A healthier environment

As energy bills rise the need to cut carbon emissions has become synonymous with the imperative for all businesses to cut their costs, not least, the NHS, Scotland’s largest employer.

In every community there are large hospitals, health centres and other community services where action needs to be taken to cut fuel bills and reduce the overall burden on the country’s overall greenhouse gas emissions.

In total, £15m of projects are under way across NHS Scotland, including the installation of greener biomass boilers, wind turbines, more efficient boilers and other measures as the sector aims to cut CO2 from oil, gas, butane and propane use by 3 per cent a year - and cut energy use overall by 1 per cent annually.

In the last financial year, the sector, which includes all health boards, the National Waiting Times Centre and the State Hospital, produced 206,436 tonnes of CO2 - above the target of 202,083 tonnes.

At the SNP conference last month, Health Secretary Alex Neil confirmed that £24m of funding was being spent between now and 2015 on ‘eco hospitals’.

The projects are expected to reduce greenhouse gases across NHS Scotland by 10 per cent and will save £4m in energy costs each year.

Schemes include a £1.3m district heating scheme at Queen Margaret Hospital in Fife and installations of wind turbines in NHS Shetland.

At Raigmore Hospital in Inverness, a 3.2MW steam biomass boiler, costing £2.1m, is expected to cut emissions by nearly 25 per cent for NHS Highland.

The steam is not just used for the heating, but for the sterilisation, laundry and kitchens and is just one way the health board is trying to become more environmentally friendly.

NHS Highland has four of its community hospitals converted to biomass already, dating back to the first at Fort William in 2006, and is looking to complete another seven in the next six months, switching from the far more expensive oil that it has had to rely on in the past. In addition, the board is in the process of installing more efficient LED lighting.

Head of Estates, Eric Green, said the impetus to cut fuel and energy costs was both for economical and environmental reasons. He said: “We’re lucky to live in a pristine environment, some of the most scenic and beautiful parts of Scotland. Obviously looking after the environment is something everybody needs to take a bit more seriously than they’ve done in the past. 

“From a financial viewpoint - a lot of boards in the central belt have had the opportunity to switch to mains gas, we don’t have that option in the Highlands; we’re very much dependent on the price of oil.

“The costs are crippling and energy costs have affected us disproportionately than other boards because we’re so dependent on oil.” Green says the work has been carried out as fast as funding has allowed - with the latest government grant meaning that the Raigmore project was able to go ahead sooner than it might have done.

But it has also been a gradual process, with a lot of research on how energy-efficient measures have worked in other health boards - and other industries such as the food sector, which has similar energy demands.

The board has also had a lot of help from the Carbon Trust which has given advice and pointed officials in the right direction to help them share expertise with other users.

“A hospital’s not somewhere you would experiment with new heating sources.

“Heating a health centre is important, but it’s not critical,” Green says. “But a hospital we need to be absolutely confident that the technology’s right.

“The steam biomass that we’re using is still something that’s still not widely used. I would think there’s under 30 in the whole of the UK, it’s still quite a new concept.” Alex Neil said the latest announcements are part of wider actions to make NHS Scotland more eco friendly, which has also included better procurement strategies to reduce the number of road journeys and green travel plans for staff at NHS boards such as Tayside.

He said: “The £4 million that will be saved each year through this scheme will be reinvested directly into front-line patient care, ensuring patients across Scotland continue to receive the best possible care and treatment.” But energy efficiency in NHS buildings is only one part of greening the healthcare sector.

Research on the overall health carbon footprint, from the Sustainable Development Unit - part of the NHS in England, estimates that the emissions from buildings and energy use accounts for only one fifth of the total - the majority coming from the pharmaceuticals and production of medical equipment that the sector is so reliant on.

At each step of the chain there is a build up of carbon emissions - the production of drugs and health-grade plastics, for example, their distribution by global companies and incineration after they have been used.

Frances Mortimer, Medical Director of the Centre for Sustainable Healthcare, said: “The NHS is a service industry and not doing a lot of high-energy manufacturing on site. It means the bulk of its carbon footprint is in the supply chain.

“A focus on how we can make the buildings more energy efficient is a good first step, but that can’t possibly be the full answer.” Mortimer, says there are four ways that public health can become greener. The first is more emphasis on preventative care, just as it is seen as a way of reducing the need for costly treatment further down the line, so that translates into less carbon production.

“Essentially, carbon can be viewed as like a different currency. Whenever we spend money, we’re also drawing other sorts of resources through the system resulting in climate change. We need to look at where we’re doing things that don’t need to be done, otherwise the scale of the challenge is too great to completely move all of our energy production to being carbon neutral in the timescale.” Improving patient self-care, enabling them to take their own blood pressure, for example, or give them a better understanding of conditions, can lead to more efficient use of resources, as can designing leaner systems for care - making the system more efficient without needless repetition of appointments, referrals, and blood tests.

She also hopes that low-carbon options should be considered in the same way that the economics of a treatment are currently taken into account.

“In the same way that some treatments are equally effective, but some are more expensive than others, some are more environmentally damaging than others.

“Once we have more information about that, we can start to factor that in to make the most environmentally and cost-effective decisions.” Scotland is already pushing ahead on this side of making healthcare greener. One of the more advanced areas that the centre has looked at is in renal care and many of the case studies they have looked at are from north of the border including schemes to improve waste management in dialysis units of NHS Greater Glasgow and Clyde and Fife.

She said: “In Scotland they’ve been really proactive. The Scottish kidney units all nominated a green representative, which in England took longer to recruit, and quite a few of the case studies of good practice came out of Scotland in terms of reducing the amount of waste in dialysis and improving waste segregation so that less is incinerated and more is recycled.

“In some ways, Scotland can be a laboratory for good ideas.”