Sustainability Strategy 2024-2025

The East of England Ambulance Service NHS Trust (EEAST) plays a pivotal role in the urgent and emergency care system. Our qualified, experienced, and diverse workforce responds to the individual needs of patients who dial 999. But we cannot deliver effective, high-quality care without operating as a sustainable organisation: environmentally, financially and for our people.

The Sustainability Strategy, alongside the Clinical Strategy and the People Strategy, constitute the three core strategies underpinning our organisation’s vision. For the purpose of this document, the definition of sustainability has been extended to include all aspects contributing towards Organisational Sustainability. This strategy sets out our objectives and activity that will drive greater efficiency and effectiveness in how we operate and support us to deliver our sustainability goals. This activity plays a critical role in providing a better and more sustainable service for the East of England.

This strategy plays an important role through this year in bringing together our delivery programmes that support us to be a sustainable organisation. As we evolve our next Trust strategy through this year for 2025-30, our sustainability objectives will evolve as part of that process and be fully embedded within our future direction as set out in the EEAST Strategy 2025-30 next year.

Tom Abell

Chief Executive Officer

Mrunal Sisodia OBE

Trust Chair

Goal 4: Be a financially and environmentally sustainable organisation.

The East of England Ambulance Service NHS Trust (EEAST) provides urgent and emergency healthcare to the communities in our region. It is however imperative for the longevity of the Trust that these services are undertaken in a manner that is sustainable, not only for the environment, but for our people and the future financial viability of the Trust, and in future, for us to consider our role as a major employer and purchaser, the impact we could have on local economic development, working in partnership with Integrated Care Systems.

EEAST’s vision of ‘Outstanding care, exceptional people, every hour of every day’ is supported by four strategic goals. These goals in turn are underpinned by three strategies, namely: the People Strategy, Clinical Strategy, and the Sustainability Strategy.

The Sustainability Strategy has been developed to bring together and raise the profile of our critical programmes that enable the organisation to become more sustainable. We have important existing activity as set out in our Green Plan and our Digital Transformation plans for example. By pulling these programmes into one place, we are demonstrating the ongoing activity that the Trust has committed to deliver to improve how we work. It is however acknowledged that our ability to involve our people and the public in decisions surrounding Fleet, Estates and Make Ready Services specifically will be critical to their success and acceptance.

In 2024, we are also evolving our next Trust Strategy for 2025-30. We are undertaking one of the most significant engagement programmes in the Trust’s history to ensure that our future direction is co-designed with our people, patients and partners.

As such, this Sustainability Strategy will articulate the Trust’s position and activity in this area for 2024 only. And our future approach including all relevant enabling activity will be captured and embedded within the EEAST Strategy 2025-30 when it is introduced next year. This will include consideration of how the Trust will work with partners in integrated care systems in our potential role as an anchor institution, supporting our sustainability while benefitting local communities, through education, employment and economic development.

The Trust provides an emergency response to six million people across six counties in the region (Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk). We operate within a complex healthcare landscape, with 17 acute trusts, across six ICSs and almost 1,000 GP practices. EEAST has over 5,800 employees, more than 1,000 volunteers, as well as a patient transport service.

In 2022/23:

• The Trust received 1.1 million emergency 999 calls (3,000 calls a day).
• Our clinical assessment team supported 58,584 patients, providing advice on self help or attending a more appropriate service.
• Clinicians attended 792,335 incidents, 14% of those being life threatening emergencies.
• We also carried out 426,500 non-emergency patient journeys.

EEAST’s Green Plan was introduced in 2021, aligning EEAST’s vision and goals to position the Trust as an environmentally sustainable, resilient, and healthy organisation. Its aim is “to set clear and unambiguous targets for reductions in the environmental impact of the Trust’s activities; to support the sustainable delivery of clinical care within the community served by the Trust and maintain the social and economic wellbeing of staff, stakeholders and communities.”

Now, as we broaden the meaning of sustainability at EEAST to incorporate social and economic sustainability, we have defined organisational sustainability as “meeting the future needs of the organisation without compromising patient care, staff wellbeing, sense of belonging, financial viability or environmental impact.”

We also have introduced over time a number of strategic plans internally to ensure we had a clear direction and programme of activity to deliver our Estates, Medical Devices, Fleet and Make Ready Services functions.

