Health improvement is central in sustainable development both to improve the efficient use of resources and to encourage healthy behaviours which are often less carbon intensive.

The NHS in England have produced the Route Map for Sustainable Health in a collaborative effort providing a description of a more sustainable health system. Every organisation can identify their own actions in a Sustainable Development Management Plan. With board approval and buy in through the whole organisation, developing and reviewing progress on sustainable development is key in monitoring performance. The NHS Good Corporate Citizen assessment test can be used to support action and provides a set of process measures for action on sustainable development.

A standardised approach to measuring and monitoring sustainability will minimise the use of resources across the health system. Many measures for sustainable development are available to use now.

Understanding the scale and impact of action is not possible without measurement, and this holds true for sustainable development. Metrics can support organisations by indicating areas for action and quantifying of the cost of inaction.

We now know that the NHS in England produces 21 million tonnes of a year and reducing these emissions forms an integral part of sustainable development. Reporting and understanding the greenhouse gas (GHG) emissions for each NHS organisation is an important step in reducing carbon emissions.

ERPHO is the Association of Public Health Observatories national lead observatory for sustainable development. We will be working closely with the Sustainable Development Unit of the NHS to review how information on carbon emissions can be included in decision making across the NHS.

Understanding the scale and impact of action is not possible without measurement, and this holds true for sustainable development. This briefing provides a framework for identifying the measures that already exist and the opportunities to include more aspects of sustainability.

By adopting standard measures for sustainable development, duplication can be reduced and the scale of potential change can be quantified. Metrics can also support organisations by indicating areas for action and quantifying the cost of inaction.

NHS organisations report use of energy (fossil fuels and electricity) in buildings, volumes of waste produced and volume of water in the Estates Returns Information Collection (ERIC). Erpho have combined ERIC information with Defra conversion factors for building energy, waste and water and the change from 2007/08 to 2011/12 has been mapped for each region.

The NHS in England has seen a 1.9% drop in the carbon footprint in relation to building energy use from 2007/08 to 2011/12, which is a significant improvement on previous years. More detail is available on the calculations and analysis.

Having a Board Approved Sustainable Development Management Plan (SDMP) is one of the cornerstones of the NHS Carbon Reduction Strategy and once again underpins the fundamental overlap between Social, Economic and Environmental factors that is core to the NHS.

The proportion of organisations, within each SHA, who have a board approved SDMP is mapped to show the performance in each region. On average, as of as of May 2012, 83% of Trusts across England had an SDMP, up from 74% in 2011. Some Regions have considerably more SDMPs and more SDMPs are in the process of being approved by the Trust boards.

Including sustainability is now mandatory for all NHS Trusts as part of their annual reporting process from 2011/12. Reporting in this way is in line with HM Treasury's Financial Reporting Manual (FReM).

The quality of sustainability reporting was reviewed during October 2012 and the results mapped for each SHA. 81% of NHS organisations included at least a short statement on sustainability and 25 organisations excelled in communicating clearly the meaning of sustainability, goals and progress in their annual reports for 2011/12.