SaTH Green Plan - 2025/28

The Shrewsbury and Telford Hospital NHS Trust

2025-2028

Contents

2

Foreword

3

Trust vision

4

Introduction

5

Integrated Care System vision

7

Policy context

8

National drivers

9

NHS drivers

9

Pathway to net zero

10

Carbon performance

11

Key milestones – our progress so far

12

The next three years and beyond

14

Our risks and challenges

15

Leadership and workforce

17

Sustainable models of care

20

Digital transformation

22

Journeys, transport and active travel

25

Estates (Hard Facilities Management)

30

Facilities (Soft Facilities Management)

33

Medicines

36

Supply chain and procurement

39

Food and nutrition

43

Biodiversity

46

Adaptation

48

References

50

Acronyms

51

Green Plan 2025-2028

Foreword Welcome to Greener SaTH 2025-28 - our third Trust-wide Green Plan; outlining our progress up to 2024 and our continuing commitment to reduce our impact on the environment. We invite you to join us on our journey.

The responsibility that the healthcare service has to our patients, visitors, staff, volunteers and community as a whole, has helped to shape the ambitions of our Trust. It is also one of the 10 Pledges that the Shropshire, Telford and Wrekin Integrated Care System (STW ICS) has committed to and is an NHS priority with targets.

In conducting our business, we want to create sustainable value through innovative solutions.

This conviction is the foundation on which the strong engagement of our people and the longterm successful development of SaTH is built. Our ambition to operate sustainably throughout the Trust and along our entire value chain will help to improve our efficiency and reduce risks. It will also positively contribute to the efforts to address climate change which affect us all.

In partnership with STW ICS, we will recognise and respond to the global climate emergency developing an environmentally friendly health and care system by delivering high quality care and improved public health without exhausting natural resources or causing severe ecological damage. The focus during the 2020/21 COVID-19 pandemic on providing many outpatient appointments remotely has demonstrated that we can deliver effective patient care and avoid thousands of miles of patient transport.

The international community has made enormous progress towards a common understanding of sustainability priorities. We want to continue to actively contribute to achieving this, through further embedding sustainability in our business. In playing our part, we are engaging with our people, utilising their knowledge and expertise, developing partnerships in all areas of our activities, and finally relying on the strength of our reputation as a sector leader in sustainability matters.

This is also part of the strategic vision for partners in our local ICS: As the world faces up to a climate emergency, we are committed to delivering an internationally-recognised system known for its environmentally friendly services that make the best use of our resources.

Our buildings-related carbon emissions continue to fall. We have a successful equipment reuse scheme, our catering department has eliminated plastic cutlery and introduced compostable takeaway containers, and we have developed garden areas for staff, patients and wildlife. We have also undertaken extensive LED lighting replacement and are in the process of completing a large Public Sector Decarbonisation Scheme (PSDS) scheme at Royal Shrewsbury Hospital (RSH) to reduce our carbon emissions.

The coming year will see us continue this good work, by refreshing our sustainability targets to reflect NHS and wider national targets. The NHS has recently set itself an ambitious target for its own activities to be carbon net zero by 2040, and those of its suppliers by 2045. As part of our future reconfiguration of clinical services, we will introduce more energy efficient buildings and the new buildings will follow national requirements to be carbon net zero.

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Trust vision As a Trust, our sustainability goal is to “provide healthcare with a kind touch and a small footprint”.

We are fortunate to be in a beautiful part of the country and we share a responsibility to keep it that way. We have a duty to protect and enhance an environment that is beneficial to the half a million people that live here now, and in the future, and also for all the visitors that come to enjoy the assets that Shropshire has to offer.

Through this Green Plan, and in conjunction with other health organisations and public sector bodies, we will work to move towards beneficial influences on the environmental, financial and social issues associated with our activities.

We will do this by undertaking an annual assessment of our impacts and focusing on the areas that give the greatest benefit to the natural and human environment. We will use the Green Plan support tool for monitoring and reporting purposes.

We will aim to ensure that our business and activity contributes positively to the following, and also to our four Values - which our staff demonstrate in their daily work and which will help us to achieve a positive contribution to these: • • • •

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the environment the community, including our staff the health of our population the future

Green Plan 2025-2028

Introduction The Shrewsbury and Telford Hospital NHS Trust (SaTH) is the main provider of general hospital services for nearly half a million people in Shropshire, Telford and Wrekin, and mid Wales.

In common with many NHS Trusts, our estate comprises a mixture of building types and ages, consuming considerable quantities of energy to heat, cool and light – £7.5m a year on energy (electricity, gas and oil) (2023/24) totalling over 50.7m kWh producing around 19,000 tonnes of CO2 per annum.

Our water usage is approximately 189,000 m3 and costs circa £317k per annum. As our main clinical services are split across two sites, we also incur significant expenditure on travel. Our staff also undertake considerable commute mileage owing to the rural nature of the county and the inconsistency of public transport.

The Trust produces in excess of 700,000 inpatient meals, generates almost three million pieces of laundry and 2,305.14 tonnes of waste per year, with all the associated resources.

We are immensely proud of our sustainability programme - we aim to create sustainable value with everything we do together with our staff, partners and stakeholders. We are committed to the protection of the environment through reducing our usage of resources. This includes single-use plastic, reducing our emissions, creating habitats and environments such as new garden areas for wildlife, which our staff and patients can enjoy, reducing inter-site vehicle movements and no longer allowing diesel models for replacement pool and lease vehicles.

In October 2020, the NHS set itself an ambitious target for its own activities to be carbon net zero by 2040 and those of its suppliers by 2045. This will greatly impact upon the way the NHS commissions and delivers its services, and the buildings that it uses to do so, undoubtedly resulting in some of the biggest changes that the NHS will have seen since its inception. It will require changes to our estate, transport, catering, aerosol inhalers and anaesthetics, models of care – including remote consultations and care at home, and greater use of technology.

This Green Plan will enable us to maintain the current momentum of sustainability improvements and will continue to deliver tangible financial and local environmental benefit.

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We see our journey to net zero as a collaboration of the organisations in our system to approach, with a broader view of delivering care to our communities.

In October 2020, NHS England published ‘Delivering a Net-Zero National Health Service’, a report that details the scale of the environmental problems faced by the NHS and the country.

This report sets ambitious targets requiring all NHS organisations to become net zero by 2040 for the NHS Carbon Footprint and by 2045 for the NHS Carbon Footprint Plus. The document is a milestone for NHS organisations in that they now have key targets to achieve by the 2030s and 2040s.

The NHS aims to provide health and high-quality care for all, now and for future generations.

This requires a resilient NHS. The NHS also needs to respond to the health emergency that climate change brings, which will need to be embedded into everything we do now and in the future.

Clearly, there will be financial investment required across the system. We aim to return on these investments over the lifetime of the output projects, or where this is not possible, for them to be cost-neutral. This may not always be possible so we must be careful in how we initiate projects and consider the benefits they provide in a holistic way.

The two key net zero targets for the NHS set in the ‘Net Zero’ (NHSEI, 2020) paper:

1

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100% by 2040 for the NHS Carbon Footprint with an ambition for an 80% reduction (compared with a 1990 baseline) by 2028 to 2032

Green Plan 2025-2028

2

100% by 2045 for the NHS Carbon Footprint Plus (see below) with an ambition for an 80% reduction (compared with a 1990 baseline) by 2036 to 2039.

Integrated Care System vision We will work together with the people of Shropshire, Telford and Wrekin, and mid Wales to develop innovative, safe and high-quality services, attracting and retaining the best staff to deliver world class care that meets our current, and future, rural and urban needs.

‘We will support people – in their own communities – to live healthy and independent lives, helping them to stay well for as long as possible. Creating partnerships to find solutions that work better for the people we serve and those who provide care.

As the world faces up to a climate emergency, we are committed to delivering an internationally recognised system known for its environmentally friendly services that make the best use of our resources. We want this journey to net zero carbon to provide population health benefits to our communities and staff throughout the process and capitalise on financial benefits where possible.

Our journey is towards local sustainability while being sensitive to global sustainability and delivering on net zero. Our approach will be one of collaboration between our member organisations to ensure we achieve our targets comprehensively and systematically together in good time, realising all of the benefits that come with it environmentally and in terms of health and service provision.’

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Policy context SaTH is committed to achieving net zero for our NHS Carbon Footprint by 2040 and for our Carbon Footprint Plus by 2045.

