NHS SNEEICS - Green Plan

Green Plan Suffolk and North East Essex Integrated Care System

The Suffolk and North East Essex Integrated Care System (SNEE ICS) is a partnership of health, local government and voluntary sector organisations. Its primary ambition is ‘health equality for everyone’. We have agreed how we will work together as an ICS. We will work together in partnership, not as a structure or hierarchy. Our ICS will create an environment that enables us to work together through our three alliances and the individual neighbourhoods within them, because every local community has different needs. Our three alliances bring together local partners in north east Essex, Ipswich and east Suffolk and west Suffolk. They will each provide a forum for planning and delivering joined-up care and services for local people. Around 1,022,000 people are registered with GPs across Suffolk and north east Essex: 412,000 in Ipswich and east Suffolk, 356,000 in north east Essex and 254,000 in west Suffolk. The population within Suffolk and north east Essex (excluding Waveney) is projected to grow 10% by 2036. On 1 July 2022, the NHS became the first health system to embed net zero into legislation through the Health and Care Act. This places duties on NHS England, and all Trusts, Foundation Trusts, and Integrated Care Boards (ICBs) to contribute towards statutory emissions and environmental targets. Trusts and ICBs will meet this new duty through the delivery of their Green Plans. The NHS Suffolk and North East Essex ICB replaces the previous Clinical Commissioning Groups’ planning functions. This Green Plan outlines the ambition that the ICB has to drive and support the wider ICS partners in addition to its own targets. Figures: August 2019 What is the Suffolk and North East Essex Integrated Care System? Ipswich & East Suffolk Alliance Our three alliances

Contents Foreword 4 Green Plan on a page 5 Introduction Why we must act 7 Why we must act quickly and decisively 8 The NHS response; Carbon and healthcare 9 The NHS carbon footprint 10 Our approach; An opportunity 10 How will we achieve our goals? 11 Our guiding principles 12 System leadership and support 13 Key Themes Workforce and system leadership 16 Air pollution 17 Climate adaptation 18 Digital transformation 19 Estates and facilities 20 Travel and transport 21 Green spaces and biodiversity 22 Medicines 23 Sustainable models of care 24 Supply chain and procurement 25 Food and nutrition 26 Waste 27 Our Actions Celebrating our successes 29 How we will be measuring our performance and impacts 30 Our initial activities 31 What will success look like in 2025? 32 References 33 Authors and Contributors 36 Suffolk and North East Essex Integrated Care System Green Plan | 3 Contents

Foreword Tackling climate change in health and social care provides not only an opportunity to think differently together, but also an opportunity to do things differently together. A system-wide approach can deliver benefits in terms of partnership working, collaboration and efficiency, ensuring we tackle the challenges of the climate emergency and improve the wider determinants of health. Reducing emissions will save admissions. Tackling the causes and mitigating the impacts of climate change will provide us with an opportunity to improve health outcomes on several fronts. 1 For instance, our strategy sets out to tackle health and environmental issues such as air pollution, which is the fourth greatest threat to public health after cancer, heart disease and obesity.2 Reducing carbon emissions by, for example, switching to cleaner, renewable energy and transitioning to electric vehicle fleets will not only improve air quality, it will also drive carbon out of our system. Both measures will also then benefit our communities, their health, and the system, in a virtuous circle - we will help break the current vicious cycle. The key pillars of this Green Plan are engagement, awareness-raising, partnership working, collaboration, training, improving data, innovation and building on the successes that the system has already achieved. Identifying and sharing best practice is critical to what we want to achieve. By embracing this the ICS can be an enabler for change, supporting our system partners to improve our climate, health, and wellbeing agenda. Our strategy is holistic, and spreads beyond the traditional successful interventions of estates and travel which have done so much to reduce our carbon emissions. We will continue to encourage the four principles of sustainable models of care - prevention, patient self-care, lean service delivery and lower carbon alternatives - at every opportunity. Our desire as a system is to embed the sustainability principles of carbon literacy, social value, and the circular economy, and to harness both digital transformation and nature to improve health and wellbeing outcomes by 2025. However, the links between climate change and health are not commonly realised. Therefore, one major objective of our strategy is to engage with our staff, system partners and communities to overcome this barrier to change. This Green Plan is intrinsic to this. By making engagement and awareness-raising key pillars, our strategy will provide an emphatic message that by tackling climate change collectively we can create positive health and wellbeing outcomes for everybody. Our Green Plan addresses the wider sustainability goals we want to achieve as system by • reducing the impacts of air pollution on health • tackling the causes and effects of health inequalities and poverty • reducing and mitigating the impacts of climate change on the system and population health • delivering the NHS Long Term Plan (value for money, staff development, embracing digital and doing things differently) and • providing leadership through actions, partnerships, engagement and transparency to deliver a net-zero NHS. Our strategy will achieve collective ownership and accountability and embed sustainability into our system. By achieving the UK climate change targets we can help save over 100,000 lives per year.3 We must all play our role in this urgent health opportunity. Foreword Suffolk and North East Essex Integrated Care System Green Plan | 4 Will Pope Chair Suffolk and North East Essex Dr Ed Garratt Chief Officer Suffolk and North East Essex Amanda Lyes Director Workforce & People Suffolk and North East Essex

