NHS Sustainability Day 2016 Exeter Road Show

Welcome to the Exeter NHS Sustainability Day 2016 Road Show

#Dayforaction

Chair’s welcome and introduction

Fiona Daly, Associate Director of Sustainability and Patient Transport,

Barts Health NHS Trust

#Dayforaction

A Trust in Action

District Heating

• Combined Heat and Power

• On-site electricity – cheaper than grid

• Heat – waste by product

District Heating

• Europe

• Scandinavians

• Nottingham – 5,000 customers

• Queen Elizabeth Olympic Park

• Bunhill – 700 dwellings, to be extended

• Birmingham - NIA, Town Hall and others

• Newcastle – £60m development

Exeter District Heating

• 2008 – Cranbrook

• ECC climate strategy

• 2010 – Planning policies

• Energy from Waste

• 2012 – Feasibility study

Exeter Heat Loads

Exeter Energy Network

• Elevator Moment


• DECC/HNDU funding for detailed work

• MoU - Transparency and team work

• Technical

• Legal

• Commercial


• Studies:

• Validated previous work

• Presented viable models to use

Lessons

• Varied skill set in project team

• Well resourced

• Patience and awareness of scale

• Decision making

• CURRENT ECONOMIC CLIMATE

• Collaborative working

Is greenspace really good for you?

Links between natural environments, health and

wellbeing

Ben Wheeler, Senior Research Fellow

Nature – Health & Wellbeing Pathways

Adapted from Hartig et al 2014

Nature & Health. Ann Rev PH

Determinants of health

• Natural environments just

one complex component of

an even more complex

system of health

determinants

Barton, H., and M. Grant. 2006. A health map for the local human habitat. J R Soc Promot Health 126:252-253.

Some evidence

Greenspace and mortality Mitchell, R. and F. Popham "Effect of

exposure to natural environment on health

inequalities: an observational population

study." The Lancet 372(9650): 1655-1660.

Mitchell, R & Popham, F (2008). Lancet, 372, 1655-1660.

Greenspace & Inequality

• Availability of greenspace

may provide resilience

against health inequalities

British Household Panel Survey (1991-2008)

Urban Greenspace & Mental Health in England

Each year 5,000 households (n > 10,000) surveyed

Focused on 84% of households in “urban” areas

Mental Ill-health: General Health Questionnaire (GHQ-12) “Compared to

usual how have you been feeling in the last few weeks”

e.g. “able to cope”, “stressed”. The higher the score, the

higher the mental distress.

Subjective well-being: Life Satisfaction (LS): “How dissatisfied or satisfied

are you with your life overall?” with responses ranging

from 1 (Not satisfied at all) to 7 (Completely satisfied).

r(GHQ/LS) = -.50

-0.15

-0.1

-0.05

0

0.05

0.1

0.15

48% (-1SD from M) 80% (+1SD from M)

Co

mp

are

d t

o M

ean

Gre

en

Sp

ace

(6

4%

)

% of green space in local area

GHQ (mental distress)

Life Satisfaction

Error bars = 95%

confidence intervals

BHPS & Mental Health

Controlling for:

Individual Level - age, income, education, health, employment status, marital status, children, commute,

house type, house size. Area Level: Income, Employment, Education, Crime,

White, Alcock, Wheeler & Depledge (2013). Would you be

happier living in a greener urban area? Psychological Science.24,

920-928.

Mental well-being (Inverse GHQ: 1-12)

(N = 12,818; Obs = 87,573)

British Household Panel Survey (1991-2008; 27,284 Urban LSOA)

0

0.1

0.2

0.3

0.4

Green space Aged 16-25(v. 46-55)

Married No healthissue

Employed

Life Satisfaction (1-7)

(N = 10,168; Obs = 56,574)

Modelling the impact of moving from an LSOA 1SD < M Green

cover (48%) to one 1SD >M green cover (81%)

BHPS & Mental Health

Controlling for:

Individual Level - age, income, education, health, employment status, marital status, children, commute,

house type, house size. Area Level: Income, Employment, Education, Crime,

White, Alcock, Wheeler & Depledge (2013). Would you be

happier living in a greener urban area? Psychological Science.24,

920-928.

-1.4

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0

0.2

High vs LowGreen space

Aged 16-25 vs.46-55

Married vssingle Healthy vs ill

Employed vsUnemployed

BHPS & Mental Health over time

T0: Move to a less green areaT0: Move to a greener area

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

T-2 T-1 T+1 T+2 T+3Inve

rse G

HQ

(C

hange fro

m b

aselin

e y

ear

T-2

)

Year relative to move

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

T-2 T-1 T+1 T+2 T+3Inve

rse G

HQ

(C

hange fro

m b

aselin

e y

ear

T-2

)

Year relative to move

Changes in (Inverse)GHQ scores compared to baseline (T-2) for moves to:

(a) a greener area and (b) a less green area (Error bars = 95% CIs).

N = 595, Obs = 2970 N = 470, Obs = 2350

Alcock I, White M, Wheeler B, Fleming L, Depledge M. Longitudinal

Effects on Mental Health of Moving to Greener and Less Green Urban

Areas. Environ Sci Technol. 2014; 48(2): 1247-55

Before/after moving home

What about ‘blue space’?

Fortescue-Fox, 1934, 1938. Lancet.

Margate Sea Bathing Hospital

Monitor of

Engagement with

the Natural

Environment

• Visits to natural

environments

• Outcomes (self-reported):

– Restoration/stress recovery

– Physical activity

MENE visit locations

MENE Subset

asked about experiences

Stress reduction: To what extent

did they feel ‘x’ after the visit:

1) Relaxed

2) Calm

3) Refreshed

4) Revitalised

Stress reduction in different natural environments

3

3.2

3.4

3.6

3.8

4

4.2

4.4

Stre

ss r

ed

uct

ion

White, Pahl, Ashbullby, Herbert & Depledge (2013). Journal of Environmental Psychology, 35, 40-51

Error bars:

95% CI

Controlled for Who (Age, gender, SES) & What (activities, duration, who with, distance

travelled etc.)

Do people who live near the coast exercise more?

