Technical Briefing

February 2011
9
Measuring Sustainable Development

Purpose Contents
Introduction 2
This is the ninth in a series of technical briefings
What can be measured? 3
produced by the Association of Public Health
Observatories, designed to support public health Who are the measures for? 6
practitioners and analysts and to promote the use of What tools are available? 6
public health intelligence in decision making. Setting goals 8
What about the bits we 8
This briefing looks at sustainable development and can’t measure directly?
carbon reduction measurement: the metrics and tools Summary 10
already available, future developments and the wider Resources 10
political and ethical context. The NHS context provides References 11
examples, but most of the principles apply to public
Glossary and abbreviations 12
sector and other institutions generally.

Further material to support the series is available at

Authors
http://www.apho.org.uk Imogen Tennison
Paul Fryers
More information about sustainable development in the Contributors
NHS, including tools to support improved
Anne Cunningham (NHS Blackburn
commissioning, procurement, leadership and with Darwen)
engagement of staff in sustainable services, is Mark Dancox
available at http://www.sdu.nhs.uk Robert Davies
Julian Flowers
Sonia Roschnik (NHS Sustainable
Development Unit)
Eric Thomas (Welsh Health Estates)
Hannah Walford
Sharon Walton
Introduction progress. As measures of sustainability other than carbon
emissions become more widely available these can be
Understanding the scale and impact of action is not integrated into reporting and monitoring.
possible without measurement, and this holds true for
sustainable development. This briefing provides a Strategic context
framework for identifying the measures that already exist
and the opportunities to include more aspects of In the UK, delivery of the Government’s sustainable
sustainability. By adopting standard measures for development strategy, ‘Securing the Future’,4 has been
sustainable development, duplication can be reduced and tasked to the public sector including all parts of central,
the scale of potential change can be quantified. Metrics can devolved,5,6,7 regional and local government as well as the
also support organisations by indicating areas for action NHS and others. High level contributions to the strategy’s
and quantifying the cost of inaction. delivery have been identified by each Government
department.
Sustainable development and health
There are 68 national sustainable development indicators8
Sustainability is defined in this document as: “Meeting our to support the ‘Securing the Future’ strategy. These
needs today without compromising the ability of others to indicators fall within four priority areas:
meet their needs tomorrow”
l Sustainable consumption and production
Figure 1 illustrates the concept of sustainable development
as the product of interaction between social, economic and l Climate change and energy
environmental activities. Acting in the interests of all three
dimensions makes progress sustainable. For example, l Natural resource protection and enhancing the
actions that are purely economically driven may have worse environment
social and environmental outcomes. The model assumes
that there are optimal choices, which can have positive l Creating sustainable communities and a fairer world
outcomes in all three aspects.
Given the link between sustainable development and health,
Figure 1: Sustainable development and the size of its contribution to the UK economy, the NHS
can help drive change by becoming a leading low carbon
and sustainable organisation. The NHS Carbon Reduction
Strategy 9 for England (CRS) sets out plans for the NHS to
Social make progress by improving sustainability in healthcare and
by reducing carbon emissions in line with legally binding
targets set out in the Climate Change Act. A strategic
approach to carbon reduction and wider action on
Sustainable sustainable development is also taking place in Scotland,
Wales, Northern Ireland and the Republic of Ireland.
Environment Economic

