Transcript without compromising the ability of others, in future or

Environment and Health:
- changing the mindset of a large public
sector organisation
Dr David Pencheon
NHS Sustainable Development Unit
28th March 2012
Environmental Association for Universities and Colleges, York
www.sdu.nhs.uk
Sustainable healthcare?
“Healthcare that meets the needs
of the present…
…without compromising the ability
of others, in future or elsewhere
now, to meet their own needs”
- Adapted from the Brundtland Commission
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Current global drivers
• Demographic – growing / ageing
• Long term conditions / CDM
• Growing / changing expectations of public,
patients and staff
• Triple bottom line health care
– Economic: more value for investment
– More health and social outcomes
– Within environmental limits
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“Climate change causes illness and death
directly and locally…
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…and globally….”
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The time is now
At least 30,000
people died
prematurely as a
result of Europe’s
heat wave in
2003 in France1
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.
and Bhattacharya, S. (October 2003), ‘European heat wave
caused 35,000 deaths’, The New Scientist.
http://www.newscientist.com/article/dn4259
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The best responses:
• Efficiency
– same business model done better
– doing better to earn early wins and buy-in for…
• Transformational change
– different business model
– doing different…models of illness prevention,
health promotion and health care
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Reduce the
carbon
footprint of
operations by
20% by 2012
To empower 60
million people to
make positive
changes to be
healthier and
happier by 2015
Maintain
financial
viability
- Barbier, E.,1987. The Concept of Sustainable Economic Development.
Environmental Conservation, 14(2):101-110.
- Adams, W.M. (2006). "The Future of Sustainability: Re-thinking Environment
and Development in the Twenty-first Century."Report of the IUCN Renowned
Thinkers Meeting, 29–31 January 2006.
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NHS England CO2e footprint 1990 – 2020
with Climate Change Act targets
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Breakdown of NHS England
2010 emissions?
16%
Travel
19%
65%
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Building energy use
Procurement
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0.62
0.27
0.21
Other procurement
0.28
Information and communication
technologies
0.29
Waste products and recycling
0.50
Water and sanitation
0.66
Construction
0.68
Manufactured fuels, chemicals and gases
0.72
Other manufactured products
0.74
Food and catering
1.00
NHS Freight transport
1.78
Paper products
2.00
Medical Instruments /equipment
4.50
Business services
Pharmaceuticals
Procurement Breakdown
5.00
4.38
4.00
3.50
3.00
2.50
1.50
1.61
0.46
Potential reductions
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Mitigation and adaptation
• Mitigation addresses causes, adaptation
addresses consequences
• Mitigation = avoiding the unmanageable
• Adaptation = managing the unavoidable
• Mitigation is the most important part of
adaptation
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Health co-benefits:
“What is good for adaptation to, and mitigation of, climate
change......is ALSO good for health and healthcare”
1. For the public’s health
– More physical activity, better diet, improved mental health,
less road trauma, less air pollution, less obesity/ heart
disease/cancer, more social inclusion/cohesion...
2. For the healthcare system
– More prevention, care closer to home, more empowered /
self care, better use of drugs, better use of information
and IT, fewer unnecessary admissions, better
models of care…
3. For global health inequalities / social justice
– Contraction and convergence, technology leapfrogging
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Why do healthcare organisations
take sustainable development and
climate change seriously?
1.
2.
3.
4.
5.
Save money
Comply with regulation
Improve resilience
Enhance reputation
Improve health
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See notes of this slides for some of the most important specific actions
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Table
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www.sdu.nhs.uk
Results of Public Opinion Survey:
Source:
Ipsos MORI
http://www.sdu.nhs.uk/healthcheck2012
http://tiny.cc/w7fg5
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Views and Values
of NHS Leaders
• Almost nine out of every ten leaders surveyed in the NHS actively
engage with sustainability and believe it is important
• 60% believing it is essential to the running of their organisation
• Easy things:
– Promoting energy efficiency
– Engaging with staff on sustainability
– Implementing travel initiatives
• More challenging:
– Improving infrastructure
– Ensuring sustainable pathways and models of care
– Working with other groups and organisations to achieve more
sustainable results
Source: RAND survey http://www.sdu.nhs.uk/documents/publications/RAND_Europe.pdf
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1. Energy:
Measuring, monitoring, displaying
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2. Travel: Better access to
health care, not more
vehicles:
Default place for health care is the home / local
community
Every unplanned admission is a sign of system failure
until proven otherwise
An infrastructure for a nationwide sustainable transport
system
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3. Using £20bn commissioning / purchasing power
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Within 6 hours, the world’s deserts receive more energy than
the world uses in a year.
http://www.desertec.org/
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Six of the lessons so far...
1. This is a journey: Therefore engagement and a call for
action is crucial: Leaders need to ask, listen, understand
and re-articulate the win-wins, and take exemplary action
2. Don’t focus too much on the environment / climate c– focus
on finances, governance, reputation, resilience and health
3. Focus on win-wins, be positive, and remember to align
change with what is driving large scale societal change
4. Communicating the science is as important as doing the
science. Be honest about risk and uncertainty
5. Measure, compare, track progress, report, in order to help
embed SD within evolving system-wide governance
6. Work on efficiency and transformational (large scale)
change simultaneously; (adaptation / mitigation)
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“I’m afraid you have humans”
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