1. Sustainable Development Unit www.sdu.nhs.uk Sustainable Development and the NHS Dartington - Public Health Residential School 25 th September 2009 David Pencheon david.pencheon@sdu.nhs.uk

2. Sustainable Development Unit www.sdu.nhs.uk Current state of knowledge about climate change? – opportunity to clarify/challenge/communicate How people think about and address sustainable development? - the language What do we know about the impact of, and opportunities for the NHS and partners? What skills do public health practitioners need to develop to take a lead on this issue What is already happening re: infrastructure, action, policy development What are some of the challenging issues we all face as professionals and citizens Opportunities for practicing engaging others…. Further reading, personal and professional action...

3. Sustainable Development Unit www.sdu.nhs.uk Sustainable development, climate change, and carbon Why now, and why the NHS? Adaptation and Mitigation Leadership, evidence and action – from whom in the NHS NHS / DH / Government Policy levers forthcoming –Regulation, finance, performance…. Organisational/practical approaches to sustainability Finance, energy, travel, buying, employer, quality…

4. Sustainable Development Unit www.sdu.nhs.uk …and NHS Sustainable Development Unit and the NHS Carbon Footprint Consultation on the NHS Carbon Reduction Strategy What it means for you personally and organisationally Address outstanding questions together –How can the NHS in this region continue to build on the progress it has already made both in leadership and delivery? –What should every NHS Chief Finance Officer know in 6 months? –How does an NHS Chair help their CEO make sustainability and carbon a corporate issue?

5. Sustainable Development Unit www.sdu.nhs.uk Business resilience, emergency preparedness, medium term strategy Sound business sense with savings reinvested into patient care Truly sustainable: exemplar local employer and contributor to local economy High quality healthcare… …within financial and environmental limits

6. Sustainable Development Unit www.sdu.nhs.uk Principles of sustainable development “Just as we are seeking greater leadership in corporate social responsibility from the private sector, the NHS must play a similar role for the public sector.” Choosing Health Chapter 4. Corporate social responsibility for health in the NHS Securing the Future – UK Government – 2005

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8. Sustainable Development Unit www.sdu.nhs.uk A few facts and figures 350 million years-worth of carbon locked away in fossil fuels 150 years100 years 50 years NOW First Oil Well 4000 cars in USA 600,000,000 cars 4,000,000,000 passenger flights First commercial jet ticket

9. Sustainable Development Unit www.sdu.nhs.uk Climate change: What is happening?

10. Sustainable Development Unit www.sdu.nhs.uk The time is now 15,000 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/cc2404.

11. Sustainable Development Unit www.sdu.nhs.uk Sustainability and health Business Sense –Efficiency and financial savings (immediate, and short ROI*) –Local economic investment Resilience and continuity –Adapting to the effects of climate change whilst seeing 1 million patients every 36 hours Sustainability and health –Physical activity and obesity / CHD / diabetes –Air pollution –Transport trauma –Mental health –Patient experience, pathways, and outcomes: High quality / carbon –Exemplar role of the NHS multiplied throughout individuals, families, and communities –Adaptation to, and mitigation of, climate chaos *Return on Investment

12. Sustainable Development Unit www.sdu.nhs.uk …and global health impacts Heat waves, flooding and other direct effects of climate chaos Disease patterns changing quickly Crop Failure Water shortages Mass Migration Resource Wars Economic Collapse Ecosystem Collapse

13. Sustainable Development Unit www.sdu.nhs.uk Why the NHS? adapt and mitigate Measuring and understanding the NHS (England) Carbon footprint –18 m tonnes carbon dioxide per annum »Energy: heating, lighting, hot water = 22% »Travel: patients, staff, visitors = 18% »Procurement: supply chain activities of companies producing goods and services = 60% Budget - Annual budget > £90 billion - Spends about £17 billion per year on goods & services - Contributes up to 10% of every regional GDP Largest employer and estate in Europe –Employs about 1.3 million –Largest estate in Europe –Employs 5% of UK workforce Waste –Increasingly costly, environmentally and financially

