NHS Climate Change Summit 2019-session 3
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Session 3 of the 2019 NHS Climate Change Summit
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NHS Climate Change Summit 2019-session 3
- 1. SESSION 3 Future opportunites & initiatives on Climate Change in healthcare In conjunction with The NHS Sustainability Day Campaign #NHSClimateChange
- 2. Small Action Big Impact
- 3. Can Behaviour Change Make a Difference? Health Care’s Climate Footprint Healthcare Without Harm / Arup 2019
- 4. We all want to make a difference To what extent do you agree that individual behaviour to support the environment, such as improving resource efficiency, reducing carbon emissions and reducing waste, is important?
- 5. Most of us don’t think we can Do you see opportunities within your current role to help the hospital become a more sustainable organisation?
- 6. Most of us don’t think we can What do you consider the most important barriers to improving sustainability in your area of work?
- 7. Small Action Big Impact
- 10. 817 pledges so far this year Whilst on the subject of plastic reduction, on Critical Care we have/are in the process of implementing the following: • Paper Drinking straws are replacing plastic • Critical Care branded china mugs have been purchased to replace plastic cups for staff, visitors and some patients. (some plastic will have to stay for certain patients) • The disposable single use plastic trays are being replaced by reusable trays that can be Clinell wiped clean between each patient (IP approved)
- 11. Small Action Big Impact
- 12. Small Action Big Impact
- 13. Small Action Big Impact
- 14. Never too small to make a difference
- 15. Mark Banahan Campaigns Manager, The Vegan Society EAT TO SAVE THE WORLD!
- 16. Rise of plant-based food Number of UK vegans quadrupled in 4 years to 2018 Predicted that vegans/vegetarians will make up 25% of UK population by 2025 1 in 3 people have stopped or reduced their meat consumption
- 17. Climate crisis – scale of emergency IPCC warned only 12 years to avert catastrophic climate change – last year Urgent need to keep global warming under 1.5 C – currently on track for 3 C rise! Biodiversity crisis – habitats being lost & average wildlife populations dropped by 60% in 40 years We need to act now!
- 18. Vegan diet is the most sustainable diet on all metrics: • Greenhouse gas emissions • Amazon rainforest deforestation • Land usage • Water usage & eutrophication 2018 Oxford Uni study: “Switching to a vegan diet is the single biggest way to reduce your impact on the planet.” Committee on Climate Change: “Public sector should take a strong lead by offering plant-based food Climate crisis – plant-based food can help
- 19. Plant-based diets have many health benefits, including being less likely to develop: • Type-2 diabetes • Heart disease • Some types of cancer (e.g. prostate) • High blood pressure • High cholesterol levels Public health British Dietetic Association (BDA) confirm that a well-planned vegan diet is suitable for all ages and life stages, including pregnant & breastfeeding women
- 20. Current situation in hospitals Clear environmental and public health benefits to offering plant-based food Hospitals should be able to provide plant-based food on request, however, in practice this often doesn’t happen Regular reports from vegans who can’t access suitable food or offered very poor options like: • Bowl of chips • An apple • Dry baked potato • Dry toast
- 21. Veganism is a protected characteristic, qualifying as a non- religious philosophical belief Public sector institutions have a duty not to discriminate and this includes ensuring that patients can access suitable food Equality Act 2010
- 22. Seeks to rectify problems vegans experience in public sector Guaranteed vegan option on every hospital menu Available to all, not just by special request Ensure vegans are not indirectly discriminated against, whilst also building familiarity with healthy, sustainable food among wider population Catering for Everyone
- 23. We have already worked with supplier Anglia Crown to develop vegan ready-meal range Registered dietitian can offer advice to hospitals or NHS trusts looking to include plant-based food on their menus Menu development Moroccan vegetable tagine Pasta Peperonata Butternut squash curry
- 24. Conclusion We need immediate action to tackle climate & public health crises Plant-based diets have many environmental & health benefits Public sector should lead by example and offer more plant-based food Hospitals & NHS Trusts should commit to offering at least 1 vegan option on all standard menus The Vegan Society can help
- 25. Questions? I am happy to answer any questions you might have
- 26. NHS: Making Sustainable Transport A Reality Will Blair- Strategic travel management officer
- 27. Public Perception Before • The Trust was not doing enough to tackle car use • Green Travel Plan (2012) developed: Perception was that it was unambitious and vague Congestion associated with the Trust identified as main concern. Limited engagement on travel with the local community, staff and patients. • Circa 50% of staff identified as living within 5 miles of the site. • Baseline assessment identified 34.7% using sustainable travel.