Delivering this Green Plan in line with national and NHS requirements will ensure we minimise the impacts of our services on the environment and secure wider social, economic and environmental benefits for the community.

We also commit to review and participate in regional strategies related to sustainable development wherever appropriate.

The Green Plan builds on work already achieved by the Trust since the previous Green Plan, providing an updated position on our achievements and objectives, targets and actions in line with the latest NHS and Government guidance.

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Green Plan 2025-2028

National drivers In line with the Climate Change Act 2008 (amended 2019), the UK have set a legally binding target to reduce national carbon emissions to net zero by 2050.

Since then, various strategic plans and frameworks have been introduced outlining how this goal can be achieved.

The current Government has placed the Environmental Manifesto goal of transforming Britain into a ‘clean energy superpower’.

Some priority areas in which pledges have been made include: • Zero-carbon electricity system by 2030 • End all new oil and gas licences and ban fracking • UK to be a leader in clean energy and green finance. The focus of current Government policy is on a movement away from high carbon energy consumption and towards the use of cleaner energy and public and active transport.

NHS drivers The NHS has recently published its new 10 Year Health Plan for England, ‘Fit for the Future’, shortly before the 77th anniversary of the foundation of the NHS. Amongst stressing the importance of financial sustainability and economic growth in protecting the health of the population, the Plan sets out the expectations of hospitals to reduce environmental impact, increase resilience to climate risk, and achieve net zero by 2040 in line with the climate change duties set out in the Health and Care Act 2022.

In 2020, the NHS launched its For a Greener NHS campaign to address its role in the climate health emergency. This set the two net zero targets herein described and aims to support trusts and staff to reduce their emissions and stay on track to achieve net zero carbon emissions.

The Delivering a net zero National Health Service report was released later that year, providing a practical route to achieving net zero targets. This outlines the immediate actions all Trusts must take to ensure they achieve net zero.

More recently, HM Treasury has established requirements for NHS organisations to report, in line with the Task Force on Climate-Related Financial Disclosures (TCFD), their approach to the governance and management of climate change risks, including the setting of appropriate metrics and targets.

NHSE has since published its Climate Adaptation Framework, which provides an approach for trusts to build capability in preparing for and responding to climate change.

The NHS Standard Service Contract outlines the targets and objectives of the NHS regarding sustainability to help assist in reaching goals and ensure organisational resilience in the future.

The NHS Operational Planning and Contracting Guidance document sets out the priorities of the NHS for the upcoming year and provides guidance on the actions required.

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For 2025/26, the guidance emphasises a need to improve the efficiency of patient care, enhance productivity, ensure financial stability, and support system-wide reforms through integrated care systems (ICSs).

There are financial, societal, environmental and health drivers for this Green Plan in addition to national and NHS legislation: Health • Climate change impacts health, so tackling this will decrease health inequalities.

Environmental • Protects the environment • Prevents the over-exploitation and consumption of natural resources.

Societal • Sustainable healthcare is expected by surrounding communities • Financial • Reduced energy costs • Cost-effective contracts • Increased NHS capacity.

Pathway to net zero Reducing our carbon footprint to net zero whilst continuing to provide high quality care to more patients presents a substantial challenge for the Trust.

Since 2023, our delivery on necessary emissions reductions was heavily reliant on external funding, to ensure sufficient resources and expertise can be accessed.

The successful delivery of this Green Plan (2025-28) will shape the success of our efforts.

There are various projects we are set to introduce, which we believe will steer us back onto our aspired trajectory: • •

•

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The implementation of our Estates Security and Decarbonisation strategy (ESD) will significantly contribute to reduced operational energy related carbon emissions The Trust has been successful in securing c. £16m funding for Phase 3c of the Public Sector Decarbonisation Scheme (PSDS). These projects have focused on energy conservation measures (ECMs), the integration of renewable technologies and a new primary heating system at RSH. This scheme is anticipated to save a cumulative 3,000 tCO2e per year.

The implementation of the Hospital Transformation Programme - building of a new lowcarbon hospital at RSH will be electrified.

Green Plan 2025-2028

Carbon performance The Trust has undertaken a significant programme of carbon reductions since 2022 to reduce our carbon footprint and improve our overall environmental impact.

With the adoption of our Sustainable Development Management Plan (SDMP) in 2017 and Green Plans in 2022, we have had a renewed focus on tackling these emissions, reducing air pollution and minimising waste.

The interventions taken have led to an overall reduction in the Trust’s total annual emissions, which is supporting our ambition to become net zero by 2040.

As shown in the graph below the Trust has achieved a 23% reduction in total annual emissions since the baseline year of 2019, from 16,578 tCO2e to 12,835 tCO2e. Whilst this reduction resembles great progress, these figures do not incorporate the recent project at RSH. Our net zero journey has been accelerated by the availability of external funding and reducing emissions will become more challenging as we approach 2040.

Driven by increased demand for our services, the Trust’s estate and clinical activity has also grown significantly over the past few years, with the opening of new facilities resulting in higher gas and electricity consumption.

This, as well as our planned and existing decarbonisation projects, gives us the confidence that we will be able to return to our aspired trajectory to achieve our net zero targets.

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Key milestones: Our progress so far Our journey to net zero has already started. Our key milestones are: Achieved by SaTH in the period April 2024-March 2025.

Waste breakdown below:

Area

23/24 Figures

24/25 Figures

Incineration (clinical) waste volume

177.24

130.75

Alternative treatment (clinical) waste volume

971.54

280.93

Offensive waste volume

98.89

793.72

Recycling waste volume

0

10.67

Domestic waste volume

2731.53

878.53

Food waste volume

0

15.81

Achieved by: • Implementation of the NHS Clinical Waste Strategy • Effective and compliant segregation of waste • Significant reduction of circa. £150k in clinical waste disposal costs, saving 45 tonnes of CO2e • Implementation of ‘Simpler Recycling’ continues across the Trust to improve our recycling rates.

• Collaborating with waste partners to adopt practices that make energy from waste such as Veolia • Introduction of cardboard balers at each acute site A reduction in reliance on fossil fuels of circa 608,918 kWh for PV arrays.

Achieved by the installation of renewable on site energy.

• •

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Green Plan 2025-2028

Completely eliminated Desflurane from our clinical practices Achieved by adopting alternative methods such as less environmentally harmful anaesthetic gases and Total Intravenous Anaesthetics (TIVA)

Over the last three years, we have achieved the following: • • • • • • • • • • • • • •

•

• •

•

Completed and updated the following documents - a heatwave plan, an adaptation plan and a biodiversity plan Ensured that sustainability is included as a material consideration in all business cases Taken account of suppliers’ carbon emissions Reviewed travel and transport policy to support sustainable travel options Annual travel survey to measure changes in the ways that staff travel to work and for work Installation of 12 electric vehicle chargers across three sites and the conversion of our vehicle lease schemes to electric or ultra-low emission vehicles for all new leases Installation of ambulance chargers at PRH Installation of two new secure cycle shelters at both sites, bringing the total to five at Royal Shrewsbury Hospital (RSH) and three at Princess Royal Hospital (PRH) Successful implementation of a park and ride at RSH and PRH to reduce single occupancy vehicles on site Secured PSDS 3c funding for a decarbonisation scheme at RSH which includes enhanced roof insulation at RSH Developed Heat Decarbonisation plans for all our acute Trust sites Successful NEEF funding for RSH for solar panels and LED lighting Successful installation of 54 ‘liftshare spaces’ at RSH and seven at PRH A furniture repair/reupholstery scheme has been introduced into the Trust. This identifies chairs and other items that have been ripped/torn and would otherwise be thrown away.

These items can now be reupholstered for a fraction of the cost, saving on inflated disposal costs, as well as procurement costs.

Implemented a range of measures to embed sustainability into Trust processes. This includes changes to financial planning and approval such as, business cases, capital plans and travel expenses.

It also includes changes to HR processes such as sustainability sections in induction documents, job descriptions and staff statutory mandatory training.

Expanded WARPIT for staff to exchange unwanted furniture, reducing waste at PRH and RSH Appointment of a Waste and Energy Compliance manager in line with NHS guidance to appointment a waste manager (0.5FTE). This has resulted in improved waste compliance and the appointment of an authorising engineer and implementation of the clinical waste strategy Trialled the reduced use of IV paracetamol for post operatives’ patients and looking to roll this out to other areas.

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The next three years and beyond The next three years will be fundamental in building collaboration and establishing early investment to maximise benefits later.

