1. Recommissioning cancer services for a credit-crunched, energy-crunched, climate-crunched world Dr Angela E Raffle, Consultant in Public Health NHS Bristol

2. Summary of Workshop October 2009 South West Public Health Residential School Key reference; Peak Oil Report for Bristol, Bristol Green Capital Momentum Group, available on http://bristolpartnership.org http://bristolpartnership.org Contact details angela.raffle@bristolpct.nhs.uk angela.raffle@bristolpct.nhs.uk

3. Recommissioning cancer services for a credit-crunch, energy- crunch, climate-crunch world In part one of this workshop, information was on A5 slips and participants studied and presented the peak-oil, UK energy balance, oil and recession, and NHS carbon reduction facts as a group exercise

4. Global data Source: ExxonMobil

5. 1869 and Pennsylvania are generally quoted as first drilling of an oil well US oil discoveries peaked in the 1930s and US production peaked in the 1970s Global discoveries peaked in the 1960s so global production is unlikely to grow for much longer The amount of oil used by the world in a year in the 1950s was equal to the amount used in 6 weeks in 2008 The International Energy Agency warned in 2008 of a real risk of oil supply crunch by 2015 ‘we are not yet running out of oil but we are running out of time’

6. Source; Oil Drum Europe

8. The UK used to have its own North Sea gas and oil Natural gas powers 43% of UK electricity, 60% of home and 23% of industrial fuel We are now net importers of gas and oil. The official position of the UK Govt is that ‘world’s oil resources are sufficient to prevent peaking in foreseeable future…IEA (2007) says reserves can meet demand to at least 2030’. IEA advice changed in 2008, warning of real risk by 2015. UK Govt has yet to change its position Coal imports may increase, but is a serious source of GHGs. Carbon capture is estimated to be 15 to 20 yrs away, and is energy intensive and expensive UK nuclear power faces a ‘cliff’ of decreased production between 2010 and 2020, new nuclear cannot replace this in time

9. Past recessions and oil spikes. Source; Jeff Rubin, CIBC World Markets Inc.

10. There is evidence that oil price spikes (oil shocks) are followed by global recession Businesses and service providers face a double impact. First they are hit by the increase in price of resources and transport. Then by a reduction in available capital and revenue In order to be resilient we need public services and food production that is less reliant on transport, petroleum based fuels, and on complex global supply systems We need a travel and transport policy that reduces the need for petroleum fuelled transport and that maximises efficient mass transport

11. Source; NHS Carbon Reduction Strategy for England, NHS Sustainable Development Unit 2009

12. The NHS carbon footprint in 2004 was estimated as 18.6 MtCo2, representing 25% of England public sector emissions 60% of this is procurement, and nearly half of this (30% of total) is pharmaceuticals Oil is a primary raw material for many drugs and supplies Healthcare is heavily dependent on transport of patients, staff, deliveries and supplies The NHS carbon reduction strategy commits us to 10% carbon reduction, from 2007 baseline, by 2015 A resilient health service will need to reduce overall energy use, reduce reliance on petroleum based products, and focus on helping people to become less dependent on the health system

13. In part two of the workshop participants used the cancer map and chose either A or B A - Scenario in the future B - Vulnerability assessment now

14. Map of cancer services… Used to help with exercises

15. A Imagining we’ve done it – The scenario is in the future, £800 NHS spend per head, fuel prices treble, fuel stoppages frequent, food and water shortages intermittent, lots of climate change refugees and more on the way. The community has risen to the immense challenges and all the basics are still provided, and everyone is very proud of the community response. What are cancer services like?

16. B Vulnerability Assessment For each element of cancer services the task was to assess the vulnerabilities To global supply chain problems To price increases To fossil fuel depletion How would you present this information in a way that helps people modify health services so that they are resilient to the pressures from carbon reduction and peak oil?

17. To finish up we reflected on learning and next steps. The main ‘take home’ messages were; The importance of building fossil fuel depletion, and carbon reduction into health service plans as of now The importance of working within and with communities to build individual and community cohesion and resilience to mitigate against conflict and social unrest, and to build a positive shared response The importance of focussing attention and effort onto the value of what you are keeping and why that matters, rather than dwelling only on the lower value things that you will have to forego