As such, our Sustainability Strategy covers multiple organisational functions that are integral to the delivery of organisational sustainability.

• Financial Sustainability
• Operational performance and efficiencies
• Digital Transformation – 5 Year Digital Plan*
• Sustainable Procurement
• Environmental responsibility – The EEAST Green Plan*
• Estates Strategic Enabling Plan*
• Fleet Strategic Enabling Plan*
• Make Ready Services (MRS) Strategic Enabling Plan*
• Medical Devices Strategic Enabling Plan*
• Building a Sustainable Workforce – People Strategy and Workforce Plans*

Areas in which specific strategic plans have already been developed are marked with an asterisk in the list above. These documents provide additional information as to how objectives will be achieved.

Financial Sustainability

EEAST finances are key to the successful delivery of our clinical strategy. A 5-year financial and workforce model is in place and financial plans are revisited annually as part of the business planning process.

To maintain strategic alignment, while ensuring financial sustainability throughout the business planning process, a combined strategy and finance-led approach has been adopted which will continue to be developed through 2024 to deliver a clear and prioritised business plan and budget.

The growth of our workforce is critical to the Trust’s performance. This growth will however place pressure on the organisation’s bottom line and must be balanced with operational efficiencies that will allow EEAST to achieve more with less over time.

Monitor Finance and Sustainability Committee (Bi-monthly)

Digital Transformation

EEAST will use technology to modernise services, making it quicker and easier for our staff and patients to access and receive care.

The Trust’s technology investment continues to be driven by sustainability. Where possible the Trust bought remanufactured technology and has worked with suppliers to reduce our carbon footprint. For example, every remanufactured laptop purchased saves 190,000 litres of water and 316kg of CO2. Our provider also plants five trees for every device purchased.

EEAST’s continued move to cloud base technology utilises modern environmentally efficient technology and removes wasted packaging, distribution costs and CO2 emissions. These facilities also provide built-in redundancies that facilitate business continuity and will contribute towards providing a more robust service. The network links between these services and the users of the service will be optimised so as to provide an improved end-user experience.

The Trust follows a 5 Year Digital Plan, which focusses on frontline digitisation, aligned to the NHS’s ‘What Good Look Likes’ with additional funding provided from the universal technology fund aimed at levelling up all NHS organisations.

The movement towards a digitally enabled frontline includes enhanced digital care, as well as ensuring data capture is conducted as close to the point of care and with as few keystrokes as possible. Double capture of data should be avoided wherever possible. The digitally enabled frontline will therefore need to insofar as is possible be mobile and interfaced with care devices and care providers.

Reduced time spent capturing data and the use of video assessments will shorten time spent at scene and will have a significant impact on the Category 2 Mean Response Times strategic metric.

The Trust will continue to explore interfaces with services such as summary care records and other NHS spine connected services in the move to simplify and optimise existing processes.

The Trust’s focus on data analysis and visualisation will continue to support data driven decision making across the organisation. The implementation of a Data Lake at EEAST is helping to ensure a single version of the truth is held across the organisation.

Technology will also be used to improve the personal safety of EEAST’s people through the use of bodycam devices and location-based services.

Sustainable Procurement

Depth of supply (the number of suitable suppliers or service providers operating in a space) and the degree to which the supply base aligns with EEAST’s values is pivotal to the organisation achieving and maintaining its desired level of sustainability.

The NHS has committed to reaching net zero by 2045 for the emissions we influence, through the goods and services we buy from our partners and suppliers. To achieve this goal, we will require the support of all our suppliers.

In September 2021, one year on from the publication of the Delivering a net zero NHS report, the NHS England Public Board approved a Net Zero Supplier Roadmap to help suppliers align net zero ambitions between now and 2030.

Monitor Finance and Sustainability Committee. Meeting bi-monthly

Environmental Responsibility

The Green Plan sets out our roadmap to net zero greenhouse gas emissions as defined in “Delivering a Net Zero National Health Service”, issued as statutory guidance as per the Health and Care Act 2022. The NHS net zero commitment has two targets:

• for the emissions we control directly (the NHS Carbon Footprint), 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), net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039.

Environmental sustainability however encompasses so much more than reducing energy demand and improving recycling rates but looks to integrate and engage with local communities and partnerships as well as internal departments. This joined up approach is vital in ensuring EEAST makes a positive contribution whilst mitigating the impact on the environment.