Box 1: Urgency of action

Adapted from Barbier E. The concept of sustainable economic Climate change is already impacting upon health;
development. Environmental Conservation 1987;14(2):101-110. however actions towards reducing emissions today could
help shape changes in future decades.10 The NHS has an
Sustainable development has clear benefits for health and urgent role to play both in resilience by adapting to the
wellbeing, for both the individual and society.1 Individuals effects of climate change and by mitigating or minimising
can benefit, for example, through better air quality and more the impact through changes to services and human
active travel. The population benefits through more efficient behaviour.
use of resources, reduction of inequalities,2 and reduction in
climate change which puts many lives at risk, now and for
generations that follow. However, many aspects are very How do we develop measures?
difficult to quantify, for example the improvement in health
and wellbeing achieved by creating cohesive communities Metrics and indicators are key to measuring progress and
and opportunities for enjoyment of green spaces. enabling action. Although, there is much that we are
currently unable to measure, new methods are evolving all
Sustainable development and carbon the time, and there are many aspects of carbon reduction
emissions that organisations can measure now. Figure 2 shows the
process by which new indicators are developed.
Carbon emissions are one aspect of sustainability where
measurement is more established. The government has set Local innovation plays a crucial role in identifying
stretching targets for carbon reduction in the UK. If the NHS opportunities and methods for organisations to contribute
is to meet the Climate Change Act 3 target of 34% reduction both to improved sustainability and ways to measure this
by 2020 this will require measurement and monitoring of improvement. As measurement develops, criteria for

2
success emerge. With many organisations trying different Table 1: Availability of process and outcome measures for
approaches comes the opportunity to identify best practice the ten categories for action
and share the learning with other organisations.
Measures available
Figure 2: Evolving new indicators and metrics into standards
and performance indicators Process Outcome

Local Criteria for Identification of Standards & Energy and carbon management 3 3
innovation success best practice performance Procurement and food 3
Low carbon travel, transport and access 3 Some
The final step in the process is to support all organisations Water 3 3
to contribute to a better future for all by establishing Waste 3 3
standards for sustainability and monitoring. Organisations Designing the built environment 3
can demonstrate achievements by meeting and exceeding Organisational and workforce development 3
minimum standards, for example through reductions in Role of partnership and networks 3
carbon emissions in line with Government targets. Governance 3
Finance 3

What can be measured?

Measuring carbon emissions is often referred to as a
The Carbon Reduction Strategy (CRS),9 published by the carbon footprint. The term can be used to refer to carbon
NHS Sustainable Development Unit, identifies Sustainable dioxide emissions alone, although it often includes other
Development as follows: greenhouse gas emissions. When other greenhouse gases
are included there is a standard calculation of how much
“The goal of sustainable development is to meet the needs of carbon dioxide would give the same global warming
today without compromising the ability of future generations potential, called the carbon dioxide equivalent. Defra
to meet their needs. Stabilising and then reducing our carbon environmental reporting guidance12 forms a framework for
emissions is key to ‘living within environmental limits’, just as organisations to report their carbon emissions in a
addressing climate change is central to a ‘healthy, just and standard way. One of the principles is to report
fair society’. Sustainable development is the framework within greenhouse gases wherever possible.
which carbon emissions will be reduced.”
Six gases – carbon dioxide (CO2), sulphur hexafluoride
Ten areas for action are identified in the Carbon Reduction (SF6), methane (CH4), nitrous oxide (N2O),
Strategy. These areas correspond closely to process hydrofluorocarbons (HFCs) and perfluorocarbons (PFCs) –
measures listed in the Good Corporate Citizenship were identified by the Kyoto protocol as the main
assessment model.11 In addition, for building energy use, greenhouse gases resulting from human activity. These
waste and water there are already outcome measures to greenhouse gases are converted into carbon dioxide
monitor the impact of action. Table 1 lists the areas identified equivalent (CO2e) for reporting the environmental impact of
in the Carbon Reduction Strategy with the type of measure an organisation. The Greenhouse Gas Protocol14 defined
currently available to measure progress. three Scopes, shown in figures 3 and 4. These Scopes

Figure 3: Forum for the Future – Scopes and greenhouse gases13

3
Figure 4: Defra Scopes with NHS organisation footprint marked

Scope 1: Direct Scope 2: Energy Indirect Scope 3: Other Indirect NHS

organisation
footprints
Fuels Combustion Purchased materials
(e.g. boilers, furnaces and fuels
or turbines) (e.g. extraction, processing
and production)

