NMU Carbon Reduction Plan

Fighting Climate Change

  • Commitment to Net Zero.
  • Publishing a Carbon Reduction Plan.

With over 12 years of ultrasound delivery experience across the North, Northern Medical Ultrasound (NMU) has actions and initiatives in place to deliver environmental benefits. NMU is committed to delivering these benefits to the NHS whilst executing the NHS Green plan.

A Collaborative Way of Working with the Supply Chain

NMU has developed a robust approach to fighting climate change, aligning with the NHS Green Plan and net-zero greenhouse gas emissions target of 2045.
NMU is exceptionally experienced in embedding ourselves in the fabric of healthcare landscapes and communities, with an established footprint across the North of England. We will conduct engagement activities with a diverse range of organisations to develop our understanding of the local environment and diversify our approach. For instance, we collaborate with the North of England Climate Coalition (NEECCo). This link will provide social value and environmental benefits that have a true impact on each locality. We will take a strategic approach to improving our environmental performance, involving collaboration between patients, staff, and stakeholders, which will deliver environmental benefits throughout the region. An example of this is working with local facilities to implement recycling.
Our Timed Project Plan attached – Timed Project Plan-Climate Change – Yorkshire Health Solutions outlines our commitments and timescales; developed with the NHS Green plans in mind.

Deliver Additional Environmental Benefits in the Performance of the Contract

NMU will work in collaboration with the Commissioner towards net-zero greenhouse gas emissions and commits to the following initiatives:

  • Minimising our net carbon footprint and improving air quality, using intelligent rostering, and committing to 75% of staff working within 25 miles of home
  • Co-locating in GP practices to minimise travel for patients
  • We are a paper-free organisation. This is achieved by maximising technological solutions – all our systems are electronic, offering great environmental benefits, and operate on a transferable cloud-based system
  • Implementing strategies to reduce wasteful use of resources, promoting recycling schemes, and aligning with Waste Electric and Electronic Equipment (WEEE) regulations
  • Developing end of life plans for the effective use of products, with disposal costs considered within the lifecycle cost
  • Selecting suppliers that optimise our positive environmental output, e.g. our ultrasound machine supplier, GE Healthcare, is committed to sustainability and reducing emissions
  • Selecting products with sustainability initiatives built into their lifecycles, e.g., using digital/AI solutions for energy efficiency, and to reduce our environmental impact and carbon emissions
  • Working with an electric car company to co-design a scheme through which our staff can access discounts and offers by switching to electric cars

Influencing Staff, Suppliers, Customers, and Communities

NMU will positively influence patients, staff, communities, and stakeholders to engage with environmental protection and improvement across the regions, promoting awareness of sustainability through programmes such as our cycle to work scheme. We will also build links with local councils and Local Enterprise Partnerships to promote awareness.
NMU commits to the following initiatives:

  • Offering salary sacrifice schemes and cycle-to-work schemes, enabling staff to make sustainable travel decisions by offering long-term payment plans and discounts (42 employees are part of our electric car scheme; 52 employees have now invested in bicycles since the inception of our cycle-to-work scheme in September 2022)
  • Empowering staff to embody our environmental approach on the frontline, ensuring organic added value and improvement to patients
  • Providing staff with a protected day to volunteer on environmental initiatives in the community
  • Providing staff training through e-Learning for Health modules (e.g. ‘Building a Net Zero NHS’)
  • Providing training on powering down rooms to reduce energy use and minimise waste
  • Offering Apple Watches and FitBits to all staff for step count monitoring, encouraging walking and sustainable transport choices through competitions and leader boards in the office
  • Collaborating with local groups and networks, such as NEECCo, to build on community assets for a positive environmental impact
  • Promoting community-wide approaches to protect and improve the environment with providers, partners, and stakeholders across GM and LSC, raising awareness of how people can positively contribute towards the environment

Monitoring, Measuring, and Reporting on Our Commitments

Our leadership team will monitor the above climate change initiatives through our continuous improvement approach to provide evidence of and remain accountable for the outputs of our commitments, ensuring they remain effective.
Katie Bonsall, as Operations Manager, will lead our day-to-day social value initiative delivery. For the contract length, Katie will be accountable for collating data in IntraDoc to enable monitoring and reporting on our environmental impact across GM and LSC. She will review the metrics, ensuring we are offering tangible environmental benefits and delivering on our commitments. Our directors, Joanne Holgate and Sarah Fawcett, have overall responsibility for social value, including our environmental commitments. The impact of our initiatives, including updated or new initiatives, will be discussed in monthly Clinical Governance meetings, with key findings reported to the Board.
We will ensure full transparency throughout the contract, providing reports on our social value metrics and progress updates to the Commissioner and relevant stakeholders, according to agreed timescales, demonstrating our progress against our Timed Project Plan.