MENE n = 183,755 – “How many days a week of ≥ 30mins

exercise” (Recommendations: 5 or more)

White, Wheeler, Herbert, Alcock & Depledge

(2014). Preventive Medicine, 69, 135-140

Controlling for area

(income etc.) and individual

controls (age, gender, dog

ownership etc).

Error bars:

95% CI

ref

0.94

0.96

0.98

1

1.02

1.04

1.06

1.08

1.1

1.12

1.14

1.16

<1km 1-5km 5-20km >20kmOd

ds

Rat

io f

or

mee

tin

g p

hys

ical

act

ivit

y gu

idel

ines

Home (LSOA) distance from the coast

‘Geo-narratives’: In-depth understandings of the value of wellbeing experiences in nature

Bell, S. L., Phoenix, C., Lovell, R., & Wheeler, B. W. (2015). Using GPS and geo-narratives: a methodological approach for understanding and situating everyday green space encounters. Area, 47(1), 88-96.

Wildlife & wellbeingTara (when asked why it’s important to her to be outdoors):

“Sometimes I go down to my allotment and I…can stand there for twenty minutes and just not do anything. Just listen to the birds…and not particularly do anything. Or I might see a fox or you know, the crows scaring off the kestrels and that. So your mind just wanders, it’s just free really of clutter, and sometimes if I’m having like a stressful day, it helps not to have to think about it ‘cos you know that’s going to distract you”

Bringing wellbeing in stressful circumstances

Grace “As a child I escaped into nature. I’d escape from home and go and lay in a field or up a tree. We had a big hill just behind our house…nobody ever went up there, and it led onto a sort of coppice and hedge with trees, and I used to go there…and just lay on the ground. I don't know what I did…the grasshoppers would jump all over me and I just felt peaceful, mmm, nobody could get at me…I mean this was during the war and life was a little bit difficult anyway”.

Health interventions: conservation

activities to promote health (green

prescriptions)

Positive processes:

• Mental health

• Quality of life

• Sense of achievement

and contribution

• Contact with natural

environment

Understanding how environmental

enhancement and conservation activities

may benefit health and wellbeing: a

systematic review. R Lovell, et al 2015

BMC Public Health 15 (1), 864

School for Public Health Research

‘Greenspace’ in the NHS?

• Design of health and social care environments

Shackell, A. and Walter, R. (2012). Greenspace design for health and well-being. Forestry Commission Practice Guide.

‘Greenspace’ in the NHS?

“By guiding NHS decision makers, Greenspace design for health and well-being will help to harness the full salutogenic potential of the NHS estate and bring the healing power of nature back into 21st century healthcare provision.”

Sir Muir Grey & Derek Feeley


View through a window…

Ulrich, R. S. (1984). View Through a Window May

Influence Recovery from Surgery. Science, 224, 420-421.

Royal Cornwall Hospital yesterday…

Key issue?

What are the opportunities to capitalise on natural

environments to support and improve human health

and wellbeing (whilst not degrading) them?

a) Prevention – health promotion?

b) Therapeutic use (‘green prescriptions’?)

c) Health and social care environments (for staff as well as

patients)

[Need evidence]

Opportunity: University of Exeter Medical School

MSc in Environment & Human Health

http://medicine.exeter.ac.uk/

http://medicine.exeter.ac.uk/

Beyond Greenspace blog http://beyondgreenspace.wordpress.com/

Thanks to colleagues

Mat White

Becca Lovell

Sarah Bell

Sahran Higgins

Mike Depledge

& the rest of the team

[email protected]@benedictwheeler

http://beyondgreenspace.wordpress.com/

Climate Change, Extreme Events

and Health

Air Pollution and Climate Change Group,

Environmental Change Department,

Centre for Radiation, Chemical and Environmental Hazards (CRCE)

NHS Sustainability Day 2016 - Exeter Road Show

Dr Bernd Eggen

Outline

Climate change & extreme events

Health and Care System Adaptation Report 2015

Heat and cold effects on health

Air pollution and climate change

Extreme events and health

Environmental health and sustainability

Climate Change and Health

Climate Change & Extreme Events

(the sciency bit !)

48 Climate Change and Health

The Rise and Rise of CO2 Emissions

49

The Rise and Rise of CO2 Emissions

The annual growth rate of atmospheric carbon dioxide measured at

NOAA’s Mauna Loa Observatory in Hawaii jumped by 3.05 parts per

million during 2015, the largest year-to-year increase in 56 years of

research.

In another first, 2015 was the fourth consecutive year that CO2 grew

more than 2 ppm, said Pieter Tans, lead scientist of NOAA's Global

Greenhouse Gas Reference Network.

“Carbon dioxide levels are increasing faster than they have in hundreds

of thousands of years,” Tans said. “It’s explosive compared to natural

processes.”

So far, pledges / commitments at COP only “hot air” …

50

Global annual mean temperature anomaly

Temperatures in the UK in 2014

Every month except

August significantly

warmer than average;

Did this register with

general public ?

52

Temperatures in the UK in 2015

Most of year around average; Nov & Dec significantly warmer, and wetter !

South-westerly air flow brought mild & very wet conditions.

53

Meanwhile, in Continental Europe

Mitigation is vital, but we need to

prepare for inevitable climate change

observations

projections

2003

2060s

2040s

Te

mp

era

ture

an

om

aly

ove

r E

uro

pe (

wrt

19

61

-90

)

°C

Hadley Centre

We are already

committed to this from

past emissions alone

Climate Change &

UK Law & Actions

e.g.

