NHS sustainability in a changing world

by Dave Stacey

02 July 2020

Where does climate change rank in the complex and increasingly crowded NHS agenda? And where do finance professionals fit in?

Roughly four months ago I sat at my desk to write a blog about NHS sustainability – how the world has changed since then. Covid-19 has brought positive and negative developments for the environment, but how can we in the NHS build on the good?

Originally this blog was scheduled to be published on 19 March 2020, which would have been this year’s annual NHS Sustainability Day. Up and down the country staff, patients and their families were due to celebrate the importance that sustainable development plays within our national health services. As with many things affected by Covid-19, this year’s NHS Sustainability Day is being re-scheduled, and I for one am looking forward to taking part when the new day is announced.

A comparison of the risks and responses relating to Covid-19 and climate change makes for an interesting debate. Both have the potential to dramatically disrupt human existence as we know it, one within a short space of time the other over decades or centuries.

It appears that we have it within our power to mitigate against both risks simply by changing the way we go about our daily lives. Yet our responses to these emergencies differ. For Covid-19 we have mostly followed the science and made the changes; for climate change we have not. It feels like the human race is a heavy smoker, resting its broken leg.

It is true that gains have been made. Five years ago, if I’d have seen a headline on NHS sustainability, I would have expected to read about funding levels, deficit positions and balance sheets. Now, the question of sustainability has a rather more fundamental tone to it – energy consumption, carbon emissions and plastics usage for example.

From a global reporting perspective, the six capitals (financial, manufactured, intellectual, human, social and relationship, and natural) are increasingly being used to report a fuller picture of an organisation’s performance and the ways in which it creates value through its business activities. Will NHS finance professionals soon be required to measure or validate the value creation of NHS organisations, I wonder?

In my role as chair of the HFMA Environmental Sustainability Special Interest Group, I’m able to hear first-hand the energy, excitement and enthusiasm coming from like-minded colleagues as they present ideas, initiatives and experiences. It does make me conscious though, that the vast majority of good work is being created by enthusiastic individuals – often above and beyond the day job. This leaves me to ask just where climate change sits in the pecking order of the near endless priorities and challenges facing the NHS?

Our most recent meeting focused on how we can include an ethos of NHS environmental sustainability as much as possible in the work to restart. Although there have been many positives, such as carbon savings from more telehealth appointments, I fear these have been outweighed by the dramatic increase in single use plastic and the additional freight miles accessing personal protective equipment (PPE). This is not to say these measures were not required, but I’m conscious we now need to begin focusing on re-establishing our previous good work and stepping up the efforts.

The Treasury’s The green book (guidance on how to appraise policies, programmes and projects) has the thread of environmental sustainability running throughout. But how does this filter down into more local-level decision making? Are our boards really considering environmental sustainability in every decision they make? And if so, just how heavily is it weighted?

At our most recent HFMA Environmental Sustainability group meeting – the first following the Covid-19 outbreak here in the UK – we spoke about having a responsibility. This is a responsibility as good corporate citizens to examine the environmental impact in everything we do – from shorter supply chains through local manufacturing to the way we’re using our PPE and how we educate our workforce.

I believe there is a need to value our use of resource through a wider lens than just productivity and finance. This should include the social and environmental impact of our NHS organisations.

Gradually, the finance function is growing beyond the realm of diligent scorekeeper to embrace the role of value maker, exerting a collaborative influence on decision-making processes more than ever before. And it’s here, in the decision-making process, where the difference between organisational approaches to climate change exists most. Those leading the way in sustainable development have it clearly embedded as a core element of their governance arrangements and mindset.

I sometimes question how much can be done locally, and how much should be driven from the centre. The launch earlier this year of the For a greener NHS campaign demonstrates the ambition of NHS England and NHS Improvement. But it also begs the question: will environmental sustainability begin to enter into the performance management or payment mechanisms of NHS organisations? This could be through CQUINs or the Quality and Outcomes Framework, for example.

On a less obvious note, a green-minded GP recently asked me who we bank with, and then went on to describe a green bank. This is a bank that promotes environmentally friendly practices from banking activities (not investing in fossil fuel industries for example).

Although the government banking service is admittedly slightly out of my control, our choice of banking partners is an interesting consideration. First it highlights that environmental choices exist in areas you may not expect. But it also directly questions our priorities by asking how exactly we are measuring our return on investment and long-term value.  

To return to my earlier analogy, the leg feels like it is healing, but the strain on the heart and lungs is getting dangerously close to irreparable.


Interested in contributing to the HFMA Environmental Sustainability Special Interest Group? Contact andrew.monahan@hfma.org.uk