NHS Climate Change Summit 2019 Insights

WELCOME TO THE
NHS CLIMATE CHANGE SUMMIT
2019
In conjunction with The NHS Sustainability Day Campaign
#NHSClimateChange

SESSION 1
How policy can influence change for our
climate
In conjunction with The NHS Sustainability Day Campaign
#NHSClimateChange

2020 NHS
Sustainability
Campaign
Aims, ambitions and goals

Resource packs free to the NHS
3 Roadshows- Clinical/Procurement/Plastics
Driving SDMP adoption across NHS
Leadership Board
New members
Support & Resources for Sustainability Managers
Aims, ambitions and goals

OUR LEADERSHIP BOARD
Claire Winter
Environmental,
Sustainability and
Facilities Manager
Smita Shetty
Service Redesign
Manager
Fran Silcocks
Sustainability
Officer, Sandwell
and West
Birmingham
Hospitals NHS Trust
Clare Nash
RGN, BSc, PGDip
Alexis Percival
Environmental &
Sustainability
Manager, Yorkshire
Ambulance Service
https://www.nhssustainabilityday.co.uk/leadership-board/
Clare Topping
MRSC, Cchem,
MIEMA, Cenv
Professional Eco-
Ninja, Energy &
sustainability
manager for
Northampton GHFT

What is today’s Summit all about?

1. Planning Sustainable Transport for our events
- We aim to source and book venues accessible via
public transport & reasonable walking distance
between transfers
- We will encourage our delegates to organise car
shares

2. No single use plastics for SD Campaign 2020
- We will make sure venues will not provide any plastic cups,
plates all cutlery
- We aim to alleviate any paper/non recyclable signage
- We ask our exhibitors to not bring plastics ‘giveaways’
- We will source Recyclable delegate badges / wallets
- Any single used plastics will be scrapped from our resource
kits for this years campaign

3. Minimise materials destined for land-fill
- We will Re-use materials where possible (such as our
delegate lanyards)
- We will now provide a Paperless agenda & event guide
which you will be able to download from our website

4. We will Favour sustainable venues for our roadshows and
events
We ask for our venues to be:
- Energy efficient
- Contain Zero single-use plastics
- Control their Waste management

5. Source locally
- We will reduce trucking and transport impact on equipment
and materials by sourcing locally
- We will Use local resources where possible to reduce travel
- We will Use local/inhouse caterers and local produce to
reduce food miles

AVAILABLE
TO
DOWNLOAD
NOW!
VISIT: https://www.nhssustainabilityday.co.uk/

Climate Summit
October 2019
Sonia Roschnik

SDU
• Funded by and accountable to NHS England and
Public Health England
• Hosted within Strategy Group, NHS England
• Set up in 2008 as the Climate Change Act came into
force (26/11/2008)
• To support the NHS to fulfil its potential as a leading
sustainable and low carbon organisation

NHS impacts
• 21.4 Mt of CO2 emissions cost society up to £2bnpa in climate
change damage
• Each year health related air pollution cost society £345m and
6,440 QALYs
• 590kt Waste, 15% to landfill and 22.7% plastic
Our impacts are often concentrated closest to the most
vulnerable, potentially contributing to health inequalities.

Progress
• 18.5% CO2 since 2007 whilst activity increased
• Water footprint down by 21% since 2010
• 71 % SDMPs in organisations (mostly providers)
• Sustainability assessments, tools and reporting
increasing
• Integrated into NHS Contracts, NHS Constitution

• Reducing NHS fleet
emissions (including
ambulances) and other
specialist vehicles
• Reducing outpatient
appointments by a third
• Working with local
government to reduce
emissions
• Greening our estates and
facilities, including
phasing out coal and oil
fuel as primary heating
• Switching to greener
asthma inhalers
• Reducing the carbon
footprint from anaesthetic
gases
• Reducing single use
plastics across NHS
catering as well as clinical
and supply chain domains
• Working to improve the
disposal and recycling
processes for plastics
• Providing alternative
options through NHS
supply chain
• Supporting data and analytics
• National procurement and supply chain
• Innovation & Technology
• Communications & Engagement
By 2023/24, we will cut
business mileages and fleet
air pollutant emissions by 20%
By 2025, we will reduce our
carbon footprint by 51%
against 2007 levels
We will deliver reductions in
single use plastics throughout
the NHS supply chain

A corporate approach
• Develop a Plan approved at Board
level (SDMP)
• Evaluate organisations approach
and progress
• Measure, monitor and report on
carbon as a minimum
• Raise awareness in staff, patients
and public

Marginal Abatement Cost (MAC) curve

Anaesthetic gases 2000-30
0
100
200
300
400
500
600
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030
Maternity Emergency N2O & O2 Ambulance N2O & O2 Sevoflurane
Isoflurane Desflurane Nitrous oxide for anaesthesia Dentists
Nitrous oxide 50:50 wedge Surgical nitrous oxide wedge Volatiles wedge Projection 2
Projection 1 - BAU

A single cataracts operation
generates ~2kg of waste (of which 1.3kg is plastic)
With thanks to Dr Caspar Gibbon &
team at North Devon Healthcare NHS
Trust

Next phase?
• Sustainable clinical practice
• Partnerships with local government
• Partnerships with industry
• Innovation and solution focussed
• Holding ourselves to account

Thank you!
sonia.roschnik@nhs.net
www.sduhealth.org.uk

Small changes, big differences
Clinical supplies – quality, safety and value at the frontline
Small Changes, Big Differences
‘How nursing staff add value to
procurement and sustainability in
the workplace’
Rose Gallagher MBE
RCN Professional Lead Infection Prevention and Control
#smallchanges

Presentation outline
• The evolution of Small Changes
• Context then – and now
• Our commitment as the Royal College of
Nursing
• Small changes to support sustainability

5 years in a snapshot
Multiple requests
for nursing views
Formalised
relationship
NHSSC
RCN Small
Changes March
2015
Clinical Reference
Board (CRB)
Proof of concept
CET
Integration of
clinical evaluation
FOM
implemented, CRB
paused
Integration of
clinical evaluation
33

Small Changes Founding
principles
• The word procurement was not widely recognised
within nursing
• We needed to engage all roles and seniority within
nursing
• This is an issue for all care settings, not just hospitals
• Procurement levers should be safety and patient
experience, not just cost
• Nursing wants to be part of the solution - Boards
need to support nurses to engage and contribute
34

The ripple effect when nursing makes
small changes
35

Making Small changes tangible
2014 survey Practical resources

Sharing experiences
Using different media Practical resources

Moving beyond procurement – influencing
small changes in waste management
2014 2018
38

Don’t think waste think disposal
Buy
Dispose
of
39

Taking a sustainable approach
40

Founding principles
• The word sustainability is not widely recognised within nursing
• We need to engage all roles and seniority within nursing
• This is an issue for all care settings, not just hospitals
• Sustainability levers should be safety and societal impact, not
just cost
• Nursing wants to be part of the solution - Boards need to
support nurses to engage and contribute
43

Sustainability as a domain of quality care
44
Sustainable
Safe and
effective
Efficient
Timely
Patient/person
centred

Understanding where healthcare fits in
• Road travel – 13% of NHS carbon footprint
• Use of anaesthetic gases
• Respiratory inhalers
• Pharmaceutical and equipment/medical instruments
are the 2 largest CO2
• producers = prescribing activity not medicines for
health
• The paradox of plastics in healthcare - identifying
alternatives or more reuse
• Waste
• NHS dealing with more extremes and erratic weather
means increased demand

Member priorities atm…
• Reduce unnecessary plastics – quick wins
• Challenging the single use culture
• Reduce waste e.g. packaging
• Reduce plastics (where possible)
• Recycle more
• Ethical procurement
• Sustainability within the RCN
46

Key messages using different
resources

How can you make small changes?
• Support the NHS Supply Chain ‘towers’ and
participate in clinical evaluation of
products/consumables
• Get involved with RCN sustainability work as it
evolves
• Share your activities and experiences with us
• Join our evolving network
• Tell us what you need
49

Small changes, big differences
Clinical supplies – quality, safety and value at the frontline
Thank you
#smallchanges

Climate Change over the UK:
The view from UKCP18
• Dr Dan Bernie
• October 3rd 2019
• Jason A. Lowe, Dan Bernie, Philip Bett, Lucy Bricheno, Simon Brown, Daley Calvert, Robin Clark, Karen Eagle, Tamsin Edwards, Giorgia Fosser, Fai Fung, Laila Gohar, Peter Good, Jonathan Gregory, Glen Harris, Tom Howard, Neil Kaye, Elizabeth Kendon, Justin Krijnen,
Paul Maisey, Ruth McDonald, Rachel McInnes, Carol McSweeney, John F.B. Mitchell, James Murphy, Matthew Palmer, Chris Roberts, Jon Rostron, David Sexton, Hazel Thornton, Jon Tinker, Simon Tucker, Kuniko Yamazaki, and Stephen Belcher.
www.metoffice.gov.uk © Crown Copyright 2018, Met Office

What changes to UK climate
have we seen?
• Changes in extremes of climate
and weather are being observed
• Warming amounts differ from the
global average and by season
• Rainfall is also changing, in total
terms and intensity in heavy
events
• Sea level has risen around entire
UK coastline

www.metoffice.gov.uk
© Crown Copyright 2018, Met Office
Need and urgency for building resilience
Impacts of extreme weather and
climate change permeate through
society affecting lives and
livelihoods
UK Flooding Events 2007
Source: © 2019 Munich Re, Geo Risks
Research, NatCatSERVICE. As of March 2019.

www.metoffice.gov.uk
© Crown Copyright 2018, Met Office
Emission reductions will lead to lower increases in
warming and impacts – but there will be an increase
relative to today

© Crown Copyright 2017www.metoffice.gov.uk © Crown Copyright 2018, Met Office
Working together on
UK Climate Projections
What is UKCP18?

Working together on
Over land area:
UKCP probabilistic
UKCP (60km) global
UKCP (12km) regional
UKCP (2.2km) local

Working together on
The global (60km), regional (12km) and local (2.2km)
provide:
• Opportunity to explore the most up-to-date
modelling and science
• Many more metrics, including daily results or
higher temporal frequency
• Spatial coherence – so you can look at impacts
at the same time at different places
• Physical coherence – so you can look at the
relationship between different metrics, e.g.
rainfall and soil moisture
Why do we need such a diverse set of projections?

Working together on
Headline result:
“a greater chance of
warmer, wetter winters and
hotter, drier summers”

Working together on
• All areas of the UK are projected to experience
warming
• Warming is greater in the summer than the
winter
• Future rise depends on the amount of
greenhouse gases the world emits
Future UK temperatures

Working together on
Summer 2018 heatwave
• Chance of such hot summers
low in the baseline period
(<10%)
• By mid-century the chance of
hot summers will be of the
order of 50%
• Beyond 2050 the chance of a
warmer summer more strongly
depends on emission scenario

Working together on
Future UK precipitation change
Summer Winter
The spatial pattern of change to 2061-2080 shows detailed structure over the
UK (RCP8.5). Compare SE England and N Scotland.

Working together on
Working together on
Future UK precipitation

Sea-level rise
Increase will generally be
greater in the south than
in the north
(by 2100 relative to 1981-2000)

Working together on
Working together on
UKCP18: sea-level rise
• Sea-level rise will occur for all emission scenarios
and at all locations around the UK
• Changes in extreme water levels are mostly driven
by changes in mean sea level
• Best estimate is that surge component won’t
change, but can’t rule out changes
• Sea level will continue to rise beyond year 2100.
But the amount is very uncertain
• There may be changes in tidal characteristics and
waves

From launch to application
Total number of users for the UKCP User Interface since launch
2311, making 96118 requests

Using UKCP18…the story so far…
Updating existing
reports & guidance
Catchment flows update
Climate scenarios for local
government
Developing CC assessment guidance
for MOD assets
Rail infrastructure climate risk
assessment
Catalyst for climate
risk assessment
Fit for the Future Network
Assessment of existing school
building stock and care homes
Exploiting new
information
CCRA research projects
CCRA climate change evidence
Water resources management
planning
Strategic Priority Fund on Climate
Resilience projects
Climate change in commonwealth
countries project

Climate change report for Bristol City
Parfitt R and Golding N (2019)

CIBSE weather files for climate risk assessment of school buildings and
care homes
Identifying when the projected 2°C (yellow lines) and 4°C (red lines) of
global temperature increase in relation to the pre-industrial period occurs in
the RCP projections
CIBSE Weather files based on UKCP09
Including ClimaCare project consideration

Future catchment flows – UKCP09 vs UKCP18 for SRESA1B
10 catchment models across
England
PDM model
CLASSIC Model
Kay A, Rudd A, Bell V and Wells S (2019)

CCRA3: Water resources project
Drought Severity Index for one Global (60km) member (PPE-05)
Durant M and Counsell C
(HR Wallingford, 2019)

@metoffice
@MetOffice_Sci
#ukcp18
https://ukclimateprojections.metofffice.gov.uk
https://ukclimateprojections-ui.metofffice.gov.uk
https://catalogue.ceda.ac.uk
Where to find the information

James Dixon MSc, FIEMA, CEnv
Head of Sustainability
Newcastle Hospitals
3rd October 2019
NHS Climate Change Summit
Wellcome Collection, London
Our Climate Emergency Journey

Newcastle Hospitals
“…Providing patient-centred healthcare to
communities in the North East of England and
beyond for over 250 years. We’re one of the
largest NHS trusts in the UK, offering a wider
range of specialist services than any other.”
• 2 million patient contacts a year
• Serve a population of over 3 million
• 15,000 staff and 1,800 beds
• £1 billion turnover
• Five main sites, plus many community sites
• L1 Major Trauma Centre with helipad at RVI
• Long history of clinical excellence:
- 1st child heart transplant in Europe (‘87)
- 1st single (‘87) & double lung (‘91)
transplant in Europe
• CQC “Outstanding” 2016 & 2019 (only
Shelford Trust)
© Jim Edwards

2011 2012 2013 2014 2015 2016 2017 2018
History of Sustainable Healthcare Leadership

Sustainable Healthcare in Newcastle (Shine)

What is a Climate Emergency Declaration?
1. A public acknowledgement of the
climate crisis which threatens
population health
2. A commitment to fast-tracking the
reduction of our carbon emissions
3. Collaborative action with our civic
partners to deliver a zero carbon
Newcastle

How NUTH might achieve Carbon Neutrality?

“…it is still not too late to
act. It will take a far-
reaching vision. It will take
courage. It will take fierce
determination to act now,
to lay foundations when we
may not know all the details
about how to shape the
ceiling. In other words, it will
take cathedral thinking.”
Greta Thunberg, Age 16
European Parliament, April 2019
Cathedral Thinking

James Dixon
0191 2821503
james.dixon@nuth.nhs.uk
@ecoboyatheart

Dr Anya Gopfert and Dr Chris Newman

DUTIES OF A DOCTOR
25: YOU MUST TAKE PROMPT ACTION IF YOU
THINK THAT PATIENT Safety, Dignity OR
COMFORT IS OR MAY BE SERIOUSLY
COMPROMISED
65: YOU MUST MAKE SURE YOUR CONDUCT
JUSTIFIES YOUR PATIENT’S TRUST IN YOU
AND THE PUBLIC’S TRUST IN THE
PROFESSION

10 % RISK OF GREATER THAN 6
DEGREES?
FROM WAGNER AND WEITZMAN

WHAT’S IN A NAME?
DISTANCE
BRANDING

NEW ORGANISATIONS
DOCTOR
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IN
DEVELOPMEN
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GOVERNMENT ACTION SINCE MAY
1ST

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