately.
NHS Nottinghamshire County has identified several ways by which it will be able to meet this challenge:

Delivering sustainable procurement as a whole PCT:
 Use the Flexible Framework: This national framework is a maturity matrix that has been successfully tried and tested across the public sector. It sets
out the steps recommended to consider the carbon impacts of procurement decisions effectively, across the procurement elements of People,
Communications and Policy, Processes, Engaging Suppliers, and Measuring & Results. Working through the Framework will enable the PCT to
measure and monitor progress in establishing a robust sustainable procurement practice. In doing so, the PCT will deliver quantifiable carbon and
cost reductions over time, and benchmark performance in its own setting and against that of other NHS organisations, in a consistent way. See
Appendix D for both the steps in the Flexible Framework and a list of supporting materials.
Identifying and targeting our procurement-related carbon emissions:
 Use the SCO2PE supply prioritisation tool: An Excel based tool allowing organisations to calculate an approximate carbon footprint by inputting
expenditure data by category. This is how the PCT’s 2008/09 baseline carbon footprint from procuring goods and services was calculated (see
‘Control’, section 2.2). The tool will provide the PCT with a screening methodology that will help prioritise which categories of spend offer the
greatest potential for both in carbon emission and in cost reductions, and a means to report carbon alongside financial expenditure.
Targeting specific purchases and areas of spend:
 Forum for the Future ‘Sustainable Procurement Toolkit’ was produced with the EM Re:Source Hub in 2006 and is a spreadsheet-based tool which
helps buyers to identify sustainability impacts and opportunities of specific goods, and guides them through realistic interventions throughout the
procurement process. The PCT will use this toolkit to further identify and target specific products or services with both high carbon and high financial
risks.
 The Government’s 'Buy Sustainable – Quick Wins' are specifically designed for procurers, and set a number of sustainable specifications for a range
of commonly-purchased products across the public sector including the NHS, such as IT equipment, white goods, paper and stationery. The PCT will
use this guide as a basis when considering the purchase of these products.
Lastly, NHS Nottinghamshire County will maximise the scope of the www.sid4health.com portal and other
contracts platforms, in terms of assessing potential suppliers’ sustainability credentials prior to tendering
for work, via their pre-qualification questionnaire (PQQ). Where specific sustainability or carbon reduction
requirements cannot be delivered through the tender process, the PCT will work on Terms and Conditions
and Memorandums of Understanding with suppliers to ensure commitment to meet these within the
contracts.
The relationship and collaboration with
suppliers has the potential to provide the largest
carbon savings. The NHS is not in this alone; all
organisations are beginning to look at their
carbon impacts and are addressing the same
challenges. There will be more chance of success
by working together.
SDU (2010). P4CR Executive Summary.

4.6. Sustainability and people – Behaviour change in the workforce
4.6.1. Sustainability and people policy
NHS Nottinghamshire County will provide its staff with the right tools, knowledge, skills and support to work in a carbon-friendly
and environmentally responsible manner, and expects its staff to fully commit to, comply with and contribute towards all the PCT’s
policies, strategies and actions that will address carbon emissions.
In any setting, the key to achieving successful carbon reduction is behavioural and culture change. No technological improvement, financial investment or
strategic framework in sustainability can be truly successful without taking the ‘people factor’ into careful consideration from the start.
As a large local employer, with over 3,500 employees, each with a workplace carbon footprint of 1.5 tCO2e, the PCT recognises that it needs to inspire and
motivate staff to successfully deliver carbon reduction and the wider sustainable development agenda.
Figure 5: NHS Nottinghamshire County staff celebrate becoming trained as Green Champions,
Lings Bar Hospital, 2009.

