Sustainable Purchasing Transformation in UK Healthcare Trusts: A Case Study

Thesis Abstract

This study investigates the drivers, challenges, and outcomes of sustainable purchasing transformation within UK healthcare trusts, aiming to illuminate how strategic procurement practices can reduce environmental impact while sustaining clinical quality and cost-efficiency. The problem addressed is the misalignment between sustainability ambitions and procurement practice in public healthcare, which often leads to fragmented supplier engagement, limited data visibility, and suboptimal adoption of green products and circularity initiatives. The aim is to develop an empirical understanding of how UK healthcare trusts implement sustainable purchasing, identify critical success factors, and provide a transferable framework for scalable adoption across the NHS. Specific objectives are (1) to map current sustainable purchasing practices across a purposive sample of five NHS Acute and Foundation Trusts; (2) to examine the relationship between procurement governance, supplier collaboration, and sustainability outcomes using a multi-country supplier framework adapted to the UK context; (3) to assess the impact of clinician engagement and internal stakeholders on the adoption of green procurement criteria; (4) to identify barriers, enablers, and trade-offs associated with sustainable procurement in pharmaceutical, medical device, and consumable categories; (5) to develop a practical, theory-informed roadmap for transformational change in purchasing functions aligned with national sustainability targets. A mixed-methods research design is employed. The population comprises NHS healthcare trusts operating within England, Scotland, and Wales that have active sustainability procurement charters. A stratified purposive sample of 30 procurement leaders, category managers, clinicians, and supplier representatives will be recruited. Quantitative data will be collected via a structured survey (n?180 respondents) measuring variables such as governance maturity, supplier sustainability performance, total cost of ownership, and outcome indicators (waste reduction, carbon intensity, and product tracing). Qualitative data will be gathered through semi-structured interviews (n?40) with senior procurement officers and clinicians, complemented by document analysis of procurement policies, category plans, and supplier scorecards. Data collection will occur over eight months, supported by NHS digital procurement records and Green NHS supplier databases. Analytical techniques include descriptive statistics and reliability tests (Cronbach’s alpha) for the survey instrument, multiple regression and structural equation modelling (SEM) to test hypothesized relationships between governance, collaboration, clinician engagement, and sustainability outcomes, and a thematic analysis of interview transcripts guided by Braun and Clarke’s approach to identify recurring themes, contradictions, and contextual nuances. A cross-case synthesis will be undertaken to extract patterns across trusts and categories, followed by a conceptual model refinement that integrates theories of institutional isomorphism, resource-based view, and stakeholder theory. Theoretical anchors include the Institutional Theory of Isomorphism to explain normative and coercive pressures, the Resource-Based View to frame capabilities in sustainable procurement, and Stakeholder Theory to interpret engagement strategies. Anticipated findings indicate that mature governance structures, clear sustainability value propositions, and robust supplier partnerships significantly predict reductions in lifecycle environmental impact without compromising clinical outcomes or total cost of ownership. Clinician engagement and internal stakeholder alignment are expected to mediate the effect of procurement decisions on sustainability metrics, while category-specific dynamics (pharmaceuticals, devices, consumables) will reveal divergent pathways and trade-offs, such as flexibility versus standardization and upfront costs versus long-term savings. The study is expected to identify a set of enablers (data interoperability, supplier scorecards with environmental KPIs, and cross-functional governance committees) and barriers (regulatory complexity, market immaturity for green products, and budgetary constraints). Contributions to knowledge include (i) a theory-informed, empirical understanding of sustainable purchasing transformation in public healthcare; (ii) a validated framework for NHS trusts detailing governance, capability development, and stakeholder engagement mechanisms; and (iii) actionable recommendations for policy-makers and procurement leaders to scale green procurement across the NHS while maintaining patient safety and service quality. The main conclusion is that sustainable purchasing transformation is achievable through integrated governance, strategic supplier collaboration, and clinician-aligned value articulation, facilitated by robust data systems and category-specific roadmaps. Recommendations emphasize embedding sustainability KPIs in procurement governance, expanding supplier development programs for green products, enhancing data interoperability for lifecycle assessment, and implementing targeted change management interventions to bolster clinician and staff buy-in.