1. Overview Sustainable development
What is it? Why important? What can I do?
Planning
Problem - obesogenic environment
Solution - planning?
Opportunities - Public Health White Paper
Future - new NPPF
SPAHG Guidance

2. What is Sustainability?
“Meeting our needs today without compromising the ability of others to meet their needs tomorrow…”
Slide 4: Sustainability Definition
Tips for the facilitator: Ask participants to turn to the person next to them and try and define sustainability [1 minute]. After one minute reveal the quote. Note: This slide has custom animation – practice it beforehand to see what pops up when you click.
Key Points:
Notice that the quote talks about ‘needs’. It does not talk about “the environment”, “being green” nor “saving the planet”. Sustainability is not about being ‘idealistic’ - it is about common sense – using resources sensibly so there are enough left for others in the world (today) and our children (tomorrow).
Essentially we need food, energy, space, homes, money, safety etc and our children, and their children and their children will need the same. Sustainability is how we ensure we achieve balance whether it is social, environmental and/or economic - to make sure we live within our means. 4

3. Sustainability – Striking the Balance
Slide 5: Sustainability is about balance
Key Points:
Sustainability includes three key areas: ‘Economic Sustainability’, ‘Social Sustainability’ and ‘Environmental Sustainability’
we often talk about carbon reduction and environmental sustainability – but sustainability for the NHS is much broader than this – it is about how we deliver care, how we create a healthier happier population, how we ensure we can afford to continue to deliver care in the future etc.
It is about striking the right balance between these three. If we just focus on getting one circle right and do not think about how they effect each other we will not find the spot in the middle and will not create a sustainable health service
Additional Info: To explain this, ask the audience to imagine a world where humans are not allowed to build anything: what problems might this cause? Answer: not building anything may be good for environmental sustainability but society would probably not be able to function (Where would people live? What would happen to our sewage? How would we generate energy etc.) and economic systems would break down. As another example, you could ask the audience to imagine a world where we build on all of our land (What would people eat? Where would we get enough materials? What would we do with our pollution? Would you like to live somewhere like this? etc)
The point is that neither scenario meets all 3 needs without compromising our ability to meet these needs in the future – sustainability is about getting the balance right.
Good Quotes: The problem of achieving sustainability and balance arises because: “Earth provides enough to satisfy every man’s need but not every man’s greed” [Mahatma Gandhi]
Venn Diagram: Barbier, E.,1987. The Concept of Sustainable Economic Development. Environmental Conservation, 14(2):
Barbier, 1987 5

4. Did you know?
If everyone on the planet had the same wasteful lifestyles and used as much energy as we do in the UK we would need THREE EARTHS to provide enough resources. We are living way beyond our means
Slide 6: Did you know?
Key Points:
What right do we have to say to the developing world that they cannot have the same lifestyles as we have? Using such large amounts of the earth’s limited resources, like we do in the UK and other ’developed’ countries, is unequal and unfair.
This is a really important point. If everyone on the planet wanted a car, a modest house, a fridge, a television, a computer, and perhaps a mobile phone or an ipod, WE WOULD NEED THREE PLANET EARTHS to provide the resources. Pose the question ‘Do you think that all people are equal?’ and if so ‘Do we have the right to say that people in developing countries cannot have the things that we are lucky enough to have?
The problem is, even if we had the money to let everyone have the same as we do the environment cannot handle it. As we saw in the previous slide it is important to get the balance right and think about how we can share and use the Earth’s resources more sensibly – We all know it that bingeing on the earth’s resources is not sustainable in the long term.
Source:
The ‘One Planet Safari’ document produced by the World Wildlife Fund (WWF) - accessed on 23/05/2011 6

5. What can I do?
Turn it off!
If every Trust cut their energy bill by 5% the NHS in England would save around £20 million per year.
Slide 7: What can I do?
Key Points:
Turn off lights, computers, appliances, TVs, heaters, coolers whenever you can.
Interesting facts:
Lighting: It is a myth that leaving fluorescent lights on uses less energy than turning them off – ALWAYS SWITCH LIGHTS OFF (UCLH)
Computers: Two thirds of the energy used by a computer is used by the screen – turn it off when it is not in use (UCLH)
A TV on standby setting uses 24% of the energy of when it is fully on (UCLH)
Heating and cooling: It costs over 4 times more to heat a room using electricity compared with gas (UCLH)
When you left your house this morning did you leave the taps running and the lights and TV on? 7