4.6.2. Sustainability and people strategy
As stated in 4.6.1. Sustainability and People Policy, the PCT will only achieve successful carbon management if it can secure the necessary commitment of its
workforce. It is widely recognised that the implementation of no-cost measures such as reduced use of energy, better segregation of waste, or more
efficient use of vehicles can save over 10% of expenditure in these areas. Lastly, individuals everywhere are becoming more aware of carbon reduction and
sustainability, and there is evidence to suggest that people want to work for sustainable organisations.
In response to this, the PCT commissioned an environmental behaviour change project across pilot sites throughout 2009, undertaken with Global Action
Plan as part of the wider PCT Carbon Reduction Project. This pilot project included (1) recruiting volunteers at the sites to act as environmental “Green
Champions”, who provide advice and engage colleagues on environmental/sustainability issues, (2) training for those Champions, (3) auditing typical
environmental behaviour and (4) supporting Champions to engage and communicate with colleagues. Both the lessons learned and the successes from the
pilot have helped shape the wider behavioural change work with staff throughout 2010 and beyond, and a summary can be found under Appendix H.
Following the pilot, NHS Nottinghamshire County has now recruited and trained over 50 Green Champions, including the majority of site managers from
health centres, hospitals and headquarters buildings, to influence colleagues to change behaviour in respect of energy use, waste management and
transport choices. Green Champions are allocated a minimum of one hour per week to undertake this valuable work. Additionally, the PCT has a
Sustainability Steering Group which provides strategic leadership, complemented by a Green Champions Group that meets regularly and provides
operational leadership on the best ways to embed sustainability into staff’s day-to-day work. To date, the Champions have led a campaign to encourage staff
 Motivate and empower its staff to play a full part in developing new ideas and initiatives
around carbon reduction.
 Ensure that all existing and new staff are fully aware of the Sustainability and People Policy &
Strategy, and are committed to implementing it in their day-to-day work.
 Communicate regularly with staff about progress and share best practice, and will proactively
consult as widely as possible on ways to improve performance.
 Formalise training and continuous professional development (CPD) opportunities for staff on
carbon and resource use related matters.
 Explore the integration of carbon reduction into personal objectives, job descriptions,
appraisal processes and competency profiles.
A culture of carbon awareness should become
an integral part of working for the NHS.
Particularly as a significant amount of the
energy used, travel choices and goods
purchased throughout the NHS is in the direct
control of individual members of staff.
As Europe’s biggest employer, the NHS has a big
opportunity to have ‘exemplar employees’
who are likely to have far reaching positive
impacts, not only on the NHS supply chain, but
also on communities throughout the UK.

to switch off PCs, monitors, printers and lights to help reduce energy consumption, together with one to raise awareness on waste disposal, increasing
recycling, and promoting a more careful use of resources. Further recruitment of Green Champions, together with the provision of a Site Sustainability Log
Book and relevant resources are scheduled in the near future.
In order to enable staff to measure, monitor and manage carbon emissions and wider resource use in their own setting and/or the area of the organisation
they are responsible for, be it a Green Champion or a Director, it is paramount that the PCT invests and continues to put in place “people solutions”. This
includes ensuring appropriate access to resource consumption data via Smart metering technology, consistent and accessible records systems, appropriate
training, and the wider support to enable them to deliver this work effectively when faced with other competing priorities.
In terms of wider communications, regular articles on sustainability appear in the weekly staff update and in the monthly staff magazine and green pages
have been developed for the Intranet. An internal communications plan is being developed to maximise opportunities for publicising sustainability issues,
green incentives, and celebrating progress made on internal carbon reduction. A staff suggestions scheme for green ideas is in place, and a Green Week is
held annually.
NHS Nottinghamshire County strongly believes that workforce engagement and commitment are critical to the successful delivery of the Carbon
Management Plan. The PCT will support staff in understanding and interpreting the strategic priorities on carbon reduction and wider sustainability, and
empower staff to make changes to achieve a sustainable workplace.
Every member of the NHS workforce should
be encouraged and enabled to take action
in their workplace. NHS organisations
should support their staff by promoting
increased awareness, conducting
behavioural change programmes,
encouraging home working, low carbon
travel, the use of ICT, and by ensuring
sustainable development is included in every
job description.
Figure 6: Display at Hucknall Health Centre, 2009.