Health and Care System

Adaptation Report 2015


Climate Change Act

2008

Climate Change Risk

Assessment

2012

National Adaptation

Programme

2013

Committee on

Climate

Change

Adaptation

Economic

Assessment

Committee on

Climate

Change

Committee on

Climate

Change

Committee on

Climate

Change

Health Effects

of Climate

Change 2012

UK

CP

09

UK

CIP

02

Health Effects

of Climate

Change 2002

Health Effects

of Climate

Change 2008

Legislative Framework: Moving

from evidence to policy


Adaptation Report for the Healthcare System

• Developed jointly by SDU, PHE & cross-system

group; published Sep 2015

• Download URL http://www.sduhealth.org.uk/arp


http://www.sduhealth.org.uk/arp

Heat and Cold Effects on Health

… several ingredients

needed …


0

20000000

40000000

60000000

80000000

100000000

120000000

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

NE

NW

YH

EM

WM

EE

LN

SE

SW

WA

SC

NI

UK

Population TrendsUK population is currently 62M rising to 69-86M (2050s)

& 72-113M (2080s)


Age Distribution

(Source: ONS)

Temperature Effects• Increases in annual mean temperatures of around 2 to 5oC under a

medium emissions scenario (A1B) by 2080.

• Quantification of preventable heat- and cold-related mortality and

morbidity, focusing on vulnerable population groups.

• Understanding the role of the Urban Heat Island in exacerbating the

impact of climate change on mortality rates.

• Improved understanding of the role of planned adaptation strategies

and long-term physiological changes.

• Provision of input to public health plans, and evaluation of their

effectiveness.

August 2003 Heatwave

2003

mortality

Baseline

mortality

2003

mortality

Baseline

mortality

(Johnson et al. 2005)


0

2000

4000

6000

8000

10000

1

2

3

4

5

-10 -5 0 5 10 15 20 25 30

Agg

rega

te c

ou

nt

of

day

s

Mea

n d

aily

dea

ths

(pe

r 1

00

K p

op

ula

tio

n)

Mean Temperature oC

England & Wales deaths

days

Cold effects Heat effects

Temperature Effects

Temperature mortality (by age group)

794

468

1573

685

421

1419

569

341

1153

456

274

933

0

400

800

1200

1600

2000

0-64 65-74 75-84 85+

Cold deaths /100K (mean)

2000s

2020s

2050s

2080s

0 418

79

1 626

113

1 11

48

206

217

77

327

0

200

400

600

0-64 65-74 75-84 85+

Heat deaths /100K (mean)

2000s

2020s

2050s

2080s

Mean estimates of heat- and cold-related deaths in the UK per year per 100,000

population

(Hajat et al. 2013)

Extreme Events and Health

Heatwaves, Cold Spells

Flooding

Draught

Windstorms


Floods (and Droughts) • Climate change is likely to affect river and

coastal flood risk.

• Some areas are particularly vulnerable to

coastal floods: South Wales, NW Scotland,

Yorkshire and Lincolnshire, East Anglia and

Thames Estuary.

• Understanding how floods (and droughts)

affect both physical and mental health of

populations.

• Development and evaluation of public

health action plans, advice and guidance.

Changes in Precipitation – Winter

River Flow between

Dec 2013 – Feb 2014

69

River-flow accumulation map for

December 2013 to February 2014.

Flows are expressed as a

percentage of long-term average

flows. Note: new period-of-record

maxima are circled with arrows.

Muchan et al, Weather, Feb 2015

Flooding

70

Somerset Levels, winter 2014

Somerset County Council and

Sedgemoor District Council

declared a major incident (24 Jan)

17,000 acres (6,900 ha) of

agricultural land having been

under water for 1month+

village of Thorney abandoned

Muchelney cut off by flood waters

for almost a month

over 600 houses flooded

Effects of Flooding on Mental Health

71

Experiencing a flood can be frightening, and the activities

of normal life can be disrupted. For most people, feeling

temporarily distressed does not interfere with their abilities

to cope with the process of recovery.

However, it is important not to underestimate the stress and

strain of being flooded and cleaning up after floods. Take

the time to consider your and your family’s mental health

and well-being. Do not overdo it when cleaning up, and

remember that tiredness, difficulty sleeping and anxiety are

normal in these circumstances.

Primary & secondary stressors can play a role

Effects of Flooding on Mental Health

72

While the experience of a flood can be distressing, events that occur after a flood can also be a source of stress. They include:

• difficulties accessing continuing healthcare and prescription medications; difficulties with getting healthcare for new health problems

• disruption to normal household activities and separation from family and friends

• loss of school facilities and interrupted attendance at school

• feelings of loss of control and worry that flooding may reoccur

• seeking compensation, recovery and re-building of homes, submitting an insurance claim, loss of employment and/or income, and loss of physical possessions

Only a minority of people are at risk of developing mental health problems

Environmental Health & Sustainability


Health Co-benefits of Mitigation• Mitigation policies may achieve health, GHG

and economic benefits simultaneously

(‘the triple bottom line’).

• Understanding the health co-benefits of

policies to reduce GHG emissions in

transport, energy generation and food

production.

• Evaluation of the health effects (both positive

and negative) of emerging ‘low carbon’

technologies and biofuel policies.

• Healthy-Polis: International Consortium for

Urban Environmental Health & Sustainability http://www.healthy-polis.org/

Conclusions • Climate change is likely to pose significant challenges to public health

in the UK by aggravating existing public health problems.

• Some UK regions (flood risk and densely populated areas) and

population groups (elderly, deprived, ill) are more vulnerable.

• Research needed on current and future interactions between climate,

and environmental and behavioural drivers that affect public health.

• The environmental public health sector needs to respond to these

challenges by:

strengthening modelling, monitoring and surveillance systems

improving the resilience of public health infrastructure

improving the assessment & communication of climate related risks

developing the evidence on health benefits of climate change

adaptation and mitigation

Acknowledgements

• Climate change, extreme events and associated research in PHE/CRCE

• Department of Health (DH); Sustainable Development Unit (SDU)

• Department for Environment, Food and Rural Affairs

• NHS Sustainable Development Unit

• UK Climate Impacts Programme

• UK Met Office


Air Pollution and Climate Change


Air Pollution


• Understanding how climate change interacts with ground level ozone

and other climate sensitive air pollutants.

• Investigation of the range and extent of health effects of ozone,

including those associated with chronic exposure.

• Understanding how vulnerable people (e.g. those with pre-existing

respiratory illness) need to be protected.

Annual mean Summer mean

Change in ground level O3 simulated by EMEP4UK for a +5oC increase in

temperature relative to the base simulation for meteorological year 2003.