Green Plan Suffolk and North East Essex Integrated Care System Air Pollution • Implement the air pollution hierarchy • Clean Air Day to raise awareness • Healthcare training on air pollution • Pollution hotspot data work Food and nutrition • Healthier low carbon diets • Reduce food waste • Local and seasonal food menus Estates and facilities • Make every kilowatt hour count – energy savings • Whole life carbon approaches • Renewable energy • Biophilic design with green spaces Workforce and system leadership • Awareness raising and sustainability training • Collaboration and partnership working • Transparent reporting • Listening to our communities Waste and the circular economy • Circular economy thinking • Waste avoidance, re-use, repair and recycle • Targeting single use plastics and food waste Travel and transport • Electric vehicle switches and infrastructure • Active travel infrastructure and activity • Mitigate supply chain impacts Climate adaptation • Planning resilience forum collaboration • Long term climate adaption planning • Climate change on risk registers Digital transformation • Digital carbon challenge – less email • Digital innovation on care pathways • Reduce digital waste and increase efficiencies Supply chain and procurement • 5Rs of sustainable procurement • Social value in all procurements • NHS Supply chain roadmap – engage suppliers Sustainable models of care • Personalised models of care • Care pathway innovation • Promote sustainable healthcare Medicines • Lower carbon medicines – inhaler and anaesthetic gas switches • Medical equipment re-use • Reduce waste and promote illness prevention Green spaces and biodiversity • Green space and biodiversity plans • Promote green space health and wellbeing benefits • Social prescribing and community hub developments Suffolk and North East Essex Integrated Care System Green Plan | 5

Suffolk and North East Essex Integrated Care System – Green Plan Introduction

Why we must act The average global temperatures have risen by over 1.2 degrees C since pre-industrial levels, predominantly caused by release of greenhouse gasses. This warming is creating an instability in Earth’s systems, leading to climate change. Climate change means we are experiencing, amongst other things, more extreme weather events which have negative health impacts.4 The negative health impacts of climate change include; • heatwaves – experts predict 7,000 extra heat-related deaths in the UK per year if climate change goes unabated • more flooding – data shows we witness 2-5 fivefold increase in mental health cases after flood events • more pollution - linked to cancer, strokes, heart disease and dementia etc, and • higher UV exposure - linked to increases in skin cancer and cataracts. Climate change places increased demand and pressure on frontline services, impacts the most vulnerable in our society and costs us financially.4 The Lancet has identified climate change as the biggest threat to healthcare in the 21st Century.5 Tackling this threat requires a system-wide response which means increasing climate resilience and addressing key vulnerability factors to reduce climate sensitive health risks identified by the World Health Organisation (WHO).6 Source: Climate change and health (who.int)6 An overview of climate-sensitive health risks, their exposure pathways and vulnerability factors Introduction Suffolk and North East Essex Integrated Care System Green Plan | 7 Climate-Sensitive Health Risks Injury and mortality from extreme weather events Heat related illness Respiratory illness Water-borne diseases and other waterrelated health impacts Zoonoses Vector-borne diseases Malnutrition and foodborne diseases Non communicable diseases (NCDs) Mental and psychosocial health Impacts on healthcare facilities Effects on health systems Health outcomes Health systems & facilities outcomes Vulnerability Climate Change Vulnerability factors • Demographic factors • Geographic factors • Biological factors & health status • Sociopolitical conditions • Socioeconomic factors Health system capacity & resilience • Leadership & governance • Health workforce • Health information systems • Essential medical products & technologies • Service delivery • Financing Exposure pathways • Extreme weather events • Heat stress • Air quality • Water quality and quantity • Food security and safety • Vector distribution & ecology

Why we must act quickly and decisively A recent (April 2022) You Gov Poll regarding UK residents attitudes to climate change found that 59% of respondents were worried about climate change. 57% felt we are still able to avoid the worst effects of climate change but it would need a drastic change in the steps taken to tackle it.7 Health and Climate Change – The View of our Residents8 The UK Climate Change Act has set a target to be carbon neutral by 2050 in order to stay within 1.5 degrees C warming from pre-industrial levels.9 Reducing our emissions in this decade is critical due to the way in which greenhouse gasses form and accumulate in our atmosphere.10 For the NHS, this means almost halving our own emissions from 2019 levels by 2030.11 Introduction Suffolk and North East Essex Integrated Care System Green Plan | 8