14. Sustainable Development Unit www.sdu.nhs.uk Areas for action and exemplar role Procurement –Energy, food, drugs, other resources Estates and facilities management –Energy use/saving/generation, carbon capture Travel –Staff, patients, visitors Employment / skills / local economy Refurbishment and new buildings –Sustainable communities and spatial planning Exemplar and partnership role of NHS –LSPs, LAAs, Spatial Planning Models and pathways of delivering care

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16. Sustainable Development Unit www.sdu.nhs.uk Travel When Enrique Peñalosa became mayor of Bogotá, Colombia in 1998, “In Bogotá, where 85 percent of the people do not use cars for their daily transport, is it fair that cars occupy most of the space on the streets?” The answers he came up with have reshaped Bogotá, home to 7 million people, into a city so easy to negotiate by public transportation that people actually voted in favour of outlawing cars in the city during rush hour by 2015

17. Sustainable Development Unit www.sdu.nhs.uk Action for us all – NHS and partners Understand the consequences of our actions as individuals and organisations (now and future) –In measurable and actionable terms –Money, carbon, and health 1. Identifying areas and acting NOW –immediate cost savings –health improvement 2. Identifying areas and acting NOW > 5 years –Business continuity - resilience - emergency preparedness - risk management – healthcare delivery 3. Identifying areas for acting NOW > 15 years –Organisational survival, and health of the population

18. Sustainable Development Unit www.sdu.nhs.uk Carbon footprint C0 2 e Understanding carbon footprints: –(Shadow) carbon pricing £12 a ton –Carbon allowances –Micro-metering – wireless energy monitors at home and at work –Understanding embedded carbon in ALL products and services (e.g. procurement)

19. Sustainable Development Unit www.sdu.nhs.uk Early priorities for NHS NHS Carbon Reduction Strategy - CONSULTATION –Testing and confirming the ambition of the NHS and partners Scorecard (incl key metric) of sustainability indicators Policy Levers to drive sustainability –Ensure fully integrated with NHS policy and strategy (e.g. Darzi) and with other broader strategies (energy, spatial strategies…) –Headline key metric (in NHS Operating Framework / Vital Signs) –Linking with the Commissioning Framework –Part of the regulatory framework (Healthcare Commission >>> Care Quality Commission) –DH/NHS and the Climate Change Bill – shadow/real carbon pricing –NHS Constitution Practical guidance on energy management, waste management, carbon management, travel plans… Model impact of alternative policies on NHS carbon footprint

20. Sustainable Development Unit www.sdu.nhs.uk NHS Sustainable Development Unit Set up by the 10 Chief Executives of the Strategic Health Authorities, 2008 Accountable through lead SHA CEO Neil McKay to David Nicholson and NHS Management Board Roles: Source of leadership and technical expertise Shape NHS policy in England Research: SD Tools, measurement and impact, SD scorecard and key indicator / disseminate and help implement effective practice Develop people, organisations, and networks

21. Sustainable Development Unit www.sdu.nhs.uk Actions of SDU so far R&D –Carbon Footprinting the NHS in England NHS SDU / SDC / Stockholm Environment Institute –Local tools of measurement / action / impact Policy shaping –Draft Carbon reduction strategy for the NHS –National performance management framework, regulatory framework and legislative framework Developing people and organisations –Increasing awareness and competence

22. Sustainable Development Unit www.sdu.nhs.uk Areas for action: carbon reduction Saving Carbon, Improving Health: draft NHS Carbon Reduction Strategy for consultation. - testing the ambition of the NHS and partners in detail…until 30 th September

23. Sustainable Development Unit www.sdu.nhs.uk Four questions for us all Is the NHS being ambitious enough in setting this challenge? Will the measures suggested in the Strategy sufficiently stimulate action and reduce carbon emissions in the NHS? What further incentives, barriers, and policies need to be addressed to enable NHS organisations to achieve this carbon reduction ambition? Are there important examples of successful innovation which need evaluating and/or spreading?

24. Sustainable Development Unit www.sdu.nhs.uk Four messages for us all Sustainability and climate change are serious and urgent health issues for us all ALL of us can and are doing things about it, but –Are we doing it quickly enough? –Are enough of us doing it consistently? –Is the NHS engaging with other sectors enough? Leadership comes from ALL of us This is happening on our watch and it is our legacy.