Ground Level Ozone

(Heal et al. 2013)


Ozone Mortality Burdens (no threshold)

(Heal et al. 2013)

Wales: 677 700 782 815 765

Sian McCartCorporate Affairs

Mission: To reduce global water

consumption by

1%

Water efficiency experts for 20 years

Advisors to the Government since 1999

Lead consultants of Watermark

£70 million

Major improvements

Metering

Billing

Reporting

Wider ranging

Greater detail

Robust

£500 million per annum in lost

revenue, which if saved coincides with a

30% reduction in water use

London’s Total Annual Water Consumption

3 billion Cups of Tea

…or filling this room 9 million times over

What this means for the NHS

10 million m3 per year

£24 million

500Different Building

BenchmarkClassifications

Why do we need you?

3 years free bill validation

Electronic water consumption profiles

Identification of high consumption anomalies

A benchmarking toolkit

More accurate reporting on water

Prepare for deregulation from 2017 and;

Tools to potentially reduce your water bill by a third

Video Case Study

07 Case Study.mp4

07 Case Study.mp4

3 Simple Steps

to Participate

We provide you with an email to send

to your water supplier

They send your future bills to us for

benchmarking assessment and

validation

Within 24 hours of receiving them, we

send your now validated bills onto you

Climate Change

Rapid Population Growth

Economic Development

True water management

- comprehensive approach

@adsmUK

#AquaMark

Your Participation

[email protected]

01753 833 880

www.adsm.com

Thank you

Emma LawesClient Support Officer

[email protected] 3102 6910

100%INTERESTFREE

mailto:[email protected]

Introduction

Knowledge sharing and case studies

Summary of the loan application process

To demonstrate how Salix can help NHS England

Our goals for today

Introduction to Salix funding model

Who we are

Established in 2004

Independent, publicly funded, not-for-profit company

100% interest-free capital finance for the public sector

Funded by DECC, Scottish and Welsh Government, EfA and DfE

Support public sector bodies such as local authorities, educational establishments and NHS Trusts

Working throughout England, Wales, Scotland and N. Ireland

Minimise wasted energy – controls and awareness raising

Efficient conversion –installing energy

efficient technology

Salix focus capital investment to

reduce energy and save carbon

Energy hierarchy

Onsiterenewable

energy

Loan funding by public sector body type

40%

30%

12%

10%

4%3%

1%

England between April 2010 - March 2015

Local Authority

Higher EducationInstitute

National Health Service

School

Further EducationInstitute

Academy

Emergency

Salix Activity within the NHS

Top 10 NHS Clients Imperial College Healthcare NHS Trust

Northern Devon Healthcare Trust

Hinchingbrooke NHS Trust

Bradford Teaching Hospitals NHS FT

Princess Alexandra Hospital NHS Trust

Northampton General Hospital NHS Trust

St George’s Hospital

Poole NHS FT

Salisbury NHS FT

Ealing NHS Hospital Trust

Energy usage in the NHS

245 eligible organisations spend over £634m on energy and utilities 1

Average of £2.5m per hospital 1

Typically 3rd largest expenditure

Our NHS clients have saved on average £200k per year 2

1. Health and Social Care Information Centre, Hospital estates and facilities statistics 20152. Salix Finance – loan applications since 2008


Case Studies

Project Knowledge Slides

Social Media

News & Blog

Salix project case studies

Northampton General Hospital - case study

Pre project conditions –

• Mixed 40 acre estate with buildings ranging in age from 1793 to 2008

• Issues with BMS control, heating networks, pipework lagging, heat loss, and inefficient lighting

Salix funded solution –

• Total project cost £381k

• Cavity wall and pipework insulation, draught proofing, BEMS upgrades, pool covers, and T5/LED lighting

• 3 year payback

Project overview Salix helped Northampton General Hospital to deliver a suite of new projects across their estate saving the hospital £127,484 per year

Project knowledge slides

Sharing of knowledge between clients

Completed projects

Before and after

Supporting comments

experiences

lessons learnt

supplier

contact details

SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK

Salix application process


Online application process


Six simple steps to apply

1. Log on to the Salix website salixfinance.co.uk/loans

2. Select the NHS loans page

3. Complete the compliance tool with project details

4. Complete an online loan application

5. Submit your application online

6. Salix will do a technical assessment

Summary

NHS Trusts and Foundation Trusts – no maximum loan amount

Help achieve energy and carbon reduction targets

Long-term funding plans, SDMPs, estates strategies

Reduce energy bills at your Trust

Thank you

[email protected] 3102 6910


Refreshments and Networking

#Dayforaction

Title bar

Body text

○ Bullet text

Carillion HealthNHS Sustainability Day Conference, Exeter

What is Facilities Management…?

People at the heart of what we do.

Focussing on our people so that they

can focus on your people…

Carillion has an engaged and

empowered workforce that

understands the NHS imperative for

a sustainable operation.

Getting it right first time…

Everything costs money and everything draws upon the limited resources we have.

Carillion understands the crucial importance

in getting the job right first time.

○ Minimising the use of chemicals

○ Minimising the amount of waste

○ Minimising the amount the of down time

○ Minimising the need for repeating the jobs

Don’t Walk By!

The number of Don’t Walk By reports recorded and actioned within

Carillion each year, globally, is in the region of 1.5 million!

Which represents, potentially, 1.5 million times that the workplaces we

operate in have been improved. But it is also 1.5 million times that we

know health, safety, environmental impact and quality have been

discussed in our workplaces.

Which means that 6000 times every day we are a making a

contribution to creating sustainable workplaces.

Helping you help others…

Carillion understands our stake in

the wider Sustainability agenda.

The health and welfare of our wider

society is paramount. Clearly the NHS

is in the vanguard with this. But

Carillion is there facilitating and

driving standards where we can.

Our People

People

Looking after our people…

Carillion recognises the need for a healthy

workforce. Recently we have brought a greater

focus to the health aspect of the Health and

Safety agenda – we call this Health like Safety.

We want our people to be in the work place

being productive.

Sustainability within our Values

Sustainability is at the heart of the Carillion

business and at the core of our values.

