Workshop 1: Where to Start

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Workshop 1 Where to Start

• Team name date

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NHS sustainable development
Why should the NHS take action?

• Well do it better tomorrow, and better still
  the day after
• Improved patient care experience
• Nicer place to work
• Reduced carbon in everything we do and use
• Resilience

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Before the programme

• You should have received this information
• Introduction to Sustainable Action Planning (SAP)
• Why, what, how, who
• Pre-questionnaire

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Workshop One

• Goal
• Team agreement on 1-2 issues to tackle first
• Agenda
• 1. Introduction to environment and health
• Environment and health
• Climate change
• 2. NHS sustainable development
• Actions for whole Trusts
• Actions taken by other teams
• 3. Discussion priorities for your team

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Environment and healthClimate change

• Part 1

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Environment and Health

• A healthy environment is essential to health
• People need clean air and water
• Our food and all our material possessions are
  derived from the worlds natural resources
• Green spaces are important to physical and mental
  health

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Climate change

• One of the biggest threats to a healthy
  environment today is climate change
• Warming of the worlds climate system is creating
  more extreme weather floods, storms and droughts
• Health researchers have called it the biggest
  global health threat of the 21st century

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Climate change can affect health directly

1. Malnutrition
2. Deaths and injuries caused by storms and floods.
   (Flooding can also be followed by outbreaks of
   diseases, such as cholera)
3. Water scarcity / contamination (droughts and
   sudden floods) increased burden of diarrhoeal
   disease.
4. Heatwaves direct increases in morbidity and
   mortality indirect effects via increases in
   ground-level ozone, contributing to asthma
   attacks.
5. Vector-borne disease malaria and dengue.

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but climate change also brings much greater
health risks from

• Drought
• Crop failure
• Economic collapse
• Mass migration
• Civil unrest
• Societal collapse

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Health impacts are worse for the poorest in the
world
Cumulative emissions of greenhouse gases, to 2002
WHO estimates of per capita mortality from
climate change, 2000
Map projections from Patz et al, Ecohealth 2007.
WHO Comparative Risk Assessment estimated that
by 2000, climate change that had occurred since
the 1970s was causing over 150,000 additional
deaths per year (WHO, 2002, McMichael et al 2004)
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Protecting health from climate change

• Adaptation managing the unavoidable
  preparing for change

• Mitigation avoiding the unmanageable
  tackling the causes of climate change

we need to understand the causes for this
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Mitigation tackling the causes of climate change
350 million years-worth of carbon locked away in
fossil fuels now being released
150 years
100 years
50 years
NOW
240,000,000 home PCs 650,000,000
cars 4,800,000,000 passenger flights 4,000,000,000
bulbs pa EUUSA alone (thats 126 a second)
First Oil Well
4142 cars, 10 miles concrete road in US
First commercial jet ticket
Domestic light bulb
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Livestock farming accounts for gt 18 global
emissions
Mitigation tackling the causes of climate
change...(2)
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Health co-benefits of mitigation

• Many actions to reduce greenhouse gas emissions
  which cause climate change are good for health!
• Active travel
• Eating less meat and dairy
• Clean energy
• Family planning

Leading doctors worldwide have called for
governments to act decisively on climate
change Politicians must heed health effects of
climate change. BMJ 2009339b3672
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NHS Sustainable Development

• Part 2a

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What is sustainable development?
Development that meets the needs of the present
without compromising the ability of future
generations to meet their own needs.
Social
Environmental
Economic
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Sustainable developmentmeeting environmental
needs
Social

• Climate change / carbon
• Resource depletion
• Water
• Fossil fuels (plastic etc)
• Biodiversity

Environmental
Economic
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NHS sustainable development
Why should the NHS take action?

• Andy Williamson, Chair GSTT Kidney Patients
  Association
• As a kidney patient, Im acutely aware of my
  own vulnerability to climate events, and my
  dependence on drugs and dialysis equipment which
  rely on cheap oil for their availability.
• June 2009

Your answers?
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NHS sustainable development
Why should the NHS take action?

• Well do it better tomorrow, and better still
  the day after
• Improved patient care experience
• Nicer place to work
• Reduced carbon in everything we do and use
• Resilience

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Climate change / carbon the NHS England carbon
footprint
18 million tonnes CO2 in 2004
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NHS carbon footprint Procurement
things in lorries
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www.sdu.nhs.uk
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NHS sustainable development
What should NHS Trusts be doing?

• Energy carbon
• Procurement food
• Travel
• Water
• Waste
• Designing built environment

What cant be done at Trust level?
NHS Carbon Reduction Strategy
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NHS sustainable development
What can specialties and clinical teams do?

• Clinical practice
• prevention, supporting patient self care
• preparation for health effects of climate change
• Local systems
• energy, travel, water, waste
• medical supplies (drugs equipment)
• non-medical supplies (e.g. food, laundry, paper)
• improvements in the way we do things

procurement / consumption
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What could our team do?
Clinical Practice Opportunities?
Disease prevention
Supporting patient self-care
Preparing for health effects of climate change
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What could our team do?
Local systems Opportunities?
Energy
Travel (staff, patients)
Medical supplies
Non-medical supplies
Water
Waste
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A different way of seeing things
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Actions taken by clinical teams

• Part 2b

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What kind of actions can we take?Current waste
- estimated loss ()

• Reducing waste to yellow bags
• Return drugs process
• Mis-labelled path lab tests

• 250,000
• 300,000
• 100,000

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Action energy

• Switch off campaign to reduce unnecessary lighting

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Action transport

• Improve communication with ambulance service
  reduce aborted journeys
• Cost of aborted journeys

2009
June 1500
July 690
Aug 400
Sept -
Oct -
Nov -
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Action water

• Recovery of waste water from purification unit
• Capital investment 14,000
• Annual saving 7-8,000
• 38 reduction in mains water use
• Carbon reduction
• 177g/m3 water
• 322g/m3 sewerage

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Action medical supplies

• Significant reduction in packaging
• Reduced deliveries 50 (mileage)
• More concentrated solutions smaller volumes
  needed
• Reduced costs by 11,000 a year
• Changed suppliers for greener products

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Action food

• Discussion with catering staff, paper menus
• Food waste reduced from 35 to 15
• Cash saving approx. 4,000/y (2 per sandwich)
• Carbon savings from
• Growing
• Cooking, preparing, packaging
• Transport
• Waste disposal
• Happier patients!

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Your priorities

• Part 3

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Which of these matter to you?
building design
paper
medicines
visitor travel
food
dialysis products
staff commuting
laundry
patient transport
number of appointments
recycling
climate risk
waste segregation
heating
equipment
lighting
air conditioning
water
preventative care
green spaces
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Where are you today?

• What are you most concerned about personally?
• What are the other priorities for the team?
• What are your teams biggest environmental
  impacts likely to be?
• What can you influence?

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Decision

• 1 2 areas to tackle first (in Workshop 2)
• Keep a list of other areas (to tackle later)

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Next time Workshop 2

• Goals
• A sustainable action plan!
• Plan for ongoing improvement
• Agenda
• 1. Exploring your chosen areas
• Describing how the process works today
• Brainstorming problems and ideas
• 2. Actions
• 3. Ongoing improvement
• Managing implementation and monitoring