bringing cost into the carbon model for dentistry a ... · taking a bite out of scotland's...
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21/06/2013 Brett Duane Specialty Registrar Dental Public health
• Scottish Managed Sustainable Health Network Dr Adam Pollard Honorary Research Fellow European Centre for the Environment and Human Health
Brett Duane Specialty Registrar Dental Public Health South East and Tayside Dental Public Health Network
Bringing Cost into the Carbon Model
for dentistry A Scottish perspective
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Introduction
• Climate change
• Scottish carbon emission targets
• NHS carbon accounting targets
21/06/2013 Brett Duane Specialty Registrar Dental Public health
SMaSH
Aims and objectives:
To develop a carbon calculator for all dental services
To pilot the carbon calculator in a healthboard
21/06/2013 Brett Duane Specialty Registrar Dental Public health
NHS Fife Dentistry Carbon footprint
1. Travel: Information on 100,000 patient postcodes
2. Energy: Building energy on new and old buildings
3. Procurement: converted from spend
21/06/2013 Brett Duane Specialty Registrar Dental Public health
NHS Fife Dentistry: Main findings
• The carbon footprint for the service was 1798.9 tonnes CO2eq per annum.
• Travel was the greatest source (45.1%) followed by procurement (35.9%) and building energy (18.3%).
21/06/2013 Brett Duane Specialty Registrar Dental Public health
NHS Fife: Surprise findings
• New buildings have higher energy consumption than their historic predecessors
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Duane B, Hyland J, Rowan JS, Archibald B. Public Health. 2012 Sep;126(9):770-7. doi: 10.1016/j.puhe.2012.05.032. Epub 2012 Aug 15.
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Conceptualising the Carbon Footprint of a Healthcare Provider
Pollard et al (2013) – Case Study, Cornwall
21/06/2013 Brett Duane Specialty Registrar Dental Public health
• Mainstreaming carbon management in healthcare systems: a bottom-up modeling approach.
• Pollard AS, Taylor TJ, Fleming LE, Stahl-Timmins W, Depledge MH, Osborne NJ.
• Environ Sci Technol. 2013 Jan 15;47(2):678-86. doi: 10.1021/es303776g. Epub 2013 Jan 3.
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Building on the Carbon Modelling
Pollard et al (2013) – Case Study, Cornwall
The conceptual model outputs costs as well as emissions….
21/06/2013 Brett Duane Specialty Registrar Dental Public health
21/06/2013 Brett Duane Specialty Registrar Dental Public health
21/06/2013 Brett Duane Specialty Registrar Dental Public health
21/06/2013 Brett Duane Specialty Registrar Dental Public health
The Cornish Pilot
Scenario Outpatients and Diagnostics Theatres and Beds
Scenario 0: Business as usual Current sites on which
outpatients are seen (13
sites)
Current sites on which all
patient types are treated (five
sites)
Scenario 1a: Expand
inpatient coverage in east
Current sites on which
outpatients are seen (13
sites)
Five sites – replace a westerly
site with one towards east
Scenario 1b: Rationalise
outpatients and diagnostics
Nine sites - including
geographical reconfiguration
towards east and closure of
smaller sites
Current sites on which all
patient types are treated (five
sites)
Scenario 2: Reduction in hot
water temperature No change
Reduction in hot water
temperature of 5 ºC in wards
Scenario 3: Improved theatre
efficiency No change
Optimal use of theatres to
reduce waste
Table 2 A description of the scenarios for which the carbon footprint of delivering
secondary healthcare by RCHT is calculated - taken from Pollard et al. (2013)
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Scenarios 0 – business as usual Scenario 1a – catchment expansion for inpatients Scenario 1b – site rationalisation for outpatients Scenario 2 – Reduction in hot water temperature Scenario 3 – Increase theatre efficiency
Mainstreaming Carbon Management in Healthcare Systems: A Bottom-up Modelling Approach – Pollard et al (2013)
21/06/2013 Brett Duane Specialty Registrar Dental Public health
In the Fife study what are we modelling?
