GOSH Green Plan 2024 to 2027

"The challenges we face in terms of both climate and ecological breakdown will impact on children in the UK and societies across the world. In 2021 - during the span of our last Green Plan - we were the first London hospital to declare a Climate and Health Emergency (CHE). We set ourselves tough Net Zero emissions targets for 2030 and 2040 and a pathway towards them for the three years ahead is outlined in this Green Plan.

We now have a clearer picture of how to decarbonise our estate, ensuring we tie in with our new master planning process across the years ahead. We are also determined to shape our response in a holistic way, beyond solely focussing on emissions. Addressing dangerous air quality, adapting to changing weather events to ensure the resilience of our services come rain or shine, reducing waste, and finding novel ways to adhere to the waste hierarchy as well as being mindful of how we support the protection of nature and biodiversity are all priority areas in our sustainability strategy.

Progress over the past three years has been positive. Our staff, including our green champions, work with remarkable energy and creativity to solve local challenges across 10 key sustainability programme areas, feeding into a new governance structure which is helping to embed change. We have also committed to creating a programme of sustainability training and education that reaches across all areas - especially clinical – within GOSH in 2024.

We’ve also had fun and worked with great people. We cycled together as a paediatric healthcare community from London to COP26 in Glasgow with messages to political leaders from our children and young people. And on a local level, we’ve enjoyed transforming Great Ormond Street during our annual Clean Air Day play street events, where we close the street to traffic and invite our children and families, and local community, to join us in play and educational activities.

I look forward to seeing what more we can achieve together over the next three years, and I am committed to ensuring sustainability will always be a Trust priority."

"As our Chief Executive has outlined in his foreword, we are determined to build a better and safer planet for our children and young people. Our core purpose at Great Ormond Street Hospital is putting the child first and always, and we cannot achieve this without considering the effects of the environment in which they live.

Over the next three years we have lots to achieve. Our ambitions include building the case to decarbonise our estate, transforming our Healthy Hospital Street concept design for Great Ormond Street into a working delivery partnership with London Borough of Camden ahead of the completion of our new Children’s Cancer Centre, and building a bespoke education programme to support our staff. Something we will be keen to share as it evolves.

Our Green Plan for 2024–27 celebrates our successes and outlines our ongoing ambitions to respond to the deepening climate and health crisis. I hope it demonstrates the efforts people from across GOSH have put into making change over the past three years and conveys our commitment to taking action towards a more sustainable future for our children and young people.

Work like this, that requires such imperative change, is a team sport. I have the privilege in my role of Executive Director of Space and Place, to witness how important sustainability is to all our members of staff at GOSH. We have teams of dedicated individuals who go above and beyond to put sustainability first – often in addition to their everyday jobs to advance our sustainability agenda. This will be evident when we delve deeper into our 10 Sustainability Programmes of Work (POWs) later on in the plan – where you will see just how many of our people are involved in our varied projects that extend across all areas of the organisation.

I am excited for what is to come – and look forward especially to welcoming in our new Sustainability Education Lead, who will carry forward our goal of embedding education for sustainability across all hospital clinical teams. This is a vital step towards helping our people to feel even more empowered to lead on sustainability projects in their area and play their role in scaling up our Trust-wide impact. We have a real opportunity to here to create positive change. It won’t be without its challenges; but I am confident that the work outlined in this Green Plan will help bring us closer to creating a better future for our children, young people – and our staff – at Great Ormond Street Hospital."

Local, regional and national policy considerations

We are facing the reality of increasingly severe and destructive changes in climate that are projected to worsen and result in transformational changes to society and our relationship with the natural world.

As a leading organisation responsible for the health of sick and vulnerable children we have a responsibility to minimise our own negative impact while educating and advocating for positive change within the health sector and beyond.

Our local neighbourhood

We are in a busy central London location in the London Borough of Camden. The local authority is itself pushing for ambitious change to its own functioning and to those operating within its boundaries.

In 2019, it declared a climate and ecological emergency and held its first citizen’s assembly on the climate crisis, which informed the development of a climate action plan 2020-2050 outlining a programme of projects to help them achieve Net Zero by 2030. They are also the first local authority to commit to achieving the World Health Organization (WHO) quality standards by 2030.

We work closely with many LBC teams and the Camden Climate Change Alliance to progress our own Climate and Health Emergency (CHE) commitments.

This collaboration includes our Play Street and Parklet programme, Healthy Hospital Street public realm transformation and joint local engagement events.

Other local partners include UCL, UCLH, Coram’s Fields, Bloomsbury Air and the Holborn Community Association with who we collaborate on local projects .

On a regional level

The Mayor of London has set a target for London to be net zero carbon by 2030 as well as becoming the world’s first National Park city.

GOSH also sits within the London congestion charge zone as well as the ULEZ. We work with the Greater London Authority and their partners at Imperial College London on the ‘Breathe London’ city-wide air quality monitoring programme with a node at our main entrance providing data over the last three years.

This partnership has allowed us to demonstrate a clear improvement in air quality over this time as shown in the data opposite.

Integrated Care System (ICS) level

GOSH is part of the North Central London (NCL) Integrated Care Board (ICB). We are members of the Greener NCL steering group and board, and lead across the patch on the Medicine’s Sustainability workstream.

The NHS context

Identifying a route to net zero emissions for a complex system as large as the NHS is particularly challenging. To understand how and when the NHS could reach net zero it established an ‘NHS Net Zero Expert Panel’ reviewed nearly 600 pieces of evidence submitted to them and conducted extensive analysis and modelling.

In October 2020, the NHS became the world’s first health service to commit to reaching net zero carbon, in response to the profound and growing threat to health posed by climate change.

The two targets they set are:

• For the emissions we control directly (the NHS Carbon Footprint), we will reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032
• For the emissions we can influence (our NHS Carbon Footprint Plus), we will reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039

The Greener NHS programme works with staff, hospitals, and our partners. It aims to build on the work being done by trusts across the country, sharing ideas on how to reduce the impact on public health and the environment, save money and reach net zero carbon.

National context

The UK Government is required under the Climate Change Act passed in November 2008 to reduce its greenhouse gas emissions by 100% by 2050, compared to 1990 levels. It sets out emission reduction targets that the UK must comply with legally. It represents the first global legally binding climate change mitigation target set by a country

A lot has changed in terms of sustainability at GOSH over the three years since our previous plan, known as our Sustainable Development action Plan. In this new Green Plan 2024–2027 we summarise our progress and outline our ambitions across the three years ahead.

In February 2021, the GOSH Trust Board and Executive Management team – following over a year of dialogue with staff and our young people – declared a climate and health emergency and committed GOSH to a process of change. This was powered by the statement that ‘we aren’t looking after children if we don’t protect the environment’.

The declaration encompassed two goals:

• GOSH Carbon Footprint (circa 24% of total emissions): The emissions within our estate that we control directly, net zero by 2030.
• GOSH Carbon Footprint Plus (remaining circa 76% of total emissions): The emissions we can influence, net zero by 2040.

Subsequently, we have strengthened our delivery and governance structure by forming ten sustainability Programme of Work (PoW) areas powered by the efforts of staff ‘green champions’ committing time beyond their substantive roles. These areas of focus include travel and transport, food and nutrition, medicines sustainability, community and public realm, digital transformation, sustainable care pathways, sustainable procurement, adaptation and resilience, our people/education and space and place. This Green Plan details this activity and the ambitions for these core areas of work.

Sustainability Programme and Oversight Boards ensure progress and support is closely monitored and fed into wider hospital governance as required. We plan to formally recognise some of our Green Champion roles and acknowledge the significant staff time commitments made, to ensure ongoing resource and capacity is genuinely built into each PoW and consequently the wider workforce.

However, the Green Plan looks beyond just our 2030 and 2040 emissions targets at our determination for the CHE response to be a holistic one and not focused solely on carbon emissions. A response that acknowledges both the local and wider context. This is guided by our Sustainability strategy and accompanying action plans that outline five priority areas. As a children’s hospital based in central London our CHE response priorities also include:

1. Environmental determinants of health (for example, air quality)
2. Climate adaptation and Resilience
3. Zero waste
4. Nature Positive road map
5. Emissions

Targeting these five priorities forms a holistic CHE response and delivering activity through our ten programme of work areas, ensures we are able to realise opportunities available to us across our service provision.

As outlined, GOSH’s response to facing a climate and health emergency (that disproportionately threatens the health and life chances of children and the most vulnerable), aims to be as holistic a ‘sustainable healthcare’ approach as possible.

However, a fundamental element of this journey is the CO2e emissions reduction-related commitments laid out within the Delivering a ‘Net Zero’ National Health Service document.

This section of our Green Plan summarises our progress so far in relation to understanding and reducing our CO2e related footprint.

NHS commitments

There are two NHS net zero targets:

1. NHS Carbon Footprint By 2040. Ambition for an 80% reduction (compared with a 1990 baseline) by 2028–2032.
2. NHS Carbon Footprint Plus By 2045. Ambition for an 80% reduction (compared with a 1990 baseline) by 2036–2039.

GOSH mirrors these targets but our goal is to achieve net zero in advance of NHS net zero timescales: GOSH Carbon Footprint by 2030, and GOSH Carbon Footprint Plus by 2040. This is highly challenging but remains the goal for us to mobilise around.

Estate-based emissions

Our building energy constitutes over 90% of the current GOSH carbon footprint. Fig.1 below shows our required emissions reduction trajectory to reach net zero by 2030, demonstrating an 8% reduction (1,279 tCO2e) over the last three years, followed by a ‘deep decarbonisation’ scenario that aims to deliver around 87% reduction in estate emissions through a programme of energy efficiency measures.

The programme will include a Building Management System (BMS), metering upgrades and optimisation, rolling efficiency measures, heat recovery and ventilation upgrades and replacement of our Combined Heat and Power (CHP) plant with an electrified energy centre. Funding is not yet in place to fully deliver this scenario.

The remaining around 13% are residual emissions relating to electricity consumption (figure dependent on rate of grid decarbonisation over time), that can be reduced only through following two existing options.

