Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

NHS sustainability day london roadshow october 2017


Published on

The NHS Sustainability Day London Roadshow Slides

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

NHS sustainability day london roadshow october 2017

  1. 1. Welcome to NHS Sustainability Day London Roadshow #Dayforaction
  2. 2. Award entries open from today Enter at
  3. 3. Morning Agenda 09.30 Chairs Introduction Professor Anthony Kessel, Honorary Professor and Co-ordinator of the International Programme for Ethics, Public Health and Human Rights (IPEPH) at the London School of Hygiene & Tropical Medicine (LSHTM) 09.45 Opening address: One Public Estate Joe Garrod, Regional Programme Manager, One Public Estate, Local Government Association 10.05 FM in 2026: How we made Sustainability matter Sunil Shah, Chair, BIFM, Sustainability Special Interest Group 10.25 Leadership strategy: engaging clinicians Dr Sarah Hammond, Anesthetic Consultant, St George’s University Hospital Trust 10.45 CSR as Economic Futureproofing: What can we learn from the private sector? Robert Barnard-Weston, Founder, Groundswell 11:10 Question and Answers 11.30 Refreshments & Exhibition
  4. 4. Chairs Introduction Professor Anthony Kessel, Honorary Professor and Co- ordinator of the International Programme for Ethics, Public Health and Human Rights, The London School of Hygiene & Tropical Medicine
  5. 5. Sustainability Day London October 4th 2017 ProfessorAnthonyKessel PublicHealthEngland LondonSchoolofHygiene&TropicalMedicine
  6. 6. Introductory Remarks • Sustainability and climate change inter-related • Current levers: air pollution, Sustainable Development Goals (SDGs) • Effecting change: psychological considerations 6
  7. 7. “Theworldaswehavecreateditisaprocessofourthinking.Itcannotbechanged withoutchangingourthinking”(AlbertEinstein)
  8. 8. Direct and indirect health effects of climate change • Impacts on health and wellbeing • Impact on health services – demand, business continuity, supply chains • Impact on infrastructure (utilities) • Economic impacts • Community resilience/cohesion 8
  9. 9. Mortalitylinkedtooutdoorairpollution (Lelieveld et al, 2015)
  10. 10. Estimates of annual air pollution deaths (WHO 2014) Air pollution mortality: outdoor and indoor
  11. 11. HealthEffectsof AirPollution “New estimates from the Global Burden of Disease project and the World Health Organisation state that between 5.5 and 7 million people die from air pollution every year. That’s more than die from malaria and HIV/Aids put together; more than the population of Scotland. In the next 10 years we can expect as many people to die from breathing poisonous air as were killed in the second world war.” [2016]
  12. 12. LANCET / ROCKERFELLER COMMISSION ON PLANETARY HEALTH Integrating Planetary Health with the Sustainable Development Goals
  13. 13. Transformation towards Sustainability Key challenges, and psychological considerations 1. Am I ready for change? 2. Is the organisation / institute ready for change? 13
  14. 14. We know climate change is happening There is now no scientific doubt. Emissions from burning fossil fuels are driving global climate change, warming our atmosphere and oceans, melting ice and driving an increase in extreme weather events. Some of the greenhouse gases we emit can last for thousands of years in the atmosphere; if we continue this way, life on earth will change dramatically. We know the consequences of climate change As a result of climate change, infectious diseases may spread; heat waves, droughts, wildfires, floods and sea level rise will disrupt communities, harm health and kill people. Climate change is also a driver of starvation, migration, poverty and conflict. A business-as-usual approach will lead to global warming that is incompatible with any reasonable characterisation of an organised, equitable and civilised global community. We need to act now to protect the planet and with it our health. What can you do to help? We can all contribute to improving our family’s health and wellbeing and that of future generations. Your actions do count; to minimise environmental impacts, to slow down our personal contributions to climate change and to protect public health. Specific examples are suggested below. This is how: One Small Step The Director General of the World Health Organisation has raised the alarm on climate change, so what can you do? Here are a few suggestions, each a small step, that you may want to adopt to make a real difference: - Consider switching to a greener energy supply that offers energy generated in a renewable or sustainable manner. - Eat fresh locally produced foods and fewer processed foods for a month - Get out and enjoy your local green spaces – aim to go for a walk with a friend once a week - Try walking or cycling for short journeys, instead of using your car - Buy energy efficient products – check the energy efficiency labels when purchasing new appliances - Reduce, reuse, recycle – see if you can cut down on one bag of rubbish each week Investigate how you can make your home more energy efficient – can you insulate and get smarter about energy use? Further information about energy suppliers and other ways you can be more sustainable are highlighted in the websites below: ‘One Small Step’ To protect our planet and our health
  15. 15. Change (or the idea of change) and uncertainty • Problematic area for humans • Big challenge for organisations • Some people manage better than others • Premised on fear and insecurity (about the future) 15
  16. 16. Uncertainty and change: how does it appear? • Memory and imagination (drawing on the past) • We live in a thought-generated experience of reality • Insecurity: expectations about the future • Human beings cope well with EVENTUALITIES but poorly with POSSIBILTIES 16
  17. 17. Effecting change: letting go (of resistance) • Connection / Rapport / Trust / Authenticity • Pointing in the direction of understanding the nature of resistance to change • Avoid enforced ‘positive thinking’ • Prudent preparatory planning and responsiveness • Letting go (of resistance to change) allows fresh thinking, hopefulness, creativity, a feeling of what is possible rather than impossible 17
  18. 18. One Public Estate Joe Garrod, Regional Programme Manager, One Public Estate, Local Government Association
  19. 19. One Public Estate Joe Garrod, Regional Programme Manager, Local Government Association
  20. 20. ● £31m to reach 95% by March 2018 ● Working with: ○ 255 councils in 63 partnerships ○ 13 main government departments ○ 400 projects – over a quarter involve partnership working with health bodies ● Already delivered: ○ £27.6m capital receipts ○ £20m running cost savings ○ Over 5,500 jobs ○ Land released for over 550 homes Where we are now
  21. 21. £615m £158m 44,000 25,000 Land released for housing Running cost savingsCapital receipts Jobs What we will deliver by 2020
  22. 22. ● The essentials ○ Asset mapping ○ Shared vision ○ Bring public sector partners together ○ Partnership with senior buy-in ○ Seed funding and ongoing support ○ Clear vision and programme of work How we work ● Partnership support ○ Funding ○ Support from LGA and GPU ○ Access to central government ○ Best practice and case studies ○ Opportunities workshops ○ Support to change policy ○ Support on benchmarking and data
