1. Lighting

Low energy lighting is a very good investments for your Trust - get low energy bulbs into every light fitting in the unit. But even a low energy light is a total waste if there's no-one in the room: run a switch-off campaign for lights not in use, and look into motion sensor light switches for store cupboards and toilets.

Useful posters and stickers may be available from your Trust’s communications team – otherwise you can order some for free from the Carbon Trust: here. Prefer a more personal approach? Try asking the hospital school whether the children can help with some drawings.

2. Heating & cooling

Find the thermostat(s) or speak to Estates about heating controls; make sure temperatures are comfortable for staff and patients, and that air conditioning and heating are not set to come on at the same time.

There are lots of carbon savings to be had from simple measures to improve heating efficiency. Get the  staff and patients to point out warm or cold areas so that maintenance issues can be sorted out and timers or thermostats adjusted. Are there any areas where heating can be switched off at night or weekends? Here are some recommended temperatures to use as a guide:

• bedheads/wards 22-24°C
• circulation spaces/wards 19-24°C
• nurses stations 19-22°C
• operating theatres 17-19°C

(CIBSE, Heating Guide B1)
It is surprisingly common to find heating and air conditioning operating at the same time in NHS units. To avoid this, make sure that there is a wide gap (5°C) between the temperatures at which heating goes off and air conditioning comes on.

3. Staff travel

Spending less time sitting in cars will make the team fitter and more dynamic!  Raise it at staff meetings, and put up an information board to tell staff about public transport options, cycling incentive schemes, and how much money they could save on parking. Are there changing facilities and secure bike parking? Let everyone know.

Many Trusts have a Green Travel Plan and will be able to help with things like mileage reimbursement, or subsidised bike purchase (the national 'Cycle To Work' scheme). There is more info on what is available in the NHS from www.spokes.nhs.uk.

Lift share can be particularly useful out-of-hours when buses are infrequent or darkness makes walking less appealing. Hospital-wide lift-share schemes are often in place but may not be well-used – find out if there’s one you can link into, and ask colleagues what would encourage them to take part. Concern about finishing late unexpectedly can often be a big factor and can be solved with back-up taxi provision. Useful site: www.liftshare.com

4. Patient travel

Develop a sustainable travel plan with each dialysis patient, liaise with patient transport services to minimise travel times and distances, and specify low-emission vehicles in the transport fleet.

Explore the transport options with patients individually, encouraging active and sustainable forms of travel where appropriate. For example, some patients may need hospital transport to get home after dialysis, but may be able to walk or take the bus on the way in, increasing fitness and independence.

When specifying low-emission vehicles for the transport fleet, there are EU regulations for cars, but not specific emissions guidelines for minibuses or smal passenger vehicles.  However, these can be treated as vans or light commercial vehicles, for which EU regulations have recently been published.  These regulations set emissions limits for newly-registered vehicles of 175 g/km CO2 (fleet average), with a long term target of 135 g/km by 2020.

5. Virtual clinics

Reduce travel and empower patients - set up a telephone follow-up service for stable transplant patients. To find out how it's been done in Coventry - see the Green Nephrology Telephone clinics case study.

6. Low carbon shopping

Introduce sustainable criteria into all procurement contracts. Need ideas? Try purchasing dialysis fluids in the smallest possible volumes (highest concentrations), asking suppliers to take back packaging, and scoring them on their environmental policies.

Here are some questions you can put to suppliers on their environmental policies:

• Do you have a sustainability policy? Please provide it.
• Does your company conform to any environmental management standards (e.g. ISO 14001, ISO 14004) - if so, does this standard apply to the whole company or just a part of it?
• Does the company produce an annual sustainability report? If so, is it registered with the Global Reporting Initiative?
• Does it disclose its carbon emissions via the Carbon Disclosure Project?

7. Paper & printers

Purchase recycled paper, monitor quarterly paper consumption and identify potential reductions (eg electronic patient letters). Set printer settings to double-sided and draft.

You can also support the National Kidney Federation by recycling printer cartridges. Find out more from the NKF website and contact them for a recycling box.

8. Reduce, Re-use, Recycle

Look for ways to use fewer resources (e.g. open sterile kit as required, not in advance). Ensure well-positioned bins for recycling (paper and plastics), domestic and clinical wastes. Undertake regular waste audits, aiming to improve segregation and reduce the proportion of clinical (incinerated) waste.

Several renal units already recycle paper and plastic packaging in clinicial areas. The Green Nephrology team will be developing case studies and how-to guides for waste management and recycling in the coming months. In the meantime, you can listen to the podcast interview with dialysis nurse Mary Thomson, who's working on this in Fife.

To help you get staff on board in your unit, download Mary's questionnaire here.

9. Save water

Introduce water saving taps, and work up a business case for recovering reject water in the dialyisis unit (help and advice from the Green Nephrology Conserving water case study). You could be saving £1000s every year.

10. Decarbonise patient care

Preventative (low carbon!) care is the best sort. Do your elderly patients get help if they are cold at home (this could have a big impact on blood pressure control)? Are the diabetics benefiting from a bit of active travel? Could families visiting the unit learn about health benefits of reducing meat, and take away some vegetarian recipes?

High-carbon lifestyles are so unhealthy they can be treated as a fully-fledged medical syndrome – read up at www.carbonaddict.org and use the 10:10 Decarbonising Care flyer to raise awareness.

Don’t stop there though – see if the unit can provide practical help with cold housing, active travel and vegetarian meals as part of routine care. Get help from the OTs, physios and dieticians.

For information on local energy efficiency programmes, contact the local council or see www.est.org.uk and www.warmfront.co.uk. For help with active travel, try Walking the Way to Health or the Sustrans resources. For another great idea, look up BTCV Green Gyms

Resource: 

RenalChecklist2.pdf