The Impact of Paper Procurement in the NHS.

Natalie Roddis's picture

As many NHS professionals will be aware the NHS has committed to reduce its carbon footprint in line with the Climate Change Act (2008) but, aside from ensuring that legislative targets are reached, the benefits of decreasing greenhouse gas emissions are well documented. Yet the NHS faces increasing financial and service pressures; meaning that ‘green’ working is not always at the forefront of consideration. 

Many NHS organisations in England procure paper through the NHS Supply Chain Core Stationary list, which only contains paper produced from virgin (non-recycled) sources. As such, out of the 3.6 million reams of paper procured through NHS Supply Chain, only 29,000 were produced from recycled sources:

  • 100% Post-Recycled Paper – 19,000 reams
  • 75% Post-Recycled Paper – 10,000 reams
  • Virgin Paper – 3.571 million reams

The manufacture of the paper procured through NHS Supply Chain in 2016/17 is estimated to have produced the equivalent of 29,062 tonnes of CO2, compared to around 15,840 tonnes had all paper procured been from 100% recycled sources (table 1 of the attached).

Unfortunately, as NHS organisations are facing financial strain, the commercial argument for the procurement of virgin opposed to recycled paper outweighs the NHS’ corporate responsibility to reduce its environmental impact. Price comparisons undertaken through NHS Supply Chain indicate that recycled paper is around 215% more expensive than virgin equivalents. A key driver behind the high price of recycled paper is low customer demand; suppliers will be in a better position to reduce the price of their recycled products should more NHS organisations purchase them. Thus, the NHS and paper suppliers are in a ‘catch 22’ situation – NHS organisations will not procure recycled paper because it is too expensive, whilst suppliers will not lower the price of recycled paper because consumption is too low.

The NHS (and those providing paper to the NHS) have a great opportunity to become exemplars for environmental protection and climate change mitigation, by reducing the quantity of virgin paper consumed. Given the proven health impacts of climate change, is it not part of the NHS’ corporate and moral responsibility to collaborate with paper companies to increase the consumption of recycled, opposed to virgin, paper? At least until the NHS is in a position to become truly-paperless.

It is my hope that, in making my healthcare colleagues aware of the hugely significant numbers mentioned above, awareness of this issue will be raised. The ‘How to Buy Paper a Low Carbon Way’ tool is available on the NHS Sustainable Development Unit website, should you wish to establish the impact of the paper procured by your organisation.

Thank you to the NHS Sustainable Development Unit and NHS Supply Chain for their respective assistance with the ‘NHS SDU how to buy paper a low carbon way’ tool and paper procurement information. 


Paper Procurement in the NHS - reducing useage

Rebecca Gibbs's picture

Thanks Natalie.  It's enormously valuable to see data on the harsh reality of NHS funding when it crashes up against expensive environmental choices.  In the spirit of prevention being better than cure (and to lift our spirits) I've set out below the paper saving work of a few Trusts that may help others.  With some fancy footwork the financial savings (paper and staff time) may help fund recycled paper purchases.  

The first is a Green Ward Competition and the second I've lifted from Mapping Greener Healthcare.  Get in touch if you’d like more info.

Anyone else have examples? 

1. Neuropsychology

Goal: To move from a paper-based to an electronic referral system 

Background: The previous referral system required paper-based communication with both referral organisations and patients.  It also required staff to manually enter data and scan forms, both labour intensive processes.


1.     Referring departments were contacted to request that all referrals be emailed.

2.     The department’s automated response email was altered to include information on the new system and a referral form.

3.     A copy and paste system was implemented in place of paper and scanned referrals.

4.     Senior clinicians in the department commenced grading all referrals electronically.

Within the competition time period paper referrals had reduced by 68% and paper use had reduced by 28%. The new referral process is expected to continue indefinitely.  In addition, the Neuropsychology Department reports that it is now ‘exploring strategies to reduce other wastage’.


  • ·      paper savings of 7.48 reams per year
  • ·      approx. annual carbon emissions reductions of 18 kg of CO2e
  • ·      approx. cost annual reductions of £47.91 on paper, £467 on ink
  • ·      £867 (or 150 hours) of administrative staff time
  • ·      100 hours or £2,430 of clinician time.

‘Patients are receiving a faster and more efficient service…’


2. Paperless Reporting of Routine Dialysis Haematology and Biochemistry Results

Positive outcome(s) of project:

Freeing up administrative and clinical time and reducing the size and weight of notes (with resulting reduction in the costs of transport and storage and improvements in readability of the notes files). Reduction in unnecessary paper reports should reduce the risk of important results being lost, with consequent benefits to patient safety. A recent adverse incident where a microbiology report was not seen was probably in part caused by the excessive amount of unnecessary reports.

  • Savings:
  • ·      £120 per year (Estimated)
  • ·      380kg CO2 per year (Estimated)


Routine monthly haemodialysis blood tests generate a very large amount of paper results (at least 20000 sheets of A4 paper per year for the approximately 160 patients on the DBH dialysis program). Such large volumes of paper result in significant clinical and administrative workload and a high risk of relevant reports being missed. All such results are reviewed electronically in the monthly dialysis MDT meetings. Given the costs and lack of utility of paper reports it was agreed with the Trust's medical director that paper reports for routine haemodialysis results could be switched off.

Details of implementation:

The first step was to agree with the Trust's medical director that not having paper results did not create a risk to patient safety or a medico-legal problem. Once this had been agreed, the Medical Records department were informed to ensure that a record is kept of which notes are affected and what results are not being filed on paper.

The pathology IT manager assigned location codes to each dialysis unit and, in March 2012, set the pathology system to paperless reporting of haematology and biochemistry reports for these locations. Staff in the haemodialysis units and  pathology specimen reception were informed of the relevant codes to ensure samples are booked in correctly.

Benefits to environmental sustainability:

The annual costs of printing 20,000 sheets of A4 paper (calculated using Hewlett-Packard's online tool) are:

  • Energy 563 kWh
  • Paper: 100kg
  • Energy & paper CO2 emissions: 380kg CO2
  • Energy & paper costs: £120

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