- 28. Embracing Green Travel Green Travel Plan (2014-2030) Ambitious target (60% by 2030) and detailed actions. Engagement pathways crucial Business cases considers all sustainability elements Budget for cycling facilities - £245k (2014) Additional £100k realised in 2017 to fund sustainable travel
- 29. Engagement – Local authority and Neighbourhood Quarterly and annual reports Neighbourhood Forum Neighbourhood News Neighbourhood Steering Groups Internet pages
- 30. Engagement – Patients and Staff Patients Intranet Patient leaflet Sustainable travel and car parking group Staff Sustainable Development Committee Sustainable travel and car parking group Bicycle User Group and mailing list Engagement events and campaigns New start flyer and Corporate induction stall Intranet pages
- 31. Cycling - Then • Cycle to work scheme in place. • Limited secure cycle parking • Limited and poorly maintained changing facilities • Barriers to cycling were identified: Changing facilities Safer cycle lanes Secure compounds Information on alternative Lack of staff engagement with cyclists. • No cycling training in place.
- 32. Site Audit Site audit conducted in partnership with TfGM active travel team found;- • Limited secure cycle parking (40 spaces) • 147 short stay spaces • Some cycle spaces poor quality • Limited shower/changing facilities (6) • No lockers available for cyclists
- 33. Cycling - Now • Free training • Secure cycle spaces (176) • Short stay spaces (149) • Changing facilities (including hair dryers, mirrors and seating) • Showers (23) • Lockers (247) • Drying areas • Bicycle maintenance points (3) • Free monthly maintenance • Free monthly cyclist breakfast • Bicycle User Group mailing list • Free pool bicycles • Partnership with local cycle shop
- 37. Walking - Then • Initially the Trust held ad-hoc seasonal walks. • Attendance was low with between 5-10 walkers • In August 2017 the Trust participated in ‘Walking for Health’ programme. 12-week programme of short walks Walk leader training
- 38. Walking - Now Walking Wednesday • Launched in Oct-17. • Weekly 30 minute walks around local community. • Five Ramblers accredited walk leaders. • Informal marketing • Social event. • ‘Walking Wednesday’ often attracts around twenty staff.
- 39. Public Transport • Greater Manchester – Improved infrastructure • Interest free session ticket loans. • Discount tickets • Journey Planning
- 40. Car Use • Eligibility testing (i.e. permits issued to those identified as essential motorists) • Free to staff - park & ride sites (The Christie) • East Didsbury Park & ride – free parking for Metrolink customers • Car share scheme • Electric Charge Points
- 41. Excellence • Sustainable travel increased to 42% • Travel Choices Active Travel Award for excellence in promoting cycling and walking (2018). • Recognised the organisation in Greater Manchester demonstrating the strongest commitment to active travel. • In addition the Trust has been awarded: NHS Sustainability Award – Public Engagement Green World Gold Award for the Health Sector TfGM Gold award accreditation for championing sustainable travel in the workplace 2017 and 2018.
- 42. Next steps • Withington Regeneration Group • Supporting local activities – Fog Lane Park • Continued partnership with local cycle shop • The Christie invited to summit a Mayor’s Cycling & Walking Fund (Bee Network) • GM Walking Voice Steering Group • NHS Collaborative Network - Sustainable Journeys
- 43. Public Perception Now •Neighbourhood forum very supportive •Local Authority quote The Christie as most proactive organisation they deal with regarding promoting sustainable travel •Transport for Greater Manchester using the Trust as an exampler
- 44. Any Questions?
- 45. The value of an SDMP to an NHS Organisation Adam Newman
- 46. • What is an SDMP? • What was Leeds’ sustainability agenda before our SDMP? • Where are we now? • How did we develop our SDMP? • Why should you develop an SDMP? Introduction
- 47. • Sustainable Development Management Plan • Central document defining an NHS organisation’s sustainability agenda • Set targets and objectives • Development of action plan • Deliver carbon and cost savings What is an SDMP?
- 48. • Largely unorganised • Lack of clarity over objectives and targets • Lack of senior level buy-in • Difficult to report and track progress What was Leeds’ sustainability agenda before our SDMP?
- 49. • Strong existing sustainability agenda: Sustainable Development Management Plan (SDMP) Strategic Sustainability Management Group (SSGM) Environmental Management System (EMS) • Sustainability interventions well underway • Identified reductions of 16,000tCO2e/annum by 2025 • Genuine senior level buy in Where are we now?
