Climate Change and the NHS

• Why and how the NHS can and should be a leading sustainable and low carbon public sector organisation from now to 2050.

• Role of nurses, doctors and other clinical staff

Dr Jammi Rao, FRCP FFPHDeputy Regional Director of Public Health, Department of Health, West Midlands, Government Office, Birmingham

UHCW Grand Round, 22 Sept 2009

• Background to sustainable development and climate change

• Why the NHS should be concerned

• The NHS Carbon Reduction Strategy

• What clinicians can and should do

• The role of clinical practice developments

Outline of this brief seminar

What is Sustainable Development?

“Meeting our needs today…….without compromising the ability to meet needs of others - today and tomorrow”

Sustainable Development?

Principles of sustainable developmentS

ecuring the Future – U

K G

overnment – 2005

Energy and carbon - the problem

Global addiction: very cheap, very useful and very dangerous

350 million years-worth of carbon locked away in fossil fuels suddenly released….

150 years

First Oil Well

100 years

4000 cars in USA

NOW

600,000,000 cars4,000,000,000

passenger flights

50 years

First commercial

jet ticket

Source: The Met Office’s Hadley Centre for Climate Protection and Research

Observed and predicted global temperature change. 1880-1920

• The 10 warmestyears on recordhave occurredsince 1990

• Extreme weatherevents are alsobecoming morecommon

90% energy coming from fossil fuels is

unsustainable for 3 reasons.

• Its running out . Some time soon we’ll have to get our energy elsewhere

• Climate change. (Some sceptics still deny this)

• Security of supply. Do we want to depend on unstable unpredictable regimes

The time is now

At least 15,000 people died prematurely as a result of Europe’s heat wave in 2003 in France1

1. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments

Jean-François Dhainaut, Yann - Erick Claessens, Christine Ginsburg, and Bruno Riou.

Crit Care. 2004; 8(1): 1–2.

Published online 2003 December 4. doi: 10.1186/cc2404.

and Bhattacharya, S. (October 2003), ‘European heat wave caused 35,000 deaths’, The New Scientist. http://www.newscientist.com/article/dn4259

Although climate change can cause illness and death...- Heat-related deaths

- Skin cancer and cataracts

- Injuries and infectious diseases as a result of

increased flooding

- Respiratory disease

- Insect-borne disease

- Food poisoning

…there are even greater risks through civil unrest:

• Crop failure

• Water shortages

• Mass migration

• Resource wars

• Economic collapse

• Ecosystem collapse

UK CP09 Key points

• Winter Temp: +1.2 to 3.2 deg Celcius

• Summer Temp: +1.2 to 4.4 deg

• Overall precipitation: Little change

• Winter ppt: +13%

• Summer ppt: -16%

• Anticipiated problems: health, water shortages, flooding, environmental degradation

“Climate change is the biggest global health threat of the 21st century.”

Worth a read…

Why should the NHS act/lead?

1. The law: 80% reductions on 1990 baseline by 2050.2. Scientific evidence - IPCC3. Opportunities for immediate health co-benefits for

individuals, health care systems, and internationally.• Physical activity and obesity / CHD / diabetes / Air pollution / Transport

trauma / Mental health / fuel poverty / improving diet• Self empowered chronic disease care closer to home with ICT

4. Potentially big savings (cost, tax, reputation…) and need for energy resilience and robustness

• flu, yes, but also floods, fuel, heatwaves

5. Willingness and commitment of NHS organisations6. Special responsibility and opportunity to lead by visible

example

Three levels of health co-benefits1. Traditional person focussed benefit

– Physical activity, mental health, trauma, air pollution, food and agriculture…

2. Benefits for health care system– Congruent with policy direction for many health care

systems: care closer to home, empowered, self care, chronic disease management

3. Benefits for international (health) inequity– Cost effective leap frogging from pre-industrial, pre-

carbon to post carbon, missing out high carbon step in the middle

– Contraction and convergence– Concentrated solar power from warmer poorer

countries

Saving Carbon, Improving Health: NHS Carbon Reduction StrategyLaunched February 2009- CEO NHS- Permanent Secretary DH- RCP- Academy of Med RC- BMA- Carbon Trust- Environment Agency- FPH- HPA- Monitor- RCM- RCN- Sustainable Development Commission- UNISON

Figure 1a - 2004 NHS England Carbon/CO2 Emissions Primary Sector Breakdown

18%

22%59%

Travel

Building energy use

Procurement

Carbon Footprint in NHS Englandc. 20 million tonnes carbon dioxide eq p.a.

Travel: patients, staff, visitors = 18%

Energy: heating, lighting, hot water, ventilation, cooling = 22%

Procurement: supply chain activities of companies producing goods and services = 60%

NHS Carbon Reduction Strategy Percentage response rate by region

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

E MIDLANDS EOE LONDON N EAST N WEST S CENTRAL SE COAST SWEST W MIDLANDS Y&H

SHA

Per

cen

tag

e re

spo

nd

ed

National launch

“…it’s a very important strategy for the NHS: it is really good for the environment, it's good for our society, it's good for our staff and for us most importantly it's good for our patients”

David Nicholson, CEO NHS England 27th January 2009

“We need set structures and responsibilities and accountabilities in the system to make it a reality.

