1. Rachel Stancliffe Centre for Sustainable Healthcare 17 th February 2015 Carbon Modelling in Dentistry overview of the day and intro to sustainable healthcare

2. CENTRE for SUSTAINABLE HEALTHCARE Aims of the day: To explore the feasibility of carbon mapping common dental procedures – exploration and collaboration Within this: 1. dentistry/sustainability exchange - understand each others’ worlds; 2. mapping/modelling – which models do what; 3. What can we do in dentistry – how can we collaborate

3. CENTRE for SUSTAINABLE HEALTHCARE Agenda 09:30 – 10:00 Tea, coffee and networking 10:00 – 10:20 Introduction: Centre for Sustainable Healthcare and PH Dentistry 10:20 – 10:40 Background on carbon counting (importance, current models, legislation) 10:40 – 11:25 3 presentations from solutions providers and discussion * Using Footprint Reporter - the approach to in-surgery carbon data collection used by the Royal College of General Practitioners Craig Simmons, Best Foot Forward * GHG accounting approaches for healthcare products and pathways Tom Penny, ERM * Green Impact in dental practices - Kim Croasdale, Green Impact Team, NUS 11:25 – 11:45 Tea Break 11:45 – 12:15 Dental informatics (English & Scottish data) – Brett Duane, consultant in dental PH, sustainability lead PHE and Samit Shah, working with PHE, NHSE, HEKSS 12:15 – 12:45 Overview of carbon modelling: how to combine approaches – Mike Berners-Lee, director and principal consultant, Small World Consulting 12:45 – 13:30 Lunch 13:30 – 14:30 Interactive session to consider ways we can collaborate 14:30 – 14:45 Gather our thoughts and agree any actions

4. CENTRE for SUSTAINABLE HEALTHCARE The expertise in the room… Name Job Where did your interest in sustainability start?

5. Sustainable healthcare: What is it, why does it matter?

6. Great innovations of the first and second healthcare revolutions MRI and CT scanning Anti psychotics Antibiotics Genetics Hip and knee replacement Chemotherapy Antidepressants Randomised controlled trials Systematic reviews Gower Street - Doll & Hill 1854 Broad Street - John Snow The First (19 th C) – public health. The Second (20 th C) – healthcare slide by permission from Sir Muir Gray 6

7. CENTRE for SUSTAINABLE HEALTHCARE BUT in 2015, health services still face major problems: QUALITY Safety Inequalities Patient experience COST Rising demand Financial crisis Waste CARBON Climate change Carbon reduction

8. CENTRE for SUSTAINABLE HEALTHCARE Climate Change Act (2008) 80% by 2050 34% by 2020 at least

9. CENTRE for SUSTAINABLE HEALTHCARE Climate change and health Direct effects: heatwaves, floods, storms, altered disease vectors Indirect effects: drought, crop failure, malnutrition, migration, conflict

10. CENTRE for SUSTAINABLE HEALTHCARE Summary of progress

11. CENTRE for SUSTAINABLE HEALTHCARE Carbon footprint – NHS England Supply chain (pharmaceuticals, equipment, everything else) Transport Energy use Transport? Energy use? Supply chain?

12. CENTRE for SUSTAINABLE HEALTHCARE Environmental SocialEconomic Bearable Sustainable Viable Equitable BIOSPHERE

13. CENTRE for SUSTAINABLE HEALTHCARE Sustainable healthcare The use of resources to deliver healthcare today without compromising the health of current and future generations. Technical vs. value based

14. Sustainable clinical practice Reduce carbon without reducing health Reduce activityPreventionSelf careLean pathways Reduce carbon intensity Low carbon alternatives Sustainable estates Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11 Sustainable clinical practice Outcome needed Secondary drivers Primary driver Infrastructure & process CENTRE for SUSTAINABLE HEALTHCARE Carbon information available

15. CENTRE for SUSTAINABLE HEALTHCARE Savings Potential savings from moderate replication of Green Nephrology case studies in UK renal units are estimated at £7 million, 11,000 tonnes CO2e and 470 million litres water… … per year. BMJ 2013;346:f588 doi: 10.1136/bmj.f588 (Published 28 January 2013) Mortimer F, Connor A, Stott A. Cumulative savings from green nephrology innovations [abstract presented as poster at joint Renal Association and British Transplantation Society 2013 annual congress].