• Patient travel – Current vs optimised
• Equipment and resources – Treatment time – Dental, rating (kW) and duration of use – Sterilising equipment, rating, capacity and frequency
• Heating and Lighting • Staff
– Rules of deployment, headcount and salaries
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Patient travel
• Patient postcodes (100,000)
• Clinic postcodes (22)
• Mode of travel (98% private travel)
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Equipment use Appointment Type Examination Fillings Scale
and
Polish
Root Canal
Treatment
Duration (mins) 15 60 19.8 45
Machine Used and Rating Duration of use of equipment per appointment type
(mins)
Dental light (52 W) 15 60 19.8 45
Curing light (3600 W) 0 4 0 0
Amalgamator (70 W) 0 0.5 0 0
Suction (950 W) 0 30 19.8 11.25
Xray (100 W) 0 0 0 0.004
Machines operated by compressor
(850 W)
0 0 19.8 5
Total power consumed (kWh) 0.0130 0.7676 0.6112 0.2880
Rate of power consumption
(kWh per min)
0.0009 0.0128 0.0309 0.0064
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Staff deployment
• Dental surgeons
• Dental nurses
• Reception staff
• Cleaners
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Operating Capacity Kirkcaldy Oakley Cowdenbeath Glenwood Leslie Dovecot Baseline
22 sites
Working days per year 210 210 210 210 210 210
Lists per day 8 1 6 1 3 1
Hours per List 6.75 6.75 6.75 6.75 6.75 6.75
Hours per year 11340 1417.5 8505 1417.5 4252.5 1417.5
Theatres per site 8 1 6 1 3 1
Lists per site 8 1 6 1 3 1
Hours per day 6.75 6.75 6.75 6.75 6.75 6.75
Baseline Capacity (mins) 680400 85050 510300 85050 255150 85050 5,017,950
Capacity Utilisation Rate 35.93% 82.03% 52.23% 73.29% 55.81% 54.36% 49.79%
Lighting (assuming 200W per theatre) 2352 368 1785 368 935 368 18,575
Theatre instruments (variable, kWh) 2354 672 2566 600 1371 445 24,463
Cleaning (stepped, kWh) 8960 2582 9772 2318 5247 1742 93,778
Autoclave (stepped, kWh) 4381 1260 4775 1132 2566 848 45,770
Total 18047 4881 18899 4418 10119 3403 182,584
(86 T CO2)
Total payable £2,707 £732 £2,835 £663 £1,518 £510 £27,388
Patient travel (km) 196,334 11,247 72,872 12,641 62,394 11,270 1,544,682
(317 T CO2)
HR cost (£) 670,534 81,053 498,181 81,053 249,091 81,053 £4,925,029
What is happening currently?
21/06/2013 Brett Duane Specialty Registrar Dental Public health
RATIONALISATION
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Assumptions:
• Actual capacity
• Uniform rates of consumption
• As the crow flies travel
• Private travel
• Staff travel
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Outcome
• Developed a carbon calculator
• Not only saves carbon
• But reduces cost
• And patient travel, providing care closer to home
• Triple win
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Conclusions:
• Appropriate use of bottom-up models can provide significant inputs to carbon decision making.
• The Pollard model estimates the carbon footprint of service delivery and quantifies its change as services are geographically reconfigured.
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Next steps - Nationally
• Working with Health Facilities Scotland
• Test the Pollard Model within the SMaSH project “developing a sustainable model of care for older people”
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Next steps- NHS Lothian
• Pilot of the Pollard model to: 1. Improve the efficiency of NHS Lothian translating services specifically: • Reduce transport costs through appropriate modeling of interviewer base
postcode and patient postcode • Reduce travel time as above 2. Investigate the appropriateness of the current provision of dental clinics within NHS Lothian specifically: • Mapping the current clinics to ensure patients are provided appropriate
care, as close to home as possible, at the most efficient cost for Lothian
21/06/2013 Brett Duane Specialty Registrar Dental Public health
Next steps - Development
Obtain funding to….
• Migrate the Model to a web-based server
• Develop an automated data feed, e.g. using HES for secondary healthcare
• Ready it for use across the NHS
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