These include entering into a power purchase agreement to ensure that all electricity is sourced directly from specific 100% zero carbon supplies or alternatively purchasing high quality carbon offsets equivalent to the level of residual emissions. Options for these are in consideration.

Reducing estate based emissions from around 15,853 to around 2,061 tCO2e during this period requires annual reductions of around 1,800 tCO2e to 2030. Such a programme would be backloaded, with the greatest savings in the second half of the decade.

To deliver the necessary interventions to reach this target will require a high level of support and funding, and overcoming the complex technical and operational challenges exacerbated by our highly space-constrained site. CO2e emissions related to other estate-based sources sitting under this target (less than 10% of 2030 target emissions) are outlined on page 10 and will be addressed through specific projects outlined within this Green Plan.

Net zero by 2040

Fig.2 below looks at the trajectory for net-zero GOSH Carbon Footprint PLUS sources by which make up around 87% (100,659 tCO2e) of GOSH’s overall emissions for which we aim to reach by 2040. The vast majority of this comprises procurement and supply chain-related emissions that we can influence but not control directly. We also include personal travel where our data is still evolving.

Procurement and supply chain CO2e emissions are currently calculated with spend data (taken from our company ledger): currently the recognised methodology. Because there isn’t always a clear correlation between cost and spend and embedded CO2e, and with many medicines used at GOSH being very expensive, this methodology is recognised as imperfect.

However, as outlined within the Green Plan we are working both internally and with partners on improving the accuracy of this measurement. Currently, there are 21 procurement subcategories (within the main areas of medical ND non-medical equipment, medicines and chemicals and other supply chain) each with a specific CO2e conversion factor. Budget lines are linked to these and a resulting CO2e figure is reached.

Delivery of this process has evolved within GOSH over time as has our baseline. We have now reached a solid total and we are delivering more projects that build the groundwork for addressing these emissions, especially relating to care pathways and procurement linked to medicines and related consumables.

Over the last three years the sustainability programme has undergone significant structural change, and a lot has been achieved that will be built on over the three years ahead.

Initially we focussed on the ten ‘Greener NHS’ specific focus areas which we have now adapted to better suit the GOSH context. A loose group of general staff green champions was formed, working across all areas instead of the targeted Programme of Work (PoW) groups that are now in place. However, many key objectives of our previous SDMP have been achieved and will allow us to build on this success over the coming three years up until 2027.

Highlights include:

Corporate approach

• We publicly declared a Climate and Health Emergency and set ourselves Net Zero targets for our emissions.
• We began to build a staff sustainability learning programme and have now committed to resource a far-reaching Climate Emergency Education programme over the coming three years.
• We’ve built formal links into ‘Art and Culture declares’ and collaborated with artists and our young people to communicate powerful messages through art and creativity.

Asset management and utilities

• We procure 100% of our energy from REGO backed renewable sources.
• We have built a Sustainability Digital Transformation programme.
• We created a building and estate decarbonisation pathway to 2030

Travel and logistics

• Established a play street programme linked to clean air and public realm in partnership with our local authority and community.
• Completed a fully costed concept design for a part-pedestrianised ‘healthy hospital street’, that is included in LB Camden’s Transport Strategy and part of the Holborn Liveable Neighbourhoods Scheme.
• Built an active travel programme offering training, subsidised equipment and further support including achieving a Gold Cycle Friendly Employer Award.
• Embedded video conferencing across the organisation.
• Introduced four electric ‘Peter Panbulances’ into the hospital fleet and are working to increase their number and range.

Climate change adaptation

• Improved public realm including planting and access to gardens.

Capital projects

• Submitted abstracts and presentations for our innovative placemaking design work to multiple industry events.
• Designed the Children’s Cancer Centre in line to achieve a BREEAM Excellent rating.

Green space and Biodiversity

• Incorporated biophilic design into the Children’s Cancer Centre, through the inclusion of spectacular roof and internal gardens.
• Set up a staff and patient gardening group.
• Created multiple artwork and installations based on the love of nature (biophilia) and human affinity with the natural world with GOSH Arts.
• Conducted a hospital green space improvement evaluation.
• Produced GOSH Honey from our rooftop apiary.

Our people

• Created a staff sustainability education programme.
• Integration of Staff wellbeing and sustainability through an online portal and face to face in the HIVE.
• Staff environmental behaviours gamified through the CHEER behaviours app.

Carbon and greenhouse gas emissions

• Catering carbon foot printing menu evaluation underway.
• Full Trust baseline and ongoing CO2 monitoring in place

Sustainable use of resources

• Bulk item, furniture and ICT, community swap and refurbishment scheme in place.

In 2023, a new sustainability strategy and action plan was devised to help guide a holistic CHE response focussed on five priority areas. Two enabling areas were also agreed to support this journey.

This action plan – summarised below – breaks down the strategy and each priority area into initiatives and sub projects. These must be delivered to realise the benefits of each priority and enabling area that we are committed to.

The Strategy presents the overarching guidance for our holistic Climate and Health Emergency response up to 2030, and this action plan represents a breakdown of how this will be delivered.

The remit outlined below is substantial and wide ranging, and although many of these project areas do currently exist in varied stages of maturity, they are not deliverable in their entirety without resourcing, funding and enhanced formal accountability.

Over the course of this Green Plan we’ll be working to secure appropriate funding sources and methods for sustaining them.

Estate Decarbonisation Programme (building energy)

• Net Zero technical working group
• BMS, metering and active management
• Rolling energy efficiency measures including LED lighting and controls
• Energy reduction behaviour change programme
• Heat recovery and ventilation and air handling upgrades
• Design and planning linked to master planning process
• Removal of CHP and install of electrified energy centre
• Local heat network planning and collaboration group.

Estate Decarbonisation Programme (non-building energy)

• Full hospital policy review for sustainability
• E-fleet mileage expansion programme
• Staff active travel support programme
• Business travel review and policy update
• Water efficiency programme
• Medical gas reduction programme
• Inhaler programme
• Electricity procurement review and planning
• Sustainable facilities management review and implementation.

Supply Chain Decarbonisation Programme

• Meet and surpass the steps outlined through the NHS Net Zero Supplier Road Map
• GOSH carbon footprint PLUS baseline improvement group formed.
• We aim to engage our supply chain through delivering on a ‘Net zero carbon 5 step supplier framework’ via:
  • Annual supplier survey
  • Supplier support package
  • Supplier CO2e emissions footprint measurement and submission
  • Suppliers net zero target publication by 2030 (aligned with our 2040 commitment)
  • Supplier CO2e emissions reduction plan created by 2030 (aligned with our 2040 commitment).

Ongoing Clean Air Hospital Framework delivery and the creation of new, dynamic programmes

• Site wide air quality monitoring programme
• Air quality education programme
• Air quality advocacy programme
• Expand into wider determinants including water, plastics and beyond.

The Healthy Hospital Street Placemaking programme

• A fully costed healthy hospital street concept design to RIBA 2 standard, for use in an ongoing capital funding programme.
• Multi stakeholder healthy hospital street project delivery group active.

Community engagement as an anchor institution

• Engage with the NHSEI CORE20PLUS5 and NHSEI ‘10 Building blocks in Building for health’ engagement processes.

Climate resilience and adaptation plan

• Hospital climate risk assessment conducted
• Climate resilience and adaptation plan working group formed
• Plan created and signed off.

Trust Risk Register

• Climate resilience and adaptation plan and reporting processes aligned with formal organisational risk register.

Single use to reusable programme

• PPE and clinical item procurement pilot programme
• Healthcare without Harm, Towards a Plastic Free Healthcare project called ‘Born Green’ will be delivered across three years on Koala Ward.

Catering

• Health Care Without Harm Cool Food pledge: Lagoon menu CO2e emissions baselining.
• Catering Emissions reduction programme.
• Food waste reduction pilot.

Following the ‘nature positive’ building block process

• Assessment & prioritisation of operational impacts on realms of nature.
• Baseline and target setting.
• Setting measures to inform decision making.
• Applying the mitigation hierarchy across value chain.
• Transforming policy and financing.
• Disclose and report results.

Our overall sustainability programme that responds to the climate and health emergency declaration is broken down into the following Programme of Work (PoW) areas.

Each area has a working group consisting of staff from relevant parts of the hospital that meet regularly. A Chair leads the group’s activity and its membership, while a senior level sponsor – responsible for delivery of each programme – is in place for an increasing number of programmes. Our aim is for a senior sponsor to step in across all PoWs within a year.

These GOSH PoW areas align with, and build upon, the core Green Plan chapters recommended by Greener NHS. However, they have been tailored for our context.

The 10 work areas that follow are:

1. Medicine Sustainability
2. Digital Transformation
3. Space and Place
4. Community and Public Realm
5. Adaptation and Resilience
6. Procurement and Circular Economy
7. Food and Nutrition
8. Our People
9. Travel and Transport
10. Sustainable Care

Headline objective

To reduce carbon emissions and address the wider environmental and social impacts of prescribing and using medicines and medical products. Further, we aim to gain insight into carbon emissions reduction in all facets relating to medicines, and ensure all related projects are definable with clearly measurable metrics. The communication of such data to clinical and executive teams as well as external bodies is key.

Why does this matter to us?

• As a system, too many medicines are wasted. 4.5 trillion medicines are made every year, and billions are never used, at huge financial cost reaching the billions of pounds every year. Meanwhile around two billion people do not have access to basic medicines.
• Medicines account for 25% of healthcare CO2e. Packaging alone accounts for around 100,000 tonnes of plastic each year, most of which is rarely recycled – even in ‘take-back’ schemes – but is either incinerated or goes to landfill. A trillion packages are estimated to be discarded globally each year.
• Patient leaflets carry a huge environmental cost, yet patients often don’t read them. £Billions of medicines are discarded due to the accompanying leaflets rarely being patient-centred.