Owned Transport Transport-related

(e.g. road vehicles, trains, activities
ships, aeroplanes) (e.g. commuting, business
travel, distribution)
Consumption of
purchased electricity,
Process Emissions heat, steam and cooling Waste disposal
(e.g. cement, aluminium, (e.g. waste, recycling)
waste processing)
Leased assets,
franchising and
Fugitive Emissions outsourcing
(e.g. air conditioning
and refrigeration leaks, Sold Goods and Services
methane leaks from (e.g. use of goods
pipelines) and services)

form a useful framework for identifying how directly carbon The figures reported for the carbon impact of activities
emissions can be influenced. Defra has also provided could therefore be updated both as activities change and
some guidance on the activities which contribute to each also with improvements in measurement. Three options are
of the Scopes. Figure 4 shows the areas NHS identified here to report carbon emissions, and illustrated in
organisations can currently include in their footprint, figure 5.
shaded in pale blue.
1. Use current conversion factors into the future – pale
Local authorities have similar ranges of activities, e.g. blue line on figure 5
schools, social services, council buildings and public
transport, but also have wider influence through their Using previously agreed conversion factors means that
oversight of local planning processes. figures are known and static for previous years and do
not need to be recalculated. Having a consistent
An organisation’s carbon footprint can either measure the methodology between years also makes comparison
direct impacts only, or it can include indirect impacts as with previous years straightforward.
well. The Carbon Trust recommends that it should include
both.15 However, indirect impacts are usually more difficult However we are currently limited in which actions are
to quantify, so process measures (e.g. demonstrating a encouraged with this monitoring. Monitoring the
reduction in travel, which implies a reduction in footprint) impact of action in a balanced way across the breadth
may be more useful. Data for building energy use, waste of sustainable development will require improved
and water are already available16 nationally, including the indicators.
majority of data for Scopes 1 and 2 and some information
from Scope 3 (see figure 4). 2. Update conversion factors each year – red line

Developing measurement Correcting and updating the conversion factors each

year will help to monitor action in a more balanced
Measurement and quantification of the carbon footprint is way. Existing figures could be used for previous years
improving as research reveals the carbon impact of however the differences from previous years will reflect
different activities. Decisions on carbon reduction options the change in definition as well as action. Using an
and incentives are influenced by the conversion factors inconsistent methodology therefore removes the ability
and categories of the carbon footprint included in to compare years.
reporting. For example, monitoring and measuring the
building energy use carbon footprint will focus action on
buildings and may not encourage action on the other
76%17 of the footprint for the NHS.

4
 Figure 5: NHS England building energy use, waste and water – carbon emissions comparison 2007/08 to 2009/10

Megatonnes of carbon dioxide equivalent (Mt CO2e)

4.5

4.0

3.5

3.0
2010 Grand Total GHG energy
2.5
Updated method each year
2.0 2000 CO2 energy

1.5

1.0

0.5

0.0
2007/08 2008/09 2009/10

3. Update conversion factors retrospectively for whole “For consistent tracking of performance over time, you may
period – dark blue line need to recalculate your base year so that you can compare
your current emissions with your historic emissions.”
Recalculating previous years in addition to current year
will reflect the impact more accurately. This provides a Reporting categories
consistent methodology between years. More
information needs to be retained in order to recalculate The draft Greenhouse Gas Protocol guidance suggests 15
previous years, but much of this information is being categories for Scope 3 emissions reporting.18 Table 2 shows
kept anyway for financial monitoring. how these categories could be applied to the NHS: if
organisations adopt this structure it will ensure
Defra clearly advocates option 3 – recalculating emissions comparability and allow reporting to develop as new
for previous years:12 measures become available.

