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Green Giant

16 February 2012 | Anita Boniface

The NHS is taking strides to promote sustainable practice among suppliers and staff – and with its vast purchasing power, any changes it makes 
could have a significant impact, says Anita Boniface.

Effective procurement 
helps the NHS save lives, while ineffective purchasing can have a potentially damaging effect.

Examples of unethical practices that infringe on human rights and high carbon emissions have been linked to NHS supply chains. For example, attention has been drawn in the past to an area in northern Pakistan that makes a proportion of the world’s surgical instruments after it was discovered children as young as seven make them. Long hours of work deny them an education, lead to illness and jeopardise supply chain stability. And the NHS generates huge amounts of waste, including 
18 million tonnes of CO2 emissions a year, 
59 per cent of which is attributed to procurement.

As a result, purchasing teams are increasingly asked to ensure their decisions reduce environmental and social risks and promote sustainable practice among suppliers and staff. But this is no mean feat. The NHS is a massive organisation and staff are already targeted to meet a variety of demands. Buyers may feel they have enough to do without tackling sustainability as well.

However, the vast purchasing power that is the NHS (it spends more than £30 billion a year on goods and services) means any changes it makes could make a significant impact. Not only that, but regulatory moves mean there is a requirement to do something about it.

Overcoming challenges

The Climate Change Act 2008 is the main statutory duty influencing sustainable procurement. It requires every UK organisation to reduce carbon emissions by 80 per cent by 2050. And within the NHS, the Sustainable Development Unit (SDU) has devised a ‘Sustainable development management plan’ and is encouraging senior managers to lead the changes. So far, 74 per cent of trusts have signed up to this at board level. SDU’s Karl Heidel says this means sustainable procurement practices receive crucial focus from senior staff.

However, procurement teams are often juggling management targets against the needs of clinicians and it can be difficult to embed sustainable practices without demand from doctors and nurses or sufficient remit to influence them.

Furthermore, doubts exist suggesting sustainable practice is actually at odds with good patient care. One procurement manager from a north of England trust said she rarely has sufficient professional remit to influence clinician’s decisions. She questioned the compatibility between quality and sustainable development, with efficiency targets often taking priority.

The Medical Fair and Ethical Trade Group at the British Medical Association (BMA) has examined the compatibility of sustainability, quality and cost in supply chain practices. BMA senior research officer Stephanie Ashmore says: “Fair and ethical trade does not have to be more expensive and often leads to improvements in quality as well as increased efficiency in supply chains. There is a growing body of evidence that providing decent working conditions can lead to increased productivity and improvements in the quality of products by boosting workforce morale and better worker retention.” 

Over the past 10 years, private sector companies that initially looked to manage reputational risk have started to realise that ethical trade makes economic sense.

NHS Supply Chain – the health service’s major supplier, operated by DHL on behalf of the NHS Business Services Authority – accepts the business case for sustainable procurement. As a private company responsible for the sourcing, delivery and supply of healthcare products to more than 1,000 NHS trusts and healthcare organisations, NHS Supply Chain has a huge role to play in influencing good practice. Sustainable procurement manager Stephanie Proctor’s role involves working with buyers to embed sustainability into internal procurement processes, as well as externally. “It is hugely important that the sustainability team works collaboratively with our colleagues in developing sustainable solutions,” she says.

To extend awareness outside the organisation, NHS Supply Chain has a Supplier Code of Conduct that requires businesses to adhere to ethical and environmental standards.

A similar principle is followed by NHS Scotland, where National Procurement’s (NP) Supplier Code of Conduct asks providers to adhere to environmental and social requirements, such as environmentally friendly technology and the prevention of child labour. Using the Sustainable Procurement Flexible Framework, a self-assessment tool developed by the business-led Sustainable Procurement Task Force, helps NP achieve its objectives. The framework includes guidance on how to engage with external suppliers, as well as work internally. It recommends identifying senior level champion(s) within trusts, who promote sustainable procurement throughout the organisation. These champions are responsible for making sure staff are adequately trained, understand the benefits and can support ethical procurement activities.

Getting staff on side

The need for building awareness among staff so procurement teams receive support for their efforts to purchases sustainably is recognised by SDU author June Lancaster. Her resource, 5 to Survive, identifies ways that NHS professional groups such as HR, finance, facilities, doctors and nurses can get involved in sustainable practices that impact procurement. The resource features a “buy, procure, commission, use better” section for each group. Junior doctors, for example, are encouraged to question whether they really need to prescribe a drug and the best way to administer it.

“The users of the product must, and in many organisations are, involved in the procurement process,” says Lancaster. “Understanding what is needed to deliver a good and safe service to 
patients and using the expertise of procurement professionals, ensures fit-for-purpose resources and can mean resources that are sustainably produced and used in practice.”

The importance of encouraging staff to embrace sustainability is emphasised by Sheffield Children’s Hospital pediatrician, Dr Natasha de Vere. In her opinion, medical staff should be encouraged to think before they open a product. Items that used to be reused, such as laryngoscopes, are now disposed of without any recycling via sterilisation – and are often thrown away even if they are not used. De Vere says: “An improvement would be to encourage people to put used equipment in the right bins and increase the number and accessibility of recycling bins.”

Concerns about unnecessary waste are echoed by David Lawson, director of procurement at Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust. He says: “The key message for me regarding sustainability is that the most wasteful thing any organisation can do is to buy a product and then not use it and ultimately throw it away.”

He believes the answer lies with small, awareness- raising choices. His trusts have switched to an examination glove made from thinner material, which results in a smaller carbon footprint while delivering a 30 per cent+ cost saving. King’s College has also switched from disposable sharps bins to reusable ones, which cut waste disposal volumes and cost. And both hospitals have introduced paper produced from 100 per cent recycled content. Ongoing inflationary pressure on chlorine raw material cost means that this product is now cheaper than normal white (chlorine treated) paper.

NHS Supply Chain is planning to launch a 
green flag logo to highlight products in its catalogue that meet Government Buying Standards. Proctor believes this will make it easy for procurement customers to identify these products and make an informed choice.

Renata Towlson, senior buyer at Nottingham University Hospitals Trust, believes procurement staff can encourage organisations to behave more sustainably by managing demand. Her team discourages staff from ordering portable heaters, instead asking them to follow the trust’s Q-Active programme to keep warm, active and alert at work. In a trust of 33,000 staff, she says such demand management makes a big difference to its carbon footprint and expenditure.

Small but significant changes that make gradual improvements are important, according to Mahmood Bhutta, co-founder of the Medical Fair and Ethical Trade Group at the BMA and a specialist registrar at John Radcliffe hospital.

Bhutta says: “Implementing lasting, systematic change takes a long time, as the private sector has found. It starts with empowering people across the NHS to do little things that raise awareness and amount to making a difference.”

That the NHS is vast and complex, with extensive supply chains, creates huge challenges for procurement teams striving to implement sustainable practice. Success is largely dependent on demand from those directly involved in patient care. This takes understanding, awareness and buy-in from staff across the organisation. It starts with internal, cultural change within the trust so that sustainable practices are valued close to home.

By encouraging staff to embrace an ethical, sustainable approach, procurement teams can be pivotal in spreading good practice across the NHS. Small steps can collectively amount to lasting change that will influence the wider market in the years to come.

5 steps 
to change

How to encourage colleagues outside procurement to understand the value of sustainable products and services :

1. Help staff understand the business case

2. Help staff understand the ethical case

3. Communicate the benefits

4. Discourage excessive use and unnecessary waste

5. Encourage small, simple changes 
in behaviour

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☛ Anita Boniface is a freelance journalist

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