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THE GREEN NEPHROLOGY SURVEY OF SUSTAINABILITY IN RENAL UNITS 2009/10 A programme of Knowledge THE GREEN NEPHROLOGY SURVEY OF SUSTAINABILITY IN RENAL UNITS 2009/10 A programme of Knowledge into Action Registered charity No. 1123566. Summertown Pavilion, Middle Way, Oxford OX 2 7 LG

INTRODUCTION Climate change presents a major threat to global health. The very provision of INTRODUCTION Climate change presents a major threat to global health. The very provision of healthcare has a significant environmental impact. The carbon footprint of kidney care is likely to be disproportionately large. A transition to low carbon kidney care is therefore required. This survey was designed to identify… how renal units currently use their resources examples of good practice in this regard areas in which renal units can achieve ‘quick wins’ transforming healthcare for a sustainable future

INTRODUCTION The survey was completed by Green Nephrology Local Representatives within 56 adult and INTRODUCTION The survey was completed by Green Nephrology Local Representatives within 56 adult and paediatric renal units across England, Scotland & Wales between October 2009 and February 2010. We hope these results provide some inspiration and ideas for you to green your own units. transforming healthcare for a sustainable future

LIGHTING National Responses Local results Low energy lightbulbs are used in ‘all or almost LIGHTING National Responses Local results Low energy lightbulbs are used in ‘all or almost all’ lights in 27. 4% of renal units. When not required, lights are ‘always or usually’ switched off in 58. 2% of units. Motion sensors, to switch off unnecessary lights, are not used at all in 65. 5% of units. transforming healthcare for a sustainable future

HEATING In 65. 5% of renal units, the staff cannot control thermostat! Is this HEATING In 65. 5% of renal units, the staff cannot control thermostat! Is this the case in your unit? transforming healthcare for a sustainable future

HEATING National Response Local Response Staff do not have access to thermostat controls in HEATING National Response Local Response Staff do not have access to thermostat controls in 65. 5% of units. Air chilling facilities don’t switch off automatically when the heating comes on in 52. 7% of units. Shading for south facing windows is provided in 60% of units. transforming healthcare for a sustainable future

INFORMATION TECHNOLOGY National Response Local Response 60% of units encourage staff to switch off INFORMATION TECHNOLOGY National Response Local Response 60% of units encourage staff to switch off computers when not in use… …but only 10. 9% of units use automated systems to ensure this really happens! transforming healthcare for a sustainable future

STAFF & PATIENT TRAVEL Patient & staff travel contributes nearly one fifth of the STAFF & PATIENT TRAVEL Patient & staff travel contributes nearly one fifth of the NHS footprint. Can your unit sever its ties with the car? How about running virtual clinics? Or signing up to the Cycle to Work scheme? Or providing staff and patients with information about public transport? transforming healthcare for a sustainable future

STAFF TRAVEL National Response Local Response 80% of units (or their trusts) have signed STAFF TRAVEL National Response Local Response 80% of units (or their trusts) have signed up to the Cycle to Work Scheme. And 69. 1% of units provide adequate shower and changing facilities for walkers and cyclists. But…staff shift patterns don’t correspond to public transport timetables in 49. 1% of units, although 96. 4% of units are well served by public transport. transforming healthcare for a sustainable future

PATIENT TRAVEL National Response Local Response 63. 6% of units don’t actively support patients PATIENT TRAVEL National Response Local Response 63. 6% of units don’t actively support patients who might wish to use public transport. And only 18. 2% of units use predominantly low emission vehicles. How about starting a telephone clinic service? 12. 7% of units currently provide some care this way. transforming healthcare for a sustainable future

PROCUREMENT Contracts for supplies include sustainability criteria in… Local response …only 7. 5% of PROCUREMENT Contracts for supplies include sustainability criteria in… Local response …only 7. 5% of units procuring PD supplies …only 9. 3% of units procuring HD supplies …and only 3. 5% of office supplies transforming healthcare for a sustainable future

PRINTERS & PAPER USE National Responses Local Responses Printers are only set to print PRINTERS & PAPER USE National Responses Local Responses Printers are only set to print double sided as default in 22. 6% of units. Less than one third of units (29. 6%) buy recycled paper. Only 7. 4% of units email any of their letters to primary care in preference to paper copies. transforming healthcare for a sustainable future

HAEMODIALYSIS SUPPLIES National Response Local Response HD fluids are purchased in cartridges in 43. HAEMODIALYSIS SUPPLIES National Response Local Response HD fluids are purchased in cartridges in 43. 4% of units. 45. 3% of units don’t purchase their dialysates in the highest available concentrations. Plastic and paper packaging from single-use HD equipment is recycled is NOT recycled in 67. 9% of units. transforming healthcare for a sustainable future

RECYCLING National Response Local Response Recycling bins are present in clinical areas in about RECYCLING National Response Local Response Recycling bins are present in clinical areas in about 76% of units Suppliers collect (and recycle) packaging from HD and PD in only 28. 3% and 15. 1% of cases respectively transforming healthcare for a sustainable future

WATER CONSERVATION Only 2 renal services salvage reject water during haemodialysis. But look at WATER CONSERVATION Only 2 renal services salvage reject water during haemodialysis. But look at the returns on investment achieved by the Kent team. . . Find out more: http: //www. greenerhealthcare. org/conserving-waterhaemodialysis-case-study-and-how-guide transforming healthcare for a sustainable future

THE BUILT ENVIRONMENT Only about a quarter of units provide green spaces for staff THE BUILT ENVIRONMENT Only about a quarter of units provide green spaces for staff (24. 5%) and patients (25. 9%). Can you improve on yours? transforming healthcare for a sustainable future

IS YOUR UNIT READY FOR THE EFFECTS OF CLIMATE CHANGE? National Response Local Response IS YOUR UNIT READY FOR THE EFFECTS OF CLIMATE CHANGE? National Response Local Response Only 13. 0% of units have incorporated the National Heat Wave Plan into their polices. Are you one of them? Kidney patients are at greater risk than most from heat waves. Is yours once of the 29. 6% of units providing patients with specific advice about this? 52. 8% have alternative plans in place if the weather should disrupt their HD patients transport. Does yours? transforming healthcare for a sustainable future

Why not agree some actions now? transforming healthcare for a sustainable future Why not agree some actions now? transforming healthcare for a sustainable future

USEFUL INFORMATION Download the 10: 10 Renal Checklist and see existing Case Studies http: USEFUL INFORMATION Download the 10: 10 Renal Checklist and see existing Case Studies http: //www. greenerhealthcare. org/1010 -renal-checklist Find out more about the Green Nephrology Programme http: //www. greenerhealthcare. org/green-nephrology Contacts at the Campaign for Greener Healthcare Andy Connor, Green Nephrology Fellow, andrew. [email protected] org Frances Mortimer, Medical Director, frances. [email protected] org transforming healthcare for a sustainable future