Achievements over the last three years

• All bags including pharmacy bags changed from plastic to sustainable alternatives.
• Individual patient leaflet handouts removed, and available through QR codes for scanning on the patient information board within the pharmacy.
• GOSH medicines sustainability PoW group active and has formed an Inter Trust Medicines waste committee.
• Joint working: GOSH PoW Chair also leads the Medicines Sustainability workstream across North Central London (NCL) ICB in partnership with colleagues from UCL. It focusses on the below key strands:
  • Procurement, for example working with sustainable suppliers.
  • Medicines waste, for example reducing medicines wasted due to temperature excursions.
  • Pharmaceutical pollution, for example reducing inappropriate disposal of inhalers.
  • Overprescribing, for examplereducing overprescribing of salbutamol inhalers. • Reducing paper and plastics, for example limiting use of intravenous antibiotics (hence reducing use of IV giving sets).
  • Formularies, for example standardised sustainability assessments, developing formularies (for example nutrition).
  • Education and training, for example bringing sustainability into credentialing.
  • Clinical care, for example increasing appropriate use of dry powder inhalers; reducing use of desflurane appropriately.
  • New models of care, for example outpatient transformation (to reduce footfall on site); remote monitoring.
• Successful Paracetamol CO2e emissions footprinting project will lead to wider embodied carbon assessments. The aim of the study was to estimate the embodied carbon of different formulations of paracetamol, its packaging and the consumables used in administration within paediatrics. NHS England priority areas:
  • Anaesthetic gases –Desflurane is a potent Green House gas. NCL’s target is to reduce its use to less than 5% of total volatile anaesthetic gas use. The Trust has gone beyond this by completely stopping its use.
  • Nitrous oxide – NCL target to reduce nitrous oxide use by 40%. The trust has conducted an N20 waste study and committed to invest in removing leaky manifold pipe work and replacing with cylinder use in 2024. Savings of over 200,000 litres of N20 are expected.

Plans and ambitions over the coming three years

• Pill School: Switching 50% of GP amoxicillin prescriptions from suspension (liquid) to tablets in one NHS region would save enough CO2e to fly someone from London to New York 31 times! Pill School will aim to switch as many children as possible from liquids to tablets. It will be piloted on one ward and an implementation plan for a full roll out has also been agreed. All information and insights will be shared with our partners.
• IV to Oral: Derived from the paracetamol CO2e foot printing project and in line with the concept behind Pill School, this project will be applied wherever appropriate to reduce embodied carbon of medicines. It will work towards implementing a gradual switch from IV to oral administration of medicine. The project will involve a significant change in approaches to working practice and available funding options will be sought.
• Virtual information provision via QR code: In collaboration with the Sustainable Medicines Partnership (SMP) and a QR video partner, the project proposal has been through hospital governance. It will design and implement child-friendly ways of communicating, using avatars that speak with the children about what the medicines are for, etc. The technology solutions will be revolutionary.
• Medicines delivery to patients: A Quality Improvement project to assess whether the delivery of medicines to patients can be made more sustainable. Comparing current delivery with a pickup system for virtual clinics, optimising pack sizes and assessing courier delivery vs patients’ collection. Children and family engagement will be crucial in the project.
• Yellow Bins: A nursing staff audit of yellow bin use will provide data on waste stream contamination and volumes of waste. Followed by an education programme for staff.
• Pharmacy Innovation Hubs: A concept already developed by UCLH that we will look to replicate, allowing for pharmacy engagement events involving our 170-pharmacy staff. We will also look to integrate the ‘medicines carbon footprint classifier’ (MCF) – developed by the SMP – into how we improve our footprinting processes and therefore target our activity. The NHS currently links footprinting of medicines to their cost which has multiple flaws. We aim to be part of creating a revolutionary new metric for measuring the impact of medicines, estimated at 25% of overall NHS CO2e.

Links to paediatric health outcomes

• Moving from IV to oral has positive implications relating to safety, infection and simplicity of measurement and application.
• Improving respiratory outcomes while reducing the Co2e impact of inhalers will be a key area in paediatrics in the coming years.

Headline objective

To harness digital technology and systems in streamlining service delivery. To support efforts to track and reduce carbon emissions and the Trust’s environmental impacts.

We’ll use our electronic patient record and mandatory data collection processes to monitor CO2e emissions and target interventions, expand the use of telemedicine and use digital systems to reduce paper usage and postage.

Why does this matter to us?

Linking progress along our climate and net zero journey into our digital systems is a key step in embedding sustainability into core service provision. It is also vital for engaging on complex ideas and presenting data in an accessible manner. The CO2e impact of our own digital footprint and use/disposal of ICT equipment must also keep up with a rapidly evolving cyber landscape.

Achievements over the last three years

• CHEER: The CHEER environmental behaviours app, developed by Jump and designed by GOSH staff and patients, encouraged 13,618 individual actions avoiding over 26,000kg of CO2e.
• Paper wastage: It was identified, that as part of our dispensing process, all prescriptions dispensed contain several leaflets printed on A4 paper. Due to the nature of our patient cohort – who often come back for review and re-prescribing of their specialist medicines – many patients and carers were receiving multiples of the same leaflet each time they visited. A GOSH branded poster (above right) has been created linking a QR code to each dispensary-based patient information leaflet. These contain generic (for example, not drug-specific) information supporting patients and carers to get the most out of their medicines. Given the increased use of QR codes globally we felt it would be an appropriate time to trial signposting our patients to the GOSH internet pages, easily available to anyone outside the Trust, rather than printing each leaflet to place with each prescription. We will survey patients and their carers on the acceptability of this approach to establish whether any improvements can be made. Printed leaflets will always be available on request for those without smartphones/preference for paper leaflets. An A4 version of the poster will also be sent with all medication posted/couriered from the hospital.
• Digital communication and education: We created and released a sustainability podcast, ‘GOSH Pods Goes Green’ focusing on sustainability in health care. In series one, we explore the issue of climate change, how healthcare practices are contributing to this emergency, and discuss the small steps that all healthcare professionals can take on the road to instigating bigger changes within the NHS. For the second series, we focussed on air pollution, exploring the impact of air quality on our health, factors contributing to air pollution, and started to think about what we can do as individuals and as healthcare professionals to improve our air quality and advocate for change. A series highlight was having a series of guest speakers on the pods. These included GOSH consultant paediatric intensivist and the Royal Society of Physicians Special Advisor on air quality Professor Sir Stephen Holgate on the show. We also featured the London Borough of Camden air quality lead; a researcher in public health at Imperial College; the co-founder of the clean air campaign Choked Up; a consultant in paediatric respiratory medicine, and; GOSH leads on public realm and electronic patient records. GOSHPods Goes Green is available to listen on Apple Podcasts and Spotify.

Plans and ambitions over the coming three years

• We will expand our podcast series.
• Integrate our expanded sustainability education programme into our staff intranet and GOLD leaning portal.
• Optimise our Green ICT reuse programme.
• Explore the expansion of our electronic patient chart to incorporate wider environmental determinants of health beyond air quality.
• Create a CO2e emissions portal.

Links to paediatric health outcomes

• Improving access to medical information by improved accessibility using QR codes can impact on potential health outcomes.
• An engaging digital and audio education podcast series communicating the impact of air quality can involve a new audience of young people on environmental determinants of health through a format they are much more used to digesting content through.
• Bringing a further layer of context and advice to patient consultations that allows patients, carers, families to take action to reduce the impact of poor air quality on their health conditions. It will educate clinical staff to incorporate impacts of other environmental and social determinants of health into their clinics over time, and has the potential to have wide reaching impacts on health.

In the spotlight: Air pollution data and the patient electronic chart

In response to the coroner’s report on Ella Adoo Kissi Debrah’s death, GOSH staff have linked the postcode specific, average annual air pollution data (supplied by Imperial College London) for all our patients to our electronic patient records.

This data is contrasted with limits recommended by the World Health Organisation (WHO) to highlight any risk this may pose. This allows air pollution data for PM2.5 and nitrogen dioxide to be displayed in each patient’s record, for their postcode area.

This will help our clinicians consider whether air pollution is a factor in a child’s illness, how it affects them or might do so in the future, and if there are steps that can be taken to help. This ‘technical build’ is being actively shared with peers across the NHS.

Next, we are working with groups including GOSH clinical staff, Camden Council, Global Black Maternal Health and our Young Person’s Forum, to create air quality simulation training materials. These will showcase different conversations that clinical staff may have with patients relating to how air pollution may affect our health and how this may present in different scenarios.

Staff training and confidence building is fundamental to ensure this innovation is an effective addition to a tailored patient consultation

Headline objective

To reach Net Zero emissions for the estate-based emissions we control by 2030. This includes emissions sources linked to our buildings, fleet, and medical gases. We will aim to reduce emissions from our buildings by around 29%, in advance of plant upgrades and electrification between 2027 and 2030/1.

Why does this matter to us?

GOSH is an energy and carbon intensive specialist acute hospital. Without significant interventions we will struggle to achieve our 2030 ‘GOSH Carbon Footprint’ net zero commitment. Our projected reductions under a business-as-usual (BAU) scenario will fall by only 7% by 2030 (in comparison to 2020/21) mainly due to decarbonisation of the national grid. Under this scenario, emissions may only fall by 11% by 2050 demonstrating that decisive action is needed to place the hospital operations on a course for deep decarbonisation.

Adhering to the challenging ‘deep decarbonisation’ scenario we have modelled, is closest to the pace of change outlined in the Paris Climate accords. It would allow us to demonstrate sector leadership and to have reduced our estate-based emissions by around 87% by 2030. The route to reach the remaining around 13% reduction is unclear but potentially through Power Purchase Agreements to specific renewable energy projects and high quality offsetting.

Achievements over the last three years

• CHE declaration and targets set: The GOSH Board and Executive Team declared a Climate and Health Emergency in March 2021. Consequently, the hospital is working towards net zero for the carbon emissions linked to estate-based operations it controls by 2030. This is a very challenging timeframe that it may not be possible to meet, however the stated target serves as a clear challenge to the organisation to maintain focus on moving as quickly as possible.
• GOSH Net Zero estate Carbon pathways report: Working with an engineering consultancy the GOSH Space and Place team created a report highlighting our CO2e emissions linked to the energy use of our estate. It includes emissions associated with providing heating, cooling and power to hospital and charity buildings. It modelled business as usual and a range of different carbon reduction scenarios to illustrate the implications of different approaches for carbon, investment, and operating costs. A high-level cost has been estimated at £30m but this is likely to change.
• Building Management System (BMS) upgrade: Business case signed off for BMS upgrade works, covering both hardware and software as well as engineering reviews of heating and cooling loads.

