Creating a Green Plan: supporting the NHS with their transition to net zero

 As England moves towards the establishment of Integrated Care Systems (ICSs) later in 2022, opportunities are emerging for NHS organisations to collaborate more closely on system-wide challenges that can have a substantial, but indirect effect on health and wellbeing, such as climate change. 

Studies estimate that only 20% of a person's health outcomes are attributed to access to good quality healthcare, with the social, behavioural, and environmental determinants of health (such as housing, air pollution, employment, and education) often having more important and triggering effects on an individual’s health and wellbeing over time. Climate change poses an increasing threat, with poor environmental health contributing to major diseases including cardiac disease, asthma, and cancer. 

Broader population health management is required to reduce health inequalities across localities and address the wider determinants of health. ICSs plan to do exactly that – to integrate and coordinate services to meet the health and care needs of their respective populations.  

A key aspect of this work includes meeting the NHS’s ambition to be the world’s first net-zero national health service. To achieve this, each ICS is first putting forward a ‘green plan’ detailing how they will reduce emissions across their geography to support the NHS’s national agenda. Global Counsel has recently completed work to support the production of the Green Plan for Bedfordshire, Luton and Milton Keynes ICS.  

The essence of strategic planning in ICSs

Global Counsel’s support focused on three areas of activity, which underpinned the development of a clear Green Plan. 

1. Benchmarking and stakeholder engagement

The first step in producing a coherent and robust Green Plan is to understand the respective priorities and progress to date of the various partners that sit within the ICS. These priorities can, understandably, vary depending on the type of organisation. For example, ambulance trusts should be concerned with reducing the carbon footprint of their fleet, whereas hospital trusts may focus on anything from reducing energy use to improving the quality of green spaces available on their sites. Rigorous stakeholder engagement is the first step to develop a comprehensive analysis of the predominant issues and initiatives taken across the ICS, allowing for a tailored green plan that effectively synthesises, aligns, and strengthens the area’s overall response. 

2. Concise multi-sectoral analysis

For the NHS to fully transition towards net zero, an integrated process of transformation needs to encompass all areas of activity, including transport, facilities, workforce, delivery of care, medicines, supply chain, digital uptake, and food and nutrition.  

Reviewing the relative progress and commitments that each partner has made across the range of themes set by the NHS, is essential to first identifying gaps in implementation across the ICSs that need to be addressed in the green plans. This includes finding answers to questions such as what are the strategies that are being taken to train staff on sustainability or what commitments have been made within the supply chain to reduce waste?  

However, on a deeper level, stakeholder engagement and multi-sectoral analysis is about finding common issues that would benefit from collaboration and ensuring that those synergies are taking advantage of to build a more integrated and comprehensive approach to health and wellbeing.  

For example, in our work, we found that having integrated strategies to insulate buildings (first output) across council and hospital estates is crucial to reducing exposure to air pollution (second output) which can subsequently help reduce admissions for asthma attacks in hospitals (third output). Councils and hospitals can collaborate through the ICSs to coordinate efforts for better insulation in buildings, and in the process reduce both emissions and provide better care for the population. 

Green plans should provide a common platform for that collaboration to occur - identifying co-benefits, setting priority targets and actions and, as result, building a system-wide consensus that allows ICS partners to take a collective approach to care. 

3. Setting a clear trajectory for progress  

Finally, setting tangible targets over the three years encompassing the green plan is essential to ensure a progressive transition towards net zero is achieved. A key part of this is identifying which metrics can be used to monitor relative progress. For example, these can include monitoring water and energy consumption in facilities or publishing annual KPIs on digitisation.  

However, finding the right balance between setting tangible targets and allowing for diversity in actions is essential to ensure that each member is given flexibility on how to meet their own distinct needs and respond to emerging issues that may not have been a part of the initial green plan. 

How can Global Counsel support your ICS?  

Global Counsel brings together health, environmental sustainability and government policy knowledge into a unique blend of expertise, which means that as a strategic advisory business we are well equipped to tackle the multidisciplinary issues ICSs face as they set strategic plans. Whether that is helping to build and implement a green plan or assisting with the digital transformation agenda. 

Global Counsel has been monitoring changes in the NHS and the broader health care sector since its creation in 2011. We provide crucial insight into the dynamics of the NHS and the evolution of system reforms, including the transition to ICSs.