Table 2: Carbon footprinting categories for reporting measurement in the NHS

Scope Suggested emissions categories

Scope 1 Owned buildings – gas

Owned buildings – coal and oil
Scope 2 Electricity
Scope 3 Leased Assets (upstream) – gas, coal, oil and electricity
Leased Assets (downstream) – gas, coal, oil and electricity
Capital goods
Business travel – air
Business travel – road
Business travel – rail
Patient and visitor travel
Employee commute
Healthcare purchased from other providers
Pharmaceuticals
Medical instruments
Waste and water
Discretionary – additional specific categories
Other

5
Who are the measures for? Decisions which impact on the NHS’s carbon footprint are
made by all the stakeholders in the NHS. Table 3 gives
Sustainable development, in the NHS and other major possible types of measurement and shows for which
institutions, is influenced by many stakeholders (patients stakeholders the different types can currently be
and public, providers, commissioners and policy makers). measured.
Decisions by each of these stakeholders can support
sustainability, if indicators are available to inform Organisation level footprints can identify which categories
and measure the impact of their actions. The Good have greatest influence and greatest opportunities for
Indicators Guide19 identifies three key roles of reductions. The ability to monitor progress through
measurement: repeated measurement is important in keeping carbon
reduction prioritised, confirming organisations’ actions and
1. for understanding: to know how a system works and adding to the evidence base.
how it might be improved (research role)
Commissioners have a role in measuring the impact of the
2. for performance: monitoring if and how a system is services they commission. Large carbon reductions could
performing to an agreed standard be achieved by moving towards low carbon patient
(performance/managerial/improvement role) pathways, through partnership working. By comparing the
carbon footprint of providers, commissioners can select
3. for accountability: allowing us to hold ourselves up to services to provide high quality low carbon health for the
patients, the government and taxpayers and be local population.
openly scrutinised as individuals, teams and
organisations (accountability/democratic role). SHAs have supported the sharing of regional good
practice by identifying organisations which are reducing
Indicators can be selected to support each of these three their carbon footprint and providing services in a way that
roles. For example the procurement carbon footprint for increases the health and wellbeing of the population.
NHS England provides a good indication of which
categories of procurement represent the largest parts of
the footprint. The scale of the procurement carbon What tools are available?
footprint is calculated using average carbon emissions per
pound spent in each economic sector, e.g. £1 spent in Estates and Facilities Management (EFM)
2004 on pharmaceuticals had on average a carbon
footprint of 0.81 kg carbon dioxode equivalent (CO2e).20 NHS trusts’ and PCTs’ estates departments throughout
England and Wales can use the secure EFM system to
Within each economic sector there are large variations in collect and analyse data efficiently (see Glossary). Data
the carbon intensity of different products. Overall these within the EFM system comprises of ‘returns’ information
variations even out, and measurement can be assumed to (including Estates information, Fires, Cleanliness etc)
be reasonably accurate at national level. However, provided by trusts. The data goes back to 1999/2000. The
calculating the emissions resulting from procurement at analysis includes a calculation of carbon emissions for the
local level is difficult to do consistently: comparisons trust buildings.
between organisations, and over time, are less reliable.
The EFM system includes the central data collection –
Estimating carbon emissions over time from expenditure is Estates Return Information Collection (ERIC). This
also problematic: price rises do not imply increased information is used by health bodies to strategically plan
carbon emissions. Other indicators, for example estates services and by the Department of Health and
measuring the quantities of specific items purchased, devolved administrations to support policy development
provide a more accurate change in the footprint over time. and strategic investment planning.21 This return is also the

Table 3: Types of measurement and who they can currently be applied to

Decision makers

Patients Providers Commissioners Local Policy National

and Public Makers Policy Makers

Measure progress 3 3
through time

Categories for action 3 3 3 3

(see table 2)