The NHS response; Carbon and healthcare The NHS is the UK’s largest employer and is responsible for 4-5% of the UK’s carbon emissions, so we have a critical role to play.12 In response to the climate challenge the NHS has pledged to be net zero carbon by 2040 on its own emissions (scope 1 direct and 2 indirect) and its entire scope (indirect emissions where we have influence) by 2045 (scope 3). Carbon neutrality, which is the same as net zero emissions, means a balance between emissions into the atmosphere and removal of emissions from the atmosphere.13 Decarbonising our system is our ethos, rather than relying on any measures to offset carbon at this stage. Offsetting involves investing into a scheme that funds something such as tree planting or renewable energy to negate or ‘offset’ carbon emissions.14 The major emissions of the NHS carbon footprint are shown in this graphic (methane, nitrous oxide, sulphur hexafluoride, carbon dioxide, CFC, perfluorocarbons, and hydrofluorocarbons). When looking at carbon emissions it’s important to note that ‘carbon’ is used as a collective term for all these greenhouse gas emissions. This is expressed as carbon dioxide equivalents.10 Decarbonising requires many actions targeting different elements across the system. Some actions are easier and low-cost, including transition to active travel modes such as walking and cycling instead of driving when commuting. Switching NHS secondary care to LED light bulbs would pay back in 3.7 years with estimated savings of £3bn over the next three decades.12 However, some areas will require financial investment and longer pay-back periods than we traditionally use, such as investing in renewable energy systems and decarbonising our heating. Thinking and approaching these decisions sustainably by considering the wider health impacts of a decision (social benefit), the carbon or pollution benefit (environmental benefit) alongside the monetary costs (financial benefit) will help drive the changes needed. For example, investing in preventative measures could cut the cost of air pollution to society by £1.7bn every year.2 Source: Delivering a Net Zero National Health Service12 Fossil Fuels Electricity NHS Carbon Footprint Scope 1 DIRECT Scope 2 INDIRECT Scope 3 INDIRECT Travel OUTSIDE GHGP SCOPES NHS Carbon Footprint Plus NHS Facilities Anaesthetics NHS Fleet & Leased Vehicles Energy WELL-TO-TANK Business Travel PUBLIC TRANSPORT, GREY FLEET ETC. Waste Water Metered Dose Inhalers Medical Devices Freight Transport Business Services Construction Manufacturing PRODUCTS, CHEMICALS, GASES Medicines Patient, Visitor Travel Food & Catering Commissioned Health Services Outside NHS ICT Staff Commuting Major Emissions CH4 N2O SF6 CO2 CFCs PFCs HFCs Greenhouse Gas Protocol scopes in the context of the NHS Introduction Suffolk and North East Essex Integrated Care System Green Plan | 9

The NHS carbon footprint In 2020 it is estimated the NHS and its supply chain produced 31 million tonnes of carbon dioxide equivalent emissions.12 The four main elements of the NHS carbon footprint are travel (14%), our estates (building energy and waste 15%) and medicines (inhalers and gasses 5%), with the remaining two thirds (62%) related to supply chain and procurement (in green). Our system-wide strategy is based on addressing these four elements under 12 themes interlinking different parts of the system to collaborate and add value. Within the Suffolk and North East Essex Integrated Care System (SNEE ICS) we will be working with Greener NHS to identify our carbon footprint across our system to benchmark for this for the first time. Source: NHS Net zero strategy12 Commissioned health services outside NHS Medicines and chemicals Medicines, medical equipment, and other supply chain NHS carbon footprint Personal travel Anaesthetic gases and metered dose inhalers Business travel and NHS fleet Patient travel Staff commute Visitor travel 1% 4% 20% 10% 8% 24% 10% 5% 5% 4% 5% 4% Medical equipment Non-medical equipment Other supply chain Building energy Water and waste Sources of carbon emissions by proportion of NHS Carbon Footprint Plus Our approach; An opportunity Climate change is recognised as the greatest threat to healthcare in the 21st Century by The Lancet.3 In a climate emergency, it is also recognised this is a health emergency. Yet, if the UK hits its climate reduction targets becoming net zero in our emissions we can save over 100,000 lives per year.3 In the SNEE ICS our approach is to treat the climate and health emergency as an opportunity.15 It is an opportunity to improve how we deliver care, how we work with our partners and communities to prevent illness and be more sustainable in our day-to-day business. Our ICS Green Plan is the first step in our system-wide response to the health challenge that climate change brings. It links our five trusts’ green plans together into a coherent, over-arching strategy and includes primary care. As part of its development, the ICS has consulted with wider system partners on areas such as air pollution, travel and transport, and social value to ensure we have a wider collaborative foundation in place. In setting the foundation we have focussed on core NHS institutions within our system. During year one we will deepen the system-wide engagement, having already consulted with wider care partners (local authorities, voluntary and community sector organisations, social care, pharmacy, public health, academia and our communities). Widening the scope of this initial strategy in year one, we will incorporate these wider system partners with our action plans, ensuring its breadth expands beyond traditional NHS institutions. Introduction Suffolk and North East Essex Integrated Care System Green Plan | 10