  23. 23. ● Nearly 20% of the acute estate predates the formation of the NHS ● Backlog maintenance presents a £5bn liability to the system ● £10bn extra capital is required to enable the delivery of STP plans ● Estate highly fragmented - NHS PS and CHP own 15% of total land ● 7,600 GP practices – many small and ill-equipped for the shift to out of hospital care ● Commercially executed disposals could generate between £2bn and £5.7bn for reinvestment ● Lack of strategic leadership in place to deliver the changes required The Naylor challenge
  24. 24. London Health Devolution National/ Regional Stakeholders London Estates Board LEDU Steering Group STP/CCG Estates Groups London Estates Delivery Unit Key Themes • £2.7bn reinvestment in health estate • Release of surplus land for homes • Co-location and service integration • New primary care provision • Rationalisation of GP estate • Upgrading, and closure, of acute care settings • Step down housing / community based care • Feasibility studies / masterplans to facilitate the above Key Challenges • Tension between maximising initial capital receipts and the lowest cost overall solution • NHS LIFT expensive, inflexible and ties up revenue in the long term i.e. 30 years
  25. 25. Bedford Town Centre Regeneration ● c£900k development funding ● 2,300 new homes and 1,400 new jobs ● Town centre regeneration: Station Gateway/Ford End Road, Riverside, Hospital South and North sites ● Health hubs – unlocked £2.33m Estates & Technology Transformation Fund
  26. 26. Mixed-use redevelopment of the CCG HQ and an adjacent mental health unit • Impact to date: o CCG has saved c£300k pa due to co-location ○ £3m receipt plus overage to NHS PS • Future impact: ○ Trust will save c£300k pa due to exit from mental health unit PFI deal ○ New GP surgery ○ 150 new homes 221 Erith Road Options Strategy, Bexley
  27. 27. ● NHS bodies, councils and central government need to work together in an open and transparent way to be successful ● Strong governance/ leadership and joint decision making with a broad range of public partners ● Your strategic objectives should be the driver for your work, your assets the facilitator ● Take a portfolio approach – include system-wide, strategic and tactical initiatives ● Integrated health and social care, community based services and new housing are key themes being delivered by OPE partnerships Lesson learnt
  28. 28. Funding round open One Public Estate ● £9m revenue funding ● £7m grant funding ● £2m loan fund for established partnerships DCLG Land Release Fund ● £45m capital fund ● Release local authority owned land by 2020 for housing Partnerships can apply for either or both pots of funding
  29. 29. FM in 2026: How we made Sustainability matter Sunil Shah, Chair, BIFM, Sustainability Special Interest Group
  30. 30. Sunil Shah, Chair, Sustainability Special Interest Group FM in 2026: How we made sustainability matter NHS Sustainability Roadshow 4th October 2017
  31. 31. BIFM Sustainability SIG Aims & Objectives > Act as a centre of excellence for knowledge and opinion within the FM sector > Promote best practice, awareness, participation and learning > Inform the facilities community and other stakeholders about the importance of effective sustainable development practice to create a framework that allows an active business contribution
  32. 32. BIFM Sustainability SIG What do we do? > Collaborate with others  Regions/Other SIGs  IET Energy Group Member  Fairplace Award  MEUC > Consultations > Annual Sustainability Survey > Good Practice Guides > Events > Articles & Newsletters > Follow us on twitter @BIFM_Sust
  33. 33. Survey Findings
  34. 34. BIFM Sustainability SIG What happened in 2007 > 11 people died in UK January storms - container ship ran aground in Devon > Kryptonite was discovered – its white and doesn’t glow > Summer flooding - Teweksbury > Madeleine McCann disappeared > Tony Blair handed over power to Gordon Brown > Bank rates up to 5.25% > iPhone launched
  35. 35. BIFM Sustainability SIG Looking Back on the First 10 Years
  36. 36. BIFM Sustainability SIG Global Influences REGULATION - Energy & Carbon - Social & Human Rights GOVERNANCE - UN Sustainable Development Goals - Paris agreement INVESTORS - CDP, DJSI - Ethical funds BEHAVIOURAL - Business culture - Leadership
  37. 37. BIFM Sustainability SIG Today’s Emerging Themes Technology > use of BIM, diagnostics and personal information provides real time information to inform the building lifecycle Social Factors > synonymous with sustainability as environmental factors > include pay, diversity, human slavery and social value Informed Decisions > evidenced based approach to wellbeing, productivity and lifecycle
  38. 38. Sustainable FM in 2026
  39. 39. BIFM Sustainability SIG Technology in 2026 Business As Usual • Sensors, off-site building management systems, diagnostic tools standard in new and refurbished locations • Real time information available to make decisions and understand performance • Build in occupant and customer feedback • Off-site management and support – removes local need for expertise Dependencies • Increased reliance on correct design, installation and set- up • Need to understand systems during moves and small scale changes • Potential overload of data – need to sort out what is important
  40. 40. BIFM Sustainability SIG Social Factors in 2026 Business As Usual • Regulatory disclosure and tracking for staff and supply chain activities • Social value built into contracts and performance measurement • Adaptability to understand and encompass local requirements • Integrate wellbeing into day to day activities Dependencies • Procurement models to reflect sustainability measures and culture • Mapping of local social requirements – community led
  41. 41. BIFM Sustainability SIG Informed Decisions in 2026 Business As Usual • Real time information allows sustainability to be part of core leadership role • Increasingly automated responses being provided to the operation of facilities, set-points • Ability to interrogate and identify optimum solutions for capital projects • Value add response rather than compliance based Dependencies • Structured sustainability framework throughout the business • Reliance upon third party data – will require validation
  42. 42. BIFM Sustainability SIG How do we get there? Procurement > Focus on lifecycle benefits and outcome measures rather than bottom line costs > Measures and metrics aligned with organisational culture Professional Standards > Used to embed skills reflecting tomorrow’s business Initiating Change > proactive role in the organisation to identify and drive innovation Value Add > Identify and deliver solutions that benefit the financial and non-financial bottom line - not just “compliance”
  43. 43. BIFM Sustainability SIG 0% 20% 40% 60% 80% 100% 0% 20% 40% 60% 80% 100% Management Implementation 1 2 3 Top group characteristics of: > Clear leadership and accountability; > Networks of opportunity and engagement; > Investing in the future of energy and people; > Long-term strategic planning, and; > A culture of sustainability > Emerging groups with distinct characteristics > How well value of sustainability is understood > How well this value is communicated SFMI Key Findings
  44. 44. BIFM Sustainability SIG Sustainability Strategy > Developing a 3-5 year programme with BIFM, Government and related bodies > Drive data capture, embed practices and demonstrate value > Focus areas on: > Lifecycle environmental impact in buildings > Social Impact > Opportunities to support the programmes
  45. 45. CSR as Economic Futureproofing: What can we learn from the private sector? Robert Barnard-Weston, Founder, Groundswell
  46. 46. Corporate Social Responsibility as Economic Future-Proofing What can the NHS learn from the private sector?