5. NHS Nottinghamshire County
Carbon Management Action Plan
Last updated: 11/05/10

How to interpret the CMAP:
Internal priority
Category Definition / Range
Essential (E) This action is indispensable for effective carbon reduction to take place, and other actions’ impacts
will directly depend on this action being implemented first/successfully.
Desirable (D) This action is recommended in order to reduce carbon emissions across its particular area.
Financial savings (£)
Definition / Range
Whenever an action is identified with the potential to result in financial savings, the saving is stated in this column.
Carbon impact (tCO2e)
Category Definition / Range
The categories below are used only where quantifiable CO2e savings are not available i.e.: it will be preferable to
feature a numerical value for the carbon impact of each measure, wherever possible.
High Actions which will result in a reduction of >5% of the core annual CO2e footprint.
Medium Actions which will result in a reduction of >1% of the core annual CO2e footprint.
Low Actions which will result in a reduction of less than 1% of the core annual CO2e footprint.

STRATEGY AND GOVERNANCE (3 pages)
Recommendations Action
Related target/
mandate
Priority
Lead
Progress to
date
Timescale/
Milestone/DL
Financial
savings(£)
Carbon
impact
1. Board-level approved Carbon
Management Plan:
a) Setting out vision on reducing
emissions over time across the
whole organisation and in
partnership with health care
providers and partner
organisations;
b) Including sections for delivery,
with a subset of specific actions,
timescales, responsibilities,
impacts, and prioritisation.
1. Final draft to be approved by SSG.
2. CMP to go to Board for approval.
3. Once approved, NEP to support on
implementation of
recommendations as per PCT Carbon
Reduction Project (CRP) SLA.
A Board approved
Carbon
Management
Strategy for all NHS
organisations by
2009 (NHS SDU).
E Sustainability
Steering
Group (SSG).
Draft Action Plan
completed +
structure agreed
in March 2010.
CMP approved
by SSG on
07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010.
2. Sustainability Steering Group to
be established, meeting regularly
to review the progress of the
Carbon Management Plan, monitor
its implementation, and report
quarterly to the Board on
performance and on any issues
arising.
1. Continue to meet throughout
2010.
E Director of
Finance,
Achieved. Group formed,
meeting on a
monthly basis.
3. Consider drivers and incentives
to promote and support
organisation-wide carbon
reduction in the short, medium and
long term, and use them
whenever/wherever appropriate.
Examples:
▪ Financial (e.g.: revenue from Feed-
in-Tariffs)
▪ Publicity, marketing and
showcasing (e.g.: awards, case
studies).
▪ Compliance (e.g.: Carbon Reduction
Commitment (CRC), Audit
Commission's Use of Resources
(KLOE)
▪ Education, training and awareness
(e.g.: Global Action Plan training).
E SSG Ongoing.
SSG reviews at
monthly
meetings.
Ongoing.

4. Identify strategic and
operational leads to ensure
effective and successful delivery of
Carbon Management Plan.
1. Identify strategic and operational
leads to ensure internal delivery
across all the areas of carbon
management, to include:
- Governance e.g.: CRC EFS, KLOE 3.1
- Carbon footprinting and reporting
- Energy management
- Transport and Travel planning
- Procurement & Commissioning
healthcare
- Waste management
- Behavioural change & awareness
E SSG Draft Action Plan
completed +
structure agreed
in March 2010.
CMP approved
by SSG on
07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010.
5. Provide information in line with
Treasury guidance for inclusion in
Annual Report.
1. SSG, with support from NEP, to
develop own set of relevant KPIs for
internal and external reporting on
performance against carbon and
wider sustainability, in line with
national best practice.
2. Once agreed, include the first
report on progress against them in
the 2009/10 Annual Report.
Treasury guidance
on information to be
included in Annual
Report.
E Task & Finish
Group,
responding to
Audit Report
on
Sustainability.
Paper on
proposed KPIs to
be taken to June
SSG for
consideration.
SSG meeting on 7th
June 2010.
Deadline for
inclusion in Annual
Report: July 2010.
6. Develop supporting
Communications Plan.
1. Communications lead to attend
SSG, Green Champions Group and
liaise with Head of Corporate
Services and NEP, to ensure that
messages on carbon and
sustainability are disseminated to
staff and stakeholders.
D Head of
Comms
Ongoing.
7. Actively work with NHS/DH
regional sustainability network
and other relevant networks and
partnerships (e.g.: County LSP
Climate Change Steering Group), to
share lessons, showcase best
practice, and identify resources.
1. Identify networks and relevant
partnerships.
2. Liaise/establish contact.
3. Become involved as/when
appropriate/feasible.
D Head of
Corporate
Services.
NHS
Nottinghamshire
County is
represented and
attends the East
Midlands NHS
Sustainable
Development
and Health
network.

