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Welcome to the London NHS
Sustainability Day 2016 Road Show
#Dayforaction
Chair’s welcome and introduction
Fiona Daly, Associate Director of
Sustainability and Patient Transport,
Barts Health NHS ...
Inspiring us in all that we do
Duncan Selbie, Chief Executive, Public
Health England
#Dayforaction
Filling the gap
Options for a sustainable UK
health and social care system
Adam Roberts
Head of Economics
February 2016
5
Public spending on health in the UK, in real terms
and as a percentage of national income (GDP)
6
Publicly funded health care spending as a share of
GDP
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Luxembourg
Ireland
Portugal
...
Annual change in total NHS spend in England
2009/10 to 2020/21 (2015/16 prices)
7
Estimated public spending on health in the UK as
a percentage of GDP, 2015/16 to 2020/21
8
9
Annual change in hospital productivity index
10
Total reported surplus / deficit of NHS trusts, 2012/13 to Q3 2015/16
11
Number of NHS trusts in deficit in 2012/13 to Q3 2015/16
12
Number of Training Places commissioned for
clinical staff 2004/05 to 2014/15
0
2,000
4,000
6,000
8,000
10,000
12,000
14...
13
The public-private hourly pay differential for
workers with similar characteristics
14
Social care spending 2009/10 to 2019/20, real
annual changes
15
Number of clients receiving services (community-based services,
residential care or nursing care) provided or commissio...
16
Need for and receipt of help with ADLs in the
last month, by equivalised household income
and sex, HSE 2014
17
Relative growth in projected spending pressures
and budget for UK publicly funded health and
adult social care
0.8
1.0
...
18
Relative funding gap for health and
adult social care in 2030/31
19
Potential funding gap for adult social care in 2019/20
20
Support for increased tax
21
Total tax revenue as a percentage of GDP in 2012
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Ireland
Portugal
Spain
Unite...
22
Cost of closing gap through taxation
Lower income tax rate
Higher income tax rate
23
Cost of closing gap through taxation
VA
T20%
23%
Keep in touch
24
Visit our website at www.health.org.uk
Subscribe to our monthly email newsletter at
www.health.org.uk/new...
C
Working together in the Public Sector
to improve Carbon & Energy Performance
Martyn Jeffery CEng MIHEEM
CEF TRUSTEE
C
The Carbon and Energy Fund
“Launched by Greg Barker MP at IHEEM in 2011 the Carbon and Energy Fund
(CEF) is a co-creatio...
C
CEF has been created for the Public Sector to:
 Transfer risk to whom is best to manage it, principally the Private Sec...
C
The Carbon and Energy Fund
In contract:
 Capital committed: £118m
 Guaranteed savings per annum: £24m
 Guaranteed car...
C
Introduction The CEF are more than just a provider of funding
• Nifes
• Jacobs
• Attest
• SKM
• Carbon Trust
•Renew Lega...
C
Procuring with the Carbon and Energy Fund
The CEF Process has been developed through pilot projects and
provides a robus...
C
Typical CEF Project
Acting as the clients advisor/partner the CEF provides the component parts necessary to
make an ener...
C
CEF Contract Overview V4
Unitary or Fixed
Guaranteed
Energy
Savings
Potential
Uplift in Savings
Time (Yrs)
Value(£k)
C
Funding options and balance sheet treatment
“The CEF is 90% of the NHS Energy Efficiency Finance Market” say The
Green I...
C
The CEF Family
C
Tranche 5
The Contractors on the Framework
• Ameresco (previously ESP)
• Bilfinger
• Bouygues
• Breathe (part of MCW)
• ...
C
Tranche 5 remaining
• March Mater Hospital; Hull
• April Nottingham City Hospital; Dorchester
• May Basildon and Thurroc...
C
Chase Farm Hospital
External view – end of phase 1
C
Chase Farm Hospital
Long Term Expansion Opportunities
C
The Trust Vision
• An energy services partner that will support the development
• Long term strategic management of the ...
C
Energy Supply Strategy
• Suitable technologies
• Partnership / opportunities / access to expertise
• Reducing impact of ...
C
Investment Objectives
• Robust infrastructure, security of supply and resilience
• Meet a tight timescale for completion...
C
The NHS Improvement (“TDA”) &
Energy Service Performance Contracts
“Energy Services Performance Contracts (“ESPCs”) are ...
C
NHS Trust Approval Pathway & NHSI
These services are
either provided by
the client or are
outsourced
Financial Value of ...
C
NHS Project Governance and CEF Fit
Membership
Contract Close Construction
Invitation to Tender (“ITT”)
Performance Contr...
C
Changes to the 2015/16 Capital Regime and
Investment Business Case Approvals Guidance
• A recognition of Energy Service ...
C
Contractual arrangements
• Started life based on NHS Standard Form PFI contract v3
• Second CEF framework updated it to ...
C
Contractual arrangements (cont.)
• Standard route is restricted route procurement, shortlisting at least
three bidders a...
C
Questions
CMO Kim Sandholdt
Your supply chain
Your responsibility
Your
company
Customer Customer Customer
Your
company
Customer Customer Customer
Your
company
Customer Customer Customer
Your
company
Customer Customer Customer
Investors
Guidelines
Legislation
Your
company
Customer Customer Customer
Investors
Guidelines
Legislation
Your
company
Customer
Investors
Guidelines
Legislation
Customer Customer
Show
compliance
Your
company
Customer
Investors
Guidelines
Legislation
Customer Customer
Your
responsibility
Your
company
Customer
Investors
Guidelines
Legislation
Customer Customer
Human Rights
Labour(child)
Environment
Anti-Corru...
Does this concern
your company?
In a Survey from 2012,
Deloitte reported that an
estimated 85% of global
supply chains had
experienced at least one
hyper-...
A study by Ernst & Young
from 2014 shows that 45
percent of all the
proposals that were
asked by investors to
company boar...
The global
sustainability agenda is
formed by mega drivers
and will significantly
impact all companies
All
Is it worth it?
A recent international study
by the danish bank Nykredit
shows that companies given
the highest sustinability
score, on av...
Several studies indicate,
that it is much easier to
attract skilled labour for
companies that
downplays the economic
aspec...
Isn't it just a hype?
Gartners Hype cycle
From control to collaboration
From legal disclaimer to proactive performance
management
From reputation to innovation
New ...
CSR issues are moving to business innovation
Partnership building between business, governments
and NGOs.
Due diligence st...
New opportunities
Creating better sustainability
performance will create value
to your business
Demonstrating transparency...
That is why we have created
the Aperitas solution
Challenges identified by our
customers
Excessive resources are spend on
collecting sustainability data from
supply chains
...
Procurement
Suppliers
CSR
Procurement
Suppliers
QACSR
Procurement
Suppliers
CSR
Procurement
Suppliers
QA
Weak integration
of QA and CSR
requirements
Limited knowledge about
QA and CSR facts in
supply chains
QACSR
Procurement
Su...
Procurement
CSR QA
Aperitas
Platform
Suppliers
RSCM
must be an integral part of the
company
Knowing
your
suppliers
Procurement
CSR QA
Aperitas
Platform
Suppliers
Efficient operationalization of strategies
Easy and efficient gathering of
...
Collect Analyze Create
Analyze
Create
Concluding remarks
The global sustainability agenda is formed by mega
drivers and will significantly impact all companies
...
aperitas.com
ks@aperitas.com
Learn more on:
Chris Large
Partner at Global Action Plan
Changing Lives in
East London
• Largest NHS Trust in the
country
• Serves 2.5M people
We help people to limit
environmental damage
Schools Businesses Communities
Brendan Rouse – Estates Manager, Energy & Sustainability
Operation TLC at GOSH
Why Operation TLC suited Great Ormond Street
• Staff and visitors expect GOSH to be a resource efficient
organisation
• Ef...
Gaining support
• Traditional business case presented to Finance Board -
0.8 year payback.
• 6 ward trial set up after gai...
Year 1 – Three Projects
• Lighting project carried out in all 26 inpatient wards
• Heating campaign in all areas of the Tr...
Understand
Change
Evaluate
Share
• Feedback results
• Celebrate success
• Barriers &
motivators
• Training
• Embedding
act...
Motivator - The child
first and always
Training & Barriers
Evaluate
Energy Data - 5% reduction in ward energy use
Surveys – 19% more staff turning lights off
17% increase in lightin...
Our Volunteers
Peter and Val
Observing & Training
"I felt like an angel! I was so concerned with one of the senior nurses,
she was in a tiny room and it was so hot inside!....
Feedback & Sharing Results
Roundabout
Carbon Culture
Newsletter
Posters & Flyers
Screensavers
Face to face
Celebrating Success
Understand
Change
Evaluate
Share
• Feedback results
• Celebrate success
• Barriers &
motivators
• Training
• Embedding
act...
SUCCESSES - Cost and Carbon Savings
• Increased natural light in mental health patient rooms
resulted in 3.7 day shorter hospital stay on average (AHRQ, 2005)...
SUCCESSES
Better patient experience and staff fulfilment
Design of a behaviour change programme
What can staff do to save energy?
How often do staff do those actions already?