Economic Inequality

Yorkshire Health Solutions (NMU) will provide patient-centered ultrasound services aligned to local need in the region, early detection of risk to target the lower life expectancy of men compared to the England average. Proven by our high patient satisfaction and key performance indicator (KPI) target delivery, our data-driven, proven approach will address inequality and improve uptake in this region.

Improving Uptake

As an experienced, Sonographer-led provider, NMU will build on our existing partnerships to address local inequality and improve uptake. We will:

  • Provide materials advertising clinic dates/venues in locations frequented by target patients e.g. post offices, community sports venues, libraries
  • Offer education for local GP practices and pharmacy staff
  • Collaborate with GP and community organisations to raise awareness, sharing accessible information
  • Work with stakeholders and engage with hard-to-reach groups e.g. homeless organisations – Shelter and Real Change.
  • Hold community events with local organisations e.g. Older People’s Network

NMU will report KPIs monthly to Commissioners, demonstrating our robust methods to increase uptake as a patient-centred service.

Patient Involvement
Plan, Do, Check, Act ensures feedback informs service improvement. By capturing feedback through SurveyMonkey, NMU makes continuous service improvements, increasing accessibility and uptake. Example: At our Manchester Canal Street Practice, a disabled patient, after several Did Not Attends (DNAs), fed back they were more likely to present if it coincided with GP attendances. We altered our appointment structure, offering scans after GP attendances for those with protected characteristics.
Continuing High Uptake
Our low DNA rates reflect our dedication to patient access and engagement, currently less than 2% across 16,000 patients we scan monthly.
After booking, we send patients written confirmation, including scan information. We use strategic patient contact to manage anxieties before appointments, providing national screening information to answer questions, and sending reminder texts 72/48/24 hours to minimise DNAs. Through clear, effective communication, we will drive uptake, prevent unnecessary deaths through early detection and target local need as heart disease and strokes are leading causes of death in GM.

Eligible Persons within the Defined Protected Characteristics

Aligned to the Equality Act (2010), our service is tailored to need using local knowledge and understanding, including:

  • Longer appointments for patients in wheelchairs
  • Use of clear language
  • Providing translation services
  • Home visits using portable scanners for housebound patients
  • Communication with GPs and integration of our Administration System, Compucare, with primary care systems, using care records to identify need

NMU is committed to equitable access, never discriminating due to protected characteristics, always acting in the best interest of the patient.
Example: Noticing a lack of bookings from the LGBTQIA+ community in our GM Non-Obstetric Ultrasound Service (NOUS), we set up weekly drop-in clinics in the Gay Village, providing accessibility in a comfortable location, demonstrating our drive to achieve full coverage.
Example: At our community-based ultrasound services in Bradford, we recognised the high Muslim population and remain mindful of religious events, e.g. Friday is a day of Congregational Prayer, so services run later on Wednesday and Thursday evenings, ensuring equitable access tailored to individual need.
NMU’ robust training procedures aid staff to identify and support underserved patients, addressing vulnerability through our approachable, highly-trained staff. All Lead Sonographers are trained to Level 3 in Adult Safeguarding, with a Lead Safeguarding Officer in each local area. Our staff have annual refresher training, with policies available on our Intranet, maintaining awareness and sensitivity.
Example: Embedded in Greater Manchester region, our Sonographers are aware of human trafficking and slavery. Outreach charities have given staff training for the knowledge and tools to handle safeguarding, including Female Genital Mutilation.
When considering excluding patients with protected characteristics, we apply high levels of diligence and follow equality and screening guidance, including national guidance relating to screening of transgender and non-binary patients. We will always signpost the correct services through an open and transparent conversation, offering support and accessibility.
Accessible Information Standard (AIS)
Patient communication needs will be identified, recorded, flagged and shared, including how needs can be best met, to provide accessible, high-quality care.

Compliant with AIS, we offer:

  • Ultrasound scan information in 18 languages, including local common languages e.g. Urdu, Arabic, Chinese
  • Information in Braille, large print, easy-read and audio
  • Hearing induction loop
  • Interpreters, including BSL and Language Line
  • Alignment with Royal National Institute of Blind People and Deaf People guidance
  • Access to national information materials, offering easy guide versions
  • Digital versions of leaflets, enabling the use of screen reader technology

As a paperless organisation we prioritise electronic surveys, but we also offer paper versions, ensuring digital exclusion does not obstruct access, supporting the Digital Inclusion Strategy.
Example: NMU has support systems for screening men with learning disabilities, including:

  • Trained technicians for learning disabilities
  • Forming relationships with men and carers, to reassure and offer full understanding
  • Providing easy-read information, printed single-sided and in colour

