1. INSTITUTIONAL RHYTHMS
Ideas and Opportunities for Energy and Mobility Demand Management in the NHS

2. About DEMAND One of Six End Use Energy Demand (EUED) Centres Core Team
Funded by RCUK Energy Programme
Core Team
Elizabeth Shove and Gordon Walker (Co-Directors) Lancaster University
Greg Marsden Institute for Transport Studies, Leeds University
Sylvie Douzou EDF R&D ECLEER, Paris
Multidisciplinary & Multi-Partner Research Team
14 Co-investigators from 10 Universities (Aberdeen, Birkbeck, Birmingham, Lancaster, Leeds, Manchester, Reading, Sheffield, Southampton, UCL)
14 core projects plus 4 additional linked projects and 12 PhDs
EDF R&D European Centre and Laboratories for Energy Efficiency Research
Transport for London, International Energy Agency

4. Institutional Rhythms and Energy Demand Working Group
To provide inspiration and review to co-develop and share research output.
Members from:
Lancaster, Leeds, Manchester, Sheffield, and UCL universities;
Airedale, Blackpool, Leeds, and Liverpool Hospital Trusts;
Red Rose, Global Action Plan, the Conclude Consultancy, Yorkshire Ambulance Service, Centre for Sustainable Healthcare…
1: Exchanging Ideas (13th Sep 2016, DEMAND, Lancaster)
2: Examining Practical Cases (7th Feb 2017, Airedale)
3: Developing New Strategies (23rd May 2017, Leeds)

5. Ideas and opportunities for reducing demand for energy and travel in the NHS from the Institutional Rhythms and Energy Demand Working Group
The Dynamics of Energy, Mobility and Demand
Greg Marsden (Institute for Transport Studies, University of Leeds)
Institutional Rhythms
Stanley Blue (Lancaster University)
Followed by group discussions and questions to a panel of:
Greg Marsden (Institute for Transport Studies, University of Leeds),
Dale Southerton (Sustainable Consumption Institute, University of Manchester),
Frank Swinton (Airedale General Hospital).

6. ?
What is energy

7. says
“Energy is not used for its own sake but as part of accomplishing social practices at home, at work and in moving around.”
“Energy demand is an outcome of the social, infrastructural and institutional ordering of what people do.”

8. What do these ideas mean for
REDUCTION ?

9. Some people think DEMAND says DEMAND reduction DEMAND reduction
The challenge is to maintain present ways of life but make related goods and services more efficient.
DEMAND says
Strategies to increase efficiency play out in a social world that is constantly on the move.
Future ways of life are unlikely to be the same as they are today.
DEMAND reduction
depends on understanding how end-uses of energy are changing and how they can be modified and steered.
DEMAND reduction
depends on asking more fundamental questions about what energy is for.

10. 52.8 million kilometres per year
Between 2002 and 2010
8.7 to 9.6 trips/person/year
13.1%
7.23 to 8.11km average distance
10.8%
52.8 million kilometres per year
Dusheiko, M. (2014) Patient Choice and Mobility in the UK Health System: Internal and External Markets, in Eds. Levaggi, R. and Monefiori, M. Health Care Provision and Patient Mobility, Springer, ISBN

11. 2000 65 85
2030

12. Source: National Travel Survey
Source: Gordon Stokes

13. The hospital shopping mall – when did this become the ‘norm’?
Driven in part by commercial revenue needs
What does this mean for energy and who thought about that?

14. Some people think DEMAND says DEMAND reduction
Energy demand reduction depends on making technologies more
efficient, and persuading people to adopt them.
DEMAND says
Technologies and infrastructures of supply are implicated in making and reproducing services and practices.
Efficient technologies can sustain social practices that call for high levels of energy demand.
DEMAND reduction
depends on reconfiguring services and social practices.
depends on recognising that technologies and infrastructures do not simply meet existing needs: they shape future practices and the demands that follow. -

15. Efficiency as the main solution

18. Changing the ways patients interface with healthcare
Technology Enabled Care

19. Some people think DEMAND says DEMAND reduction DEMAND reduction
Energy demand is something that can be turned up and down.
Some think demand is like a commodity that suppliers can manage.
DEMAND says
Patterns and peaks of energy demand reflect sequences and societal rhythms of practice - across the day, the week and the year.
DEMAND reduction
at peak hours depends on understanding which practices occur at peak times, and why.
What are the forms of temporal fixity/flexibility associated with each?
DEMAND reduction
depends on modifying social and institutional rhythms.

21. Saturday
3-5pm
Sunday
11am - 4 pm
March
Sep - Oct
June - Aug
Dec

22. Some people think DEMAND says DEMAND reduction
The only policy relevant to energy demand reduction is energy policy.
DEMAND says
There are many areas of public policy that unknowingly impact on the range of social practices enacted in society, and hence on energy demand.
These include education, employment, business, health, planning and more.
DEMAND reduction
Depends on understanding the unintended consequences that ‘non energy policies’ have on what people do, and hence on energy demand.
Depends on actively fostering new social arrangements and different ways of life.

24. And the NHS is rife with conventions and initiatives that have nothing to do with energy and everything to do with energy

25. Some people think DEMAND says DEMAND reduction
Energy demand is about energy use in the home, or at work.
Or that it is about people driving cars. But…
DEMAND says
These are not totally separate ‘domains’.
Different forms of energy demand intersect: they link together in the course of a day, and over peoples’ lives.
DEMAND reduction
depends on combining
expertise from traditionally separate areas – including transport and buildings.

26. E.g. On-line shopping

27. To finish
Different methods of thinking about energy demand have practical implications for
The questions that are asked
The data that is needed to understand how and why energy is used
The range of actors who are part of the ‘energy problem’
The types of solutions that could be considered

28. INSTITUTIONAL RHYTHMS
Ideas and Opportunities for Energy and Mobility Demand Management in the NHS

29. 2016. "Health Check: Sustainable Development in the Health and Care System." NHS England Publications. Available at:

30. How do hospitals make demand for energy, transport, and goods?

34. Example 1: Sequences and Hospital Discharge

37. Example 2: Boundaries of Professional Responsibility and Patient Transport

40. Demand for resources is made through the organisation of hospital services.
Issues of timing, sequencing, and responsibility are central topics for sustainable development.
Need to expand what counts as sustainable development to seriously engage with (what are currently) invisible energy procedures, policies, and practices.

41. Extending the sustainable development agenda:
to bring together a wide range of expertise and resources,
to develop and embed sequences and ways of working that can reduce demand for energy, travel, and goods.

42. References:
2016. "Health Check: Sustainable Development in the Health and Care System." NHS England Publications. Available at:
Home First -
Thanks to noun project: Suji; Linseed Studio; Luis Prado; parkjisun; Rohit Arun Rao; Danil Polshin.