Every Chief Executive in the system needs to have a responsibility to deliver a more sustainable service and reduce carbon. Individual boards need to take responsibility for this - to look at the totality of the services that they provide in the context of this strategy and the way they provide them.” DN Jan 2009

NHS England CO2 baseline to 2020 with Climate Change targets

10% target from 2007

26% target from 1990 baseline

64% target from 1990 baseline

80% target from 1990 baseline

0.00

5.00

10.00

15.00

20.00

25.00

1990 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Year

Mt C

O2

NHS England

NHS England forecast

2007 baseline

Carbon Reduction Strategy Target

10% target from 2007

1990 baseline

Climate Change Act Target

26% target from 1990 baseline

64% target from 1990 baseline

80% target from 1990 baseline

Reference: Carbon Reduction Strategy for England, NHS SDU, Jan 2009

www.sdu.nhs.uk

Special opportunities for Chairs and NEDs• Good governance, clear accountability and

responsiveness to those we serve

• Ask questions about understanding, measurement, management, and reduction of environmental impact of NHS

• Carbon and literacy, numeracy, and action at board level

• Objective setting with CEO and cascade

NHS Regional level reporting• “Every SHA Board should receive at least annually a

report about progress in meeting the requirements of this strategy in their region” (p.63).

• Building energy: collate the same nationally available trust level ERIC datasets and methodology as used for the national NHS Carbon Footprinting report

• Travel: assemble Trust level data where collated (patient transport services, fleet mileage and business mileage, travel surveys)

• Procurement: developing datasets from Regional Procurement Hubs

NHS WM Regional level actions• Regional Steering Group set up – comprises Board

level leads, chaired by Malcolm Stamp, CE of UHCW.

• Regional CRSD Network in operation for 2 years, brings together estates, energy managers– Building energy workstream: develop and encourage

sound metrics

• Travel: SHA/PHO will develop methods to estimate health care related travel by patients and consequent CO2 emissions.

NHS – Role of Chairs / NEDs• Awareness: NHS Carbon Reduction Strategy• NHS Good Corporate Citizenship Toolkit• Appointments processes – workforce development• Objectives in senior posts• Risk register• Shadow carbon pricing for the NHS• Resilience/Business Continuity• Local economic investment• “SHAs will have in place mechanisms to ensure that

NHS Trusts have a Sustainable Development management plan ….”

• The Sustainable Board – development module• Launch West Midlands: 30th April 2009

• 15 GJ/100m3/year• There was no cost premium for the sustainable design.• Carbon dioxide emissions are only 31 tonnes/year, so

climate change levy payments will be low• Patient and staff experience highly favourable

NHS Good Corporate Citizenship Assessment Model

10 corporate actions now:1. Chair: NHS Good Corporate Citizen sign up – CEO objective2. CEOs: SD / CSR / Good corporate citizenship / carbon

governance3. All senior executives: sustainability objectives / reporting

mechanisms4. Corporate Climate change > a specific section on risk register5. Finance: CRC, shadow carbon pricing, carbon standard, co-

invest, clear risk management: e.g. single use vs. sterilise6. Performance: CQC, Operating Framework, carbon governance7. Estates/facilities: Energy measuring across all departments as

possible: smart metering, access / travel planning – sustainable access, Liftshare, incentivising low carbon and active travel options

8. Commissioning and Procurement criteria and standards9. Workforce. Board development > staff development / T&C10. Comms: Staff and public buy-in, corporate objectives

and image, website

10 things NHS Trusts should do:1. Develop SD Management Plan2. GCC guide and assessment – www.sd-

commission.gov.uk3. Sustainable Transport and travel plan4. Carbon Trust’s NHS carbon Management

Programme5. Consider Options for on site renewable energy6. Energy Audit .. Incl DEC7. Procurement Audit.. 8. Conduct a Waste Audit9. Report to Board on CRC and its implications10.Staff education and training programme

Quick examples and ideas• Smart metering• Travel and access policy• Commissioning / procurement / contracts• Energy efficiency of buildings• Telephone follow up as substitutes for clinics• Video and tele-conferencing

– Does your next meeting have to be this carbon intensive?

• Cut down waste, procure less, save money

Measuring, monitoring, displaying

Better access, not more cars:

- Car pooling

- Lift sharing

- Multi-occupancy vehicle parking

e.g. www.Liftshare.com

Commissioning / procuring:Example of statements

• “Criteria relating to sustainability and low carbon operations will increasingly be used in the commissioning of services and the procuring of goods”

• “Each year/cycle we will increase the weighting given to your qualitative and quantitative commitment to a sustainable and lower carbon health service”

Sustainable clinical practice?

• Think prevention

• Patient centred

• Develops lean pathways

• Considers carbon when choosing treatment

Health service changes

• Telephone follow up of patients instead of out-patient appointments

• Replace face to face committee meetings with conference calling

• Community staff to receive home visit itinerary and travel routes direct to their home so they don’t need to come in to a central base every day

Health Service Changes

• Tight monitoring of staff mileage claims

• Multi-skilling staff to avoid same patient being visited by different professionals within short space of time.

• Reduce waste of prescribed medications

Other action

• NHS Confederation Special Interest Group

• Metrics– The importance of establishing and validating

measurement processes– Quality Observatories

• 1.3 million staff– Appointments Commission– Workforce development

Summary• Multiple benefits for health service.

– Law, science, money, health, economy, examples and future.

• Efficiency AND transformational change

• Needs to be part of core business / good governance throughout NHS organisations

• Leadership, staff empowerment, and middle management delivery: all essential

• The most serious and strategic health threat we face on our watch….