Green Plan Annual Report 2024/2025

• A reduction of the emissions associated with our building energy usage by 434 tonnes of co2 equivalent (4,651 tonnes of co2e for 22-23 vs 4,217 tonnes of co2e for 23-24)
• £78,000 awarded through National Energy Efficiency fund for our LED lighting upgrade (saving us £1,500 per month in energy bills and 3000kg per month of carbon emissions)
• 6 roofing upgrades
• 40 Green Network Champions recruited
• 12 members of staff made the switch to reusable theatre caps
• 5 guided cycle sessions hosted for staff  
• 900 bulbs planted in the CCC Wirral Glade
• An increase of staff travel survey responses from 226 in (Nov 2022) to 447 (Nov 2023)
• 1 sustainability work experience student hosted
• 1 sustainability award achieved at Staff Excellence Awards
• 78% increase in the number of patients being treated by our Clatterbridge in the Community service
• 5 sustainability-related courses included in staff prospectus
• 6 new telehealth booths available for remote consultations
• 1 national study assessing the carbon footprint of a clinical pathway
• 1,095 kg the amount of co2 equivalent per patient receiving proton eye therapy treatment
• 12 in-person staff engagement events promoting sustainability
• 764,000 searches carried out through Ecosia, resulting in the planting of around 15,000 trees across the globe – a size equivalent to approximately 16 football pitches
• 2 new on-site showers installed
• 10 bird boxes, 1 owl box and 2 bug hotels installed around our CCC-Wirral Woodland Glade
• A reduction in monochrome printing rates of 68%
• 86kg of carbon saved from implementing recyclable inpatient food trays with our meal service providers Apetito (the equivalent of boiling 2,150 kettles)
• 148 electric items returned as part of our electrical equipment refresh programme (resulting in a cost saving of over £5,000)
• Amended settings on cold water end-of-line valves saving our water consumption by approximately 1.3 Olympic size swimming pools per year
• 2 named adaptation leads for the Trust

The Trust has a Board-level lead for sustainability (the Directory of Strategy), a multidisciplinary Sustainability Action Group, and has launched its first ever Green Plan. In addition, in June 2023 CCC successfully appointed a permanent Sustainability Programme Manager to the Trust. The Sustainability Manager plays a leading role in building on the progress of previous years in establishing sustainability as a key part of the business of our organisation.   

Sustainability continues to be included as one of the key corporate risks for the Trust – captured in our Board Assurance Framework. In addition to the annual reporting cycle, Board assurance on the sustainability programme is provided through quarterly update reports at Performance Committee meetings.

In addition to the above, sustainability is now included as part of the new vacancies and recruitment processes. At induction, new starters to the Trust are presented with information relating to the Trust’s sustainability work, as well as information regarding sustainable travel and the different schemes and incentives that we have available in order to support them to make a greener commute to work (at least occasionally). This can have a positive impact in terms of employee recruitment and retention, highlighting to our staff, and prospective staff, that CCC is an organisation that cares about the climate crisis and that we are committed to reducing our environmental footprint.  

This year we have had some significant ‘firsts’ with regards to our corporate approach and sustainability, including:

•  Sustainability being included as an award category at our annual Staff Excellence Awards. The worthy winner (pictured to the right) was Zoe Morris (Infection Prevention and Control Nurse Practitioner) for her on-going hard work and dedication as part of the ‘Gloves-off’ campaign – more information included in the ‘care
  models’ section of this report)
   
• Hosting our first sustainability work
  experience student
   

Sustainability courses being included in our staff prospectus (and the prospectus itself being in a digital-only format for the first year)

Over the coming 12 months we aim to encourage more of our staff members to complete the free ‘Building a Net Zero NHS’ eLearning course on ESR. We are also planning on working with our Workforce and Organisational Development team to explore opportunities to offer sustainability apprenticeships for staff members who may be interested in obtaining a formal qualification within this area of work.

In addition to this, CCC’s strategic plan is due to be updated within the next year, and we will ensure that sustainability is included as a key commitment within this.  
 

1. 1. Background

CCC’s unique networked model of care continues to see care delivered locally where possible and only delivered centrally where this is necessary. This model allows us to deliver services across multiple hospital sites in Cheshire and Merseyside for a population of 2.4 million while reducing to a significant degree the amount of travel required for patients.

Our Clatterbridge in the Community (CIC) service (delivering chemotherapy in a patient’s home or workplace) aims to provide our patients with a high quality, safe service which is more efficient and convenient. This service continues to result in significantly lower volumes of car traffic than if this care had been delivered in hospital premises. Giving patients the choice to receive their care closer to home also reduces the time and expenses spent travelling to and from clinics and waiting for their treatment, improving patient experience and enhancing quality of life. The service has grown each year since it was first deployed in 2019, resulting in a 78% increase in the number of patients being treated by CIC.

Across the NHS, anaesthetic and analgesic gases are responsible for over 2% of all emissions. CCC is not a heavy user of anaesthetic gases as we are not a provider of surgical care. Nevertheless in order to minimise our environmental impact we have sought to understand our anaesthetic and analgesic use and achieved assurance that this is as environmentally sustainable as it could be.

We are currently in the process of developing a comprehensive, in-house carbon reporting tool which will allow us to measure and compare the carbon emissions associated with our services at CCC in a consistent and cost-effective way. Using this tool will enable us to track and compare data from our original 19/20 baseline and subsequent years, up to the present day. The unit of measurement that we use for this tool and our individual measures is tonnes of carbon dioxide equivalent (co2e).

NHS emissions are calculated using a set of countable activities multiplied by the carbon intensity of each activity (‘emissions factors’) through the NHS Carbon Footprint Plus model, and our carbon reporting tool adopts this methodology. The model combines ‘top-down’ spend data with ‘bottom-up’ activity data (based on a range of inputs from our Trust, such as buildings’ energy use, medicines data, and fleet data collection).

Our reporting tool will enable us to quantify the carbon emissions associated with the following activities: building energy (electricity, gas and steam), waste, water, anaesthetics, inhalers, business travel and fleet emissions, medicines and chemicals, medical equipment, non-medical equipment, other supply chain, patient and visitor travel, and staff commute.

