Sustainability in the health sector across countries and cultures

1. Sustainability in the health sector across countries and cultures Sophie Clyne Melbourne, February 2011

2. My background and drivers... Team Manager Staff Team of 52 Population 300,000 Greater Peterborough Multi- disciplinary Team 24 Hour Service 0-18 years Multi-agency/Partnership Approach Holistic basis

3. My week in Victoria...

4. Impressive points from visit.. • Health Purchasing Victoria- new post, challenge of working with international companies, level of control • North Yarra Community Services- health promotion (food market, cycle fleet with SV ), findings on leadership, paper- uses recycled; policy linked (reduced paper use 17% in 6 mths), environmental group with budget,reward and recognition (chocolate, display board) • Peninsula Health- new waste contract; able to specify measures wanted, waste education e learning, example of recycling batteries, would like sustainable component of budget identified. • Koo Wee Rup; community health service; self contained and sustainable environment, garden, mens shed, water tanks, personal involvement and engagement, commitment and clear leadership. Applicability? • Sustainability Victoria- sustainable practice going on under different ‘hat’, lack of leadership in organisations noted • Western Hospital –PVC, reusable trays, grass roots led, sustainability officer recruited through risk management • Eye and Ear Hospital; ResourceSmart going for 18 mths, good relationship with flexible recycler, 40% all paper recycled, ipads for exec’s • Dept Health; Climate; Health Impact Assessment Tool for mapping projected needs and predictions. Hugely evidence based; useful for planning departments; picked up; implications? • Commissioner for Environmental Sustainability; position to be able to showcase best practice. Voice that guarantees a response, interesting to think about how info published could be used. • Environmental Sustainability Team- skill mix, dedication, expert resource, drivers for others

5. What’s happening in the nhs? • The NHS England carbon footprint is 21 million tonnes of CO2 equivalent (CO2e) • This is a rise of 3 million tonnes since the footprint was first calculated.  The rise is due to an increase in the growth in NHS services but also because we now measure six greenhouse gases rather than just one. • The first NHS England carbon footprint was published in 2009 and was 18 million tonnes.  The ground breaking research commissioned by the NHS Sustainable Development Unit and the Sustainable Development Commission enabled the full consumption-based footprint to be calculated for the NHS in England for the first time.  It formed the evidence base for the NHS Carbon Reduction Strategy(2009). • The footprint (in a basic form) is composed of building energy (24%), travel (17%) and procurement (59%).

6. What do the Sustainable Development Unit (SDU) do? • The SDU are a source of leadership, expertise and guidance concerning sustainable development to all NHS organisations in England. • They raise awareness of the actions and responsibilities that the NHS has regarding sustainable development and climate change. This includes promoting a culture of measurement and management which leads to a process of carbon governance. • They help shape NHS policy, locally, nationally and internationally.  This makes sustainable development and dealing with climate change both necessary and possible for every NHS organisation. • They ensure the very best practice and innovations on sustainability in the NHS and elsewhere are evaluated and costed and the mechanisms for implementation are made fully available to all NHS organisations. • They work in partnership with the NHS, government, industry and the third sector to achieve the above

7. SDU Carbon Reduction Strategy • 5 Key Actions for each of the following: 1) Energy and Carbon Management 2) Procurement and Food 3) Low Carbon Travel, Transport and Access 4) Water 5) Waste 6) Designing the built environment 7) Organisational and workforce development 8) Role of partnerships and networks 9) Governance 10) Finance 11) Looking Ahead

8. LEADERSHIP: Carbon Reduction Strategy release in 2009; promising? • Leadership behaviour and what will make this work? • Study using NHS Management Trainees

9. Summary of Perceived Benefits • Board support and prioritisation will lead staff by example. • Inclusion of finance directors will maintain the cost effectiveness and awareness of sustainable changes. • Specific posts will drive the changes and not take time away from positions already in role. • More partnership working will encourage best practice and joined up thinking. • Beneficial to use IT solutions to further reduce costs and waste. • Good to raise public profile and awareness of sustainable practice. • Changes to JD’s are fairly easy, yet make an organisational statement. • More working from home and remote communications will reduce travel and increase convenience for employees • Inclusion in commissioning will ensure durability of new initiatives. • Those qualified with a Green Degree will enthuse and motivate others • Working with unions will encourage buy in and engagement from staff. Trainee Views on Sustainability Sophie Clyne, NHS General Management Trainee, April 2009

10. Summary of Perceived Restrictions • Prioritisation • Lack of incentives • Ingraining recommendations into foundations of Trust’s • Lack of support and information shared • Would appeal to particular target group but not all • Huge culture shift • Possibility of ‘tokenistic’ efforts • Lack of expertise in this area • Taking resources from clinical need • Time consuming to manage Trainee Views on Sustainability Sophie Clyne, NHS General Management Trainee, April 2009

11. Evaluation of Review • Although the representation of the trainees was only around 15% of the years cohort, the group was a good representation of the specialism's, regions and genders of the scheme. • It was interesting to note that there was no difference in awareness of the SDU which is based in the East of England for those trainees who are East of England trainees compared to the other regions • To obtain more responses in the future, I would send the questionnaire out again and follow up with phone call interviews. • One of the biggest barriers to sustainability within the NHS appears to be lack of understanding and information. • Leadership and ownership also appear to be key; I would recommend efforts to be focused on helping leaders understand sustainability implications, and then providing them with the required support. Trainee Views on Sustainability Sophie Clyne, NHS General Management Trainee, April 2009

