There are a great many interventions that may improve upon the cost, environmental and social effectiveness of the NHS, Public Health and Social Care system. This is a brief introduction and glossary to those that we are currently evaluating or seeking to evaluate further.
Building and Energy Interventions
| 1 degree C | Review heating set points and reduce by 1 degree Celsius wherever possible. |
| Biomass Boiler | Replacement of fossil fuel boiler with one fired by biomass. The nature of the biomass (primary material or waste) and the source of supply should also be taken into account |
| Boiler replacement/optimisation | Boiler replacement and/or measures to improve boiler efficiency |
| Building Management System optimisation | A BMS is a computer-based control system that allows energy-using services to be centrally managed, notably heating, ventilation and air conditioning (HVAC) and sometimes lighting.
When improperly maintained or configured these are clearly less effective than their potential and may even be worse than not being implemented at all. |
| CHP installation | Installation of a Combined heat and power (CHP) system that simultaneously generates usable heat and power (usually electricity) through a single process. |
| Decentralisation of hot water boilers | Replacement of large, centralised boiler plant (typically steam) with a number of smaller, more efficient localised condensing boilers. |
| Energy Awareness Campaign | Staff energy awareness campaigns that target areas of energy wastage (e.g. encourage switch off lighting and equipment when not in use). For example: TLC originated at Barts NHS Health Trust in London and can contribute not only energy savings but also better patient outcomes through less disturbed sleep and otherwise reduced stress environments |
| Energy efficient lighting | Use of energy saving lighting technology (e.g. high frequency lighting, LED lighting, low energy lighting) |
| Energy Performance Contracting | Energy Performance Contracting |
| Green spaces | Green spaces reduce urban heat island effects during heatwaves, provide a flood defence during heavy rain fall and provide health benefits from exercise and wellbeing |
| Improve Heating controls | Improving a building or site’s heating controls (e.g. fitting of thermostatic radiator valves (TRVs) to radiators, installing PIR occupancy sensors and other automatic timing controls, and upgrading room thermostats). |
| Improve Insulation to pipe work, and/in boiler house | Insulating pipe work to the standards set out in BS 5422 (2001) on both heated and cooled pipe work and surfaces (including valves, flanges etc). |
| Improve lighting controls | Use of lighting controls to reduce lighting in areas that do not need to be fully lit at all times (e.g. passive infrared sensors, photoelectric/ dimming controls, zonal switching) |
| Chiller Efficiency | Implementation of measures that will operate a chiller at peak performance can save energy as well as maintenance costs (e.g. keeping condenser and evaporator tubes clean, pre-treating condensing water, fitting variable speed drives to chiller motors, modernising chiller control systems and possibly even replacing older plant) |
| Improve the efficiency of steam plant or hot water boiler plant | Opportunities to improve boiler efficiency for district heating systems (e.g. boiler or burner replacement, heat recovery systems like stack economisers, flash steam or condensate recovery, improving controls like applying TDS blowdown on steam boilers. |
| Install high efficiency lighting and intelligent lighting controls | Use of energy saving lighting technology (e.g. high frequency lighting, LED lighting, low energy lighting) and of lighting controls to reduce lighting in areas that do not need to be fully lit at all times (e.g. passive infrared sensors, photoelectric/dimming controls, zonal switching) |
| Insulation – window glazing and draught proofing | Improving the U-value of external windows by replacement and implementing draught proofing measures, based on the U-values determined by the 2006 Building Regulations. |
| Photovoltaic | Hospital buildings, with their abundant roof spaces, are best placed to benefit from Solar PV’s. These help businesses to manage their electricity costs while reducing their carbon emissions, and will provide a choice about where you obtain your power. |
| Roof insulation | Replacing or installing insulation to loft or roof spaces, based on the U-values determined by the 2006 Building Regulations. |
| Solar Hot Water | Installation of a Solar Hot Water system. |
| Upgrade garage and workshop heating | Make improvements to the heating of the garages and workshops used for the ambulances. |
| Variable Speed Drives | Installation of VSDs to fan and pump motors.
