Welcome to Embedding Sustainability in Health and Social Care · Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009)

Follow us on Twitter: @SouthRSHN #SRSHN Follow us on Twitter: @SouthRSHN #SRSHN

Welcome to Embedding

Sustainability in Health

and Social Care

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use #SRSHN in tweets

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OPENING COMMENTS

James Mapstone and Caroline Jessel – Leads for the South Region Sustainability and Health Network






Welcome

Caroline Jessel Clinical Transformation and Outcomes Lead

Sustainability and Health Lead NHS England South





Follow us on Twitter: @SouthRSHN #SRSHN

HOUSEKEEPING

• No fire drill expected • Phones on silent please • Catering and market place • Workshops • Twitter: @SouthRSHN and use #SRSHN in

tweets • WIFI log in details: Network: At-Bristol-Events

Password: Max-hertZ!WE11









AGENDA FOR THE DAY

10:00 M

arke

t P

lace

Opening comments

James Mapstone and Caroline Jessel – Leads for the SRSHN

10:15 Sustainable NHS England priority programmes

Nigel Acheson – Regional Medical Director NHS England

11:00 Workshops: Each will run twice allowing you to attend two of the four

12:15 Keynote address: Why embed sustainability?

David Pencheon – NHS and PHE Sustainable Development Unit 12:45 Lunch and market place

13:45 Workshops: Each will run twice allowing you to attend two of the four

15:00 Climate change and the public health agenda

Stephen Morton – National Lead for Sustainability and Health

15:30 Panel question time – Caroline Jessel, James Mapstone, Stephen Morton and David Pencheon

15:50 Closing remarks – James Mapstone and Caroline Jessel

16:00 Tea and networking




Introduction

James Mapstone Deputy Regional Director






Welcome




Public health and sustainability




PHE overall emissions




PHE business travel










SUSTAINABLE NHS ENGLAND

PRIORITY PROGRAMMES

Nigel Acheson – Regional Medical Director NHS England





www.england.nhs.uk

Sustainability for NHS England- our Priority Programmes

October 14th 2015

Nigel Acheson Regional Medical Director (South)

15

www.england.nhs.uk

1. Obesity

2. Population living longer with more long term conditions

3. Mental health –parity of esteem

4. Dementia – rising numbers although age related prevalence is falling

5. Financial challenge – 22 billion gap

6. Social care funding and Better Care fund

Context

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www.england.nhs.uk

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Transactional 1. Vanguard programmes 2. Right Care – avoiding waste and ensuring all interventions

are based on evidence

Transformational 1. Personalised medicine – 100,000 genome project 2. Better use of technology

Patient centred and co-designed 1. Focus on Prevention 2. Self care and personalised health budgets 3. Investment in mental health and integration of services 4. Strengthening community resilience and use of the

voluntary sector

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Potential solutions

www.england.nhs.uk

18

Transactional change – doing things better

www.england.nhs.uk

19 19

The aggregation of marginal gains

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“If a mechanic sticks a tyre on, and someone comes along and says it could be

done better, it’s not an insult – it’s because we are always striving for

improvement, for those 1% gains, in absolutely every single thing we do.”

Sir David Brailsford; Coach British Cycling Team

www.england.nhs.uk

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Transformational change – doing better things

www.england.nhs.uk

21 21

"Yelena Slesarenko jumping 2007" by I, Bjarteh. Licensed under CC BY 2.5 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Yelena_Slesarenko_jumping_2007.jpg#/media/File:Yelena_Slesarenko_jumping_2007.jpg

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www.england.nhs.uk

Five Year Forward View Focus on Prevention

www.england.nhs.uk

• Health and wellbeing are the work of a lifetime • They do not happen by chance • Health must be promoted all through life

Good education

Strong community

Decent housing

The building blocks of good health

Sense of Purpose

Meaningful work

Adequate income

Safe Environment

Individual behaviours

We know what we need for good health

www.england.nhs.uk From the Global Burden of Disease report 2014

Overweight & obesity

Top 10 contributors to years of life lived with disability

…and these align with the

immediate causes of ill health…

www.england.nhs.uk

Obesogenic lives?

www.england.nhs.uk

“The potential benefits of physical activity to health are huge. If a

medication existed which had a similar effect, it would be regarded as a ‘wonder drug’ or ‘miracle cure’.” Liam Donaldson, Annual report of the Chief Medical Officer, 2009

www.england.nhs.uk

National diabetes type 2 prevention programme

Solutions

7 demonstrator sites Evidence review Consultation National roll out

The Challenge 22,000 people with diabetes die every year Leading cause of preventable sight loss, kidney disease, heart disease and stroke Costs £8.8bn per year (9% health budget) Obesity major cause of type 2 – XS sugar principally

27

www.england.nhs.uk

28

Solutions

What about sugar and poor nutrition?