  47. 47. …but could this be an opportunity in disguise: the evolutionary entrepreneurs’ chance to shine? The NHS: in a vicious circle …or not?
  48. 48. Some Notable CSR Successes: • M&S Plan A • Body Shop • Tesla
  49. 49. Some Notable CSR Disasters: • BP • VW • NatWest
  50. 50. Some notable community-focused CSR successes: • Asda and Urban Poverty • National Grid • The Thoughtful Coffee Company
  51. 51. “What makes or breaks consumers' experience with a brand is… these five things: • Transparency; • A deep understanding of customers; • Respect; • Authenticity; and • A willingness to be open and honest about both its strengths and weaknesses.” Customer Quotient Analysis, 2016 - Adage
  52. 52. Brand Equity = TRUST Body Shop re-examined
  53. 53. …and the Number One brand of which the British people are most proud is…
  54. 54. Ipsos Mori 2016
  55. 55. Unless… However, the Catch-22 remains…
  56. 56. Q: What is the difference between Corporate Social Responsibility and Corporate Social Investment? A: A well-planned investment is designed to make a specific difference AND pay a measured return to its investors. CSI does this by measuring and reporting not only inputs but also outputs and outcomes, tangible and intangible, in all significant areas. CSR vs CSI
  57. 57. THE BOOTSTRAP MODEL: • Quick Wins • Win-Wins • Pioneering Wins
  58. 58. • Estates/FM • Waste • Water • Energy • Transport • Food • Procurement • Partnerships • Employee Engagement • Patient/Community Engagement High ROI Areas:
  59. 59. Integrated CSI Communications INTERPERSONAL COMMUNICATIONS ARTEFACT-BASED COMMUNICATIONS INTERNAL COMMS Stakeholder Engagement I Qualitative Research Quantitative Research Learning & Coaching Intranet Staff Magazines Management Briefings EXTERNAL COMMS Stakeholder Engagement II Seminars Conferences Events Annual Reports PR Website Social Media • Dialogue replaces monologue • Iterative, evolutionary process
  61. 61. A Shared, Uniting Agenda that: • Connects together existing projects • Maximises Return on Investment • Links partners across STPs • Activates Sustainable Development Management Plans • Advances 5-Year Forward View performance • Supports Carter, QIPP, CIP, CQC 5 Key Questions Joining up the Dots…
  62. 62. Finally: GOAL GROUPS and the HEWLETT PACKARD STORY…
  63. 63.
  64. 64. Reuse as a gateway habit for behaviour change Alexander Ford, Sustainability Co-ordinator, The Shrewsbury and Telford Hospital NHS Trust
  65. 65. • 6,000 staff • 2 main sites, 19 miles apart • Plus 6 satellite areas
  66. 66. • To use current resources in a sustainable way. • Encourage staff to recycle and reuse equipment rather than sending it to landfill. • Save £££ Why Warp-it
  67. 67. Warp-it Timeline @ SaTH 2015 Launch • Membership peaks at 50 staff • Few items listed 2016 Re-Launch - November • Corporate Social Responsibility committee asked to reinvigorate Warp-it • 120 staff joined the Warp-it community • 205kg of Co2 saved • £589 saved 2017 To date • 433 staff members joined the Warp-it community • 5179kg of Co2 saved or 7 trees • £9,470 saved
  68. 68. How we used a “warp drive” for Warp-it Involve all departments: • Procurement – Warp-it link added to purchasing system • IMT – Warp-it links on the Intranet page & “sticky topic” on Trading Post • Facilities – Liaised with porters and external transport provider • Estates • Kaizen Promotion Office Promotion:  Launched targeted Warp-it poster campaign • Ward clerks • Department managers  SaTH global email campaign
  69. 69. An Extra Boost! Offered free one to one staff training: • How to add a picture • Add a meaningful description • Adding an item to your wish-list Creating a feel good effect: • Offering staff a reward for a successful posting
  70. 70. Continuous Updates Dear Colleague, Our Trust has implemented an equipment re-use and management system called Warp-it. Warp-it makes it very easy for you to loan or give surplus items that you no longer need to other staff in the Trust. The scheme helps the Trust to save money and reduce disposal costs, carbon emissions and sending waste to landfill. Some items listed on Warpit on 17.08.2017
  71. 71. Add Feedback to your message “I found using Warpit very easy and straight forward to use and it has worked very efficiently. I will be recommending it to my colleagues within the department. Many thanks again for popping over and assisting me in the initial set up, I will have no problems using this again in the future.” (Healthcare Science Support Worker). “It is my first port of call if we need anything for the offices. It is always worth seeing of any pre-loved items could be given a home before spending unnecessarily on new items. The system works for us.” (Legal Services). “Woo Hoooo ;-) Now I know how to do it, I am going to add our other items.” (Clinical Trials Dept).