The tool reports against nationally and internationally recognised standards and reporting guidelines wherever possible. The full list of emissions factors used to make these calculations can be found here. These factors have been derived from the UK Government Greenhouse Gas Conversion Factors for Company Reporting (‘DESNZ’ factors) dataset, which have been developed in line with the international Greenhouse Gas Protocol standards and are consistent with the official UK GHG inventory. 

Our carbon reporting tool will be an invaluable resource in helping us to measure the impact that our CCC sustainability programme (and its associated projects) is having on the Trust’s carbon footprint and will help us to identify the areas where we can make the most meaningful changes in order to have the biggest impacts. We anticipate that the reporting tool will be finalised and ready for use by mid-2025.

CCC’s unique networked model of care continues to see care delivered locally where possible and only delivered centrally where this is necessary. This model allows us to deliver services across multiple hospital sites in Cheshire and Merseyside for a population of 2.4 million while reducing to a significant degree the amount of travel required for patients.

Our Clatterbridge in the Community (CIC) service (delivering chemotherapy in a patient’s home or workplace) aims to provide our patients with a high quality, safe service which is more efficient and convenient. This service continues to result in significantly lower volumes of car traffic than if this care had been delivered in hospital premises. Giving patients the choice to receive their care closer to home also reduces the time and expenses spent travelling to and from clinics and waiting for their treatment, improving patient experience and enhancing quality of life. The service has grown each year since it was first deployed in 2019, resulting in a 78% increase in the number of patients being treated by CIC.

Across the NHS, anaesthetic and analgesic gases are responsible for over 2% of all emissions. CCC is not a heavy user of anaesthetic gases as we are not a provider of surgical care. Nevertheless in order to minimise our environmental impact we have sought to understand our anaesthetic and analgesic use and achieved assurance that this is as environmentally sustainable as it could be.

The past year has seen the progression of the Trust-wide outpatient transformation programme, which includes work streams directed at increasing the proportion of outpatient appointments conducted by video call and rolling out risk-based models of outpatient follow-up that reduced the need for patient travel in addition to other benefits for patients. To support this initiative, in October 2024, with the support of PropCare and the Digital team, we opened six new telehealth booths in our recently acquired Paddington Community Diagnostic Centre (CDC). The facilities have been designed to meet the needs of telehealth clinics, with quiet space, headphones and equipment well suited to video and phone consultations.

In a bid to help move us towards our net zero goals, work has commenced which aims to identify disposable consumables that are used as part of the care that we deliver at CCC, and exploring options for making the switch to reusable alternatives. As an example, our procurement data from Health Procurement Liverpool (HPL) has shown us that, over the last year, we disposed of approximately 5,000 single-use theatre caps. In a bid to reduce this, our Clinical Intervention team (the biggest users of disposal theatre caps) and Interventional Radiology team have followed the example set by our Theatre team and made the switch to a reusable alternative. All teams use the same small business as their supplier, which has an impact both from a sustainability and social value perspective.
 

• This year, on World Hand Hygiene Day (5^th May 2024) we launched our ‘Gloves-off’ campaign to help raise awareness of and reduce inappropriate glove use across the Trust. Currently, it is estimated that over 1 billion pairs of single-use plastic gloves are used across the NHS each year. Much of this glove use (estimated to be up to a third of cases) has been found to be unnecessary. Research has shown that removing gloves when clinically appropriate can lead to improved hand hygiene practices and increased patient safety. Data from our HPL colleagues has revealed that throughout the 22-23 period we used approximately 2.5 million single-use plastic gloves (equating to 15 tonnes)

As part of our gloves-off campaign, we collected data regarding our baseline levels of glove use, worked with our housekeepers to carry out audits of glove use, and engaged with our communications team who designed posters and screensavers showing when glove use is necessary and when it isn’t. We also teamed up with Infection Prevention and Control to host in-person engagement and education events across all sites and at Team Brief, which were well received.

Follow-up procurement data was compared six months post-launch (November 2024) and revealed that purchasing figures for single use gloves had not altered significantly since the launch of the project. This demonstrates the challenge of effecting behaviour change in support of our sustainability programme, particularly where practices are deeply ingrained. 

The team involved will be reconvening in early 2025 to discuss this in more detail and identify the next steps that can be taken to help reduce inappropriate glove use across CCC. This includes continuing to monitor and report on our glove use at regular intervals throughout the year and to continue to engage with our clinical staff members both digitally, with the support of our communications team, and via in-person engagement events in order to ensure that the messaging of the campaign is not forgotten. Potential opportunities for the future could include moving to a more sustainable product for our gloves and/ or looking to purchase these items from more local and sustainable suppliers within Europe (an initiative that is currently being trialled in the South of England).  

This year an excellent piece of work (the first of its kind in the UK) was carried out by Dr. Mark Hardy (CCC Consultant Clinical Scientist), Alistair Smith (Trainee Clinical Scientist) and colleagues as part of a wider project to provide an initial estimate of the carbon emissions associated with the proton radiotherapy service that is offered at CCC. The proton service is an essential national service used to treat patients with cancerous eye tumours. At CCC we provide proton therapy for over 300 patients each year. The aims of the project were to: provide a baseline reference for measuring the changes in the carbon footprint of this service, identify where carbon reduction efforts should be focussed, and compare data with those providing a similar service in other centres. Government greenhouse gas conversion factors were used to calculate the various carbon emissions associated with this treatment including: electricity use, patient travel, disposable and non-disposable consumables used, and machine maintenance. The results showed that the proton therapy service at CCC results in approximately 331 tonnes of co2 equivalent being released in to the atmosphere each year (equivalent to an average of 1,095 kg of co2 equivalent per patient). The largest contributors were the energy used for the cyclotron and the emissions associated with patient travel. The recommendations following the study were to:

• Switch to a renewable electricity source (investing in green energy will greatly reduce the carbon footprint of this service)
• Improve the energy efficiency of the cyclotron
• Implement a refrigerant leakage monitoring system
• Investigate if the sterilisation of equipment can be performed more locally
• Set up a quality improvement programme to continue to reduce co2 emissions
• Repeat a carbon footprint analysis every four years

By reducing our carbon footprint we stand to not only support the NHS with its net zero targets but can also benefit the trust with reduced electricity and maintenance bills. By successfully implementing the study’s recommendations it would be possible to reduce what is likely one of the higher carbon footprint per patient services that we provide at CCC (far more carbon intensive per patient than external beam radiotherapy). The team are aiming to publish their findings as part of a wider
research study in the near future.