School diets

Levels of inactivity

Culture around food –fast food, family meals etc

The Challenge

Can we tackle this issue by screening and individual behaviour change?

What other interventions have been shown to work?

www.england.nhs.uk

Planning places with people • National Planning Policy Framework. • Public Health England – Healthy People, Healthy Places

*

https://www.gov.uk/government/publications/national-planning-policy-framework--2

https://www.gov.uk/government/news/healthy-people-healthy-places-building-a-healthy-future




http://www.tcpa.org.uk/data/files/TCPA_FINAL_Reuniting-health-planning.pdf

http://www.tcpa.org.uk/pages/reuniting-health-with-planning-phase-2-project.html

http://www.tcpa.org.uk/pages/planning-out-obesity-2014.html

www.england.nhs.uk

https://www.gov.uk/government/publications/obesity-and-the-environment-briefing-increasing-physical-activity-and-active-travel

www.england.nhs.uk 31

The NHS RightCare Approach Helps health economies to link outcomes with spending on healthcare. Where outcomes are poor, it can help to drive improvements that increase the quality of care and reduce costs. Drives efficiency and helps to build a sustainable health economy.

www.england.nhs.uk

RightCare Process

www.england.nhs.uk

• An estimated 674000 people in England have dementia –likely to grow

• I in 3 people will care for someone with dementia in their lifetime

• Annual cost is £23bn – set to triple by 2040 • Ambition is to make Britain the best place in world to

receive dementia care by 2020 and the best for research

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The dementia challenge


Dementia villages

www.england.nhs.uk

• 100000 genome project- one size doesn’t fit all • Improved prevention and earlier intervention • Less invasive care – less carbon too • More precise diagnosis – more targeted intervention • Patient in control – can use budget to access the

most suitable treatment for them –in some cases this might mean improved home insulation, or access to a social group rather than an operation

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Personalised medicine and personalised health budgets


Examples of excellence in the region

www.england.nhs.uk

• Brighton –social prescribing, happiness strategy, green spaces and gardening for all

• Plymouth university sustainability and health group –excellence in teaching and research

• Wiltshire – air quality programme • Kent- sustainability JSNA • South Devon and Torbay CCG –offsetting • Sussex Community NHS Trust Care Without Carbon

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More examples

www.england.nhs.uk

Any questions?

Nigel Acheson [email protected] @AchesonNigel

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Thank you for listening

mailto:[email protected]


WORKSHOPS

Each workshop will run at 11am and 11:40 am

• Sustainability and social prescribing: Main hall

• Supporting health and sustainability through food: Francis Crick

• Energy efficiency audits for NHS trusts: Maurice Wilkins

• Building alliances and achieving momentum – Lessons from Bristol: James Watson




WHY EMBED SUSTAINABILITY?

David Pencheon NHS and PHE Sustainable Development Unit





Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk

Embedding sustainability into all we do David Pencheon Sustainable Development Unit NHS England and Public Health England

14TH OCTOBER 2015, BRISTOL, UK SRSHN - Embedding Sustainability in Health and Social Care Conference.


Why this is core for some people and organisations…not an add-on

1. aligns with saving money, saving resources… 2. aligns with emerging law, regulations, policy, and

expectations: a) CCA04, CCA08, PS(SV)12, Adaptation Reporting… b) 5YFV: prevention (diabetes), partnership, de-hospitalising care,

empowering patients/staff with tech’, MUCH better models of care…

3. improves resilience of systems and models of care 4. empowers people, and communities 5. reputation: sets a powerful example from trusted

professionals 6. improves health, holistically, now 7. aligns with values of staff…. ?and organisations / systems


Embedding in…governance

1. Civil Contingencies Act 2004

2. Climate Change Act 2008

3. Public Services (Social Value Act) 2012 – (Chapter 3)...requires public authorities to have regard to

economic, social and environmental well-being.