We are currently focused on:

• Routinely monitoring progress to ensure EEAST is on track to achieve Net Zero by 2040.
• Taking action to reduce the EEAST Carbon Footprint.
• Reducing energy consumption of our estate per annum.
• Increasing our annual kWh generation via renewable energy sources.
• Reducing fleet fuel consumption of existing and new carbon-based fuel fleet.
• Achieving a minimum of 10% of our fleet comprising of Ultra Low Emission or fully electric vehicles.
• Reducing waste volumes.
• Creating ‘future-proofed’ network of electric vehicle charging points.
• Optimising waste collection services.
• Enhancing the biodiversity of the estate.
• Promoting the use of active travel.

Monitor Finance and Sustainability Committee. Meeting bi-monthly.

Estates Strategic Enabling Plan

As a critical enabler to service delivery, the objective of our Estates Strategic Enabling Plan is to provide cost effective and efficient premises of the right size, location and condition to support the delivery of clinical care to the community served by the Trust.

The Estates Strategic Enabling Plan focusses on ensuring the Trust’s estate meets the following:

• Compliant with legislation, guidelines, and best practice.
• Fit for purpose and safe.
• Contributes to improved patient care and safety.
• Is located in the right place to meet service needs and patients’ needs.
• Has a mix of facilities to undertake all the Trust’s duties.
• Is dynamic and easily adaptable to respond to changing needs.
• Embraces technological developments to enhance operations and reduce running costs.
• Underpins high performance principles to meet response times and maximise economic efficiencies.
• Fosters joint working with other healthcare, emergency, and public sector organisations.

In line with our Clinical Strategy, the overriding ambition of the Estates Plan is to provide a value for money compliant estate, with facilities located to support Operations to deliver frontline services.

To support our environmental responsibility objectives, the plan seeks to reduce energy related carbon emissions, by designing new properties to achieve an excellent rating for energy efficiency and to install efficient equipment into our existing portfolio.

Monitor Finance and Sustainability Committee. Meeting bi-monthly

Fleet Strategic Enabling Plan

As a critical enabler to service delivery, the objective of our Fleet Strategic Enabling Plan is to provide cost effective and efficient fleet of the right size, specification and condition to support the delivery of clinical care to the community served by the Trust.

This plan focusses on ensuring the Trust’s Fleet is:

• Agile and responsive to meeting changing needs in vehicle type, number and location.
• Fit for purpose and safe through planned maintenance and capability.
• Located in the right place and right time to meet patient needs.
• Has an appropriate mix of vehicles to undertake all the Trust’s duties including frontline, support and staffing requirements.

EEAST must however consider the need to fully decarbonised its fleet by 2035, with its ambulances following in 2040. We are developing plans over the coming years which will form a foundational part of the EEAST Strategy 2025-30.

The Fleet plan must also ensure the management of the service is responsive to the requirements of vehicle servicing, maintenance and repair of the Fleet Vehicles, and that the fleet is planned and managed so Fleet vehicle availability is optimised.

Fleet principles:

• The Trust’s fleet should accommodate the peak usage modelled, plus additional spare capacity to meet operational requirements, maximise efficiency and minimise running costs, whilst providing a high-quality working fleet. The spare capacity requirement allows:

  • Flex to meet operational daily demand and provide resilience to meet additional increases in demand,
  • Vehicles to be out of service whilst either being made ready for duty or undergoing or awaiting service, maintenance, or repair.

• Full utilisation of existing fleet capacity should be considered before seeking to increase the size of the fleet – this will include the dynamic management of vehicles across the Trust to meet demand and test/challenge the efficiency of staff rotas to optimise the number of vehicles required.

• Vehicle design will meet clinical and operational requirements and in line with any national specification as far as is safe/practical/possible, environmentally sustainable and fully compliant with relevant legislation and regulations.

Fleet service transformation:

• Review all Trust vehicles replacement schedules to align with Sustainability Strategy to decarbonise the fleet.
• Implementation of Telematics and CCTV provision to provide fleet data to support fleet reduction costs e.g., fuel (engine idling which also supports Sustainability Strategy), accident damage (video imagery of vehicle incidents to improve training and education of drivers).