○ We care

○ We achieve together

○ We improve

○ We deliver

Sustainability in facilities management is all

about the people.

The business case for reuse:Daniel O’ConnorHead of Customer [email protected]@WarpIt_


Overview

Financial

Environment

Social

Overview

NHS real case studies

Free resources How to set up your own

Business case templates

Legal templates

Value

“It is only a waste when it is in the wrong place”

The Enemy

Time

Space

Distance

Priority?

Reuse has a much great impact than recycling

Purchase & Waste costs Staff time

Supply Chain Impacts

60% NHS Carbon from supply chain

Supply Chain

Social

Internal Collaboration

Procurement & waste avoidance benefits

Internal Collaboration

External Collaboration

Friend requests


Aber Unisave £10K in 1st trade!! (audio room)

Metrics from NHS Tayside

Metrics from CWP

Metrics from NHS Highland

Metrics from GMW

Top 10’s

Win win win

Take home tip

Explore developing a reuse target

>Track your savings

>>Put more resources into reuse

Free resources

Freegle

Warp It (is free really)

Legal document for donation to 3rd parties

Business case for reuse system

GetWarpIt.com

Book a callback!

Linkedin: Daniel Bede O’Connor

[email protected]@WarpIt_


Engaging with Organisational Sustainability

What’s the problem?

What is sustainability?

Strategic planning for sustainability

What this might mean in practice? -Engagement

Who are we?

• Low Carbon Europe – work with a range of clients to deliver sustainable outcomes

• Energy and carbon management specialists

• Strategic sustainable development planning and organisational change

Source: Jae Mathers, Carbon Free Group, IEMA Presentation, 03/09/15

What is the problem?

What is sustainability?

"Meeting the needs of the present generation without compromising the ability of future generations to meet their needs." Bruntland Report (1987)

From this…

…to this

It’s common sense really…

Strategic planning for sustainability

What might this mean in practice? – Board Level

• Sustainability Steering group oversees progress of SDAP

• Agree dedicated resource to deliver sustainability

• Building partnerships to deliver effective early interventions, support community recovery and reduce readmissions

• Consider the use of technology as patient empowerment tools

• Mobilise external organisations to deliver improvements to support the Trust’s aims

• Consider future service changes (demographics) or adaptation needs (resilience)

Initial steps…

• Informal discussions to understand each service area and implications/feasibility for sustainability

– What are the quick wins?

– What might be time or budget constrained?

– Baseline data, monitoring and evaluation requirements

– Training needs

• Initiation of Sustainability Steering Group to develop the SDAP and oversee its implementation

• Reporting of SDAP to the Board annually

What might this mean in practice? – Staff Engagement

• A systematic approach to recruitment • Developing a network of champions • Managerial approval to allow staff time to participate• Develop and run dedicated workshops focussing on the

context of your Trust • Departmental Action Planning & Working Groups

– Clinical pathways – Sustainability Aspects (Transport, Water, Energy, Waste, Food &

Procurement)

• Seeing is Believing Tours & Action Planning Updates • Evaluation & Monitoring• Sharing & Celebrating – NHS Sustainability Day

What might this mean in practice? – Communities

• Partnership working

– Schools, Colleges, Universities

– Local Government

– Local Businesses

– Charities

• Health & Wellbeing Projects

• Patient Surveys and Focus Groups

Any questions?

Sarah MooreSustainability Consultant

T: (01273) 862582M: 07712 [email protected]

Low Carbon Europe LtdQueensberry House, 106 Queens Road, Brighton, BN1 3XF


http://www.lowco2.eu/

Convert what you throw away into what you need

Rod Fountain

CEO and founder

we take this

and make this

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we take this

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we take this

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The circular economy creates amazing returns for all of us

ECONOMIC

Huge savings for

NHS trusts.

Higher prices for

waste.

Lower costs for

furniture and fittings.

Subscription option

frees the capital

budget.

Reduces FM costs.

ENVIRONMENTAL

Huge reduction in

carbon footprint.

Reduces or eliminates

waste to landfill.

Optimises use of

resources.

SOCIAL

Raises quality of

working environment

for staff and patients.

Creates new form of

positive engagement.

Supports CSR

programme.

FluteOffice: Critical for the NHS to embrace the circular economy

“The FluteOffice solution represents the future for our Trust. The opportunity

exists to save many millions of pounds for the NHS if it embraces the circular

economy across the country.”David Sissling CEO Kettering General Hospital NHS Foundation Trust

“We find the FluteOffice model utterly compelling and we intend to roll it out

throughout our estate.”Martin Riley Managing Director Medway Community Healthcare

“We want everyone who works for us to be proud of what we are doing to make

their working environment much better and at the same time much more

environmentally responsible and sustainable. We are all very excited about the

future potential of working with FluteOffice.”

Julie Sherlock, Board Lead Customer Care & Facilities, Your Healthcare

Kingston

FluteOffice: Everyone loves it!

FluteOffice: Example of the closed loop model for the NHS

We take waste cardboard from NHS trusts and use it to make

stunning furniture and interior office products….

….which we then resupply to the

NHS for use in its buildings for as

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FURTHER INFORMATIONRod Fountain [email protected]+ 44 (0) 7957 424976

FluteOffice LtdThe Studio, Gardeners Cottage,Jayes Park Courtyard, Ockley,Surrey, RH5 5RR+ 44 (0) 1306 400070

www.fluteoffice.com 215

Version 1

What is Sustainability?

SUSTAINABILITY = THE ABILITY TO CONTINUE DOING SOMETHING INDEFINITELY

....or put another way:

‘Living within our means’

Or

‘making the most out of what we’ve got’

Or

‘waste not want not’

Our Environmental Objectives• To reduce the carbon footprint of each of our businesses

• To reduce our reliance on natural resources

• To become a zero waste to landfill business

• To improve our environmental and compliance performance

Our Group Sustainability report for 2015 highlights the achievements Stericycle have made with these objectives

Energy generation –Knostrop Incinerator Leeds

A true first in the Clinical waste industry

• The generator uses innovative power generation technology that enables it to produce ‘free’ electricity using our steam and is the first of its kind in the clinical waste industry.