What...
How did people
save energy?
Natural Light
QUIET
TIME
NIGHT
MODE
HIGH
ENERGY
AREAS
BUILDING
AWARENESS
How did people save energy?
What encouraged and enabled people to act?
PATIENTS
PEOPLE
PLANET POCKET
Patient – Staff – Estate
Triangle
What encouraged and enabled people to act?
How did we measure the impact and savings?
PATIENT
SURVEY
METER
DATA
LIGHT
METERS
SPOT
CHECKS
From energy saving to better relationships
Help is at hand to run your own Operation TLC
Scope
• Quantify
energy waste
• Create
business case
• Engage clinical
leade...
What advice would we share?
Top 3 tips
Be specific. Saving energy is abstract.
Opening the curtains and turning off the li...
Chris Large
Partner at Global Action Plan
chris.large@globalactionplan.org.uk
@chrislarge1
Refreshments and
networking
#Dayforaction
Welcome back
David Pencheon OBE, Director, SDU
#Dayforaction
‘Buying for the Long Run’
Sustainable Procurement
David Picton
25 February 2016
• Tarmac Group – De-Merged in 1999
− Tarmac, Wimpey, Cubitts and Mitchell Construction
• Further Acquisitions:
− Mowlem (2...
123
Maintenance
Utilities
Facilities
Defence Infrastructure
Rail
Health
Education
What Do We Do ?
Carillion’s 6 Positive Outcomes
Sustainability 2020
Challenges
• ‘Triple Bottom Lines’
• Economic Responsibility
• Environmental Responsibility
• Social Responsibility
• Repu...
Reputation – Role of the Supply Chain
Delivery Through Other Companies
• Supplier accreditation and risk management
• Audi...
Supply Chain Risk
“… firms are placing not only their financial security, but their reputations in the
hands of suppliers ...
Supply Chain Sustainability School
Collaboration (noun):
… working with another or others on a joint
project to achieve sh...
Supply Chain Sustainability School
Skills Focus for the Full Built Environment
• Free Virtual Learning Environment
− Suppo...
• £335M capital cost, 3 year build – plus £100M support services, 30 year concession
• One of the largest all single-bed h...
• Phased and staged packages of procurement
• Preferred supplier base – pre-accredited suppliers
• ‘Meet the Buyer’ events...
Nottinghamshire University Hospitals Trust
• Nottinghamshire University Hospitals Trust
• Patient Meals – App and tablet b...
‘Buying for the Long Run’
Sustainable Procurement
David Picton
25 February 2016
Sustainable, nutritious
and tasty hospital
food?
Alexandra Hammond
Associate Director, Sustainability
IMAGINE…
Hospital food
140
143
144
149
Food recycling
• Partnership with waste team to eliminate waste
• Locally reprocessed into compost
• Collected from wards,...
Weighing and understanding waste
an NHS first
Award winning waste management programme
The best healthcare runs
efficiently, uses resources
wisely, fosters healthy living
and provides patients with the
best po...
Special thanks to the catering and hospitality teams!
Alexandra Hammond
Associate Director, Sustainability
alexandra.hammond@gstt.nhs.uk
@alexandrajhr
156
www.trakeo.com
Supply chain
carbon and
sustainability
platform
www.trakeo.com
www.trakeo.com
www.trakeo.com
www.trakeo.com
www.trakeo.com
www.trakeo.com
➢ Rationalisation and consolidation of freight.
➢ Purchasing efficiencies.
➢ Cooperative solution propositi...
Sustainability
Resource Efficiency through Segregation
Presented by Jide Lawal and Earl Mensah
Aggressive on Waste
For a s...
Who are we
 Established in 2008
 Kwik Sweep is a waste management company
specialising in the removal of junk and bulky
...
“Aggressive on Waste for a Sustainable Future”.
Our services
 Home, office and junk clearances
 Refits clearance
 Construction/canteen waste removal
 Events clearance...
Our commitment to our
client
 Health and Safety
 Customer service
 Quality
 Flexibility
 Reliability
Clients
NHS Erith demolition
Brent Council
Amazon Westway Development Trust
Cluttons
Amazon
Brent Council
Policy
Key Environmental Objectives
 To reduce the amount of waste sent
to landfill
 To promote the 3 R’s (reduce, reuse...
Our service work within the
Health Sector
 Great Ormond Street Hospital (GOSH) is an
international centre of excellence i...
Segregation
 Toolbox talk
 On site Training
 Staff engagement
 Safety
Segregation
Environment Manager Epsom and St Heliers
Hospital Trust
“One of the benefits that we have gained is that as
Kw...
Great Ormond Street Hospital
Before and after picture
St Heliers Hospital
BEFORE AND AFTER PICTURE
GOSH waste composition
 Waste composition 2014
The following diagram below shows breakdown of materials
collected in 2014...
Breakdown of resources
1.37
20.42
9.45
0.65 0.05
GOSH 2015 resource tonnages
Waste
Wood
Metal
Paper/card
Soil
GOSH waste composition
 Waste composition 2015
31.94 tonnes of bulky waste collected from GOSH
Wood: 20.42 tonnes
Metal: ...
Comparison
0
5
10
15
20
25
Waste Wood Metal Paper/card Soil
Tonnages
Resources
2014/2015 Comparison
2014 2015
Approved Facility sites
 Waste Material Type
Wood, paper & cardboard,
rubble and general waste
Wood, mattresses, paper &
...
Way forward
RDF/SRF
With technology such as Refuse derived fuel and Solid
recovered fuel, Kwik Sweep Ltd can now ensure hi...
SOCIAL RESPONSIBILITY
 Donation
 Community engagement
Waste Collection Reinvented
 Kwik Sweep is using mobile technology to reinvent the bookings process.
 Kwik Sweep app is ...
THANK YOU VERY MUCH
The business
case for reuse
Daniel@warp-it.co.uk
@WarpIt_
Overview
 Financial
 Environment
 Social
Overview
 Free resources
 How to set up your own
 Business case templates
 Legal templates
Value
“It is only a
waste when it is
in the wrong
place”
The Enemy
 Time
 Space
 Distance
Priority?
Reuse has a
much greater
impact than
recycling
Win win win
Win win win
Win win win
Purchase &
Waste costs
Staff time
SupplyChain
Impacts
60% NHS
Carbon from
supply chain
#
SupplyChain
Social
Internal
Collaboration
Internal
Collaboration
Internal
Collaboration
Procurement
& waste
avoidance
benefits
Internal
Collaboration
External
Collaboration
Friend
requests
External
Collaboration
External
Collaboration
Aber Uni save
£10K in 1st
trade!! (audio
room)
Metrics
Value of reuse
Audit
Management
Behaviour
change
Examples
warp-it.co.uk/nhsggc
warp-it.co.uk/gmh
warp-it.co.uk/CWP
warp-it.co.uk/lthtr
Win win win
Win win win
Win win win
Take home tip
Explore developing a
reuse target
>Track your savings
>>Put more resources
into reuse
Free resources
Freegle
Warp It (is free really)
Legal document for
donation to 3rd parties
Business case for reuse
sys...
The business
case for reuse
Daniel@warp-it.co.uk
@WarpIt_
100%
INTEREST
FREE
ENERGY EFFICIENCY AT
FRIMLEY HEALTH NHS
FOUNDATION TRUST
Tim Morozgalski
Programme Manager
Gillian Brow...
Introduction
Salix Finance and Frimley Park Hospital
Summary of the loan application process
To demonstrate how Salix can ...
Introduction to Salix funding model
Who we are
Established in 2004
Independent, publicly funded, not-for-profit company
100% interest-free capital finance for...
Minimise wasted energy – controls
and awareness raising
Efficient conversion –
installing energy
efficient technology
Sali...
Loan funding by public sector body type
40%
30%
12%
10%
4%
3%
1%
England between April 2010 - March 2015
Local Authority
H...
Salix Activity within the NHS
Energy usage in the NHS
245 eligible organisations spend over £634m on energy and utilities 1
Average of £2.5m per hospita...
Knowledge sharing and case studies
Knowledge sharing and case studies
Case
Studies
Project Knowledge
Slides
Social
Media
News &
Blog
Salix Finance and Frimley Park Hospital
Background
Frimley Park Hospital Salix application approved 2006
Motivation: Energy Efficiency
Carbon Management Plan star...
Achievements of Frimley Park so far
Plant room insulation
Automatic doorsLED lighting
Boiler optimisation
Energy consumption
1. New ED / CCL – full running year
2. CHP engine rebuild
3. CHP running 24/7 – exportation
4. Increase...
Benefits
Patient & staff comfort improved
Links into operation TLC
Simple process
Salix team on hand to help through every...
Next steps
Produce a new Frimley Health SDMP & Carbon
Reduction Plan.
Re-baseline Frimley Health CO2 emissions
Replicate F...
SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK
Salix application process
SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK
Online application process
SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK
Six simple steps to apply
1. Log on to the Sa...
Summary
NHS Trusts and Foundation Trusts – no maximum loan amount
Help achieve energy and carbon reduction targets
Long-te...
