Building a sustainable and healthy NHS

1
Building a sustainable and healthy NHS?

• Karen Jochelson
• Kings Fund

2
Government policy on sustainable development

• a better quality of life for everyone, now and
  for generations to come
• Policies
• greening government estate
• regeneration to build local economies and tackle
  poverty
• minimise waste, promote recycling and reuse
• reduce car usage through planning and public
  transport
• reduce CO2 emissions by 20 by 2010

3
NHS strategy on sustainable development

• address inequalities and regeneration through
  investment in staff and capital, the purchase of
  services, and the development and regeneration of
  local economies.
• transport strategy to change travel habits and
  meet health targets
• reduce primary energy consumption by 15 or 1.5m
  tonnes of carbon by March 2010
• estates performance management

4
NHS owns land 64 Hyde Parks
6 1/2 Hyde Parks in London
5
NHS floor space 140 Canary Wharfs
27 Canary Wharfs in London
6

• 600,000 tonnes of waste pa
• 100,000 elephants

70 elephants a week in London
7
NHS carbon emissions 7.5 million tonnes of CO2 pa
8
Cars for 3/4 of hospital visits 1/2 of GP and
pharmacy visits
9
11 billion - goods services2 billion in
London
401 m towels
4 m gloves
13.5 m kg
1.3 m chicken legs
12.3 m loaves
61 m litres
1.1 m kg butter
10
Regional role

• Major employer
• Economic impact
• Wages
• Other industries
• Procurement
• Development and planning

11
Sustainable development good health
NHS Resources
Influences
Local economic, social and environmental
conditions
Level of demand for health services
Health of local population
Health of local population
Levels of demand for health services
NHS capacity to provide quality services
12
Procurement - EU Rules

• Fair and open competition
• Propriety and regularity
• Value for money
• Procurement can support local economies and
  environmental policies if worded correctly

13
Green Procurement

• Few trusts use environmental criteria
• Lewisham Hospital - 18 kg of mercury in
  thermometers and sphygs. 18 months to replace
  with non-mercury equivalents
• PASA - contracts for recycling prosthetic limbs,
  wheelchairs, hearing aids, some hazardous waste
• minimise resource use, waste and get price savings

14
Local Food

• Cornwall hope to produce ready-made and special
  meals using local produce and local labour for
  all Cornwall trusts from brownfield site
• Powys - Local sourcing of fruit, vegetables,
  bread and local meat
• Benefits
• Price?
• Seasonal menus
• Less food waste on ward and from overstocking
• Nutritional benefits for patients eg ice-cream
• Good supplier relationships flexible, faster
  delivery, cauliflower and goats cheese in
  Cornwall
• New jobs, new businesses and local investment

15
Sustainable buildings

• 8 billion in London NHS by 2016
• do more with less
• land use, building design, materials, waste,
  water use, energy efficiency
• green travel
• whole life costing
• good design promotes productivity and patient
  recovery

16
Princess Margaret Hospital

• greenfield site
• energy efficiency
• lower whole-life running costs for building
• 20-40 less CO2
• waste reduction in construction
• reduced landfill tax, transport costs, ecological
  impact of construction, manufacturing costs of
  suppliers
• car sharing

17
Trust attitudes

• Socially responsible corporate citizen?
• Focus on clinical and financial targets
• Boards unconvinced of benefits of environmental
  or social agenda
• Weak recognition of links between environmental
  impact and health
• Focus on short term

18
Regional issues

• Influence of health issues in regional assembly
  and development agencies
• Recognising the social and environmental impact
  of public sector services
• Changing practice to meet public sector principles

19
Next steps

• Policy, strategy, action!
• Recognise costs of business as usual
• Shift from piecemeal gestures to systemic change
• Sustainability corporate agenda
• Performance management targets at regional and
  Trust level.