- 50. Electricity Gas Water Clinical Waste Non-Clinical Waste Fleet Vehicles 36,965 26,478 710 2,402 1,463 136 Business Travel Patient Transport Visitor Travel Commuting Anaesthetic Gas Total 4,412 1,843 1,545 19,347 4,165 99,464 How did we develop our SDMP?
- 51. • NHS Standard Contract 2019/20 Service Conditions- 18.2 • Centralise sustainability strategy • Set objectives and targets • Track progress against objectives and targets Why should you develop an SDMP?
- 52. Adam Newman- Interim Sustainability Manager adam.newman@nhs.net adam.newman@wrm-ltd.co.uk Thanks for your attention
- 53. WelLPRES Smita Shetty, Healthier Lancashire & South Cumbria Integrated Care System (ICS) Zan Virtnik, Parsek Managing Care Pathways Effectively and Efficiently
- 54. NHS-related traffic accounts for 5% of road traffic in England
- 55. Healthier Lancashire and South Cumbria ICS and their partners - Parsek and others who have shared core values and principles i.e. Developing and implementing sustainable and scalable digital solutions in healthcare Reducing carbon footprint, waste, duplication, variation across our organisations Increasing efficiency and productivity PARTNERSHIP
- 56. Aligning with NHS Long Term Plan, Sustainable Development Strategy and other national objectives Patient centric solution - WelLPRES Co-designed with our citizens, clinicians and other stakeholders First Use Case - Breast Cancer Follow-up Pathway - 23 Oct 2019 Project Management Style WELLPRES
- 57. Some of the benefits of implementing WelLPRES are: Reducing travel for both clinicians and citizens Reducing the need to print documents including patient information leaflets, appointment letters, as these will be available digitally Offering 'Personalised Care' and support self-care/self- management Improving patient engagement and communication BENEFITS OF WELLPRES
- 58. Vitaly Managed CareVitaly Patient Patient access Professional access WELLPRES WelLPRES consists of two products from Vitaly’s solution pack:
- 59. WelLPRES Smita Shetty, Healthier Lancashire & South Cumbria Integrated Care System (ICS) Zan Virtnik, Parsek Managing Care Pathways Effectively and Efficiently
- 61. 90 percent of all spreadsheets have errors that affect their results Source: 2017, Cornell University, Ghada AlTarawneh, Simon Thorne, arXiv:1703.09785v1
- 62. Vitaly Managed CareVitaly Patient Patient access Professional access WelLPRES A comprehensive ecosystem of collaborative solutions on top of the interoperable platform.
- 63. Continuity of care for patients. Providing access to documents. Better control of current health condition. Better patient experience & satisfaction. OVERALL BENEFITS Reducing travel and carbon footprintCO2
- 67. QUESTIONNAIRES
- 68. DOCUMENTS
- 69. MESSAGING
- 70. HEALTH JOURNAL
- 72. NHS guidelines Flexible DISEASE-SPECIFIC CAREPLAN Parsek © Confidential do not duplicate
- 73. All in one place Smart filtering Up to date Parsek © Confidential do not duplicate ORGANISED DATA
- 74. Other follow up programmes Colorectal cancer Prostate cancer FURTHER DEVELOPMENT Parsek © Confidential do not duplicate
- 75. Inclusion in active treatments More tasks More patient engagement needed OPTIONS FOR THE FUTURE Video collaboration (PP-HC, HC-HC) Remote patient monitoring Parsek © Confidential do not duplicate
- 77. Through an intuitive interface, Vitaly eHealth Platform enables patients and healthcare professionals a secure access to relevant data when and where it is needed. USER-CENTERED CARE
- 78. Vitaly collects relevant clinical data from various healthcare information systems in a standardised form. ATNA XDS XUAFHIR PIX INTEROPERABILITY AND ARCHITECTURE Our platform is fully healthcare IT compliant. Core of the platform is FHIR (Fast Healthcare Interoperability Resources) HL7
- 79. Using responsive design, Vitaly offers the same user experience on all devices – smartphones, tablets and PCs. When designing user interaction we always test the experience. OPTIMAL USER EXPERIENCE
- 80. Ease of use Room for improvement
- 81. Ease of use Room for improvement
- 82. WCAG “WCAG is a set of guidelines for making content accessible for all users, including those with disabilities.” WCAG 2.1 for ICT (info. comm. tech)
- 84. Better informed and empowered patient Parsek © Confidential do not duplicate Can easily be modified for out-patient management of other medical conditions CONCLUSION Lower healthcare costs Better health outcomesReducing carbon-footprintCO2 Better informed empowered HCPs Better decision-making Optimisation of workflows
- 86. healthcare@parsek.com Thank you. Parsek © Confidential do not duplicate smita.shetty@nhs.net @HealthierLSC @parseksolutions
Editor's Notes
- Actions speak louder than words
- MB Campaigns Manager at TVS TVS oldest vegan org, campaigning & ed charity Share benefits of veganism Here today to talk about how what we eat can help to save the world
- You may have noticed recently that PB food becoming more popular Increase in number of UK vegans and this is expected to continue to rise in coming years, prediction that vegans/vegetarians will make up 25% of UK population by 2025 Big increase in people reducing meat/animal product consumption also, 1 in 3 report some level of meat reduction The increasingly popular Veganuary campaign highlights the increase in number of vegans, participants doubled in 2019 from previous year
- UN IPCC informed us last year that we had just 12 years to avert catastrophic runaway climate change Need to limit global warming to max 1.5C – on track for over 3C rise Also have a biodiversity crisis - Average wildlife populations have dropped by 60% in 40 years We need to act now!
