NHS managers ordered to look at environmental impact of decisions - The Guardian

The NHS produces nearly as much carbon dioxide annually as Croatia. Photograph: Pulse Picture Library/PA

Flower arranging classes for ulcer patients, water-powered air conditioning for hospitals and instructions to doctors on using the correct bin – all are key elements of a greener future for the National Health Service to be set out today.

Health service managers will be handed a "route map" laying out some of the measures they need to take to meet the government's greenhouse gas targets. The NHS, which produces nearly as much carbon dioxide annually as Croatia, must cut its carbon emissions by 10% by 2015.

Under the plans, the NHS will have to change its focus from curing sickness to becoming a "preventative and tailor-made wellbeing service", taking into account the environmental costs of decisions as well as their financial implications. This could potentially include the radical redeployment of health service funds, such as paying for home insulation for older people, which could reduce hospital admissions in winter.

Several primary care trusts and treatment centres have already begun taking unusual steps to reduce their greenhouse gas emissions in ways they say will also result in better outcomes for patients. At one GP practice in London, older patients with leg ulcers are sent to flower arranging classes.

Making use of local amenities is also key; in Nottinghamshire, the Kings Mill Hospital development includes a £4m geothermal energy project – one of the biggest in Europe – at a nearby reservoir. Through a system of heat exchangers, the water provides cooling in summer and 40% of the energy needed to heat the hospital in winter.

Encouraging medical staff to recycle correctly is saving money for several trusts, which have discovered they are wasting hundreds of thousands of pounds paying for expensive clinical waste disposal for bins stuffed with normal rubbish.

Throughout the country, more hospital meals will be vegetarian and more food will be sourced from local farms. Managers are being encouraged to consider installing solar panels and wind turbines or incorporating features such as "green roofs" into new buildings.

Tim Ballard, a GP practising in rural Wiltshire, said many practices were enthusiastic about the plans, particularly the emphasis on providing more treatments as close to the patient as possible, removing the need to travel to hospital. "GPs are very good at seeing things holistically," he said. "We understand the impact that even small changes can have on patients' quality of life."

Other measures could prove more controversial. At one centre in Oxford, telephone interviews with bipolar patients will replace face-to-face sessions with health professionals.

Missing from today's announcement is any indication of what might happen to the green aspirations when GPs are put in charge of commissioning services. It is not clear whether GP consortiums will be given responsibility for meeting carbon reduction targets at the same time as they are handed the NHS purse strings.

David Pencheon, the director of the NHS sustainable development unit, said savings on energy bills and other resources would provide a spur: "GPs will see the advantages in improving efficiency."

Sir David Nicholson, the chief executive of the NHS, said the health service should not only make decisions based on finance "but must focus too on social and environmental sustainability, so that the NHS of the future remains in the best possible position to improve quality and to limit its impact on the environment".

Simon Burns, the minister of state for health, said: "At a time when we are driving forward significant change to improve outcomes and meet the financial and practical challenges of increasing demand for our services, we have the opportunity to create a truly sustainable NHS. "

But the cuts being made by the government may do more to reduce the NHS carbon footprint than any other measure, without installing a single solar panel or wind turbine. If operations are cancelled or hospitals are closed, as some fear, carbon emissions will fall almost inevitably.