ENERGY EFFICIENCY
of the fi nancial business case for reducing carbon, is absolutely essential. So much so that now, when we work with NHS trusts and offer them support to help them pull together a carbon management plan and to fully understand the fi nancial implications of that plan, we insist that they must have a named, board-level sponsor, plus a writ- ten letter of support from either the fi nance director or chief executive in order for us to work with them.
“We’ve done that because we found that it makes all the difference when the board understands the issue; it means that hu- man resources and fi nancial resources are allocated across the trust, and the strategy is embedded at a much wider level.
“The single point person is also a helpful person to have, however: someone whose full-time job it is to ‘manage down’ energy costs and the carbon impact of energy. But the key is the board-level buy in.”
Making the commitment
The statutory Carbon Reduction Commit- ment has been weighing heavily on some managers’ minds, and the fi rst emissions reporting deadline, July 2011, has just passed.
Pryce said: “Overall, it’s defi nitely signifi - cant as a driver and it’s defi nitely acting as an additional fi nancial driver, and via the league table, it’s acting as a reputational driver as well. It’s one of the things, for in- stance, that’s been driving the NHS to take up the Carbon Trust Standard in increasing numbers – it helps with their position on the league table. I don’t think NHS trusts want to be seen as ineffi cient on carbon and energy costs.
“CRC has been more of a concern for some of the smaller mental health trusts, who only just fall within the size threshold for participation, than it has for some of the larger acutes. They tend to have a very dispersed estate, and a large number of small buildings, often scattered to the four winds, and they have historically had less of a good handle on their carbon emis- sions and where their energy use is com- ing from. Some of them have found meters they didn’t know they had, or meters they are paying for that are no longer in use. The CRC has helped to smoke out some of that kind of thing.
“Overall, though, the biggest driver is re- ducing the amount of money the NHS spends on energy. The thing you hear people in the NHS talk about the most is the rising cost of gas and electricity – that
60 | national health executive Jul/Aug 11
seems more of a concern than the CRC spe- cifi cally.”
Telecare
Climate change is a long-term problem, and the NHS of the future may work us- ing different models of care. In particular, it has been suggested that a shifting em- phasis away from acute hospitals and onto home-based and community-based health- care could also have a transformative effect on carbon emissions – with implications in terms of lower energy use, fewer trips being made by patients, and more energy- effi cient care pathways.
Pryce told us that he thinks this is likely to become a bigger and bigger issue for the NHS, but for the moment, managers are focused more on the immediate needs to save money and hit emissions targets.
He explained: “From my experience with the NHS trusts I’m working with now, they want to make their estates run more effi - ciently, so they want to identify the build- ings that are chucking out heat, they want to identify where they’ve got out-of-date boiler plants, out-of-date equipment and ventilation systems and so on, and they want to replace all of that.
“For example, we’ve worked with Guys and St Thomas’ NHS Foundation Trust, who have managed to reduce their carbon emis-
sions by over 20% since 2007. They have done that despite quite a bit of growth in the size of the Trust, precisely by replacing life-expired boiler systems with combined heat and power systems and dealing with things like lighting left on in corridors where no-one is using them, and dealing with staff awareness on the cost of energy use and the fact it’s taking resources away from the front line and patient care. The Trust is spending £1.7m a year less on en- ergy than it was four years ago.
“That kind of work is what the NHS is cur- rently focusing on. The payback period of what Guys & St Thomas’ has done is about six years – and the lifetime of a combined heat and power system is probably about 20-25 years. So, the fi nancial business case from doing that is undeniably strong. There are lots of opportunities like that.
“The whole ‘model of healthcare’ debate isn’t yet being thought of quite so seriously in the NHS, but having said that, I think that beyond the current fi ve or ten year pe- riod, it is likely to become important.
“That’s not just with home-based health- care, but also with the very interesting ide- as coming out about allocating resources, making end-of-life care more effi cient and better for the patient, and in terms of mak- ing sure people take more responsibility for their health, and therefore need to go to hospital less.”
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