Comparison 3 3 3 3
with others

6
main source of information for many of the carbon boards as an integral part of the process. EMS systems
footprint calculations. are also regularly audited by external assessors to ensure
compliance.
Carbon Trust footprinting tool
Figure 6: Planning cycle
22
The Carbon Trust has developed a tool to enable
organisations to calculate their carbon footprint based on
fuel usage, vehicle usage, employee travel and utility bills.
Organisations who participate in the Carbon Trust carbon
management program use this tool to baseline and Plan for
monitor their emissions. improvement
Good Corporate Citizenship assessment model (GCC)

Developed by the Sustainable Development Commission

in 2006 with funding from the Department of Health, and
later revised in 2009 in cooperation with the NHS
Sustainable Development Unit, this model helps the NHS,
other organisations and individuals to identify how they
can contribute to sustainable development.11 Review for Implement
effectiveness plan
The model includes:

l Information on some key areas for action on sustainable

development

l A self assessment test to help you understand and

Strategic Health Asset Planning and
monitor your progress with sustainable development Evaluation (SHAPE)

l Guidance on how to develop Good Corporate SHAPE has been developed by the North East Public
Citizenship in your organisation Health Observatory and the Department of Health. It is
designed to support commissioners in the strategic
l Case studies with inspirational ideas on new things you planning of services and physical assets across the whole
can do health economy.23 SHAPE uses hospital activity data and
estates information, creating scenarios to help plan
l Resources to give you further information and other services for the future.
useful tools
SHAPE aims to:
l A forum to allow you to network with your peers
l Provide strategic and local analysis of current clinical
The model aims to help in tackling health inequalities and activity
shift the focus from treatment to prevention. The model will
help organisations to contribute to the UK climate l Bring together whole health economies, physical estate
reduction targets (80% reduction in carbon emissions by and capacity
2050, compared with 1990 levels) and in many cases will
also reduce costs. l Incorporate geographical information system (GIS)
functions
EMS (Environmental Management System) and
other systems l Inform potential for operational savings within a health
economy
The EMS model uses concepts from the Shewhart and
Deming cycle of continual improvement e.g. a Plan-Do- l Highlight the potential for services to transfer from acute
Check-Act cycle. to primary care settings

The cycle enables continuous improvement so processes l Provide strategic analysis to support investment needs
can be adapted with changing circumstances. Within the and disinvestment opportunities
context of sustainable development this system recognises
the continuously changing environment and allows new l Support scenario planning
plans to be implemented in the next cycle.
Including the carbon impact of services as one of the
EMS systems help to integrate environmental issues and indicators will provide an opportunity to include
improvement plans into higher management decision sustainable development in these strategic decisions.
making, with regular reporting to healthcare management

7
Setting goals
The Carbon Trust and the NHS Sustainable Development Unit provide the following guidance on target setting:

“In setting targets for carbon reduction, it is important both that NHS Trusts consider all emissions sources and that Trusts
first target the largest reductions which are also easiest to measure and influence. The 10% NHS SDU target covers all
emissions sources _ buildings, transport, waste and procurement. To reduce emissions in line with this target action is
needed in all areas of the footprint. To demonstrate progress, this action should be supported with stretching targets for the
footprint we can measure i.e. from buildings and own transport. Previous experience from the Carbon Trust suggests that an
absolute emissions reduction, for these areas, of between 20 and 25% over a 5 year period is readily achievable. Targets in
this range are in line with the Climate Change Act targets and sufficient to set Trusts on a course to meet vital long term
carbon reduction targets.” 24

Having a board-approved Sustainable Development Management Plan (SDMP)25 provides a governance structure for
action. Box 2 shows how the content of a SDMP could be assessed for progress, scope and quality.

