Michael Smeeth, director of healthcare infrastructure at MedTech firm, GE Healthcare, made the plea at last week’s NHS Innovation Expo in London, claiming that something as simple as a good financing package could be a deciding factor in future procurement decisions, particularly for NHS purchasers.
“There is strict legislation around carbon emissions coming in very soon and this is particularly relevant for the NHS, where it will have a huge impact,” he said.
“Most acute trusts in the country are the size that will need to be registered and, suddenly, there is the threat of a huge fine coming in that they haven’t budgeted for.
There is strict legislation around carbon emissions coming in very soon and this is particularly relevant for the NHS, where it will have a huge impact
“There are a lot of great technologies out there, but what happens if you are a trust with no capital? Technology is not the problem and people are largely sold on the benefits. It is just overcoming the money side that is the issue.
“In the UK we have some of the best innovation, but it tends to be very slow at being deployed. We need to start doing things differently. It might be as simple as putting a product together that has an interesting finance option.”
He added that, rather than just install the latest environmentally-friendly devices, NHS organisations needed to take a much wider view of sustainability.
“The problem with the word ‘green’ is that it’s a catch-all term. It’s more of an ethos. Sustainability is what we should be striving for and to do this we need to look at people, processes and systems and how can we increase productivity by combining all these together.”
As patients opt to use you and your facilities, you need to make yourselves the place of choice, and there are people who will choose based on environmental performance
As well as the introduction of the Carbon Reduction Commitment, and fines for emissions, the drive for wider patient choice will also put pressure on NHS trusts to improve sustainability.
Smeeth told delegates: “As patients opt to use you and your facilities, you need to make yourselves the place of choice, and there are people who will choose based on environmental performance.”
Advising trusts on the most cash-efficient ways to improve sustainability, he urged them not to consider technologies in isolation, but to look at the bigger picture. He added: “A lot of money can be saved. The only problem tends to be whether it’s the right person looking at the issue and that they understand it is not just about infrastructure; it’s about the whole patient pathway. You have to look at how you operate as an organisation and maximise your return for the least amount of investment. It’s not just about being ‘green’. It’s about a well-run organisation and, if you have that, then you are ‘green’.”
Key technologies that could have a major impact on NHS emissions include combined heat and power (CHP) systems, which have been installed in a handful of hospitals in the UK, including Guy’s and St Thomas’ in central London.
We need to start doing things differently. It might be as simple as putting a product together that has an interesting finance option
Estimated to provide savings of up to 40% compared to conventional systems, CHP works by taking a gas feed and, instead of producing heat and power separately, it does it together, therefore minimising waste.
Smeeth said: “Here’s a way of saving money that involves no sacking of staff. When 70% of NHS costs are staff pay, you have only a little wiggle room, but CHP provides a way of making efficiencies without affecting frontline services.
“If the trust is big enough, and the demand is there, then CHP is the way forward. Up until now, however, the NHS has not had a great history of embracing CHP. It tends to be just forward-thinking and cash-rich organisations.”
At Guy’s and St Thomas’ the introduction of CHP has led to a £1.5m saving on energy bills and a cut of 11,000 tonnes of CO2. The asset will have paid for itself in four years, and has a lifespan of 15 years.
Smeeth said: “The return will only get better as energy prices go up. There are people who have done this not just to save money, but for energy security. When running a hospital you want the lights to stay on at all times and CHP is more reliable than the National Grid.”
Other options include:
- Solar technologies: Described by Smeeth as ‘green bling’, solar cooling and heating can be useful, particularly in diverse estates. He said: “Solar technology maximises the benefits of government feed-in tariffs and is a proven solution, but it is not a one-size-fits-all solution.
The important thing is planning. A lot of people rush to put new technologies in and they do it in isolation. If you do anything, you need to take a whole-systems approach
- Lighting: Smeeth advised: “Lighting is never going to be the biggest thing you do, but you can achieve a lot from it. You can get payback within a year and there’s not many options where you can get that. While you are never going to lead with lighting, it is an important part. It’s high impact for low investment
- Electric vehicles/fleet management: While electric vehicle technology is still in its infancy, the switch from petrol and diesel cars can have an impact, particularly among community health workers who make multiple short trips
- Water efficiency technologies: These are expected to become much more relevant in the UK as global warming affects the availability of water supplies and new technologies are slowly emerging
- Smart metering systems: This is an area for substantial growth, but one that will need to be sold to finance chiefs. Smeeth said: “Estates and facilities people want smart monitoring down to a ward or department level. Often that request will go up the chain and they will be asked what return it gives. The answer doesn’t sound sexy, but it is a valuable tool to help change staff behaviours. In most organisations most people do not price the value of energy into their daily workload in the same way they look at clinician time, the cost of medical devices etc. Metering at ward level provides a useful comparison. It does not have to be used as a blunt stick to beat people over the head with. You can set departments targets and if they save money, they will get a percentage back to spend on improving services. It’s a way of getting an approach instilled that can pay for itself through behaviour change. It can also help to see where anomalies in energy use exist
Within healthcare in the UK we need to be doing more with less, or delivering better outcomes. It’s not a salami slice approach. It’s about finding different ways of working
“One of the most important things is the cost,” Smeeth said. “Within healthcare in the UK we need to be doing more with less, or delivering better outcomes. It’s not a salami slice approach. It’s about finding different ways of working.
“Hospitals use three or four times the energy of a typical commercial building and run constantly with constant loads. We can’t just build new hospitals, so it’s about looking at what is there already and what is the best way of making the biggest impact and the biggest return on investment.”
