Promoting Sustainability in Healthcare – How to Stay Positive 27th April 2018 Identifying Sustainable Development Opportunities in Community Healthcare Claire Jordan, Darzi Fellow Care Without Carbon Sussex Community NHS Foundation Trust

Darzi Fellowship 1 Year Project Clinical Leadership Leadership in Health Post Grad Cert - LSBU Head space/time – wicked/complex problems Pharmacist – Counsellor – Psychological Therapist – Clinical Sustainability - ?

Darzi Project Outline To identify and develop opportunities to integrate sustainable development into the Trust's clinical care model as well as improve engagement with frontline community staff on key sustainability issues.

NHS – Direction of Travel Five year Forward View Sustainability & Transformation Partnerships Place Based Care Integrated working Prevention – All Our Health Making every contact count GIRFT Carter review Model Hospital Shared decision making What Matters to you CQC – use of resources One Public Estate

Sustainability Work in Health Sustainable Development Unit - South regional network Centre for Sustainable Healthcare UK Health Alliance on Climate Change Health Care Without Harm Europe Global Green and Healthy Hospitals Lancet Countdown Sustainable Health & Care Week/Awards Chief Medical Officer Report 2017 – Health Impacts of All Pollution – what do we know? Royal College of Physicians, April 2018 Less Waste, More Health – A health professionals guide to reducing waste The UK Health Alliance on Climate Change brings together doctors, nurses and other health professionals to advocate for responses to climate change that protect and promote public health. The Alliance was formed in March 2016 to coordinate action, provide leadership and help amplify the voices of doctors, nurses and other healthcare professionals across the UK Professor Dame Sally Davies's ninth independent report as CMO discusses the threat to health posed by pollution to people living in England Published march 2018 Good waste management is critical to reducing the negative environmental impacts of an NHS organisation, and applying best practice in their field helps to reduce operational costs which can be reinvested back into critical front line patient care. Clinical staff especially have a critical role to play in helping their NHS organisation better manage their waste and the practical solutions set out in this report should be adopted at scale across the system. Senior clinical leaders should work with their teams to start identifying the simple changes they can make today that will deliver efficiencies and better outcomes for our environment both now and in the future. Dr Kathy McLean Executive Medical Director and Chief Operating Officer NHS Improvement

What do people think? SDU NHS Staff study 6,200 responses: 98% think it is important for health and social care sector to support the environment However….71% think their organisation actively supports environmental sustainability Parliamentary survey, public: Top issues that public want senior politicians to discuss more 18-24 year olds: Climate Change 18-40 year olds: Health, Climate Change Blue Planet – plastic Air pollution

National Strategy, Direction Front line, individuals

80 % clinical decision making

Care Without Carbon PEP Tool How in SCFT can teams/services work out what to do to be more sustainable? 3 key areas of opportunities: Prevention – actions taken now that prevent more resources being needed at a later time Efficient use of Resources Pathways – does information or a patient flow through a system in best way

PEP Tool 3 Themes – Prevention, Efficiency, Pathways 85 Questions, 35 non clinical, 50 clinical Written for SCFT Approx 20-30 minutes to complete Action Plan created Some quick wins eg right bin Areas for service /QI development Pre QI ideas generator

Feedback Comments It made me think Hadn’t realised how much we were already doing Not realised that before I get it now - sustainability is all about prevention Shouldn’t we all be doing this

Staying Positive Other people don’t think like you do – this may not be because they don’t care about the environment – they just haven’t thought about it. Link in with other teams doing same work eg QI, Lean A Marathon is run one step at a time Twitter - @CareWithoutCO2 @ClaireAJordan Information, sharing, encouragement

Language and Communication Harness the power of social proof (website Bluetribe.co) Experiment in San Marcos area , USA, 1 of 4 messages delivered once a week for a month, asking the residents to reduce their energy consumption. the environment will benefit it’s the socially responsible thing to do it will save you significant money on your next power bill most of your fellow community residents do try to conserve energy at home 1 of 4 messages delivered to homes in the San Marcos area, 1x week for month, asking the residents to reduce their energy consumption. 3 of the messages contained a frequently employed reason for conserving energy: the environment will benefit; or it’s the socially responsible thing to do; or it will save you significant money on your next power bill. The 4th message played the social-proof card, stating (honestly) that most of your fellow community residents do try to conserve energy at home At end of the month, recorded how much energy was used - social-proof-based message had generated 3.5 times as much energy savings. Surprised by the result – residents expected the social proof message to be the least effective. Researchers surmised that the reason the social proof message was so effective was because of the high degree of uncertainty the residents felt in achieving energy savings. Benefits of energy efficiency are somewhere off in the future so not sure if you will in fact save any energy at all – the problem of uncertain achievability. This problem exists in many areas of sustainability from energy efficiency to the benefits of reducing carbon emissions. Here the principle of social proof was effective because the note stating that most of the residents neighbours do try to conserve energy had the effect of destroying the problem of uncertain achievability. Once the residents learned that others were saving energy then this removed any doubts about whether it was achievable and it became realistic and therefore implementable.

Staying Positive - making it normal 98% think it is important for health and social care sector to support the environment Network Connections Joining dots for other people Every little helps