Environment and Health — changing the mindset of

Environment and Health: - changing the mindset of a large public sector organisation Dr David Pencheon NHS Sustainable Development Unit 28 th March 2012 Environmental Association for Universities and Colleges, York www. sdu. nhs. uk

Sustainable healthcare? “Healthcare that meets the needs of the present… …without compromising the ability of others, in future or elsewhere now, to meet their own needs” - Adapted from the Brundtland Commission www. sdu. nhs. uk

Current global drivers • Demographic – growing / ageing • Long term conditions / CDM • Growing / changing expectations of public, patients and staff • Triple bottom line health care – Economic: more value for investment – More health and social outcomes – Within environmental limits www. sdu. nhs. uk

“Climate change causes illness and death directly and locally… www. sdu. nhs. uk

…and globally…. ” www. sdu. nhs. uk

The time is now At least 30, 000 people died prematurely as a result of Europe’s heat wave in 2003 in France 1 1. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments Jean-François Dhainaut, Yann - Erick Claessens, Christine Ginsburg, and Bruno Riou. Crit Care. 2004; 8(1): 1– 2. Published online 2003 December 4. doi: 10. 1186/cc 2404. and Bhattacharya, S. (October 2003), ‘European heat wave caused 35, 000 deaths’, The New Scientist. http: //www. newscientist. com/article/dn 4259 www. sdu. nhs. uk

The best responses: • Efficiency – same business model done better – doing better to earn early wins and buy-in for… • Transformational change – different business model – doing different…models of illness prevention, health promotion and health care www. sdu. nhs. uk

www. sdu. nhs. uk

Reduce the carbon footprint of operations by 20% by 2012 To empower 60 million people to make positive changes to be healthier and happier by 2015 Maintain financial viability - Barbier, E. , 1987. The Concept of Sustainable Economic Development. Environmental Conservation, 14(2): 101 -110. - Adams, W. M. (2006). "The Future of Sustainability: Re-thinking Environment and Development in the Twenty-first Century. "Report of the IUCN Renowned Thinkers Meeting, 29– 31 January 2006. www. sdu. nhs. uk

NHS England CO 2 e footprint 1990 – 2020 with Climate Change Act targets www. sdu. nhs. uk

Breakdown of NHS England 2010 emissions? 16% Travel 19% 65% www. sdu. nhs. uk Building energy use Procurement

- www. sdu. nhs. uk 0. 50 0. 29 0. 27 0. 21 Water and sanitation Waste products and recycling Information and communication technologies 0. 62 Other procurement 0. 28 Construction 0. 66 Manufactured fuels, chemicals and gases 0. 68 Other manufactured products 0. 72 Food and catering 0. 74 NHS Freight transport 1. 00 Paper products 1. 78 Medical Instruments /equipment 2. 00 Business services 4. 50 Pharmaceuticals Procurement Breakdown 5. 00 4. 38 4. 00 3. 50 3. 00 2. 50 1. 61 1. 50 0. 46

Potential reductions www. sdu. nhs. uk

Mitigation and adaptation • Mitigation addresses causes, adaptation addresses consequences • Mitigation = avoiding the unmanageable • Adaptation = managing the unavoidable • Mitigation is the most important part of adaptation www. sdu. nhs. uk

Health co-benefits: “What is good for adaptation to, and mitigation of, climate change. . . is ALSO good for health and healthcare” 1. For the public’s health – More physical activity, better diet, improved mental health, less road trauma, less air pollution, less obesity/ heart disease/cancer, more social inclusion/cohesion. . . 2. For the healthcare system – More prevention, care closer to home, more empowered / self care, better use of drugs, better use of information and IT, fewer unnecessary admissions, better models of care… 3. For global health inequalities / social justice – Contraction and convergence, technology leapfrogging www. sdu. nhs. uk

www. sdu. nhs. uk

Why do healthcare organisations take sustainable development and climate change seriously? 1. 2. 3. 4. 5. Save money Comply with regulation Improve resilience Enhance reputation Improve health www. sdu. nhs. uk

See notes of this slides for some of the most important specific actions

www. sdu. nhs. uk

Table www. sdu. nhs. uk

www. sdu. nhs. uk

Results of Public Opinion Survey: Source: Ipsos MORI http: //www. sdu. nhs. uk/healthcheck 2012 http: //tiny. cc/w 7 fg 5 www. sdu. nhs. uk

Views and Values of NHS Leaders • Almost nine out of every ten leaders surveyed in the NHS actively engage with sustainability and believe it is important • 60% believing it is essential to the running of their organisation • Easy things: – Promoting energy efficiency – Engaging with staff on sustainability – Implementing travel initiatives • More challenging: – Improving infrastructure – Ensuring sustainable pathways and models of care – Working with other groups and organisations to achieve more sustainable results Source: RAND survey http: //www. sdu. nhs. uk/documents/publications/RAND_Europe. pdf www. sdu. nhs. uk

1. Energy: Measuring, monitoring, displaying www. sdu. nhs. uk

2. Travel: Better access to health care, not more vehicles: Default place for health care is the home / local community Every unplanned admission is a sign of system failure until proven otherwise An infrastructure for a nationwide sustainable transport system www. sdu. nhs. uk

3. Using £ 20 bn commissioning / purchasing power on w carb d lo bility an in the taina to sus gly be used curing of lating teria re will increasin s and the pro “Cri ons rvice operati sioning of se s commi goods” ith iness w ine, bus ty does trate a genu versi al / uni an demons ch to ospit “This h ations that c ble approa a organis l and measur ate change. ” r ce you e a actica ility and clim pr edu ainab r and r bility will b o sust monit will ina r a to e sust your tende plans rov atic ystem act and imp on which “S p on rbon im ificant criteri ca ign ighly s ” h ed e judg b www. sdu. nhs. uk

www. sdu. nhs. uk

www. sdu. nhs. uk

www. sdu. nhs. uk

Within 6 hours, the world’s deserts receive more energy than the world uses in a year. www. sdu. nhs. uk http: //www. desertec. org/

Six of the lessons so far. . . 1. This is a journey: Therefore engagement and a call for action is crucial: Leaders need to ask, listen, understand re-articulate the win-wins, and take exemplary action 2. Don’t focus too much on the environment / climate c– focus on finances, governance, reputation, resilience and health 3. Focus on win-wins, be positive, and remember to align change with what is driving large scale societal change 4. Communicating the science is as important as doing the science. Be honest about risk and uncertainty 5. Measure, compare, track progress, report, in order to help embed SD within evolving system-wide governance 6. Work on efficiency and transformational (large scale) change simultaneously; (adaptation / mitigation) www. sdu. nhs. uk

“I’m afraid you have humans” www. sdu. nhs. uk