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Workshop 1: Where to Start. [Team name & date]. NHS sustainable development. Why should the NHS take action?. 2. “We’ll do it better tomorrow, and better still the day after” Improved patient care & experience Nicer place to work Reduced carbon in everything we do and use Resilience.

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workshop 1 where to start

Workshop 1: Where to Start

[Team name & date]

nhs sustainable development
NHS sustainable development

Why should the NHS take action?


“We’ll do it better tomorrow, and better still the day after”

Improved patient care & experience

Nicer place to work

Reduced carbon in everything we do and use


b efore the programme
Before the programme


You should have received this information:

  • Introduction to Sustainable Action Planning (SAP)
    • Why, what, how, who
  • Pre-questionnaire
workshop one
Workshop One



Team agreement on 1-2 issues to tackle first


1. Introduction to environment and health

  • Environment and health
  • Climate change

2. NHS sustainable development

  • Actions for whole Trusts
  • Actions taken by other teams

3. Discussion: priorities for your team

environment and health
Environment and Health
  • A healthy environment is essential to health
  • People need clean air and water
  • Our food and all our material possessions are derived from the world’s natural resources
  • Green spaces are important to physical and mental health
climate change
Climate change
  • One of the biggest threats to a healthy environment today is climate change
  • Warming of the world’s climate system is creating more extreme weather: floods, storms and droughts
  • Health researchers have called it the “biggest global health threat of the 21st century


climate change can affect health directly
Climate change can affect health directly…
  • Malnutrition
  • Deaths and injuries caused by storms and floods. (Flooding can also be followed by outbreaks of diseases, such as cholera)
  • Water scarcity / contamination (droughts and sudden floods) – increased burden of diarrhoeal disease.
  • Heatwaves– direct increases in morbidity and mortality; indirect effects via increases in ground-level ozone, contributing to asthma attacks.
  • Vector-borne disease – malaria and dengue.
but climate change also brings much greater health risks from
…but climate change also brings much greater health risks from
  • Drought
  • Crop failure
  • Economic collapse
  • Mass migration
  • Civil unrest
  • Societal collapse

Health impacts are worse for the poorest in the world

Cumulative emissions of greenhouse gases, to 2002

WHO estimates of per capita mortality from climate change, 2000

Map projections from Patz et al, Ecohealth 2007.

WHO Comparative Risk Assessment estimated that by 2000, climate change that had occurred since the 1970s was causing over 150,000 additional deaths per year (WHO, 2002, McMichael et al 2004)

protecting health from climate change
Protecting health from climate change
  • Adaptation: “managing the unavoidable” = preparing for change

we need to understand the causes for this…


Mitigation: “avoiding the unmanageable”= tackling the causes of climate change

mitigation tackling the causes of climate change
Mitigation: tackling the causes of climate change…

350 million years-worth of carbon locked away in fossil fuels – now being released

150 years

100 years

50 years


240,000,000 home PCs

650,000,000 cars

4,800,000,000 passenger flights

4,000,000,000 bulbs pa EU+USA alone (that’s 126 a second)

First Oil Well

4142 cars, 10 miles concrete road in US

First commercial jet ticket

Domestic light bulb

livestock farming accounts for 18 global emissions
Livestock farming accounts for > 18% global emissions

Mitigation: tackling the causes of climate change...(2)

health co benefits of mitigation
Health “co-benefits” of mitigation

Leading doctors worldwide have called for governments to act decisively on climate change

“Politicians must heed health effects of climate change.” BMJ 2009;339:b3672


  • Many actions to reduce greenhouse gas emissions which cause climate change are good for health!
    • Active travel
    • Eating less meat and dairy
    • Clean energy
    • Family planning
what is sustainable development
What is sustainable development?

Development that meets the needs of the present without compromising the ability of future generations to meet their own needs.





sustainable development meeting environmental needs
Sustainable developmentmeeting environmental needs


  • Climate change / carbon
  • Resource depletion
    • Water
    • Fossil fuels (plastic etc)
  • Biodiversity




nhs sustainable development2
NHS sustainable development

Why should the NHS take action?

Your answers?


  • Andy Williamson, Chair – GSTT Kidney Patients’ Association:

“As a kidney patient, I’m acutely aware of my own vulnerability to climate events, and my dependence on drugs and dialysis equipment which rely on cheap oil for their availability.”

June 2009

nhs sustainable development3
NHS sustainable development

Why should the NHS take action?


“We’ll do it better tomorrow, and better still the day after”

Improved patient care & experience

Nicer place to work

Reduced carbon in everything we do and use


nhs carbon footprint procurement
NHS carbon footprint Procurement

“things in lorries”

nhs sustainable development4
NHS sustainable development

What should NHS Trusts be doing?

What can’t be done at Trust level?

NHS Carbon Reduction Strategy


Energy & carbon

Procurement & food




Designing built environment

nhs sustainable development5
NHS sustainable development

What can specialties and clinical teams do?

procurement / consumption


  • Clinical practice
    • prevention, supporting patient self care
    • preparation for health effects of climate change
  • Local systems
    • energy, travel, water, waste
    • medical supplies (drugs & equipment)
    • non-medical supplies (e.g. food, laundry, paper)
    • improvements in the way we do things
what kind of actions can we take current waste estimated loss
What kind of actions can we take?Current waste - estimated loss (£)

Reducing waste to yellow bags

Return drugs process

Mis-labelled path lab tests




action energy
Action: energy


Switch off campaign to reduce unnecessary lighting

action transport
Action: transport
  • Improve communication with ambulance service – reduce aborted journeys
  • Cost of aborted journeys
action water
Action: water
  • Recovery of waste water from purification unit
  • Capital investment £14,000
  • Annual saving £7-8,000
  • 38% reduction in mains water use
  • Carbon reduction
      • 177g/m3 water
      • 322g/m3 sewerage


action medical supplies
Action: medical supplies
  • Significant reduction in packaging
  • Reduced deliveries 50% (mileage)
    • More concentrated solutions: smaller volumes needed
  • Reduced costs by £11,000 a year
  • Changed suppliers for greener products
action food
Action: food
  • Discussion with catering staff, paper menus
  • Food waste reduced from 35% to 15%
  • Cash saving: approx. £4,000/y (£2 per sandwich)
  • Carbon savings from:
      • Growing
      • Cooking, preparing, packaging
      • Transport
      • Waste disposal
  • Happier patients!
which of these matter to you
Which of these matter to you?





visitor travel


dialysis products

staff commuting


patient transport

number of appointments


climate risk

waste segregation




air conditioning




green spaces


where are you today
Where are you today?
  • What are you most concerned about personally?
  • What are the other priorities for the team?
  • What are your team’s biggest environmental impacts likely to be?
  • What can you influence?




1 – 2 areas to tackle first (in Workshop 2)

Keep a list of other areas (to tackle later)

next time workshop 2
Next time – Workshop 2


A sustainable action plan!

Plan for ongoing improvement


1. Exploring your chosen areas:

  • Describing how the process works today
  • Brainstorming problems and ideas

2. Actions

3. Ongoing improvement

  • Managing implementation and monitoring