The Trust has completed a carbon foot printing assessment. The intention is to understand these results and integrate these into the Trust’s strategies.

The next three years is an opportunity for SaTH to progress and build on the achievements already realised since 2021. Discussions with departmental sustainability leads will ensure that the next three-year actions are planned, programmed and actioned.

Adopting a collaborative approach to both the actions at organisational and system levels will ensure we maximise benefits and realise any financial saving opportunities. It will also provide consistency in reporting and some resilience in terms of team member movement.

Therefore, our key actions are to identify opportunities in the system where we can share learning, optimise efficiencies and capitalise on collaborative working.

To do this, we will: • • •

• • • • • • •

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Ensure that we have the right people delivering our net zero agenda Consider how we can deliver care in a sustainable, balanced way Harness digital technologies to approach a multifaceted challenge of delivering quality care outcomes, improving the quality of our care and diagnostics, reducing waste, and optimising our building services Encourage our communities to avoid contributing to our carbon output Focus on our supply chain’s commitments to achieving net zero Build on progress in reducing these “point of use” emissions, while improving patient care and reducing waste Continued implementation of decarbonisation plans, continuing our transition to renewable energy and in the interim making every kilowatt of fossil fuel energy count Adopt practices to avoid creating waste that persists in nature and recycling those we cannot.

Adapting our services to meet the challenges of climate change and extreme weather events Outline a plan to decarbonise NHS travel and transport, while also providing cost-saving and health benefits.

Green Plan 2025-2028

Our risks and challenges Dependence on Infrastructure Projects, Funding and Backlog Maintenance Approximately 68% of our reportable carbon footprint is associated with the consumption of gas. Our ability to deliver on emission reduction targets therefore depends heavily on the successful implementation of infrastructure projects across the Trust. However, these projects require a significant amount of investment, so there is a growing financial risk associated with the costs of adapting our systems, services and infrastructure. The current financial constraints faced by the Trust restrict our ability to implement changes.

We currently have backlog maintenance costs of approximately £113 million and the financial resources we do have will always be prioritised on addressing critical infrastructure risks, business continuity and patient safety. Moreover, although we have been successful in our bids for funding so far, it has been announced by the UK Government that the PSDS funding which has been available to support our decarbonisation in recent years is scheduled to be unavailable from 2027. A significant amount of additional investment is needed for us to achieve net zero by 2040.

Climate Change Risk There is growing risk associated with the increased frequency and intensity of climate events like heatwaves. This will affect service delivery and the ability to manage and maintain the Trust’s estate. The Trust’s Emergency Planning, Resilience and Response (EPRR) team recognises the risk from climate change and this is formally recorded on the Trust risk register.

Climate change poses significant risks to the Trust and all its services, encompassing our buildings, workforce, and patient safety. Failure to improve our resilience to climate change could limit our ability to provide safe and effective care for patients. In recognition of these risks, we have developed a Climate Change Risk Assessment (CCRA) and Adaptation Plan (CCAP) which has assessed the risks and prepares the Trust for change.

The plan contains a list of agreed climate adaptation options to be implemented and be monitored by a newly formed Climate Change Risk Preparedness group (CCPG). We have also undertaken a physical vulnerability assessment to understand how to future-proof the Trust’s estates and facilities.

Reliance on the action of suppliers The delivery of our services relies on the procurement of a huge variety of goods, works and services. Medical devices and equipment, medicines, ICT, construction, manufactured products and commissioned healthcare services, although essential, each contribute to our scope 3 emissions as part of our Carbon Footprint Plus.

Our progress towards net-zero relies heavily on our suppliers reducing their carbon impact to ensure the goods and services we procure produce the smallest impact possible. This risk increases in cases where the Trust has already signed onto long-term contracts and agreements which do not currently consider carbon reduction, and which will therefore make the implementation of changes challenging.

In response to this risk, we have signed onto the NHS Evergreen Framework, which requires all procurements to include a minimum 10% net zero and social value weighting. We are also working in line with the NHS net-zero Supplier Roadmap and request carbon reduction plans from clinical suppliers for contracts of any value. In situations where suppliers fail to improve their sustainability, it is important we look elsewhere where possible to source items from more environmentally conscious suppliers.

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Our Sustainability Action Plan This structure will form the basis of our strategy. Each subheading discusses the progress made so far (and our baselines, where applicable), our key targets, timeframe and how we intend to achieve this.

We also feel that it is important to include biodiversity under its own subheading because a broad and diverse environment locally, nationally and internationally is central to tackling the key issues addressed in this document.

Leadership and Workforce

Travel and Transport

Food & Nutrition

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Green Plan 2025-2028

Sustainable Models of Care

Estates (Hard Services)

Digital Transformation

Facilities (Soft Services including Waste)

Supply Chain & Procurement

Medicines

Adaptation

Leadership & Workforce Our people are central to delivering our care services sustainably.

SaTH manages sustainability through various roles within the Estates department. The Trust has an active climate change group which is responsible for reporting out on the current actions. This is chaired by the Assistant Chief Executive (executive lead for green.)

Whilst we already have excellent examples of collaboration and governance through the ICS Climate Change Working Group, there are opportunities to focus the coordination of collaborative working to drive efficiencies between the Trust and ICS - both environmentally and financially.

All our staff have a responsibility to contribute to achieving net zero, and can help by: • • • • • • • •

•

Where practical, and meeting the service needs, work from home wherever possible Use greener methods of transportation such as EV vehicles ‘Active travel’, and where this is not possible, use public transportation and car pools Minimise waste, reuse if safe to do so and use recycling facilities provided Holding local sustainability working groups Challenge colleagues where socially and sustainably responsible behaviours need improvement Increase awareness by discussing with colleagues and teams Sensible use of technology to enable remote working and drive efficiencies – for example, embracing the use of electronic devices for delivering services in the community or holding a MS Teams meeting rather than traveling to meet face to face.

Raising sustainability awareness to our colleagues, service users and communities by participating in campaigns, sustainability days, sustainability competitions, and so on.

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Sensible use of technology to enable remote working and drive efficiencies As job descriptions throughout the whole workforce are reviewed and refreshed on a routine basis, we must ensure that sustainability and waste management are highlighted as an essential requirement to the day-to-day responsibilities of each colleague, expecting sustainability as ‘business as usual’ facet of our work practices.

Some of the organisations in our system teams already have colleagues in senior leadership positions who have completed carbon literacy training.

This training is a formally recognised certificate which we intend to roll out for senior leaders in the whole system. We will use a train-the-trainer model, capitalising on collaboration, to improve our understanding of how we can tackle our emissions by changing behaviours and embedding carbon performance in our service delivery.

A by-product of this training would encourage and identify climate and carbon champions in all service areas.

Collaborative opportunities 1. Individual and System Baseline Carbon Foot-printing to look at procurement opportunities (we have a stronger position for negotiation through economies of scale) 2. Introduce a network of Net Zero Carbon Champions (staff, service users and members of the public) 3. Improvement in communication by sharing regular cross-system sustainability-related information, such as benchmarks and how colleagues can change behaviours to have a collective impact on our carbon footprint 4. Share training to provide consistent approaches, and capitalise on economies of scale

We will recognise the fantastic work and milestones achieved by our colleagues throughout the system through nominations at national level sustainability awards and at local levels through internal nominations for individual recognition.

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Green Plan 2025-2028

Action plan Leadership and Workforce Action

What resource is needed?

How will we measure progress?

Target Date

Promote specialist training for staff

Funding and time allocation

Number of persons trained

April 2026

Ensure Climate Change issues are discussed at Board meeting

Climate Change reports and Task Force on Climaterelated Financial Disclosure (TFCD) reporting

Number of Board meetings attended

April 2026

Green Plan to be reviewed and actions measured every 12 months with a view to amend accordingly

Central coordination/Climate Change group to review

Quarterly reporting in the Climate Change group

Annually

Ensure that sustainability behaviours are considered while reviewing job descriptions

Communications with HR/People services and Recruitment

Job descriptions updated to include sustainable behaviours

April 2026

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Sustainable Models of Care Delivering the best care is our business – it’s what we do. As a system we have huge opportunity to organise our services in such a way that patient care improves whilst we make carbon efficiencies.

We must consider the location of our services – utilising existing buildings, collaborating on projects that improve care across our membership and ensuring we have the right services in the right places.

We are committed to creating and embedding sustainable models of care and ensuring our operations and estates are as efficient, sustainable and as resilient as possible.