8. Embed carbon accounting
alongside financial accounting.
Finance, Corporate Services and
Property Services staff to be trained
by NEP to calculate carbon footprint
using DEFRA methodology and
opportunities for embedding wider
carbon accounting in-house.
E Head of
Finance.
A carbon
accounting
masterclass took
place on
28/04/10.
Ongoing.
Annual report in
September 2010
to include financial
KPIs.
9. Carbon management is
accorded appropriate priority
within corporate priorities and
policies.
Work with directorates to integrate
this into internal policy documents
and cycles.
Saving Carbon,
Improving Health
(NHS SDU).
E SSG Ongoing.
10. Comply with the Carbon
Reduction Commitment Energy
Efficiency Scheme (CRC EFS).
Provide information disclosure to the
CRC Administrator (EA) between
April and September 2010.
CRC EFS (2010). Head of
Corporate
Services.
NEP has advised
PCT current
liability is limited
to registration.
Liability will be
kept under
review.
Register and make
information
disclosure before
end of Sept’2010.

PROCUREMENT – COMMISSIONING HEALTHCARE SERVICES (1 page)
Related target/
mandate
Priority
Lead
Progress to
date
Timescale/
Milestone/DL
Financial
savings(£)
Carbon
impact
1. Influence the commissioning
framework to ensure that provider
organisations with contracts with
NHS Nottinghamshire County
actively reduce, monitor and report
on their own carbon emissions
regularly to the PCT.
1. Define local format, method and
timeframe for provider
organisations to use when
reporting their own performance
on carbon management to the PCT.
2. Work to roll this clause out to
provider organisations
appropriately e.g.: with
accompanying letter, at ‘Meet the
Buyer’ or similar forum.
Saving Carbon,
Improving Health
(2009).
AC KLOE 3.1.
requirements for
obtaining Level III
World Class
Commissioning i.e.:
competencies 1, 2,
8, 10.
Documented
objectives within
SLAs for all
commissioned
services (internal).
E Primary Care
Mental
Health
Implementati
on Manager
The SSG is
developing
environmental
standards for
inclusion in
existing and
future
specifications
and contracts.
Sept 2010 for
inclusion in 2011
/2012
commissioning
agenda.

ENERGY IN BUILDINGS (4 pages)
Related target/
mandate
Priority
Lead
Progress to date
Timescale/
Milestone/DL
Financial
savings(£)
Carbon
impact
1. Full buildings survey of the
entire estate, to assess energy and
carbon savings.
1. Carry out a detailed survey of each
building within the estate, by a
qualified surveyor.
2. NEP to provide the PCT with the
detailed, site-by-site reports for their
records.
Strategic Service
Development Plan
(SSDP)
CIAMS Section 6.
Environmental
E NHS Property
Services
Achieved. Provide site
reports by June
2010.
2. Analysis of the quality of data
sources available to Estates with
regards to energy consumption for
use in carbon footprinting, to
ensure accuracy and consistency,
and to enable accurate monitoring,
reporting and reviewing of
emissions over time.
1. Review all data sources available,
and rate them with regards to
carbon footprinting criteria provided
in national guidelines and by NEP.
2. Clarify what emissions are
accounted for in each data source
and which ones are not measured.
3. Identify the best source of data
available, decide which data source
will be used to calculate a baseline
carbon footprint, and identify a way
forward for improving data and gaps
in future.
D NHS Property
Services
Achieved for
2007/2008.
To be completed
for 2008/2009 and
2009/2010.
3. Calculate the buildings-related
CO2e emissions across the whole
estate.
1. Identify lead or teams that will be
responsible for delivering this
recommendation.
2. Carry out the footprinting
exercise, following the format and
methodology used for the baseline.
25% reduction in
kgCO2e emissions
from owned estate
across 5 years
(SSDP).
E NHS Property
Services
Achieved (2009). To be completed
for 2008/2009
(with support from
NEP) and
2009/2010.

