1. 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] 1

2. “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 development Why should the NHS take action? 2

3. Before the programme You should have received this information: Introduction to Sustainable Action Planning (SAP) o Why, what, how, who Pre-questionnaire 3

4. Workshop One Goal Team agreement on 1-2 issues to tackle first Agenda 1. 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 4

5. Environment and health Climate change Part 1 5

6. 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

7. 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 21 st century 7

8. Climate change can affect health directly… 1.Malnutrition 2.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.

9. …but climate change also brings much greater health risks from Drought Crop failure Economic collapse Mass migration Civil unrest Societal collapse

10. 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

11. 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 11

12. 240,000,000 home PCs 650,000,000 cars 4,800,000,000 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 years100 years 50 years NOW First Oil Well 4142 cars, 10 miles concrete road in US First commercial jet ticket Domestic light bulb

13. Livestock farming accounts for > 18% global emissions Mitigation: tackling the causes of climate change...(2)

16. Health “co-benefits” of mitigation Many actions to reduce greenhouse gas emissions which cause climate change are good for health! o Active travel o Eating less meat and dairy o Clean energy o 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 16

17. NHS Sustainable Development Part 2a 17

18. 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. 18

19. Environmental Sustainable development meeting environmental needs Climate change / carbon Resource depletion o Water o Fossil fuels (plastic etc) Biodiversity Social Economic 19

20. 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 development Why should the NHS take action? 20

21. “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 development Why should the NHS take action? 21

22. Climate change / carbon the NHS England carbon footprint 18 million tonnes CO 2 in 2004 22

23. NHS carbon footprint Procurement “things in lorries”

24. www.sdu.nhs.uk

26. 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? 26

27. NHS sustainable development Clinical practice o prevention, supporting patient self care o preparation for health effects of climate change Local systems o energy, travel, water, waste o 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 27

28. What could our team do? Clinical PracticeOpportunities? Disease prevention Supporting patient self- care Preparing for health effects of climate change

29. What could our team do? Local systemsOpportunities? Energy Travel (staff, patients) Medical supplies Non-medical supplies Water Waste

30. A different way of seeing things

31. Actions taken by clinical teams Part 2b 31

32. 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 32

33. Switch off campaign to reduce unnecessary lighting Action: energy 33

34. Action: transport Improve communication with ambulance service – reduce aborted journeys Cost of aborted journeys 2009£ June£1500 July£690 Aug£400 Sept- Oct- Nov-

35. 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/m 3 water 322g/m 3 sewerage 35

36. 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

37. 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

38. Your priorities Part 3 38

39. Which of these matter to you? staff commuting heating food laundry equipment patient transport visitor travel number of appointments paper lighting air conditioning dialysis products recycling waste segregation preventative care water building design medicines green spaces climate risk 39

40.  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? 40 Where are you today?

41. Decision 1 – 2 areas to tackle first (in Workshop 2) Keep a list of other areas (to tackle later) 41

42. Next time – Workshop 2 42 Goals A sustainable action plan! Plan for ongoing improvement Agenda 1. Exploring your chosen areas: Describing how the process works today Brainstorming problems and ideas 2. Actions 3. Ongoing improvement Managing implementation and monitoring