• The Heliex System is a novel rotary device that recovers energy from the steam generated during the incineration process.

• The systems currently produces 100kw of energy 1/3 of the whole facility’s energy usage reducing costs and reducing CO2 emissions

• Our new incinerator in Avonmouth, Bristol will also have a HeliexSystem

Sharps Management Service• SRCL wash line is unique in the sector, it is a fully automated wash line

using state of the art robotics

• Powered by the neighbouring Knostrop incinerators, utilising the steam and energy generated to give a true sustainable solution

• On site autoclave processes single use metal instruments which are then sent for recycling rather than incineration

• Sustainable service that brings innovation to sharps management

• It’s a service, not just a container!

• A fully integrated service that:

– Reduces costs 10-20%

– Reduces needle stick injuries

– Much more of a sustainable service –used 600 times

– Saves time

– Free up storage space

What is it?

UN Approved Reusable Containers

7.5L Vertical Drop Container

The Sharps Containers are colour coded in line with HTM The Safe Managementof Healthcare Waste.

• Robust & easy to manoeuvre

• Curved edges and minimal bolts for easy cleaning

• Optional work area/Instrument tray holder

• Braked 65mm sealed medical grade casters

• Robust nylon modified polyester coatings

• Weighted low centre of gravity base for

greater stability

Point of patient care –transport trolley

To date 95 individual hospitals, pharmacies and

Laboratories are using SRCL’s Bio-Systems Service

Supporting documentation

• Reduces costs

• Reduces waste

• Reduces needle stick injuries

• Saves space

• Frees up hospital staff

• All containers are puncture resistant

• Environmentally sustainable

• Full training provided

Summary of the benefits

Join usJoin us

Healthy Eating

“The Route to Health and Wellbeing”

“Why we need healthy new proteins with

a low environmental impact”

Who is Tim Finnigan???

• Married, two children (grown up)

Who is Tim Finnigan???• Married, two children (grown up)• Likes running up hills and likes a pint• 30 years R&D in Food and Drink• PhD Canola protein, Government food research, APV,

General Foods and...

I’D LIKE TO LOOK AT THREE THINGS

WHY WE NEED HEALTHY NEW PROTEINS WITH A LOW ENVIRONMENTAL IMPACT.

THE GOOD NEWS THAT ‘IT CAN BE DONE’ - QUORN AS AN EXAMPLE

HOW WE FEEL WE CAN HELP, AND WHAT WE’VE BEEN DOING

The 1960s was a time of

huge achievements...

But First some context…….

....And growing concerns

The Green Revolution

1964 A man with a big idea

Inter-generational equity

236

From 1964 to 1985 – time flies……….

+ a large number of ducks, rabbits, horses, turkeys…

..3 camels and one unfortunate mule

Chickens 110,000

Pigs 2,630

Sheep 922

Goats 781

Cows 557

The scale of livestock production is driven by our desire for cheaper and more plentiful meat, but there are damaging

consequences, which at the moment are forecast only to intensify

The current context…

https://en.wikipedia.org/wiki/File:Cowspiracy_poster.jpg

https://en.wikipedia.org/wiki/File:Cowspiracy_poster.jpg

Challenge Consequence

To feed 9bn in 2050 FAO say we need a 60% increase in food production

some of the true costs of cheap and plentiful animal protein

Our demand for ever cheaper and more plentiful meat has a number of potentially devastating consequences…

238

Bowel Cancer • Is the third most common cancer in the UK • Eating 100 to 120 g of red and processed meat a day

- things like ham, salami and sausages – increasing the risk of developing bowel cancer by about 25% -we need to eat less

• Fibre offers a protective effect – we need to eat more (SACN Report)

Quorn are supporting bowel cancer awareness

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2121650/pdf/pmed.0040345.pdfhttp://scienceblog.cancerresearchuk.org/2007/11/12/how-does-red-meat-increase-bowel-cancer-risk/http://www.dietandcancerreport.org/?p=ERhttps://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report

http://scienceblog.cancerresearchuk.org/2007/11/12/how-does-red-meat-increase-bowel-cancer-risk/

http://scienceblog.cancerresearchuk.org/2007/11/12/how-does-red-meat-increase-bowel-cancer-risk/

http://www.dietandcancerreport.org/?p=ER

https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report





240





242

Mishka Henner

MEAT THE No 1 CONTRIBUTER 1/3rd water use. 18% -30% of global GHG emissions. 45% of all land. 91% of rainforest destruction to date (1 acre per

second). Species loss. Ocean deadzones. Habitat destruction. The rise of the superbug. Micronutrient depletion. Unaccounted costs of poor health and

environmental impact. Animal welfare and cruelty on an unprecedented scale.

Our biggest lever that can address both environmental impact and improve our health

Who’s responsibility is it anyway ?

Issues for the NHS reflect these global

mega trends

''Today 25% of the nation is obese and 37% is overweight”. If we could reduce the number of cases

by 20% over the next 5-10 years, we could save the NHS up to £16bn per year.

“In 2015 NHS will spend about £8 billion a year (increasing to £10-£12bn by 2020) on the medical

costs of conditions related to being overweight or obese and a further £10 billion on diabetes.”

“Shortfall in NHS funding £20bn target by 2020”

“NHS as an employer sets a national example in the support it offers its own 1.3 million staff to stay healthy, and serve as “health ambassadors” in their local communities”.

Simon Stevens Five Year Forward

Tackle the root causes of ill health.

A radical upgrade in prevention and public health.

Hard hitting action on Obesity, Alcohol and other major health risks.

248

Easy to use, easy to enjoy – Quorn are proud

to support the NHS in achieving this vision

Creating the world’s leading meat-alternative business

So, what exactly is Quorn and

what have you been doing to

help??

Quorn video

“Quorn ….began by taking the original fungi found in soil and domesticating it in the same way that our ancestors did with many plants.”

Spector, T (2015) The Diet Myth. Weidenfield and Nicholson pp 137

A new way of farming…….