By implementing this technology a close match may be achieved between the motor speed and the output requirements |
| Voltage optimisation | Voltage optimisation (also known as ‘voltage correction’) to eliminate the discrepancy between supply voltage and the optimum voltage needed by electrical equipment and reduce energy losses. |
| Wall insulation | Replacing or installing insulation to external walls, based on the U-values determined by the 2006 Building Regulations. |
| Wind turbine | Installation of a stand alone wind turbine. |
Care Models
| Babies born at home (or midwife led unit) (Simon Says) | Babies born in hospital are more likely to receive more intensive treatment at greater cost and with higher associated carbon emissions. Midwife led births at home or in community settings often have better outcomes and reduced resource use. |
| Capitated whole health budget | Commissioning under a delegated capitated budget providing accountability for the whole health needs of a registered list of patients e.g. using Accountable Care Organisations (from Simon Says) |
| Care delivered locally | Care delivered locally (care closer to home in Simon Says phraseology) reduce travel, increase community resilience e.g. chemotherapy or end of life |
| Co-production of mental health services | Co-production of mental health services e.g. Lambeth case study |
| Commissioning for outcomes | Focusing on delivering efficient and effective treatment through both traditional health and care provision and lower carbon alternatives could create a shift to improved health with a lower carbon footprint. |
| Empowering communities through first responder, dementia friendly communities, flood and heat planning etc. | Building social assets reduces dependence on carbon and cost intensive treatment through hospitals and A&E admissions. Examples include both ongoing support such as dementia friendly communities and also planning support during unusual events such as flooding or heatwaves. |
| Over prescribing of antibiotics with resource/carbon and health benefits | Antimicrobial resistance is a major threat to health and is being created through the over use of antibiotics. Reducing ineffective use of antibiotics will in turn reduce costs, pollution and carbon emissions. |
| Prescribing walks for depression (demedicalisation of care) | Physical activity has been found to reduce depressive symptoms, walking can be easily undertaken by most people, fits into our daily schedules, is low-cost and comes with little risk of adverse effects. Reducing dependence on pharmaceutical products will also reduce raw material use, costs and carbon emissions. |
| QIPP interventions evaluation (old/new) | Reducing length of stay and improving the effectiveness of treatment can reduce dependence on high intensity treatments. |
| Reduce drug wastage | NHS England has identified £300 million in savings on pharmaceuticals through a range of measures including a shift to lower cost drugs and reducing wasted prescriptions. Reducing over prescribing saves money, reduces use of resources and carbon emissions. |
Procurement
| Anaesthetic gases | Reducing carbon intensity of anaesthetic gas use (including nitrous oxide) e.g. reduced flow rates and reliance on nitrous oxide or nitrous oxide scrubbing technology |
| Decarbonising drugs | Pharmaceutical products are used extensively in the NHS, innovation is already being used to reduce the carbon emissions of producing drugs. |
| General Waste reduction & recycling | With increasing waste costs recycling saves money and reduces carbon emissions. |
| Healthy sustainable food | Reductions of red meat have proven improvements to health as well as providing significant savings both to costs and the carbon footprint of their production. |
| Innovation in pharmaceuticals and medical instruments | procurement and product switching / innovation in pharmaceuticals and medical instruments |
| Medicines waste | Medicines waste comes in several forms including over-prescribing in acute settings, when trying a patient on a new medication and from repeat prescription requests as well as patient non-compliance. |
| Packaging | Reducing the volume and materials used for packaging through innovative design and streamlining processes can reduce raw material use as well as disposal costs. |
| PVC health impacts (+/- mercury) | Production of products with PVC (polyvinyl chloride plastics) uses chemicals which are harmful to human and animal health. These chemicals are leached into the water both during production and use. Reducing use of products made with PVC by reducing need, switching products or innovative health and care provision can reduce this environmental impact. |
| Reducing propellant | Prescribing treatment for asthma without propellant inhalers (MDI with HFC vs dry powder inhaler) |
| Refurbished product procurement | Seeking suppliers of refurbished products instead of brand new items can extend the life of those items avoiding the raw material and energy incurred in new production and costs of waste disposal. |