• The NHS Constitution...

• Public Health, NHS and Social Care Outcomes Framework

• NHS Standard Contract

• Expectation to formally report on progress (as in financial reporting)


Embedding in…quality 1. Compassionate [being kind, caring, and treating people with

dignity]

2. Effective [employing the very best techniques systems known to work]

3. Safe [doing no harm]

4. Efficient [using the least resource that ensures the best outcome]

5. Fair [prioritising actions and investment where social justice maximised]

6. Sustainable [ensuring addressing today’s needs and assets that doesn’t prejudice doing the same tomorrow]

S Atkinson, J Ingham, M Cheshire, and S Went. Defining quality and quality improvement. Clinical Medicine 10 (6):537-539, 2010


Embedding in…commissioning

S Atkinson, J Ingham, M Cheshire, and S Went. Defining quality and quality improvement. Clinical Medicine 10 (6):537-539, 2010


A Guide to Sustainable Development for Clinical Commissioning Groups - The Royal College of General Practitioners in conjunction with the Sustainable Development Unit developed this guide for CCGs to help them understand the case and some practical considerations for embedding sustainability in how they commission services. www.sduhealth.org.uk/areas-of-focus/commissioning-and-procurement/commissioning.aspx

http://www.sduhealth.org.uk/areas-of-focus/commissioning-and-procurement/commissioning.aspx










Embedding in… …saving money

…improved patient experience …staff morale


Embedding in …health and its

causes


30,000 early deaths across the UK per annum attributable to air pollution. (60,000 if NOx from diesel engines included) Average 8 month loss of life for every person Especially lung disease and stroke


Embedding in… …ethics, values, and social justice


The world map reflecting production related to climate change. “Climate

Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009).

Who produces the greenhouse gases?


Who bears the burden?

The world map reflecting mortality related to climate change. “Climate

Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009).



Fair Society, Healthy Lives 1. Tackling health inequalities means tackling climate

change – locally and globally

2. Understanding that economic growth is not the most important measure of our country’s success.

3. Prioritising policies and interventions that reduce both health inequalities and mitigate climate change: i. sustainable and resilient local communities

ii. active transport

iii. sustainable food production

iv. good quality green spaces across the social gradient

v. zero-carbon housing will have health benefits for all


Making this actually happen needs…

• Reward systems to incentivise substantial cobenefits

• Leadership that can think and act for the long term

• Engagement of staff, public, policy makers, politicians in well framed and well evidenced business cases


www.sduhealth.org.uk/sds

http://www.sduhealth.org.uk/sds

Enable the positives

Reduce the negatives

“Sustainable, resilient, healthy, places and people” NHS England and PHE, Jan 2015


Embedding sustainability into all we think, plan, do and deliver ensures good health

and wellbeing today and tomorrow

Environmental sustainability: Living within

planetary limits

Social sustainability:

Healthy and resilient people

and communities

Economic sustainability:

Fair and sustainable economic

system

Sustainable Health and wellbeing

Head in the sand…or…..line in the sand?