252

Additional InterestSCFA productionFibre (chitin and ẞ-glucans)

Mycoprotein as a food ingredient

Physical

Properties (shape)

Denny, A, Aisbitt, B and Lunn, J (2008) Mycoprotein and health. BNF Nutrition Bulletin 33: 298 – 310.Bottin, J. (2014) Nutrition and Surgical Influences on appetite regulation in obese adults. PhD Thesis Imperial College London

BENEFITS

Texture creation• Authentic meat-like texture• Creation of fibrosity through fibre assembly

General Nutrition• High quality protein• Low fat content (membranephospho-lipids)

• High fibre (cell wall)• Low energy densityClinical Research Programmes• Lowering serum cholesterol• Satiety• Insulinemia and

glycemia in diabetics

Composition

Key comparisons - Quorn

By working closely with Carbon Trust we have established that Quorn foods offer significant environmental benefits relative to meat.

Quorn is the first and only meat free brand to have carried out such a systematic third party analysis of its

environmental footprint.

1 Geraldes, E & Freire F (2013) Greenhouse gas assessment of soyabean production: implications of land use change J Cleaner Production 54, 49 -60

2. Matsuka, T& Goldsmith, P (2009) World soyabean production: Area yield and projections. In: J Food Agric Management review 12 (4) 143-161

3. Ercin, AE Aldaya, M &Hoekstra, AYl (2011) The water footprint of soymilk, soyburger and equivalent animal products. UNESCO IHE Inst Water Education. Report 49

4. Carbon Trust. Report to Marlow Foods (2014) Available on request

ENVIRONMENTAL COMPARISON PROTEINS AND MYCOPROTEINGHG

(kg/kg)LAND

(ha/te)WATER (m3/te)

MYCOPROTEIN 1.6 0.17 860

source#4: carbon trust lifecycle analysis of mycoprotein. Report 2014

QUORN MINCE 2.4 0.4 1900

SOYABEAN 0.1 - 17.8 0.43 2500

source#1 source#2 source#3

BEEF (GRAZED) 121(114 - 130) 5 21500

BEEF (MIXED) 30(16 - 69) 3.5 19500

source#4: carbon trust lifecycle analysis of mycoprotein. Report 2014

POULTRY 9 0.7 3970

Compared with Quorn mince ex factory

GHG LAND WATER

Beef (mixed)

X12 X9 X10

Beef (grazed)

X50 X12 X11

Poultry X4 X2 X2

An easy way to remember this…….

Member of the FUNGI family

That’s grown by FERMENTATION

And is FILAMENTOUS

That helps us to create FIBROSITY

Which we achieve through FREEZING

The Eight F’s

And creates nutritious new FOOD

With a low environmental FOOTPRINT

And a new way of FARMING

What have we have been doing……

../../../../Videos/Sustainability Day 2016 EJ.mp4

../../../../Videos/Sustainability Day 2016 EJ.mp4

What if every NHS member of staff ate the

same lunch as you will be eating today??

THANK YOU

Lunch and Networking

#Dayforaction

Welcome back



#Dayforaction

Creating the story of changeSusie Vernon and Rick Lomax

Sussex Community NHS Trust in partnership with Capita

1. Sustainability at Sussex Community NHS Trust:Care Without Carbon

2. Carbon road mapping

3. Engaging Staff: Dare to Care

Contents

Excellent Care at the Heart of the Community

4,500 staff serving 1.1m people throughout the community

315 Inpatient beds in 9 locations£196m annual spend (£1m surplus)

plus £4m capital spend

Brief history of sustainability at SCT

First Sustainable Development Management Plan approved by Board in 2010: “15 by 15”

Focused on demonstrating the value of sustainability through tangible results

Laying foundations for future development of the programme

Where to next?...

Well on the way to achieving our 15 x 15 targets Challenge from Board – great but where next?! How do we build on successes and accelerate pace of

progress and change? How do we better integrate sustainability into

operational fabric of Trust and put it at the heart of “core business”?

How do we give sustainability a personality and drive real and lasting cultural change?

Performance 2010 - 2015

CO2 reduction 2010 – 2015

NHS Carbon Footprint

Climate Change Act target: 34% by 2020(baseline year

1990 or 2007)

1990 Baseline

2015 Target 10%

2020 Target 34%

2050 Target 80%

Climate Change Act (2008)

ERIC submission data – where Trust’s think they are

Stage No. of Trusts Percentage

No Sustainable Development Management Plan or Carbon Plan

63 26%

No Target included in Plan 18 8%

Target included but not on track to be met 56 23%

On track to meet target 103 43%

Achieving 34%: Carbon Road Mapping

CARBON ROAD MAP: a strategic and planned approach for an NHS Trust/provider to achieve 34% carbon reduction target by 2020.

Identifies viable, cost-effective saving opportunities (especially in

the context of today’s Budget update)

Helps demonstrate an organisation’s commitment to tackling climate change to commissioners, employees and patients

The process: three key steps

1 2 3


Where you are Review site and operations Data analysis and benchmarking Carbon footprinting Identify baseline

1 2 3


Where do you want to be? Set your targets – 34% by 2020 Identify progress to date Plot trajectory to 2020 and Value at Stake Quantify carbon shortfall

1 2 3


How do you get there – your bespoke roadmap Known Knowns: review current planned projects Identify and quantify measures to achieve the

shortfall Outline potential funding mechanisms

1 2 3

Summary

0

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BASELINE

BUSINESS AS USUAL

REDUCED EMISSIONSSCENARIO

Carbon shortfall

Identify, quantify and outline funding for:•Planned projects•Energy reduction measures•Efficient energy generation•Green travel•Waste management•Staff engagement

CLIMATE CHANGE ACT TARGET

“Every Trust should have a Carbon Road Map. We are working towards having a detailed plan of what we need to achieve and a process to validate that achievement each year. The Road map is indicating annual cost effective savings of around £200k and through innovative funding mechanisms could achieve a further £200k from our energy bill to fund carbon saving measures.”

Andy HayesHead of Estates & FacilitiesSomerset Partnership NHS FT

Key staff engagement challenges

• Too many initiatives in NHS are top down – Board can’t do it alone, needs grass roots action

• How do we show that sustainability is relevant to frontline staff and make it meaningful?