Box 2: Sustainable Development Management Plan _ progress, scope and quality

Progress Scope Quality

Is the SDMP agreed by partners Are all core areas covered? Does the SDMP deliver?
and processes in place?
1. The SDMP includes targets for 1. Below agreed targets in most
1. Review has not taken place; no improvements for four or fewer areas – inadequate performance.
baseline or targets; of the areas listed 2. Only above agreed targets in
implementation not started. 2. The SDMP includes targets for some areas – adequate
2. Areas reviewed; baseline improvements for five or six of performance.
identified and targets agreed with the areas listed 3. Consistently above agreed
some partners; implementation of 3. The SDMP includes targets for targets – performing well.
SDMP started. improvements for all the areas 4. Well above agreed targets –
3. Targets agreed with all partners listed performing strongly.
and SDMP implemented
4. Progress against agreed targets
reported to board annually
against SDMP

Partners include: SDMP core areas:

1. Board(s) of provider organisations 1. Assessment and progress through Good Corporate Citizenship model11
2. Board(s) of commissioning 2. Building energy use carbon footprint
organisations 3. Site/building carbon footprint provided on DECs and DEC advisory reports
3. SHA(s) (see glossary)
4. Local Authorities 4. Performance against BREEAM (see glossary)
5. Other strategic partners 5. Travel plan performance with reduction targets for all travel to NHS sites
6. Waste reduction (domestic and clinical/hazardous) and recycling targets
7. Reduce water use through routine measuring, monitoring and reporting
water use

The SDMP can also provide evidence to support regulatory circumstances and need. Consistent, standardised
requirements, for example the annual report. Further details measurement would allow the assessment of progress
on the metrics trusts can use now are available on the and identify areas for action. Research is continuing into
Sustainable Development Unit website.24,25 methods for a balanced scorecard of sustainable
development indicators including existing measures of
carbon reduction.
What about the bits we can’t
Given current research it is clear that there are health
measure directly? benefits of increased sustainability, and acting on this
takes us in the right direction. In the future, research may
Broader sustainable development indicators improve efficient allocation of resources by quantifying the
benefits of alternative actions.
Sustainable development includes a broad range of
activities and progress is dependent on local
8
Measuring procurement Carbon footprinting models can be evaluated for their
fitness for purpose on four fronts:
The footprinting work for NHS England is groundbreaking
in terms of including procurement emissions. Including the 1. NHS organisation decision making requirements
procurement footprint represents the total impact of NHS 2. Robust calculation of whole carbon impact
activities more accurately. There are several methods for 3. Administrative burden from information gathering and
calculating procurement emissions depending on the calculation
application and no single method is currently available to 4. Fair measurement of organisations so they can be
satisfy all requirements. benchmarked

Box 3: Procurement carbon footprinting fitness assessment framework

1. For an NHS organisation to make robust decisions the 2. Carbon footprinting models would include the whole
footprinting methodology would perform well when carbon impact:
evaluated against the following requirements:
l Carbon impact at each level of the supply chain
l Understand scale of carbon emissions back to raw materials
l Target areas for reduction of procurement footprint l Production, use and disposal of products
l Measure reductions in carbon emissions over time l All greenhouse gases, in addition to carbon dioxide
l Support decision making between low-carbon and
high-carbon products

3. Additional analysis is currently required to consider 4. Benchmarking allows organisations to compare

the carbon impact. The impact of this additional performance with their peers, and should be seen in
information can be evaluated as follows: the context of their activity levels and the health
benefits they provide:
l Information available now for NHS organisations
l Increase in carbon literacy of suppliers l Appropriate for all health-related organisations
l Able to establish national standards
l Organisations can compare results with peers