Thank you
Tim.morozgalski@salixfinance.co.uk
020 3102 6910
Lunch and networking
#Dayforaction
Welcome back
Professor Hugh Montgomery MB BS BSc
FRCP MD FRGS FRSB FRI FFICM
UCL Professor of Intensive Care Medicine
Cons...
NHS Sustainability Day: London
Roadshow
Awards2013Building
Finalist
Awards2014
Finalist
Building
Finalist Finalist
www.vir...
www.virtus-consult.co.uk
Contents
 Introduction
 HEFT Background / Targets
 Client Brief
 HEFT Energy Profile
 Delive...
www.virtus-consult.co.uk
Introduction
 Virtus deliver exemplary results;
ensuring every stage of a project’s
life is meti...
www.virtus-consult.co.uk
Introduction
“You make us think differently”
John Sellars, Director of Asset Management, HEFT
 D...
HEFT Background / Targets
5
 One of the largest Trusts in England, employing approx.
11,000 people
 Annual budget of £65...
Client Brief
5 www.virtus-consult.co.uk
 Current Energy Spend £5.2m
 Carbon reduction targets
 5% year on year cost sav...
HEFT Energy Profile
5 www.virtus-consult.co.uk
HEFT energy spend profile
2008 - 2013
 Energy cost has risen
consistently ...
Delivery Process
5 www.virtus-consult.co.uk
 Site Survey, Interviews and Questionnaire
 OJEU Competitive Dialogue
 9 mo...
Initiatives
5 www.virtus-consult.co.uk
 LED Lighting & Controls
 Pipework Insulation
 Variable Speed Drives
 Pump repl...
Achievements
5 www.virtus-consult.co.uk
 Guaranteed savings of circa £900k per annum (18%
of annual spend)
 Payback of 4...
Project Review
5 www.virtus-consult.co.uk
Questions
5 www.virtus-consult.co.uk
B I R M I N G H A M O F F I C E
The Penthouse
Lancaster House
67 Newhall Street
Birmi...
How to reduce your energy
costs without reducing
comfort or safety
NHS Sustainability Day 2016 – London
25th February 2016...
Kier Hardie Health Park, Merthyr
Architect: BDP
Building Services Engineer: AECOM
Main Contractor: Laing
O’Rourke
M&E Cont...
Air to water
heat pumps
Low
temperature
convectors
Integrated
heating &
ventilation
Air to water
heat pumps
Low
temperature
convectors
Integrated
heating &
ventilation
“With obstructions like fixed furniture throughout the health park,
we knew it would be a challenge to find radiators that...
Air to water
heat pumps
Low
temperature
convectors
Integrated
heating &
ventilation
“The use of properly-controlled DCV
systems can provide improved internal
environments while saving operational
costs”
Pro...
“It was important to find a solution that
would provide effective ventilation to the
space as well as heating it,”
Sarah G...
In summary
 Using heat pumps to power a low-temperature heating system
saves money and reduces emissions
 Low mass, low ...
How to reduce your energy
costs without reducing
comfort or safety
NHS Sustainability Day 2016 – London
Barts Health NHS T...
Vasco Dimitroff
Corporate Affairs
Mission:
To reduce global water
consumption by
1%
 Water efficiency experts for 20 years
 Advisors to the Government since 1999
 Lead consultants of Watermark
£70 million
 Major improvements
 Metering
 Billing
 Reporting
 Wider ranging
 Greater detail
 Robust
£500 million per annum in lost
revenue, which if saved coincides with a
30% reduction in water use
London’s Total Annual Water Consumption
3 billion Cups of Tea
…or filling this room 1 million times over
What this means for the NHS
 10 million m3 per year
 £24 million
500Different Building
Benchmark
Classifications
Why do we need you?
 3 years free bill validation
 Electronic water consumption profiles
 Identification of high consumption anomalies
 A ...
 More accurate reporting on water
 Prepare for deregulation from 2017 and;
 Tools to potentially reduce your water bill...
3Simple Steps
to Participate
 We provide you with an email to send
to your water supplier
 They send your future bills to us for
benchmarking assessm...
 Climate Change
 Rapid Population Growth
 Economic Development
True water management
- comprehensive approach
@adsmUK
#AquaMark
Your Participation
AquaMark@adsm.com
01753 833 880
www.adsm.com
Thank you
Lucy Saunders - Public Health Specialist – Transport & Public Realm
Improving the health of Londoners – 1 year into delive...
315
• TfL has duties to improve the health of Londoners
under the Mayor’s statutory duties. Local authorities
in London ho...
316
More than 2 million Londoners
need to build some walking or
cycling into their daily routine.
London’s transport & str...
Photo: E Kramer
London’s transport & streets are central to good health
We can only get more people walking and cycling more often if we change the look and feel
of our streets.
Streets need to ...
How do you make a tool valid for all types of street?
321
9 Street types
2014 and 2015 combined data
65 sample sites and 6,702 respondents
City Hub
Local Street Town Square City Place
High Street...
Objectives of our survey• One tool that can be applied to all streets in
London
• Asking people about their experience the...
Survey summary
• Attractive
• Clean air
• Noisy
• Enjoyable
• Ease of crossing
• Somewhere to rest
• Finding shelter
• Int...
Questions grounded in the ‘here and now’
Example question: How clean do you think the air on this
street is today?
• Pleas...
Average score for each indicator
Londoners expect the streets to be healthier
Building stronger business cases
331
We are strengthening our systems for setting out the health
benefits in our business ...
332
We are supporting boroughs to deliver
their new public health responsibilities
through their transport policy, plannin...
333
• Transport & Health in London models the impact on the health of Londoners of a range
of different transport scenario...
334
• Strengthening our Health Impact
Assessments
• Strengthening the London Plan
• Working with government
• Working with...
lucysaunders@tfl.gov.uk
Closing comments
Professor Hugh Montgomery MB BS BSc
FRCP MD FRGS FRSB FRI FFICM
UCL Professor of Intensive Care Medicine
...
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
Nhs Sustainability Day 2016 London Road Show
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Nhs Sustainability Day 2016 London Road Show

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March 26th this year saw over 300 healthcare organisations take action to promote sustainability and increase public health awareness and we are fortunate enough to have the support of; Public Health England, Department of Health, Department for Energy and Climate Change and The Prime Minister, David Cameron. Working with these stakeholders we aim to further develop the links between health and sustainability thus improving economical and health outcomes within the UK.

For the 2016 campaign, beginning in September, and to celebrate our 5th year of the campaign we will be promoting 50kg of carbon. This is effectively promoting what the public and health professionals can do to save 50kg of carbon. This could be achieved through; walking to work, cycling, planting a tree etc.

Published in: Health & Medicine
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Nhs Sustainability Day 2016 London Road Show

  1. 1. Welcome to the London NHS Sustainability Day 2016 Road Show #Dayforaction
  2. 2. Chair’s welcome and introduction Fiona Daly, Associate Director of Sustainability and Patient Transport, Barts Health NHS Trust #Dayforaction
  3. 3. Inspiring us in all that we do Duncan Selbie, Chief Executive, Public Health England #Dayforaction
  4. 4. Filling the gap Options for a sustainable UK health and social care system Adam Roberts Head of Economics February 2016
  5. 5. 5 Public spending on health in the UK, in real terms and as a percentage of national income (GDP)
  6. 6. 6 Publicly funded health care spending as a share of GDP 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% Luxembourg Ireland Portugal Greece Finland Spain Italy UnitedKingdom Austria Belgium Germany France Denmark Sweden Netherlands 2000 2012 2012 average
  7. 7. Annual change in total NHS spend in England 2009/10 to 2020/21 (2015/16 prices) 7
  8. 8. Estimated public spending on health in the UK as a percentage of GDP, 2015/16 to 2020/21 8
  9. 9. 9 Annual change in hospital productivity index
  10. 10. 10 Total reported surplus / deficit of NHS trusts, 2012/13 to Q3 2015/16
  11. 11. 11 Number of NHS trusts in deficit in 2012/13 to Q3 2015/16
  12. 12. 12 Number of Training Places commissioned for clinical staff 2004/05 to 2014/15 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 trainingplacescommissioned adult nurses AHP undergraduate medical Source: NAO
  13. 13. 13 The public-private hourly pay differential for workers with similar characteristics
  14. 14. 14 Social care spending 2009/10 to 2019/20, real annual changes
  15. 15. 15 Number of clients receiving services (community-based services, residential care or nursing care) provided or commissioned by local authorities with social services responsibilities, by client type, 2009/10 to 2013/14, England Physical Disability, 841,645 Mental Health, 257,540 Total, 1,273,280 - 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1,800,000 2009/10 2010/11 2011/12 2012/13 2013/14 Source: NASCIS; Referrals and Packages, module P1
  16. 16. 16 Need for and receipt of help with ADLs in the last month, by equivalised household income and sex, HSE 2014
  17. 17. 17 Relative growth in projected spending pressures and budget for UK publicly funded health and adult social care 0.8 1.0 1.2 1.4 1.6 1.8 2.0 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 2024/25 2025/26 2026/27 2027/28 2028/29 2029/30 2030/31 Index NHS spending pressures NHS budget Adult social care spending pressures Adult social care budget (assuming falling by 16% by 2019/20)
  18. 18. 18 Relative funding gap for health and adult social care in 2030/31
  19. 19. 19 Potential funding gap for adult social care in 2019/20
  20. 20. 20 Support for increased tax
  21. 21. 21 Total tax revenue as a percentage of GDP in 2012 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Ireland Portugal Spain UnitedKingdom Greece Netherlands Germany Luxembourg Austria Sweden Italy Finland Belgium France Denmark Tax to GDP ratio Median
  22. 22. 22 Cost of closing gap through taxation Lower income tax rate Higher income tax rate
  23. 23. 23 Cost of closing gap through taxation VA T20% 23%
  24. 24. Keep in touch 24 Visit our website at www.health.org.uk Subscribe to our monthly email newsletter at www.health.org.uk/newsletter Register for email alerts to be notified about our latest work at www.health.org.uk/updates Take part in conversation and debate about current healthcare issues on our blog Follow us on Twitter, Facebook or LinkedIn. For all the latest news and developments from the Health Foundation:
  25. 25. C Working together in the Public Sector to improve Carbon & Energy Performance Martyn Jeffery CEng MIHEEM CEF TRUSTEE
  26. 26. C The Carbon and Energy Fund “Launched by Greg Barker MP at IHEEM in 2011 the Carbon and Energy Fund (CEF) is a co-creation with the NHS for the NHS. Originally set up via a collaboration agreement with the NHS via NHS SBS it has subsequently been procured by the Countess of Chester Hospital and is a partner of Oxford Academic Health Science Network delivering infrastructure upgrades that guarantee energy, carbon and cost savings. With a proven track record and in-depth experience of procurement, engineering, legal and finance, CEF is the only organisation that successfully guides Public Sector clients through the complex processes involved.”
