Climate Change and the NHS

1. This is about more than carbon and energy – it is about how the NHS acts as an excellent corporate citizen to: Reduce the impact on environment Reduce carbon & greenhouse emissions Improve sustainability of its operations Make positive impact to health of employees & local people Contribute to sustainable communities and stimulating the local economyThis is about more than carbon and energy – it is about how the NHS acts as an excellent corporate citizen to: Reduce the impact on environment Reduce carbon & greenhouse emissions Improve sustainability of its operations Make positive impact to health of employees & local people Contribute to sustainable communities and stimulating the local economy

2. 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

3. What is Sustainable Development?

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

5. Principles of sustainable development Bit of history: Securing the Future – UK Government – 2005 Choosing Health – 2004 DH SDAP (2006) DH High – Level SD Group (2007) NHS SDU (2008) DH SD Strategy (2008) “Just as we are seeking greater leadership in corporate social responsibility from the private sector, the NHS must play a similar role for the public sector.” Choosing Health Chapter 4. Corporate social responsibility for health in the NHS Bit of history: Securing the Future – UK Government – 2005 Choosing Health – 2004 DH SDAP (2006) DH High – Level SD Group (2007) NHS SDU (2008) DH SD Strategy (2008) “Just as we are seeking greater leadership in corporate social responsibility from the private sector, the NHS must play a similar role for the public sector.” Choosing Health Chapter 4. Corporate social responsibility for health in the NHS

6. Energy and carbon - the problem

7. This image shows just how incredibly thin the world’s atmosphere is. Useful comparison is the brown skin on an onionThis image shows just how incredibly thin the world’s atmosphere is. Useful comparison is the brown skin on an onion

8. Global addiction: very cheap, very useful and very dangerous 350 million years-worth of carbon locked away in fossil fuels suddenly released….

9. Present CO2 concentration (381 ppm v) CO2 concentration after 50 years of unrestricted fossil fuel burning (600 ppm) We have released 930 billion metric tonnes of CO2 since in the last 150 years. Half of that since 1970. We are losing 3 species an hour. Due to the deadly trio of overhunting/overfishing, climate change, and habitat destruction Hurricane GAFILO in 2003-2004 was the first ever recoded SOUTH Atlantic hurricane. Present CO2 concentration (381 ppm v) CO2 concentration after 50 years of unrestricted fossil fuel burning (600 ppm) We have released 930 billion metric tonnes of CO2 since in the last 150 years. Half of that since 1970. We are losing 3 species an hour. Due to the deadly trio of overhunting/overfishing, climate change, and habitat destruction Hurricane GAFILO in 2003-2004 was the first ever recoded SOUTH Atlantic hurricane.

11. 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

12. The time is now Climate change is probably the most serious threat to life, to our health and well-being. Unless we take effective action now, millions of people around the world will suffer from flooding, drought, hunger and the spread of disease, threatening to contribute to conflict and global migration. In 2000, climate change caused 150,000 deaths In 2003 heatwave, 35,000 people died prematurely IPPC predicts that by 2080, 1.1-3.2 billion people would be experiencing water scarcity, 200-600 million hunger and 2-7 million a year coastal flooding. The United Nations predicts that there will be millions of 'environmental' migrants by 2020 with climate change as one of the major drivers of this phenomenon." "Europe must expect substantially increased migratory pressure." In the Middle East, water systems are already under huge stress with significant reductions in crop yields predicted. Climate change could also have a dramatic impact in South Asia, with serious consequences in Europe because of trading and financial links. Higher sea levels could threaten almost two billion people because 4 out of 10 people in Asia live within 60 kilometres, or 38 miles, of a coast.Climate change is probably the most serious threat to life, to our health and well-being. Unless we take effective action now, millions of people around the world will suffer from flooding, drought, hunger and the spread of disease, threatening to contribute to conflict and global migration. In 2000, climate change caused 150,000 deaths In 2003 heatwave, 35,000 people died prematurely IPPC predicts that by 2080, 1.1-3.2 billion people would be experiencing water scarcity, 200-600 million hunger and 2-7 million a year coastal flooding. The United Nations predicts that there will be millions of 'environmental' migrants by 2020 with climate change as one of the major drivers of this phenomenon." "Europe must expect substantially increased migratory pressure." In the Middle East, water systems are already under huge stress with significant reductions in crop yields predicted. Climate change could also have a dramatic impact in South Asia, with serious consequences in Europe because of trading and financial links. Higher sea levels could threaten almost two billion people because 4 out of 10 people in Asia live within 60 kilometres, or 38 miles, of a coast.