The NHS is committed to moving to out-of-hospital and digitally-enabled care where clinically appropriate, improving prevention of ill health and reducing health inequalities. These changes also underpin our commitment to net zero. Net zero clinical transformation should ensure high-quality, preventative, low-carbon care is provided to patients at every stage.

We are harnessing technologies to reduce the need to invite patients to sites, often through ‘virtual’ consultations.

We must encourage our patients to live balanced, healthy lifestyles and geographically we must provide this care that is accessible for all engaging in active travel. The #TogetherWeMove movement is a charity-led initiative encouraging active travel, exercise and the benefits that come with this.

Raising sustainability awareness to our colleagues, service users and communities by participating in campaigns, sustainability days, sustainability competitions, and so on.

Collaborative opportunities Align individual digital technology to offer care closer to home to reduce bed days.

Partner to develop and deliver the Shropshire Joint Health and Wellbeing Strategy, specifically: • reducing stigma of mental illness • reduce inequalities that are the cause of ill health • influence planning decisions regarding fast food takeaways and green spaces • support people as they are discharged from hospital • promote the health, wellbeing and social change needed to improve health in Shropshire Signposting to energy efficiency advice to patients, staff, public, financial help with energy bills, improve their health and wellbeing, etc. directly or via charities (e.g. Beat the Cold, Keep Shropshire Warm #WeMoveTogether).

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Green Plan 2025-2028

Action plan Sustainable Models of Care Action

What resource is needed?

How will we measure progress?

Target Date

Sustainability to be included as a quality dimension in care models

Identify a clinical lead with oversight of net zero clinical transformation, with formal links into board-level leadership and governance

Quality improvement initiatives undertaken at the medical care level and reinforce their chances of success and sustainability

April 2028

Establishing a clinical lead and multidisciplinary working group responsible for reducing emissions in the clinical area(s)

Completing quality improvement project(s) in the clinical area(s) that focus on a measurable reduction in emissions, with co-benefits for outcomes and quality of care, efficiency and reducing healthcare inequalities (supported by resources in Annex B: selected resources)

April 2028

Reduce the need for patients to travel to an acute setting unless absolutely necessary

Review and implement alternative methods of providing patient consultations e.g. video link

April 2028

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Digital transformation We’re using technology to help health and care professionals communicate better and enable people to access the care they need quickly and easily, when it suits them.

The NHS Long Term Plan was published on 7 January 2019. The plan sets out our ambitions for improvement over the next decade, following the fiveyear funding settlement announced by the government in July 2018. The plan underpins the importance of technology in the future NHS; setting out the critical priorities that will support digital transformation and provide a step change in the way the NHS cares for citizens.

The introduction of MS Teams reduced our carbon footprint significantly within the space of just a few weeks. There is now real opportunity to further drive down our key carbon emissions through harnessing digital infrastructure, particularly in delivering patient care but also through hybrid working.

Collaborative opportunities Enable ability for staff to work from other stakeholders locations if closer to home or patients Remote monitoring. We will be expanding on our virtual ward, remote monitoring and virtual consultations services. We will give our patients more control over the care they receive and increase the support available to manage their health.

Joint booking systems for clinical and non-clinical Spaces

We are building resilience in the event of major incidents, outbreaks, and enabling colleagues to perform flexibly and efficiently by improving communications – for example, pivoting to VOIP telephones and integrating telephone services with Microsoft Teams.

Digital exclusion, the term used for inequalities in access to digital technology, is a barrier to providing care in our communities; particularly with respect to our ambition to provide 25% of outpatient activity and we will aim to review progress with this in mind and exploring options to support our communities to overcome this.

Collaboration between council and NHS organisations may also benefit our services; particularly where we share building spaces, whereby staff can work from nearest office space throughout the entire system.

A joint space booking system is currently being investigated to cover the entire system both for non-clinical and clinical space. Councils also have a role to play in working with NHS partners in the system to develop and enhance digital solutions to support people to live safe and well at home, to ensure the right care, at the right time in the right place - and care is not being overprescribed.

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Green Plan 2025-2028

Electronic Patient Records (EPR) The recent NHS Long Term Plan has an expectation that all services should have met ‘a level of core digitalisation by 2024’. The move to EPRs supports this as well as helping with compliance with the General Data Protection Regulation (GDPR) as well as the visibility of patients’ notes improves care. SaTH went live in 18 months which is ongoing and detailed within the Digital Strategy.

Work From Home and Agile (Hybrid) Working Where service delivery is not impacted there are clear benefits to continuing this model: • Improved wellbeing for staff due to reduced commuting, better work-life balance, local emissions reductions and so on • Reduction in carbon from commuting, less local pollution, improved access to parking for site visitors • Reduction in utilities usage, such as water, electricity and gas on site Improving building services monitoring and control Adopting the latest technologies in Building Management Systems (BMS) will provide significant and often direct carbon emissions at local level. Although frameworks exist for service providers in this industry, there is real opportunity to collaborate on maintenance contracts where similar systems are being employed across multiple sites, and to support transition to improved equipment. Organisations can link and pool expertise through peer meetings to ensure that benefits of BMS systems are being maximised.

Action plan Digital transformation Action

What resource is needed?

How will we measure progress?

Target Date

Outpatient attendances are clinically necessary at least 25% of this activity should be delivered remotely

ICT equipment and training, engagement and clinical teams – Attend anywhere

All outpatient services delivering 25% of activity

April 2026

Continue to develop agile working protocols, which reduce staff travel journeys and time

HR/IT/Finance

Reduced travel expenses

April 2026

Streamline the use and increase repurpose of electronic equipment such as phones and laptops as well as ensuring environmental disposal

Centralised IT requests

Reduction in IT requests

April 2026

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24

Assess the energy and environmental impact of digital tools to ensure they support our pathway to net zero

IT

Explore the implementation of electronic forms for requests such as blood tests to reduce paper usage

Procurement/IT

Reduction in paper usage

April 2026

Implement an office desktop energy saving scheme

Procurement/IT (time and resources required)

Reduction in energy bills

April 2028

Implement more digital care models, where appropriate for our patient demographic learning from ICS partners

Procurement/IT

Integrated Care record

Implement a project to convert to electronic patient appointment letters in all settings

Patient Engagement

Implement a patient self-scheduling tool to reduce the number of patient letters sent

Green Plan 2025-2028

April 2028

April 2028

Journeys, transport and active travel Business travel and staff commuting are major contributors to Trust Scope 3 emissions. SaTH is tasked with outlining plans to reduce the carbon emissions arising from travel and transport.

Fig 3: Greenhouse gas emissions by sector, 2019, by proportion (BEIS, 2020)

Total Domestic GHG Emissions in 2019: 454.7 MtCO2e

The NHS fleet is the second largest fleet in the country, consisting of over 20,000 vehicles travelling over 460 million miles every year. This fleet, combined with the impact of commissioned services and staff travel, directly contributes to the 36,000 deaths that occur every year from air pollution. This burden is borne disproportionately by those with pre-existing health conditions, older people and children.

An NHS Net Zero Travel and Transport Strategy was published in October 2023 which provides a clear timeline to achieve the commitments in Delivering a Net Zero National Health Service for travel and transport emissions. SaTH is already well aligned to the approach and targets set out in the strategy. The diagram below shows the roadmap from the strategy that we will follow.

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The NHS will have fully decarbonised its fleet by 2035, with its ambulances following in 2040.

Several key steps will mark the transition of NHS travel and transportation: • • • • •

•

By 2026, sustainable travel strategies will be developed and incorporated into Trust and integrated care board (ICB) green plans From 2027, all new vehicles owned and leased by the NHS will be zero emission vehicles (excluding ambulances) From 2030, all new ambulances will be zero emission vehicles By 2033, staff travel emissions will be reduced by 50% through shifts to more sustainable forms of travel and the electrification of personal vehicles By 2035, all vehicles owned and leased by the NHS will be zero emission vehicles (excluding ambulances) and all non-emergency patient transport services (NEPTS) will be undertaken in zero emission vehicles In 2040, the full fleet will be decarbonised. All owned, leased, and commissioned vehicles will be zero emission.

It should be noted that in the case of the 2026 target to convert the staff salary sacrifice scheme to electric, SATH has been procured in readiness for 2026.

To support this transition, we will work to make all travel more sustainable. The diagram below shows the sustainable travel hierarchy with the least sustainable mode at the bottom in light green. The diagram represents the order of priority for modal shift up the triangle.