  27. 27. C CEF has been created for the Public Sector to:  Transfer risk to whom is best to manage it, principally the Private Sector  Enable the Public Sector to realise the benefits of large scale procurement via a framework of 17 of the UK’s top ESCO/DH contractors  Make competitive and task specific funding (15 -30 year energy infrastructure finance) available for the NHS  Provide a fast and robust procurement route for the Public Sector therefore reducing overall risk and costs  Provide the Public Sector with the necessary task specific technical, legal and project management resources and on-going support for the project  Prove and audit savings annually for whole contract period, with reimbursement for savings not achieved In partnership with
  28. 28. C The Carbon and Energy Fund In contract:  Capital committed: £118m  Guaranteed savings per annum: £24m  Guaranteed carbon savings per annum: 111,000T In procurement:  Capital: £90m  Guaranteed savings per annum: £15m  Guaranteed carbon savings per annum: 52,000T Total expected by end of 2015:  Capital committed: £208m  Guaranteed savings per annum: £39m  Guaranteed carbon savings per annum: 163,000T CEF Track Record
  29. 29. C Introduction The CEF are more than just a provider of funding • Nifes • Jacobs • Attest • SKM • Carbon Trust •Renew Legal • Hill Dickinson • DAC Beachcroft • In-house • TEC •NHS SBS • PFPM • WT • Millbridge • Internal • Lending Banks • Pension Funds • GIB • ECB • Equity Investors Commercial and Financial Project Management TechnicalProcurement and Legal
  30. 30. C Procuring with the Carbon and Energy Fund The CEF Process has been developed through pilot projects and provides a robust methodology to procure projects Stage 1 Membership Stage 2 Invitation to Mini- Competition Stage 3 ITT and Contract Close Stage 4 Construction Stage 5 Monitoring and Verification 4 weeks 8 weeks 20 weeks Project Dependent
  31. 31. C Typical CEF Project Acting as the clients advisor/partner the CEF provides the component parts necessary to make an energy project happen and transfer risk. Energy ProjectBuild These services are either provided by the client or are outsourced Client Advisors • Feasibility • Outline Design • Procurement • Technical Support • Legal • Monitoring and Verification Funded by ClientDesign Operate Funded by CEF Funded by Contractor Funded by Contractor Framework
  32. 32. C CEF Contract Overview V4 Unitary or Fixed Guaranteed Energy Savings Potential Uplift in Savings Time (Yrs) Value(£k)
  33. 33. C Funding options and balance sheet treatment “The CEF is 90% of the NHS Energy Efficiency Finance Market” say The Green Investment Bank With the UK the CEF is the only organisation to provide Hospitals with independent access to 3rd Party finance. A Trust may use its own capital, (inc FTFF or TDA Finance) or 3rd Party Finance via a funding round that will include the Governments Green Investment Bank and Salix We currently have rates from our panel of funders that are in the region of 1.5% real The CEF contract has been deemed as off balance sheet and bankable. *Each project should be subjected to an accounting review to establish balance sheet status
  34. 34. C The CEF Family
  35. 35. C Tranche 5 The Contractors on the Framework • Ameresco (previously ESP) • Bilfinger • Bouygues • Breathe (part of MCW) • Cofely • Cynergin • Doosan Babcock • eDF • ENER-G • EON • Imtech • Kier • Mitie • SSE • Veolia (previously)Dalkia • Vital
  36. 36. C Tranche 5 remaining • March Mater Hospital; Hull • April Nottingham City Hospital; Dorchester • May Basildon and Thurrock • June Buckinghamshire • July • Queued/ tranche 6: Huddersfield; Southern Health; Basingstoke; UCLH; Hillingdon • Already in progress – Manchester City DE, Barnet & Chase Farm, Sheffield Childrens
  37. 37. C Chase Farm Hospital External view – end of phase 1
  38. 38. C Chase Farm Hospital Long Term Expansion Opportunities
  39. 39. C The Trust Vision • An energy services partner that will support the development • Long term strategic management of the site energy and utility infrastructure • Risk transfer • Financial savings • Carbon savings • Continuous improvement • Enable compliance with Enfield Council planning requirements, the Building Regulations and the London Plan
  40. 40. C Energy Supply Strategy • Suitable technologies • Partnership / opportunities / access to expertise • Reducing impact of energy / fuel price increases • Carbon targets and costs • Risk transfer • Resilience and increased security of supply • Good Corporate Citizenship • Self funding using external capital
  41. 41. C Investment Objectives • Robust infrastructure, security of supply and resilience • Meet a tight timescale for completion of new hospital • Risk transfer to the ESCo • Flexibility to support future development of the site • Deliver the Trust’s commitment within its Carbon Management Plan • Third Party Investment • Deliver Guaranteed Savings in terms of energy costs
  42. 42. C The NHS Improvement (“TDA”) & Energy Service Performance Contracts “Energy Services Performance Contracts (“ESPCs”) are contracts that are typically 15 to 25 years long with an energy services company delivering an organisation’s energy and carbon strategy. Funding is usually, but not exclusively, provided by a third party investor. The NHS Trust pays a unitary payment to the supplier but gains the benefit of guaranteed savings. In developing this type of investment proposal NHS Trust’s should consider issues such as the accounting treatment, the development of a robust public sector comparator, the realisation of guaranteed savings and rates of return.” The CEF has made a proposal to NHSI for the streamlined approval of all EPC’s. This matter is under central discussion with NHSI and the model hospital programme
  43. 43. C NHS Trust Approval Pathway & NHSI These services are either provided by the client or are outsourced Financial Value of the Proposed Scheme Key Stage Documentation Capital and Quality Business Case Checklist Required Up to £5m or 3% of turnover whichever is the lower NHS Trust internal governance process No Between £5m, or 3% of turnover whichever is the lower, and £15m Outline Business Case and Full Business Case required Yes £15m to £35m Strategic Outline Case, OBC and FBC required Yes £35m to £50m Strategic Outline Case, OBC and FBC required Yes Over £50m Strategic Outline Case, OBC and FBC required Yes
  44. 44. C NHS Project Governance and CEF Fit Membership Contract Close Construction Invitation to Tender (“ITT”) Performance Contract Management SOC OBC Divisional Exec OBC NHS Trust Management Executive OBC NHS Trust Board OBC NHS NHSI FBC Divisional Exec FBC NHS Trust Management Executive FBC NHS Trust Board FBC NHS NHSI Post Project Evaluation
  45. 45. C Changes to the 2015/16 Capital Regime and Investment Business Case Approvals Guidance • A recognition of Energy Service Performance Contracts (“ESPC”) as a type of service contract. This follows the increase in ESPC investment proposals being received by NHSI. • Increased guidance on how to calculate Whole Life Costs • Reinforcing the requirement to demonstrate compliance with relevant accounting standards and to obtain audit advice where schemes are novel or contentious • A requirement to clarify treatment of VAT • An expansion of the traditional 5 Case Model to include the consideration of a Clinical Quality Case • More detailed Post Project Evaluation considerations
  46. 46. C Contractual arrangements • Started life based on NHS Standard Form PFI contract v3 • Second CEF framework updated it to make it SOPC4 compliant and to incorporate lessons learnt from further projects • Latest CEF framework incorporates further lessons learnt and makes the contract easier for NHS Trusts to use • Has been found to be off balance sheet as an operating lease (including under more strict Scottish accounting rules) • Currently taking advice as to whether it will continue to meet latest Eurostat guidance with regards to balance sheet treatment • Incorporates Willis insurance advice honed over several recent NHS projects.