Monitor Finance and Sustainability Committee. Meeting bi-monthly.

Make Ready Strategic Enabling Plan

As a critical enabler to service delivery, the objective of our Make Ready Strategic Enabling Plan is to ensure the right vehicles are available in the right place and at the right time and to the right standards to enable the Trust to fulfil its clinical obligations.

This plan focusses on ensuring the Trust’s Make Ready Services meets the following:

• Is agile and responsive to meeting changing needs in vehicle preparation and equipment management.
• Minimises cross infection and maximises patient safety.
• Supports response time reliability with a supporting network of demand-centric response posts and an appropriately situated Hub.
• Supports the operation of a regionally managed fleet.
• Supports estates rationalisation and releasing efficiencies back into the system.
• Supports delivery of a regionally managed fleet.

The Make Ready plan must also ensure the management of the service is responsive to the requirements of vehicle cleaning, preparation, checking and stocking of the Make Ready Vehicles, and that the Make Ready schedule is planned and managed, so vehicles’ operational availability is optimised.

The enabling plan supports the clinical strategy through:

Infection Control

• The cleaning (including deep cleaning) of all operational ambulances, both the inside and outside.
• Decontamination of operational vehicles after they have been used to transport of patients who may have had a health care associated infection – MRSA, CDIFF.
• Follow clinical waste disposal guidelines.

Medical Equipment Diagnostics and first line repair

• Diagnostic and functionality check on all the ambulances medical equipment.
• Day to day audit of medical equipment usage and condition.
• Reporting of damaged or faulty equipment and arranging repairs.

Control of medical consumables, drugs, and medical gases

• The loading to a standard load list all medical consumables, drugs, and medical gases onto operational vehicles.
• The ordering, security, storage, and issue of medical consumables.

Vehicle inspection and defect reporting

• Pre-shift checks to ensure each vehicle is fit for purpose and safe to deploy operationally.
• Reporting of vehicle defects.
• Movement of vehicles between stations and external agencies, garages, repairers, etc.
• Delivery and collection of operational equipment and consumables between stations.

Logistic Support to Major Incidents

• Deployment to the scene of a major incident in support of clinicians.
• Logistic support to specialist operations and events.

Medical Devices Strategic Enabling Plan

The objective of the Medical Devices Strategic Enabling Plan is to ensure all Trust Medical Devices are innovative, cost effective and leading from the forefront in delivering high quality patient care.

The objectives of the Medical Devices Sustainability Plan are to:

• Manage medical device assets effectively - to provide short, medium- and long-term plans to produce a Medical Device asset base which provides safe and serviceable equipment in the right place and of the right type to allow an agile and responsive service delivery to the public based on a changing population. This will be dynamically managed using RFID systems. Recognising that all Medical Devices are a significant investment to the Trust, the strategy will systematically seek to maximise utilisation and availability of devices to deliver the Trust’s services. By doing so we will contribute towards the Trust’s overall plan and Quality Cost Improvement Plans (QCIP).
• Support strategic service initiatives - the Trust will ensure that it provides a Medical Devices asset base that supports its strategic objectives as set out in the Trust’s overall business plan. This will aid and encourage cooperation and joined up working throughout the Trust, and with other healthcare system providers, emergency services, public sector organisations, private providers, the military and further education establishments as required.
• Maintenance of the existing Medical Devices - the Trust will strive to reduce as far as practical, long term out of service maintenance on all devices. It will ensure statutory compliance issues are resolved, standards such as Care Quality Commission (CQC), Model Ambulance and the Carter Report are met, whilst moving towards better utilisation, energy efficiency and overall quality in the department.
• Disposal and acquisition strategy - effectively manage Medical Device obsolescence and lifecycle replacement to meet the Clinical Strategy, ensuring minimal disruption to services.

Building a sustainable workforce

Sustainability in business refers to the effect companies have on the environment and society. A sustainable business strategy aims to positively impact one or both of those areas, thereby helping address organisational challenges. Some of the issues we look to address from a workforce point of view include:

• A workforce that adequately addresses the activity of the trust
• Income inequality
• Human rights issues
• Fair working conditions
• Racial injustice
• Gender inequality

A sustainable workforce is seen as an integral building block of a sustainable organisation.