Plans and ambitions over the coming three years

The next three years are fundamental to our hopes of meeting our 2030 target. The success of the ‘deep decarbonisation’ scenario requires that we establish a more detailed understanding of our current energy systems and building management to deliver the necessary energy efficiency interventions across the estate. This foundational understanding is integral to the next steps.

An Estate Decarbonisation strategy and business case must address each of these factors sequentially, to gather a far better understanding and control over energy use across the estate. This foundational understanding and improved controls will deliver efficiencies and better inform our teams about where to target further operational efficiencies. Once this granular understanding of energy use across the estate is established and available ‘no regrets’ measures have been implemented (for example, LED lighting upgrades, variable speed pumps and fans) then delivering on plans to decarbonise heating and cooling will begin.

In parallel, measures to improve energy efficiency will be implemented, wherever work is being done to the estate. Given the significant costs and disruption involved in undertaking work in a live hospital environment, the extra costs of adding energy efficiency measures or increasing the efficiency of existing systems being changed, will nearly always prove to be cost effective in comparison.

Removal and replacement of the gas CHP units (beyond the time scope of this Green Plan) in the energy centre is a major undertaking and will be a core component of our upcoming GOSH Estates Strategy and site Master Plan. They will both need to explicitly plan for and support the move to low carbon heating and cooling, including through the following measures:

• Providing necessary space for a new energy centre or connection into local decarbonised heat networks should this prove to be possible.
• Incorporating allowances for necessary controls and metering to optimise energy use and reduce average costs by enabling effective demand response measures.
• Incorporating opportunities to reduce demand through energy efficiency measures as part of estate replacement and improvement works.
• Ensuring that new facilities maximise potential for renewable energy generation where this does not conflict with operational or amenity value.
• Minimising the amount of estate required for service provision, through operational efficiencies linked to digital service delivery as well as optimising our building utilisation.

In the spotlight: Carbon reduction pathways

The carbon reduction pathways we have modelled illustrate how the above principles can be applied and the scale of carbon savings that might be achieved by 2030 as well as the likely scale of investment and implications on operating costs.

Headline objective

The aim is to redevelop Great Ormond Street Hospital (GOSH) and its surrounding public realm to create a healthy, green, and child-friendly environment. The existing challenges include air pollution exceeding WHO guidelines and a lack of open space. The Children’s Cancer Centre (CCC), part of the redevelopment, presents an opportunity to improve the hospital’s relationship with the community and create a model for a Healthy Hospital Street.

Why does this matter to us?

• Great Ormond Street can be unsafe and is noisy, dominated by vehicles and traffic congestion and its air pollution levels frequently exceed World Health Organisation guidelines. This is of particular concern for GOSH which receives and treats children with respiratory disease.
• The CCC is in Phase Four of the site development and offers a chance to redefine the hospital’s connection to the street and surrounding community.
• Bloomsbury, where GOSH is located, has socio-economic challenges and a shortage of open space.
• Various assessment methods, including the TfL Healthy Streets Framework and Breathe London Monitor, contribute to creating a baseline for future improvements.

Achievements over the last three years

• The Great Ormond Street Parklet: Parklets are a way of temporarily removing parking bays and evaluating the impact before permanent measures are implemented. It is possible to experience at a smaller scale the potential effect of a greener, healthier and more people friendly street which is our ultimate aim. In partnership with Camden Council, the parklet has transformed a parking bay on Great Ormond Street into a green space, filled with plants and seating areas, giving people a moment of respite seconds away from the hospital’s main entrance.
• Play Street: Activity emerging from our Clean Air Hospital Framework resulted in the joint sustainability/play ambition to transform our busy street into a space which prioritises children and the environment. Play streets aren’t only good for children’s health and happiness, they give them a sense of belongin and encourage residents to become involved also, creating greater community cohesion. Events such as the Play Street help us envision a different future. It is possible to experience at a smaller scale the potential effect of a greener, healthier and more people friendly street which is our ultimate aim for a Healthy Hospital Street.
• Bloomsbury 2030: Putting children at the heart of urban design could transform cities around the world for the better. This project involved working with local children from the Holborn Community Association, and also children at the GOSH school. They were asked to envision how they imagined the local area would look like in 2030. They created beautiful optiques working with artist Una Knox. Due to COVID-19 restrictions these were designed to be in individual boxes each containing all the components to create the optique.

Plans and ambitions over the coming three years

• Aims to transform Great Ormond Street into the first “Healthy Hospital Street” in London.
• Goals include creating a welcoming hospital entrance, reducing congestion, improving air quality, and enhancing play-friendly environments.
• Emphasis on green infrastructure, community-friendliness and climate resilience.
• Input into the GOSH masterplan – GOSH is undergoing a 40-year redevelopment, and the Masterplan outlines key considerations.
• Integration of climate resilience, collaboration with Camden Council, and community impact assessment are crucial.
• Collect noise, pollution and traffic data to provide a solid baseline of information to evaluate future changes to the street.
• Commit to being an active participant in the broader community, extending our influence beyond medical care to address environmental sustainability, climate resilience, and social determinants of health. The hospital aims to play a transformative role in fostering community well-being and actively responding to the challenges posed by the climate emergency.
• Continue to work with Camden Council who, from the outset, have supported our vision for a Healthy Hospital Street. The project is included in Camden’s Transport Strategy, and going forwards the project will form part of the wider Holborn Liveable Neighbourhood Project.

Links to paediatric health outcomes

Greener streets contribute to a holistic and supportive environment for paediatric health, encompassing physical, mental, and social well-being. Implementing green initiatives in urban planning and healthcare infrastructure can have lasting and positive effects on the health outcomes of children.

• Improved Air Quality: Green streets with abundant vegetation act as natural air purifiers by absorbing pollutants and releasing oxygen. This is particularly crucial for children, as exposure to clean air is essential for lung development and overall respiratory health.
• Reduced Exposure to Air Pollution: Planting trees and creating green spaces along streets can act as a barrier, helping to reduce children’s exposure to harmful pollutants from vehicular emissions. This is of particular importance for children with respiratory conditions.
• Enhanced Physical Activity: Green streets provide inviting spaces for physical activity and play and encourage children to engage in outdoor activities, promoting physical health and reducing the risk of childhood obesity.
• Positive Mental Health Impact: Exposure to nature and greenery has been linked to improved mental health outcomes. Green streets provide opportunities for relaxation, stress reduction, and improved overall well-being, which can positively impact children’s mental health.
• Community Interaction and Social Development: Green streets can serve as community hubs, bringing people together and fostering social interaction. Children benefit from a sense of community, social connections, and shared play spaces, contributing to positive social development.
• Temperature Regulation: Urban greenery helps regulate temperatures by providing shade and reducing the urban heat island effect. This is particularly important during hot weather, reducing the risk of heat-related illnesses among children.
• Biophilic Design for Healing: Incorporating biophilic design principles into healthcare facilities located on or near green streets can contribute to the healing process. Nature-inspired environments within and around hospitals can positively impact the emotional and psychological well-being of pediatric patients.
• Reduced Traffic-Related Risks: Green streets designed with pedestrian-friendly features and reduced vehicular traffic contribute to safer environments for children. This minimizes the risk of accidents and injuries associated with traffic.
• Educational Opportunities: Green streets provide opportunities for environmental education. Children can learn about nature, ecology, and sustainable living through interactive green initiatives, fostering a sense of environmental stewardship.
• Climate Resilience: Green infrastructure, including street trees and green spaces, contributes to climate resilience. This is particularly important in the context of climate change, as it helps mitigate extreme weather events and ensures a more stable environment for children.

In the spotlight: Healthy Hospital Street

Supporting the pathway to net zero emissions, and creating a healthier, child-friendly public realm around the hospital. The vision is to transform a polluted and traffic dominated street into a climate resilient, healthy, and child-friendly one.

This has the potential to become the first ‘Healthy Hospital Street’ in London, a concept which could be replicated further afield.

Exploring the potential co-benefits of projects which integrate climate resilient solutions, whilst creating beautiful spaces for people is often a powerful way of putting forward an idea and garnering support for green interventions and neighbourhoods.

As has been stated by GOSH CEO Matt Shaw: “There is an inextricable link between the environment and health which is vital for GOSH given the fact we treat some of the sickest children. It is now not enough to only treat the child in front of us, we must treat the environment they are in.”

The objective as detailed in our RIBA two stage fully costed concept design is to is to create a street that:

• Is a suitable and welcoming entrance for the hospital
• Reduces congestion on the street
• Increases greening and contact with nature, incorporating climate resilient solutions
• Improves air quality and reduce emissions
• Is play-friendly
• Makes the environment safer
• Makes the street more community friendly, for all generations
• Creates opportunities to sit, interact and play
• Provides opportunities for drinking water
• Is capable of incorporating SuDs and rain gardens
• Provides safe, segregated cycling routes
• Offers safer routes and improved wayfinding and accessibility
• Introduces adaptive strategies for future streets

Headline objective

This workstream is concerned with plans to mitigate the effects of climate change and extreme weather on GOSH’s functioning. Concern about extreme weather events on Trust infrastructure, patients, and staff requires action to be embedded in hospital systems.

Our aim is to ensure GOSH is a “future fit” organisation that is adaptable and resilient to the effects of climate change. A hospital Adaptation and Resilience plan will be signed off and linked to the Trust risk register. The public realm improvement work described in the ‘Community and Public Realm section, will also contribute to improving the estate’s climate resilience.

Climate adaptation and resilience is also classed as one of the five key priority areas within GOSH’s Sustainability Strategy and action plan.

Why does this matter to us?

As the NHS works to mitigate climate change, there is a parallel requirement to adapt to changes that are already happening and set to intensify. As climate change accelerates globally, in England and the UK we are seeing direct and immediate consequences of heat waves and extreme weather on our patients, the public and the wider NHS system.