  72. 72. Repeat your message What items can be reused through Warp It? • Reusable furniture • Electrical equipment • Fixtures and fittings • Office consumables (such as stationery, ink jet cartridges, new clothing) So, if you have an item that is taking up space that you do not need, put it on Warp It. Or if you are looking for an item check Warp It before you buy new! How do I register? Visit our homepage here: Best viewed in Google Chrome.
  73. 73. Challenges & Opportunities  A community of 500 SaTH Warp-it users  How do we tap into the global resource of Warp-it • Collection and external transport costs • Temporary storage facilities  Health & Safety / Infection control concerns  An online forum of NHS Warp-it champions • To share successes • What didn’t work?
  74. 74. Funding energy efficiency to create a sustainable NHS Vikas Ahuja, Energy Manager from Imperial College Healthcare NHS Trust, Laura Couldrey and Sameen Khan Client Support Officers, Salix Finance
  75. 75. Laura Couldrey Client Support Officer, Salix Finance Vikas Ahuja Energy Manager, Imperial College Healthcare NHS Trust 100% INTEREST FREE @SalixFinance #SalixFunded
  76. 76. Opportunity for savings in the NHS Knowledge sharing and case studies Salix Finance and Imperial College Healthcare NHS Trust To demonstrate how Salix can help Trusts and Foundation Trusts Summary of the loan application process Our aims for today @SalixFinance #SalixFunded
  77. 77. Benefits of Energy Efficiency Reduced revenue expenditure Improved patient, visitor and staff comfort Maintenance savings Estate backlog Improved resilience Over the next 10 years the Department for Business Energy and Industrial Strategy (BEIS) estimate that: Electricity prices will increase by 5p per kWh (46%) Gas prices will rise by 1.75p per kWh (71%) @SalixFinance #SalixFunded
  78. 78. Introduction to Salix funding @SalixFinance #SalixFunded
  79. 79. Who we are Not-for-profit company established in 2004 Funded by BEIS, Scottish and Welsh Government, EFA and DfE 100% interest-free capital finance for the public sector Over 100 technologies funded Supports public sector bodies such as local authorities, educational establishments and NHS Trusts and Foundation Trusts NHS Improvement approve of Salix’s Invest to Save model @SalixFinance #SalixFunded
  80. 80. Our innovative funding model Client contribution (were applicable) @SalixFinance #SalixFunded
  81. 81. Salix’s work with the NHS @SalixFinance #SalixFunded * Calculated using emissions factors published by government for carbon footprinting Figures as of April 2017
  82. 82. Top 10 Salix clients within the NHS* @SalixFinance #SalixFunded Total Fund Imperial College Healthcare NHS Trust Above £8 million Wrightington, Wigan and Leigh NHS FT Above £5 million George Eliot Hospital NHS Trust Above £3 million Northern Devon Healthcare NHS Trust Above £2 million University Hospitals Of Morecambe Bay NHS FT Lewisham and Greenwich NHS Trust Hinchingbrooke NHS Trust Bradford Teaching Hospitals NHS FT Above £1.5 million St Helens & Knowsley Teaching Hospitals NHS Trust The Princess Alexandra Hospital NHS Trust * By loan value up to financial year 2016-17
  83. 83. Knowledge sharing and case studies @SalixFinance #SalixFunded
  84. 84. Knowledge sharing and case studies Case Studies Project Knowledge Slides Social Media @SalixFinance #SalixFunded News & Blog Best Practice Calculations @SalixFinance #SalixFunded
  85. 85. @SalixFinance #SalixFunded Salix Events Salix host free annual regional meetings for the public sector Queen Mary University, London, 13th October University of Manchester, 20th October Hampshire County Council, 10th November Gateshead Council, 17th November Nottingham City Council, 1st December CHP workshops University of Liverpool, 10th November University of Birmingham, 24th November London, 6th December Private Sector workshops London, 28th November Manchester, TBC
  86. 86. Salix Finance and Imperial College Healthcare NHS Trust Hammersmith Hospital Queen Charlotte’s and Chelsea HospitalCharing Cross Hospital St Mary’s Hospital Western Eye Hospital
  87. 87. Achievements of Imperial so far
  88. 88. Imperial’s projects since 2010 Project Type Value No. of project Annual £ Savings Lifetime £ Savings Annual CO2 savings (tonnes) Boilers £599,664 1 £154,660 £1,674,968 792 Building management systems £2,949,301 6 £832,971 £7,159,133 5,234 Heating £193,339 1 £63,970 £972,358 394 Heating and hot water £954,769 4 £267,770 £5,956,919 2,377 LED lighting £886,250 3 £221,343 £2,877,469 1,075 Lighting upgrades £673,260 6 £159,988 £3,199,775 1,090 MPS £219,108 1 £117,877 £1,032,042 906 Street lighting £190,950 1 £43,142 £862,853 294 Transformers £177,414 1 £54,729 £1,641,883 373 Ventilation and cooling £106,000 2 £22,498 £256,901 129 Voltage Management £640,007 1 £150,491 £2,859,343 1,027 VSDs/Motor Controls £816,280 6 £183,876 £1,886,571 1,147 Grand Total £8,406,344 33 £2,273,322 £30,380,220 14,837
  89. 89. Benefits to Imperial Patient and staff comfort improved Reduced revenue expenditure Lighting/LED upgrades have seen a reduction in labour costs on reactive maintenance Improved resilience Supported in capital investment when internal is not available
  90. 90. Lessons learned Timescales Stakeholder management Next steps Condensing flue gas economiser at Charing Cross Hospital Draught proofing Burner upgrades Lighting improvements
  92. 92. Feasibility Internal Consultation Procurement Mobilisation Installation Business case checks Meet with finance department Offer reservation of funding for Trust Board Workshops and calls with other Trusts for advice Interim Payments Phase works over financial years How Salix can support your application @SalixFinance #SalixFunded