Equity of Access

Premises Locations
In Leeds, men from disadvantaged areas have a lower life expectancy of eight years compared to those from affluent areas. NMU propose 41 scanning locations across Leeds, ensuring premises are CQC appropriate, geographically spread and have good transport links to encourage uptake. This gives us proximity to areas of high deprivation and poor health outcomes, where residents can struggle to access care; we will liaise with stakeholders and community providers to optimise location choices.
Our community locations will be co-located with GP practices, ensuring consistency and access compliant with the Equality Act and NHS Care Quality standards, with:

  • Good transport links
  • Wheelchair-accessible ground floor rooms
  • Equipment to support bariatric patients during assessment
  • Facilities for carers

During our years of service development, we will continually audit site suitability, ensuring premises contain:

  • A >12spm, wheelchair-accessible room, with a handwash basin and adjustable lighting
  • Privacy infrastructure e.g. soundproofing, lockable doors, privacy curtains
  • Staffed reception and waiting area
  • Accessible toilet facilities
  • Preferably, an air conditioning system

Locations will be flexible, reviewed against demand and safety of service delivery, using data to capture local need, ensuring we can achieve the best outcomes to address local health inequalities, increase uptake and reduce DNAs.

Example: Noticing the fluctuations in attendance in the Traveller community in Bolton, we made appointment times flexible, allowing members of the community to drop-in, ensuring equitable access and tailoring our service to improve uptake.

Invitation Methods

Eligible patients are invited using the national screening software solution provided by NHS England and Improvement, including a letter and screening information leaflets, using various methods aligned to AIS. Informed by demographic information from SMaRT, and patient information from primary care clinical systems, YHS will select the best invitation method/format for each patient, tailored to GM’s diverse population.

Lowering attendance barriers, our invitation procedure will include:

  • GP endorsement with invitation letter
  • Reminder letter/texts two weeks before appointments
  • Late opening of our booking centre

Extended Hours
Based on experience, extended hours are vital in improving service uptake and addressing inequalities. We will operate 08:00-20:00 Monday-Friday, 08:00-18:00 on Saturdays and 08:00-16:00 on Sundays, reviewing opening times according to local demand, tailoring our service to suit varied needs and ensuring accessibility.
From mobilisation, we will conduct analysis to identify demand and expand/amend timings, remaining flexible whilst maintaining contractual compliance. Our timely screening services and effective use of resources, proven 12 years’ experience, maximises delivery.
Example: We collaborated with Cornbrook Medical Centre (Manchester) to offer ultrasound scans at their weekly homeless outreach evenings. NMU hold appointment slots for homeless patients, scanning until 20:00, ensuring equity of access to underserved groups.

External to the Community

We will engage with individuals external to the community, ensuring we cover the entire region to drive uptake, providing care equitable to what they would receive within the community, including:

  • Housebound
  • Armed forces personnel and veterans
  • Dependents registered with defence medical centres
  • Mental health units
  • Detained locations
  • Care homes

Example: At HM Prison Armley, we use our portable equipment to offer ultrasound services, offering a safe screening process in the patients’ setting, ensuring accessibility for a hard-to-reach cohort.

The inclusion of underserved men relies on strong relationships with local providers. We will continue to work in collaboration with Mind Manchester on mental health outreach. NMU will collaborate with local providers to identify eligible men, informing necessary adjustments to our service maximising accessibility and offering AAA education to inform personal choice. Example: Following feedback from two ex-military Healthcare Assistants, we used their experience to collaborate with Manchester’s Military Veterans Group and Veterans in Mind, ensuring our service is equitable and suitable for veterans. By developing collaborative relationships, we centre our service on inclusivity, guaranteeing AAA provision for eligible men without discrimination.

Health Equity Assessment (HEA)

NMU takes a systematic data-driven approach to identifying and addressing inequalities, continuously improving and responsive to evolving need. Using the PHE Health Equity Assessment Tool (HEAT), NMU commits to developing a HEA and Action Plan during mobilisation to inform our inclusivity practices, guaranteeing accessibility and increasing service uptake. NMU will work with the Screening Quality Assurance Service to quality assure our processes.
Committed to equal access, we will share the HEAT and our HEA findings to local health services, working collaboratively to upskill and promote equity across the locality.
HEA data will be accessed within the national SMaRT system and reviewed and monitored by Katie Bonsall to evaluate outcomes. NMU will use our IT solution, Compucare, to capture data including protected characteristics, socioeconomic factors and vulnerability. From this data, we can identify hidden inequalities for underserved groups in the community, making improvements to our service as part of our lessons learnt culture, offering further outreach opportunities.
Our Action Plan will build on the accessibility we already provide. We are proactive to changing need and strive for full uptake, coverage and continuous improvement, carrying out annual checks at Board level, refreshing our HEA and Action Plan as required. We will maintain a transparent relationship with the Commissioner and stakeholders, collaborating to address inequalities proactively. Data is disseminated to staff in monthly meetings and audits, discussing lessons learnt as part of our open culture and ensuring continuous improvement.

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