The outpatient transformation programme will continue to deliver results in the coming year that will further reduce the need for patients to travel for outpatient care when this is not clinically required.

Next year we also plan to do more work around the consumable items that are associated with our CCC care models. We have recently established a working group (consisting of clinicians and Infection Prevention and Control) to come together to explore our options for making the switch to reusable tourniquets across the Trust (where clinically appropriate). Our procurement data has shown us that, at present, CCC use approximately 32,000 tourniquets every year with only 1,000 of these being reusable. Samples of various reusable solutions have recently been requested, and we will soon be coming together as a group to assess our best option to trial (keeping in mind both the cost and carbon saving impact of making this switch, as well as the improved patient experience from better cannulation success rates – reducing both the need for cannulation packs and the infection rates associated with failed cannulation attempts). Over the course of the year we will aim to investigate even more ways of making some of our consumable items more sustainable, where it is clinically appropriate to do so.

In addition to the above, over the coming year we will work with other clinical teams to encourage them to quantify the carbon emissions of their services and identify opportunities for carbon reduction, in a similar way to the proton eye therapy service.
 

CCC employs approximately 1,900 members of staff across all of our sites. Our workforce is one of the greatest assets that we have at CCC with regards to bringing about sustainable change across the Trust. Last year, we launched a comprehensive staff awareness and engagement campaign, raising the profile of sustainability at CCC and highlighting the (often behind-the-scenes) work that is taking place to improve our organisation’s carbon footprint. With the continued support of our Communications team, the engagement campaign has sought to raise awareness among staff and pave the way for continued behaviour change through various methods including: the design of a ‘Creating a Greener CCC’ banner for in-person engagement events, updates and information being shared via screensavers, staff surveys around travel and waste management practices and perceptions, CCC-Live sessions, updates at Team Brief and on the staff intranet, and the inclusion of sustainability-related projects and updates as part of our staff-wide e-bulletins. Our workforce continue to demonstrate considerable enthusiasm and interest for the green agenda at CCC.   

This year, we have engaged our workforce with the sustainability programme in the following ways:

• We have established the Trust’s first Green Network Champions group enabling us to harness the expertise and enthusiasm of our colleagues across all sites. A green network champion is someone  who wants to create change to improve the environmental impact associated with our services at CCC. The network is an inclusive group, encouraging the support of staff from all professional backgrounds within the Trust. It is recommended that group members complete the ‘Building a Net Zero NHS’ course on Electronic Staff Record (ESR). The group will meet on a quarterly basis to discuss the successes and challenges of the sustainability programme over the previous three months, and will also provide a space for staff to bring their own ideas and initiatives to the group for further discussions. The aim of the green network champion is to be the ‘green eyes’ within their area of work – identifying carbon emitting/ waste producing processes and raising these with their colleagues, the champions’ group and the Sustainability Programme Manager to work together to identify more sustainable solutions. The creation of this group will significantly increase our capacity for rolling out sustainability-focussed projects across our organisation
   

• Colleagues across the Trust (including Workforce & Organisation Development and Pharmacy) are working to digitise more of their paper processes (including the process of submitting flexible working requests)
   ​​​​
• Throughout March and April 2024 we hosted a number of herbal walks for our staff, led by our very own Dr Heulwen Sheldrick (Principal Speech and Language Therapist) who is also a qualified Medical Herbologist. During the 30-minute sessions, Dr Sheldrick discussed foraging, identified the plants and flowers around our hospital sites and discussed their natural medicinal properties – from nutrient-rich nettles to liver-supporting dandelions, cleavers for lymphatic support and wild garlic for cleansing. The sessions were very well received by staff across our three main sites who attended. This collaboration demonstrated one of the many ways in which sustainability, caring for our natural environment, and health and wellbeing are intrinsically linked
• In December 2023, we made Ecosia the default search engine on all CCC laptops and PCs. Ecosia is an eco-friendly search engine that uses 100% of its profits from advertising revenue to plant trees. Ecosia has one of the largest and most diverse tree-planting portfolios in the world – planting in over 50,000 locations with over 70 partners across more than 35 countries – protecting not only the planet, but also benefiting local communities and allowing wildlife to thrive. Making the switch to Ecosia as our default search engine was a simple, free, and immediate way for our organisation to make a small change that can have a big impact. The Trust receive monthly tree reports from Ecosia, detailing how many trees our staff have been responsible for planting (approximately 50 searches results in one tree being planted). We are delighted to announce that over the last year staff at CCC carried out over 764,000 searches through Ecosia, resulting in the planting of around 15,000 trees across the globe – a size equivalent to approximately 16 football pitches.

In October 2024 we called upon the help of our colleagues to support us with a bulb-planting event at our CCC-Wirral site. Throughout the day over 40 CCC staff volunteered half an hour of their time to help us plant over 900 bulbs in and around our Woodland Glade area. The event was coordinated by our Sustainability Programme Manager and very kindly led by Liverpool University Hospitals Foundation Trust (LUHFT’s) Nature Recovery Ranger (Centre for Sustainable Healthcare). When the bulbs flower in spring 2025, they will benefit insects like bees and butterflies who rely on nectar and pollen for their survival.
By planting early-flowering species, we will help to suppor tour pollinators as they emerge from
hibernation. Daffodil bulbs were planted on the grassy area adjoining the main staff car park, near to the beginning on the woodland path, and in the Glade itself, we planted snowdrops, crocus and bluebells. These flowers will boost the number of pollinating insects around our site, which will also attract and support other local wildlife. The event was very much enjoyed by those who took part and we are grateful for their help and support. 
 

