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With the unrelenting focus on the need to mitigate climate change, it was surely only a matter of time before the carbon reduction bandwagon reached the National Health Service.

The NHS has a carbon footprint of 18 million tonnes of carbon dioxide per year, representing 25 per cent of public sector emissions in England and 3.2 per cent of all the nation's carbon.

However, that did not mean that the sector's communicators were necessarily ready for the challenge.

How else can one interpret the furore in January after the Guardian reported that a new green NHS strategy was going to take meat off hospital menus.

It was almost like the famous 'British sausage' campaign that secured Jim Hacker the Prime Minister's job in the classic final 'Yes Minister' episode but at least he didn't have to deal with the Internet.

The story in the Guardian prompted 166 comments on its website and a 'clarification' from David Pencheon, director of the NHS Sustainable Development Unit (SDU).

MEAT REMAINS

'There are absolutely no plans to completely remove meat from NHS menus,' he insisted, adding that to suggest otherwise represented a 'wilful misreading' of the National Health Service's 'Saving Carbon, Improving Health' strategy document.

Despite the NHS being the largest procurer of food in Europe, the SDU says the organisation spends only £10m a year - 0.01 per cent of the NHS budget - on meat and poultry, while meat accounts for just two per cent of the NHS carbon footprint.

'The strategy, in line with best practice in sustainable sourcing, calls for more use of seasonal food, more local food, and more use of sustainable and nutritionally valuable produce such as fish,' the clarification continued.

'Doing this, will of course, reduce the reliance on meat and other products but will not remove them from the menu.'

So that's alright then. Fewer British sausages, but not quite their extinction in NHS canteens. The nation can relax again.

Or can it? The Government's carbon emission emissaries, such as The Carbon Trust, the not-for-profit organisation devoted to spreading the carbon neutral message, have never sought to hide the fact that carbon reduction has to make major inroads into the lives of UK citizens if it is going to deliver the improvements the issue needs.

'Saving Carbon, Improving Health' suggests that the National Health Service reduce its carbon emissions by 10 per cent by 2015 - five years before the first national carbon reduction target set out in last year's Climate Change Act comes into force.

Announcing the initiative, NHS chief executive David Nicholson and Care Services Minister Phil Hope said the health service also aims to at least meet legally-binding Government targets to reduce carbon emissions by 80 per cent by 2050.

The magnitude of achieving such a task will be clear to anyone who has ever set foot in a UK hospital.

The NHS is the largest employer in the UK and the third largest in the world, while statistics unearthed by the Ethical and Green Blog claim that the organisation actually has one million patient contacts every 36 hours.

However, 'Saving Carbon, Improving Health' sets ambitious goals, from tough carbon-cutting targets to encouraging staff to walk and cycle to work.

WALK ON WATER

It recommends NHS organisations to avoid buying bottle water, to promote the use of audio, video and web conferencing technology and conduct reviews of the need for staff, patients and visitors to travel. It requires all NHS organisations to set up a sustainable development management plan at board level.

And it says that carbon reduction targets should replace energy reduction targets, while sustainability and carbon governance will be a responsibility for all chief executive and director-level posts.

So how easy will it be for the health service's first carbon reduction strategy to succeed in its mission?

Sceptics reply that the NHS is so large and fragmented that it is not easy for it to achieve anything comprehensively with speed. And the NHS does have an enormous carbon footprint.

Based on its 2004 carbon emissions figures, if the NHS was a country it would have been ranked as the 81st biggest polluter that year, between Estonia and Bahrain.

Moreover, the health service's carbon footprint has increased by more than 40 per cent since 1990 and the organisation expects that it will have risen again since 2004.

Without action on carbon emissions, the 'Savings Carbon, Improving health' report warns that the figure could rise to 55 per cent by 2020. 'Stabilisation alone,' it says, 'will be a massive challenge'.

However, the NHS's carbon reduction efforts have not just started. Indeed, the Carbon Trust began its carbon management programme with the NHS back in October 2006, working with selected NHS trusts to assess their carbon footprints and develop a strategy to dramatically reduce them over five to ten years.

Ten NHS Trusts took part in the first phase, with another 20, including trusts in Birmingham, Manchester, Cornwall and Norfolk, joining the second phase in May 2007.

They identified annual savings of more than £14m and 125,000 tonnes of carbon dioxide; a further 18 trusts joined the third phase last May, pledging to cut their collective carbon footprints by 60,000 tonnes.

A HUGE UNDERTAKING

The problem is the immensity of the task. There are more than 100 NHS foundation trusts in England alone. Then there are acute, ambulance, care, primary care, mental health trusts as well as strategic and special health authorities. These employ not only nurses, doctors, pharmacists, midwives and health visitors but also physiotherapists, radiographers, podiatrists, speech therapists, counsellors, occupational therapists, psychologists and healthcare scientists. Then there are all the receptionists, porters, cleaners, information technology specialists, managers, engineers, caterers and domestic and security staff.

Richard Rugg, head of public sector at the Carbon Trust, points out that the 'Savings Carbon, Improving Health' document stops short of advocating that the NHS goes carbon-neutral.

The document itself also has no teeth, as it is merely a recommendation to NHS authorities and trusts that these are the sorts of issues that they should address.

It is up to each NHS trust and strategic health authority, he says, to decide on whether to adopt the recommendations. However, he warns that NHS bodies that do not take action on carbon emissions may be caught by existing and incoming legislation that does contain penalty mechanisms.