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Green Plan 2025-2028

Investing in low emission fleets and reviewing the organisations transport of goods, patient transport, work patterns and location of services are also beneficial. The current process of renewing the Local Transport Plan (LTP4) for Shropshire will provide opportunities to generate co-benefits for both health and carbon performance.

Shropshire Council health and transport colleagues are working together to improve the health impact of the new Shropshire LTP, along with the LCWIP – Local Walking and Cycling Infrastructure Plan and the Bus Strategy. The actions will increase access to public and active travel and help to mitigate any negative health impacts.

Additional effort and investment is required to: • • • •

Reducing barriers to using active travel Reduce business mileage Develop and appraise travel plans to assess progress and quantify emissions saved Replace fleet with low emission (LEV/ULEV/ZLEV) alternatives

SaTH can utilise the Clean Air Hospital Framework – a free resource available to help clean up their air. This is a self-assessment tool designed to benchmark and shows areas to improve air quality across sites and in the local community.

The framework is focused on seven key areas: 1. Travel 2. Procurement and supply chain 3. Construction 4. Energy 5. Local air quality 6. Communication and training 7. Hospital outreach and leadership Increasing ‘Active Travel’ and use of public transport are some of the interventions which some of the organisations in the ICS have already underway. For example, improvements to availability of shower facilities and increased cycle storage, as well as improving footpaths and lighting and introducing salary sacrifice schemes for cycle purchase or season tickets. Not only improving staff fitness but improving site emissions. SaTH has to date, 38 electronic vehicles on lease (another 19 on order) and 60 bicycle purchases via salary sacrifice.

Car sharing just once a week will help to reduce the amount of traffic on our roads, improve the local environment and our health. Similarly, walking once a week has obvious health benefits and helps to reduce the amount of traffic on our roads.

There are currently two Air Quality Management Areas (AQMAs) in the Shropshire Council area, in Shrewsbury and Bridgnorth, where action is required to address poor air quality.

Traffic management measures and new infrastructure, together with support for a move to ULEV transport options are likely to result in a reduction of particles and other more harmful emissions. Telford & Wrekin Council is implementing discounts available from Arriva and West Midlands Trains to staff. Arriva also offers discount on monthly season tickets to NHS staff.

The NHS guidance on Travel plans are due to be refreshed in 2026. The Trusts travel plan will be updated and refreshed in line with this guidance during the Green plan period.

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Staff commuting contributes to Trust Scope 3 emissions, therefore, any action taken now will begin to reduce our contributions.

Currently SaTH has 60 bikes purchased under salary sacrifice, a bicycle user group and cycle champion promoting the service and benefits amongst staff.

Collaborative opportunities Develop a system-wide Green Travel Plan which will in turn influence organisations’ Green Travel Plan – focusing active travel, business travel and grey fleet.

Set up regular meeting between key staff from each stakeholder to share ideas, developments and successes.

Action plan Travel and Transport

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Action

What resource is needed?

How will we measure progress?

Target Date

Ensure that, for new (fleet) purchases and (fleet) lease arrangements, the solely purchases and leases cars that are zero emissions vehicles (ZEVs)

HR/Facilities/ Procurement and additional EV chargers

It is anticipated that all contracts transitioned and (fleet) lease arrangements, the transition will occur when their existing contracts are renewed, purchases and leases cars in contract will aim to move to ZEVs once those contracts end.

April 2026

Green Plan 2025-2028

Improve guidance to staff on the most sustainable ways to travel

April 2026

Reduce the impact of motor vehicle travel by encouraging green travel options (e.g. cycles, walking, car sharing, carbonefficient vehicles, bus fare subsidies); the Trust currently pays 20 pence per mile to staff who cycle between work locations for business purposes

Estates/ Sustainability team

Continue to improve cycle storage as well as shower and changing facilities

Estates – cycle audits

Number of cycles using the shelters

April 2026

Install additional appropriate electric vehicle charging points at our premises

Estates and utilize external funding

Number of EV chargers installed

April 2026

Explore the use of government buildings such as local council sites as additional hot desk areas for domiciliary staff so they do not need to return all the way to their base office

Space Utilisation

Number of agreements in place

April 2028

Annual travel survey completion

Estates

Number of staff completing the survey aiming for 10%

April 2026

Reduce the grey fleet mileage

Estates, Facilities and Finance Explore the use of a cross shuttle service bus Tracker’s data utilized to identify pool cars

Reduction in grey fleet milage claimed

April 2026

Maintain and promote the Trust bike trial and cycle scheme and carry out audits on cycle usage Promote and manage Liftshare car share database and aim to increase the number of car sharers each year

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Estates (Hard Facilities Management) NHS England’s guidance, Estates ‘Net Zero’ Carbon Delivery Plan, advises a four-step approach to decarbonising estates.

Our estate has a significant role in reducing our Scope 1 emissions and we have made huge progress with reducing our direct emissions burden. We have installed photovoltaic (PV) solar panels, replaced lighting for LEDs, boilers and associated equipment with ultra-efficient alternatives, and improved installation to buildings and pipework. For indirect (scope 2) emissions, (electricity supplied to the grid from renewable energy sources), we have achieved electrical savings of at least 600,000 kWh/annum through the installation of PV solar panels, protecting future finances from expected grid cost inflation and price rises from the supply crisis.

The NHS organisations in our system collectively consumed over 116,000,000 kWh (NHSEI, 2021) in natural gas in the year 2020-21. These scope 1 emissions are a key challenge that we will aim to reduce over the next three years.

Some examples of the efforts so far include: • • • • •

The installation of photovoltaic (PV) solar panels at Royal Shrewsbury Hospital (RSH) Installing LED lights across multiple sites Improving the insulation, or U-Value, of our buildings so that it takes less energy to reach required temperatures Completed heat decarbonisation plans for both RSH and Princess Royal Hospital (PRH) Replacing antiquated Building Management Systems (BMS) with smarter controls.

We’re taking responsible measures to not only reduce our carbon emissions, but to realise financial benefits using the philosophy that less kWh used means less money spent - making every kilowatt count. We are also pro-actively accessing public grants and funding available such as the Public Sector Decarbonisation Scheme (PSDS); for example, SaTH in 2024 was successful in receiving PSDS funding for £16.4 million to assist the Royal Shrewsbury Hospital site reduce carbon emissions including de-steaming, installing PV panels, insulation and upgrading BMS installations.

The four-step approach to decarbonise the NHS estate by 2040 (Source: Estates ‘Net Zero’ Carbon Delivery Plan, NHSEI) Includes indicative numbers to illustrate the scale of the challenge to decarbonise the NHS estate by 2040. These are not actuals.

30

Green Plan 2025-2028

The infographic on page 30, published in the NHSE ‘Estates ‘Net Zero’ Carbon Delivery Plan, estimates that every £1 million invested across the NHS in the actions listed will deliver a 1.33ktCO2e saving per year.

The cumulative capital costs of these investments would be offset by equal revenue savings over only 3.8 years. By generating a proportion of the energy, we consume at our sites, we are protecting our finances against inflationary and market price rises of importable utilities.

We intend to collaborate between our organisations at a local level; sharing building space, and day services are being reviewed with view to offer building-based services to a wider group across all ages.

This space utilisation will in some cases reduce the burden on capital budgets and have an impact on carbon output, as well as reducing our consumption of building products which further contribute to climate change.

Collaborative opportunities Share benefits of installation of EV charging points through joint tender exercises Give early warning to peers on grants, loans and other schemes that may benefit our reduction of scope 1 emissions Share benefits of adopting emerging technologies and offer unique access to case studies.

Explore feasibility of shared power generation and consumption from PV farms, district heat networks and other renewable technologies.

Action Plan Estates Action

What resource is needed?

How will we measure progress?

Target Date

Capital Backlog commitment of 5% to improve the Estate in line with the NHS Net Zero Building Standard

Capital Programme and Estates to deliver

Number of sustainable schemes completed

April 2028

Replace any habitat removed as part of development on site – this includes car parking

Estates

Monitored through the SaTH Climate Change Group Biodiversity Report

Quarterly

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Action

What resource is needed?

How will we measure progress?

