NHS Estates: Delivering Sustainable Practice across the Estate

At our annual NHS Estates conference in July 2021, several NHS Executives spoke about individual strategies that have been developed to help rebuild the Estate and tackle the maintenance backlog.

An emphasis on sustainability in the sector is becoming increasingly important as climate awareness is at the forefront of the global agenda.

In October 2020, the NHS became the first in the world to commit to delivering a net-zero carbon national health system. With around 4% of the country’s carbon emissions, and over 7% of the economy, the NHS has an essential role to play in meeting the net-zero targets set under the Climate Change Act (Delivering a ‘Net Zero’ National Health Service).

Two clear targets are outlined in the Delivering a ‘Net Zero’ National Health Service report [1]:

• The NHS Carbon Footprint: for the emissions controlled directly to meet net zero by 2040

• The NHS Carbon Footprint Plus: for the emissions that can be influenced to meet net zero by 2045

Cornwall and the Isles of Scilly Health and Care Partnership – Green Plan 2021 – 2026

Roberta Fuller is Head of Hospital Reconfiguration for the Royal Cornwall Hospitals NHS Trust [2]. They presented their vision for a more sustainable and green NHS Estate.

Roberta introduces the plan by highlighting the fact that Cornwall and The Isles of Scilly as a health system are very interested in promoting sustainability within the NHS.

The partnership has developed three key aims to promote sustainability in the NHS built environment:

• To reduce carbon, waste, and water

• To improve air quality

• To reduce the use of avoidable single use plastics

The Royal Cornwall Hospital Trust’s Construction Programme: Environmental Controls

There are 4 Major Capital Projects commencing in the next 12 months within the Cornwall Trust: one of these is a new Women and Children’s Hospital (National Hospital Programme).

Roberta presented the environmental action plan that has been developed to guide the construction of the new hospital.

Environmental controls and targets for this project include:

• A Considerate Constructors Scheme (CCS).

• An overall target of zero pollution incidents

• Energy use measured. Fuel use in litres as well as bottled gas measured.

• Automatic meter reading meters to be installed and usage recorded on a SMART system

• Water use recorded on SMART system – target maximum water use of 70m³ / £1 million

• Waste production and % of waste diverted from landfill. Contractors and Sub-Contractors required to log all waste transfers

• Waste to be segregated for recycling on site with 95% of all waste removed from site recycled rather than to landfill

• All timber is to be from Forest Stewardship Council (FSC) or Programme for the Endorsement of Forest Certification (PEFC) sources

• Environmental risks covered in site induction and environmental toolbox talks monthly

• Project Environmental Management Plan to be reviewed quarterly

• Modern Method of Construction (MMC) score of 70% in line with governmental requirements 

Innovation in Recycling Waste Anaesthetic Gas

Theatre Capture Device:

Alongside creating sustainable construction strategies, the Trust has been working on ways to develop sustainable practices within the operating theatres of its hospitals.

Roberta explains how the Trust has been working with SageTech Medical Limited since 2019, to develop a way to capture harmful waste that is released into the atmosphere when using anaesthetic gas.

Patients only ingest about 2% of the anaesthetic gas and the rest of it is scavenged out of the atmosphere through the Anaesthetic Gas Scavenging System (AGSS) in the operating rooms and blown out into the atmosphere. This excess gas is a pollutant.

The partnership is now designing and developing a device that can capture pollutants in anaesthetic gas including Isoflurane, Sevoflurane and Desflurane.

Medical Extraction Machine:

SageTech Medical Limited has also asked the trust to help them pilot a medical extraction machine that will be situated in the theatre.

The machine is fully automated and would extract isoflurane, sevoflurane and desflurane into 30L bulk vessels. It recycles capture canisters for re-use. The harmful gases are turned back into a liquid and reused again. This means there is no need for storage or production of disposable canisters.

The key aim of utilising these devices is to stop harmful anaesthesia scavenging, as well as the net-zero gains that it would provide the NHS. The eventual goal is for them to be used in every hospital.

Innovation in Recycling Personal Protective Equipment (PPE)

Roberta discusses the ways that the Trust are thinking innovatively to promote sustainability considering the Covid-19 pandemic.

At the Royal Cornwall Hospitals in Cornwall staff and patients have been using up to 10,000 masks a day – compared to around 300 per day in 2019 – all destined for incineration.

To control the environmentally harmful process of incineration the Trust has introduced:

Reusable masks for non-clinical areas: introduced October 2020 to support Cornwall System-wide Climate Emergency Declaration that holds a target to become Carbon Net-Zero by 2030. The December 2020 Procurement Team audit showed a reduction in single-use masks by 46%

Reusable masks in clinical areas: are being rolled out and have been approved by IPAC and the trust decontamination team. These masks are being trialled in selected departments first and supported by Occupational Health for individual clinical staff experiencing difficulties with single-use masks.

Sterimelt: introduced melting of polypropylene items including single-use masks. 10,000 masks used per day in the Trust and 3000 per day now melted. The waste from the Royal Cornwall Hospital in Truro is melted into plastic blocks which can be made into bins and other items. Every ton of polypropylene saves £550 as waste is diverted from incineration. The Trust is seeking an Environment Agency certification license to repurpose other health organisation masks.

The mask recycling scheme is being piloted in three areas at the Royal Cornwall Hospital to get staff used to segregating masks from other clinical waste, to decide on the most efficient method before rolling it out right across the Trust’s three hospitals in Truro, Hayle and Penzance [3].

Innovation in Waste Reduction and moving to Carbon Net Zero

The Trust advocate using digital systems to save on environmental costs within the trust.

Virtual clinics: These were introduced during the Covid-19 pandemic to reduce footfall and patient contacts. This has resulted in environmental gains

Virtual Dashboard: This was created to demonstrate change and encourage green practice. In the 16 months (from January 2020 to May 2021) virtual working has diverted 234,499 face to face appointments and saved 1693 tons of CO2. The Trust has a commitment in place to support Remote Working and Active Transport policies.

[1] NHS. 2020. Delivering a ‘Net Zero’National Health Service report

[2] Fuller, Roberta. 2021. Head of Hospital Reconfiguration for the Royal Cornwall Hospitals NHS Trust

[3] Royal Cornwall Hospitals Trust