4. Reduce electricity, gas and
water consumption by 10% by
2015.
1. Reduce ambient room
temperature in all premises to 19
degrees.
SSDP D NHS Property
Services
Reduced HQ
energy
consumption by
better energy
controls, regular
monitor checks,
removable plugs
identified,
double sided
printing as
standard,
removal of
personal heaters
and fans.
3% reduction
August 2010.
7% reduction
December 2011.
10% reduction by
January 2015.
Yes M
5. Adopt a Corporate Energy
Policy, Strategy and Action Plan,
providing a public statement of
intent to manage carbon
emissions.
1. Approve by SSG and Board as part
of CMP.
2. Monitor progress and review
actions required regularly.
SSDP E NHS Property
Services +
SSG
Draft Action Plan
completed +
structure agreed
in March 2010.
CMP approved
by SSG on
07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010.
6. Capital plan for owned estate,
with prioritised measures for
investment to include their carbon
saving potential and paybacks at
current and future energy prices.
To be updated annually and linked
to the overall financial planning
cycle.
1. Produce a full, costed list of
measures for investment in the
owned estate, using the data from
the site surveys.
2. Calculate energy and carbon
saving, capital cost, and paybacks.
3. Put recommended measures into
a prioritised list by carbon saving and
payback, to advise on investment.
SSDP E NHS Property
Services
Achieved (2009) Dec'2009:
Recommendations
for investment in
carbon and energy
reduction
measures across
owned provider
sites is produced
and presented to
Finance and
Estates for
consideration,
circa <£1.1m.
Yes H
7. Assess all planned and future
capital investments in terms of
their relative carbon saving as a
means of targeting and prioritising
investment over time, in CO2e per
relevant unit e.g.: m2.
Use the criteria NEP applied for
recommending investment in the
capital works programme 2009/2010
(see Recommendation 6.).
SSDP E NHS Property
Services
Use in 2010/2011
Capital investment
planning.

8. Use carbon as the key metric for
assessing and benchmarking
buildings performance, replacing
now dated energy measurements
(e.g.: GJ per 100m3).
Rate all buildings for which energy
data is available in terms of their
carbon emissions, and establish
comparisons between similar types
of buildings for benchmarking
purposes.
SSDP D NHS Property
Services
Completed in
2010 for owned
and directly
leased sites.
9. Introduce half-hourly metering
of electricity, gas and water.
1. Install Smart/half-hourly electricity
metering in all owned estate.
2. Pilot gas and water submetering
across a selection of representative
sites.
SSDP D NHS Property
Services
Estates and NEP
are currently
leading a roll-out
programme of
Smart electricity
meters across
the owned
Estate. 6 HCs
installed (April
2010).
Aim to finalise
electrical Smart
meter installations
end of May 2010.
Pilot gas and
water in 2010
(TBC).
10. Carry out a renewable energy
survey for potential on-site
generation across the whole
estate (including land and leased
assets), with an aim to develop a
strategic plan on renewable energy
generation and developing energy
resilience.
1. Identify potential sites (desktop
analysis).
2. Physical survey of potential sites.
3. Calculate the potential for energy
generation.
4. Explore logistics and financial
options for on-site renewable energy
generation.
5. Produce a renewable energy
strategic plan reflecting the findings
and making recommendations for
action.
SSDP D NHS Property
Services
Potential for
solar hot water
and photovoltaic
systems in
owned estate
sites has been
identified, and
recommendation
s have been
made for
investment.
H