6. Why is sustainability important…?
1) It improves Health
2) It saves Money
3) The NHS can Make a Difference
Slide 8: The case for sustainability
Tips for the Facilitator:
Before you reveal the three points, ask the group to guess the three main ‘answers’ (they might think of some other answers, too!). Don’t wait to long if nobody is guessing the answers on the slide and try to link the answers that they come up with, to the 3 points.
Key Points:
1) There are two reasons why sustainability improves health:
A changing climate threatens health (directly and indirectly – this will be explained in slides 11 and 12)
A low carbon lifestyle is a healthy lifestyle: Eating better (more fruit and vegetables, less red meat, less processed foods, more local produce etc), more walking and cycling etc. are both good for health and good for the environment.
2) Sustainability can save money through: reducing waste, using resources more efficiently and by being less dependent on resources that are running out.
3) The NHS is in the business of health. According to The Lancet (a well respected medical journal) climate change is: the “biggest global health threat of the 21st Century”. The values of the NHS to protect health and well-being mean we must take the lead. As an enormous organisation with millions of staff and huge buying power, we should be able to do this.
Source: UCL Health Commission/Lancet: Managing the Health effects of Climate Change. May 2009 8 6

7. How will you help deliver this?
Did you know?
The NHS has to reduce its carbon emissions by 10% by 2015 to help meet the Climate Change Act (2008) target of 80% by 2050.
How will you help deliver this?
Slide 9: Did you know?
The Climate Change Act (which is a law that was brought in by the UK Government in 2008) legally requires the NHS to reduce carbon emissions by 80% (on 1990 levels) by 2050.
The NHS has an interim target of a 10% reduction (on 2007 levels) by 2015. 9

8. Is that face to face meeting really necessary?
What can I do?
Reduce travel!
If teleconferencing replaced 5% of business miles travelled, the NHS (England) would save over £13.9 million each year
Slide 10: What can I do?
Key points:
Is that face to face meeting really necessary? Think about the business miles you travel each month….
Could you work from home one or two days each week? Could you go home earlier and do your e-learning at home?
Could you tele, video and web-conference more?
> Less travel saves time, money and carbon!
If you do have to travel:
Get on your bike! (or walk, or catch the bus/train)!
- Active travel (walking and cycling) are good for health and good for the planet
- Cars cause traffic congestion, air and noise pollution, pedestrian deaths, and high car use is associated with obesity and therefore heart disease, high blood pressure, strokes… etc.
Interesting facts:
1 in 20 road journeys in England are on NHS business (CRS)
Travel makes up 17% of the NHS’s carbon footprint (CRS Update)
Is that face to face meeting really necessary? 10

9. Did you know?
The Government’s Carbon Reduction Commitment (CRC) scheme requires many NHS organisations to participate in an “energy league”. Good performers will do well in the league table and the CRC will cost them less money than poor performers.
Slide 14: Did you know?
Key Points:
Under the Carbon Reduction Commitment (CRC) Energy Efficiency Scheme, many NHS organisations must report, monitor and reduce their energy use.
If people want more information on the CRC direct them to the NHS Sustainable Development Unit website (
Saving carbon will save the Trust money that can be reinvested in delivering services! 14

10. NHS carbon footprint1 17% Building energy use 24% Procurement 59% 15
travel
17%
NHS carbon footprint1
Building energy use 24%
21 million tonnes CO2e
Procurement
59%
Slide 15: The NHS Carbon footprint
Key Points:
Ask the audience to guess what they think the NHS carbon footprint is: The answer is 21million tonnes of CO2 equivalent (based on 2007 data).
The average person in the UK has a carbon footprint of 9 tonnes per year. In China the average is 3 tonnes per year and in India only 1 tonne per year. The average American has a footprint of 20 tonnes per year (based on 2005 data). As we saw on slide 6 earlier we are using an unfair amount of the world’s resources.
The NHS footprint is made up of:
17% travel (e.g. patient, staff and visitor travel)
24% building energy use (e.g. heating, cooling, lighting)
59% procurement (buying of goods and services e.g. drugs, food, furniture, hospital supplies, medical equipment etc.)
Tips for the Facilitator:
You might like to ask if anyone knows what their own carbon footprint is, and then explain that you can also measure the carbon footprints of organisations or businesses.
This slide has custom animation so you may want to practice it - You could announce each of the areas (travel comes up on the first click, energy use on the second and procurement on the third) before bringing it up on the screen and ask the audience to guess what percentage each area makes up. They should be able to work the last one out!
Note: CO2e means ‘Carbon dioxide equivalent’ - As we mentioned earlier, there are six main greenhouse gases which cause climate change. Each gas has a different global warming potential. For simplicity, the mass of each gas emitted is commonly translated into a carbon dioxide equivalent (CO2e) amount so that the total impact from all sources can be added up to give one figure.
Source: NHS Carbon Reduction Strategy Update, NHS Sustainable Development Unit, 2010 15
1 England. NHS Sustainable Development Unit 2010

