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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?
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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
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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.
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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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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
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• 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
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Livestock farming accounts for > 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!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?
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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
• 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
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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 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 -
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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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• 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
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• 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
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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?
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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
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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