- Vegan food is most sustainable on all metrics Vegan diet has 50% less GHG emissions than standard western diet Animal ag responsible for 91% of Amazon deforestation Vegan diets require 50% less land than meat-eating diets Also benefits from less water usage & less eutrophication/water pollution 2018 Oxford Uni study found switching to a vegan diet is the ‘single biggest way’ to reduce an individual’s impact on planet CCC: public sector should take a strong lead by offering plant-based food
- UK currently also facing many diet-related public health crises – cost to NHS is more than smoking, alcohol abuse or lack of physical activity PB diets have many health benefits found in population studies Less risk of: Type-2 diabetes, heart disease, some types of cancer, high blood pressure, high cholesterol levels BDA confirm well planned vegan diet suitable for all, inc pregnant & breastfeeding
- Despite clear benefits to the environment & public health, you would think that plant-based food would be widely available in the public sector, especially in hospitals, however, this is not the case. Although in theory all hospitals should be able to provide PB food to patients on request, in practice this often doesn’t happen Regularly receive reports from vegans in hospital who can’t access any vegan food or are offered very poor options. Some options we have heard from patients: bowl of chips, an apple, a dry baked potato, dry toast – not a proper nutritionally balanced meal.
- Veganism is protected characteristic under Equality Act, qualifying as a non-religious philosophical belief Public sector institutions have a duty not to discriminate against patients and this includes ensuring that all patients can access suitable food By not providing vegans with suitable food, hospitals & NHS Trusts are breaking the law
- C4E campaign seeks to rectify the problems that vegans experience in hospitals & other public sector settings Calls for a guaranteed vegan option on every hospital menu Available to all, not just by special request Would enable growing number of vegans & flexitarians to be properly catered for (avoiding indirect discrimination), whilst building familiarity with healthy, sustainable food among wider population
- TVS have already worked with supplier Anglia Crown to develop a range of vegan ready meals which are supplied to over 100 hospitals nationally. These include the pictured items, Moroccan vegetable tagine, pasta peperonata and butternut squash curry We have a registered dietitian on staff who can offer advice to hospitals or NHS Trusts looking to include vegan options on their menus
- To conclude: Clear that we need immediate action to tackle climate & public health crises Plant-based diets have many environmental & health benefits Public sector should lead by example and offer more plant-based food Hospitals & NHS Trusts should commit to offering at least 1 vegan option on all their standard menus TVS can help with menu development
- That concludes my presentation today, hope you found it useful. Happy to answer any questions you might have
- Do you know what is this icon? (Go silent for 3 seconds) And this is the same tool how which is in use for managing low risk patients in Breast Cancer Follow Up Programme
- According to researchers from Cornell University
- The implementation consists of a combination of two key elements of Parsek's Vitaly health care solution set: - A Patient portal for facilitating patient engagement and allowing them to access their electronic health record. - A Managed Care system, which enables personalised and remote coordinated healthcare for clinical teams. This first phase will digitise the 5-year supported self-managed follow up programme, and in the future phases will add 2 additional cancer recovery programmes (Colorectal and Prostate supported self-managed follow up). The solution is designed to support patients with stable disease to self-manage their follow up care. Following treatment of breast cancer, the clinical teams assess the patient’s eligibility to enter a supported self-managed follow up pathway by following risk stratification protocols.