  93. 93. Key Application Steps 1. Visit our website at 2. Simple on-line application process Application in five easy steps Download a project compliance tool For projects valued over £100,000 – business case template 3. Public Sector Body or supporting body submits application 4. An automated email is generated and sent to the authorised official which they need to reply to confirm their approval 5. Application assessed & decision made typically within two weeks @SalixFinance #SalixFunded 1 2 3 4 5
  94. 94. Summary 100% interest free funding available for NHS Trusts and Foundation Trusts – no maximum loan amount Cost neutral - repaid through savings to the energy bill Helping the NHS achieve energy and carbon reduction targets Supporting long-term funding plans, SDMPs, estates strategies Reduce energy bills at your Trust @SalixFinance #SalixFunded
  95. 95. Smart Cities and how they have the potential to be an integral part of Health & Social Care- Mark Griffiths, Regional Director, Bouygues E&S FM UK Ltd
  96. 96. Mark Griffiths Regional Director Bouygues Energies & Services
  97. 97. Smart technology - can it be an integral part of Estates & Facilities in Healthcare? AGENDA: • Introduction • What is Smart • Delivering Smart • Delivery • Drivers and Benefits
  98. 98. The Bouygues Group: Building Smart Cities Communications Construction Power £36 B turnover
  99. 99. Bouygues’ French Headquarters - Challenger First building in the world to achieve triple certification (2011) • LEED® “Platinum” (US) • BREEAM® “Outstanding” (UK) • HQE® “Exceptional” (FR) Delivery Challenge • Phased works from 2010 to 2014, Shifts over 67,000m2 • Occupied site Energy • 90% Energy and CO2 savings • Ventilated, double skin façades • Geothermal energy from heat pumps • 100% of available BREEAM energy credits achieved • 25,000m2 photovoltaic panels on roofs, terraces and solar farm Water • Rainwater harvesting • 60% water savings • 100% of sewage will be treated and re-used on site (phyto-filtration garden)
  100. 100. What is Smart?
  101. 101. Lots of Independent solutions
  102. 102. Process – Identify the needs Public Spaces Infrastructures Housing Public amenities Commerce and business New usages Local services Nature in the city Water Energies Wastes Mobility Digital
  103. 103. Delivering Smart
  104. 104. GreenCity – Zurich 2000W Community Today 5.000 W/hab Accomodation 1.500 W Transportation 900 W Consumption 1.100 W Infrastructure 900 W Electricity 600 W Goal 2.000 W/hab
  105. 105. The Drivers
  106. 106. So why SMART for NHS?
  107. 107. The Art of the possible…. • 700 bed hospital • 1,800,000 sg ft of GIA • Automatic tinting windows using IP technology • Full fresh air ventilation systems • Gains in efficiency of Healthcare staff • Real time data available both clinically & estate wise • Efficiency in bed utilisation / optimisation • 50% reduction compared to a typical model hospital • A single source of data & benefits…
  108. 108. Scheduling Data (HIS) Staff Locations (RTLS) Nurse Call System Unified Comms Real Time Audit / Analytics Nurse / Bed Assignments (HIS) Agent keeps track of people, locations, Schedules, Roles, Beds, Assignments Nurse Agent receives notifications for the attached user and interacts with them… Nurse Assist Agent identifies the right nurse and notifies them Track everything in real time Capture Nurse Call Events Intelligent Alerting Voice call initiation Workflow Management End Users and Computing Devices Data, System and Healthcare Things Interaction InterconnectionIntelligence ThoughtWire makes everything smarter…Nurse Assist - Receive and respond to nurse call events on any desktop or mobile device.Health 111
  109. 109. Smart City & Health Drivers for now and the future…
  110. 110. Thank You
  111. 111. Easing Parking Pressure and Encouraging Active Travel Bernard Stebbing, Account Manager, Basemap
  112. 112. Easing Parking Pressure and Encouraging Active Travel Bernard Stebbing, Account Manager Basemap
  113. 113. PARKING PRESSURES IN NHS • Pressures of hospital car parking constantly in the news • Reduce the number of car parking spaces & introduce a sustainable parking permit system • Parking very emotive • Complaints about lack of spaces • People who could travel by alternative means or park somewhere else • Need fair system for monitoring and controlling to ensure spaces allocated in the best way
  114. 114. ENCOURAGING ACTIVE TRAVEL • Active travel relieves parking pressures & encourage staff health and wellbeing • Promote cycle to work and car share scheme - Provisions for cycle racks & showers • Communicate the benefits of walking/cycling • Highlight public transport options & routes • Collaborate with local transport partnerships/companies • 2030 target of reducing carbon emissions by 40%
  115. 115. OXFORD HEALTH NHS FOUNDATION TRUST - THE PROBLEM • Needed to introduce sustainable car parking permit system following increase pressure on parking • Increase due to business growth, changes in services & staff travelling further • Health & safety issues - cars blocking emergency access • Wanted to increase active travel & reduce congestion around hospital • New car parking management system needed to be fair to all • Manage over 100 sites • Straight line or circle approach not sufficient - important to look at travel time & consider all variables
  117. 117. ▪ Quick easy analysis of travel time and distance • Public transport (all modes) • Car • Cycle • Walking ▪ Can adjust the transport network • Add new roads, exclude dangerous roads • Add or remove a bus service WHAT IS TRACC? • Outputs • Travel time contours maps • Origin to destination time/distance spreadsheets • Origin to destination path report • Demographic data reports • Catchment maps
  120. 120. OXFORD HEALTH NHS FOUNDATION TRUST: THE SOLUTION Get the union to decide to cut off travel times • 25 minute Cycle • 25 minute Walk • 45 minute public transport outbound – morning peak • 45 minute public transport Inbound – afternoon peak Analyse every postcode within a 2 hour buffer • New and Existing Staff • Results outputted as a large CSV file • Results imported linked into existing HR system • Gave a score where travel time was an element Change in travel behaviour after system went live • Increase in active travel • Reduction in congestion • Robust evidence for appeals