  47. 47. C Contractual arrangements (cont.) • Standard route is restricted route procurement, shortlisting at least three bidders and asking them to provide final bids • Alternate investment grade audit route available if considered preferable. • Easily altered to cater for multiple-site projects • Can deal with multiple-site, staggered-start projects (as on Cheltenham and Gloucester): • Outline scope of the project is set in the contract • Procedure for bid and prices to be updated • If the re-priced bid meets a pre-agreed NPV calculation, that part of the Project Agreement is triggered.
  48. 48. C Questions
  49. 49. CMO Kim Sandholdt
  50. 50. Your supply chain Your responsibility
  51. 51. Your company Customer Customer Customer
  52. 52. Your company Customer Customer Customer
  53. 53. Your company Customer Customer Customer
  54. 54. Your company Customer Customer Customer Investors Guidelines Legislation
  55. 55. Your company Customer Customer Customer Investors Guidelines Legislation
  56. 56. Your company Customer Investors Guidelines Legislation Customer Customer Show compliance
  57. 57. Your company Customer Investors Guidelines Legislation Customer Customer Your responsibility
  58. 58. Your company Customer Investors Guidelines Legislation Customer Customer Human Rights Labour(child) Environment Anti-Corruption
  59. 59. Does this concern your company?
  60. 60. In a Survey from 2012, Deloitte reported that an estimated 85% of global supply chains had experienced at least one hyper-critical supply disruption over the past 12 months. 85%
  61. 61. A study by Ernst & Young from 2014 shows that 45 percent of all the proposals that were asked by investors to company boards, were about sustainability. 45%
  62. 62. The global sustainability agenda is formed by mega drivers and will significantly impact all companies All
  63. 63. Is it worth it?
  64. 64. A recent international study by the danish bank Nykredit shows that companies given the highest sustinability score, on average achieved a gain of almost 23 percent of their investments, which is more than twice as high as the companies with the lowest score. 23%
  65. 65. Several studies indicate, that it is much easier to attract skilled labour for companies that downplays the economic aspect in favour of the employer brand. Employer Branding
  66. 66. Isn't it just a hype?
  67. 67. Gartners Hype cycle
  68. 68. From control to collaboration From legal disclaimer to proactive performance management From reputation to innovation New agendas
  69. 69. CSR issues are moving to business innovation Partnership building between business, governments and NGOs. Due diligence studies and impact studies. Ensuring license to operate. New agendas
  70. 70. New opportunities Creating better sustainability performance will create value to your business Demonstrating transparency and compliance will build public trust and credibility Improved collaboration within your supply chain will build relationships with confidence
  71. 71. That is why we have created the Aperitas solution
  72. 72. Challenges identified by our customers Excessive resources are spend on collecting sustainability data from supply chains No measurements to validate sustainability initiatives Weak internal organising of CSR requirements
  73. 73. Procurement Suppliers
  74. 74. CSR Procurement Suppliers
  75. 75. QACSR Procurement Suppliers
  76. 76. CSR Procurement Suppliers QA
  77. 77. Weak integration of QA and CSR requirements Limited knowledge about QA and CSR facts in supply chains QACSR Procurement Suppliers Sustainability strategies don’t get into work. You can just show policies – but no results.
  78. 78. Procurement CSR QA Aperitas Platform Suppliers RSCM must be an integral part of the company
  79. 79. Knowing your suppliers
  80. 80. Procurement CSR QA Aperitas Platform Suppliers Efficient operationalization of strategies Easy and efficient gathering of sustainability information Easy to show compliance and manage risk
  81. 81. Collect Analyze Create
  82. 82. Analyze
  83. 83. Create
  84. 84. Concluding remarks The global sustainability agenda is formed by mega drivers and will significantly impact all companies RSCM is vital to strategic sustainability RSCM must be an integral part of the company Aperitas can make RSCM profitable
  85. 85. aperitas.com ks@aperitas.com Learn more on:
  86. 86. Chris Large Partner at Global Action Plan
  87. 87. Changing Lives in East London • Largest NHS Trust in the country • Serves 2.5M people
  88. 88. We help people to limit environmental damage Schools Businesses Communities
  89. 89. Brendan Rouse – Estates Manager, Energy & Sustainability Operation TLC at GOSH
  90. 90. Why Operation TLC suited Great Ormond Street • Staff and visitors expect GOSH to be a resource efficient organisation • Effective behaviour change campaigns have great potential but are difficult to get right • GOSH didn’t have the expertise to create a bespoke campaign
  91. 91. Gaining support • Traditional business case presented to Finance Board - 0.8 year payback. • 6 ward trial set up after gaining support from core team and the wards involved • Results of this trial presented to Trust Board to get sign-off on full roll-out of programme
  92. 92. Year 1 – Three Projects • Lighting project carried out in all 26 inpatient wards • Heating campaign in all areas of the Trust • Switch-off for Christmas and high usage areas (Labs)
  93. 93. Understand Change Evaluate Share • Feedback results • Celebrate success • Barriers & motivators • Training • Embedding activities • Stakeholder engagement • Baseline measurement • Prioritise • Measure & evaluate • Energy/waste/water data • Experience
  94. 94. Motivator - The child first and always
  95. 95. Training & Barriers
  96. 96. Evaluate Energy Data - 5% reduction in ward energy use Surveys – 19% more staff turning lights off 17% increase in lighting satisfaction Observations – 9% improvement in observed behaviours
  97. 97. Our Volunteers Peter and Val Observing & Training
  98. 98. "I felt like an angel! I was so concerned with one of the senior nurses, she was in a tiny room and it was so hot inside!...I was able to tell her how she could take more control of the temperature.“ - Peter "We were around able to see the improvements first hand on the wards. It became more evident when you went and you saw the lights dimmed or off, you would see a calm and peaceful atmosphere.“ - Val
  99. 99. Feedback & Sharing Results Roundabout Carbon Culture Newsletter Posters & Flyers Screensavers Face to face
  100. 100. Celebrating Success
  101. 101. Understand Change Evaluate Share • Feedback results • Celebrate success • Barriers & motivators • Training • Embedding activities • Stakeholder engagement • Baseline measurement • Prioritise • Measure & evaluate • Energy/waste/water data • Experience
  102. 102. SUCCESSES - Cost and Carbon Savings
  103. 103. • Increased natural light in mental health patient rooms resulted in 3.7 day shorter hospital stay on average (AHRQ, 2005) • Cervical and lumar spinal surgeries patients who received more natural light saw a 22% decrease in painkilling medicine use (Joseph, 2006) Behaviour change in action Increasing natural light exposure Reduction in artificial light • Darkening hospital rooms at night – reduced sleep disturbances by 38% (Bartick et al,. 2009)
  104. 104. SUCCESSES Better patient experience and staff fulfilment
  105. 105. Design of a behaviour change programme What can staff do to save energy? How often do staff do those actions already? What is the value of doing those actions more often? What stops people acting and how can we help uptake?
  106. 106. How did people save energy? Natural Light
  107. 107. QUIET TIME NIGHT MODE HIGH ENERGY AREAS BUILDING AWARENESS How did people save energy?
  108. 108. What encouraged and enabled people to act? PATIENTS PEOPLE PLANET POCKET
  109. 109. Patient – Staff – Estate Triangle What encouraged and enabled people to act?
  110. 110. How did we measure the impact and savings? PATIENT SURVEY METER DATA LIGHT METERS SPOT CHECKS
  111. 111. From energy saving to better relationships
  112. 112. Help is at hand to run your own Operation TLC Scope • Quantify energy waste • Create business case • Engage clinical leaders Change • Face to face engagement • Personalised comms materials • Coaching for champions and project leaders Measure • Improvements in staff taking energy action • Cost and carbon savings • Patient experience benefits • Staff benefits
  113. 113. What advice would we share? Top 3 tips Be specific. Saving energy is abstract. Opening the curtains and turning off the light is real. Make energy saving genuinely meaningful for staff. But don’t kid yourself that saving money is that meaning.
  114. 114. Chris Large Partner at Global Action Plan chris.large@globalactionplan.org.uk @chrislarge1
  115. 115. Refreshments and networking #Dayforaction
  116. 116. Welcome back David Pencheon OBE, Director, SDU #Dayforaction
  117. 117. ‘Buying for the Long Run’ Sustainable Procurement David Picton 25 February 2016
  118. 118. • Tarmac Group – De-Merged in 1999 − Tarmac, Wimpey, Cubitts and Mitchell Construction • Further Acquisitions: − Mowlem (2006); Alfred McAlpine and Vanbots (2008) − EAGA (2011); John Laing Integrated Services (2013) − Rokstad Distribution (2014) and Outland (2015) − Ask Developments (2016) • 40,000 employees • UK, Middle East, Canada • £4.1Bn turnover (2014) • 2015 results – March 2016 • FTSE 250 PLC Who Are We ?