11. Establish a protocol of 'shared
pain, shared gain’ of financial and
environmental savings derived
from acting upon the impacts of
landlord and tenants’ use of
energy and other resources on-
site, that establishes regular
communication and relative
responsibilities for either party, as
there is an inability for either party
to take full control over these
buildings in a changing
environment and in unforeseen
weather events, without the other
party's involvement.
1. Pilot the Energy Protocol
produced by NEP & GN LIFTco in a
LIFT site.
2. Monitor progress and take-up.
3. If deemed successful, expand to all
PFI sites within the organisation.
NHS Property
Services
LIFTco
Energy Protocol
has been
produced which
incorporates the
key elements of
'shared pain,
shared gain'
thinking applied
to the landlord-
tenant
relationship and
their use of
resources on
split/PFI sites.
November 2010.
12. In all new leasing
arrangements, minimum
standards of CO2e emissions to be
assessed and benchmarked.
SSDP. NHS Property
Services
LIFTco
13. All new leased assets must
have a minimum of submetering
facilities for energy and water for
the area we will occupy.
Independent metering such as
Smart half-hourly meters should be
introduced whenever possible, and
continuous utility monitoring (of
both consumption and billing) to
become the norm.
1. Consider the existing metering
arrangements -and the opportunities
to improve these easily/cost-
neutrally- when looking into new
leases.
2. Ensure appropriate mechanisms
are put in place to enable access to
accurate metered data before
commissioning new leased sites e.g.:
agreement in the contract,
agreement with the supplier, etc.
NHS Property
Services
14. Ensure that when procuring
building elements in existing or
new buildings:
- carbon is used as a metric
- major refurbishments are
designed to withstand significant
climate change
- have a requirement for persistent
low carbon footprint
- Whole Life Costing is applied
1. NEP to advise and work with NHS
Property Services.
SSDP
All new healthcare
buildings to be low
carbon by 2015 and
zero carbon by 2018
(DCLG & DH).
NHS Property
Services

TRAVEL, TRANSPORT AND ACCESS (3 pages)
Related target/
mandate
Priority
Lead
Progress to date
Timescale/
Milestone/DL
Financial
savings(£)
Carbon
impact
1. Calculate the travel-related CO2e
Scope III emissions i.e.: business
mileage, when data is available.
1. Calculate the Scope III carbon
footprint on a baseline year.
2. Identify the contribution that
business mileage has on overall
footprint.
SHA target to have
Board approved
Travel Plan.
E NEP
contracted
under SLA
to do this.
Currently work is
underway to
ascertain best
available dataset
to calculate Scope
III i.e.: business
mileage in own
vehicles.
Calculate
emissions for
2008/2009 and
2009/2010 from d
leased vehicles
and business
mileage, by
September 2010.
2. Agree smart targets for corporate
travel practices on a 2007/2008
baseline year and adopt it in NHS
Nottinghamshire County's
Sustainable Travel Plan.
1. Analyse current travel and
transport data.
2. Compare to national
benchmarks.
3. Work to design appropriate
targets, together with a consistent
mechanism to measure emissions
reduction this over time.
4. Embed this target into the
Sustainable Travel Plan.
5. Review any existing systems that
remove the need for travel, and
their uptake amongst staff /
effectiveness e.g.:
teleconferencing, home working, e-
meetings, etc.
Reducing the carbon
footprint (from
energy use,
procurement and
travel) by 10% by
2015 on a 2007
baseline across the
whole of the NHS
(NHS SDU).
E Head of
Corporate
Services.
Summer 2009:
Staff travel survey
took place with
27% response
rate, providing
evidence for
setting targets,
together with
informing the
Sustainable Travel
Plan and
recommendations.
June 2010.