Target Date

Continue to rationalise our estate to reduce utility costs and usage as well as reduce our carbon footprint

Space Utilisation Manager

Reduce our electricity usage through energy efficiency measures (excluding uplifts from the installation of heat pumps)

April 2026

External Funding opportunities

Business case submissions

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Continue to replace standard lighting with LED (light emitting diode) lights as well as deploy smart lighting controls

Funding opportunities through NEEF and Estates

Number of schemes implemented and reduction in energy costs

Annually

Reduce our water usage

Inform and educate staff, visitors and patients about how their actions impact upon energy and water consumption working with our Energy and Waste Manager

Reduction in water bills

Annually

Increase on-site energy generation from renewable resources such as solar photovoltaic (PV) systems

Funding opportunities through NEEF and Estates

Generation through solar

Annually

Ensure all applicable new building and major refurbishment projects are compliant with the NHS Net Zero Building Standard

Estates

Compliance measured through SaTH Climate Change Group

Quarterly

Green Plan 2025-2028

Facilities (Soft Facilities Management) In our current economy, we take materials from the earth, make products from them, and eventually throw them away as waste - the process is linear. In a circular economy, by contrast, we stop waste being produced in the first place. The world’s economy is only 7.2% circular. We must be bolder about saving resources.

As the area the sites depend on to maintain a pleasant, healthy and safe working environment is instrumental in the day-to-day operations, it is a key priority that we work to reduce waste as well as air and water pollution to improve local environments.

The Trust employed a Waste and Energy manager in 2023 to Comply with the NHS Clinical Waste Strategy.

Waste The management of healthcare waste is an essential part of ensuring that healthcare activities do not pose a risk or potential risk of infection and are securely managed. UK-wide guidance provides a framework for best practice waste management.

The management of waste in the NHS falls into three main categories: 1. Domestic – generated as a result of the ordinary day-to-day activities The Shrewsbury and Telford Hospital NHS Trust

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2. Clinical (including sharps) – waste produced from healthcare that may pose a risk of infection, e.g. swabs, bandages, dressings; or may prove hazardous, for example medicines.

3. Offensive – non-infectious but may be unpleasant to anyone who encounters it e.g. nappies, feminine hygiene products, used but uncontaminated PPE. Review and update our internal waste policies and procedures to embed the new NHS clinical waste strategy and achieve the 20:20:60 targets by the end of 2024.

We have embedded the NHS Clinical Waste Strategy within the Trust. As a result, infectious clinical waste has dropped significantly - from 86.62 tonnes (83%) per month to just 14.01 tonnes (14%). In contrast, offensive waste has risen from 0.65 tonnes (0.5%) to 72.47 tonnes (76%), reflecting correct waste segregation. This shift alone has reduced clinical waste disposal costs by approximately £150,000 and cut carbon emissions by 50 tonnes CO2/e.

2024

2025

The Trust will commence the implementation of recycling processes for the control and segregation of domestic waste.

The initial trial of introducing mixed recycling at one of our major Hubs has resulted in the site’s waste production being at 50% recycling, which is a 6,000kg saving in CO2e. SaTH no longer purchases single use plastic stirrers and straws and is looking into alternatives to single use plastics in catering and reduce use of cups, cutlery, gloves and aprons in other areas.

Cardboard balers have been installed at both of the main sites in order for us to bale our cardboard into 500kg bales and sell to recyclers. Not only has this been implemented and embraced completely, but we recycle an average of 10 tonnes of cardboard per month, which also generates revenue for the Trust. This covers the rental of the machines as well as be used in further waste initiatives. In line with ‘Simpler Recycling’ Legislation, we have implemented recycling into many parts of the hospital, with further plans to implement across the sites.

Collaborative opportunities Set up quarterly compliance meeting involving senior trust stakeholders to measure success against strategy, address and raise issues, as well as share developments and successes.

Share ways to improve waste management practices and improve specifications for tendering between trusts and ICS’ across the country. We are a key stakeholder in NHS England Waste Regional Delivery Groups.

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Green Plan 2025-2028

Action Plan Facilities Action

What resource is needed?

How will we measure progress?

Target Date

SaTH will divert 100% of waste to landfill

Review contracts quarterly

Quarterly benchmarking at the SaTH Climate Change group

April 2026

Expand the WARPIT provision across PRH and RSH

Promotional material and procurement

Savings measured through the WARPIT app

April 2026

Increase furniture repair service

Waste and Energy Manager to manage

Number of items repaired

April 2026

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Medicines Medicine optimisation as well as safe and effective use in health and social care can contribute to Scope 3 emission reductions.

Medicines account for around 25% of NHS emissions. A few medicines account for a large portion of these emissions, for example, anaesthetic gases (2% of NHS emissions) and inhalers (3%). There have been no specific sustainability schemes focused on medicines in the period of our previous Green Plan.

Progress so far against key national targets: Anaesthetic gases Both Royal Shrewsbury Hospital (RSH) and Princess Royal Hospital (PRH) have removed Nitrous Oxide and do not use Desflurane. Our dental and paediatric surgeons do use nitrous oxide, however this is bottled and not piped.

Inhalers The majority of emissions from inhalers come from the propellant contained in pressurised metered dose inhalers (pMDIs). pMDIs contain propellants known as hydrofluorocarbons (HFCs), powerful greenhouse gases, which are used to deliver the medicine rather than the medicine itself.

Source: NHS England and NHS Improvement. Delivering a ‘Net Zero’ National Health Service.

Published October 2020 and NICE Inhalers for asthma (patient decision aid).

Published 23 May 2019. Last updated 01 Sept 2020. pMDIs account for 71.6% of all inhaler device types prescribed in England, 68.8% in Wales and 66.6% in Scotland Source - NHSBSA Apr-Jun 21.

The NHS England Long Term Plan published in January 2019, outlined the national targets of reducing the carbon footprint of health and social care in line with the Climate Change Act targets of 51% by 2025.

Many people will be able to achieve the same benefit from DPIs. DPIs have a much lower average estimated carbon footprints of 20g CO2e per dose (two puffs) compared to pMDIs which are estimated at 500 g CO2e per dose (two puffs).

There are key national targets which SaTH is working towards: 1. The IIF ES-01 has a target for pMDI prescriptions as a percentage of all non-salbutamol inhaler prescriptions issued to patients aged 12 years or over on or after 1 October 2021 (range: 35% to 44%). This aims to reward increased prescribing of DPIs and SMIs where clinically appropriate with a target of 25% of non-salbutamol inhalers prescribed will be pMDIs by 2023/24.

2. The IIF ES-02 indicators has a target for the mean carbon emissions per salbutamol inhaler prescribed on or after 1 October 2021. This aims to reduce the mean propellant carbon intensity of salbutamol inhalers prescribed in England to 11.1 kg per salbutamol inhaler prescribed by 2023/24 36

Green Plan 2025-2028

Shropshire, Telford and Wrekin Current Performance

NHS Shropshire, Telford and Wrekin ICS

Total items

Carbon footprint per inhaler kgCO2e

Total carbon footprint gCO2e (K = thousands)

Carbon footprint per 1,000 patients gCO2e (K = thousands

46,645

25.1

1,651,348K

3,117K

Currently STW ICS prescribes 55.66% on non-salbutamol inhalers as pMDI, ranking 57th/133 CCGs or health boards in England and Wales. Target is 25%.

pMDI (excluding salbutamol)

NHS Shropshire, Telford and Wrekin ICS

DPI & SMI (excluding salbutamol)

Grand total

Total items

% of total items

Total items

% of total items

Total items

36,619

55.66%

29,177

44.34%

65,796

Source: Medicines Management, Shropshire, Telford and Wrekin ICS As well as addressing the prescription of pMDIs, correct disposal is also essential, as the harmful propellants remain in the inhaler even when it is empty of medication, and these can leak into the atmosphere if disposed of in general waste. The Trust has implemented pMDI inhaler recycling (Sep 2025) for inhalers used by inpatients, and is working to increase awareness of the importance of correct inhaler disposal (by returning to any pharmacy for incineration, which destroys the harmful propellants) amongst all patients.

Other actions in our progress include: • Monitoring how local prescribing data on the inhaler carbon footprint compares to the national data using the PrescQIPP inhaler carbon footprint data tool and visual data pack; and identify where local improvements can be made to ensure timely progress is being made.

• Support high-quality, lower-carbon respiratory care in secondary care, including: • Supporting patients to choose the most appropriate inhaler(s) in alignment with clinical guidelines (asthma inhalers and the environment: BTS, NICE and SIGN patient decision aid) • Regularly checking and improving patient’s inhaler technique • Promoting the appropriate disposal of inhalers • Reducing SABA overuse and increasing the percentage of patients on the Quality and Outcomes Framework (QOF) Asthma Register who were regularly prescribed an inhaled corticosteroid over the previous 12 months (target for IIF RESP-01 indicator in PCN DES is range 71% to 90%) • Increase use of leukotriene receptor antagonists where clinically appropriate • Wherever possible use combination inhalers for patients on dual or triple inhaled therapy.

