SUSTAINABLE ACTION PLANNING

A programme of Knowledge into Action | Registered charity No. 1123566. Summertown Pavilion, Middle Way, Oxford OX2 7LG

Workshop 1: Where to Start

[Team name & date]

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“We’ll 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

NHS sustainable developmentWhy should the NHS take action?

2

Before the programme

You should have received this information:• Introduction to Sustainable Action Planning (SAP)

o Why, what, how, who• Pre-questionnaire

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Workshop One

GoalTeam agreement on 1-2 issues to tackle first

Agenda1. 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 world’s natural resources

• Green spaces are important to physical and mental health

Climate change

• One of the biggest threats to a healthy environment today is climate change

• Warming of the world’s 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. Malnutrition2. 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.

…but climate change also brings much greater health risks from

• Drought

• Crop failure

• Economic collapse

• Mass migration

• Civil unrest

• Societal collapse

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)

Health impacts are worse for the poorest in the world

• Mitigation: “avoiding the unmanageable” = tackling the causes of climate change

• Adaptation: “managing the unavoidable” = preparing for change

we need to understand the causes for this…

Protecting health from climate change

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240,000,000 home PCs650,000,000 cars4,800,000,000 passenger flights

4,000,000,000 bulbs pa EU+USA alone (that’s 126

a second)

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

First Oil Well

4142 cars, 10 miles concrete road in US

First commercial jet ticketDomestic

light bulb

Livestock farming accounts for > 18% global emissions

Mitigation: tackling the causes of climate change...(2)

Health “co-benefits” of mitigation

• Many actions to reduce greenhouse gas emissions which cause climate change are good for health!o Active travelo Eating less meat and dairyo Clean energyo Family planning

Leading doctors worldwide have called for governments to act decisively on climate

change“Politicians must heed health effects of climate

change.” BMJ 2009;339:b3672

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NHS Sustainable DevelopmentPart 2a

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What is sustainable development?

Social

Environmental Economic

Development that meets the needs of the present without compromising the ability of future generations

to meet their own needs.

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Environmental

Sustainable developmentmeeting environmental needs

• Climate change / carbon

• Resource depletiono Watero Fossil fuels

(plastic etc)• Biodiversity

Social

Economic

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• Andy Williamson, Chair – GSTT Kidney Patients’ Association: “As a kidney patient, I’m 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?

NHS sustainable developmentWhy should the NHS take action?

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“We’ll 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

NHS sustainable developmentWhy should the NHS take action?

21

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”

www.sdu.nhs.uk

NHS sustainable development

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

What should NHS Trusts be doing?

NHS Carbon Reduction Strategy

What can’t be done at Trust level?

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NHS sustainable development

• Clinical practice o prevention, supporting patient self careo preparation for health effects of climate change

• Local systems o energy, travel, water, wasteo medical supplies (drugs & equipment)o non-medical supplies (e.g. food, laundry, paper)o improvements in the way we do things

What can specialties and clinical teams do?

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

What could our team do?

Local systems Opportunities?

Energy

Travel (staff, patients)

Medical supplies

Non-medical supplies

Water

Waste

A different way of seeing things

Actions taken by clinical teamsPart 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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• Switch off campaign to reduce unnecessary lighting

Action: energy

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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 -

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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• 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

Action: medical supplies

• 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!

Action: food

Your prioritiesPart 3

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Which of these matter to you?

staff commuting

heating

foodlaundry

equipment

patient transport

visitor travel

number of appointments

paper

lightingair conditioning

dialysis products

recyclingwaste

segregation

preventative care

water

building design medicines

green spaces

climate risk

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What are you most concerned about personally?

What are the other priorities for the team?

What are your team’s biggest environmental impacts likely to be?

What can you influence?

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Where are you today?

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

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GoalsA sustainable action plan!Plan for ongoing improvement

Agenda1. Exploring your chosen areas:

• Describing how the process works today• Brainstorming problems and ideas

2. Actions3. Ongoing improvement

• Managing implementation and monitoring