11. Reduce, reuse and recycle!
What can I do?
Reduce, reuse and recycle!
The NHS spends £20 billion every year on buying goods and services
Slide 16: What can I do?
Key points:
As we saw on the last slide - Procurement (buying goods and services) makes up 59% of the NHS’s carbon footprint (CRS Update)
By using resources wisely there is huge scope to save money:
Reduce the amount that we buy and use
Re-use items wherever possible
Recycle
Examples: paper (only print documents if absolutely necessary, print double-sided and 2 sheets to a page), hospital and office equipment, water
Interesting facts about water:
Water and sewage cost some/ one trust more than £11,000 each week.
On average each person in the UK uses 140 litres (31 gallons) of water EVERY DAY. (UCLH)
A shower uses only 40% of the hot water needed for a bath.
What you can do: report dripping taps, leaks
Don’t’ use more water than you need, avoid overfilling kettles, use a sink plug or bowl when washing dishes.
Think about everything you use in your job and the amount of things you throw away: which of them could be used better, reused or recycled? 16

12. Can we make a difference? True or False?
21 million tonnes of CO2e is the same as some medium sized countries (e.g. Estonia and Slovenia)
TRUE
2) The biggest chunk of procurement emissions is the manufacture of medical devices
FALSE
3) The NHS is the largest emitter of greenhouse gases in Europe
4) 1 in 20 journeys on UK roads are health related
Slide 17: The NHS can make a difference…
Tip for the Facilitator: Ask participants to guess whether the statements are true or false.
Key Points:
2) The biggest chunk of procurement (good and services) carbon emissions is actually drugs (pharmaceuticals)
Due to its size the NHS and the people who work in it are in a position to make a huge difference.
The NHS…
Is the biggest employer in Europe
Is the centre of many communities
Touches many people’s lives: 1 million patient contacts every 36 hours
Has massive buying power
Must set an example: NHS staff are well respected
So….people often think their individual actions cannot make a difference. However, being part of something as big as the NHS means that if we, acting together, choose to we can make a difference. In fact as a health organisation we have a responsibility to take action.
Good Quote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” (Margaret Mead – American cultural anthropologist)
Source:
Statement 1: Taken from the United Nations Framework Convention on Climate Change (UNFCCC) website accessed on 23/05/2011 (based on total emissions excluding LULUCF/LUCF Aggregate_GHGs, Gg CO2 eq., 2008)
Statement 2: NHS Carbon Reduction Strategy – pg31 Figure accessed 23/05/2011
Statement 4: Healthy Futures #5 produced by the Sustainable Development Commission - accessed on 23/05/2011 17

13. You may like to include slides with:
Making the presentation specific to your Organisation
You may like to include slides with:
Your Organisation’s sustainability statement
Who the SD Champions are in the Organisation
Who the Board level sponsor is for Sustainable Development work
Specific information and data from your Organisation (e.g. amount Organisation spends on energy, how much water the Organisation uses etc)
Information about staff events promoting sustainability
The key actions you want people to take in the Organisation to help improve sustainability and reduce carbon
Slide 19: Adding Organisation specific slides to the presentation…
Instructions:
The basic presentation could be supplemented with slides that provide information about sustainability in the Organisation and how people can get involved in taking this forward. 19

15. NHS England CO2e footprint 1990 – 2020 with Climate Change Act targets:

16. Results of Public Opinion Survey:
Source:
Ipsos MORI

17. Table

18. What organisations can do:

19. NHS England carbon intensity kgCO2e/£ 1990 to 2010:

20. Breakdown of NHS England 2010 emissions:

21. Procurement Breakdown:

22. “Planning is part art, part science and part politics, quite rightly, and there will be uncertainties, difficulty and argument all the time”, December 2011
Dr Hugh Ellis
Chief Planner, Town and Country Planning Association

23. Public Health White Paper
‘Local government and communities will have new resources, rights and powers to shape their local areas. DCLG will support local areas with streamlined planning policy that aligns social, economic, environmental and health priorities into one place.’
‘Public health will be better integrated with areas such as social care, transport, leisure, planning and housing, keeping people connected, active, independent and in their own homes.’

25. Planning levels and assessment tools
POLICY
Example: Energy NPS
PLAN
Example: Long-term national waste strategy
PROGRAMME
Example: Solihull Waste Management Strategy
PROJECT
Example: Construction of an incinerator
SEA or SA
EIA
HIA
AoS
Run through examples of PPPP
In the UK
SEA Directive 21st July 2004
EIA yes/no how?
SEA where? Whether? When? What form?
earlier = cumulative, synergistic, large-scale (biodiversity, global-warming)
IPPC
HIA merged with SEA or standalone?
SEA: Strategic Environmental Assessment AoS: Appraisal of Sustainability EIA: Environmental Impact Assessment SA: Sustainability Appraisal HIA: Health Impact Assessment 25

26. + ? ? ? ? ? SEA LDF £££ health % GI Public health professional Planner
Health premium +
The built and natural environment
Population health

28. Another way U.S. immigrants are assimilated: Weight gain
Bad news for new Americans: A study published today shows that simply moving to the USA packs on the pounds.