• The clinical workforce plan should provide a trajectory towards an optimally resourced workforce that balances optimal patient care and effective staff utilisation. The plan must also provide assurance surrounding alignment between recruitment, and clinical and driver training.
• EEAST have made significant inroads in developing an effective organisational culture that supports the delivery of the clinical strategy and gives our people an increased sense of belonging.
• Building a diverse and inclusive organisation that is representative of the communities we serve should go a long way towards integrating our services into these communities.
• The EEAST training and education teams ensure that our clinical staff are able to provide the best possible levels of care to our patients in support of our clinical strategy.
• The EEAST leadership development team meanwhile ensure that our management staff are best equipped to manage their teams effectively.
• EEAST endeavour to communicate the benefits of healthier living and lifestyles to patients and staff.

Monitor Tactical Delivery Group, Workforce Planning Group, People Committee

The success of the Sustainability Strategy will be measured by:

• Effective delivery of the enabling plans as set out in this strategy;
• Regularly reporting on our compliance against our legal obligations;
• Regularly reporting on our environmental sustainability actions and impact to ensure understanding and drive change across the organisation;
• Delivering the ‘connected planning’ programme which brings together operational performance with financial, operational and other support levers to develop a more responsive and coordinated planning function;
• Having a clearly established direction and delivery plan in each of these critical enabling functions that sit as the building blocks of the EEAST Strategy 2025-30.

Sustainability Element: Financial Sustainability

People: Funds available for training and people development.

Patient: Improved standards of care.

Planet: A financially viable trust is better equipped to focus on environmental issues and could attract responsible investment.

Sustainability Element: Digital Transformation

People:

• Allow clinical staff to concentrate on delivering care as opposed to data capture.
• Innovation is aided and encouraged.

Patient: Improved response times and standards of care.

Planet: Reduced carbon footprint through re-manufactured devices and modern data centres.

Sustainability Element: Sustainable Procurement

People: The knowledge that you are working for an environmentally responsible organisation.

Patient: Consumables depth of supply ensures continuous supply.

Planet:

• Reduced carbon footprint and waste.
• Build better relationships with suppliers through shared value systems.

Sustainability Element: Environmental responsibility

People:

• 94% of Gen Zs and 80% of millennials feel businesses have the responsibility of tackling wider environmental and social issues.
• Improved recruitment and retention: 71% of job hunters seek environmentally sustainable employers. By building a reputation as a sustainable service provider, we can attract and retain the right employees for your company.
• 89% of executives believe an organization with shared purpose will have greater employee satisfaction.
• Productivity gains of 15 to 31% realised in companies adopting greener policies due to a happier workforce.

Patient:

• Promoting a healthier lifestyle.
• Understanding the local effects of global change, as energy consumed is often locally generated and can have a negative impact on air quality in the region.
• Vehicle emissions impact air quality in our region. Air pollution can be attributed to the cause of around 9% of deaths globally.
• 88% of consumers want brands to actively help them make a difference in their environment.
• Being environmentally conscious builds local credibility and positive brand equity.

Planet: Reduced carbon footprint and waste, resulting in reduced legal and regulatory risk and better relationships with government and regulatory agencies.

Sustainability Element: Estates Strategic Enabling Plan

People:

• Improves the space in which people live their lives and do their business.
• Reduced sickness due to fewer building contaminants.

Patient: Improved response times by positioning estates effectively and improved standards of care.

Planet: Reduced carbon footprint.

Sustainability Element: Fleet Strategic Enabling Plan

People: Reduced levels of workplace stress.

Patient: Improved response times by positioning fleet effectively and improved standards of care.

Planet: Reduced carbon footprint.

Sustainability Element: Make Ready Services (MRS) Strategic Enabling Plan

People: Reduced levels of workplace stress.

Patient: Improved response times by positioning fleet effectively and improved standards of care.

Planet: Reduced carbon footprint.

Sustainability Element: Medical Devices Strategic Enabling Plan

People: Reduced levels of workplace stress.

Patient: Improved response times and standards of care.

Planet: Reduced carbon footprint.

Sustainability Element: Sustainable Workforce

People:

• Promoting a healthy, happy, inclusive workforce.
• A happy workforce is 31% more productive and 3 times more creative.

Patient:

• Improved standards of care.
• Our people are the face of our organisation and could build positive brand equity.

Planet: An adequately trained and resourced workforce should generate less waste.