24Spire Healthcare Annual Review 2010. We are working closely with Schneider Electric to produce new monthly energy consumption reports to benchmark similar sites and highlight any high energy users. The reports will also monitor progress against our reduction targets. TM44 Air Conditioning Inspections have been completed in line with Energy Performance of Buildings DirectiveWasteEstablishing Spire's National Distribution Centre (NDC) has enabled us to make significant progress against a number of carbon reduction commitment targets, including:. reducing cardboard and packaging waste. Our own vehicles collect cardboard and packaging from hospitals and bring it to our NDC, avoiding the need for extra fuel by making practical use of the return trip on existing supply runs. In 2010 we recycled 310 tonnes of cardboard and 1.5 tonnes of plastic, generating an income for the business of £20,000. Approximately 3,421 trees would need to be felled to produce this amount of virgin cardboard. 152 tonnes of security shredding was also returned from hospitals using the Spire transport fleet. It was subsequently destroyed and recycled through the NDC, and equates to approximately 1,672 trees that would need to be felled to produce the same amount of virgin cardboard. The shredded paper is sent on to UK mills and recycled into tissue products. installation of wormeries at the NDC and Spire Parkway and Tunbridge Wells hospitals aid with reducing organic waste produced from sitesAs a business founded on looking after people, we believe we have a duty to care for the environment and the local communities around our hospitals. We are also fortunate to be able to use our expertise and medical supplies to help others, both in the UK and abroad. Carbon reductionWe are committed to reducing our carbon footprint by becoming even more efficient in the way we manage four key areas: buildings, procurement, transportation and waste. We have stated our aims and reduction targets in our Carbon and Environmental Policy, which is woven throughout our Group operations. A Carbon Management Group is in place, with representation at Board level, to ensure progress is made against a Group-wide action plan. During 2010 we particularly focused on buildings and waste management. BuildingsCarbon reduction targets have been agreed and are now in place. We are working to closely monitor and reduce usage of electricity, natural gas, water and refrigerants that heat, light and run our 37 hospitals, London Fertility Centre, various satellite clinics and three support services offices.. Energy Remote Monitoring (ERM) system has been installed at all of our sites to provide us with real consumption information on electricity and gas, which we can use to monitor and identify changes that may be necessary to conserve more energy. We are in the process of adding water meters to the ERM systemAs a business founded on looking after people, we believe we have a duty to care for the environment and the local communities around our hospitals. Corporate social responsibility

25Charitable donations and contributing to local communitiesIn 2010 Spire staff raised and donated more than £285,000 to the local communities around our hospitals and other worthy causes.. Medical supplies totalling £103,000 were given to support the relief effort in Haiti. This included everything from protective gloves to essential theatre equipment needed to perform life and limb-saving operations. The team at Spire Southampton Hospital helped Mr David Warwick, consultant orthopaedic surgeon, to fundraise when he undertook a 12,000 mile off-road motorbike ride across South Africa. £7,000 was generated for Unicef, Sentebale - The Princes' Fund for Lesotho, the Nelson Mandela Children's Fund and Touch Africa, charities that help save the lives of some of the poorest people living in Africa. Spire Murrayfield Hospital (Edinburgh) provided £50,000 worth of reconstructive cosmetic surgery and a surgically implanted hearing aid to Kade Romain, an orphan from Trinidad who was born with no ears and partial hearing. Staff at Spire Bristol Hospital supported prostate cancer awareness by taking part in the 5k 'Run for the Future' and providing free PSA testing to men, totalling more than £5,000. For the past five years Pauline Nevin, out-patient team leader at Spire Cheshire Hospital, has organised an annual golf day in memory of Greta Larkings, a specialist breast nurse who died from breast cancer in 2005. All proceeds have been given to Breast Cancer Care, and in 2010 another £4,200 was donated, bringing the total five year tally to more than £25,000Education programmesSpire Healthcare makes a valuable contribution to clinical training in the UK. In 2010 we offered training placements to 269 under and postgraduate nurses and 46 pre-registration allied health professionals such as physiotherapists and operating department practitioners. In addition, a further 177 members of staff took National Vocational Qualifications and 133 completed degree modules.We operate our own internal training and development programme. This saw 5,574 candidates complete critical care courses, and staff complete a staggering 46,000 e-learning modules using our new web-enabled platform.To support the continuing professional development of doctors, Spire has four surgical research fellow positions, where postgraduate surgeons are able to hone their specialist skills by working alongside recognised experts in their fields. Our hospitals also deliver continuing development programmes for primary care staff, including GPs and practice staff, physiotherapists, optometrists and dentists, which count towards the Continuing Professional Development credits required to maintain their professional registration. For example, 674 GPs attended educational events at Spire Bushey Hospital, while at Spire Cambridge Lea Hospital a major GP education conference was attended by 109 GPs, with contributions from 26 specialist consultants.