1. Sustainable healthcare: doctors as managers, doctors as clinicians Frances MortimerKate Charlesworth Campaign for Greener HealthcareNHS Sustainable Development Unit Sustainable Healthcare Education Learning objective 3 http://greenerhealthcare.org/sustainable-healthcare-education

2. What is good management? What do you understand by ‘stewardship’?

3. Sustainable healthcare Doctors are critically important in the transformation to sustainable healthcare. Sustainable healthcare should improve other aspects of quality of care You may need to change your clinical practice… (how good are you at supporting patients in caring for themselves?)

5. Setting direction… Scenarios for low-carbon healthcare 2030

6. [show DVD]

7. Setting direction Can you add 2 or 3 additional features to each scenario? Which scenario do you prefer? Which are you most uncomfortable with? What real-life examples of activities are there that are consistent with each scenario? What skills will doctors need in the future? What is the role of doctors in shaping the future of a health service?

8. The challenges and opportunities for health and the NHS 1.The law 2.Strength of scientific evidence 3.Economic savings 4.Health co-benefits 5.Willingness and commitment of NHS staff and organisations 6.Reputation: NHS as a public sector exemplar

9. www.sdu.nhs.uk

10. A medical leadership challenge…

11. UPDATE 1.More recent data 2.NHS England Carbon Footprint 3.Marginal Abatement Cost (MAC) Curves 4.CO2e Reduction Potential Graph (Policy Wedges)

12. So what exactly would we need to change to achieve major carbon reductions?

13. Carbon footprint – NHS England ?

14. Carbon footprint – NHS England Procurement breakdown

15. Carbon footprint – NHS England Quick – call the Estates & Facilities team!

16. CO2e Reduction Potential for NHS England Fig: NHS England CO2e baseline to 2020 with 8 reduction policy wedge measures

18. Marginal Abatement Cost (MAC) Curve

19. 1.Prevention of disease, health promotion 2.Greater engagement of patients in managing their own care 3.Lean care systems: minimising low value activities (including travel) 4.Preferential use of effective & proven technologies with the lowest carbon footprint Principles of sustainable clinical practice Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11

20. Sustainability & Quality of Care Patient safety Efficiency Clinical effectiveness Equity of access Timeliness Patient experience Sustainability ?

21. Managing & Improving Services Case study: introducing a teleclinic in kidney care

23. You are a consultant nephrologist thinking of setting up a telephone follow up service. 1.What are the potential benefits? o to patients o to staff o to the NHS o to society

24. You are a consultant nephrologist thinking of setting up a telephone follow up service. 1.Are there any risks, e.g. to patient safety? How could these be avoided or reduced?

25. You are a consultant nephrologist thinking of setting up a telephone follow up service. 1.What do your patients think of the suggestion? How could you find out?

26. You are a consultant nephrologist thinking of setting up a telephone follow up service. 1.What resources are needed to run the service?

27. Working with others Role play

28. Managing Resources Travel footprinting

29. 1.The telephone service goes ahead and you want to measure the carbon savings from reduced patient travel. How do you do this? (How much carbon would have been saved if everyone in the room had stayed at home today?)

30. Sustainable healthcare: doctors as clinicians

31. Remote consultation skills Role-play

32. You find out that procurement of drugs and medical equipment make up 30% of the NHS carbon footprint and decide that helping patients to become more involved in their own care would be an effective way to reduce the need for medications, follow up and tests. What could you change in your clinical practice to empower your patients?

33. You find out that procurement of drugs and medical equipment make up 30% of the NHS carbon footprint and decide that supporting sustainable lifestyle change in your patients would be an effective way to reduce the need for medications, follow up and tests. What lifestyle changes (e.g. travel, diet) would help to prevent [disease] in your patients? What could you do in your clinical practice to support these changes?

34. Your turn: identify an opportunity to improve sustainability in your medical school or in a clinical setting and the channels by which change can be brought about. What unsustainable practices can you think of: a) On a general medical ward? b) In an operating theatre?

35. Sustainable healthcare Doctors are critically important in the transformation to sustainable healthcare. Sustainable healthcare should improve other aspects of quality of care You may need to change your clinical practice… (how good are you at supporting patients in caring for themselves?)