3. Adopt a corporate Sustainable
Travel Policy, Strategy and Action
Plan as the public statement of
intent on managing the carbon
emissions and reducing the wider
environmental impacts derived from
staff, patients and visitors' travel
and transport practices.
Take from the Sustainable Travel
Plan, once it is available.
A Board approved
Sustainable Travel
Plan for all NHS
bodies by 2010 (NHS
SDU).
Reducing the carbon
footprint (from
energy use,
procurement and
travel) by 10% by
2015 on a 2007
baseline across the
whole of the NHS
(NHS SDU)
E Head of
Corporate
Services /
NEP.
Draft Action Plan
completed +
structure agreed
in March 2010.
CMP approved by
SSG on 07/05/10.
Aim to finish
Travel Plan by end
of May 2010, then
consult and
approve at
strategic level
early summer
2010.
4. Record mileage claims from staff
business travel in a format that is
compatible with national travel
carbon footprinting guidelines.
1. NEP to provide advice and
support in producing a format for
this.
2. Liaise with Finance and possibly
SBS on how to implement this.
E Head of
Finance
5. Decarbonisation of
a) leased vehicles and
b) business mileage.
Implement the Sustainable Travel
Plan recommendations, once they
are agreed and it is published.
Reducing the carbon
footprint (from
energy use,
procurement and
travel) by 10% by
2015 on a 2007
baseline across the
whole of the NHS
(NHS SDU)
E Sustainabilit
y Steering
Group (SSG)
Sustainable Travel
Plan is currently
being developed.
Aim to finish
Travel Plan by end
of May 2010, then
consult and
approve at
strategic level
early summer
2010.
6. Review directorate travel budgets
and set targets to reduce them.
SSG November 2010.

7. Publicise current travel
initiatives so that staff are aware of
them and their take-up is
maximised.
1. Review current sustainable
travel initiatives e.g.: car sharing
scheme, cycle2work, cycle training,
etc., and where they are publicised.
2. Work with HR, Workforce and
Corporate Services on improving
the offer of initiatives available,
guided by the feedback from the
2009 Staff Travel Survey.
3. Work with Comms Team on
publicising the initiatives.
E Head of
Comms
HR Manager
Car sharing
scheme launched
in April 2010.
Travel Plan and
sustainable travel
options to be
publicised to staff
throughout Green
Week 14-18 June
2010.
8. Identify patients’ travel needs. A Board approved
Sustainable Travel
Plan for all NHS
bodies by 2010 (NHS
SDU).
D SSG Sustainable Travel
Plan is currently
being developed.
Aim to finish
Travel Plan by end
of May/June 2010,
then consult and
approve at
strategic level
early summer
2010.

WASTE MANAGEMENT (2 pages)
Related target/
mandate
Priority
Lead
Progress to date
Timescale/
Milestone/DL
Financial
Savings(£)
CO2impact
1. Calculate the CO2e Scope III
emissions derived from waste
management practices across the
whole owned and directly leased
estate, divided into a) clinical, b)
domestic, and c) confidential waste
streams.
footprint for 2008/09 and 2009/10.
Reducing the carbon
footprint arising
from waste by 10%
by 2015 on a 2007
baseline across the
whole of the NHS
(NHS SDU).
E NEP
contracted
under SLA
to do this.
Jan'2010: Work
underway with
Supplies team and
waste contractors
to acquire data on
historical waste to
calculate the
footprint.
By June 2010.
2. Agree a specific year-on-year
CO2e reduction and/or waste
stream reduction target from waste
management practices on the
2007/2008 baseline year and adopt
it in the most appropriate internal
strategy/policy.
1. Analyse current waste data.
2. Compare to national
benchmarks.
3. Work to design an appropriate
reduction target, together with a
consistent mechanism to measure
emissions reduction this over time.
4. Embed this target into the Waste
Management Strategy.
Reducing the carbon
footprint (from
energy use,
procurement and
travel) by 10% by
2015 on a 2007
baseline across the
whole of the NHS
(NHS SDU).
E SSG Draft Action Plan
completed +
structure agreed
in March 2010.
CMP approved by
SSG on 07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010 .
3. Adopt a corporate Waste
Management Policy, Strategy and
Action Plan as the statement of
intent on managing the carbon
emissions and wider environmental
impacts derived from waste
management practices.
E SGG Draft Action Plan
completed +
structure agreed
in March 2010.
CMP approved by
SSG on 07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010 .
4. Develop communications plan to
ensure staff are aware of waste
management procedures.
E Head of
Communica
tions
Dec-10