In 2022 we saw mass flooding and wildfires in London for the first time. As a result of this, GOSH will need to alter some of its processes to ensure that operations can continue under the pressures extreme weather events might bring. These may include patients being less or unable to access the hospital, staff having greater difficulty getting into work, potential flooding of buildings and the impacts on the functioning of staff and site infrastructure during prolonged heatwaves.

In July 2021, Camden was subject to a major flooding incident, that impacted over 100 homes and businesses. Public space needs to adapt, to mitigate the future risk that surface water flooding, drought, overheating, and biodiversity loss present.

Great Ormond Street sits within an area identified as having the highest climate risk, as identified by the Greater London Authorities Climate Risk Mapping. This mapping looks at 13 different metrics, ranging from age ranges, income deprivation, surface temperatures, deficiency to public open space, flood risk and air pollution to name a few. Camden is currently developing a Climate Resilience Plan in 2023 that GOSH will dovetail with.

Achievements over the last three years

Over the last two years during the RIBA stages one and two of the Children’s Cancer Centre development, the following adaptation and resilience planning has been designed in.

A Preliminary Ecological Appraisal (PEA) of the proposed building has been undertaken. Appropriate measures will be implemented for the avoidance, mitigation or compensation of the potential impacts of the development on local ecological receptors. The site is currently of low ecological value, and proposals maximise enhancements to biodiversity. An Urban Greening Factor (UGF) of 0.334 is achieved for the building. Green space is prioritised and maximised through creation of a roof garden and balconies, aiding the health and well-being of the occupants.

The proposed development will mitigate against climate change impacts by implementing the following measures:

• A fabric-first approach to the building envelope.
• Use of native and drought resistant planting.
• A biodiverse (green) roof.
• A drainage strategy accounting for future climate change.
• Provision of low water-use fittings.
• Use of durable and resilient materials.

A site-specific Flood Risk Assessment (FRA) has been prepared. Available data has been assessed to determine the potential risk of flooding at the site, and recommendations provided, where applicable. The FRA confirms our development is located in Flood Zone 1, as defined in the NPPF as land having a less than 1 in 1,000 annual probability of river or sea flooding (less than 0.1% AEP).

The drainage strategy aims to provide resilience for 1 in 100-year storm, with a 40% uplift for climate change, using attenuation tanks to reduce runoff to greenfield rates.

We conducted a climate change adaptation strategy appraisal for structural and fabric resilience and also a study to explore the ease of disassembly and the functional adaptation potential of different design scenarios.The design of the proposed development incorporates the below mitigation measures to help create a building which has the capacity to adapt to the projected effects of climate change

• Designing a fabric first approach with a high-performance facade and glazing to ensure that the building envelope U values exceed those required by the Part L of the Building Regulations.
• The heating and cooling systems ensure compliance against BREEAM NC 2018 credit Hea-04, using software in accordance with CIBSE AM11 Building Energy and Performance Modelling. Additionally, thermal analysis shall account for future thermal comfort, modelling climate change forecasts specific to the proposed project’s geographical location.
• Air Source Heat Pumps are selected to operate in ambient condition extremes of minus 12°C and plus 40°C.
• The proposals do not increase impermeable area, and surface water generated from the site will be managed and discharged to the existing sewer system at a rate not exceeding the existing rates. Drainage of the site will be assessed as part of the drainage assessment for the site.

Plans and ambitions over the coming three years

• Ensure all CCC resilience measures continue to be incorporated in ongoing design and delivery of the project, and real world realities.
• Estate adaptation and resilience plan in place and linked to hospital risk register.
• Healthy Hospital Street: Full design, key partnerships and funding in place ahead of delivery of the Healthy Hospital Street. The street transformation will offer several significant health and environmental benefits including:
  • Climate resilience measures: Exchanging paved impermeable surfaces for porous surfaces and introducing sustainable urban drainage systems; introducing plants and trees which provide shade; reducing the use of cars and providing cleaner air. Green infrastructure, including street trees and green spaces, contributes to climate resilience. This is particularly important in the context of climate change, as it helps mitigate extreme weather events and ensures a more stable environment for children.
  • Improved Air Quality: Green streets with abundant vegetation act as natural air purifiers by absorbing pollutants and releasing oxygen. This is particularly crucial for children, as exposure to clean air is essential for lung development and overall respiratory health.
  • Reduced exposure to air pollution: Planting trees and creating green spaces along streets can act as a barrier, helping to reduce children’s exposure to harmful pollutants from vehicular emissions. This is of particular importance for children with respiratory conditions.
  • Temperature Regulation: Urban greenery helps regulate temperatures by providing shade and reducing the urban heat island effect. This is particularly important during hot weather, reducing the risk of heat-related illnesses among children.

In the spotlight: Understanding our building energy use

Building Management Systems (BMS) are computer-based systems that control and monitor the building’s mechanical and electrical equipment such as ventilation, lighting, power systems and our energy centre (the Combined Heat & Power systems and boilers).

The GOSH BMS is being upgraded to improve compliance with ICT requirements, enhance the monitoring of critical areas and to reduce the risk of plant failure. The existing GOSH software and hardware are at the end of their expected useful lives, presenting a number of substantial challenges.

Therefore we have built a business case and budget cost specification with an external expert for BEMS upgrades (Building and Energy Management System) and a digital platform to be issued for a tendering process.

This is also a first key step towards meeting a number of objectives in order to build the insight required to realise the significant estate efficiencies as previously discussed in our Net Zero Estate pathway to 2030.

Headline objective

To consider GOSH’s purchase of goods and services and find ways to use buying decisions and supplier engagement to reduce our emissions to meet our GOSH Carbon Footprint PLUS by 2040. To promote sustainability more broadly in line with the goals and procurement best practice shared by NHS England and Improvement (NHSE/I). We also aim to advance the circular economy and promote waste hierarchy principles to improve resource efficiency and decarbonise our supply chain.

Why does this matter to us?

Procurement is around 85% of our overall CO2e emissions footprint and fundamental to meeting our 2040 Carbon Footprint PLUS Net Zero target. Delivering a series of procurement, supply chain and supplier engagement and collaboration projects over the coming three years will prepare us and our partners for the change required ahead of 2040. We will be following and aiming to work in advance of the Greener NHS Sustainable Procurement Roadmap.

Achievements over the last three years

Preparation completed within the GOSH Procurement team, for delivery of the NHS Net Zero Supplier Roadmap. This sets out the steps suppliers must take to align with the NHS net zero ambition between now and 2030.

Plans and ambitions over the coming three years

The procurement team will follow the Greener NHS Sustainable Procurement Roadmap to ensure that NHS requirements for all suppliers in relation to sustainability, social value, Net Zero and modern slavery are met.

• Carbon reduction plan: A full CRP will be required for procurements of value over £5 million. This will require the handful of successful suppliers of contracts at this level to provide a full CRP. Over 1,000 existing and new smaller suppliers will be required to demonstrate a less detailed Net Zero Commitment.
• Social Value: All tender procurements covered by the Procurement Regulations 2015 must include a minimum 10% net zero and social value weighting. For full integration this will be linked in with our automated procurement system to provide a seamless approach. Higher weighting will also be explored.
• Across the duration of each contract, suppliers required to deliver and report progress on delivering their Net Zero and Social Value Contract Commitments. The Trust procurement team will monitor delivery and reporting of these supplier commitments through the procurement portal.
• EverGreen Assessment: NHS supply chain partners will be monitored for their completion of the EverGreen Sustainable Supplier Assessment.
• Modern Slavery: All GOSH’s 1,000 plus commercial suppliers with an annual turnover of £36 million or more must publish an annual statement setting out the steps they take to prevent modern slavery in their business and/or complete an on-line Modern Slavery Assessment Tool (MSAT). The procurement team will ensure that all our applicable organisations publish an annual statement and every supplier a has sufficient policies to comply with the Modern Slavery Act.

Links to paediatric health outcomes

• Reduction on the transport based emissions and pollutants from across our value chain impacting on health.
• Building momentum to protect people from exploitation from modern slavery due to our supply chain.

In the spotlight: Weighting

Meeting our 2040 Net Zero PLUS target to address procurement based emissions we’re linked to. Addressing the Net Zero Supplier Roadmap includes:

• Full Carbon Reduction Plan for five major suppliers.
• Net Zero Commitment from 1,014 smaller suppliers.
• Social Value: At least 10% net zero and social value weighting on all procurements with ongoing reporting on progress required.
• EverGreen Sustainable Supplier Assessment to be completed by NHS Supply Chain suppliers and potentially others also.
• Modern Slavery act to be complied with by 1,014 suppliers and subcontractors, who will also return an annual statement and/or complete the Modern Slavery Assessment Tool.

Headline objective

To consider ways to reduce the impact, including carbon emissions, of the food that is procured, prepared, processed and served at GOSH. To reduce overall food waste and ensure provision of healthier, locally sourced and seasonal menus high in fruits and vegetables.

Why does this matter to us?

Waste: The UK throws away around 9.5 million tonnes of food waste annually – enough to fill 38m wheelie bins – nearly half of which is considered edible. Simultaneously, 8.4m people in the UK are defined as being in food poverty. Within the NHS, around 0.5kg of food waste is produced per patient per week. Most food waste is currently either disposed of mixed as part of the general waste stream or macerated for disposal to sewer. Although food waste from our Lagoon restaurant is taken to an off site anaerobic digester, it is still far more preferable to reduce waste initially.

Achievements over the last three years

Meet-free Mondays: Meat accounts for nearly 60% of all greenhouse gases from food production, represents 35% of all global emissions and the production of meat worldwide causes twice the pollution of production of plant-based foods. The Worldwatch Institute estimates that a staggering 70% of the world’s freshwater supplies goes towards agriculture – a third of this to grow animal feed crops. A 2020 Oxford University study found that even if harmful greenhouse gas emissions from fossil fuels stopped immediately, it wouldn’t be possible to keep global heating to the lowest safe limit without a shift to a more plant-based diet.

