Environmental and social impact assessment in healthcare business planning: a national survey of NHS trusts in England

BackgroundDecision-making in healthcare should include considerations for its environmental and social consequences as well as clinical and financial. Business cases represent projects which are likely to have particularly high impact, in which performing an Environmental and Social Impact Assessment may reduce negative effects. The practice of assessing these impacts is not mandatory, therefore our aim was to determine to what extent environmental and social considerations are incorporated into business planning across NHS trusts in England. We also set out to identify examples of good practice, common challenges and possible solutions to overcome these. MethodsWe conducted a cross-sectional survey across trusts in NHS England to capture current practice. This was carried out online between April and July 2024. ResultsNinety seven out of 210 trusts (46%) responded to the survey. Thirty two currently assess the environmental and/or social impact of their business cases and 25 are in the process of doing so, illustrating a growing practice. There is significant variation between trusts in terms of content, format and process of the assessment. DiscussionThis was the first study to portray not only whether and how environmental and social impacts are assessed in NHS business planning, but also the barriers and potential solutions in embedding this assessment. The variation in practice signifies heterogeneity of NHS trusts and there is unlikely to be a single tool that would suit every organisation. An impact assessment process with a clear purpose, that reflects organisational values, and is supported by multidisciplinary expertise is likely to be more meaningful. We include an Environmental and Social Impact Assessment tool for our trust, which has been developed based on the learning points from this study and modified to our trusts needs, as an example.