A full review of all footprinting models is outside the scope will also increase carbon literacy and increase the
of this document. A quick review of the existing information available for calculating a carbon footprint for
methodologies indicates that there are significant trade- procurement. It should also be noted that while reducing
offs, with no footprinting method offering a reasonable fit in emissions is vital, responsible procurement should also
all areas. For example, Life Cycle Analysis and monitoring take account of other environmental issues, such as
quantities of individual items provides good monitoring deforestation, soil erosion, etc. Research is continuing to
over time although it might not be comparable across include more elements of sustainability into balanced,
organisations and would also not provide a mechanism to standardised sets of measures.
monitor the whole carbon footprint. Including the
procurement in the carbon footprint at a national level Advice on integrating sustainable development into public
identifies the scale and potential key areas for reducing procurement decisions is available from Defra28 and the
carbon emissions. European Commission.29 Defra provides government
buying standards,30 including advice for incorporating
Quantifying procurement, for example using the SCO2PE sustainable development into procurement and specific
tool,26 allows comparison of its impact with those of travel guidance for individual products. The European
and buildings. The SCO2PE tool can also compare the Commission Green Public Procurement Toolkit31 also
risks and opportunities of action in different categories of includes training materials for implementation.
expenditure for an individual organisation. However, as
discussed on page 6, monitoring changes over time using Sustainable development indicators for
expenditure is problematic as it does not take account of commissioned services
price rises.
Commissioners have an important role to play in ensuring
NHS Procuring for Carbon Reduction (P4CR) publications27 that services they commission contribute as little as
include actions on reducing carbon emissions – for possible to carbon emissions. The NHS Sustainable
example: reduce demand; efficiency in use; substitution Development Unit has published guidance for
and innovation; and supply chain management. Working in commissioners,32 and work is in progress to develop
partnership with suppliers to minimise carbon impact and indicators and quantify the scale of carbon reduction that
promote sustainability could have the greatest impact on can be achieved through their action.
carbon reduction. Engaging suppliers in carbon reduction

9
Summary
Measures to support sustainable development are available and ready to use. Including these metrics in a Sustainable
Development Management Plan and getting this approved at board level can be used to demonstrate progress on
sustainable development. Many organisations have already taken these first steps.

The most progressive organisations have taken sustainability much further, for example by embedding sustainability
requirements into their organisational governance mechanisms. Identifying leading organisations and sharing learning and
best practice supports progress on this agenda. Regional networks can enable this process to embed sustainability in all
organisations. Given the health benefits to be gained from sustainable development, including mitigating climate change,
the NHS has a role in continuing to be a leading organisation in understanding and reducing the impact of the services it
commissions and provides.

Resources

Procuring for Carbon Reduction (P4CR) – Carbon Trust footprinting tools

measuring and monitoring resources

Implementation pack

http://www.carbontrust.co.uk/cut-carbon-reduce-
costs/calculate/pages/default.aspx

Calculating your carbon footprint from procurement –

SCO2PE Tool V2

Estates and facilities guidance from The Department

of Health (England), Department of Health, Social
Services and Public Safety (Northern Ireland), Health
Facilities Scotland and Welsh Health Estates
http://www.spaceforhealth.nhs.uk/

Estates Return
Information Collection
(ERIC) data and
Monitoring action on sustainable procurement – P4CR analysis
Self Assessment Tool

http://www.sdu.nhs.uk/publications-resources/
23/Procuring-for-Carbon-Reduction-P4CR--NEW/ http://www.erpho.org.uk/viewResource.aspx?id=21647