The year to come provides us with exciting opportunities to continue to build upon the engagement and awareness work that has happened over the last three years. We will continue to maintain our close working relationship with the Communications team, who have played a pivotal role in supporting us to engage with our staff on the sustainability agenda within the Trust. In addition to this, we aim to engage with our workforce on the sustainability agenda over the year in the following ways:  

• Hosting in-person ‘Big Conversation’ engagement events at all of our sites around the theme of sustainability
   
• By working closely with our colleagues in the Innovation team to encourage and support staff-generated sustainability-related ideas and innovations
   
• Produce a “Green Plan on a Page” document for our wider colleagues, showcasing the plans that we have for the year ahead with our sustainability agenda (following the publication of our refreshed Green Plan)
   
• Explore opportunities for the production of seasonal sustainability newsletters to keep our staff up-to-date with our on-going work
   
• Continue to update our online presence (both internet and intranet) to keep staff informed of the progress of our programme 
  
   

The NHS fleet is the second largest fleet in the country (after Royal Mail), consisting of over 20,000 vehicles travelling over 460 million miles every year. This fleet, combined with the impact of NHS commissioned services and staff travel directly contributes to the 36,000 deaths that occur every year from air pollution.

In October 2023, the NHS produced a Net Zero travel and transport strategy. This strategy outlines the goals and targets that NHS Trusts should work towards in order to tackle the challenges of climate change and air pollution. The strategy states that the NHS will have decarbonised its fleet by 2035 and includes information and targets relating to: vehicles owned and leased by the NHS, staff travel emissions, and ambulances and non-emergency patient transport services. The strategy also outlines the benefits that making these changes will bring to patients, staff, and society as a whole.

Last year, on World Car Free Day (22^nd September 2023) we published the Trust’s first ever Green Travel Plan. Given the nature of our patient population, the majority of this plan is focussed around staff commuting and business travel. The plan includes information regarding the existing initiatives that are in place to encourage and support staff to make greener choices as part of their commute (mentioned in more detail below). It also sets out the future actions that we will take to continue to support even more staff to consider making a switch where they can (such as upgrading our bike storage and staff change facilities on-site and working towards establishing an Active Travel User Group). Following the publication of the Green Travel Plan we hosted a CCC-Live event to promote it and answer any questions that our colleagues had regarding its content.

• ​​​​​ This year we hosted a number of guided cycle sessions between Bebington train station and
  CCC-W. The purpose of these sessions was to help show staff that there is a safe way to cycle to the hospital. The sessions were supported by the Workforce & OD team who provided pastries and juices for those who took part. The sessions themselves were well attended and well received and we plan to re-run this initiative in the hope of encouraging more of our staff to take part. The benefits of cycling to work include: improved health and wellbeing of those taking part, reduced traffic congestion and safer roads around the hospital site, reduced need for car parking on-site and, of course, the carbon saving benefits of encouraging our staff to make a greener commute to work (at least occasionally)
• On clean air day (20^th June 2024) we teamed up with other local NHS Trusts and Merseyrail to offer free rail tickets to our colleagues in a bid to encourage staff to make a greener commute:  https://www.merseyrail.org/tickets-passes/the-walton-centre-free-ticket-promotion/
• We have also collaborated with five other NHS Trusts in our local region to offer a formal car sharing platform for our staff, again with the aim of reducing traffic congestion and car parking pressures at our sites, whilst improving the carbon footprint of our staff commute. The ‘Liftshare’ platform is expected to be available for our staff to use from mid-2025 onwards for an initial trial period of two years  
• We have also upgraded our staff change facilities at our Clatterbridge Wirral site (in the new Seaton building) in a bid to break down some of the barriers that may be preventing our colleagues from making a greener commute
• In addition to our work regarding staff travel, improvements have been made to the travel and transport arrangements for some of our business services. For example, at the beginning of 2023 we introduced a formal hub delivery service managed by our Clatterbridge Pharmacy Ltd. (CPL) vans to deliver medications to our patients. Many of the deliveries now undertaken by this Patient Delivery Service were previously done by taxi. CPL vans now run twice a day for both patient and hub deliveries, leading to potential reductions in the carbon emissions and air pollution levels associated with extensive taxi use, as well as a reduction in the cost associated with this service 
   

With regards to travel and transport, our ambitions over the year to come include:

• Work with PropCare and colleagues across the Trust to devise a clear plan on electrifying our fleet (this will include addressing the issues with our electrical supply at CCC-W so that we can look to install EV charging on-site)
• Exploring funding opportunities to upgrade our bicycle parking across our sites
• Including a dedicated page of our staff intranet with regards to active travel (including useful resources, cycle and walking routes to and from key locations, information on how to access bicycle sheds, information regarding our on-site facilities to support active travel, and more)
• Work towards establishing an Active Travel User Group for people interested in walking, running, or cycling to work to link people with others in their area to share advice and encouragement
• Working with the provider of the shuttle bus from the CCC-L patient car park to develop a carbon reduction plan for the service and ultimately its provision with a zero emission vehicle
• Re-run our staff travel survey which will provide us with continued insight in to the commuting behaviour of our colleagues and information on some of the potential barriers preventing staff from making a more sustainable journey to and from work
• We will work with CPL in the coming years to continue to lessen the impact of the service on carbon emissions and air quality through the development of a carbon reduction plan with an objective of ultimately delivering the service with zero-emission vehicles
• Assess the current vehicles available to staff through our salary sacrifice scheme (with partners Vivup) and begin to explore incentives for encouraging staff to choose ultra-low (ULEVs) or zero emissions vehicles (ZEVs), with the eventual plan to phase-out from this scheme the availability of vehicles that are not ULEV or ZEV compliant
• Continue to work with our partners to influence the planning and investment in our local active travel infrastructure and to lobby for improvement to the cycle lanes and walking routes serving our sites
   

The Estates Net Zero Carbon Delivery Plan (published in August 2021) aims to address the aspects of the net zero strategy related to estates and facilities activities. The document references a range of actions that can be taken to tackle climate change, including: a four-step approach to decarbonise the NHS Estate, driving forward a circular economy, the electrification of the NHS fleet, engaging the supply chain, and preparing the estate for severe weather.

At CCC, we have already taken a number of steps in previous years to moderate and reduce our energy consumption and our use of other utilities. Our CCC-L site has a comprehensive building management system (BMS) in place for increased energy efficiency and 30% of its electricity is generated on-site by low and zero carbon systems (including photovoltaic panels on the roof) with 100% of the electricity purchased for the site being from renewable sources.

