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A King's Fund and Health Development Agency Report

This report is available on the Health Development Agency website at www.hda.nhs.uk

The King's Fund is the largest funder of health research in Britain. The Health Development Agency is the national authority and information resource on what works to improve people's health and reduce health inequalities in England. It gathers evidence and produces advice for policy makers, professionals and practitioners, working alongside them to get evidence into practice.

This report summarises the potential of the NHS to contribute as a good corporate citizen to local regeneration and sustainable development through its procurement, employment, capital build, travel and waste management activities. It highlights general trends in these activities across the regions. It also provides an overview of the national policy context, how health sector policies are integrated with regional policies and the potential role the NHS could play in each region.

Although the report purports to include transport, in fact there is little integration of transport in the report, particularly when assessing the current spend at regional level and suggestions for performance indicators to measure the health trusts contribution to environmental, health and transport improvements.

As a buyer of goods and services, the NHS can minimise its environmental impact by greening its supply chain and strengthening the local economy by opening its contracts to local small and medium-size enterprises (SMEs). This could open up opportunities for social needs transport providers.

The report highlights travel as an area of opportunity for Trusts. It reports that:-

• several large trusts and PCTs are implementing successful travel plans, and smaller trusts are coordinating with local partners to create the volume of passengers needed to strengthen their bargaining power with transport providers.
• The success of travel plans depends on changing the expectations of the work culture - incentives for sustainable choices need to be complemented by improved public transport services and reductions in car-parking spaces available to staff.
• Regional strategies around transport and land use form the context for local travel plans. All regions should assess these strategies for their health impact so that the consequences of choices made by regional government are made more transparent.

Many of those interviewed during the compilation of the report also suggested new performance management criteria to ensure trusts implemented the sustainable development agenda. SHAs and public health professionals also need to recognise this broader role for the NHS. Understanding that managing NHS assets differently could lead to environmental and health improvements, and help reduce health inequalities, strengthens the corporate citizenship agenda by relating it to current health issues.

Hopefully the forthcoming public health white paper, Choosing Health' will introduce new incentives for NHS involvement in corporate citizenship, and the Healthcare Commission will include corporate citizenship measures in the new healthcare standards.

Reports commissioned by the regions recognise that the NHS plays an economic role in providing employment and buying goods and services. Mention of the NHS's impact on the physical environment through travel procurement is virtually absent.

The report commissioned by the North West Regional Assembly, The Health and Social Care Economy in the North West,(2003) found that the health and social care sector

• Has a mainly female workforce, and 80% of male and 95% of female staff in health and related occupations earn under £400 a week. This means health staff have an amplified dependency on public transport and the safety of it
• Has significant research capacity, producing 13% of all research papers, the third highest in England
• Is forecasting growth by 2007-8 of 12,000 new clinical and related jobs for the NHS and £5billion p.a. spent on goods and services.

The report assessed that in the north west the health sector currently spends £678m on clinical supplies and services, £114m on general supplies (catering and laundry), £144m on office-related items and £282m on utilities, maintenance and cleaning. No comparable figures are given for transport spending.

The report states that procurement managers often lack board-level support. Many trusts focus solely on clinical performance and do not recognise the impact of the social, environmental and economic activities of the NHS. It would be helpful if a business case were made for corporate responsibility in the public sector.

The report includes examples of good practice. Manchester, Salford and Trafford LIFT is one such example. As far as public transport is concerned, other projects which mention transport are:-

University Hospital Birmingham claims their new building will improve transport and access to South Birmingham

Great Western Hospital in Swindon, a PFI with Carillion, tried to reduce staff travel by employing local labour and encouraging car sharing.