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The Trust will support prescribers through education in lowering the inhaler carbon footprint, sharing data, reviewing respiratory prescribing guidelines to include lower carbon footprint inhalers, and how to optimise prescribing; ensuring lower carbon footprint inhaler options are included in medicines formularies and ensure stock availability with suppliers. Reduce waste through encouraging patients to look after their inhalers, not over-order and increase the use of re-usable inhalers.

Other opportunities for medicine optimisation include reductions in Polypharmacy (most often defined as the use of five or more medications daily by an individual), which could also decrease the risk of avoidable hospital admissions.

Avoidable medicines-related admissions to hospitals may equate to nearly 2 million bed days in England per year (Source: Environmental impact report: Medicines optimisation Implementing the NICE guideline on medicines optimisation (NG5).

We also need to begin discussions with suppliers to assess and reduce blister pack carbon footprint and recycling opportunities. For example, the Association of the British Pharmaceutical Industry tool can be used to provide a quick approximation of the carbon impacts.

Collaborative Opportunities The Think Twice, Order Right campaign is an initiative to reduce medicine waste, encouraging patients to check their current medicine stocks before ordering repeat prescriptions and to only order what they need. They are also asked to return any unused or expired medicines back to a local pharmacy for safe disposal.

Action Plan Medicines Action Support highquality, lowercarbon respiratory care in secondary care, including supporting patients to choose the most appropriate inhaler(s) in alignment with clinical guidelines, performing inhaler technique checks with patients and promoting the appropriate disposal of inhalers

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Green Plan 2025-2028

What resource is needed?

How will we measure progress?

Target Date

Amount of inhalers being recycled

April 2026

Supply chain and procurement Over 60% of the total NHS Carbon Footprint sits within the supply chain, therefore, suppliers and procurement will play a pivotal role in reducing our emissions.

To ensure a better quality of life now and for future generations, we need to look seriously at the way we use the earth’s resources, operate our businesses and live our lives. A sustainable approach recognises the broader impacts of our actions and aims to minimise any adverse effects.

Sustainable procurement requires taking environmental and social factors into account in purchasing decisions. For example, looking at what products are made of, where they come from, and who has made them and, therefore, minimising the environmental and social impacts of the purchases we make.

The Trust is looking to increase sustainable procurement principles within its procurement, collaborating with other NHS Trusts and other organisations to improve knowledge and understanding of sustainable procurement - and to seek shared opportunities and benefits, consolidate orders to reduce deliveries, improve stock rotation to avoid product expiry.

Collaborative opportunities Set up quarterly meeting between procurement team members from each stakeholder to share ideas, developments and successes Identify sustainability initiatives across the system Engage and work with local suppliers, where possible within current rules, to reduce delivery miles

In January 2020, a Greener NHS which sets out a path to a ‘net zero’ NHS and as a result the below targets have been set: •

for the emissions we control directly (the NHS Carbon Footprint), net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032

We must demonstrate leadership in sustainable procurement and will work with our supply chains to achieve this by addressing specific aspects of sustainable procurement such as: • • • • • • •

Reduce fossil fuel usage to minimise climate change Reduce usage of hazardous materials Reduce waste Ensure fair pay and working conditions through the supply chain Reduce use of transport Reduce the use of Single Use Plastics Move to working with suppliers to minimise packaging, use reusable containers for deliveries and manufacture using renewable energy.

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A more sustainable product can be described as: • Fit for purpose and providing value for money • Energy and resource efficient • Reusable and recyclable or durable, easily repairable or upgraded • Ethically sourced (i.e. wasn’t made in a socially irresponsible way) • Doesn’t deplete natural, non-renewable resources • The production, distribution, and/or consumption uses as little energy as possible and minimises/responsibly disposes of waste.

Source: www.england.nhs.uk/wp-content/uploads/2021/09/item4-delivering-net-zero-nhs-updated.pdf *To account for the specific barriers that small and medium enterprises and voluntary, community and social enterprises encounter, a two-year grace period on the requirements leading up to the 2030 deadline, by which point we expect all suppliers to have matched or exceeded our ambition for net zero.

Building Net Zero into NHS procurement

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Green Plan 2025-2028

NHSE&I will launch the Sustainable Supplier Framework

April 2022

2022

April 2023

April 2024

NHS will adopt PPN 06/21 so that all contracts above £5m will require suppliers* to publish a carbon reduction plan for their direct emissions as a qualifying criteria

All suppliers* will be required to publicly report emissions and publish a carbon reduction plan aligned to the NHS’ net zero target for their direct emissions, irrespective of contract value

April 2028

April 2030

NHS will adopt PPN 06/20 so that all NHS tenders include a minimum 10% net zero and social value weighting

All suppliers* will be required to publicly report emissions and publish a carbon reduction plan aligned to the NHS’ net zero target for both their direct and indirect emissions (Scope 1, 2 and 3)

April 2027

New requirements will be introduced overseeing the provision of carbon foot printing for individual products supplied to the NHS

All suppliers will be required to demonstrate progress in-line with the NHS’ net zero targets, through published progress reports and continued carbon emissions reporting

2045

•

Net Zero Supply Chain

•

Net Zero NHS

Action Plan Supply Chain and Procurement Action

What resource is needed?

How will we measure progress?

Target Date

NHS will adopt PPN 06/21 so that all contracts above £5m will require suppliers* to publish a carbon reduction plan for their direct emissions as a qualifying criteria

Procurement

Collated data – reporting out of themes and contracts which have social value included Reporting out social value spend

Half yearly

Monitor and communicate NHS Net Zero scope 3 emissions

Procurement

Baseline data collated in 2024 – monitor reduction based on contractors

Yearly reporting

Continue to implement the NHS supplier procurement roadmap including the requirement from April 2024 that all suppliers (over £5 million) will be required to publish a carbon reduction plan.

Procurement

Review and comment upon carbon reduction plans received from suppliers

Quarterly

Proactively review our supplies, medicines and medical equipment to look for opportunities to reduce packaging and waste (particularly plastic waste)

Procurement

Use our purchasing power wisely, working with suppliers to procure products that minimise packaging and offer innovative solutions to waste reduction by ensuring that this is fully integrated in tender processes

April 2026

Ensure sustainability criteria are included in all supplier tenders.

This will be in the main requirements specification and not just in the social value section

Procurement

Measured in contracts

April 2026

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All suppliers will be required to publicly report emissions and publish a Carbon Reduction Plan for their direct emissions and social value included in the evaluation and award, irrespective of contract value *SME and Voluntary sector have a 2year grace period to adhere to this

42

Green Plan 2025-2028

Procurement

Ensure sustainability of supplier vehicle fleet is included as part of procurement criteria

April 2026

Food and nutrition “It is estimated that food and catering services in the NHS accounts for approximately 6% the NHS’ Carbon Footprint Plus” – Source NHS England Greener NHS website Members need to consider ways to reduce the carbon emissions from the food made, processed and served within our organisations. Members currently have various solutions, but it is essential work on reducing overall food waste and ensuring provision of healthier and seasonal menus. Making menus seasonal and adaptable can save money as buying items in season is more cost effective.

Challenging the amount of food waste and reducing the carbon emissions of the food consumed as well as changing to healthier items can have a large impact.

The Trust is exploring electronic food ordering in line with the NHS Food Standards.

Collaborative opportunities Set up quarterly meeting between catering staff and dieticians from each stakeholder to share ideas, developments and successes Look to award joint contracts to enable utilisation of fresh food sourced locally, where applicable Share strategies to minimise food waste ICS members to join the Shropshire Good Food Partnership and Marches good food group Develop or update the organisation’s Food & Drink Strategy - starting with aims to improve staff andpatient nutrition and hydration, as well as ways to reduce carbon Combined procurement for provision of food and drink and use of local supply chains Combined procurement of environmentally friendly catering items (e.g. takeaway containers, cups and cutlery)

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Shropshire Good Food Partnership is working across Shropshire taking a food systems approach to improve sustainability, amongst other objectives, in the local food system.

Engagement by ICS partners with the local food system is an opportunity to reduce food miles and to engage with producers who are using sustainable forms of food production.

Food production is responsible for one quarter of the world’s greenhouse gas emissions.