  122. 122. “If we hadn’t had TRACC, our only alternative would have been a system that wouldn’t have considered public transport options and we wouldn’t have been able to achieve these very detailed results” “We have seen an increase in people travelling a different way & finding different solutions as a result” Tanya Street, Estates & Facilities Business Change Manager at Oxford Health NHS Foundation Trust
  123. 123. HOW IS TRACC USED IN OTHER NHS DEPARTMENTS? • Distance: staff and patient access to NHS sites • Travel times to NHS sites for staff and patients using postcode data • Have an educated look at bus subsidies • Looking at public transport access to NHS sites • Impact on service cuts
  126. 126. HOW IS TRACC USED IN OTHER NHS DEPARTMENTS? • Look at new developments and impact of site/unit closures on staff and patients • Use TM-Speeds data to look at car driving times • Look at catchment areas of hospitals and services • Look at commissioning of new and existing health services
  129. 129. NHS Sustainability Day Case Study: Guy's and St Thomas' NHS Foundation Trust Teresa Agudo, Sustainability Officer, Guy's and St Thomas' NHS Foundation Trust
  130. 130. NHS Sustainability Day Case Study: Manchester University NHS Foundation Trust (MFT) Claire Igoe, Acting Head of Environmental Sustainability, Manchester University NHS Foundation Trust
  131. 131. Delivering Sustainable Healthcare at MFT our story so far… Claire Igoe Acting Head of Environmental Sustainability Manchester University NHS Foundation Trust
  132. 132. Background Large multi-site Acute NHS Trust 18,500 members of staff New city-wide hospital Trust was formed on the 1st October 2017
  133. 133. Key delivery areas Sustainability Behaviour change and staff awareness Waste reduction and reuse Sustainable Travel Energy & water efficiency Sustainable Development Management Plan (SDMP)
  134. 134. Context 412,000 m3 175,000 MWh 4,300 tonnes 26 million miles
  135. 135. Highlights
  136. 136. Energy and water efficiency Rolling programme of day and night energy audits Maintain active pipeline of schemes • Housekeeping projects • Refurbishment enhancements • Lifecycle programme upgrades • Stand alone energy saving schemes Delivered so far in 2017/18; • Car park LED lighting scheme • Upgraded Catheter Theatre controls • Steam Infrastructure Audit • Variable Speed Drives • Plant room insulation
  137. 137. Waste reduction and reuse • Rolling programme of waste audits to check segregation • Improved bin labelling and developed waste e-learning • Engage staff • Introduced offensive waste stream in 2014
  138. 138. Waste reduction and reuse Warp It - saved over £100k in 18 months At source waste segregation and recycling – e.g. chewing gum, theatre masks, paper, food, coffee cups Public area recycling trial
  139. 139. Staff Engagement Events programme Dedicated email account Monthly E-Newsletter Staff Groups Green Impact
  140. 140. Green Impact Most successful staff engagement channel Environmental accreditation and awards Started in 2013 - now in our 4th cycle Student support
  141. 141. Sustainable Travel Target: 10% shift in single occupancy car travel Focused on; • Improving our sustainable travel infrastructure • Providing staff with information on their travel options • Engaging staff with sustainable and active travel
  142. 142. 0 50 100 150 200 250 2009/10 2013/14 2014/15 2015/16 2016/17 Carbon Emissions (tCO2) Thousands Year Total Carbon Emissions by Source Procurement Travel Water Waste Energy 0 50 100 150 200 2009/10 2013/14 2014/15 2015/16 2016/17 Carbonemissionsperpatientcontact (kgCO2/Pc) Year Organisational Carbon Footprint per Patient Contact Procurement Travel Water Waste Energy
  143. 143. Lessons learned Work with PFI constraints Engaging staff is key Be flexibleHave a plan Takes time and patience!
  144. 144. What next? • Developing new approach to environmental sustainability in the merged Trust • Opportunity to innovate • Sustainable communications strategy • Further delivery areas – e.g. climate change adaptation, air pollution monitoring
  145. 145. Creating the environment where close engagement and collaboration are the norm Dawn Chamberlain, London Productivity Director, NHS Improvement
  146. 146. Making Lord Carter’s Review a Reality Dawn Chamberlain, London Productivity Director October 2017
  147. 147. Who we are: 165 Patient Safety (NHS England) NHS TDA ACT Academy (from NHS Improving Quality) Monitor Intensive Support Teams (from NHS IMAS) NHS Improvement Operational Productivity (Carter, GIRFT, Model Hospital)
  148. 148. NHS Improvement’s Objectives 166 Quality of care Continuously improving quality of care, helping to create the safest, highest quality health and care service Finance & use of resources Balancing provider finances and improving productivity Operational performance Improving and sustaining performance against NHS Constitution standards Strategic change Ensuring every area has a clinically, operationally and financially sustainable pattern of care Leadership & improvement capability Building and maintaining capability to deliver sustainable services NHS Improvement will support providers in continuously improving in these five areas
  149. 149. Our Role 167 NHS Improvement is responsible for overseeing NHS foundation trusts, NHS trusts and independent providers. We offer the support these providers need to give patients consistently safe, high quality, compassionate care within local health systems that are financially sustainable. By holding providers to account and, where necessary, intervening, we help the NHS to meet its short-term challenges and secure its future.