10
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10. Committee on Climate Change. Building a low-carbon 26. NHS Sustainable Development Unit. SCO2PE tool. Available
economy - the UK’s contribution to tackling climate change: at: http://www.sdu.nhs.uk/publications-resources/50/
supporting research. London: Committee on Climate Change; Procuring-for-Carbon-Reduction-P4CR—Additional-
2008. Available at: http://www.theccc.org.uk/reports/building-a- Supporting-Materials/
low-carbon-economy/supporting-research 27. NHS Sustainable Development Unit. P4CR documentation.
11. Sustainable Development Commission. Good Corporate Available at: http://www.sdu.nhs.uk/publications-
Citizen assessment model. 2009. Available at: resources/23/Procuringfor-Carbon-Reduction-P4CR—NEW/
http://www.corporatecitizen.nhs.uk/ 28. Defra. Sustainable Development in Government. Available at:
12. DECC, Defra. Guidance on how to measure and report your http://www.defra.gov.uk/sustainable/government/index.htm
greenhouse gas emissions. London: Defra; 2009. Available at: 29. European Commission. Green Public Procurement. Available
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g-guidance.pdf 30. Defra. Government Buying Standards: how to procure
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Carbon Neutrality. 2008. Available at: /government/advice/public/buying/index.htm
http://www.forumforthefuture.org/library/getting-to-zero 31. European Commission. Green Public Procurement: GPP
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Glossary and abbreviations About the Association of Public
BREEAM: Building Research Establishment Environmental Health Observatories (APHO)
Assessment Method for buildings (http://www.breeam.org)
The Association of Public Health Observatories
Carbon dioxide equivalent emissions (CO2e): This refers to (APHO) represents and co-ordinates a network of
six greenhouse gases: Carbon dioxide (CO2); Hydrofluorocarbons 12 public health observatories (PHOs) working
(HFCs); Methane (CH4); Nitrous oxide (N2O); Perfluorocarbons across the five nations of England, Scotland,
(PFCs); Sulphur hexafluoride (SF6). Details of the industrial Wales, Northern Ireland and the Republic of Ireland.
processes which result in emissions of these gases are provided
on the Defra website.20 Using CO2e allows different greenhouse APHO facilitates joint working across the PHOs to
gases to be compared on a like for like basis relative to one unit of produce information, data and intelligence on
CO2. people’s health and health care for practitioners,
policy makers and the public.
Carbon footprint: A footprint measures the impact of activities
related to a specific organisation, product or service. The carbon APHO is the largest concentration of public health
footprint is normally the carbon dioxide equivalent emissions from intelligence expertise in the UK and Republic of
these activities. Ireland, with over 150 public health intelligence
professionals.
DEC: Display Energy Certificate. Since October 2008 public
buildings in the UK over 1,000m2 must display a DEC prominently APHO helps commissioners to ensure that they get
at all times, showing the energy use of the building. It is the information they need and our websites provide a
accompanied by an advisory report which details how energy use regular stream of products and tools, training and
can be reduced. technical support. We work with partners to improve
the quality and accessibility of the data and
EFM: Estates and Facilities Management system, used by NHS intelligence available to decision makers.
estates and facilities managers for secure collection and analysis
of data. The system is available with a login at: We are constantly developing and learning new and
http://www.efm.ic.nhs.uk/ better ways of analysing health intelligence data. We
use these new methods to improve the quality of our
GHG: Greenhouse gas emissions. own work, and share them with others.

Scopes: Term used in the GHG Protocol14 to define emissions Updates and more material, including methods
according to how directly organisations can influence them. and tools to support our technical briefing series
are available through our website at
SHAPE: Strategic Health Asset Planning and Evaluation tool to http://www.apho.org.uk
support commissioners in the strategic planning of services and
physical assets across the whole health economy. About the NHS Sustainable
Sustainable development (SD): The goal of sustainable Development Unit (SDU)
development is to meet the needs of today, without compromising
the ability of future generations to meet their needs. The NHS SDU works in close collaboration with NHS
organisations, the Department of Health (DH), the
Sustainable Development Management Plan (SDMP): Department of Energy and Climate Change (DECC),
The Carbon Reduction Strategy identified a board approved the Department for Environment, Food and Rural
Sustainable Development Management Plan as a way to monitor Affairs (Defra), and environmental groups to support
and reduce carbon emissions. policy direction, recommend research and convene
leaders to address opportunities and barriers in the
system.

The SDU consults widely within the NHS and with its
partners and has published a carbon reduction
strategy and route map for sustainable health. More
information about Sustainable Development in the
NHS, including tools to support improved
commissioning, procurement, leadership and
engaging staff in sustainable services, available at
http://www.sdu.nhs.uk

For further information contact:

Association of Public Health Observatories
Innovation Centre, York Science Park,
Heslington, York YO10 5DG

Telephone: 01904 567658 Cert no. SGS-COC-004224

http://www.apho.org.uk