LUNCHTIME AND MARKET

PLACE

Workshops begin again at 1:45 pm






WORKSHOPS

Each workshop will run at 1:45pm and 2:25pm

• Clinical leadership for sustainability: Main hall

• Making sustainable connections in social care: Frances Crick

• System transformation thriving in a changing world: Maurice Wilkins

• System resilience and adaptation: James Watson




CHRIS DUNFORD

Sustainability Engagement Manager





Energy

Energy

Energy

Energy

Energy

Energy

Energy

Energy reduction since 2010

743,000 kilowatt hours of electricity and

390 tonnes of carbon dioxide per annum

Energy

X 242

Energy

Energy reduction since 2010

Energy Reduction Group

Behavioural measures

Technological measures

Energy

Energy

Water

Green roofs

Rainwater harvesting

Reduction measures

Water

Procurement

Waste

Reduction

Re-use

Re-sale or donation to charity

Recycling

Reduction of volume – baling

Waste

Travel

Monitoring

Cycle parking, pump and showers

Public transport drop off points

Public transport promotions

Travel

Travel

Nature

Nature

Nature

Social

Access, Inclusion, Diversity

Community Engagement

Investors in People Award

Education and Engagement

Awards

Gold Green Tourism Award 2011 & 2014

Winner Destination Bristol Sustainable Tourism Award 2013

Silver South West Sustainable Tourism Award 2012 & 2015

Highly Commended Visit England Sustainable Tourism Award 2013

Bronze Visit England Sustainable Tourism Award 2015

10:10 Campaign

West of England Carbon Champions 2011, 2012, 2013 & 2014

Key role in the city – Bristol 2015

Green lighting effects, all spaces, January to December

Honey bee mural, Anchor Square, from February, permanent

Energy Tree, Millennium Square, from April, permanent

Wildflower Truck, Anchor Road, May only

Wildflower Meadow, Millennium Square, from May, temporary

Tap into Bristol, Millennium Square, from June, permanent

Bristol Whales, Millennium Square, 17 July – 31 August

20:20 Vision, Millennium Square, 21 July - 4 September

Chris Dunford

Sustainability Engagement Manager

01179157184 / 07967334184

[email protected]

Questions or comments


CLIMATE CHANGE AND THE

PUBLIC HEALTH AGENGA

Stephen Morton National Lead for Sustainability and Health





Climate Change and Public Health

Stephen Morton, Programme Director, Sustainability for Public health Benefits Bristol; October 2015

Sustainability for Public Health Benefits

Purpose:

The programme will enable PHE to develop a clear approach to sustainability as an underpinning principle to deliver all of its work, linking it, with strategic priorities such as chronic non-communicable diseases, environmental protection and asset based community development.

Sustainability for Public Health Benefits

PHE Work on Climate Change, Sustainability potentially linked to Public Health Climate change and extreme events (heat, cold and floods)

Sustainable Development Management Plan

Healthy people, healthy places (housing, transport, green space…)

Pollution, air quality, waste disposal/incineration

Blue-green algae, water supply

Obesity, nutrition, physical activity

Health inequalities, best start for children

Social networks, dementia, limiting long term conditions

Vision Statement

A future where everyone, wherever they live, is able to live, work and play in a place that promotes health and wellbeing, sustains the development of supportive and active communities and helps reduce health inequalities. In short, “Healthy places to grow up and grow old

in”.

Healthy People, Healthy Places Programme

Key Aim for the year: Almost all local PH depts are engaged in spatial planning and health

Health and Place

National Planning Policy Framework • Promoting Healthy Communities - The

planning system can play an important role in facilitating social interaction and creating healthy, inclusive communities. Source: DCLG (2012)

National Planning Practice Guidance - Health • Local planning authorities should ensure

that health and wellbeing, and health infrastructure are considered in local and neighbourhood plans and in planning decision making. Source: DCLG (2014)

Planners and public health staff

BMI projections

Physically active adults, 2012 • Percentage of people

doing at least 150 “equivalent” minutes of at

least moderate intensity physical activity per week

• Percentages varied from 44% in Kingston upon Hull to 69% in Windsor and Maidenhead

• England = 56%

Source: PHOF. Health protection, Indicator 2.13i – Percentage of physically active and inactive adults - active adults

Climate Change


Source: IPCC AR5, Working Group 1, Climate Change 2013: The Physical Science Basis

Our future climate

IPCC Climate Change 2013 The Physical Science Basis.

http://www.climatechange2013.org/images/report/WG1AR5_ALL_FINAL.pdf

http://www.climatechange2013.org/images/report/WG1AR5_ALL_FINAL.pdf

Direct and indirect health effects, including

• Impact on health services – demand, business continuity, supply chains

• Impact on infrastructure

(utilities) • Economic impacts

• Community

resilience/cohesion

Heat 1,974

3,281

7,040

12,538

0

5000

10000

15000

20000

2000s 2020s 2050s 2080s

A: Heat deaths

Source: Hajat et al. (2014) Source: ARUP (2014b)

Source: Zero Carbon Hub (n.d.)

Heat deaths

Heat and cold-related mortality

Hajat S, et al. J Epidemiol Community Health 2013;0:1–8. doi:10.1136/jech-2013-202449

Flooding UK winter 2013-14 wettest on record: 7,800 homes, 3,000 commercial properties were flooded.

