Financial green light

by John Williams

14 April 2021


Those of us working in healthcare, who care about reducing health inequalities and providing a sustainable environment for our children to build upon in generations to come, can help to deliver urgently needed action. And the finance community needs to be at the heart of this agenda.

Earlier in the year, Sir David Attenborough warned that it was already too late to avoid climate change. ‘The poorest, the most vulnerable, those with the least security, are now certain to suffer,’ he told the UN Security Council. But he offered grounds for hope, with fast action enabling a new stable state to be reached.

Health and social care in England is both a contributor to the problem – responsible for approximately 5.4% of the national carbon footprint – and a big part of the potential solution. But we must act now.

Implementing a net carbon zero NHS by 2040 will take a huge leadership commitment and will not be achieved using historical approaches; managing it as a cost budget, service line or programme. It needs to become part of our conscience, our decision making, our clinical strategies and our cultures. This is as much a social challenge, as it is technical.

The NHS finance community has a huge opportunity and leadership responsibility to help achieve this ambition and it should capitalise on the learnings of the past 12 months.

First, rather than emerge into a ‘new post pandemic normal’, we should proactively consider and discuss what the workplace of the future should look like. How do we support our teams in a brilliant place to work in a way that contributes to environmental sustainability?

My current organisation has initiated some exciting conversations about this, trust-wide and within departments. We have framed these around the year 2030, on the basis that this is far enough into the future to be creative and innovative, but close enough to ensure a dose of realism.

We need to consider our workplace of the future from the perspective of different stakeholders – patients and carers, colleagues and future colleagues, and, in particular, ‘generation Z’. My eldest son, Rafferty, who is 8, could be working in the NHS by 2030. What type of organisation would he wish to work for (his IT skills are already better than mine!) and how will this generation want to access clinical services?  

Capturing the benefits from the Covid-19 response helps to focus on where changes that have been made should be sustained for the future. My trust, like many organisations, implemented virtual outpatients. We have subsequently calculated that we have saved journeys equivalent to over 2 million patient miles, equivalent to around 55 tonnes of carbon, during the first 12 months of the pandemic.

Agile and flexible working has provided benefits for work-life balance and for the environment, albeit with some challenges around reduced social interaction and IT.

As organisations implement green plans, finance teams, working with estates, facilities and procurement colleagues, are in a great position to get involved. Find out who is leading this in your organisations and ask what you can do to help!

As accountants, we often want things to be specific and absolute. However green plans will evolve as research and innovation brings more to the table. So, we need to focus on implementing the direction of travel and not get side-tracked by the search for perfection.

We can adapt as business cases shift in their design. We will need to consider what the ‘do nothing’ scenario looks like, albeit seemingly creating a further widening of the health inequalities gap. We will need to develop understanding and value for ‘green premiums’, as Bill Gates recently described.

Supporting visible quick wins makes sense, signalling future intent. Examples include:

  • sustaining agile and flexible working arrangements
  • promoting health and wellbeing
  • recycling initiatives
  • biodiversity improvements, such as tree planting or taking green pledges
  • improving carbon literacy and supporting training and education opportunities for staff.

There are some great ideas already out there, with Twitter in particular highlighting some good examples – some trusts even have their own green Twitter handles. We can help by working across NHS sectors and with other anchor organisations within our systems, using our broad networks to share best practice and facilitate change.

However, there are difficult conversations and challenges ahead. For example, we will need to tackle the cost premium of doing right by the environment and the long-term cash pay back of significant capital investment. There needs to be an increased focus on prevention – public health budgets remain a fraction of the overall NHS budget. And with 60% of the NHS carbon footprint relating to the supply chain, finance departments have to explore the potential for local, ethical and sustainable procurement.

Our workplaces will never be the same again, largely for the better. But we need to grasp this opportunity to shape the future and, at the same time, continue some of the great progress made in achieving the NHS environmental sustainability targets. This is our chance to leave a lasting legacy for our children and young people.



John Williams is a member of the HFMA Environmental Sustainability Special Interest Group.