Our holistic strategy isn’t just focused on climate change and carbon reduction. It represents a shift in emphasis to address wider sustainability goals that we want to achieve as a system: • tackling the causes and effects of health inequalities and poverty16 • reducing the impacts of air pollution on health • reducing and mitigating the impacts of climate change on the system and population health • delivering the NHS Long Term Plan17 (value for money, staff development, embracing digital and doing things differently) and • providing leadership through actions, partnerships, engagement, and transparency to deliver a net zero NHS. The key pillars of our Green Plan to achieve these goals are engagement, awareness raising, training, partnership working, collaboration, improving our data, innovation and to build momentum on the successes that the system has already achieved. These pillars will build the foundations for future activities to underpin collective ownership and accountability and embed sustainability into our culture. By the end of this strategy, we will develop a roadmap to transition from our 2025 position to carbon neutrality of our own emissions before the 2040 NHS target. How will we achieve our goals? We have outlined our goals to drive the outcomes necessary to take our system forward. These are underpinned by strategic objectives in 12 key themes. Within these themes we have outlined key activities that we need to undertake to support our objectives. Within the first six months of our strategy each key theme will have action plans in place owned by leaders within the system. Our approach is to tackle each of the themes and issues at system level with shared goals that different providers, partners and suppliers can support, using a green thread to connect health and wellbeing with actions to reduce carbon emissions, promote prevention, tackle inequalities and drive improvement and productivity. We have already started this programme, having developed a soon to be launched sustainability guide for primary care, supported procurement functions, consulted with our medicines management team, Trusts and our pharmacists to develop a low carbon inhaler switch programme. We have also embarked on systemwide engagement around electric vehicle infrastructure. Introduction Suffolk and North East Essex Integrated Care System Green Plan | 11 12 Guiding Principles • Inspire/educate • Equip/upskill • Climate resilient • Sustainable models of care • Linear to circular economy • Low carbon travel • Embed digital • Make every kilowatt hour count • Establish our carbon footprint • Data driven for continuous improvement • Be a positive anchor • Think big act locally 12 Themes • Workforce • Air Pollution • Climate adaptation • Digital transformation • Estates • Travel • Green spaces and biodiversity • Medicines • Sustainable models of care • Supply chain • Food and nutrition • Waste To deliver Guided by 5 Sustainability Goals Embed Sustainability in our Culture To achieve • Tackling health inequality • Tackling air pollution • Tackling climate change impacts on population health • NHS Long Term Plan • Visible leadership Collective ownership Accountability Engagement Awareness Raising Training Partnership Working Collaboration Improving Our Data Innovation

Our guiding principles 3 Ensuring SNEE is a climate resilient health system capable of anticipating, responding to, coping with, recovering from and adapting to climate-related shocks and stress, so as to bring about sustained improvements in population health, despite an unstable climate.18 1 To inspire and educate our workforce, system partners and communities to be more sustainable in their work and home lives. 5 To commence the transition from a linear consumption model of ‘reduce, reuse, recycle, dispose’ to a circular economy that minimises waste, carbon and consumption. 9 To establish our carbon footprint and a carbon budget providing visibility and measurement to drive positive outcomes, ultimately achieving the NHS carbon reduction target by halving emissions from 2019 levels by 2030. 2 To equip, upskill and provide the right tools for an inspired system workforce to drive the behaviour and system changes required to deliver a net zero system. 6 To inspire and equip our people to adopt low carbon travel options, maximising active travel, digital and hybrid ways of working opportunities wherever possible. 10 To be data driven in order to provide transparency, show leadership and underpin a culture of continuous improvement and accountability. 7 To embed the eight principles of our ICS Digital Strategy into our sustainability programme, ensuring our staff recognise and embrace digital transformation as an enabler to reduce carbon emissions, improve patient care and optimise system working. 4 To be an ICS that embraces the principles of sustainable models of care, namely prevention, patient self-care, lean service delivery and providing low carbon alternatives. 11 To reduce health inequalities within our communities using our position as a key anchor organisation to drive positive social change that improves health and wellbeing outcomes. 8 To embed the principles of the NHS ‘make every kilowatt hour count’ approach to decarbonising our estate as we transition to a low carbon estate and renewable energy sources. 12 To think big and act locally, ensuring a targeted local focus accelerates progress and inspires specific communities where key activity is focused. Introduction Suffolk and North East Essex Integrated Care System Green Plan | 12

System leadership and support Leading and influencing change Within our system, the ICS and trusts have nominated a ‘Board Lead’ responsible for sustainability. This is a critical step in developing accountability and supports us to weave sustainability threads into all aspects of our organisations, demonstrating to our communities, workforce and partners that sustainability is a strategic priority. Supporting our communities and our role as anchors As an anchor institution (a large not-for-profit public sector organisation that’s anchored – tied - into its community)19 the system can positively contribute to our local communities in many ways beyond providing health and care services.20 As an anchor institution we can influence many organisations and people to embrace the principles of sustainability and impact carbon across a geographic area. As an anchor organisation we intend to make an impact on carbon in SNEE by influencing staff (around what they do at home), wider partners and providers of healthcare, social care, VCSE and suppliers and manufacturers, local businesses education providers and partners. Supporting and integrating with our system partners Through our existing work with our partners the ICS is delivering value and supporting our communities as members of the Essex Climate and Social Value Anchors Working Groups, Suffolk Climate Board, Suffolk Air Quality Group and Colchester Travel Club. As an ICS we are already sharing goals with our partners linking climate and health actions together. Supporting Primary Care Primary care represents 23% of the NHS carbon footprint21 yet it meets 90% of our patients.22 Acting as a trusted messenger with our communities, primary care is at the front line in helping the ICS to engage with our communities on tackling climate change to improve health outcomes.23 Supporting primary care to achieve our climate change targets is therefore a critical element of our strategy. The ICS, in conjunction with Greener Practice Essex and Source: The NHS as an anchor institution (health.org.uk)20 Purchasing more locally and for social benefit In England alone, the NHS spends £27bn every year on goods and services. Using buildings and spaces to support communities The NHS occupies 8,253 sites across England on 6,500 hectares of land. Widening access to quality work The NHS is the UK’s biggest employer, with 1.6 million staff. Reducing its environmental impact The NHS is responsible for 40% of the public sector’s carbon footprint. Working more closely with local partners The NHS can learn from others, spread good ideas and model civic responsibility. What makes the NHS an anchor institution? NHS organisations are rooted in their communities. Through its size and scale the NHS can positively contribute to local areas in many ways beyond providing health care. The NHS can make a difference to local people by: As an anchor institution, the NHS influences the health and wellbeing of communities simply by being there. But by choosing to invest in and work with others locally and responsibly, the NHS can have an even greater impact on the wider factors that make us healthy. Introduction Suffolk and North East Essex Integrated Care System Green Plan | 13

