From eliminating single-use plastics and cutting emissions, to building resilience to pandemics, the list of sustainability issues the NHS has to contend with is endless. Heidi Barnard, PIEMA, head of sustainability at NHS Supply Chain, tells Chris Seekings how she tackles them.
Despite facing numerous challenges, the NHS remains a great source of national pride for the UK public, and consistently features among the most important issues for people up and down the country.
As the largest employer in Europe, it also has a huge environmental impact, accounting for around 4-5% of the UK’s total carbon emissions and 40% of the public sector’s emissions in England.
The majority of these fall within scope 3 of the NHS’ carbon footprint – a complex value chain for a vast array of products and services, managed by NHS Supply Chain.
As the organisation’s head of sustainability, Heidi Barnard faces the daunting task of ensuring it is consistent with the NHS’ target to become the “world’s first net-zero carbon national health system” by 2045.
A new challenge
She spent nearly 14 years working in the built environment, before joining the healthcare sector at the Northern Care Alliance NHS Foundation Trust in 2019, and then NHS Supply Chain in September last year.
“I wanted a new challenge that would appeal to my interest in social sustainability. The healthcare sector really speaks to that, and the link between the climate crisis and health.”
NHS Supply Chain manages the sourcing, delivery and supply of healthcare products, services and food for NHS trusts in England and Wales – including everything from toothpaste to MRI scanners – managing more than 7.7 million orders per year across 16,705 locations.
“The first 14 years of my career were all about products and manufacturing processes, which was very straightforward,” Barnard says. “But when you move into the healthcare sector, you’re looking at things from a very different perspective. It’s not about delivering a product, it’s about delivering healthcare, which encompasses millions of different products. More importantly, it’s about people and about how you make people feel. It’s a much more emotionally-led conversation.”
Although the workings of the NHS can be similar to those of many other large organisations, there are some very unique considerations that Barnard has to make when it comes to minimising its environmental impact.
All about context
“We’re buying on behalf of the NHS, and not one or two products; we’re buying millions or in many cases billions of items,” she says. “So, for things like personal protective equipment (PPE), theatre caps and aprons, we always need to ask if there are reusable alternatives.”
However, she also has to consider how all these products will eventually be used by the clinicians themselves in a hospital setting and abide by medical device regulations. Similarly, when making a large capital investment in a piece of equipment, there are a whole range of considerations.
“When you go out to tender, you will obviously be looking at the environmental impact and the energy efficiency of that product, but it’s also about understanding how it is used within a particular diagnostic centre or particular theatre suite to understand what’s driving carbon in that patient pathway,” she says.
“If we’re bringing patients in from miles around, is it worth looking at how we do diagnostics in the community? It’s about understanding the whole system side of things, not just the individual product side of it.”
At the same time, the health and social care system is facing an unprecedented financial challenge, and Barnard is one of a small four-person team looking to embed sustainability throughout the supply chain.
To this end, a key part of her role is influencing the numerous companies and people connected to the NHS to make more sustainable decisions. “We need everyone to come on that journey with us and look at how we can deliver better value for the NHS in terms of financial, social and environmental value, having conversations with all our stakeholders,” she explains. “Changing the product is probably the easiest part, but actually changing the behaviour around that is more difficult because people get used to what they do, and they’ve been taught to do something in a certain way. If you’ve got somebody doing a 12- or 13-hour surgery and they are used to doing it a certain way, changing that is going to take time.”
Again, there always has to be consideration of potential knock-on effects for patients. “It’s thinking about how changing one item impacts on everything else you’d need for a particular process or procedure,” says Barnard.
“It’s a huge challenge to try to do things differently when you’re in the middle of a post-pandemic recovery situation – there’s a lot of pressure to deliver.”
When it comes to selecting product suppliers, this is guided by the NHS’ Supplier Roadmap, which includes a list of key criteria, such as a requirement for carbon reduction plans, and for all procurements to include a minimum 10% net zero and social value weighting.
“The latest tool that the NHS has deployed is the Evergreen assessment, which is a kind of one-stop shop for suppliers to tell the NHS what they’re doing on all sorts of environmental impacts,” Barnard says. “It allows recognition of companies undertaking third-party auditing because, again, if you think about the breadth of suppliers we’ve got, trying to tackle that level of assurance becomes mind-boggling in terms of the size of team you’d need to do it.”
Although single-use plastics are prevalent in so many of the everyday products and packaging we all purchase, they are ubiquitous throughout healthcare owing to factors unique to the sector. “It could be infection control, risk, ease of use, cost or cleanability. It can also be about product efficacy because the plastic within the product has a functional use and there is no alternative at the minute.”
The Department for Environment, Food & Rural Affairs (Defra) has announced that businesses will no longer be able to sell single-use plastic plates, bowls, trays, containers and cutlery, starting from October this year. NHS Supply Chain has been making changes where necessary, but shifting away from plastic is not always possible in a hospital setting. “Post-pandemic, we went from having reusable cutlery to single-use cutlery because of the fear of infection control,” Barnard explains.
“Infection control often gets positioned as the enemy of sustainability, but they’ve been some of our best allies when it comes to understanding why we’ve got to where we are, and how we might do things differently,” she adds.
For needles, gloves, syringes and other single-use products, there are regulations that NHS trusts have to contend with regarding infectious and non-infectious waste, but many of these products are destined for incineration.
“There are a few different projects trying to extract plastics and look at the value chain, but again, it’s the infrastructure and behaviours around how we manage those waste materials that actually are the barrier we need to overcome.”
Barnard says. “If you think about how healthcare waste is collected and about how it’s transported, there’s limited segregation as it is really quite complicated. And again, if you think about a healthcare setting, it’s not like you’ve got acres of space to have lots of different bins for different things.”
Barnard joined NHS Supply Chain as the UK was emerging from the pandemic, and also missed much of the shock and confusion caused by the Brexit vote in 2016. However, she is still having to deal with some of the consequences. “Because we are not necessarily doing what the rest of Europe is doing now, our suppliers may have to provide niche products for the UK that add a cost,” she says. “However, there is a trend looking more to how we can standardise everything in the net-zero space so that suppliers are all moving in the same direction, and the rest of the world is looking to what we’re doing.”
Following the outbreak of Covid-19, the UK government set up a PPE dedicated supply channel, which was a parallel supply chain to the normal NHS Supply Chain service, allowing NHS Supply Chain to focus on ensuring the supply of medical devices and clinical consumables to the NHS. “The experience has helped us build resilience since the pandemic, in terms of our forecasting and understanding what we’re going to need to have stocks of at certain times,” Barnard explains.
Another key area of her work concerns modern slavery, and all suppliers to the NHS must now undertake an appraisal using a Modern Slavery Assessment Tool. “I deal with evaluating labour standards and adding social value,” she says. “There are known issues that we have to manage, and understanding our supply chains, the raw materials, and everything else that goes into our products and services is a fundamental part of that story.”
Eliminating modern slavery and responding to pandemics are just a couple of the global challenges that highlight the interconnectedness of supply chains and the benefits of mutual cooperation – something that is going to become increasingly important as the climate crisis intensifies.
“Wildfires and other big weather events may shut down a factory that produces a specific component, which has a knock-on effect for the NHS, for example. We’ve seen that already with microchips in equipment, and supply chains being impacted by climate changes. Every day really is a school day when it comes to determining demand patterns and supply issues.”