- The overall benefits of Patient portal Better guidance and patient support which can minimize unnecessary examinations, unnecessary doctor’s office visits and avoid losing patients to follow up. Better patient experience & satisfaction. Providing access to documents Better control of current health condition. It is also Enable continuity of care by providing information about patient conditions between defined healthcare episodes Increased therapy compliance Optimize healthcare service by in-time reaction to patient condition changes
- Patient Responsibilities: - Attend annual planned mammography screenings. This test consists of digital x-ray imaging of breasts. Images are then reviewed by a radiologist who prepares a report. - Fill out the questionnaire to highlight any red flag symptoms or patient concerns (which is subsequently reviewed by a health professional). A decision is made by the health professional on the outcome of the mammogram and Questionnaire results (if everything is OK or further examination is needed). Let’s have a look from a functional perspective point of view as a patient
- Patient can access all different medical information Patient Portal will also be integration with new citizen identity service, NHS Login so non-professional users will be able to use NHS Login as part of the verification and authentication process
- all tasks are created in Managed care by Cancer care coordinator Such as: Questionnaires, annual mammography appointment, regular appointments, progress tracking,
- digital questionnaires, engage patients to contribute information where and suits them best, reduce unnecessary administration overhead, effective information management Cancer care coordinastor will based on clinical guidelines thresholds receive a notifiation to detect and react to potential issues sooner
- Patients will also be able to access all the documents residing in LPRES backbone and all manually uploaded documents to MC (HCP facing solution). In future phases there is plan to include also structured data (such as immunizations, medications, allergies and conditions)
- better communication between health professionals and patients patients are not left alone after the procedure, easily share information and get in contact with the hospital and/or the doctor.
- Health journal involves patients in the process of care and gives them ability to track self observations or add different patient-generated measurements (such as body temperature, blood pressure, oxygen saturation etc) health journal will also guide to be complient to digital care plan
- And now have a look on Managed Care which is HCP facing solution
- The solution used on HCP side is Vitaly Managed Care, which is used for implementing, managing and carrying out of the patient‘s careplan. The careplan is based on a disease-specific template, which includes the appointments and other tasks. In case of breast cancer follow up programme, the template is done according to NHS guidelines, but has enough flexibility to cover the differences in individual institution‘s workflows. It includes the yearly mammographies, questionnaires and clinical reviews, as well as a number of one-time appointments, such as educational appointments.
- The result is well organised data that replaces excell spreadsheets and similar solutions that were used for managing the follow up programme untill now. The data is All in one place Automatically organised and Updated in real time with input from the pateint and HCP‘s side This mean less time lost looking for the required information, as well as Less chance of mistakes Along with allowing remote interventions, this anables more optimised workflows and consequently lower healthcare costs, as well as better health outcomes.
- In July we start work on implementing well-press into other follow up programmes being carried out on these institutions, namely colorectal cancer follow-up and prostate cancer follow up. The implementations will be similar in purpose and basic functionality, but will differ in appointments and tasks, specifics to the follow up-programme. They will again be done according to NHS guidelines, but will allow for institution specific workflows.
- All of these follow-up programmes are just for monitoring patients when active treatment is finished and are relatively lightweight, with just a few appointments and tasks every year. But the solution being implemented here is designed in such a way that in future it can be easily be applied to active outpatient treatment of various diseases. Actually, the more tasks the patient must regularly do, such as measurements, questionnaires, therapy applications, etc, the more benefits can be expected by using telemedicine functionalities.
- We have a platform which is fully healthcare IT standard compliant and providing HL7 v2 and v3 (core of the platform is FHIR, entitiy/domain model is HL7 FHIR and all internal communication is implemented using HL7/FHIR) We have healthcare IT standard access control, we have Open ID and SAML tokens (the same as NHS Login) The connector layer (which is capable of communication with healthcare IT standard (HL7 v2, v3 and IHE) with external services and sources. Our platform is highly secured Internet/DMZ.
- Web Content Accessibility Guidelines Well to put it simply, it’s a set of guidelines that prevent situations like this but on the web
- To conclude, implementation of well-press results in better informed and empowered patient and HCPs, which enables better health outcomes and lower cost of healthcare. In future, the solution can easily be modified to cover any sort of out-patient disease management, bringing the same benefits there.
- We believe in a better way of managing patients.