13. 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

14. …there are even greater risks through civil unrest: Crop failure Water shortages Mass migration Resource wars Economic collapse Ecosystem collapse

16. 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

19. Why should the NHS act/lead? The law: 80% reductions on 1990 baseline by 2050. Scientific evidence - IPCC 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 Potentially big savings (cost, tax, reputation…) and need for energy resilience and robustness flu, yes, but also floods, fuel, heatwaves Willingness and commitment of NHS organisations Special responsibility and opportunity to lead by visible example

20. Three levels of health co-benefits Traditional person focussed benefit Physical activity, mental health, trauma, air pollution, food and agriculture… Benefits for health care system Congruent with policy direction for many health care systems: care closer to home, empowered, self care, chronic disease management 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

21. NHS Strategy from the NHS for the NHS. Setting out a systematic approach to carbon reduction in the NHS. Aim is to meet and exceed government target to reduce CO2 emissions by 80% by 2050. NHS Strategy from the NHS for the NHS. Setting out a systematic approach to carbon reduction in the NHS. Aim is to meet and exceed government target to reduce CO2 emissions by 80% by 2050.

22. Carbon Footprint in NHS Englandc. 20 million tonnes carbon dioxide eq p.a. Travel: patients, staff, visitors = 18%

23.

24. 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”

25. “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

28. Shaping NHS policy and delivery NHS Constitution Performance management in national, regional, and local NHS frameworks Part of the regulatory framework Vital signs, Care Quality Commission, Monitor, LSP, LAA, CAA… World Class Commissioning Framework Climate Change Act EU ETS >> Carbon Reduction Commitment

29. 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

30. 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

31. 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.

32. 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

33. Plowright Medical Centre Swaffham North Norfolk When this surgery had to be rebuilt they went out looking for land to build on and found this plot owned but the council. The council gave them permission to build but said they must build it ‘green’. They went to the architect and this was no problem-the building is just built smartly and efficiently. This is the benchmark of how all building should be done now if we are aiming to reduce carbon emissions by 80% by 2050.Plowright Medical Centre Swaffham North Norfolk When this surgery had to be rebuilt they went out looking for land to build on and found this plot owned but the council. The council gave them permission to build but said they must build it ‘green’. They went to the architect and this was no problem-the building is just built smartly and efficiently. This is the benchmark of how all building should be done now if we are aiming to reduce carbon emissions by 80% by 2050.

34. Present CO2 concentration (381 ppm) CO2 concentration after 50 years of unrestricted fossil fuel burning (600 ppm) We have released 930 billion metric tonnes of CO2 since in the last 150 years. Half of that since 1970. We are losing 3 species an hour. Due to the deadly trio of overhunting/overfishing, climate change, and habitat destruction Hurricane GAFILO in 2003-2004 was the first ever recoded SOUTH Atlantic hurricane. Present CO2 concentration (381 ppm) CO2 concentration after 50 years of unrestricted fossil fuel burning (600 ppm) We have released 930 billion metric tonnes of CO2 since in the last 150 years. Half of that since 1970. We are losing 3 species an hour. Due to the deadly trio of overhunting/overfishing, climate change, and habitat destruction Hurricane GAFILO in 2003-2004 was the first ever recoded SOUTH Atlantic hurricane.

35. 10 corporate actions now: Chair: NHS Good Corporate Citizen sign up – CEO objective CEOs: SD / CSR / Good corporate citizenship / carbon governance All senior executives: sustainability objectives / reporting mechanisms Corporate Climate change > a specific section on risk register Finance: CRC, shadow carbon pricing, carbon standard, co-invest, clear risk management: e.g. single use vs. sterilise Performance: CQC, Operating Framework, carbon governance Estates/facilities: Energy measuring across all departments as possible: smart metering, access / travel planning – sustainable access, Liftshare, incentivising low carbon and active travel options Commissioning and Procurement criteria and standards Workforce. Board development > staff development / T&C Comms: Staff and public buy-in, corporate objectivesand image, website

36. 10 things NHS Trusts should do: Develop SD Management Plan GCC guide and assessment – www.sd-commission.gov.uk Sustainable Transport and travel plan Carbon Trust’s NHS carbon Management Programme Consider Options for on site renewable energy Energy Audit .. Incl DEC Procurement Audit.. Conduct a Waste Audit Report to Board on CRC and its implications Staff education and training programme

37. 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

38. Measuring, monitoring, displaying

40. 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”

41. Sustainable clinical practice? Think prevention Patient centred Develops lean pathways Considers carbon when choosing treatment

43. 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

44. 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

45. 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

46. 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….