At CCC-W, where our buildings are less modern, in addition to the work that we have previously undertaken to insulate and lag pipework to reduce energy consumption, we have now also refurbished our old physics building (now known as the ‘Seaton’ building) and upgraded the roofing in a number of areas on-site, having a positive impact on the building’s energy efficiency.  

Last year at CCC-L we teamed up with colleagues from VINCI and PropCare to use data from our BMS to feed in to an energy dashboard. This allows us to take a more targeted approach towards areas of high energy consumption across our CCC-L site using meters and sub-meters to provide live and historic energy usage within the hospital, on a floor-by-floor basis. This dashboard allows us to implement, manage, and review energy saving and carbon reduction measures using real-time data, whilst ensuring that the patient environment is managed to its optimum. Using the dashboard and, following the production of a decarbonisation audit by VINCI, several energy and cost saving initiatives have already been implemented at CCC-L, including: scheduled operation of air handling units, window settings in the atrium being managed to better control fluctuating temperatures, chilled beams automatically switching off out of hours, and better controls of underfloor heating in a number of locations across floor M3.

This year we have made significant progress with regards to our energy and utilities including:

• Establishing the Trust’s first Energy and Sustainability working group
   
• In July 2024, VINCI began to provide their facilities management service at our Wirral site in addition to the service they provide at CCC-L. Over the years to come we will work with VINCI to assess our options for upgrading our BMS at CCC-W in order to increase our energy efficiency. We would also like to support VINCI to produce a decarbonisation audit for this site, highlighting initiatives and changes that can be implemented in order to save energy, costs, and carbon 
   
• Our CCC carbon reporting tool now enables us to measure the tonnes of co2e associated with our building energy use (electricity, gas, steam, and water). On a Trust-level, at our 19/20 baseline, our building energy usage for our three main sites was equivalent to 2,649 tonnes of co2e. This rose to 4,651 tonnes of co2e in 22/23 following the opening of CCC-L. Interestingly in 23/24 this figure fell to 4,217 tonnes of co2e – despite the opening of our new Paddington building. It is anticipated that this may be due to the installation of a combined heat and power unit (CHP) at CCC-L, and as a result of us obtaining our electricity from greener sources at CCC-W
   
• At CCC-A, following a recent successful funding bid from the National Energy Efficiency Fund (NEEF) submitted by our PropCare partners, we were able to upgrade all of our lighting to more energy efficient LED lighting, resulting in a monthly energy cost saving of approximately £1,500 and monthly carbon saving of approximately 3,000kg co2e
   
• At CCC-L we have installed labels on temperature controls across the site in a bid to ensure that they are used correctly, which will hopefully result in an energy saving
   
• This year we have engaged with MACE, a consultancy who are able to support organisations to map out a route to carbon net zero and assist with identifying and applying for funding associated with energy decarbonisation. MACE are currently completing a heat decarbonisation and efficiency solutions assessment for the Trust, as well as an impact assessment of key opportunities which will contribute towards us achieving carbon net zero. This also includes an analysis of current building performance with original design criteria and external best practice benchmarks. On completion of the works CCC will have a defined pathway to carbon neutrality and net zero by 2040 that considers the most practical method, based on risk, operational constraints, budget, and procurement
   
• In addition to the above, this year our digital team have produced the Trust’s first printing policy. This will primarily include communications to improve the printing practices of our colleagues, however there are also plans in place to default all of our printing to black and white and double sided, saving up to 75% of the energy associated with printing as well as reducing waste. The policy is almost ready to be launched – which will hopefully have a positive impact on the energy consumption associated with our printing at CCC, and reduce our paper use. 

Next year, at CCC-L we will continue to work with VINCI to use the energy dashboard to improve the building’s performance. We will work closely to identify more energy-saving quick wins. We will also begin to replicate this work at CCC-W.

At CCC-W we will continue to invest in refurbishments and improvements that increase energy efficiency whilst also continuing to work on the longer term redevelopment of parts of the site.

Our other plans for the year ahead include working with the digital team to roll-out an in-house energy saving software solution across all sites which will automatically turn off electronic devices (such as computer monitors and laptops) when not in use, saving both costs and carbon.

We will continue to work with site partners and local energy suppliers in a bid to moving towards more renewable sources for our external electricity supply at CCC-W and CCC-A.

In addition to the above, we are looking to team up with NHS colleagues from Wirral University Teaching Hospital (WUTH) and Cheshire Wirral Partnership (CWP) to roll out a joint energy-saving campaign for our workforce over the coming year, with potential ideas including a ‘switch off your lights/ computers/ desktops/ heating/ air conditioning etc. overnight’ campaign.
 

The NHS is one of the largest producers of waste in the country, and it is everyone’s responsibility to dispose of waste in a safe, efficient, and sustainable manner. NHS providers in England produce approximately 156,000 tonnes of clinical waste each year that is either sent to high temperature incineration (HTI) or for alternative treatment (AT). This is equivalent to over 400 loaded jumbo jets of waste. This has a significant environmental impact and is associated with high running costs and carbon emissions.

It is a legal requirement for NHS providers to comply with waste legislation and regulations. Doing so ensures that waste is minimised, treated and disposed of in a safe way that reduces environmental harm, protecting patients, staff, the NHS, and the wider community.    

In March 2023, a Clinical Waste Strategy was produced which sets out NHS England’s ambition to transform the management of clinical waste by eliminating unnecessary waste, finding innovative ways to reuse, and ensuring that waste is processed in the most cost effective, efficient, and sustainable way. This strategy contains advice and guidance on: data management, investing in a skilled workforce, compliance requirements, developing a resilient infrastructure that meets future demand, waste segregation targets, improving our use of resources, reducing our carbon impact, and establishing a commercial waste model that delivers better value for the NHS.

At CCC arrangements are in place to ensure that none of our domestic general waste ends up in landfill, with the majority of this being used as refuse-derived-fuel (RDF) at a waste-to-energy facility. Staff engagement with regards to waste management has shown us the importance to staff of recycling, with many staff asking for the installation of bins within our buildings to allow the separation of waste at source. We acknowledge, however, that development of our plans for how we deal with waste now and in the future needs to cover interventions to reduce waste and reuse items as well as increasing recycling.