5. Ensure better management of
corporate waste contracts for all
waste streams to maximise
environmental and financial savings,
and ensure compliance and VFM
over time.
Review legal duties, data
availability, current costs and rates,
disposal methods, providers’
credentials, etc.
- access to data on waste produced
in-house by volume and waste
stream on a daily/weekly basis
from the suppliers.
- Agree monitoring and reporting
duties and systems with the
suppliers.
- Monitor and manage the quantity
and cost of all waste streams and
set trajectories to Monitor, manage
and reduce them over time.
E SSG &
Supplies
Work currently
underway
between Supplies,
Corporate
Services, Estates,
providers, the
Re:Source Hub and
NEP to review
current contracts
and try to embed
lean management
principles,
improve
communications
and records, and
maximise
opportunities for
savings. Recycling
facilities provided
at all HQ premises
and health
centres.
6. Develop training and awareness
programmes to ensure correct
segregation of waste.
Develop training programme. E SSG
Workforce
representati
ve
Dec-10
7. Undertake periodic (at least 6-
monthly) waste audit trails, to
assess the effectiveness of current
systems and make improvements
wherever necessary.
Waste audit system to be
developed and implemented.
E Karen
Sullivan
Site logbook to
include
information on
waste
management and
surveys.
8. Identify “quick hits” to prevent
waste arising in the first place, to
reduce waste and the cost of waste
disposal for the PCT. Identify no-
cost/low-cost opportunities for
preventing/recycling waste or waste
recovery.

PROCUREMENT – GOODS AND SERVICES (3 pages)
Related target/
mandate
Priority
Lead
Progress to
date
Timescale/
Milestone/DL
Financial
Savings(£)
CO2impact
1. Calculate the CO2e Scope III
emissions derived from purchasing
goods and services across the
organisation.
footprint on a baseline year,
using P4CR Scope tool.
2. Identify the contribution that
procurement (goods and
services purchased) has on
overall footprint.
Reducing the carbon
footprint (from energy
use, procurement and
travel) by 10% by 2015
on a 2007 baseline
across the whole of the
NHS (NHS SDU).
E NEP Provisional
baseline
footprint
achieved for
2008/09, in
partnership
with Re:Source
Hub using P4CR
toolkit, based
on tCO2e/£
spent.
Do again for
2009/10 (by July
2010).
2. Attain Level 3 in flexible
framework on sustainable
procurement by 2013.
Based on the results of the
footprinting exercise, set
specific reduction targets for
the largest areas of
procurement i.e.: the ones with
the largest expenditure, with
the highest carbon impact. Use
Flexible Framework to guide
this process.
Reducing the carbon
footprint by 10% by
2015 on a 2007
baseline across the
whole of the NHS (NHS
SDU).
E Sustainability
Steering Group
(SSG)
Draft Action
Plan completed
+ structure
agreed in
March 2010.
CMP approved
by SSG on
07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010 .
3. Use theP4CR to target high areas
of carbon emissions.
Reducing the carbon
footprint by 10% by
2015 on a 2007
baseline across the
whole of the NHS (NHS
SDU).
E Sustainability
Steering Group
(SSG)
Draft Action
Plan completed
+ structure
agreed in
March 2010.
CMP approved
by SSG on
07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010 .

4. Adopt a corporate Sustainable
Procurement Policy, Strategy and
Action Plan on managing the carbon
emissions and wider environmental
impacts of its procurement
practices.
Use Flexible Framework to
guide this process.
E SSG Draft Action
Plan completed
+ structure
agreed in
March 2010.
CMP approved
by SSG on
07/05/10.
CMP to be taken
as a paper to
Board 27th
May
2010 .
5. Incorporate national and regional
best practice, knowledge, resources
and guidance into PCT’s own
practices.
E Supplies
representative
on SSG.
HQ stationery
now from
sustainable
sources if
financially
viable.
Jan-11
6. To train and regularly update
procurement staff on new
procurement systems and to enable
them to gain new skill and
knowledge on sustainability.

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