Plans and ambitions over the coming three years

• Health Care Without Harm Cool Food pledge: We’ll conduct CO2e emissions baselining of our Lagoon restaurant menu, followed by annual monitoring of food related GHG emissions - emissions per pound of food - and (if data available) emissions per meal or transaction.
• Food related emissions reduction programme: Focussed on food from the Lagoon, the project aims to build on the baselining and help us serve delicious food while slashing food-related greenhouse gas emissions. Links to paediatric health outcomes General principles, driven by this work, will result in GOSH providing both a healthier and more sustainable diet for patients and staff. They include:
  • More plant-rich options.
  • Meeting a five-a-day target.

Headline objectives

To engage, educate and develop our workforce in defining and delivering carbon reduction initiatives and achieving our broader sustainability goals.

To foster an organisational culture that considers sustainability and responds to the climate and health emergency, through working groups and committees, employee engagement, training, education and investment in staff.

Why does this matter to us?

Mobilising and developing our people and partners through a sustainability education, research, and innovation programme is fundamentally important and a key area in responding to the Climate and Health Emergency.

Whether green champions or wider teams, Executive or Non-Executive Directors, children and young people or GOSH Children’s Charity colleagues and partners, their mobilisation is key. Our existing sustainability governance and delivery structure involves staff groups bringing passion, creativity, and local understanding to the implementation of projects across our 10 distinct areas of sustainability.

However, to successfully empower our staff and 10 PoW groups to deliver on GOSH’s 5 Climate and Health Emergency priority areas, grass roots activity must be encouraged, formally embedded, and adequately resourced.

The Greener NHS makes it clear that reducing emissions – especially difficult residual emissions – will require considerable research and problem solving locally. Meaningful sustainability education, research and innovation is required to support such innovation within the hospital.

A sustainability education programme will aim to provide learning and training opportunities via the GOSH learning academy, build partnerships with other institutions and deliver an innovative resourcing programme covering sustainability fellowships, apprentices, and graduates.

We will also collaborate wherever beneficial and incorporate existing bes practice. For example, the Green Ward competition is taking grass roots ideas through to implementation and empowers our staff to be part of the change through supported Quality Improvement projects.

Achievements over the last three years

• 10 active sustainability Programme of Work areas created.
• Ongoing staff engagement and workshops delivered across hospital teams.
• Regular Breakfast Sustainability events for staff with guest speakers.
• Climate Sustainability Training: A course that delivered a five-part climate sustainability training series. The series covered a range of topics including Carbon tipping points, nature and pollution. An expert insight session focussing on change within the health sector was held as part of the fifth session.
• All recordings of the training are available for staff on the intranet. The GOSH Learning Academy (GLA) provided the funding for the training and further sustainability educational resources will continue to be available to all staff.
• Training on air pollution: Training is being offered on the ‘patients postcode project’. Our electronic patient record, Epic, flags air pollution levels by postcode on patients’ records. Training on how to deliver information to patients is being created.
• Fridays for future training has begun. Each PoW will have a training session based on their topic area. The first session has taken place on Sustainable Medicine and involved 36 attendees from seven different institutions across North Central London.
• GoshPODS Goes Green: Two series of 14 episodes have been released to date. The second series focussed on air pollution. Spotify listening numbers were over 1,500 views.
• Allied Health Professional (AHP) student leadership programme saw project ideas covering reuse of milk bottles and reduction in milk prescriptions, engaging fellow students in sustainability education projects, walking aid reuse and recycling by physios and issue of reusable period products by occupational therapists.

Plans and ambitions over the coming three years

• Resourcing a new dedicated clinical sustainability education role in partnership within the GLA.
• Resourcing protected time for sustainability engagement roles and PoW Chairs across the Trust.
• To broaden out the ‘Our People’ programme of work to include the Human Resources and Organisational Development elements as well as education. Embedding sustainability within the suite of formal Trust templates, guides, processes and policies.
• Offer information and support on eco anxiety, especially to children and young people.
• Create a Sustainability Fellows programme involving yearlong projects, monitored for financial and carbon savings. Delivered by fellows with formalised sustainability responsibilities and training within their roles.
• Fridays for futures to continue and expand across all 10 PoW areas.
• Broaden the GOSHPods series in subjects and guest presenters.
• Deliver a programme of air quality collaboration with clinicians from across NCL and London.
• Weave sustainability and air quality into the existing training in the trust, for example asthma training to incorporate a slide on air quality instead of specific air quality training. Theatre training to include consideration of carbon savings, etc.
• Higher education institutes host PhD students to look at sustainability and air quality relating to child health.
• Enhanced training courses available on the GOSH intranet for all 10 POW areas.
• Teaching packages - Bespoke clinicians conversations on air pollution simulated for training purposes.

Links to paediatric health outcomes

• If our clinicians aren’t empowered to talk to patients about air quality (and other environmental determinants of health) and how to reduce their exposure, then they are at higher risk of related adverse health outcomes.
• From an education perspective, if we don’t teach staff how to safely reduce our carbon footprint, then we are not building a future for our children and putting the hospital at risk as climate impacts worsen.

Headline objective

To reduce the environmental impact of travel by people and the transport of goods and services. We will increase active and sustainable travel (business and commuting, patients, and families), invest in zero-emission vehicles, engage with suppliers to reduce fleet emissions and maximise transport efficiencies.

Why does this matter to us?

A green thread runs through travel and transport and creates impacts and opportunities across our service provision. Our organisational travel plan covers elements including procurement and delivery of services, digital transformation, our staff, and the local community.

Addressing travel and transport related emissions is important in reducing our own estate-based footprint but also in bringing organisational resilience to our service provision and supporting our staff wellbeing.

Organisational resilience is the capability of an organisation to respond, adapt and prosper in times of crises. The concept relies not only on the individual adaptability and resilience of staff, but also the organisation and its relationship with, our local neighbourhood and communities, government, and more. At GOSH, organisational resilience is integral for ensuring the health and wellbeing of our staff, the smooth continuation of our operations and services, and above all, the child, first and always.

Supporting an active staff travel programme has proven important to us in reducing our vulnerability to external events. During the COVID-19 pandemic that impacted on safe travel options, during periods of industrial action affecting public transport reliability, and through economically challenging times leading to a lack of disposable income, the option to travel actively builds both organisational and personal resilience.

Also, travel and transport has a significant impact on air quality and therefore health. We continue to work towards becoming a clean air hospital and have progressed through the framework we created from a baseline of 11% to 43% complete at last assessment. As part of this we have delivered on the travel related actions outlined in the Clean Air Hospital Framework. Working to electrify our Non-Emergency Transport fleet and engaging with our suppliers on their delivery vehicles are all necessary to lower transport-related emissions and reduce air pollution around the hospital.

Achievements over the last three years

• We have transitioned to an agile working policy, continue our season ticket loan offering, publicise offers on NHS discount on hire bikes, and continue offering our cycle to work scheme as incentives for staff through saving money.
• Set up a Safe, Active and Sustainable (SAS) Travel Working group.
• We developed the a GOSH Love to Ride group comprising 353 people, cycling 403k miles over nearly 50,000 rides saving almost 50,000kg of CO2e.
• Publicised a variety of discounted hire cycle options for staff.
• Developed a walking time map from mainline rail stations to GOSH.
• Promoted the Cycle to Work Scheme resulting in an increase in uptake on the previous three years. Over the three years to 2023, a total of 228 certificates were issued for a value of £327,817 for new cycle purchases for GOSH staff.
• Improved staff changing rooms, lockers and showers.
• Undertaken safe travel surveys.
• Carried out cycle parking occupancy beat surveys.
• Promoted the Bike Register scheme.
• Established a GOSH NHS Staff Parkrun group.
• Updated the staff travel plan.
• Achieved a cycle friendly employer Gold Award.
• Conducted a staff commuting postcode analysis.
• Recorded video walkthroughs of routes to cycle parking.
• Recruited Cycle Champions.
• Developed a Staff Travel Information Pack for the intranet.
• Set up a supportive staff cycling to work email group.
• Lost use of the area containing 96 important cycle parking spaces and transitioned to a new space with the difficulties that this created for all plans.

Plans and ambitions over the coming three years

• Eliminate harmful air pollution generated by our transport and logistics activities.
• Increase proportion of people accessing site by active and sustainable travel methods.

Headline objective

To embed net zero principles across clinical services, considering the ways in which care is delivered. Promote lower carbon and lower waste interventions, provision of care closer to home, and changes to medical practices and material usage, PPE for example.

Why does this matter to us?

A crucial area of the Trust’s sustainability strategy is to look at the environmental impact of our patient pathways and the ways we deliver care to our patients. As a paediatric hospital, it is our responsibility to not only consider the short-term impact of our care during our patients’ time with us but also to consider the bigger picture and long-term impacts of the hospital’s work on the planet those children will grow up in.

Achievements over the last three years

The hospital’s dedicated Sustainable Care POW has led on many successful and innovative projects of the past few years, such as:

• The Gloves Are Off: GOSH’s glove use and hand care, in nursing and social care project. Over a two year period this simple project reduced the total amount of non-sterile plastic gloves ordered by 4.3 million, saving £108k in reduced purchasing cost, £1.5k in reduced disposal costs and reducing the demand for plastic by 21 tonnes.
• Reusable sharps bins: These have been introduced and their impact will be monitored across the years ahead.
• Desflurane phase-out: The use of this as an anesthetic gas at GOSH has been completely phased out. It is 2,540 times more potent a greenhouse gas than CO2.

Nitrous Oxide waste survey: A medical Nitrous Oxide (N2O) waste survey established the levels of leakage, the reasons for it and the approach to preventing it. Changes have been signed off for implementation in 2024 that will aim to reduce wastage by 280,000 litres annually. N2O has 298 times the global warming potential of CO2.