In October 2023 the water supply for CCC-W was transferred to a nearby borehole, a process that was managed by our neighbours at WUTH. This involves fresh water being sourced from a water table directly below the site from a narrow well. Boreholes are better from an environmental perspective as, although they don't play a part in reducing water consumption, 60% of mains water is recycled wastewater which requires treatment (using a significant amount of energy and chemicals). In comparison, water sourced directly from boreholes only requires limited treatment, resulting in energy savings and an improved carbon footprint for CCC-W. In addition to this, the decarbonisation audit report carried out by VINCI for our CCC-L site has enabled us to save on our water consumption by amending the settings on cold-water end-of-line valves (resulting in an annual saving equivalent to approximately 1.3 Olympic size swimming pools).

With regards to waste, over the last 12 months, we have:

• Continued to work closely with our waste contractors at B&M (who have a zero waste to landfill policy in place) to obtain a better understanding of our waste arrangements across our sites and identify opportunities for improvement (including on-site visits at our three main sites and a visit to the B&M depot in Bromborough in April 2024)
• Explored our opportunities at each site to implement segregation of dry mixed recycling
• Worked with PropCare to review our compliance with the waste segregation recommendations outlined in the clinical waste strategy (20:20:60 – 20% incineration, 20% alternative treatment, 60% offensive) and identify areas of potential improvement
• Worked to reduce the waste associated the consumable items that are used in the provision of our clinical care (gloves, theatre caps, tourniquets)
• Discussed opportunities for the installation of a cardboard bailer at CCC-W and for our cardboard waste at CCC-A to be taken over to LUHFT’s on-site bailer
• Investigated what waste-related training is offered at induction and explored options for introducing waste management training across the Trust
• Re-launched the electrical equipment amnesty with the digital team. This involved asking members of staff who have old Trust equipment/ electrical devices that are no longer needed to either bring them to the IT department or to arrange collection with our digital colleagues in order to minimise electrical equipment waste
• We have implemented an initiative that allows us to recycle our inpatient food trays with our meal service providers, Apetito, via a 100% closed loop recycling process. Given the number of meals served each day to inpatients, this will make a significant difference to our sustainability across the catering service
• Explored opportunities for sustainable mattress disposal
• We have changed our supplier for our soap dispensers who are able to offer a more sustainable alternative, with the soap dispensers being made of up to 70% recovered coastal plastic
• Investigated opportunities for upgrading our taps to automatic taps with leak detection built in
• Worked with PropCare to rehome some office furniture that was no longer needed in our Paddington building
• Installed bin magnets across CCC-L and CCC-W to encourage the correct items to be disposed of in the correct bins

At CCC, we know that there is more we could and should be doing with regards to our waste management in order to make it more sustainable. Over the year ahead, we plan to:

• Reviewing the current Trust Waste Policy
• Work with PropCare to produce the Trust’s first Sustainable Waste Management Plan/ Policy
• Update our waste signage across the Trust
• Engage with HPL to begin a review of the packaging associated with items purchased through our supply chain, and how this can be greener
• Make the switch to the new national uniform initiative and identify the most safe and sustainable way of disposing of old uniforms
• Strengthening our waste management processes through improved waste reporting
• Look to launch a ‘waste champions’ initiative (and providing members with access to waste training opportunities)
• Continue to explore alternative, greener options for our consumable items (such as couch roll)
• Implement a formal furniture rehoming scheme across the Trust to reduce office furniture that is no longer needed ending up in landfill (saving on waste disposal costs as well as the costs of procuring new furniture)
• Understand our processes for managing the disposal of old medical equipment and identify the ways in which we could improve our Waste Electrical and Electronic Equipment disposal (BMA auctions)
• Explore opportunities for re-fillable wipe buckets with the support of Infection, Prevention and Control  
• In addition to us making the switch to a reusable sharps bin alternative, we are planning on working with Infection, Prevention and Control to conduct a review of our current sharps containers across the Trust and to work with Communications to encourage colleagues to fill sharps bins up to the correct fill line and avoid disposal after three months (no longer a requirement)
• Make the switch to the new national uniform initiative and identify the most safe and sustainable way of disposing of old uniforms
   

The NHS Net Zero Building Standard (published in February 2023) provides technical guidance to support the development of sustainable, resilient, and energy efficient buildings that meet the need of patients both now and in the future. As previously noted, our CCC-L building was designed and built to a high standard, with features including photovoltaics panels on the roof and a combined heat and power unit. CCC-A is a slightly older building but still relatively new compared to the majority of NHS estate. CCC-W is where the Trust’s oldest building stock is located and is therefore the site with the biggest opportunity for capital development to improve its environmental credentials. 

We have previously launched a process to look at the wider redevelopment of our CCC-W site beyond the immediate refurbishment programme. The competitive process to procure architectural support for this included a 15% weighting for sustainability and social value to ensure that this is considered as a key component of any proposals. We have also worked with our sustainability consultants to conduct a survey of the potential for the CCC-W site to support the generation of renewable energy, as part of the longer-term redevelopment plans for the site.

This year has seen significant investment in the maintenance and refurbishment projects at CCC-W, all of which contribute to the wider sustainability agenda by improving building energy efficiency. These investments include:

• The continuation of major roof and insulation investments (helping to maintain optimal temperatures within our buildings for the comfort of our patients and staff)
   
• A full refurbishment of the Seaton Building
   
• Improvements in some of our staff change facilities to support staff to make a greener commute to work
   
• Installation of higher performance glazing in the Seaton building (increasing the building’s energy efficiency)

The coming 12 months will see further capital investment to improve the green credentials of CCC-W, including:

• Continuing to invest in the maintenance and refurbishment of the CCC-W estate in a way that contributes to a reduction of our environmental impact
• Continuing to ensure that sustainability is considered as an integral part of all larger scale capital developments

The positive impact that spending time in and around green spaces can have on both our physical and mental wellbeing are widely acknowledged. Enhancing our green spaces at CCC can have a positive impact on the well-being of our staff, patients and visitors as well as helping our local wildlife to thrive.

