During 2002/2003, the NHS in England consumed 40.3 million cubic metres of water and produced 34.4 million cubic metres of sewage. This comes at a cost - not just financial, but at a cost to the environment. Financial savings of up to 20% may be achieved through water-efficiency measures, with little or no cost in investment. This translates to a possible saving of GBP9.5 million per year. Much of these savings can be immediately realised through minor repairs to existing infrastructure and through staff behaviour, while others may require an initial capital investment that can be recovered within a specified payback period. This Health Technical Memorandum encourages investigating these possible savings. Additionally, it examines water-managementdecisions in the context of: patient health and well-being; social and behavioural aspects; and available and appropriate technology. Methods for auditing facilities are outlined, with common areas of high water use discussed and technical solutions proposed. Guidance on establishing necessary social and behavioural aspects such as staff awareness, appropriate use of technology and a clear definition of responsibilities are also outlined