12. SDU recommendations for leadership actions 1. Build capacity in carbon management so that the lead can come from Chief Executive and Board level. The SDU is considering developing a Sustainable Board Programme specifically for Trust Boards. 2. Train Directors of Finance so that they are up to speed with forthcoming shadow carbon pricing and the requirements of the Carbon Reduction Commitment (CRC). 3. Invest in high quality technical capacity in order to support executive decisions on carbon management. All trusts could create permanent posts for Energy and Sustainable Procurement Managers. 4. Learn to work in partnership with universities, local authorities, charities and local business through Local Strategic Partnership arrangements as well as at regional level through Economic Forums and Spatial Planning Frameworks in order to play its part in developing a sustainable and resilient health economy. 5. Follow DEFRA’s lead (RenewIT scheme) and move to providing staff with 100 per cent low carbon highly efficient laptops and challenge suppliers of Information Technology to develop low carbon IT contracts using the latest Sustainable Information Technology 6. Learn to report progress on carbon reduction to local citizens, patients and staff on an annual basis. Communication with both staff and public is essential for buy-in to the organisations corporate objectives and making change happen. 7. Train Human Resources personnel to ensure that carbon reduction and sustainability is included as a competence on job descriptions for Chief Executives and Director level posts in all Trusts and that all new staff who come in to the service will receive induction training on carbon awareness and their individual responsibility. Carbon reduction and sustainability should also be a criterion for appointment of Non-executive posts in all Trusts as well as appearing in the terms of reference for all board and senior level meetings. 8. Invest in and learn how to use video and teleconferencing technology which avoids staff having to travel to meetings in an effort to support a cultural shift in the organisation away from heavy use of cars to travel between meetings. This should be part of wider travel planning, enabling and encouraging sustainable access and active travel, for all staff. 9. Train Commissioning staff to demonstrate skills for managing carbon in the commissioning process and that these should feature in the suite of Commissioning competencies that already apply. 10. Train staff to specify local goods and services in procurement or provider contracts and support this with standard phrases in commissioning plans. 11. Encourage staff to take part in a voluntary ‘Green Degree’ scheme open to all staff which would improve their knowledge and understanding of how to apply carbon and environmental awareness to day to day practical activities within the NHS 12. Work closely with Staff and Unions to develop a process of improving staff knowledge and education on carbon and sustainability which is fair and inclusive of all staff

13. Leadership in action... • 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; Chief Executive NHS

14. What’s been helpful... • Raising Awareness; tool for facilitating team discussions regarding carbon reduction; encourages debate, discussion; very user friendly • Good Corporate Citizenship Assessment Model • Board Approved Sustainable Development Action Plan • Travel Plans; ideas and recommendations. Problems with... • Actions outlined under each area for Trust’s to follow • Team and Organisational Extranets and Newsletter; example of team newsletter and reporting measures

15. Key points from study trip • Lots of ‘sustainable’ practice is going on under different guises or hats; Health Promotion, Risk Control etc. • Currently in Victoria, seems sustainable practice is reliant on key individuals and their dedication not top down or objective/target driven • Some exciting times with new appointments; Health Purchasing Victoria and Western Hospital • Lots of barriers; health and safety reg’s (bottle tops, eye and ear; innovation and determinate needed!) • Increasing use of technology; space saving equipment in eye and ear, ipads in boardroom. UK and use of technology (pharmacy robots, portable laptops). • Gap in market for local recycling companies; many can be inflexible or ship out to China • Alexandra Hospital Study; implications of this are very exciting!

16. Blue sky thinking • Expert Consultancy Service offering environmental evaluations and planning; specific role and tool. Results in agreed action plan. Financed by central body OR independent organisation that agrees payment plan according to changes agreed and made. • Procurement role? Providing official sustainability ratings on companies that can be trusted by Services; stringent measures which include life expectancy, recyclability, packaging, biodegradability etc.

17. Staff Culture and Environmental Factors • Triggered from conversation at Western... What makes individuals go the extra mile/adopt sustainable practice? Staff Group/Profession? Approach of nurses, anaesthetists, orthopaedics and managers...elements of profession chosen that are more conducive to behaviours needed for sustainability? How can this be used to appeal and approach staff groups to result in higher success? Environment? Certain environments adapted to sustainable practice? ICU/operating theatre compared to wards. Recommended ‘start up’ areas More to follow...

18. What needs to happen? • Education; what is climate change? Making it real • Role of values- NHS very ‘value’ driven. Health essentially a ‘caring’ profession. Use this to engage; doing the ‘right’ thing. Implications of a dual health system and disparities. • Different ways of working; use of theatres and areas, sharing resources and equipment across sites • Expectations; temperature maintenance across hospitals? use evidence base • Approach; clear direction and using disciplinary action when appropriate.

19. Making it work • Leadership- has to be top down and bottom up; combination of clear executive commitment and grass roots movement and empowerment to make changes • Providing the tools and knowledge, education on what is climate change and how it affects our industry and us individually • Living by values is only way for ‘sustainable’ change in practice; no double standards • Organisation needs to prioritise- commit to training employees and creating an environment where this can work • Have some weight behind you; The Climate Change Act (UK Government 2008) legally requires the NHS to reduce carbon emissions by 80% (on 1990 levels) by 2050. • Give answers and solutions, alternatives; outline clear actions that will have an effect (if possible in monetary terms or making meaningful on individual level). Be specific • Make it visual and present; signage, topical talks, include in newsletters, staff meeting agendas, feedback. • The right organisations on the right page- NHS strategy had various groups and research behind it. Use one another! • ‘Core Business’ argument and approach

20. Useful sites/contacts • www.sdu.nhs.uk; use search tool for specific info (some resource examples in hard copy) • www.corporatecitizen.nhs.uk; tools • www.addenbrookes.nhs.uk; good travel plan • www.institute.nhs.uk ; case studies and awards Sophie.clyne@nhs.net www.worldhealthtour.weebly.com Thank You!!