 When it comes to green space, CCC-W sits in Wirral’s green belt and, on two sides, our buildings look out over open fields. Over recent years we have maintained the site’s green space to a good standard and responded to the changing nature of the site, for example by landscaping the areas left by the removal of temporary buildings following the expansion into CCC-L. We are very fortunate at this site to have an area of mature oak woodland known as the Wirral Glade to the back of the hospital, near the radiotherapy bunkers. Previously, we have created paths in this area and improved the fencing to make it an accessible space for our staff, patients and visitors. We have also engaged the services of a landscape architect who has developed plans and proposals for us regarding seating, sculptures, planting strategies of native plant species, upgrading the existing pond area, and the installation of wayfinding and interpretation panels. Last year we successfully secured a grant from the Clatterbridge Cancer Charity to install a range of accessible outdoor furniture in the Glade for the benefit of our staff, patients and visitors.  

Our other main sites, CCC-A and CCC-L, are in more urban locations and, therefore, do not benefit from the same level of surrounding green space. Nevertheless, CCC-A is in close proximity to the award-winning Bluebell Woodland space (where red squirrels were recently spotted) and also benefits from the protected ‘no mow’ areas on-site - both of which are managed by our LUHFT neighbours, with whom we share the site. At CCC-L we have the winter garden and five outdoor terrace areas serving the upper floors. Further work has been carried out since the opening of CCC-L with the support of the Clatterbridge Cancer Charity to enhance the terraces and winter garden with furniture and planting.  

Following last year’s green space audit (which aimed to bring together a record of the various green spaces on the site and undertake an assessment of their potential for improvement) we have been working with partners to obtain further advice and guidance as to what we can do to further develop our plans to improve the outdoor space and increase biodiversity at our CCC-W site. This included:

• A site visit from Biodiversity Wirral (part of Wirral council) to discuss their tree planting and pollinator strategies for the Wirral region, and identify potential opportunities for collaboration
   
• A formal ecological site assessment being conducted by Arbtech (through a free initiative run by the Centre for Sustainable Healthcare). Following this assessment, we received a detailed report from Arbtech providing us with a baseline for where our site is currently at with regards to opportunities for biodiversity, and advice on how this can be improved (including information regarding planting and pruning, how to create habitats for invertebrates around the site, strategies for introducing hedgerows to the site, and making improvements to the pond area, amongst other recommendations)    
   
• Advice from our on-site grounds maintenance contractors Green Jackets who provided us with information regarding planting strategies when engaging with our colleagues during the bulb planting event (details above in the ‘Workforce’ section)

Other ways that we have made improvements to our green spaces this year include:

• The purchase and installation of outdoor furniture at our Wirral and Aintree sites. We took care to ensure that the wood used to make this furniture was FSC-approved, sustainably sourced, and purchased from a local supplier within the UK
   
• The re-launch of our ‘no-mow’ initiative at our Wirral site. This year we installed some signage detailing why we were doing this and took care to rope-off the area for added protection
   
• In November 2024 we collaborated with Wirral Barn Owl Conservation who installed an owl box on our Wirral site. When working with the team to identify the best position for this owl box we discovered that the best tree for its location was in Maggies’ garden, our on-site neighbours. Maggies were more than happy to support this project and we look forward to monitoring the owl box over the months and years to see if we are lucky enough to have any owls nesting there
   

With regards to green spaces and biodiversity enhancement across our sites, our plans for the year ahead include: 

• Produce the Trust’s first Biodiversity Management Plan

• Engaging with our neighbouring land owner to identify opportunities for upgrading the pond area
   
• The installation of new, sustainably-sourced wayfinding and interpretation panels – explaining the plans and ecological strategies for the area, as well as offering descriptions of the trees, plants, and wildlife that can be found on-site
   
• Continue conversations with our Arts Therapy team to explore options for the installation of an artistic sculpture (one that can also ideally support biodiversity enhancement in some way)
   
• Continuing to explore additional funding opportunities that would allow us to develop the area to its full potential in a quicker timeframe
   
• Reengage with NHS Forest to discuss obtaining free tree bundles for our site (with the support of the planting advice obtained from Arbtech’s ecological survey report) 
   
• Explore opportunities for the creation of a wildflower meadow at CCC-W

This year we teamed up with woodworking students from Wirral Met College who made us some bird boxes and bug hotels for installation around our Wirral site.

The wood used for the bird boxes was reclaimed wood that had been donated by Wirral Food Bank, and the twigs and leaves used for the bug hotels were obtained directly from our site. Students researched the best options for eco-friendly paint solutions for their creations, and were able to come to CCC-W to install them on our trees and around the Glade themselves. We were so grateful for their support and to be able to have the opportunity to collaborate on a project that brings, not only enhancements for our local birds and wildlife, but also the opportunity to engage with members of our local community in a way that promotes social value. Karen Campbell, progress coach for Wirral Met (pictured far right) said: “Seeing the students’ confidence and their enthusiasm about giving back to the local community makes us so proud of them”. One of the students who participated said “So many people have a connection to Clatterbridge – it’s great to be part of something that is giving back and knowing I’m doing something that others can enjoy. It’s really rewarding being able to see the end result of our hard work”. 

Currently, NHS England procures goods and services from around 80,000 suppliers. The activities and practices of our suppliers make up a large part of our wider carbon footprint. The NHS supply chain is currently estimated to be responsible for a staggering 60 – 80% of the NHS’s carbon emissions. Only through engaging with our suppliers, and our many other partners, will we be able to fully address our impact on the environment.

In November 2023, NHS England produced a roadmap to help suppliers align with our net zero ambitions between now and 2030. 

At CCC, we are working to ensure that our suppliers are decarbonising their own processes and helping them to align with our net zero supplier roadmap. We continue to work with our colleagues in Health Procurement Liverpool (HPL) who act as a shared procurement function for Clatterbridge and three other specialist Trusts in our region (Alder Hey Children’s Hospital, Liverpool Heart & Chest and The Walton Centre). Last year HPL published a strategy document outlining the organisation’s strategic aims and ambitions over the next three years. HPL include sustainability and social value as part of their key strategic aims within this document. They state that HPL will work with their member Trusts to ‘promote and develop the sustainability and social value agenda and build all mandatory requirements into projects supported by and undertaken through procurement’.

