Some of the most convincing reasons to be concerned about global warming are linked to health. In April, the World Health Organisation said high temperatures in western Europe in 2003 were associated with 70,000 more deaths than in previous summers, and that deaths from asthma are expected to climb by nearly a fifth over the next decade as a result of climate change increasing levels of airborne particles.

So it is surprising that there is relatively little green computing work going on within health, compared with other parts of the state sector. Only one of the entries in the green IT category in this year's GC Awards for Innovation (run by Smart Healthcare's sister magazine) came from health: North Mersey Health Informatics Service. All the others were from local authorities and national government departments.

North Mersey HIS provides the IT services for eight trusts in and around Liverpool, put forward its work reducing printer cartridge use through use of special software. It has used the Print Green and Save print management and toner optimisation solution from Team Logic Systems to reduce the usage of consumables - paper and toner - and get a picture of the true cost of its printing.

It has said the return on investment should exceed 35% of the costs, and projected that implemented across the NHS it scould provide savings of up to £10m per year.

Dinah McLeod, head of BT's recently established sustainability practice, says that of the six external clients her practice has gained so far, there are three each from local government and the private sector. Although the unit is working with other parts of BT to talk to health service organisations - and despite the firm's major contracts with the health service - it does not have any NHS customers.

"Green issues are not a top item on the NHS agenda," says Victor Almeida, a senior analyst for Kable, who adds that he has not come across any large initiatives in this area.

"Perhaps it is because people are not pointing fingers at the NHS - it's not a big polluter. Local authorities have a lot of responsibility at community and citizen level which the NHS doesn't have, and if you look at the main items on the green agenda, it's recycling at home and congestion. The NHS plays a limited role in these."

Given their environmental responsibilities, it may make sense that local authorities are leading on green IT work, but the same techniques could easily be applied to the health service.

The most obvious method - and the one being pushed by many vendors - is to install more efficient equipment. Leeds Partnerships NHS Foundation trust reduced its number of servers from 32 to nine through use of virtualisation technology: the software, provided by VMware and installed by CSA Waverley, allows one server to do the job of many.

However, although the mental health trust saw energy efficiency as one reason for the move, it cited improved disaster recovery as the main justification for the work.

Tim Dawes of Socitm Consulting, author of a recent report on green ICT in the public sector, says new equipment should be seen as one option among several. "It's not just about greener stuff, it may be about procuring less often," he says, as it requires energy to manufacture the equipment. "IT people may get really into (buying more efficient equipment), it's the nerdy thing to do. The greener thing to do may be not to buy anything, which is terribly hard for IT people."

He suggests low tech options for reducing power consumption. Of the organisations he researched, "the ones that seem most effective are explaining to people and getting them to turn off at the plug," he says.
A good example is Chesterfield Borough Council, which has lengthened its replacement cycle from three years to five, and run a campaign asking staff to turn computers off at the plug, which has the same effect as physically unplugging it.

Warwick Andrew, the council's head of e-government and ICT, says the latter is worthwhile: a personal computer turned off but plugged in uses 13w, as its power transformer is still on. The council has reduced the number of computers left plugged in from 60 to fewer than 25.
"We've had to invest no money, except in terms of time wandering around the building seeing which PCs are turned off," he says - a flashing light on a network card betrays a plugged in machine.

Cheapskate

As a working computer uses around 130w, the final 10% may seem like small change. But Andrew points out that most computers are on for less than a quarter of the time. As a result, a computer's switched off but plugged in state can account for around a quarter of its power use. "It's a belt and braces approach, and quite a cheapskate one," he says.

Socitm's Dawes believes that measurement should be the priority for IT departments seeking to save energy, as it justifies the work. But he warns against relying on manufacturers' estimates, as models change often and power consumption depends partly on usage: "There's quite a big variation between what they actually do and what they say. You have to test it."

Such testing of existing equipment has been a key part of work by Fujitsu, one of the biggest NHS suppliers, in its preparation to move the Cabinet Office to a greener computing model. The department is joining the Flex framework agreement that it runs with the vendor, which is designed to be shared by other public sector organisations.

Phil Brown, technical project manager for the Flex framework, says the Cabinet Office will cut its IT energy use by 20% when it has completed its move from desktop computers to thin clients, with a few exceptions for those staff requiring specialist software. Other organisations moving to Flex could see comparable savings, he adds, although much depends on whether most staff can use a standard suite of software.

"The headline figures were that by the end of 2011, the Cabinet Office would have saved in excess of 300 tonnes of carbon dioxide," he says, for its 2,000 users. This is primarily due to moving computing power from desktops to a data centre, where it can be allocated more efficiently.

Although a bigger data centre and a higher bandwidth network requires more energy, Brown says this is overshadowed by more efficient desktop equipment. In moderate to heavy use, Fujitsu's thin client draws 23w, compared with an average of 115w for the Cabinet Office's desktop computers.

The department's existing flat screens, which are likely to be retained as they are fairly efficient, each use 30w. As a laptop experiencing similar use draws 70w, the thin client plus screen remains more efficient, although Brown says laptops can use less power than thin clients and screens if lightly used.

And the thin clients can be switched to the most power efficient settings, such as blank screen savers: "If you have swirly things on your screen, that costs 30 watts. If you have nothing, you are burning virtually nothing," says Brown.

Cautious calculation

Brown adds that the calculation of energy savings "erred on the side of caution," and did not include saving fuel on travel, through the system enabling home working and collaborative working.

BT's Dinah McLeod says these broader savings should be added into organisations' calculations, to help justify efficiency work. Her practice has created a carbon impact assessment tool, which looks at a wide range of sources of emissions. "There's huge emphasis on the kit," she says of most calculations. "It's part of the equation, but only part."

The BT assessment includes commuting: McLeod says that even for data centres, staff travel to work is responsible for 7% of emissions, according to research at four BT facilities. But when the firm looked at one of its offices in a Welsh city centre, where many employees used public transport to commute, it found that home working would make little difference to carbon emissions: staff at home use power and heating they would not otherwise. "We have found a magic number of 25 miles to and from work (by car)," says McLeod, above which home working is a clear energy saver.

ICT makes possible other savings on transport, such as by allowing teleconferencing. BT's conferencing division says it saved NHS customers from emitting 4,500 tonnes of carbon dioxide (and £2.7m in travel expenses) through the 33,000 virtual meetings health service employees held through its facilities last year, which include teleconferences and broadcast streaming to up to 2,500 computers.

So far the NHS has apparently been slow to exploit the potential offered by the various technologies to reduce the environmental impact of its IT. But given the increasing focus on the subject it is unlikely to be long before its organisations begin to learn some of the relevant lessons from other parts of the public sector.