Senior Lecturer and Clinical Lab Sustainability Champion Sheri Scott with the latest on clinical laboratories and sustainability.
A year on from the Health and Climate Act 2022, clinical laboratory practice at first glance may seem just as resource intensive as it was in preceding years. However, if we look a little closer significant changes in practice can be seen. In this article I provide a review of those changes and outline guidance on further steps labs can take to become more environmentally friendly and support the UN sustainable development goals (SDGs).
Education and certification
In 2019, the health service’s emissions totalled 25 megatonnes of carbon dioxide equivalent. The source of these emissions is generally broken down into three key areas: direct emissions from healthcare facilities (scope 1), purchased energy such as electricity and steam (scope 2), and other emissions such as suppliers (scope 3). Although this figure still seems very high, it actually demonstrates a significant reduction since 1990 (26%). Changes from the supply chain have contributed to 62% of this reduction, with the remainder of the decrease coming from direct delivery of care (24%), the staff commute and patient and visitor travel (10%), and from NHS-commissioned private health and care services (4%). Despite this reduction, there is still a long way to go for the NHS to meet its net zero targets. With the continued climate health crisis, sustainability measures should be a key consideration for all labs. Quality improvement is fundamental as we strive for quality practice and sustainability.
The challenge that we face to achieve sustainable practice requires a collaborative approach by the organisations, the professional bodies, the workforce and suppliers.
Over the last two years, we have seen an increase in sustainability awareness both at a practice and educational level.
Education
In 2023, The Quality Assurance Agency for Higher Education launched an updated benchmark statement for biomedical science. This statement now includes the competencies of education for sustainable development (ESD). ESD provides students with the opportunity to gain knowledge, skills, attitudes and values, to become socially responsible global citizens and shape a sustainable future. ESD covers all aspects of sustainability – environmental, social and economic issues. The inclusion of these competencies in biomedical science courses will ensure graduates and the future laboratory workforce will enter the profession with sustainability very much part of their everyday practice. The key aim is that students will develop skills of critical thinking, while understanding new ways of being and practising. With the growing utilisation of apprenticeships, it is hoped these skills will foster sustainability conversations at the bench and that research projects will include sustainable considerations.
Furthermore, Greener NHS has facilitated the growing awareness of the climate health crisis at a professional level, fostering healthcare professionals to work together to meet sustainability challenges. If we were to conduct a search on scholarly articles alone, the growing number of publications and their subsequent citations relating to healthcare, and specifically clinical lab sustainability, demonstrate the increase in awareness. Further still, evidence can be seen through the actions of our associated professional bodies. In the last year we have seen sustainability feature in our conferences, webinars, publications and in an increase in sustainability-related professional development opportunities. Significant examples of professional body activities and their key achievements in lab sustainability include:
- The 2022 launch of the Centre for Sustainable Healthcare Clinical Labs Sustainability Network (Clinical Labs Susnet).
- European Federation of Clinical Biochemistry and Laboratory medicine (EFLM) published green and sustainable guidelines (2022), launched its educational programme for professional body representatives and launched its own green lab certification.
- UCL’s Martin Farley has adapted the Laboratory Efficiency Assessment Framework tool to meet clinical laboratory needs, with several pilot studies taking place across the UK.
- The Association of Clinical Biochemistry and Laboratory Medicine has established its own Green Champion group, facilitating conversation, education and promoting action.
- The IBMS, ACB and RCPath collaboration with Greener NHS.
The sustainability conversations are taking place, best practices are being shared and the messages are being heard. Labs across the country are considering green certification and Green Champions are stepping forward. Labs have begun to question the way they practise, whether this is turning off an incubator when not in use, going paperless, cleaning out a freezer or looking at email policy to name a few examples. It can now be said that clinical laboratories are contributing to NHS sustainability aims. Yet, there is still a long way to go and sustainability isn’t just about decreasing carbon emissions. It is important to remember that there are 17 global SDGs, covering health, social and economy as well as the environment. It is by working with suppliers that a lab can truly look to supporting these goals.
Working with suppliers for social value
Social value is the way for the public sector to ensure its suppliers are companies that behave in a responsible and sustainable manner.