| Single use items including ethical procurement | Medical instruments are often produced through global supply chains where basic employment rights are not maintained. Poor working conditions and child labour have been documented in the manufacture of several NHS-procured medical products. Increasing the use of multi-use items through appropriate kit contents, sterilisation, reprocessing and innovation can reduce carbon emissions, costs and ethical impacts. |
| Smart Prescribing | Reducing routine overprescribing of drugs e.g. Pharmacy prescribing, Depot prescribing |
| Sustainable food | Food production produces greenhouse gases both through land use change and fertiliser use. Transportation and processing adds to the carbon emissions of food. Local, sustainable, low-meat diets have been shown to improve health as well as decrease carbon emissions. Hospitals, care homes and office environments often provide food or sell food to service users and staff. Providing sustainable, low carbon food reduces carbon emissions and improves health. |
| Theatre kits in hospitals – reducing packaging | Theatre kits can be optimised to include the instruments needed, this can reduced cost, resource use, improve theatre efficiency and reduce carbon emissions. |
| Toxicity of drugs | Pharmaceutical products released into water or air cause pollution both during use and disposal of waste. Reducing over prescribing also reduces production emissions. |
General
| Ecotherapy | Ecominds ecotherapy improving wellbeing, reducing costs and improving environmental impacts |
| Excellent management of Long Term Conditions | Improving the management of Long Term Conditions reduces the need for acute care and improves patient experience. One example is home dialysis, where patients are able to use dialysis machines in their own home rather than travelling to services many times per week. |
| Introduce hibernation system for stations | Hibernation systems shut down all computer systems to save energy when not in use. |
| Home insulation | Home insulation to reduce fuel poverty with benefits for health and environment |
| Hospital environment recovery rates | Recovery rates improving if you can see a tree, be on the shady side of a hospital in hot weather etc. Torquay |
| Living wage across health and social care system to reduce inequalities | Inequalities in income and opportunties are correlated with poor health outcomes and reduced life expectancy. Inequalities can be reduced through organisations chosing to pay a living wage. The health and care sector includes some of the lowest paid staff and employs over 1.4 million people. Employment practices for the health and care sector could reduce inequalities and improve health. |
| Office electrical equipment improvements | Measures to reduce the impact of IT and office equipment (e.g. Enable energy saving features, purchase equipment with the Energy Star logo). |
| Paper use in organisations | UK government is moving towards greater access to services through digital by default. The health and care sector can also improve services through adopting technologies which reduce dependence on paper. Paper and paper pulp products rely on large areas of land used for forestry, processing and transportation of wood, pulp and paper. Reducing paper use, particularly from virgin material decreases use of resources and carbon emissions. |
| Reducing reliance on acute healthcare | Public health and community programmes Reducing reliance on acute healthcare |
| Smoking cessation | Smoking cessation services using techology to improve quit rates. |
| Supporting vulnerable people | Vulnerable people register for community resilience |
| Teleconferencing | The NHS, public health and social care system employs over 1.4 million staff working across the country. Teleconferencing can reduce the need to travel to meetings, saving time, money and carbon emissions. |
| Telehealth/Telecare | Telehealth/Telecare whole system demonstrator with environmental/social included |
Travel
| Active travel | Active travel e.g. for staff and visitors with reduced air pollution and increased exercise and health |
| Cycling to work for staff | Staff cycle to work schemes increase physical activity and decrease carbon emissions. Health improvements through physical activity outweigh increased accidents and respiritory disease from air pollution. |
| Electric Vehicles | Electric vehicles produce less air pollution and decrease carbon emissions with decarbonisation of the electricity grid.
Conventional diesel or petrol vehicles used within the hospital fleets to be replaced with electric vehicles and used for all journeys under 25 miles. |
| Flat mileage rate | Introduction of a flat mileage rate for all business miles across the NHS, this would encourage low cost options such as cycling, walking and public transport while also encouraging cars with lower fuel consumption. |
| Travel Planning | Improving access to services through improved local planning arrangements including public transport, pedestrian and cycle routes as well as campaigns to reduce vehicles engines running outside hospitals reduces air pollution and carbon emissions |