In particular, the European Union's Emissions Trading Scheme, which is already in place, requires heavy energy users, which will include some hospital incinerators, to buy carbon credits if they do not bring emissions down to certain levels.

CARBON SAVINGS LEADS TO COST SAVINGS

The UK's new Carbon Reduction Commitment legislation, which comes into force next year and affects medium-level energy users, will work in much the same way with mid-level energy users, which will include a lot of NHS trusts, he says.

However, the potential benefits to the cash-strapped service are also clear. Tom Cumberlege, public sector manager at the Carbon Trust, says: 'The NHS in England currently emits approximately 3.7 million tonnes of carbon dioxide every year from its buildings alone. Improving carbon management will also enable the sector reduce the £400m energy bill it faces each year, releasing important funds that can be better used elsewhere.'

Indeed, the Ethical and Green Blog reckons that a 15 per cent reduction in energy consumption at the NHS roughly equates to the cost of 7,000 heart bypass operations.

So what is involved in reducing emissions from the NHS and how achievable is the target? The NGS Sustainable Development Unit has calculated that 22 per cent of the organisation's emissions are from buildings, with 18 per cent from transport and the remainder from procurement, including drugs, medical equipment and food, which accounts for only two per cent of the total.

Therefore, it argues that longer-term measures to reduce the need for people to travel to big acute hospitals for out-patient care by providing more care in the community facilities will produce a better patient experience, whilst reducing travel, resulting in lower energy needs for hospitals and improved sustainability.

However, it stresses there are limits to the sustainability agenda and that there is no suggestion that out-patient wards or any other part of the NHS will be closed purely because of sustainability issues.

In terms of the shorter-term detail, Cumberlege says the Carbon Trust's NHS carbon management programme is designed specifically for NHS trusts, providing staff with support and guidance to integrate good carbon management into their organisation's infrastructure and day-to-day operations at all levels.

A COMMITMENT

He says the initiative requires significant commitment from NHS Trusts that wish to apply and is most suitable for mid to large hospitals. The Carbon Trust's initial assessment, advice and support, analysis and training are all free of charge, but NHS trust project leaders are required to devote at least two days a week to the programme's implementation during its ten month duration, while capital investment may also be needed to replace infrastructure with more energy efficient models.

Two years ago, Guy's and St Thomas' NHS Foundation Trust had an energy bill approaching £10m and annual emissions of more than 67,000 tonnes of carbon dioxide. However, after working with the Carbon Trust the trust identified measures, such as the installation of boiler controls and upgrading the hospital's heating and ventilation systems, that could reduce emissions by as much as one fifth and potentially save £2.95m a year.

ENERGY AND TRANSPORT CHANGES

Similarly, Hull and East Yorkshire Hospitals NHS Trust, which employs 7,000 staff, spends £3.7m a year on energy and emits more than 26,500 tonnes of carbon dioxide. The Carbon Trust suggested installing more efficient heating and hot water services and automatic external doors, improving pipe work insulation, replacing boilers and providing automatic controls to switch off lighting when it is not required.

As a result, the trust aims to reduce its energy and transport carbon emissions by 15 per cent over five years.

'Developing the carbon management programme has focused our attention on what we can achieve at the trust,' says communications manager Miles Howell. 'It marks the beginning of a long journey to becoming a sustainable organisation.'

So what do such initiatives demand of NHS communicators? Lorraine Hesketh, communications manager at the Wrightington, Wigan and Leigh NHS Trust in Lancashire, says there is a huge internal communications job to do among its 4,300 staff, which the trust does through regular newsletters and campaigns.

'We have put up a lot of posters, telling people how many beds we can fund if everyone remembers to turn lights off,' she says. 'We use the slogan You have the power on a logo with a world with a hand on it and we have run quizzes and competitions.'

Interestingly, while such initiatives might appear to be the preserve of internal communications, Hesketh points out that, with 300,000 people visiting the trust's out-patients departments and 100,000 going through accident and emergency every year, the trust's hospital walls reach a much bigger audience than any of the local newspapers.

'We're now looking at doing podcasts and vodcasts about carbon management,' she adds. 'We want to communicate what we're doing on every level.'

The trust expects to reduce its carbon dioxide emissions by 4,000 tonnes, thanks to measures implemented so far, with the help of the Carbon Trust. Energy cost savings of £380,000 are expected over the same period.

But these are tiny figures against the overall picture and there are many barriers in the way of the NHS achieving its grand vision.

An NHS Confederation poll last year found that 40 per cent of NHS managers surveyed had not yet begun to develop plans to reduce carbon emissions in the health service.

Martin Leaver, partner at Oxford Health PR, a specialist public relations agency that provides communications services for the NHS in southern and south-west England, says: 'It's very much early days for the NHS in terms of going green. Trusts are digesting the new 'Saving Carbon, Improving Health' strategy and what it means for them. But competing priorities with tougher sticks behind them are likely to continue to preoccupy NHS organisations more than 'going green' - at least in the short-term.'

The Carbon Trust's Rugg, however, believes that the NHS can meet the new targets. 'With the right policies in place, the right investment in energy efficiency and the right cultural acceptance of the need to do something about climate change, I think it's definitely possible,' he says. 'Everyone has just got to understand that saving carbon in the NHS means saving money and delivering much better healthcare.'  

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