  119. 119. 123 Maintenance Utilities Facilities Defence Infrastructure Rail Health Education What Do We Do ?
  120. 120. Carillion’s 6 Positive Outcomes Sustainability 2020
  121. 121. Challenges • ‘Triple Bottom Lines’ • Economic Responsibility • Environmental Responsibility • Social Responsibility • Reputation Sustainable Procurement
  122. 122. Reputation – Role of the Supply Chain Delivery Through Other Companies • Supplier accreditation and risk management • Audit, relationship management and development • Key area for: − Spend − Risk − Brand reputation − Customer opinion • Small – Medium Enterprises – a critical ‘tail’ • Government initiatives – core to economic recovery • Niche skills, innovation, flexibility – but stretched
  123. 123. Supply Chain Risk “… firms are placing not only their financial security, but their reputations in the hands of suppliers they have little understanding of … negative news can now spread around the world almost instantly …” (Bureau van Dijk) Costs of Supply Chain Failure ?
  124. 124. Supply Chain Sustainability School Collaboration (noun): … working with another or others on a joint project to achieve shared goals … co-operating as a traitor, especially with an enemy occupying one’s own country
  125. 125. Supply Chain Sustainability School Skills Focus for the Full Built Environment • Free Virtual Learning Environment − Support resources − Multi-media – videos, articles, webinars • Non-mandatory and confidential self-assessment • Action Plans focused on Continuous Improvement • Develop sustainability knowledge and competence • Supplier Days / Workshops – networking and best practice • Developing 5-year Business Plan for School • Full Leadership Council and Focus Groups
  126. 126. • £335M capital cost, 3 year build – plus £100M support services, 30 year concession • One of the largest all single-bed hospitals in UK (646 beds, 40-bed CCU, 18 theatres) • One of the UK’s 'greenest' hospitals: • Dedicated cycle centre and 10 electric car charging points • Renewable energy systems • Low carbon materials, systems • Water meters, leak detection • £240M to local economy • 750 full-time jobs during build • 60% to local people • 60% materials locally-sourced • 15% workforce from priority areas • 100 apprenticeships created Opportunities – Royal Liverpool Hospital Royal Liverpool Hospital
  127. 127. • Phased and staged packages of procurement • Preferred supplier base – pre-accredited suppliers • ‘Meet the Buyer’ events • Trust and City Council – links to ‘priority wards’ • Community Engagement Officer • Previously a Business Connector • Business in the Community regional management team • Charitable trusts – managing applications and allocations • Specific delivery against Community Schedule in pre-contract agreements • Supply Chain Sustainability School – Supplier Day • Apprenticeships and Work Placements • Supplier engagement and planning Process – Royal Liverpool Hospital Buying for the Long Run
  128. 128. Nottinghamshire University Hospitals Trust • Nottinghamshire University Hospitals Trust • Patient Meals – App and tablet based food ordering system – Developed in partnership with catering supplier – Food waste reduction from 18% to 10% (target 6%) – Elderly lady in her 80s – not eaten for 2 weeks • Gold Soil Association ‘Food for Life’ Catering Mark – Buying local wherever possible – Purchase of organic produce (% depends on operation) – 75% meals freshly prepared on site – No fish products from MSC ‘fish to avoid’ list – Use of only free range eggs – Use of Farm assured products
  129. 129. ‘Buying for the Long Run’ Sustainable Procurement David Picton 25 February 2016
  130. 130. Sustainable, nutritious and tasty hospital food? Alexandra Hammond Associate Director, Sustainability
  131. 131. IMAGINE… Hospital food
  132. 132. 140
  133. 133. 143
  134. 134. 144
  135. 135. 149
  136. 136. Food recycling • Partnership with waste team to eliminate waste • Locally reprocessed into compost • Collected from wards, kitchens and nurseries
  137. 137. Weighing and understanding waste an NHS first
  138. 138. Award winning waste management programme
  139. 139. The best healthcare runs efficiently, uses resources wisely, fosters healthy living and provides patients with the best possible care. Sustainability Strategy 2013 - 2018 Guy’s and St Thomas’ NHS Foundation Trust
  140. 140. Special thanks to the catering and hospitality teams!
  141. 141. Alexandra Hammond Associate Director, Sustainability alexandra.hammond@gstt.nhs.uk @alexandrajhr 156
  142. 142. www.trakeo.com Supply chain carbon and sustainability platform
  143. 143. www.trakeo.com
  144. 144. www.trakeo.com
  145. 145. www.trakeo.com
  146. 146. www.trakeo.com
  147. 147. www.trakeo.com
  148. 148. www.trakeo.com ➢ Rationalisation and consolidation of freight. ➢ Purchasing efficiencies. ➢ Cooperative solution propositions (consortia) Collaboration Network
  149. 149. Sustainability Resource Efficiency through Segregation Presented by Jide Lawal and Earl Mensah Aggressive on Waste For a sustainable future
  150. 150. Who are we  Established in 2008  Kwik Sweep is a waste management company specialising in the removal of junk and bulky waste. We ensure the reduction of general waste sent to landfill.  We offer a bespoke on-demand service to public sector and commercial customers.
  151. 151. “Aggressive on Waste for a Sustainable Future”.
  152. 152. Our services  Home, office and junk clearances  Refits clearance  Construction/canteen waste removal  Events clearance  WEEE recycling  Fly tipping clearance and hazardous waste collection
  153. 153. Our commitment to our client  Health and Safety  Customer service  Quality  Flexibility  Reliability
  154. 154. Clients NHS Erith demolition Brent Council Amazon Westway Development Trust Cluttons
  155. 155. Amazon
  156. 156. Brent Council
  157. 157. Policy Key Environmental Objectives  To reduce the amount of waste sent to landfill  To promote the 3 R’s (reduce, reuse and recycle)  To meet the requirements of quality and environmental system
  158. 158. Our service work within the Health Sector  Great Ormond Street Hospital (GOSH) is an international centre of excellence in child healthcare.  Formed in 1852  Over 255,000 patient visits to the hospital each year  Epsom and St Helier University Hospitals NHS Trust provides a range of medical services to approximately 420,000 people living across southwest London and northeast Surrey.
  159. 159. Segregation  Toolbox talk  On site Training  Staff engagement  Safety
  160. 160. Segregation Environment Manager Epsom and St Heliers Hospital Trust “One of the benefits that we have gained is that as Kwik Sweep is responsible for loading the waste, we can ensure that there is no inappropriate waste (i.e. hazardous WEEE) in the load. Previously we had 40 yard skips on site which were often loaded with flytipped waste, including TVs and refrigeration equipment which would subsequently be incorrectly consigned with the general waste”
  161. 161. Great Ormond Street Hospital Before and after picture
  162. 162. St Heliers Hospital BEFORE AND AFTER PICTURE
  163. 163. GOSH waste composition  Waste composition 2014 The following diagram below shows breakdown of materials collected in 2014 34.92 tonnes of bulky waste collected Wood: 22.62 tonnes Metal: 9.08 tonnes Waste: 2.48 tonnes Paper & cardboard: 0.74 tonnes 93% recycled
  164. 164. Breakdown of resources 1.37 20.42 9.45 0.65 0.05 GOSH 2015 resource tonnages Waste Wood Metal Paper/card Soil
  165. 165. GOSH waste composition  Waste composition 2015 31.94 tonnes of bulky waste collected from GOSH Wood: 20.42 tonnes Metal: 9.45 tonnes Waste: 1.37 tonnes Soil: 0.05 tonnes Paper & cardboard: 0.65 tonnes 96% recycled
  166. 166. Comparison 0 5 10 15 20 25 Waste Wood Metal Paper/card Soil Tonnages Resources 2014/2015 Comparison 2014 2015
  167. 167. Approved Facility sites  Waste Material Type Wood, paper & cardboard, rubble and general waste Wood, mattresses, paper & cardboard, rubble and general waste  Approved Facility Site McGovern Brother (Haulage) LTD 26-27 Brent Terrance, Claremont Ind Estate, Hendon, London, NW2 1BG HTL Recycling & Waste Management Services Deptford Recycling Centre Landmann Way Deptford London SE14 5RS
  168. 168. Way forward RDF/SRF With technology such as Refuse derived fuel and Solid recovered fuel, Kwik Sweep Ltd can now ensure higher diversion of resources from landfill. These new technologies for the treatment and disposal of waste will help the Trust reduce carbon emissions and save money.