The UK Government has a responsibility to ensure public money is spent on services and products from companies that operate without damaging the environment.
The Social Value Model, which came into force on 1 Jan 2021, supports buyers to differentiate between suppliers, via the tendering process, based on how the company behaves towards society.
The Social Value Model consists of five key themes:
- COVID recovery
- Tackling economic inequality
- Fighting climate change
- Equal opportunity
- Wellbeing
These five themes are further broken down into eight outcomes and 27 different criteria and can be linked back to the 17 SDGs.
It is clear from conversations with BIVDA, the national industry association representing manufacturers and distributors of IVD products in the UK, that the role of social value in the tendering process is not clearly understood by all involved. BIVDA represents more than 95% of the industry and over two hundred organisations and they have been running sustainability seminars for its member organisations since 2021. At their most recent sustainability seminar, social value was discussed in some depth.
With the NHS commitment to reach net zero by 2040 for direct carbon emissions and for goods and service emissions from partners and suppliers by 2045, partnerships for the goal (SDG 17) are clearly required.
Building on existing UK Government procurement policy, in September 2021 the NHS England Public Board approved a roadmap to assist suppliers to align with the NHS net zero aims. The roadmap contains several key requirements to help achieve these targets (see list, right).
The Evergreen tool
The Evergreen Sustainable Supplier Assessment is a self-assessment and reporting tool for suppliers to share sustainability information with the NHS. The tool supports supplier sustainability engagement and assists in their understanding on how to align with the NHS net zero ambition. The tool provides a pathway for communication and data gathering.
With net zero and social value holding a 10% weighting on all tenders, it is unsurprising that the lab suppliers have been considering laboratory sustainability ahead of the labs themselves.
Evergreen provides the NHS with a way for improved understanding of supply chain, it increases conversations with suppliers and supports contract management, by informing conversations and promoting alignment with the NHS sustainability priorities, such as key performance indicator emission reductions. The tool benefits suppliers by providing a benchmark against current and future NHS priorities, standardising sustainability communications and supporting sustainability ambitions.
Laboratories need to be aware of how suppliers can assist with sustainability and social value goals, and Evergreen permits suppliers a way to showcase their net zero progress and wider sustainability efforts.
The net zero roadmap
- From April 2022: all NHS procurements will include a minimum 10% net zero and social value weighting.
- From April 2023: for all NHS contracts above £5 million per annum threshold, suppliers are required to publish a Carbon Reduction Plan for their UK scope 1 and 2 emissions and a subset of scope 3 emissions.
- From April 2024: the NHS will extend the requirement for a Carbon Reduction Plan to coverall procurements.
- From April 2027: all suppliers will be required to publicly report targets, emissions and publish a Carbon Reduction Plan for global emissions aligned to the NHS net zero target.
- From April 2028: new requirements will be introduced overseeing the provision of carbon footprinting for individual products supplied to the NHS.
- From 2030: suppliers will only be able to qualify for NHS contracts if they can demonstrate their progress through published progress reports and continued carbon emissions reporting through the Evergreen sustainable supplier assessment.
Next steps
Going forward, conversations are required with suppliers before the tendering process begins. Labs need to consider which of the SDGs are of particular importance to their organisation and community. Are there areas such as education, wellbeing or environment that need addressing? Open conversations before the labs go out to tender will ensure the most relevant and valuable questions are asked and thus maximise the value of responses. Often the priorities will vary location to location, but unless discussion has taken place prior to the restrictions of an open tender, opportunities for social value will be missed. It is important that the lab is involved in the question setting, so that the social value questions are relevant to them.
Ongoing research hopes to provide insight into laboratory carbon hot spots and as the outcomes of the LEAF pilots are shared, the hope for the future is bright, but there is a need for lab leadership to promote change. Lab leaders will need to develop sustainability awareness and promote change from the top down. The IBMS and associated professional bodies are looking to hold a sustainability education event in October to support sustainability lab leadership.
Sheri Scott is a Senior Lecturer at Nottingham Trent University, an Advanced Biomedical Scientist and a Clinical Lab Sustainability Champion.
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