Last year HPL started working to add our suppliers to the Atamis system. The Atamis solution acts as a portal whereby all suppliers and contracts are listed, acting as a centralised database containing all the necessary information regarding our external partners. In addition to this, a new assessment tool for suppliers known as the ‘Evergreen Sustainable Supplier Assessment’ (an Atamis-based tool) was rolled out last year. The assessment is an online self-reporting tool for suppliers to engage with the NHS on their sustainability journey and understand how to align with the NHS net zero and sustainability ambitions. The benefits of this tool are that it allows for an improved understanding of the supply chain, enables more transparent conversations between Trusts and suppliers, it can support contract management and, ultimately, can help NHS organisations to achieve their sustainability goals. We have previously engaged with HPL colleagues to encourage suppliers to attend drop-in sessions for Evergreen assessment and to complete the assessment itself.

Over the last year we have continued to engage with partners and suppliers across multiple areas within the Trust, including:

• Estates and facilities contractors with regard to the energy efficiency of our buildings (PropCare & VINCI)
   
• Waste contractors with regards to waste reduction and recycling (B&M and SRCL)
   
• MACE and North West Net Zero Hub regarding our plans for energy decarbonisation
   
• NHS partners on our different sites with regard to wider sustainability issues
   
• Colleagues at Centre for Sustainable Healthcare, NHS Forest & external consultancy Arbtech regarding the use of our green spaces to increase opportunities for biodiversity enhancement
   
•  Members of Wirral Council (including Biodiversity Wirral and Active Wirral)
   
• Bus service and train providers with regard to encouraging public transport (Arriva & Merseyrail)
   
• Our independent fruit and veg provider for CCC-W who sell their produce at the site’s main entrance every Tuesday morning
   
• Our café providers at our CCC-W site who already have sustainability-related initiatives in place including a reusable coffee cup incentive and donating used coffee granules for gardening  

• This year, we have worked closely with our catering partners (ISS & Apetito) who have implemented a number of sustainability-related initiatives including:
  • Adopting the Coolfood pledge and committing to reducing food-related greenhouse gas emissions by 25% by 2030 (ISS now have 100 Coolfood-accredited recipes within their menus, with more to be included in the year ahead)

• Reusable inpatient food trays
   
• Including more plant-based vegan options in our inpatient menus (34% of the ISS plated menu is now plant-based, with these meal options being positioned at the start of all menus)
   
• An assessment of how locally our food is sourced, with the potential to identify opportunities for improvement
   
• Working together to review the recently launched NHS recipe bank (offering Trusts a searchable selection of delicious, healthy, and carbon-conscious recipes)
   
• Boosted recipes initiative – replacing some of the meat in our menus with plant proteins
   
• Old menu booklets now replaced with a laminated A3 bedside style menu – reducing paper use
   

With regards to our suppliers and partners, our plans over the year to come include:

• Continuing to maintain links with the sustainability teams at our neighbouring NHS Trusts in a bid to align strategies, goals, and projects where appropriate and share challenges, successes, and best practice where possible
   
• Continuing our work with HPL to move us closer to achieving our next zero ambitions and create social value within our organisation
   

• Working with suppliers to identify options for reducing plastic items such as packaging
   
• Explore options for sharing any surplus food that we have with local food banks
   
• Continuing to engage with our catering partners & café providers to explore further opportunities for collaboration. ISS already have some plans in place for the near future. 

As the Third Health and Care Adaptation Report states: ‘Climate change is already here. There is a clear and immediate need for the health and care sector to reduce its carbon emissions to net zero, and to adapt to the impacts of climate change that can’t be avoided, building resilience into the system as it protects and promotes the health of populations now and in the future’.

The report is co-developed by the NHS and Public Health England (PHE) and outlines the practical steps that can be taken by NHS Trusts to help build resilience and adapt to climate change.

Adaptation is the process of adjusting our systems and infrastructure to continue to operate effectively while the climate changes. At CCC, we continue to have business continuity plans in place for all services which, while they may not explicitly mention climate change, set out plans for some of the impacts of a changing climate – like flooding and extreme heat events. The ‘Delivering a Net Zero NHS’ strategy commits to building resilience and adaptation in to the heart of the net zero agenda, understanding that these two issues must be tackled as two sides of the same coin.

This year, we have begun to make some significant progress with regards to adaptation, including:  

• We now have two nominated adaptation leads in place (our Trainee Emergency Preparedness Resilience and Response manager and our Sustainability Programme Manager)
   
• We have updated the Trust’s adverse weather plan
   
• Our adaptation leads have started working through a climate adaptation framework produced by ‘weADAPT’ (one of the world’s leading and longest-running collaborative platforms for climate change adaptation) that has been developed specifically for NHS organisations in England to help them understand, prepare for and respond to climate change and its impacts  
   
• We have started to review some relevant case studies to raise our awareness of other adaptation-related initiatives that are being put in to place across the UK and beyond
   

Our plans for the year ahead with regards to adaptation include:

• We will ensure that our business continuity plans are updated to reflect climate change risks and our wider emergency plans are also updated and aligned to those of our local and national partners
• Work with local stakeholders to identify the key climate change risks across our area
• We will continue to review relevant case studies and complete the climate adaptation framework to help us gain a better understanding of the Trust’s current position with regards to adaptation planning  
• Exploring training options for our staff relating to dealing with extreme weather events (e.g. heatwaves, flooding)
• Embedding the effects of climate change (e.g. extreme weather events) in to our organisation's risk register, considering clinical needs, estates, and supporting infrastructure
• Exploring opportunities for the generation of a local adaptation plan
   

The third year of the programme to implement the CCC Green Plan has continued to deliver positive progress and,  in-line with our ambitions for the sustainability agenda at CCC, we are now beginning to introduce and champion projects and initiatives across the Trust that bring about long-term change, reducing the environmental impact associated with our organisation’s services and activities.  

The key challenges for the fourth year of this programme will be obtaining sustained engagement in the programme, as well as continuing to introduce projects that influence policy and bring about change across the Trust, as change can take time to adjust to. However, it is anticipated that, with the support of our staff and partners, we will continue to take significant steps towards achieving carbon net zero within our organisation in order to support the NHS with its wider ambitions to become the first carbon-neutral healthcare provider in the world.