  169. 169. SOCIAL RESPONSIBILITY  Donation  Community engagement
  170. 170. Waste Collection Reinvented  Kwik Sweep is using mobile technology to reinvent the bookings process.  Kwik Sweep app is a valuable platform which allows the user to send pictures/videos for an instant quote.  Make an instant booking for collection at a day and time that suits you. BENEFITS  Instant booking  Submit images for an accurate quote  Removes the need for on-site assessment, reducing carbon footprint and improving time management  Helps management/porter to deal instantly with the removal of waste
  171. 171. THANK YOU VERY MUCH
  172. 172. The business case for reuse Daniel@warp-it.co.uk @WarpIt_
  173. 173. Overview  Financial  Environment  Social
  174. 174. Overview  Free resources  How to set up your own  Business case templates  Legal templates
  175. 175. Value “It is only a waste when it is in the wrong place”
  176. 176. The Enemy  Time  Space  Distance
  177. 177. Priority? Reuse has a much greater impact than recycling
  178. 178. Win win win
  179. 179. Win win win
  180. 180. Win win win
  181. 181. Purchase & Waste costs Staff time
  182. 182. SupplyChain Impacts 60% NHS Carbon from supply chain
  183. 183. #
  184. 184. SupplyChain
  185. 185. Social
  186. 186. Internal Collaboration
  187. 187. Internal Collaboration
  188. 188. Internal Collaboration
  189. 189. Procurement & waste avoidance benefits
  190. 190. Internal Collaboration
  191. 191. External Collaboration
  192. 192. Friend requests
  193. 193. External Collaboration
  194. 194. External Collaboration Aber Uni save £10K in 1st trade!! (audio room)
  195. 195. Metrics Value of reuse Audit Management
  196. 196. Behaviour change
  197. 197. Examples warp-it.co.uk/nhsggc warp-it.co.uk/gmh warp-it.co.uk/CWP warp-it.co.uk/lthtr
  198. 198. Win win win
  199. 199. Win win win
  200. 200. Win win win
  201. 201. Take home tip Explore developing a reuse target >Track your savings >>Put more resources into reuse
  202. 202. Free resources Freegle Warp It (is free really) Legal document for donation to 3rd parties Business case for reuse system
  203. 203. The business case for reuse Daniel@warp-it.co.uk @WarpIt_
  204. 204. 100% INTEREST FREE ENERGY EFFICIENCY AT FRIMLEY HEALTH NHS FOUNDATION TRUST Tim Morozgalski Programme Manager Gillian Brown Environment Manager Frimley Health NHS Foundation Trust
  205. 205. Introduction Salix Finance and Frimley Park Hospital Summary of the loan application process To demonstrate how Salix can help NHS England Our goals for today
  206. 206. Introduction to Salix funding model
  207. 207. Who we are Established in 2004 Independent, publicly funded, not-for-profit company 100% interest-free capital finance for the public sector Funded by DECC, Scottish and Welsh Government, EfA and DfE Support public sector bodies such as local authorities, educational establishments and NHS Trusts Working throughout England, Wales, Scotland and N. Ireland
  208. 208. Minimise wasted energy – controls and awareness raising Efficient conversion – installing energy efficient technology Salix focus capital investment to reduce energy and save carbon Energy hierarchy Onsite renewable energy
  209. 209. Loan funding by public sector body type 40% 30% 12% 10% 4% 3% 1% England between April 2010 - March 2015 Local Authority Higher Education Institute National Health Service School Further Education Institute Academy Emergency
  210. 210. Salix Activity within the NHS
  211. 211. Energy usage in the NHS 245 eligible organisations spend over £634m on energy and utilities 1 Average of £2.5m per hospital 1 Typically 3rd largest expenditure Our NHS clients have saved on average £200k per year 2 1. Health and Social Care Information Centre, Hospital estates and facilities statistics 2015 2. Salix Finance – loan applications since 2008
  212. 212. Knowledge sharing and case studies
  213. 213. Knowledge sharing and case studies Case Studies Project Knowledge Slides Social Media News & Blog
  214. 214. Salix Finance and Frimley Park Hospital
  215. 215. Background Frimley Park Hospital Salix application approved 2006 Motivation: Energy Efficiency Carbon Management Plan starts 2010 Frimley Health created October 2014 Heatherwood Hospital Frimley Park Hospital Wexham Park Hospital
  216. 216. Achievements of Frimley Park so far
  217. 217. Plant room insulation Automatic doorsLED lighting Boiler optimisation
  218. 218. Energy consumption 1. New ED / CCL – full running year 2. CHP engine rebuild 3. CHP running 24/7 – exportation 4. Increased patient activity 5. Long hot summer – additional cooling required Potential emissions without Salix funding 0 5,000 10,000 15,000 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 Frimley Park Hospital energy emissions (tCO2e) Salix Finance £450k CMP starts Salix Finance £260k
  219. 219. Benefits Patient & staff comfort improved Links into operation TLC Simple process Salix team on hand to help through every stage – including technical support Supports energy reduction where capital investment is not available Lessons learnt Don’t forget to use the cost + vat on compliance tool!
  220. 220. Next steps Produce a new Frimley Health SDMP & Carbon Reduction Plan. Re-baseline Frimley Health CO2 emissions Replicate Frimley Projects at Wexham & Heatherwood Work closely with Capital Projects team EPC - utilise Salix Finance for Energy Efficiency projects Salix Finance – next step if internal capital is unavailable
  221. 221. SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK Salix application process
  222. 222. SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK Online application process
  223. 223. SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK Six simple steps to apply 1. Log on to the Salix website salixfinance.co.uk/loans 2. Select the NHS loans page 3. Complete the compliance tool with project details 4. Complete an online loan application 5. Submit your application online 6. Salix will do a technical assessment
  224. 224. Summary NHS Trusts and Foundation Trusts – no maximum loan amount Help achieve energy and carbon reduction targets Long-term funding plans, SDMPs, estates strategies Reduce energy bills at your Trust
  225. 225. Thank you Tim.morozgalski@salixfinance.co.uk 020 3102 6910
  226. 226. Lunch and networking #Dayforaction
  227. 227. Welcome back Professor Hugh Montgomery MB BS BSc FRCP MD FRGS FRSB FRI FFICM UCL Professor of Intensive Care Medicine Consultant Intensivist, Whittington Hospital #Dayforaction
  228. 228. NHS Sustainability Day: London Roadshow Awards2013Building Finalist Awards2014 Finalist Building Finalist Finalist www.virtus-consult.co.uk Energy Sustainability Project
  229. 229. www.virtus-consult.co.uk Contents  Introduction  HEFT Background / Targets  Client Brief  HEFT Energy Profile  Delivery Process  Initiatives  Achievements  Project Review  Questions Jan Ponsford Director, Virtus Consult
  230. 230. www.virtus-consult.co.uk Introduction  Virtus deliver exemplary results; ensuring every stage of a project’s life is meticulously planned and perfectly executed  Respond to the unforeseeable with innovation and pragmatism  Save money and minimise risk  Have a team of passionate and driven industry specialists Virtus Consult is an award winning construction and management consultancy firm offering tailored solutions to our broad range of clients “I can’t remember ever working with such dedicated and personable people with such integrity” Rolls-Royce
  231. 231. www.virtus-consult.co.uk Introduction “You make us think differently” John Sellars, Director of Asset Management, HEFT  Do not shoehorn our solutions to fit, we listen to our clients to tailor the perfect solution  Are trusted partner to a number of blue chip organisations  Build long term relationships Services  Cost Consultancy  Project Management  Development Management  Energy Consultancy  Principal Designer  Construction Claims Consultancy Sectors  Education  Energy  Healthcare  Hotels & Leisure  Industrial  Nuclear  Offices  Residential  Retail
  232. 232. HEFT Background / Targets 5  One of the largest Trusts in England, employing approx. 11,000 people  Annual budget of £650m  General and specialist hospital care for the people of East Birmingham, North Warwickshire, Sutton Coldfield, Tamworth and South Staffordshire; in excess of 1,800 beds  Continually striving for excellence and efficiency Targets and Constraints:  CIP Targets of 5% year on Year  Carbon Reduction - 34% 2020 / 50% 2025 / 80% 2050  Spend to Save / Guaranteed Savings  Introduce Market intelligence and competition  Compliance with OJEU Guidance www.virtus-consult.co.uk
  233. 233. Client Brief 5 www.virtus-consult.co.uk  Current Energy Spend £5.2m  Carbon reduction targets  5% year on year cost savings  OJEU compliant solution  No disruption to the Trust’s core activity  Option for 3rd party funding  Continued improvement  Low implementation costs
  234. 234. HEFT Energy Profile 5 www.virtus-consult.co.uk HEFT energy spend profile 2008 - 2013  Energy cost has risen consistently across the HEFT estate due to energy price and estate volume increases  Increasing energy demand due to more energy intensive clinical equipment  HEFT joined EU ETS and CRC
  235. 235. Delivery Process 5 www.virtus-consult.co.uk  Site Survey, Interviews and Questionnaire  OJEU Competitive Dialogue  9 month process  Project management of the installation  Monitoring of performance to ensure HEFT receives guaranteed savings  Estimated Demand Side Reductions of c20%  Energy Cost and Carbon Reduction c£1m p/a
  236. 236. Initiatives 5 www.virtus-consult.co.uk  LED Lighting & Controls  Pipework Insulation  Variable Speed Drives  Pump replacement  Display energy meters  Refrigeration Control  Solar PV  Energy Manager
  237. 237. Achievements 5 www.virtus-consult.co.uk  Guaranteed savings of circa £900k per annum (18% of annual spend)  Payback of 4.3 years  Low implementation costs – 0.05% of savings  Speed of implementation – 9 months  Options for 3rd party funding  Continued improvement over 4 year framework  Combined with CHP, exceeded Carbon Target
  238. 238. Project Review 5 www.virtus-consult.co.uk
