Dr. Frances Mortimer Centre for Sustainable Healthcare February 2013 Sustainable Specialties Green Nephrology

“ Health and social care services must be planned, financed and delivered in ways that allow them to meet the needs both of today’s population and of future generations.” Naylor & Appleby. Environmentally sustainable health and social care: Scoping review. NIHR (2012)

Financial sustainability Environmental sustainability Social sustainability Triple Bottom Line “Sustainable healthcare delivers the highest possible value to patients from a radically reduced resource input.” Green Nephrology Summit 2012 – position statement

Results of Public Opinion Survey: Source: Ipsos MORI ns/Ipsos_MORI_Survey.pdf

NEWS NHS could save £1bn by adopting green strategies used in kidney units BMJ 2013; 346 doi: (Published 28 January 2013)

NHS England CO 2 e footprint with Climate Change Act targets

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

Models of care 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 Outcome needed Secondary drivers Primary driver CENTRE for SUSTAINABLE HEALTHCARE

Models of care 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 Outcome needed Secondary drivers Primary driver CENTRE for SUSTAINABLE HEALTHCARE

Models of care 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 e.g. dry powder inhalers (1/18 x carbon of MDI)

CENTRE for SUSTAINABLE HEALTHCARE CSH Sustainable Specialities Fellowships 1.Network Local champions Case studies Summit & Awards 1.Research / demonstration project

Case studies - infrastructure Salvage of reject water from RO plant (Ashford, Canterbury, Stevenage) 3+ million litres water & £6,000+ saved per year Central delivery of acid for haemodialysis (Bradford) 16 tonnes CO 2 eq & £22,000 saved per year Energy-efficient lighting (Bradford) 2.3 tonnes CO 2 eq & £600 saved per year, improved environment for staff and patients CENTRE for SUSTAINABLE HEALTHCARE

Case studies – process (1) Paperless reporting of routine lab results (Doncaster) 0.4 tonnes CO 2 eq & £120 saved per year;  patient safety Improved waste segregation (Fife, Glasgow x6, Leicester) tonnes CO 2 eq & £11-15,000 saved per year Reduction in dx consumables (Cornwall, Fife, Glasgow) tonnes CO 2 eq & £15-30,000 saved per year CENTRE for SUSTAINABLE HEALTHCARE

Case studies – process (2) Coordination of dialysis transport (Cornwall) 17 tonnes CO 2 eq & £18,000 saved per year, improved patient experience Linen reduction (Cornwall) 2 tonnes CO 2 eq & £5,000 saved per year Bolus administration of IV antibiotics (Fife) 10 tonnes CO 2 eq & £17,000 saved per year; increased nurse-patient contact CENTRE for SUSTAINABLE HEALTHCARE

Case studies – models of care Telephone follow up of transplant recipients (Coventry) 2 tonnes CO 2 eq saved per year; cost: neutral; improved patient experience / ?empowerment Electronic consultation as alternative to referral (Bradford) 2 tonnes CO 2 eq saved per year; potential cost reduction from avoided referrals; potential benefits to patient exp/out Remote monitoring in CKD (Cornwall, Sheffield) tonnes CO 2 eq saved per year; potential cost/patient benefits CENTRE for SUSTAINABLE HEALTHCARE

CENTRE for SUSTAINABLE HEALTHCARE “Thanks to Green Nephrology, sustainability is now the seventh dimension of Quality. The work over the past couple of years has caught the imagination of the whole kidney community and has launched a social movement to provide better, greener and leaner kidney care.” Dr Donal O'Donoghue, National Clinical Director for Kidney Care

CENTRE for SUSTAINABLE HEALTHCARE Does your Green Nephrology Local Representative have…? Senior support Time Access to finance Green Nephrology Survey of Local Representatives 2010