UK Agriculture contributed 10% to total greenhouse gas emissions in 2018, including 70% of nitrous oxide emissions, (generated by synthetic fertilizer use), and nearly half of total methane emissions.

Greenhouse gas emissions across the food supply chain: Source: https://ourworldindata.org/food-choice-vs-eating-local

Land use change Above ground changes in biomass from deforestation, and below ground changes in soil carbon

Transport Emissions from energy use in the transport of food items in-country and internationally

Farm Methane emissions from cows, methane from rice, emissions from fertilisers, manure, and farm machinery

Animal feed On-farm emissions from crop production and its processing into feed for livestock

Retail Emissions from energy use in refrigeration and other retail processes

Processing Emissions from energy use in the process of converting raw agricultural products into final food items

Packaging Emissions from the production of packaging materials, material transport and end-of-life disposal

It is also important to utilize each patient contact to promote healthy and sustainable lives, inc. diet and exercise options.

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Green Plan 2025-2028

Action plan Food and nutrition Action

What resource is needed?

How will we measure progress?

Target Date

Introduce resuseable food containers

Capital spends for reusable items

The reduction of vegware box purchased

April 2026

The number of reusable food waste containers purchased Encourage the use of reusable cups

Promotional materials

The decrease in number of cups purchased

April 2026

Reduction in food waste

Procurement – Supply Chain Nutritional strategy across the Trust

Reduced food waste – measuring food waste through the waste machines

April 2026

Electronic food ordering

Capital costs – circa £25k per site Procurement assistance

NHS food standard

April 2028

Identifying different menu choices – seasonal menus, healthy and lower carbon options

Procurement

Number of portions ordered

April 2026

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Biodiversity Biological diversity, or biodiversity, can be described as “the variety of life on Earth. It includes all organisms, species, and populations; the genetic variation among these; and their complex assemblages of communities and ecosystems.” (Benn, 2010) Biodiversity is incredibly important for sustaining life on the planet. The interdependency we have with the species of flora, fauna, animals, birds, insects and micro-organisms is vital in sustaining our existence through absorbing carbon and regulating environmental change such as climate and disease, providing renewable sustenance at all levels of the food chain, and balancing species population.

It is important, then, that the activities we carry out in providing the services, and which we are commissioned to deliver, do not negatively impact our local, national and worldwide ecosystems.

What are we doing to sustain biodiversity?

There are great examples of encouraging biodiversity in our ICS. SaTH is collaborating with local beekeepers to provide hives at the Shrewsbury site, as well as bat boxes and swift boxes to divert such creatures away from buildings whilst providing space for them to live. This is in addition to planted trees and improved gardens and courtyards with native plants to attract pollinators.

Princess Royal Hospital (PRH) planted trees and shrubs from the NHS Forest scheme in 2024.

In 2021, Telford & Wrekin Council gave away 14,525 free trees to residents and organisations in Telford & Wrekin as part of the Trees4TW project.

What will we do now?

Look to ensure any impact of development is replaced e.g., trees, wild areas or hedges removed are replaced nearby.

We will ensure that the local habitats of our native species are considered during capital works to ensure that any works we complete have a positive impact on local wildlife. We will adopt methods already employed by some organisations in the system to provide beehives, bat and swift boxes where appropriate and plant trees and plant species in our green spaces.

Include educational plaques or signs within our green spaces to highlight the work that has been carried out to engage staff, patients and visitors and continue to assess overall biodiversity in existing green spaces.

Collaborative opportunities Share funding models / share information on available grants for investment in surveys introduction of habitats Work together to develop or update organisations ICS Green Space Strategy

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Green Plan 2025-2028

Action plan Biodiversity Action

What resource is needed?

How will we measure progress?

Target Date

Consider the impact on wildlife and nature – ensure either neutral or positive impact by developing green spaces in proximity to works and no green space removal

Organised through Capital project schemes

External verifications Governance through the Climate Change Group

April 2026

Maintain and protect healthy habitats across our estate to promote biodiversity

Include educational plagues or signs within our greenspaces to engage staff, patients and visitors

Monitoring engagement through Climate Change Group

2027

The Shrewsbury and Telford Hospital NHS Trust

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Adaptation The care we provide must be consistent throughout major incidents such as wildfires, floods, heatwaves, droughts and infectious diseases.

Sustained extremes in weather and climate are likely to become the status quo in the UK, and varied sources and data indicate that: •

•

•

•

• •

Wildfires are likely to increase 14% by 2030, 30% by the end of 2050 and 50% by the end of the century (UNEP, 2022) Flooding will increase by 15-35% by 2080, with Shropshire, Telford and Wrekin likely to experience an increase of around 25% (figure, right) (Visser- Quinn, 2021) Heatwave frequency, length and average temperatures are significantly increasing – their average length more than doubling – increasing from 5.3 days in 1961-90 to over 13 days in the decade 2008-2017 (Met Office, 2018) Sustained droughts are more common. From September 2010 to March 2012 many parts of England experienced the driest 18 months for over 100 years (Environment Agency, 2017) The emergence of SARS-CoV-2 and subsequent COVID-19 crisis in 2020 set a precedent for future outbreaks and how the country will address subsequent variants and other pandemics.

Although it is unrealistic to expect a service to continue in the event of localised flooding or incidents that incapacitate certain service delivery for some organisations, there may be opportunity to provide contingency, support or mutual aid from the wider system. Preparedness for infectious disease outbreaks is not covered in detail this document, although it is recommended that there be a systematic approach to building resilience to future pandemics and infectious disease outbreaks – for example, the mutual aid between NHS organisations in the system during the COVID-19 pandemic.

How we adapt now to the climate crisis will have significant influence on the investments required later, so it would be prudent to intervene at an early stage. The Department of Health publication for resilience in estate planning (HBN 00-07) offers guidance and all our NHS organisations should adopt this approach when producing Estates Plans. Some of the guidance is transferrable for council estates planning, and other documents such as the CIBSE guidance suite is relevant and applicable.

Collaborative opportunities

A coordinated Clinical Strategy

Shared working spaces and agile (hybrid) working to generate carbon and climate resilience benefits

Coordinated Estates Strategy and Business Continuity Plans

Mutual aid 48

Green Plan 2025-2028

Action plan Adaptation Action

What resource is needed?

How will we measure progress?

Target Date

Trust to ensure contingency plans are in place in the event of adverse weather and major incidents to provide business continuity, staff and patient safety and care provision

Engage with the organisation to ensure comprehensive and joined-up approach

Escalate through the Climate Change Group

April 2026

Ensure the Trust considers 00-07 when developing the Estates Strategies

Engagement with Estates

HBN 00-07 specified in Estates

April 2026

The Shrewsbury and Telford Hospital NHS Trust

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References Net Zero Travel and Transport Strategy NHS England » Net Zero travel and transport strategy NHS Green Plan Guidance NHS England » Green plan guidance Net Zero Building Standard NHS England » NHS Net Zero Building Standard ERIC return data Estates Returns Information Collection - NHS England Digital Shropshire Council Climate Change plan Climate strategy and action plan | Shropshire Council Telford and Wrekin Climate Change Telford & Wrekin Council | Climate change and sustainability HTM 07 Waste Management NHS England » Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste Clinical Waste Strategy NHS England » NHS clinical waste strategy NICE (2015), Medicines Optimisation: The Safe and Effective use of Medicines to Enable the Best Possible Outcomes. Available at: https://www.nice.org.uk/guidance/NG5

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Green Plan 2025-2028

Acronyms Acronym

Definition

C02e

CO2e accounts for carbon dioxide and other gases such as methane and nitrous oxide

DPI

Dry Powder Inhaler

EPR

Electronic Patient Records

GHG

Greenhouse Gases

ICB

Integrated Care Board

ICS

Integrated Care System

MPFT

Midlands Partnership NHS Foundation Trust

MS

Microsoft

NICE

National Institute for Clinical Excellence

pMDIs

Pressurised Metered Dose Inhalers

PV

Photovoltaic (Solar panels that convert the Sun’s energy into useful electrical power)

QIPP

Quality, Innovation, Productivity and Prevention

REGO

Renewable Energy Guarantees of Origin

RJAH

The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

ROI

Return on Investment

SaTH

The Shrewsbury and Telford Hospital NHS Trust

SC

Shropshire Council

SCHT

Shropshire Community Health NHS Trust

SM

Salmeterol

TW

Telford & Wrekin Council

WMAS

West Midlands Ambulance Service

The Shrewsbury and Telford Hospital NHS Trust

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