• The introduction of period pants for inpatients: A project to support young people having access to free sustainability period products. A social inclusion element was also identified for patients identifying as male, there were sustainable boxers available as opposed to the standard period pads. A triple bottom line evaluating patient outcomes with social impacts.
• Born Green: Funding has been secured for Born Green project, focussing on eliminating the health impacts of microplastics from single-use plastics. It was launched in late 2023 and will continue through the length of this plan.
• Green Teams: Our Green Teams project is running from 2023–2024. It has invited six teams to engage in a ten-week project with mentoring from the Centre for Sustainable Healthcare (CSH) facilitators (all of whom are both healthcare professionals and sustainability consultants). The project allows the teams to identify, develop, run and measure outcomes of sustainable quality improvement, or ‘SusQI’ projects. The competition is designed to empower both clinical and non-clinical staff, and fosters change within existing clinical communities. Crucially, the project will not only enable us to identify opportunities for cutting carbon but also to share these local remedies for improving clinical practice to address the hospital foot print. The competition award ceremony will be held in April 2024.

Plans and ambitions over the coming three years

Born Green

A successful funding application in partnership with HealthCare Without Harm and other Europe wide paediatric health and academic partners has secured this ground-breaking project that will span the three years of this Green Plan. The project has been launched with identification of a target ward, key GOSH staff and a full plastic audit of the unit. The project aim is that by 2030 the first generation of babies in over a century will be born free of plastic pollution and toxic chemicals. This will be thanks to a new model of medical best practice that creates the safest and most sustainable maternity, neonatal and paediatric wards and embeds environmental health approaches and behaviours among healthcare professionals and parents. The project focusses on:

• Innovating Practice: We will create a model for paediatric units that protects human health and the environment by reducing single-use (plastic) items and phasing out harmful chemicals. The model will also amplify and include instructions for the creation of Paediatric Environmental Health Speciality Units.
• Shifting Culture: We’re designing this project from the bottom up to create a “ripple out effect” from ward-to-ward, hospital-to-hospital, and into culture more broadly – by harnessing the power of narratives.
• Transforming Policy: We will co-develop with leading healthcare professional organisations and international organisations (for example, WHO) a global framework for environmentally sustainable and safe new-born and maternal care, which builds upon the model and the lessons learned from the pilot.

Virtual Clinics

The COVID-19 pandemic forced GOSH and other Trusts rethink how it delivered appointments to avoid the spread of the virus by offering virtual clinics. An impact of this was a significant carbon saving. This year GOSH have consulted with patients and families on their experiences of virtual clinics, gathering feedback that might help us decide how to incorporate virtual clinics into patient pathways in the future. The growing use of telemedicine is an interesting development happening across the health sector, and one which GOSH recognises has the potential to decrease the carbon intensity of care by reducing the amount of travelling required for our patients.

Expanding the use of reusable PPE and equipment

The COVID-19 pandemic also saw the use of disposable PPE used at the hospital rapidly increase. This was vital to protect our patients, staff and general public from the virus. Now that the height of the pandemic has passed, GOSH is in a position to look closely at when PPE is being used and if there are ways that we can safely transition to more sustainable alternatives. In a similar vein to the Gloves Are Off campaign, the re-evaluating our current approach to face masks, theatre caps and gowns would likely yield positive results for both patient safety, experience and sustainability.

Increasing the scope of returnable equipment

Each year, hundreds of children will receive equipment from GOSH as part of their course of treatment. Often this equipment, such as crutches or other forms of walking aid, are needed only for a short period and are then of no use to the patient. In order to prevent these pieces of equipment being unnecessarily disposed of, GOSH aims to establish a system whereby appropriate equipment can be returned, decontaminated and or repaired, and redistributed to future patients.

Increasing the use of non-gas administered anesthesia

Anaesthetic gases make up 2% of the NHS’s carbon footprint, and so as part of our provision of sustainable care at GOSH, the reduction of anaesethtic gas use, particularly problematic greenhouse gas, is vital. Nitrous oxide, a particularly harmful gas is currently used across the hospital and is delivered via a piped system. In order to improve efficiency around N2O use, GOSH aims to move to a cannister-based rather than piped system.

Links to paediatric health outcomes

• Making sure children are born free of plastics for the extended future.
• Making sure children access quality care with the least carbon footprint.

In the spotlight: The Gloves Are Off!

A small team at GOSH took a closer look at the use of disposable gloves at the hospital. It found that 200,000 gloves were ordered a week and often that the gloves were used unnecessarily in many cases.

A campaign was launched, encouraging clinicians to only wear disposable gloves when coming into contact with bodily fluids, non-intact skin, or mucus membrane. As a result, 21 tonnes of plastic was saved, at a cost saving of over £100k with over 4m fewer gloves ordered.

In addition, one member of staff reported having dry, cracked hands and was questioning being able to continue nursing. Now, after the project, her hands are no longer painful

Urban greening

• Green space is maximised through a roof garden and balconies, promoting health and well-being for the occupants.
• A child-centred roof garden, including accessible play opportunities, sensory features, as well as impact attenuating surfaces to mitigate injuries from falls.
• Rainwater-harvesting irrigation system.
• The site is of low ecological value, and proposals improve biodiversity.
• An Urban Greening Factor (UGF) of 0.334 is achieved for the building, where scores range from one for semi natural vegetation, through to zero for impermeable sealed surfaces.

Energy strategy

• Design measures lead to an 83% reduction in heating consumption and 43% reduction in cooling consumption over baseline.
• Design follows the Cooling Hierarchy to reduce solar gains and cooling loads.
• Design follows the Heat Hierarchy and addresses key elements of the London Plan and Camden Local Plan’s Policy by connecting to existing site network.
• Design prioritises green spaces and a holistic approach to sustainability with key considerations for health and wellbeing.
• The hot water distribution temperature was lowered utilising copper-silver ionisation to mitigate legionella risk. Currently only employed in two hospitals in the UK.

Construction and demolition waste

• A pre-demolition audit was undertaken to support a reduction in waste being generated during the strip-out and demolition phases of the project.
• The proposal provided internal, dedicated and appropriately labelled and segregated waste management facilities.

Whole Life-Cycle Carbon (WLC) emissions

• LETI performance benchmark comes in at approximately 505.1kg CO2e/m2 for modules A1–A5, against the 2020 LETI design target of 600kg CO2e/m2.
• Embodied carbon has been optimised through recycled content in the materials selected and a highly efficient structure. The embodied carbon results align with current best practice in hospitals.
• WLC emissions reduction decisions include using a concrete flat slab solution instead of cross-laminated timber flooring on steel beams overlaid with concrete and reducing the amount of brick used.

Adaptability

• The concrete frame has inherent durability and fire protection.
• The concrete flat slab can easily accommodate floor openings in a range of locations, allowing for relocation of rooms or plant runs and service distribution without significant structural intervention.
• Mitigation measures help the building adapt to the projected effects of climate change

In 2021, Great Ormond Street Hospital declared a climate and health emergency and have been developing a plan to achieve net zero. In 2022, the charity developed its principles for ESG and in late 2023 started work on three foundational workstreams related to ESG and sustainability.

Materiality assessment

To support the development of a roadmap for sustainability at the Charity, we are undertaking an ESG materiality assessment so we can better understand sustainability risks and opportunities as they relate to fundraising and donors, investments, projects, operations and governance. The outputs of the assessment will inform the development of a comprehensive sustainability strategy including supporting objectives and KPIs and understanding where we can have the most positive impact beyond our core purpose of supporting the hospital.

The ecological impact of fundraising

As a charity we have taken several steps to reduce the impact of our fundraising on the environment over recent years – for example reducing our use of single use plastics at events – but most of the changes have been organic and team-led rather than purposeful and linked to a clear plan of action. In early 2024, we are going to review the carbon impact of our current fundraising activities, events and materials, to identify where we can make the greatest positive impact and develop a portfolio of sustainable options and alternatives for fundraising. This is with a view to not materially impacting income and minimising any increase in spend. The recommendations made as part of this piece of work will therefore consider the impact on our supporters and our income and the findings will help us to develop guidelines for sustainable fundraising. This project is being supported by a working group of colleagues from across the Fundraising directorate.

The ecological impact of major partners and supporters

Another foundational piece of work is to establish a new ESG framework for GOSH charity which can be used assess the impact of major partners and supporters. Our supporters include a number of significant donors and partners where their wealth may be derived from sources that have a real or perceived impact on the environment and/or business activities may be considered to have a detrimental impact on the environment. However, we recognise that many partners and supporters are on a journey, as is the Hospital and the charity, and that our approach needs to be both balanced and pragmatic

Ride for their Lives came from the Safe, Active and Sustainable travel group we formed by GOSH staff during the pandemic. It was the brainchild of two people in particular: consultant paediatric intensivist Mark Hayden and CAD manager Vincent Lee.

The group was concerned about the shadow that the climate crisis casts over today’s children. It was decided to highlight this threat by cycling from London to Glasgow in the run-up to COP26, spreading the word to other healthcare providers and the public, and putting pressure on world leaders to act.

After much organisation and collaboration, 70 healthcare providers came together for the 800km journey from London to Glasgow where the summit was held.

We were accompanied by a UK tour of Michael Pinsky’s award-winning installation Pollution Pods in a unique collaboration between the arts and healthcare sector to inspire action on the air pollution crisis. Simultaneously, healthcare providers around the world collectively cycled over 1m kilometres as part of a virtual Ride for their Lives. That initial story ended with a talk at COP26 in Glasgow that brought together our loose alliance of partners that had formed around the ride including the many NHS trusts, the UK Health Alliance on Climate Change, the Global Climate and Health Alliance and the World Health Organization.

A key legacy of the ride was the creation of an active, committed network of healthcare providers determined to clean up the air and shift the world’s climate trajectory to save children’s lives, starting with Ride for their Lives 2022.

The ‘Blue Bag’

Healthcare staff enjoy high levels of public trust, which gives a unique ability to drive action on planetary health. On the first R4TL mission to Glasgow paediatric patients (some of whom joined the ride) wrote urgent messages on the ‘blue bag’.

We carried these messages to world leaders at the international climate conference COP26 in Glasgow.

Before we left off, the Head of Climate Change and Health at the WHO cycled from Geneva to our starting point in London carrying a report on the health argument for climate action. When he arrived in London, he placed it in the blue bag alongside a healthy climate prescription. A diverse group of paediatric healthcare cyclists carried these messages on to Glasgow.