• Staff are busy, stretched and suffer from initiative overload

• Staff are very dispersed – large geography and number of sites

• How do we know engagement has been successful?

1. Looked at language – and visual identity

Developed a brand CWC is shorthand for a

sustainable NHS Making sustainability more

intuitive for frontline staff Instantly recognisable across

Trust – not just another initiative

2. Created a narrative

Bringing the CWC brand to life Talked to our staff – workshops to help identify what would

motivate our staff

The narrative: CWC is about doing new things that will make you feel good AND create a healthier, happier and more sustainable NHS

3. Identified the right format

Drew on external expertise e.g. EAST model Easy Accessible Social Timely

3. Identified the right format

Pledge based system: Dare to Care (language again!)

Fun “can do” approach, not preachy “must do”

Range of dares – something for everyone; each has a cost, environmental and wellbeing benefit

Easy for staff to build actions into working day

Dare refresh every 6 months –reflect organisational priorities & staff ideas

3. Format: online

Bespoke online platform as main vehicle for the campaign carewithoutcarbon.org

24/7 access Public website Capturing information and

measuring progress

http://www.carewithoutcarbon.org/

4. Format: online

3. Format: posters

3. Format: face-to-face

4. Incentivising

Goodie bags Quarterly prize draw Dare Challenges Sponsored by local suppliers

Dare in numbers

Dare in numbers

Staff survey: engagement score increased on last year, above national average for community trusts

“I have completely changed the way I work over the last 6 months and no longer drive my car to work. I catch the train and walk from the station, it’s much more enjoyable than driving –no parking issues and I get all of the health benefits. If I need a car I use a fleet car, it’s easy to arrange and always a friendly service. Without Dare to Care I probably would not have done this, so thank you!“

Andrea Richardson, Occupational Health

“I wanted to let you know how much I have benefitted from the Care Without Carbon campaign. I used to jump into my car to go from Burgess Hill to Haywards Heath for two of my evening activities. Since daring to make 1 less car journey I take the train to Haywards Heath for both these activities. This involves walking to the train station (and back). The train journey costs about the same as using the car. I now also usually walk to my local Pilates class instead of taking the car. As well as saving carbon I have noticed a marked improvement in my sleep as I am now taking more exercise. “

Claire Bird, Speech & Language Therapist

Where next?

NHS Sustainability Day! Measurement and reporting – CWC, Dare and wellbeing Supporting other Trusts with their own sustainability journeys Extending the reach (and impact) of the Dare campaign –

collective action across the NHS with bespoke campaigns for individual Trusts

Susie [email protected]

Rick [email protected]

Bristol Improving Environmental and Social Sustainability

Sam Willitts

Energy and Sustainability Manager

“Green Impact has given some structure to the Green Champion role. Instead of just receiving a newsletter and having a green lanyard, now I have a clear role and can see the effect I’m having.”

“Being involved in Green Impact has given a new aspect to my role – I’m learning things and developing professionally. I’m definitely classing this as CPD.”

“It’s given me some legitimacy – people don’t just think of me as the office nag any more, they can see a reason why I’m doing it.”

“It’s great to see the Trust supporting this centrally. It’s not just about the few enthusiastic people now”“There is definitively momentum building with the green agenda in the Trust.”

0

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BHI Electricity KWh

BHI

Rolling 3 yr Average

Bristol Method• Effective engagement with staff, patients and

public

• System-wide (and beyond) approach to sustainability

• Impact -delivering environmental, financial and social benefits

• Best practice from others combined it in our own way and spreading it more widely

Evidence-based sustainability in healthcare

curriculaProfessor Janet Richardson

Plymouth University

Year 1

Induction

Year 2

Skills

Year 3

Leadership

Skills, waste,

reflective practice

Health inequalities,

global health, public

health, prevention,

disease management

Management,

public health, skills,

reflective practice

Year 1 Induction

(Case Study)

Nursing Sustainability by Design http://youtu.be/zIFT2Dbg08o

http://youtu.be/zIFT2Dbg08o

It is Summer in Cornwall and a 7

year old boy is admitted to the

ward with acute diarrhoea,

abdominal pain and fever.

Chris Large

Partner at Global Action Plan

Changing Lives inEast London

• Largest NHS Trust in the country

• Serves 2.5M people

We help people to limit

environmental damage

Schools Businesses Communities

SUCCESSES - Cost and Carbon Savings

• Increased natural light in mental health patient rooms

resulted in 3.7 day shorter hospital stay on average (AHRQ, 2005)

• Cervical and lumar spinal surgeries patients who received

more natural light saw a 22% decrease in painkilling

medicine use (Joseph, 2006)

Behaviour change in action

Increasing natural light exposure

Reduction in artificial light

• Darkening hospital rooms at night – reduced sleep

disturbances by 38% (Bartick et al,. 2009)

SUCCESSES

Better patient experience and staff fulfilment

Design of a behaviour change programme

What can staff do to save energy?

How often do staff do those actions already?

What is the value of doing those actions more often?

What stops people acting and how can we help uptake?

How did people

save energy?

Natural Light

QUIET

TIME

NIGHT

MODE

HIGH

ENERGY

AREAS

BUILDING

AWARENESS

How did people save energy?

What encouraged and enabled people to act?

PATIENTS

PEOPLE

PLANET POCKET

Patient – Staff – Estate

Triangle

What encouraged and enabled people to act?

How did we measure the impact and savings?

PATIENT

SURVEY

METER

DATA

LIGHT

METERS

SPOT

CHECKS

From energy saving to better relationships

Help is at hand to run your own Operation TLC

Scope

• Quantify energy waste

• Create business case

• Engage clinical leaders

Change

• Face to face engagement

• Personalised comms materials

• Coaching for champions and project leaders

Measure

• Improvements in staff taking energy action

• Cost and carbon savings

• Patient experience benefits

• Staff benefits

Chris Large

Partner at Global Action Plan

[email protected]

@chrislarge1

Concluding comments



#Dayforaction

NHS Sustainability Day 2016 Exeter Road Show

Health & Medicine

Transcript of NHS Sustainability Day 2016 Exeter Road Show