Immediate effects • Drowning • Physical trauma • Other health effects

Later • Mental health impacts • Carbon monoxide poisoning • Skin & gut infections • Respiratory disease • Rodent-borne disease

‘EXTREME’ WEATHER IN THE UK

2000 – flooding 2001- flooding 2003 – heatwave 2005 - flooding 2006 – drought 2006 - heatwave 2007 – flooding 2008 – flooding 2008 – snow and ice 2009 – snow and ice

2009 – flooding 2010 – flooding 2010 – snow and ice 2011 – warm spring 2011 – warm autumn 2012 - drought 2012 – wet summer 2013 – snow and ice 2013 – heatwave 2014 – flooding

Alex Nickson, GLA

UK adaptation policy cycle

Source: Committee on Climate Change (2015b)

UK progress in reducing emissions

Source: Committee on Climate Change (2015a). Data based on DECC Provisional UK greenhouse gas emissions national statistics 2014, CCC calculations.

UK GHG emissions against legislated budgets and 2050 target (MtCO2 e)

Global problem requiring multiple responses

Source: Committee on Climate Change (2015a)

Determinants of health

Barton, H. and Grant, M., (2006) A health map for the local human habitat, Journal of the Royal Society for the Promotion of Public Health, 126 (6) pp252-2

Source: Sustainable Development Unit (2014)

Sustainable development

• Reduce the harmful impacts of how we live

• Enable a transformation in the environment, society, health and wellbeing

The Lancet Commission on Health and Climate Change, June 2015

Source: 2nd Lancet Commission on Climate Change and Health (Watts et al., 2015)

Mitigation co-benefits


All the water in the world (1.4087 billion cubic kilometres of it) including sea water, ice, lakes, rivers, ground water, clouds, etc., on a single sphere. In the same scale, on the right, all the air in the atmosphere (5140 trillion tonnes of it) gathered into a ball at sea-level density.

The Ehrlich Equation The Arithmetic of Growth

I = environmental impact(I) P = population

A = Affluence T = Technological intensity

I = P x A x T

For example, carbon dioxide emissions are given by the product of population (P) times income (measured as dollars of GDP/person) times the carbon intensity of economic activity (measured as gCO2/$):

C = P x $/person x gCO2/$

Acknowledgement to Tim Jackson; Prosperity without Growth (2009)

The Ehrlich Equation The Arithmetic of Growth

In 1990, when the population was only 5.3 billion and the average income was $4,700 but carbon intensity was860 gCO2/$, total carbon dioxide emissions C were given by:

5.3 x 4.7 x 0.87 = 21.7 billion tonnes of CO2.

For the year 2007, when the global population was about 6.6 billion, the average income level in constant 2000 dollars (at market prices) was $5,900, and the carbon intensity was 760 gCO2/$, we find that the total carbon dioxide emissions C were:

6.6 x 5.9 x 0.77 = 30 billion tonnes of CO2.

Acknowledgement to Tim Jackson; Prosperity without Growth (2009)

The Triple Bottom Line

Environment

Social Wellbeing

Economy


Environment

Social Wellbeing

Economy


Environment, Economy and

Wellbeing

UN Sustainable Development Goals No poverty

Zero hunger

Good health and well-being

Quality education

Gender equality

Clean water and sanitation

Affordable and clean energy

Peace, justice and strong institutions

Partnerships for the goals

Decent work and economic growth

Industry, innovation and infrastructure

Reduced inequalities

Sustainable cities and communities

Responsible consumption and production

Climate action

Life below water

Life on land

Best Buys for Sustainability and Public Health Benefits

Active Travel

Air quality, greenhouse gases, childhood obesity, social networks…

Urban Green Space

Heat islands, mental health, children and nature, aging well…

Energy Efficient Homes

Excess winter morbidity, greenhouse gases, fuel poverty, heat-wave resilience….

Acknowledgements

Contributions of slides or content:

• Angie Bona, Head of Extreme Events and Health Protection

• Sotiris Vardoulakis and PHE Air Pollution and Climate Change Group

• David Pencheon (Sustainable Development Unit)

• Carl Petrokovsky and the PHE Healthy People Healthy Places Group


PANEL QUESTION TIME

Caroline Jessel, James Mapstone, Stephen Morton and David Pencheon






CLOSING REMARKS

Caroline Jessel and James Mapstone






THANK YOU

Tea and coffee is available in the market place before you head home





Documents

Welcome to Embedding Sustainability in Health and Social Care · Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697 pp 1659-1734, May 16-22 2009)