  239. 239. Questions 5 www.virtus-consult.co.uk B I R M I N G H A M O F F I C E The Penthouse Lancaster House 67 Newhall Street Birmingham B3 1NQ t 0121 200 2855 O X F O R D O F F I C E 267 Banbury Road Summertown Oxford OX2 7HT t 01865 339 439 L E E D S O F F I C E Ground and First Floor 1200 Century Way Thorpe Park Business Park Colton Leeds LS15 8ZA
  240. 240. How to reduce your energy costs without reducing comfort or safety NHS Sustainability Day 2016 – London 25th February 2016 Phil Marris, Managing Director, Jaga Heating Products (UK)
  241. 241. Kier Hardie Health Park, Merthyr Architect: BDP Building Services Engineer: AECOM Main Contractor: Laing O’Rourke M&E Contractor: Crown House Technologies
  242. 242. Air to water heat pumps Low temperature convectors Integrated heating & ventilation
  243. 243. Air to water heat pumps Low temperature convectors Integrated heating & ventilation
  244. 244. “With obstructions like fixed furniture throughout the health park, we knew it would be a challenge to find radiators that would work efficiently the low-temperature system without over-sizing, we found the answer in the Maxi LST radiators which are compact and therefore relatively unobtrusive — yet met the heat loads”. Sarah Gealy, AECOM
  245. 245. Air to water heat pumps Low temperature convectors Integrated heating & ventilation
  246. 246. “The use of properly-controlled DCV systems can provide improved internal environments while saving operational costs” Prof. Tim Dwyer, UCL Demand Controlled Ventilation (DCV) measures the CO2 level in a space, and brings in just the right amount of fresh air to maintain good indoor air quality
  247. 247. “It was important to find a solution that would provide effective ventilation to the space as well as heating it,” Sarah Gealy, AECOM
  248. 248. In summary  Using heat pumps to power a low-temperature heating system saves money and reduces emissions  Low mass, low water content “radiators” get the best out of the system and maintain heating comfort most effectively  LST radiator casing design should be safe to avoid injury and treated to help infection control  Integrated, demand-controlled heating and ventilation ensures a healthy indoor air quality, maximises comfort and saves money
  249. 249. How to reduce your energy costs without reducing comfort or safety NHS Sustainability Day 2016 – London Barts Health NHS Trust, 25th February 2016 Phil Marris, Managing Director, Jaga Heating Products (UK)
  250. 250. Vasco Dimitroff Corporate Affairs
  251. 251. Mission: To reduce global water consumption by 1%
  252. 252.  Water efficiency experts for 20 years  Advisors to the Government since 1999  Lead consultants of Watermark
  253. 253. £70 million
  254. 254.  Major improvements  Metering  Billing  Reporting
  255. 255.  Wider ranging  Greater detail  Robust
  256. 256. £500 million per annum in lost revenue, which if saved coincides with a 30% reduction in water use
  257. 257. London’s Total Annual Water Consumption
  258. 258. 3 billion Cups of Tea
  259. 259. …or filling this room 1 million times over
  260. 260. What this means for the NHS  10 million m3 per year  £24 million
  261. 261. 500Different Building Benchmark Classifications
  262. 262. Why do we need you?
  263. 263.  3 years free bill validation  Electronic water consumption profiles  Identification of high consumption anomalies  A benchmarking toolkit
  264. 264.  More accurate reporting on water  Prepare for deregulation from 2017 and;  Tools to potentially reduce your water bill by a third
  265. 265. 3Simple Steps to Participate
  266. 266.  We provide you with an email to send to your water supplier  They send your future bills to us for benchmarking assessment and validation  Within 24 hours of receiving them, we send your now validated bills onto you
  267. 267.  Climate Change  Rapid Population Growth  Economic Development
  268. 268. True water management - comprehensive approach
  269. 269. @adsmUK #AquaMark Your Participation AquaMark@adsm.com 01753 833 880 www.adsm.com Thank you
  270. 270. Lucy Saunders - Public Health Specialist – Transport & Public Realm Improving the health of Londoners – 1 year into delivery
  271. 271. 315 • TfL has duties to improve the health of Londoners under the Mayor’s statutory duties. Local authorities in London hold statutory public health duties, budgets and specialist staff since the Health & Social Care Act 2012. • In February 2014 TfL published the world’s first transport health action plan. • The plan set out 10 actions that TfL would take over 3 years to more explicitly recognise and demonstrate our role in improving the health of Londoners. • This document also sets out the evidence base for the impacts of transport on health in london, the policy context, useful tools and resources. • Each year TfL publishes an annual progress report. • Lucy Saunders, TfL’s Public Health Specialist, coordinates TfL’s health work programme including the delivery of this action plan lucysaunders@tfl.gov.uk TfL’s Health Action Plan The report focuses on the main health impacts of transport in London: • Physical activity • Air Quality • Road traffic injuries • Noise • Access and severance
  272. 272. 316 More than 2 million Londoners need to build some walking or cycling into their daily routine. London’s transport & streets keep people active 4 in 10 adults 7 in 10 children in London are not active enough
  273. 273. Photo: E Kramer
  274. 274. London’s transport & streets are central to good health
  275. 275. We can only get more people walking and cycling more often if we change the look and feel of our streets. Streets need to feel welcoming places to be, that means tackling air pollution, noise and road danger too. 10 indicators of a Healthy Street
  276. 276. How do you make a tool valid for all types of street? 321
  277. 277. 9 Street types
  278. 278. 2014 and 2015 combined data 65 sample sites and 6,702 respondents City Hub Local Street Town Square City Place High Street City StreetConnector Core Road 11 sites 1,239 respondents High Road LocalsignificanceStrategicsignificance Local significance Strategic significance 7 sites 715 respondents 8 sites 843 respondents 7 sites 705 respondents 10 sites 1,108 respondents 4 sites 348 respondents 8 sites 836 respondents 5 sites 447 respondents 5 sites 461 respondents
  279. 279. Objectives of our survey• One tool that can be applied to all streets in London • Asking people about their experience there & then • Including experience elements – noise, smell, feelings • Differences between different types of street? • Differences between ‘experience’ & ‘expectation’?
  280. 280. Survey summary • Attractive • Clean air • Noisy • Enjoyable • Ease of crossing • Somewhere to rest • Finding shelter • Intimidation by traffic • Stressful experience • Safe from crime & antisocial behaviour • Safe from road danger
  281. 281. Questions grounded in the ‘here and now’ Example question: How clean do you think the air on this street is today? • Please give an answer between 0 and 10 where 0 means you think the air on this street is not at all clean and 10 means you think the air on this street is extremely clean Not at all Extremely 0 1 2 3 4 5 6 7 8 9 10 Are you finding this street noisy? How easy do you think it would be to cross this street? How safe from crime and anti-social behaviour do you feel on this street today?
  282. 282. Average score for each indicator
  283. 283. Londoners expect the streets to be healthier
  284. 284. Building stronger business cases 331 We are strengthening our systems for setting out the health benefits in our business cases. This enables us to build a strong case for many of the projects in our roads modernisation programme which will improve ‘place’ function and increase active travel. • Trained over 150 transport and public health practitioners to use the HEAT tool • Published a manual for practitioners in London to monetise health benefits in their business cases • Identifying new health measures that can be quantified and monetised for inclusion in business cases The business case for the Cycling Vision included the health benefits from increased physical activity and reduced sickness absence. These benefits made up a third of all the monetised benefits.
  285. 285. 332 We are supporting boroughs to deliver their new public health responsibilities through their transport policy, planning and practice. • Our public health specialist offers bespoke input to all boroughs in the form of advice, presentations to boards, data and briefings. • Training is offered to all boroughs on monetising the health benefits of transport interventions and writing a chapter on transport for their Joint Strategic Needs Assessment. • Borough-specific data on active travel was published in a special health evidence chapter of Travel in London 7 to support local policy making. Supporting boroughs Average time spent walking per person per day for London residents by borough 2013/14 Source: Transport in London 7 (TfL 2014) Launch of ‘Transport & Health in London’ at the Hackney Cycling Conference Borough specific data on active travel & health published in Travel in London 7
  286. 286. 333 • Transport & Health in London models the impact on the health of Londoners of a range of different transport scenarios • Improving the health of Londoners sets out the evidence base for the major health impacts of transport in London • Health Impacts of Cars in London was requested by health professionals to show the local picture • Travel in London 7 & 8 each included a special chapter on the role of the transport system of enabling Londoners to meet their physical activity needs. Car ownership is the biggest determinant of low activity levels. Building the health evidence base
  287. 287. 334 • Strengthening our Health Impact Assessments • Strengthening the London Plan • Working with government • Working with academic institutions • Supporting our staff and other businesses to travel actively • Encouraging the NHS to conduct travel analysis And plenty more....
  288. 288. lucysaunders@tfl.gov.uk
  289. 289. Closing comments Professor Hugh Montgomery MB BS BSc FRCP MD FRGS FRSB FRI FFICM UCL Professor of Intensive Care Medicine Consultant Intensivist, Whittington Hospital #Dayforaction

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