  150. 150. 169 NHS Provider Performance - Q1 2017/18 5.51m Attendances at England’s A&E departments £520 million Savings achieved through cost improvement programmes 347,860 Bed days lost due to delayed transfers of care 109,469 Patients waited more than 4 hours for a bed £736 million Year-to-date deficit 88% Providers agreed ambitious control totals for 2017/18 22% Reduction in agency spending compared to same period last year £ 0.8% Increase on the same period last year
  151. 151. Background: the Carter Review • Lord Carter was commissioned to lead a review into operational productivity in the NHS. This focused on acute non-specialist trusts and found that high-quality patient care and good value go hand-in-hand. • He identified £5bn of efficiency opportunities by 2020-21, if unwarranted variation can be removed. This consisted of: • The Operational Productivity directorate has been set up within NHS Improvement to support trusts to understand their productivity relative to others and what good looks like across every area of a hospital. • The scope is now expanding to include new sectors: mental health and community.
  152. 152. Improving NHS productivity: understanding acute sector quality and efficiency 171 Understanding Variation There is substantial variation in trusts’ costs – some will be warranted, but there are clear opportunities. The below chart shows variation between trusts in Cost per Weighted Activity Unit (WAU), a measure of clinical output. It shows that the most expensive trusts cost £1,000 more than the least expensive to produce each unit of output. Total Cost Per WAU Pay cost per WAU Non Pay cost per WAU Pay splits into nursing, medic, AHP cost per WAU Cost per WAU can be broken down to give a more granular picture
  153. 153. What is the Model Hospital? • Online digital tool provided by NHS improvement to help trusts identify and realise productivity opportunities • Break down key performance and productivity metrics across all the activity of a trust • Benchmark information against the whole country or a specific selected peer group • Nearly 5,000 users have registered so far Why should providers use it? The Model Hospital brings together a wide range of data in one place, covering both clinical and productivity themes: • Peer and national comparison ‘at a glance’ – identify high-performing trusts and build a picture of ‘what good looks like’ • Opportunity Scanner allows easy identification of potential productivity opportunities across a trust – focus and prioritisation • Clearly themed compartments: o Clinical service lines including clinical metrics from Getting It Right First Time (GIRFT) programme o Operational areas including procurement, estates and corporate services o Workforce and board-level oversight based on CQC and SOF assessments • Standard, comparable measure of productivity and output – cost per Weighted Activity Unit (WAU) Register online at
  154. 154. • Trust used the peer functionality to select appropriate peer comparator trusts Five out of Six CIP plans linked to Model Hospital compartments are all either exceeding or within 15% of target at month 5 North Teaching Hospital M5 CIPS show: • Doctors and Nursing: 20% over plan at M5 • Procurement: 3% under a £1.2m M5 target • Estates within 15% of target at M5 • Corp and Admin: 150% over plan at M5 • Only Meds and Pharm is behind target at M5 • No Unidentified CIPS, overall on plan Each Model Hospital compartment has been matched to a CIP work stream or Strategic programme within the trust • Programme management around the CIP programmes is allied to the Model Hospital • CIP / Strategy leads are responsible for interpreting and using Model Hospital outputs Model Hospital - Example Teaching Hospital
  155. 155. BETTER PRODUCTIVITY, SUSTAINABLE FINANCES BETTER PRODUCTIVITY, UNSUSTAINABLE FINANCES WEAKER PRODUCTIVITY, SUSTAINABLE FINANCES WEAKER PRODUCTIVITY, UNSUSTAINABLE FINANCES 174 Relationship between quality, productivity and overall financial position (England) – targeting our efforts on trusts in most need of improvement  Trusts with a lower cost per WAU (more productive) tend to have a smaller deficit and more sustainable finances  Lower quality trusts tend to have weaker productivity and unsustainable finances  Higher quality trusts have higher productivity and more sustainable finances The national programme objectives actions will only be met by specific actions taken within and across trusts – NHSI and partners need to target our limited support for greatest impact • Icons: 136 non-specialist acute trusts • Size of Icon: Standardised clinical output (WAU) • Colour/shape of icon: CQC rating • Cost per WAU: is from Reference Cost 15/16 • Surplus deficit: from trusts accounts, figure excludes impact of impairments and transfers by absorption and charities (15/16)
  156. 156. Operational Productivity Directorate in NHS Improvement 175
  157. 157. Regional Structure 176 • Providing direct support to trusts, prioritised with input from regional and other NHSI teams, as relevant Regional Productivity Director Regional Productivity Manager Regional Productivity Lead Regional Pathology & Imaging lead Regional pharmacy & Medicine lead Regional Procurement lead Regional Corporate Services lead Regional estates lead Delivery Improvement Director Dotted line to relevant project in Operational ProductivityBusiness support Regionally funded role / team Operational productivity funded
  158. 158. NHS Improvement Operational Productivity Programme Objectives Clinical Workforce sub-programmes Doctor: To ensure that the right doctor is available to patients at all times and they are utilised for delivering efficient and effective care, using effective and comprehensive job planning, rostering and leave planning for all medical staff. The target productivity gain for 2017/18 is between £116m and £152m. The target productivity gain for 2020.21 for all of Clinical Workforce will be £1.4bn Nursing: To ensure the right nurse and support workers staffing levels are available for patients and that they are utilised for delivering efficient and effective care; optimising trusts’ use of e-rostering tools and systems to match care availability to demand as expressed in Care Hours Per Patient Day. The target productivity gain for 2017/18 is between £141m and £185m. Allied Health Professionals: To ensure that patients can see Allied Health Professionals when needed and they are utilised for delivering efficient and effective care; utilising effective and comprehensive job planning, e-rostering and optimising therapy hours per contact. The target productivity gain for 2017/18 is between £64m and £84m. Clinical support sub-programmes Pathology: To improve the quality and efficiency of pathology service provision; establishing up to 28 consolidated pathology networks to reduce unwarranted variation in the cost and quality of services. The target productivity gain for 2017/18 is between £30m