Since then, the bag has been on multiple journeys around Europe, attended COP26 and COP27.

WHO Director-General Dr Tedros Adhanom Ghebreyesus responded to the request for world leaders to listen to children with, “We must!”. The journey received significant press attention and raised the profile of how the climate crisis is a health crisis.

To continue creating the wide-reaching change required at GOSH over the next three years and beyond, we must invest in our people’s education for sustainability journey. This is vital to build the capacity required to transform how we provide the services we do.

Our ability to adapt to the changes all organisations (especially in the NHS) will face across the coming years will be dependent on the willingness of our staff and leadership to be part of driving change. Therefore, a programme of engaging, stimulating and relevant sustainability education is key.

Over the last three years – beyond our active learning PoW structure – a wider education programme has begun to take shape and over the next three years we are committed to evolve and embed this as a powerful tool for change and staff development.

The last three years:

• 10 PoW areas have been created and supported to to engage and educate staff to take action across key areas of sustainability.
• Live Aim Hi Climate leadership training sessions for 100 Green Champions that are now available for all GOSH people.
• Climate and air quality leadership courses created and available on the staff intranet.
• The Fridays for Futures programme was launched with a Medicines Sustainability session for sustainability leaders from across North Central London.
• Ongoing sustainability teaching sessions with staff linked into existing learning forums across the Trust.
• Allied Health Professional (AHP) student leadership programme has formally incorporated a sustainability focus.
• MS Teams green champions learning communities created.
• Green Breakfasts programme invites guest speakers, and provides sustainability updates and knowledge sharing.
• The Ride for their Lives cycle ride from GOSH to COP26 in Glasgow, created significant media attention and incorporated experiential learning opportunities along the way. People along the route were invited to engage in an immersive installation by artist Michael Pinsky made up of five geodesic domes mimicking polluted environments in cities globally.
• Working with GOSH Arts, other artists and GOSH children and young people, powerful sustainability and air pollution related pieces were created as engagement tools.

The next three years

• A dedicated Sustainability education role will be recruited to embed education for sustainability across all hospital clinical teams and build a resourcing programme to scale up impact.
• 10 PoW areas will receive more support and resource to increase their reach, potency and further embed their activity.
• The sustainability education programme will evolve to include a full set of intranet based courses and live Fridays for Futures sessions, across all 10 areas.
• Sustainability fellowship, apprentices and graduate programme to be introduced as part of the resourcing efforts.

Engagement and mobilisation relating to our CHE response efforts will aim to increase our impact in 3 distinct but interconnected ways, as:

1. Role model: Minimising the impact from our activity including staff, visitors, patients, procurement, deliveries, building design, construction, energy generation both inside and outside the hospital.
2. Educator: Informing staff on how to reduce their impact, training clinicians on how to provide information and advice to patients.
3. Advocate and champion: Collaborating with local partners on area wide improvements as well as national/global partners to influence and lead the debate within the health sector and on a wider policy level.

Delivering our Climate and Health Emergency response to the level required will need both staffing and budgetary resources. Securing this will involve our ability to respond effectively to national, regional and system level financing and grant opportunities that become available. We will not be able to solely rely on leveraging funding from internal budgets, so collaboration between GOSH Charity and Trust will also be required.

Whilst any estate redevelopment schemes can provide a significant opportunity to deliver a net zero carbon hospital, we know that the budget may be constrained, increasing the need still further for creation of a compelling case for measures with longer term paybacks or no cashable savings.

As outlined above, our people are a key engine driving the problem solving required for the transformation we need to undergo. The need to invest in them through our PoW areas and other avenues, and ensure that they have the required expertise to understand what net zero carbon means in relation to their area of responsibility and identify the opportunities available to them.

All major business cases need to consider whether they have a positive or negative impact on CO2e emissions and, and how this can be tackled to enhance the benefits or minimise the disbenefits from the outset. We know that retrofitting costs significantly more than getting measures implemented as part of life cycling and new build.

In terms of our 2030 target to decarbonise our estate, we are aware that this is a huge task and presents technical, operational, and financial challenges. From a financial perspective our Capital Estates Zero Carbon Pathways report has modelled a ‘deep decarbonisation’ scenario potentially allowing us to reduce our estate-based emissions by around 87%. The remaining around 13% would likely be addressed through Power Purchase Agreements and potential offsets that we are yet to have clarity on cost for. An indicative cost (subject to many variables so likely to change significantly) of around £27m to has been reached for the around 87% reduction.

The next three years

Over the next three years we have identified an initial allocation of funding to deliver the first phase of the BMS and sub metering upgrade in priority areas between 2023 and 2025. Revenue investment It has become clear over the last three years that supporting and resourcing our sustainability PoW areas as they grow and require ever more commitment from already stretched staff above their substantive roles is going to be necessary.

We have identified a route to begin this process which we will ensure evolves across the years ahead

Clear leadership and accountability are needed to ensure progress against this strategy is delivered consistently, efficiently and at pace across our large and complex Trust.

Proposed Sustainability and Climate and Health Emergency Governance Structure During the early phase of this Green Plan this structure will be embedded in an evolving ‘GOSH Sustainability Policy

Trust Board

The Trust Board is responsible for pursuing our Above and Beyond Strategy principle 5: ‘Ensuring sustainable business practices allow our people to make the right sustainability choices’, and that we meet our Net Zero emissions goals, as laid out in our Climate and Health Emergency Declaration.

Executive Management Team

Responsible for ensuring that the approval of all new strategies, policies, capital investments and major contracts takes account of the climate & health emergency and is aligned to our net zero emissions, clean air and other priority areas laid out in the sustainability strategy.

Executive Lead for Sustainability

Responsible for supporting the Chief Executive at Board Level and chairing the Sustainability Programme Board. Accountable to the Sustainability Executive Oversight Board.

Sustainability Executive Oversight Board (SEOB)

Chaired by NED Lead for Sustainability and meets monthly to complement the existing governance structure. It is reported into by the Executive Lead for Sustainability and Head of Sustainability and provides strategic direction and swift decision making for delivery priorities.

Non-Executive Lead for Sustainability

Responsible for advising the Trust Board on progress achieved through the SEOB which they Chair.

Sustainability Programme Board

Chaired by the Executive Lead for Sustainability, the SPB currently reports to the ‘Above & Beyond Oversight Group’. A multidisciplinary committee with senior representatives from: Space & Place, nursing; medical; procurement; finance; communications; GOSHCC and the YPF. SPB is responsible for monitoring Trust performance with regards to delivering on the priorities and projects set out in the Sustainability Strategy and accompanying Sustainability Action Plan.

Sustainability Steering Group (to be confirmed)

Chaired by the Head of Sustainability and reporting into the SPB will be a committee made up of executive ‘sponsors’ of each of the 10 Sustainability Programme of Work (POW) areas. Meeting bimonthly it allows executive sponsors to convey progress with the sustainability PoW, linked to the hospital area they are responsible for. To also identify cross over between areas.

Core Sustainability Team

Includes the Head of Sustainability, Sustainability Delivery Project Manager, Project Lead for Placemaking with a dotted line to the GLA and the new Sustainability Education lead.

Sustainability Programme of Work (PoW)

Chairs Each sustainability POW area is Chaired by a member of staff tasked with guiding the direction of activity and reporting monthly to the POW executive sponsor in advance of the Sustainability Steering Group.

PoW group members and Green Champions

Members of each of the 10 PoW areas have specific skills and knowledge. Each of the 10 PoW areas is likely to include six to eight regular members (with relevant expertise and organisational positioning) and can flex membership around specific project delivery needs.

Each team will require a Chair (and Deputy) to lead meetings/drive progress/ engage with the executive sponsor, and a team administrator to coordinate minutes/action logs to coordinate reporting into the Sustainability Steering Group (SSG).

Directorate Managers and Directorate

Directors Directorate Managers, and Directorate Directors, are responsible to the Executive Group for ensuring effective implementation of this policy.

Ward Managers and Heads of Department

Ward and department managers are responsible for ensuring policy implementation and compliance within their area(s).

All Staff

All staff will be responsible for complying with this policy and taking action where appropriate to mitigate the climate emergency and support our zero carbon, clean air and zero waste goals. Staff will have a duty to engage with patients and visitors and advise of their need for compliance with this policy.

Conveying a complex picture using simple and consistent messaging is important to communicate to the varied stakeholders involved in the hospital and beyond.

We have used a number of routes to do this including the following internal and external channels.

Internal

• Teams Green Champions and sustainability projects community: We’ve created active MS Teams channels containing key information for staff and a forum through which they can share ideas and updates in real time.
• PoW groups meet regularly to work through projects and address challenges: Updates from the groups are communicated through various governance channels including to the Sustainability Programme Board, Governors and more.
• Headlines: Our weekly newsletter often contains sustainability and CHE updates generated from across the hospital and linking back to our overall targets.
• News Review: When projects garner media attention they are shared across the hospital through our regular new review.
• Big Brief: Our whole organisation biweekly hybrid catch-up allows opportunities for Climate and health Emergency updates to be made and for staff to ask questions about areas of concern or opportunity.
• Staff intranet: GOSH Web contains a lot of information and advice for staff on sustainability and the CHE response. Training courses to learn more are evolving and will expand further into a full organisational sustainability education programme across the course of this Green Plan with our new Sustainability Education role.
• Senior Leadership Team: Our three slides in five minutes slot is often used to convey new projects and solicit support and recruitment support.
• The Governors’ sustainability group: Our Governors have created an active sub group focussing on sustainability activity and the involvement of our non-executive directors also. Quarterly updates come from our Company Secretaries office on progress.

External

• GOSH Green: Our active social media feed, @GOSH_Green on X, chronicles activity of note and making contact with new and existing partners.
• External communications team: Our communications team works with teams making change internally to convey messages outwards. These might involve examples we’d like to share as well as advocacy campaigns we’re involved in, such as adaptations to local travel options or air quality innovation.
• The gosh.nhs.uk website: We are able to communicate on progress through our website, for example when the Mayor of London joined GOSH patients for Play Street.