Suffolk, has developed a guide to support general practices in tackling climate change. Integrating primary care and secondary care within our strategy is allowing us to collaborate in initiatives (such as switching to low carbon inhalers) more effectively, ensuring we can drive down carbon emission whilst we optimise patient care. Supporting Our Trusts The five trusts working within our system are the East of England Ambulance Service Trust (EEAST), the Essex Partnership University Hospitals Trust (EPUT), the East Suffolk and North Essex NHS Foundation Trust (ESNEFT), the West Suffolk NHS Foundation Trust (WSFT) and the Norfolk and Suffolk NHS Foundation Trust (NSFT). Where a system-wide approach can be a point of difference for our trusts, we have identified key areas to act as a positive enabler, including travel and transport infrastructure, greening spaces and adopting nature-based approaches, estates collaboration, electric vehicle charging infrastructure, digital transformation, supply chain and procurement, training and upskilling staff and partners, climate adaptation and system resilience, innovation and clinical partnerships and providing social benefits. Supporting our external suppliers With two thirds of the NHS carbon footprint associated with goods and services that we procure, commission and consume from external organisations, working with our supply chains is an essential element of our sustainability strategy.12 Developing a ‘whole cycle’24 approach to procurement means we can embed at the beginning of a process (the ‘concept and design stage’). This will mean supporting our system decision makers, procurement teams and supply chain in our journey to net zero. We will encourage adopting a ‘value chain’24 approach to drive best practice and innovation that increases social value benefits and reduces waste and carbon emissions. Our initial focus will be on data gathering, supplier engagement and projects that target personal protection equipment, walking aids, single use plastics (catering and clinical), furniture re-use and reducing packaging and food waste. Using the NHS supply chain road map, we will send a clear message to our suppliers on our intentions, giving them time to prepare for the changes needed. * 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. Jan 2022 April 2027 April 2028 April 2022 April 2024 April 2023 April 2030 April 2045 • Net Zero Supply Chain • Net Zero NHS New requirements will be introduced overseeing the provision of carbon footprinting for individual products supplied to the NHS 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 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 demonstrate progress in-line with the NHS net zero targets, through published progress reports and continued carbon emissions reporting 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) 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 NHSE&I will launch the Sustainable Supplier Framework NHS Supply Chain Net Zero Roadmap25 Introduction Suffolk and North East Essex Integrated Care System Green Plan | 14

Suffolk and North East Essex Integrated Care System – Green Plan Key Themes

The opportunity – what we can achieve The NHS employs 1.3 million people and is the largest employer in the country, giving us reach and impact. Engaging our workforce is critical. Positive engagement can have a huge bearing on developing work habits that staff can also take home to achieve low impact living, also influencing family and friends. Nine in ten NHS staff support the NHS taking action to tackle climate change and want to move this opportunity forward.26 YouGov Poll, July 2021 – Q: To what extent do you oppose or support the NHS taking action to reach net zero 87% in favour Base: 2,690 NHS staff Positive system leadership can raise awareness, build understanding and inspire action. We need to continue to develop the tools to support our people Strategic objectives Develop a programme of awareness raising, sustainability training and personal development that increases carbon literacy across our system. Making sustainability training mandatory. Support, engage and develop our workforce and system partners to define and deliver carbon reduction initiatives and broader sustainability goals Provide assurance and governance models driven by the development of annual reporting for sustainability and a dashboard to measure the health impacts which are transparent and measure how we are delivering real change. Why it matters Health, wellbeing and climate change are inextricably linked. A Net Zero NHS is not achievable unless we influence the ‘hearts and minds’ of all our staff and communities. Climate change impacts are about people and will impact how we as individuals will live. Tackling climate change supports our communities’ ability to live well. Suffolk27 and Essex28 Wellbeing Strategies. More than half of the emissions reductions necessary require changes in people’s behaviour.29 Raising awareness of health benefits and climate mitigation and together may increase public support and action in response to climate change. As a large local employer, our reach and impact can be powerful beyond the workplace. Key activity ICS-wide workshop sponsored by our People Board to implement sustainability training across the system. Driving a system wide approach to making sustainability training mandatory. Continue wider partnership collaboration through the Essex County Council Climate and Social Value Anchors work and Suffolk Climate Emergency Action plan, prevent duplication, provide value for money, identify and coordinate responses to systemwide issues. Community engagement through the ICS VCSE Strategy group and other forums such as localised patient participation groups to engage, listen and learn to support delivery of carbon reduction initiatives and broader sustainability goals. Workforce and system leadership Suffolk and North East Essex Integrated Care System Green Plan | 16 Key Themes

The opportunity – what we can achieve If the UK hits its climate change target, we will annually save 5,700 lives nationally every year from reducing air pollution.3 Tackling air pollution will reduce the number of diseases associated with it, such as heart disease.2 Improvements to air quality are also an important co-benefit of interventions targeting other health outcomes, such as active travel and increased physical activity.30 Working with our partners, we can help prevent future illnesses rather than just treat them. Making small changes can make a big difference - just a small change in activity to reduce pollution (1µg/m3 reduction in PM2.5 concentrations) could prevent 50,000 new cases of coronary heart disease this year and 9,000 new cases of asthma by 2035.2 Why it matters Air pollution is the top environmental risk to human health in the UK, and the fourth greatest threat to public health after cancer, heart disease and obesity.2 In 2020 a coroner recorded the first instance of air pollution as a cause of death in the UK.31 Air pollution causes ill health and mortality. It is the leading environmental cause of premature death globally, with outdoor (ambient) air pollution causing approximately 4 million premature deaths annually, predominantly due to stroke, heart disease, lung cancer and chronic respiratory diseases.32 Recent research commissioned by Public Health England has found that the health and social care costs of air pollution (PM2.5 and NO2) in England could reach £5.3 billion by 2035. This is a cumulative cost for diseases which have a strong association with air pollution, such as coronary heart disease, stroke, lung cancer and childhood asthma.33 Strategic objectives Demonstrating leadership and empowering our workforce and our communities to help them understand how they can protect themselves by making practical improvements. Working with ICS partners to prevent, mitigate and avoid air pollution and improve health outcomes. Reviewing air pollution data and targeting key pollution hotspots to improve health outcomes. Key activity Implement the air pollution hierarchy Clean air day to raise awareness Clean Air Day | Action for Clean Air Healthcare training on air pollution Baseline data reviews to determine action plan Air pollution Air Pollution Hierarchy of Intervention PREVENT MI T I GAT E AVOI D Consider policy interventions and technological abatement (dust abatement, emission ceilings, emission concentration limits) Reduce demand for more polluting forms of transport and use cleaner vehicles Consider changes in livestock housing and management, feeding Regime and manure management Redesign spaces to introduce barriers and separate people from pollution Take steps to reduce our personal contributions to pollution at home and on the move Redesign spaces to reduce polluting activities and encourage active transport Try to keep sources of pollution away from people Displace pollutant emissions outside hot spots and populated areas to reduce population exposure Try to take less polluted routes and reduce time spent in polluted places Source: Public Health England34 Suffolk and North East Essex Integrated Care System Green Plan | 17 Key Themes

The opportunity – what we can achieve Well-designed actions to promote adaptation can also reduce the negative health impacts of climate change.35 The World Health Organisation (WHO) outlines areas where health systems require climate resilience. Climate adaptation, environmental sustainability and four fundamental requirements for providing safe and quality care and link to our climate resilience.36 Why it matters As our planet warms, the number of extreme weather events triggered is increasing. This is leading to more frequent storms, extreme rainfall events and increasing heat episodes.37 Sea levels are rising and along with excess surface water both mean human infrastructure is at increased risk to flooding. Mental health cases increase 2-5 fold after flooding events. Heat episodes increase hospital admissions, particularly for those with respiratory conditions. If climate change remains unchecked, we will witness 2,000 extras deaths in the SE per year.4 Road access through extreme heat events is a potential issue in the future – roads melted during the heatwave of 2020.38 Building climate resilience into health and social care across the system between tertiary, primary and social care is complex. It benefits from a system-wide approach.39 Overall, the impact of climate change and our ability to adapt is clear - climate change places increased pressure on front line services, infrastructure and functions and impacts the most vulnerable in society disproportionately.4 Strategic objectives Build resilience by working with Local Resilience Forum partners to ensure our planning arrangements are complimentary and provide the best possible outcomes for our communities Build long-term climate adaptation planning into the Green Plan by 2025 Key activity Climate change placed on organisation risk registers. Surveillance on service continuity and preparedness for patient risks and health and wellbeing reviewed. Develop a sense of the infrastructure investment and action priorities needed to reduce identified risks including on digital infrastructure and overheating. Climate adaptation Source: WHO Guidance for climate resilient and environmentally sustainable health care facilities Climate resilience and environmental sustainability in health care facilities36 CAPACITY & Health workforce Energy health care waste Water, sanitation, hygiene and CLIMATE RESILIENCE CLIMATE RESILIENCE Health care facilities Healthy people Healthy environment ENVIRONMENTAL SUSTAINABILITY Infrastructure, technologies and products Building blocks of health systems Suffolk and North East Essex Integrated Care System Green Plan | 18 Key Themes

The opportunity – what we can achieve Developing a faster, more efficient service that speeds up care pathways, reduces patient anxiety and embraces care closer to home that maximises health benefits and outcomes.40 Creating a digitally fairer society can support wellbeing and help to tackle inequality.41 We can build on remote and agile working and care that we developed during the COVID-19 pandemic.40 Increasing the switch to a circular economy – reducing resource consumption, ensuring longevity of digital equipment and ensuring all E-waste is re-used or recycled. 83% of laptop carbon is embodied within it i.e., from its manufacture. So, reducing digital waste saves money, raw materials and carbon.42 Strategic objectives To achieve a minimum of 25% initial outpatient appointments and 65% patient follow-ups digitally. Ensure we make targeted efforts to generate good habits to minimise society’s growing digital carbon footprint as we accelerate digital models of care and ways of working. To digitise, connect and transform services safely and securely to improve the outcomes, experiences, and safety of our citizens whilst reducing patient travel-related carbon emissions. To support the ICS digital strategy43 pillar of sustainable change through shared capabilities and pooled resources to improve care, healthy populations and carbon reductions. Why it matters Applied correctly, digital innovation can improve patient care and reduce carbon.44 Despite the digital opportunity, digitalisation also creates carbon from increased electricity needs, datacentres, accounting for 2% of the world’s energy needs,45 meaning we need to also be digitally efficient and use smart foundations. Digitalisation can create inequality for our patients if not managed correctly.46 50 million tonnes of electrical goods waste are generated a year globally.47 By 2040, the storage of digital data is expected to produce 14% of the world’s total carbon emissions,48 so, we need to develop good practice and digital habits to mitigate that impact now. Key activity Follow Digital Transformation ‘NHSX - what good looks’ like.40 Embrace the Greening Government ICT digital services strategy49 outputs to reduce carbon, waste, and cost, increase resilience, increase responsibility (by doing the right things), use digital as an enabler to increase transparency and collaboration and use it to increase accountability. Continue to seek innovative ways of digitally providing the appropriate care/self-care to individuals at their abode whilst, utilising our local learning Digital Health and Care in Suffolk and North East Essex46 Actively seek to exploit remote process automation to reduce inefficient and carbon generating activities e.g. mailing, leaflets and improve patient care pathways. Digital carbon challenge-related activity to reduce digital carbon impacts. Digital transformation Suffolk and North East Essex Integrated Care System Green Plan | 19 Key Themes

PV installations 278 ktCO2e Investment needed Saving Carbon saving £1,936m £131m pa 278 ktCO2e Step 4 Increase on-site renewables Coal boiler removal 3 ktCO2e Oil boiler removal 7 ktCO2e Heat pumps and hydrogen CHP 454 ktCO2e Hot water 55 ktCO2e Investment Saving Carbon needed saving £1,364m -£14m pa 519 ktCO2e Step 3 Switch to non-fossil fuel heating Building Fabric 114 ktCO2e Investment Saving Carbon needed saving £326m £15m pa 114 ktCO2e Step 2 Prepare buildings for electricity-led heating The opportunity – what we can achieve Low carbon, low polluting, resilient, energy efficient buildings that are digitally smart, powered and heated by renewable energy sources. Switching secondary care across the NHS to LED lightning would save £3b over the next three decades.12 By adopting the NHS Estates Net Zero Strategy ‘making every kilowatt hour count’ mantra, we can reduce emissions, improve air quality and transition to renewable energy through making the interventions highlighted below which, shows the total NHS carbon savings that can be made.50 Strategic objectives To support our primary care estate, establish a base line and action plan for making every kilo watt hour count in transitioning to a lower carbon estate. To support system partners on transitioning to 100% renewable electricity sources, using LED light bulbs and adopting smart systems to underpin future investment opportunities. Developing and interlinking where possible a range of system-wide mechanisms that support our net zero transition including shared spaces, collective purchasing, active travel and transport infrastructure and hybrid working models. Why it matters The NHS estate and its supporting facilities services account for 15% of all NHS carbon emissions (including waste).12 Carbon in our estates isn’t just ‘operational’ (heating, building performance and utilities) it’s also ‘embedded carbon’ (from the materials used, construction methods, transport and the waste produced). How we procure, build, refurbish and undertake maintenance all impacts our carbon footprint.51 A holistic approach is required. Our buildings and infrastructure need to be ready for climatic changes and extreme weather events such as extreme heat.37 Key activity Make every KW/ Hour count by investing in energy saving measures and identifying retrofitting opportunities. Encourage a ‘whole life’ carbon approach to our estates recognising that we must reduce construction impacts, operational carbon (energy use) and increase renewable energy. Collaborate with system partners on alternative models of energy generation and funding mechanisms including community energy, onsite renewables and collective purchasing. Actively link greenspaces plans and biophilic design principles into our estates strategies with wilding and planting projects. Estates and facilities Source: NHS Estates & Facilities net zero strategy50 Making every KWh count Digitalisation 15 ktCO2e Small appliance 8 ktCO2e Carbon and energy management 756 ktCO2e Building service distribution systems 31 ktCO2e Investment needed Saving Carbon saving £1,322m £346m pa 1,757 ktCO2e LED lighting 376 ktCO2e Building Management Systems 352 ktCO2e Air conditioning and cooling 21 ktCO2e Ventilation 80 ktCO2e Space heating 118 ktCO2e Step 1 Make every kWh count Suffolk and North East Essex Integrated Care System Green Plan | 20 Key Themes

The opportunity – what we can achieve • 37,000 lives a year could be saved in the UK through more active lifestyles by using our feet and legs more and our cars less.3 • Transition towards an entirely zero emission NHS fleet. As a result of rapid improvements in ultra-low emission vehicle technology and a shift towards greener travel options the NHS carbon savings are estimated to be the equivalent to powering 100,000 homes with electricity for a year or taking 54,000 cars off the road.52 • Switching to active travel commuting, studies show that cycling to work is associated with a 46% lower risk of developing cancer.53 Strategic objectives Support an integrated electric vehicle charging infrastructure model that complements wider system partner networks thereby maximising collaborative working and investment. Continue to work with local authority partners on the planning and development of active travel infrastructure and engagement that promotes healthy low carbon alternatives. Why it matters Approximately 3.5% (9.5 billion miles) of all road travel in England relates to patients, visitors, staff and suppliers to the NHS, contributing around 14% of the system’s total emissions – 4% of which is within the control of the NHS directly.12 Road transport is the main source of nitrous oxide pollution emissions (34% and up to 80% near roadsides).54 This can exacerbate respiratory symptoms and those with heart conditions.55 Air pollution hotspots are often situated in areas of higher poverty and health inequality.55 During the first COVID-19 lockdown nearly 2 million people with lung conditions noticed improved symptoms as a result of a drop in air pollution (British Lung Foundation research).56 Key activity Work with local authorities to support the development of cleaner air zones, support active travel infrastructure and the location of EV charging infrastructure. Salary sacrifice schemes for bicycles and continued commitment to develop active travel infrastructure. Use digital transformation as an enabler to reduce staff, supplier and patient travel impacts whilst improving patient care and workforce productivity and wellbeing. Cross-reference air pollution and procurement projects and ensure anti idling work is uniform across our system wherever possible. Travel and transport Source: Gear change: a bold vision for cycling and walking57 What are the health benefits of physical activity Regular physical activity reduces your risk of... Dementia by up to 30% Hip fractures by up to 68% Depression by up to 30% Breast cancer by 20% Colon cancer by 30% Type 2 diabetes by up to 40% Cardiovascular disease by up to 35% All-cause mortality by 30% Suffolk and North East Essex Integrated Care System Green Plan | 21 Key Themes

The opportunity – what we can achieve Greening spaces and nature-based health interventions has multiple wellbeing and health benefits,58 helps to mitigate the impacts of extreme weather events, plants act as pollution filters, provide estate benefits such as shading, insulation, reducing surface water run-off, reducing urban heat effects.59ab Soil is an excellent carbon sink.60 Biophilic design concepts actively incorporate planting and nature into building spaces.61 Studies show greener (plants) infrastructure in care settings can improve patient recovery and wellbeing.62abc Improving access to nature and green space could save millions of pounds each year for the NHS and social care services whilst improving patients mental health and wellbeing (The Green Light Trust) especially our most vulnerable.63 The centre for sustainable healthcare surveyed the impact of green spaces on NHS staff. Up to 83% of surveyed NHS staff said they would like to spend more time in a green space at their site than they did. Value to green spaces for staff were being calm, refreshed, energised with positive physical and mental health and wellbeing.64 Strategic objectives To reboot our relationship with nature recognising it can be a positive and visual enabler to overcome inequality and provide economic, food, environmental, estates and health and wellbeing benefits. Act as a system-wide enabler to support partner organisations with their green space and biodiversity plans; linking these to our social prescribers and staff wellbeing and health ambassadors to improve patient and staff mental, physical and digital health. Work with our partners to reduce the green space inequality gaps for residents that are impacted (socio economic status, deprived areas, minority ethnic groups, elderly, low income, long term health conditions), providing support, access and confidence to use.65 Why it matters Biodiversity loss, degradation, damages and change to ecosystems are already key risks for every region due to past global warming and will continue to escalate with every increment of global warming.66 Socio-economic status is related to access to natural spaces – you are less likely to have visited a natural space in if you are living in an area of high deprivation, have a low income, have a low level of education, or are not working. Older people, people from minority ethnic groups, those with a long-term illness or condition, and those without children are less likely to have visited a natural space.67 In research following the COVID-19 recovery 89% of people surveyed agreed increasing the amount of accessible green space will help to improve people’s general health.68 Key activity Act as a system-wide enabler to support partner organisations with their green space and biodiversity plans. Link the agenda to our green champions and health and wellbeing ambassadors to improve staff welfare. Promote, educate and emphasise the multiple benefits of green space to health and wellbeing, particularly to our clinical and estates teams using nature as an interactive engagement tool. Create SNEE health and green space corridors with wider partner organisations that link to our social prescribing teams to maximise health, wellbeing and environmental benefits. Green spaces and biodiversity Suffolk and North East Essex Integrated Care System Green Plan | 22 Key Themes