and £50m. The target productivity gain for 2020/21 will be £211m Imaging: To improve the quality and efficiency of imaging services; developing a sophisticated understanding of current imaging service delivery and constructing proposals for revised models of service delivery to deliver quality and efficiency gains. The target productivity gain for 2017/18 will be set in Q3 of 2017/18 FY. Hospital pharmacy: To drive the implementation of medicines optimisation to improve patient outcomes and deliver financial efficiencies aligned with the NHS wide Medicines Value Programme. To improve the efficiency and value of hospital pharmacy services; creating a more clinically-facing workforce and consolidating pharmacy infrastructure services. The target productivity gain for 2017/18 is between £120m and £260m. The target productivity gain for 2020/21 will be £854m Corporate sub-programmes Corporate services: To support trusts in delivering modern, effective, low cost corporate services; setting out the future state and support Trusts and STPs to consolidate services and to reduce costs. The target productivity gain for 2017/18 is between £70 and £120m. The target productivity gain for 2020/21 will be £266m Procurement: To improve the value the NHS achieves from its procurement clout; leveraging national buying power, co-ordinating trust-level procurement and leading larger scale procurement initiatives via central action and local support. The target productivity gain for 2017/18 is between £120m and £370m. The target productivity gain for 2020/21 will be £809m Estates and facilities: To ensure NHS providers deliver a clean, safe, appropriate and productive patient environment; reducing unwarranted variation in benchmarking trust estates use and facilities costs and supporting them to help reduce costs and maximise the use of NHS land. The target productivity gain for 2017/18 is between £100m and £160m. The target productivity gain for 2020/21 will be £974m Mission: To support all NHS trusts to improve their productivity, reduce unwarranted variation, and enhance the quality of services for patients. The 2017/18 headline aim is to deliver between £1bn and £1.8bn of productivity gains on the way to delivering overall productivity gains of £5bn by 2020/21. Getting It Right First Time: A clinically led programme to identify and implement recommendations across 34 medical and surgical specialties to reduce unwarranted variation, improve patient outcomes and deliver efficiency and productivity improvements between £240-420m in 2017/18 and £1.291bn- £1.461bn savings over 4 years Clinically Led Programme
  159. 159. Introducing GIRFT 178 Innovative use of data sets to identify unwarranted variations in the way services are delivered National Joint Registry Hospital Episode Statistics HSCIC NHS Comparators NHS Indicators Productivity metrics Patient Reported Outcome Measures National Hip Fracture Database NHS Resolution NHS Atlas of Variation Arthritis Research National data sources Waiting times Example data set for orthopaedics pilot: • Led by frontline clinicians who are expert in the areas they are reviewing • Peer to peer engagement helping clinicians to identify and deliver changes that will improve care and deliver efficiencies. • Support across all trusts and STPs to drive locally designed improvements and to share best practice across the country Agreed savings targets: c.£1.4bn per year by 2020-21, starting with between £240m and £420m in 2017-18 Improved patient outcomes, experience & safety Improved bed capacity, reduced flow to AQP Overall improvement in trust balance sheets Significant taxpayer savings Re-empowered clinicians
  160. 160. 179 Uncemented: £5,300Cemented: £650 GIRFT Emerging Lessons No evidence that hip on right provides better outcome for over 70s Lower back pain surgery costs >£100m per annum with little evidence of efficacy £0 £1,000 £2,000 £3,000 £4,000 £5,000 £6,000 £7,000 Obstetric litigation cost per birth (5 years) N = 135, Range = £55 - £6896 England average £1398 Huge variation between trusts in litigation averages: • General surgery: £17 - £477 • Urology: £4 - £117 • Vascular: £1 - £6,353 • Obs & Gynae: £55 - £6,896
  161. 161. Hospital Pharmacy & Medicines Optimisation: Reduced spend (and increased use) of individual medicines can be tracked monthly Monthly spend on 4 high cost medicines can be shown to be reducing due to moves to Biosimilars/generics The 4 drugs (Infliximab, Etanercept, Rituximab and Imatinib) show a reduced spend but increased usage Reduction from circa £47million/month to £27million Volume of product same/higher £47m £27m Cost Volume
  162. 162. Doctors Productivity Case Study – Sherwood Forest Hospital NHSFT 181 Issues identified: • Variable Pay spend in excess of £20 M • Annual Leave Discrepancies • Poor Job Planning process, inconsistent approach • Multiple Manual Templates Quality Benefit • 98% of consultants have signed off job plans • Transparent and consistent allocation of tariff for corporate and mandatory PAs • Established executive challenge to all team and individual job plans ensuring consistency and transparency of outputs. • Reallocation of PAs to daily Board Rounds and ‘good practice’ ward rounds • Management of annual and study leave to ensure safe staffing levels – all grades Efficiency • Release of posts within the medicine budget - £300k • Removal of WLIs incorporated into standard sessions - £40k and substantive cost avoidance costs • T&O job planning to introduce a hot week, reduction in independent sector work and an increase in theatre productivity- £ 675k • Releasing locum posts by redirecting activity and ensuring locums are job planned to 9 PAs - £250k achieved and further savings in costs expected • Increased income via outpatient clinics where demand is high, reduced WLIs and/or independent sector work • Review of junior doctor rotas and ward staffing reducing locum cover - £200k Intervention Introduction of an electronic software for job planning and clinical activity management (rostering)
  163. 163. The Director of Finance at Bedford hospital had used the Model Hospital benchmarks for pathology to negotiate an improved deal with the pathology service provider. As a result, pathology costs have fallen by over £700k. Case study – Bedford - pathology Bedford
  164. 164. Managed Service Contract Single LIMS Project Process Improvement Project 3 Concurrent Saving Initiatives £5,769,122 Savings Process FlowsEssential Services Laboratory DesignOrganisational structureLaboratory Layout Design Context: • Multi-site acute Trust running full lab service on multiple sites What change are they making?: • Consolidation of specialist and “cold” pathology on a single site • Establishing Managed Service Contract for all lab equipment and reagents • Implementing single LIMS IT platform • Revising operational processes across the service • Restructuring staffing to deliver 24/7 service with new Benefits: