Tackling wasteful spending on health - a significant share of health spending in OECD Countries is at best ineffective and at worst, wasteful. Is VBHC a solution to support this? The path to sustainability - How can we use VBHC to help close the gap
STOP spending on things that do not improve health for example unnecessary surgeries and clinical procedures SWAP inputs and change approaches when less pricy alternatives of equal value exist e.g. by encouraging the use of generic drugs, developing advanced roles for nurses o ensuring that patients who do not require hospital care are treated in less resource consuming settings such as primary or community care.
Considering outcomes instead of quantity, partners instead of source and cost instead of price
So here are some of the early examples of where Wales is attempting to put outcomes at the heart of the procurement decision process
Stomacare - an opportunity to provide an equitable service across Wales, limit variation and understand the financial flows, building outcome collection into the contract.
ERAS - opportunities to look at reduced length of stay and post-op complications, with payments based on % return and improved outcomes after Year 1.
And finally an outcomes based contract, which looks to collect outcomes for patients suffering with severe faecal incontinence - which we believe is working ‘Backwards’ starting with what matters to the patient - a partnership with Industry ‘doing the right thing’
I want to share with you a short video that describes our approach to this challenge, I am delighted to share the stage with Dr Julie Cornish who has been a pioneer in this work. This video is delivered by patients who have given their consented to share how this contract will help to support their future quality of life.
But before I do just to say that we are passionate in Procurement to improve care together, Wales has the right climate and we are PROUD - thank you
So what are we talking about when we say ‘Value Based Procurement’ - procurement professionals amongst would say that we have always provided Value in Procurement, and what procurement services in Wales have tried to do is devise a framework that evidences value in its different guises.
Product - traditional well proven methodology and still appropriate allowing best quality above price - examination gloves as an example (This is Value) Process - looks at resource utilisation in addition to best quality above price, and eliminating unnecessary costs, ultimately decreasing the efficiency and effectiveness of care e.g. wound care - not only cost of product, but usage, right place, right person
A million plastic bottles are sold every minute around the world– a figure that’s expect to grow by 20% by 2021
Over 13 billion plastic bottles are used every year in the UK – that’s more than 35 million a day.
Just over half (57%) of all plastic bottles are recycled in the UK and 15 million plastic bottles are littered, landfilled or incinerated every day.
Landfill and incineration of plastic bottles from the UK produces approximately 233,000 tonnes of CO2e emissions a year.
Refill is an award-winning campaign to prevent plastic pollution at source by making it easier to reuse and refill your water bottle on the go than buy a single-use disposable plastic bottle. The campaign works by connecting people who are looking for water with thousands of local business, transport hubs and public spaces where they can refill for free via a location based app. Participating cafes, bars, restaurants, banks, galleries, museums and other businesses simply sign up to the app and put a sticker in their window – alerting passers-by that they’re welcome to come on in and fill up their bottle.
85% of us are concerned about plastic pollution.
32% of people feel guilty about buying plastic bottled water.
64% of us would stop buying bottled water if tap water refills were freely available.
65% of people would be more likely to use a reusable water bottle if tap water refills were freely available.
Give ‘everyday activists’ a simple way to create lasting change by setting up a Refill scheme. Make sure people can quickly and easily find free tap water refills through our app. Make free tap water more widely available in public spaces like transport hubs, shopping areas and civic venues.
If all our Refill stations are used just once a day, we're stopping around 5 million plastic bottles at source in a year.
Just a third of people own and regularly use a reusable water bottle.
13% think reusable bottles are becoming fashionable.
66% of people are using a reusable bottle to reduce the amount of plastic they use.
67% of people said knowledge of the Refill Scheme made them more likely to carry a reusable bottle.
Welcome to Plastipak here in Wrexham. Thank you for joining us. Has everybody signed in? We will take some photos in the meeting room but strictly no photos during the site tour. Toilets, fire alarms and emergency exits. Phones turned off please Competition Law statement Quick round of introductions
Don’t forget your own role!
Pizza Hut Restaurants, Marks & Spencer, Morrisons and Lidl have all stopped selling or giving away plastic straws. Pizza Hut Restaurants’ customers now have to request a straw, resulting in a 90% reduction in straws being used. Asda and Morrisons are starting to remove some of the single-use packaging on their fresh produce ranges. Asda have removed the plastic from six million swedes, resulting in a 14 tonne reduction of plastic. Morrisons are trialling the effect of removing plastic packaging from fresh fruit and veg in a number of their stores – replacing the single-use plastic bags with paper versions. Asda, Morrisons and Lidl have all removed plastic stemmed cotton buds from their stores, replacing them with paper or biodegradable alternatives The majority of Quorn’s in-store packaging has changed from black to white or clearer alternatives, saving 300 tonnes of black plastic from entering the value chain each year. Coca-Cola European Partners (CCEP) has launched smart Coca-Cola fountain dispensers in partnership with the University of Reading and at Summer festivals. The refillable containers are micro-chipped to interact with the dispenser technology, allowing students and staff to buy all their soft drinks in reusable bottles. This refill system will test new technology and consumers’ adoption of refillable types of packaging. Braiform developed the first-ever closed loop hanger solution. By partnering with retailers and garment manufacturers they have created a reuse system for hangers that dramatically reduce the number that ends up in landfill. In 2017, they reused over 1 billion items, representing the same reduction in carbon emissions generated from manufacturing over 4 billion plastic bags. Both Coca Cola and Highland Spring have made all their packaging, including the bottle caps and labels 100% recyclable. Ecover’s bottles are designed to be re-usable and Ecover has offered refill solutions for a number of years. They offer consumers 5 litre ‘drums’ to buy online that can be used to refill their bottles at home and 15 litre bag in box refills in selected health food stores across the UK in washing-up liquid, laundry liquids and all-purpose cleaners. To make bottles more recyclable Ecover do not use bright colours – the white or transparent plastic they use is easier to recycle because it is easier to re-dye and re-purpose. Morrisons has pledged to ensure 100% of the plastic in its own-brand packaging is recyclable by 2025 and the retailer is currently 82% of the way towards this aim. Tesco's organic bagged prepared salads are the first to move to PE film plastic to increase recyclability. The PE film can be recycled into their 10p bags for life that are made from 94% recycled plastic, 80% of which is recycled material from recovered Tesco packaging waste. Lidl has replaced all black plastic in their fresh produce range, replacing with recyclable alternatives, saving an estimated 50 tonnes of black plastic waste per year. Aldi have switched the packaging for a range of cooked meat from non-recyclable packaging to clear, recyclable alternatives to save more than 1,000 tonnes of plastic annually. Novamont have collaborated with the Co-op to create compostable dual use carrier bags, replacing their current 60 million single-use plastic carrier bags with an EN 13432 certified compostable alternative. After carrying shopping home, consumers are encouraged to reuse the bags to line food caddies which will be accepted by over 150 local authority food waste collection systems. Alternatively, they can be home composted. Nestlé have changed the colour of their Nescafe Original caps from dark brown to red and their Nescafe Gold Blend Barista Style lids from black to gold as they are widely recyclable, and this ensures that they will be detectable in the recycling system. Asda have moved from black polystyrene pots to green polypropylene pots for their 'Growing Herbs' range, as well as changing the SRP trays they sit in from black plastic to clear. 2.7 million trays and 48 tonnes of plastic are now fully recyclable.
Slide comments: This slide can be used for initial introductions and for introducing Centrica Business Solutions.
Speaker notes: This presentation will talk through the current issues that are facing the leisure industry today, how to address these challenges, what organisations should be focused on and how Centrica can help solve these challenges.
Slide comments: This slide sets the scene and demonstrates that we understand the broader market trends impacting healthcare operators
Speakers’ notes We know from our work with several NHS trusts that a number of significant market trends are creating new challenges for healthcare organisations in the UK:
Increased demand for services An ageing population, more chronic conditions and costly new treatments all create increased demand Life expectancy is 13 years longer today, compared to when the NHS was established An average 65 year old costs the NHS 2.5x more than the average 30 year old and an 85 year old costs >5x more.
Partly as a result, pressure on a budgets is at an all time high: Funding shortfalls and increased input costs are creating budget pressures In the UK, it has been estimated that the NHS will face a funding shortfall of £22 billion by 2022/ 23 (Joint statement on health and social care, Nuffield Trust/ The Health Foundation/ The Kings Fund, November 2017) Many healthcare providers are operating within tight financial constraints and can’t absorb the costs of lost output Funding/margin pressures are forcing healthcare providers to diversify and look for new revenue streams as there is an additional strain through increasing input costs and expensive new treatments
Staff shortages and skills gaps are creating pressures across all areas of healthcare, including operational management Analysis in December 2017 shows the NHS in the UK has at least 36,000 full-time equivalent nursing vacancies, and the number could be as high as 42,000 (Health Service Journal 4/12/17 as referenced by Nuffield Health
The funding squeeze, the impacts of under-investment in NHS estates, and the staff shortage are all contributing to a worsening performance against government targets. In December 2018 the number of A&E admissions seen in 4 hours or less dropped to 77.3% in Type 1 A&E departments, way below the target standard of 95%. (March 2018 Quarterly Monitoring Report from The King’s Fund)
With limited capex available for healthcare organisations to invest in operational estates, they are having to rely on ageing equipment and hope that it holds together Ageing infrastructure can put the quality of care at significant risk - failures of vital equipment, have a serious impact on patient care and satisfaction.
The demand from politicians and patients for 24/7 access to many services is creating new pressures on resources and infrastructure
As is the desire to move towards a paperless NHS and take advantage of digital healthcare (Regulation and security)
Slide comments: This slide focuses more specifically on the specific challenges that healthcare organisations face in relation to their energy usage
Speakers’ notes Against this backdrop, we know that there are very specific challenges that healthcare organisations like yours face relating to their usage of energy:
Continuity of energy supply is critical – a power outage can have catastrophic consequences A far greater reliance on digital technology in all aspects of healthcare is increasing the impact of power outages. For example, digital patient records, which contain critical information to ensure appropriate care, need to be accessible at all times. The impact of system outages can be catastrophic, leading to wasted resources and lost revenues, and ultimately endangering patients. In a recent survey by Centrica, 77% of healthcare/medical respondents agreed that the cost of being energy resilient is far less than the impact of an energy failure Compounding the issue, the increasing frequency of extreme weather events is leading to greater risk of grid failures. In the Centrica survey, 46% of healthcare/medical respondents stated that their organisation had suffered an interruption of energy supply due to external factors in the last 12 months.
There is increasing pressure from government and regulatory bodies to meet new energy targets The European Energy Performance of Buildings Directive (EPBD) requires hospitals over 1000m2 to display energy performance certificates The NHS has committed to a target of reducing carbon reductions by 80% by 2050, in line with the 2008 Climate Change Act. Sector-specific regulations in areas such as airflow and cooling, is putting additional pressure on operational functions
Alongside this, consumers are increasingly concerned about the green credentials of service providers, including within the healthcare sector. As patient satisfaction and attitudes are likely to have a greater impact on future funding, it’s becoming more important to build a brand with strong green credentials Many UK hospitals have published carbon reduction targets - E.g. the world renowned Great Ormond Street Children’s hospital has a target of 34% reduction in its Carbon Footprint by 2020 against a 2012/13 baseline
Many healthcare providers are running ageing and inefficient energy estates – this is leading to unnecessary wastage and consuming budget that could be better invested in patient care. With older estates it can be difficult to see where energy is being wasted and therefore where to start when looking for inefficiencies.
Skills and resource gaps in operational functions mean that many providers are not effectively managing their energy estates, and lack the time or the expertise to address inefficiencies In the Centrica survey, 58% of healthcare/medical respondents agreed that “we do not have enough internal expertise to monitor and implement efficiency improvements”
Slide comments: This slide introduces Centrica Business Solutions' point of view about the areas we believe healthcare organisations should be focusing on, where energy has a vital role to play in helping them achieve their broader goals
Speakers’ notes If healthcare organisations are to effectively manage their risk, compete in a changing market and deliver a quality of care, then we believe it’s essential they can: Maximise operational efficiency to enable investment in improving patient outcomes Ensure the resilience of critical health services to protect patient care Harness the potential of energy to build a more sustainable healthcare future
Energy has a key role to play in supporting each of these objectives. I’d like to look at each of them in a bit more detail.
Speakers’ notes With budgets under intense pressure, it’s essential that healthcare providers eliminate avoidable spend and optimise operational performance – so that they can devote more resources to frontline healthcare activities
By becoming more energy efficient, healthcare organisations can reduce energy costs and free up opex and capex for investment in front-line patient care activities 35% of healthcare respondents listed “managing cost and providing comfortable care” as the number one challenge facing healthcare professionals over the next 12 months
Reducing the dependence on in-house operational staff frees up the maintenance team to work on generating new efficiencies rather than shoring up creaking equipment.
To maximise their operational efficiency to enable investment in improving patient outcomes, healthcare providers should take advantage of new technologies and new approaches to managing energy. Specific opportunities for healthcare organisations include: Insight and analytics solutions help identify opportunities to improve energy efficiency across disparate healthcare estates On-site generation (CHP, Solar) and Energy Efficiency solutions (e.g. Energy Audits, LED lighting) enable reductions in energy consumption and cost Flexible funding models remove barriers to deploying new technologies and free up capital to invest in enhancing patient outcomes End-to-end delivery capability and fully-managed service options help alleviate skills and resource shortages, and enable healthcare providers to focus on frontline services
Centrica research found that: 35% of Healthcare respondents listed “managing cost and providing comfortable care” as the number one challenge facing healthcare professionals over the next 12 months 58% stated that they ‘do not have enough internal expertise to monitor and implement energy efficient solutions’
The impact of system outages within a healthcare facility can be catastrophic, leading to wasted resources and lost revenues, and endangering patient care
Ensuring the resilience and compliance of all parts of their operation should be of paramount importance for any healthcare provider, to ensure they meet their duty of care to patients and other stakeholders
Too many healthcare facilities are dependent on outdated environmental and energy systems, which are increasingly prone to failure, shorten the life of expensive medical equipment, and create a risk of compliance breaches. To effectively manage their risk, healthcare providers need to ensure they have a resilient and compliant energy strategy, which: Reduces exposure to grid failures or natural disasters, by taking advantage of on-site generation and storage technologies to achieve greater security of supply Ensures their energy estate is effectively managed and maintained, and enables outdated infrastructure to be replaced
To ensure the resilience of critical health services to protect patient care, healthcare providers should take advantage of distributed energy technologies. Specific opportunities for healthcare organisations include: On-site generation (inc. CHP and Back-up generators) and storage solutions ensure a secure and scalable supply, and reduce exposure to grid failures Sensor solutions enable early detection of potential equipment failures, and inform preventative maintenance programmes Full Operations & Maintenance support of energy assets ensures the reliability of on-site infrastructure Expert advice and advanced Energy Management Systems help ensure a safe, secure and compliant environment Resilience-as-a-Service to overcome resource/ capex constraints
Centrica research found that: 77% of healthcare/medical respondents agreed that the cost of being energy resilient is far less than the impact of an energy failure 66% of healthcare/medical respondents thought that sources of back-up supply in the event of a power outage were very important (26% quite important)
Regulatory and consumer pressures mean its essential for healthcare providers to have a strong focus on environmental sustainability At the same time, funding pressures mean that providers need to find new revenue streams to ensure their long-term viability Many healthcare facilities have under-utilised real estate (e.g. roof spaces) that could be used for renewable energy generation, however they are often held back because of the perceived capital investment required By taking advantage of low-carbon technologies, and supply-side incentives, healthcare providers could simultaneously improve their environmental performance, reduce energy costs and generate new revenue streams to invest in front-line services.
Healthcare providers should focus on: Exploring opportunities to generate new revenue streams from existing assets and real estate Improving energy sustainability – by transitioning to more efficient, low-carbon technologies – to satisfy the demands of both regulators and patients Transition to a more flexible and resilient energy infrastructure that will provide a platform for digital healthcare and potential diversification -enabling providers to realise the full potential of technology to transform their organisations
Specific opportunities for healthcare organisations include: Renewable, low-carbon technologies (eg CHP, Solar) help reduce your emissions and generate your own energy supply Demand Side Response and energy trading solutions enable you to generate new revenue streams from your on-site energy assets Energy insight and analytics solutions help you identify opportunities to reduce energy consumption and lower carbon emission Expert advice helps you deliver and execute a sustainable energy strategy Flexible funding models remove the barriers to deploying new, lower-carbon technologies Environmental reporting solutions help you demonstrate the results of your sustainability programme to patients, employees and regulators
Centrica research found that: 90% of Healthcare sector respondents agreed that there were opportunities for energy strategies to help enable a sustainable business model
Centrica Business Solutions enabled Shrewsbury and Telford NHS Trust to install a CHP unit that reduced their CO2 emissions by 2,000 tonnes per year with zero capital investment. The unit is remotely monitored in real-time by our service centre engineers, and backed by a comprehensive service package
Slide comments: This slide introduces the three core Centrica Business Solutions propositions and their relevance for the healthcare sector. The are intended to link to the existing Proposition slide modules as appropriate
Speakers’ notes Centrica Business Solutions can help healthcare organisations meet today’s challenges and take advantage of tomorrow’s opportunities through our three core propositions:
Powering Performance – enables Healthcare operators to drive down energy costs and improve patient outcomes
Powering Resilience – ensures the resilience of critical health services
Powering the Future – helps build a sustainable modern healthcare sector
(Lead into relevant proposition and/ or product slides depending on customer’s main areas of interest)
Slide comments: This slide is intended to introduce the main Centrica Business Solutions products that have a relevance for the Healthcare sector. They show how Centrica Business Solutions has the solutions to help Healthcare organisations capitalise on the opportunities highlighted on the previous slides. The slide modules for each of the products can then be used to provide additional detail as required.
Speakers’ notes Combined heat and power (CHP) generation: Reduce energy costs and carbon emissions in facilities where there are combined heat, power and cooling requirements Renewable generation (incl. Solar) & storage: Take advantage of un-used real estate to reduce carbon emissions reduce costs, and improve site resilience Panoramic Power sensors and analytics: Identify energy efficiency opportunities across healthcare facilities, and highlight potential equipment failures that could compromise patient care or staff safety Flexible funding models: Enable deployment of new, more efficient energy technologies, while freeing up capital to invest in new health systems End-to-end delivery and energy management: Reduce dependence on limited, in-house, operational resources, and ensure the security and resilience of your ongoing energy supply Demand Side Response: generate revenues from your on-site generation assets that you can invest in patient care
Slide comments: This slide summarises Centrica Business Solutions proposition to the healthcare sector, the main differentiators and positions them as specifically relevant for the healthcare sector
Speakers’ notes: So to summarise why Centrica is the right partner for the healthcare sector:
Centrica Business Solutions innovative and flexible energy solutions, end-to-end delivery model, and proven track record of solving healthcare firms’ energy challenges, means that we’re ideally placed to meet your long-term energy needs – helping you reduce costs, improve patient outcomes, ensure the resilience of patient care and enable a sustainable future.
Hello thank you for your time today…
Ice breaker for announcing the name…
For those of you who do not know us that well - We deliver services to over 5000 patient beds in the uk, employ over 3000 staff etc etc
With the squeeze on budgets, local authorities are looking at ways to reduce costs by introducing efficiencies in local services, reducing energy consumption and natural resource wastage. This has to be achieved without disenfranchising the local citizens.
The ‘Smart City’ deploys and utilises technology and data to introduce these efficiencies and improvements. However, to truly realise these benefits, a software platform is required to interact with the other systems to drive the behaviours which can run autonomously without the need for a complex operations centre.
Like all partners involved with Smart Cities, Bouygues Energies & Services believe that their role is to integrate all the technology seamlessly. We know from our experience how to achieve the optimum solution for a city.
We all know that by introducing a Smart City approach there will be new ways to add value. This will drive economic growth which in turn drives employment, and provide residents with a better place to live. By making the city smarter it automatically becomes more attractive to businesses and occupants, becomes desirable and gives the city a competitive edge. However what we hope will be clear from this presentation is efficiencies and improvements that can be achieved in the provision of local services can easily transmit to healthcare…
Reference the BYSA investment in innovation (50m euro) the 3 primary lines of the group geographical locations of work...
We believe in leading by example at Bouygues - During the first part of this century Bouygues had to decide whether to build a new HQ or take an innovative approach to their current headquarters which was then over 25 years in age…
I have had the pleasure of talking about the potential of Smart City & the associated technology's being a part of health and social care in the future at the previous set of roadshows, with the publication of the Carter review and the subsequent Naylor report perhaps we should be starting to deliver the possible inE&F in the NHS? With a “Smart culture” we can drive efficiencies in mobility, energy and local services in conjunction with improvements in environment, safety and security and health and wellbeing. Overarching everything is the provision of a connected city, from connectivity of technology, to enable system integration, so perhaps a connected hospital estate is the way forward....
We can all claim we need to be empowered to effect change but perhaps, and I am challenging all of us here, we also need to step up lead not only those working for us but those around us. Without this change we will not be able to deliver the NHS we all take pride in and care about so much, despite our backgrounds or our paymasters, the NHS is unique and impacts all of our lives
We have seen recently with Sustainability Day declaration to the government where we wish to go but lets not hide behind this - by building on the networks that Scott and the team have developed here we can start to really tap into what can be achieved .
By changing the culture and being exemplar leaders we can cast a significant leadership shadow and meet our challenges By utilising all that’s available to us , both big and small, we can genuinely move this issue forward to the point I would say that we treat the whole subject as BAU rather than an exceptional item
(Skip through this slide) we have many examples of where these benefits in these City’s have been delivered…
An outstanding example - The average energy consumption is 5.100 W by a Swiss person (July 2008) The fixed goal is to reach an average energy consumption of 2.000 W by 2050.
Carter & Naylor… Risk-based methodology for managing backlog Innovative methods of funding Sustainability…
By adopting some of the elements of Carter Report and the Naylor review we could achieve some of what Carter and Naylor are driving at; Risk-based methodology for managing backlog Best practice advice on undertaking a detailed survey to establish backlog. It introduces a model for measuring risk in relation to sub-standard assets King’s Fund: Time to think differently How the NHS estate could help to improve efficiency, move more care out of hospitals and exploit new technologies
Sustainable development unit: NHS carbon reduction strategy The strategy shows the scale of reduction in carbon required for the NHS to meet its legal targets set out in the Climate Change Act
All of what could be available to us is from the IoT so why wouldn’t we want to capitalise on the benefits to all of us. Personally I think good quality data analysts will be required in lots of professions in the future especially E&F and not just in the NHS… Forbes magazine recently identified drivers such as; “Technologies of sensor networks, data collection and storage have made it possible to have real time observations of complex engineered systems. Sensor networks have the power to employ big number of small, cheap, and energy efficient sensors that would collaboratively collect and process data and measure wide range of parameters including temperature, sound, vibration, pressure, water quality, motion, pollutants” Remember BMW… With such innovation why cant an app also monitor E&F workstreams?
This is Humber River hospital in Canada
This is a simple depiction of ThoughtWire in action in an Internet of Health Things Scenario supporting nurse call events. In this the platform supports real time interconnection with the health things and system; Leverages our ambiant intelligence (a new form of AI) to intelligently identify the right nurses to alert and our omni-channel interaction capabilities to provide a simple interface on the nurses blackberry device to help them keep track of the tasks assigned to them.
In live settings the entire transaction from the original nurse call event to delivery takes less than 200 milliseconds.
NHS Sustainability Roadshow Cardiff
Session 1: Value Based Procurement
Chance to win a water
station worth £2000
Ceremony May 16th-
NHS Sustainability Roadshow
Sustainability Across NHS Wales
Senior Environment & Facilities Management Advisor
• NHS Wales Carbon Footprint 2016/17
• Policy & Legislation
• Data Reporting
• Sharing Good Practice (WHEF)
NHS Wales Carbon Footprint 2016/17
• Original exercise was undertaken in 2009
• In partnership with Carbon Trust Wales
• Scope 1, 2 and 3 coverage
• Response to Welsh Government policy ambitions (eg. Carbon Neutral
Public Sector by 2030)
NHS Wales Carbon Footprint 2016/17
• Next Steps
– Feeds into Welsh Government policy development (LCDP)
– Periodic review and update
– Improve data accuracy
– Inform the development of future targets and NHS policy
(All footprint graphics reproduced by kind permission of Carbon Trust Wales)
Policy & Legislation
• BREEAM standards for new-
build and refurb
• ISO 14001 environmental
• Welsh Government Low Carbon
• Environment (Wales) Act 2016
• Well-being of Future Generations
Data Reporting / Benchmarking
• EFPMS (Estates & Facilities
Performance Management System)
• Collates data from all HBs and
Trusts in NHS Wales (except PHW)
• Covers the whole estate and types
of data gathered includes energy,
waste, water and the range of FM
• Increasing focus on benchmarking
means that we need to improve our
data quality and how we utilise it
Sharing Good Practice
• Welsh Health Environmental Forum (WHEF)
• Originally formed in 2001 and still going strong
• Representatives from all over NHS Wales with
specific groups focussed on energy and waste
• All are welcome*
* Must provide own lunch
VELINDRE CANCER CENTRE
Reducing Single Use Plastic in partnership with
Keep Wales Tidy
INSPIRED BY THE BLUE PLANET PROGRAMME
This initiated a new European Strategy for Plastics, raising
awareness in National/Local press and on Social Media
“REDUCTION OF SINGLE USE PLASTIC”
THE START OF OUR JOURNEY
Internal audit of dining room to establish what plastic items were in use.
Quick wins implemented eg removing all plastic straws
“Great, we have done our bit. No more turtles in the ocean suffering from our
straws”. However, it was quickly realised this was not enough.
Invited external companies, including Keep Wales Tidy to demonstrate what
products could be used as an alternative to plastic.
KWT introduced us to Eco To Go and their reusable products
Internal evaluation work undertaken by our environmental teams and
Operational Services on suitability and sustainability of the compostable
products available (Vegware, Cornware).
Last year Velindre Cancer Centre used over 70,000 disposable hot drink cups,
placing the cups end-to-end would be the equivalent of:
7.25 x the height of Pen y fan 5.75 X the height of Snowdon The equivalent distance
from VCC to Cardiff Castle
Start up costs for purchase of Eco cups and the display stand = £1,100
Offered promotional incentive to customers during the launch. 1 free hot
beverage when purchasing an ECO to GO cup.
10p discount for drinks purchased in reusable cup
Adjustments to beverage machines to accommodate the 14oz drinks.
Re-introduced ceramic cups for customers sitting in
Eco to go cup product information was uploaded to the epos till database
enabling us to capture the sales data (i.e. Eco Coffee, Eco Tea etc).
LAUNCH OF ECO TO GO CUPS
Launch date 13th November 2018.
Manned display stand in dining room of Eco to Go cups and product information.
Trust intranet and leaflet drops advertising launch day information.
Staff encouraged to purchase the cups on the day at the reduced price (£2.99)
with a free beverage included. Usual cup price = (£3.99)
Support from Keep Wales Tidy to promote the cups and benefits to the
environment. This included media release, social media coverage and web
INFORMATION TO STAFF
The Velindre Cancer Centre are proud to launch a new range of Reusable 12oz hot Drinks Mugs
These reusable mugs will be available from mid-morning Tuesday 13th November 2018 in the Parkside Dining Room at an
Introductorily price of £2.99 each, which includes a voucher for one hot drink of your choice.
The Eco to go mugs are made from 80% Risk Husk and 20% Plant Resin which are both biodegradable. The mugs are also Microwave and
Dishwasher safe. They are available in a Pink, Blue and Green.
Following the purchase of your reusable mug, you will receive a 10p discount on every hot drink purchased when using your Eco to go
Please ask for your Eco to go Reusable Mug in the Parkside Dining Room
Did you know that in Velindre Cancer Centre we are using 70,000 single use hot drink cups.
End to end that’s enough cups to reach between VCC the Centre of Cardiff.
Recent figures released by the Independent showed, that in the UK we use 7 million disposable coffee cups every day – that's 2.5
billion every year
You can make a difference, by purchasing an Eco to go reusable mug at the introductory price of £2.99 (including a free hot drinks
voucher) from the Park Side Dining Room, you will also be eligible for a 10p discount on every hot drink purchased when using
your Eco to go Mug.
The mugs are made from 80% Risk Husk and 20% Plant Resin which are both biodegradable, and are Microwave and Dishwasher
By simply buying one of these mugs, you will help reduce the impact on our environment and save money.
Please ask for your Eco to go Reusable Mug in the Parkside Dining Room
PROGRESS AND ACHIEVEMENTS - QUARTER ONE
300 ECO to Go cups purchased for launch. SOLD OUT by December. A further 150
purchased for January 2019.
The environment is more aesthetically pleasing, less mess and no paper cups full of
slops for canteen staff to clear away
ECO display is real focal point, drawing lots of attention from both staff and visitors.
Cup sales of £1,243 to offset initial outlay.
Waste reduction of 114 kilos of general waste and continuing to fall. Cost savings.
In comparison to the same period last year, 5,000 fewer paper cups used (38%
reduction. Dropped from 13,000 to 8,000). Predicted cost saving of £1,032 p.a.
Feedback from staff has been very positive. Some purchased cups for family
and friends, so re-use message is reaching outside of Velindre too.
Some departments purchased cups for the whole teams on launch day.
There has been interest from other health boards and universities who want
to start their own plastic-reduction journey.
People were very surprised to learn about the interesting facts and
information used as part of our launch Campaign.
REDUCE SINGLE USE PLASTIC
Before and After Implementation
October 2018 February 2019
Removed paper cups from display and replaced with reusables
Despite some initial expected moans from staff, the trial has been widely
Delivered cost savings (less cups bought, reduced waste costs, outlay
covered by customers) and a cleaner canteen environment
Future plans include a reusable food container trial late spring/summer
Great example of how to make a start on removing single-use items
Keep Wales Tidy are keen to work with any Health Board who wants to follow
Velindre’s excellent example and reduce their single-use waste
• H2020 EU Bid Rapid Diagnosis Hospital Acquired Pneumonia
• Point of Care Testing
Patient: Outcomes based payments
• Reduced LOS & Post-op
• Payment based on % return and
improved outcomes after Year 1
• Enhanced after care model -
reducing variation across Wales
• Financial Flow - allocative Value -
• Outcomes collection built into
Product - Patient: Whole system approach
Renal Satellite Units
• Enhanced patient experience
• Improved patient reported outcomes
From theory to practice – Some examples, early pilots
The Refill Vision – our
Prevent plastic pollution
Make carrying a reusable
water bottle 'the new normal’.
Make free tap water more
widely available in public
spaces like transport hubs,
shopping areas and civic
Step 2: Get more taps for our
Making it easier for people to
Refill their water bottle is one
of the most effective ways to
prevent the use of single-use
Refill can introduce Trusts to
our product partners who
have fantastic solutions.
Step 3: Reusable bottles
Just 1/3 of people own a reusable water bottle
67% of people said using the Refill app made
them more likely to carry a reusable bottle.
5. Engage with your local
Refill is a grassroots, community-
led campaign with over 160 local
Ask Refill for information on your
local scheme, and get access to
volunteers ready and raring to
tackle plastic pollution in your area.
NHS – have you
bottle?!For any more information on
bringing Refill to your Trust,
please contact me via
STUART JONES | DIRECTORATE SUPPORT
MENTAL HEALTH AND LEARNING DISABILITIES SERVICE
WHAT IS THE PROBLEM?
WHAT CAUSES THE PROBLEM?
HOW DID WE OVERCOME THOSE BARRIERS?
WHAT ARE WE DOING NEXT?
WHAT WE DID TO TACKLE THE
WHAT BARRIERS DID WE FACE?
WHAT BARRIERS DO WE STILL FACE?
WHAT WAS THE IMPACT?
TOP TIPS FOR SUCCESS
1 Retired as Community Service Manager!!
2 Came back to support/ advise
3 Obvious problem with surplus assets
4 Tasked with exploring the issue
How we got
5 I knew everybody on the estate, so perfect
Do-ers not talkers!
Assess and record
”Nid da lle
”There is always room
STUART JONES | DIRECTORATE SUPPORT
MENTAL HEALTH AND LEARNING DISABILITIES SERVICE
is our system
£18 million in cost avoidance in the
UK University and Healthsector
What are our
• Our customer happiness monthly average
score has never been below 8 out of 10
• 1800 customer have given us a 10/10 in
last 2 years!
• Would you like to stop staff buying assets that the
organisation already has surplus elsewhere?
• Would you like to reduce unnecessary departmental
• Would you like to reduce unnecessary quote/purchase
• Are you looking to procure sustainably?
• Do you want to give the rest of the organisation a
reason to champion the procurement department?
• Do you want to automise your existing system so that
people are not emailing and calling the procurement
department or store manager looking for surplus?
• Do you have any issues with reusable items being
• Is the waste bill too high?
• Is this a reputational risk?
• Are staff dismantling assets?
• Are staff double handling?
• Are there too many skips/ dumpsters on the estate?
• Are there regular large amounts of assets produced as
part of room/ building refurbs which could be managed
• Would you like to give the organization a chance to
champion the FM function?
Or get in touch for a
121 by clicking link in
DANIEL O’CONNOR | email@example.com
Session 2: Tackling waste and driving
savings in Wales
Reducing waste in every way
NHS Sustainability Roadshow
14th March 2019
MJ Rose - Business Development Manager
The importance of segregation…
The way we handle waste has to change!
Volume of wastes going to UK landfill - In 2016, 15.7 million tonnes of municipal waste
was sent to landfill. Of this, 7.7 million tonnes was biodegradable municipal waste.
Around 10 million tonnes of food and drink was wasted in the food chain in 2015 -
around 60 per cent of this is avoidable.
The problem with plastic…
8.3 billion tonnes of virgin plastic created to date
79% accumulated in landfills
If this trend continues, roughly 12 billion tonnes will be landfilled by 2050
Where can your general waste go?
General waste incinerated to produce energy, with
incineration temperatures reaching over 850
Reduction in greenhouse gas emissions between
32% - 41% compared with sending to landfill
Local EfW facility generates enough electricity for
23% of renewable energy comes from energy from
waste – equivalent to 726,000 tonnes of oil
Where can your food waste go?
Uses microorganisms to break down food waste in
an enclosed system, without oxygen
As it breaks down, methane is produced which is
collected and converted to biogas
Biogas used to generate electricity, heat or
Also creates a nutrient-rich fertiliser for use in
The importance of segregation…
Higher chance of achieving zero to landfill
Valuable, recyclable materials recovered at source with lower
disposal charges, or rebates achieved
Full traceability of waste destinations
Efficient waste management in the NHS
Case study – the problem
NHS hospital trust
13 tonnes of unsegregated waste produced per month
general waste and cardboard all in together!
Increased container collections per annum, leading to a high carbon footprint
Health & Safety concerns and disruption to site through high container frequency
Case study – the solution
collected from around
waste loaded into
Waste taken for
Cardboard segregated at
source and baled.
Collected every 2 months
with rebate achieved. Compactor emptied
once a month.
Case study – the outcome
Reduction in general waste by 50%
Collection frequency's reduced from 2 visits PCM to only 1 PCM – 50%
Cardboard waste generating income
Carbon footprint reduction in general waste movement.
Baler hire costs covered by rebate.
Looking at things differently…
Looking at things differently…
Don’t look for a ‘like for like’ service
Have your lifts been reduced?
Is the proposed service more
Will it achieve/exceed your
What should be happening…
Diolch am eich amser.
Thank you for your time.
UK Plastics Pact
WRAP's vision is a world in which resources are
used sustainably. Working with governments,
businesses and communities to deliver practical
solutions to improve resource efficiency.
Our mission is to accelerate the move to a sustainable,
resource-efficient economy by:
• re-inventing how we design, produce and sell products,
• re-thinking how we use and consume products, and
• re-defining what is possible through re-use and recycling.
Waste and Resources Action
Ellen MacArthur Foundation ‘New Plastic Economy’
Partnership with WRAP to deliver UK initiative
Voluntary commitment from industry – manufacturers,
brands, LA’s and waste sector
• Advisory Group – Collaborative Action Groups –
UK Plastics Pact
A world where
A world where
plastic is valued
• Initially plastic packaging
• All plastic packaging
placed onto the UK
• All polymers and
• All of the plastics value
• Including citizen and
• Packaging makes up around 60% of manufactured plastic
• Most plastic packaging is used only once – a very durable
material with a short use phase
• 95% of the value of plastic packaging material (worth $80-
120 billion annually) is lost to the economy.
• Change requires transformation, major overhaul of our
approach to its manufacture, use and disposal.
What will the Plastics Pact deliver?
• Environmental benefits: less virgin, increased recycled content.
• A step change in reuse and recycling rates for all formats
• Convergence of polymers and eradication of problematic materials
• Reduced leakage from the system: less litter, less waste
• Positive citizen participation and awareness
• A constructive platform for dialogue with customers, suppliers,
competitors and government
• Support UK reprocessing: delivering jobs, skills and value
Businesses are increasingly influenced by public concern over plastic.
Want to be recognised as part of the solution not part of the problem
Business using recycled content for many years but not actively promoting.
Evian (Danone) commitment to use 100% recycled by 2025
May require development of new business models and new technologies to
become environmentally responsible
The Challenge -Business &
70+ businesses across the value chain + 38 supporter organisations, 500 followers
Members are responsible for over 83% of the plastic packaging on products sold through UK
UK Plastics Pact Signatories
Guide to plastic free goods – good practice for loose veg, alongside evaluation of instore trials
Sustainable Packaging checklist
A non-technical summary of the key considerations to make when specifying packaging
Guidance on polymer choices - considerations around recyclability i.e. which polymers are ‘more
Agreed list of which plastic items are considered recyclable/not recyclable for post-consumer rigid
Evaluation of Non-mechanical recycling technologies
Recyclability of fibre based packaging
Opportunities for compostable plastics
Guidance and research in progress
• Food waste prevention is the key priority!
• Review plastic packaging and plastics portfolio
• Develop Action Plans, KPIs and embed targets in their processes and
• Develop a consistent plastic packaging strategy
• Understand/avoid unintended consequences
• Embed circularity in procurement processes and specifications
Focus for businesses and organisations
First reporting period April 2019
ASDA - Through product innovation and redesign, Asda has reduced plastic in
almost 1000 individual product lines – from fresh fruit and veg to electronics and
homewares – removing the equivalent weight of 600 million empty plastic bottles.
Aldi have switched the packaging for a range of cooked meat from non-
recyclable packaging to clear, recyclable alternatives to save more than 1,000
tonnes of plastic annually.
Coca-Cola use on-pack messaging to encourage people to recycle – a “Recycle
Me” message is now on the closures of nearly 500 million bottles.
All Innocent bottles contain a minimum of 30% recycled plastic and their new
smoothie bottle contains 50% recycled plastic and 15% plant plastic.
Tesco flavoured water bottles have been reduced in weight and now have a 25%
recycled content (rising to 51% soon).
What are signatories doing?
What does this mean for the NHS?
Impact on the supply chain
• Retailers demanding change
• Major brands amending packaging formats
• Packaging companies changing formats and
• New product development and initiatives
• support improved recycling – simpler waste streams
and clearer messaging
Research and Guidance
Freely available see http://www.wrap.org.uk/category/materials-
Support procurement choices
Contribution to broader sustainability strategies
• Major changes underway to packaging materials and
• Influence of change likely to go beyond packaging
• Lots of resources available to support decision making
• Be cautious – no knee jerk reactions
• Beware of unintended consequences - always consider
impact of alternative materials
• Waste hierarchy
WRAP Cymru Plastics Procurement Guidance
5-7 Cathedral Road
+44 (0)2920 100100
Move to digital
The healthcare sector is facing intense pressures
Leading to unique energy challenges
of healthcare respondents
agreed the cost of being
resilient is far less than the
impact of an energy failure
respondents agreed that
“we do not have enough
internal expertise to
monitor and implement
can have a
on care, productivity
and staff safety
funding issues driving
need to improve
to waste and risk
Skills gaps making
it harder to
The energy landscape is evolving
Powering business advantage 132132CentricaBusinessSolutions
Centralised energy supply is
giving way to distributed
technology, providing Trusts
with smart, secure and
affordable solutions to the
energy challenges they face.
Centrica Business Solutions has been created to
develop new thinking, new technologies and new ways
of working to help our healthcare customers
We assisthospitalsto improvetheiroperationalefficiency,
ensuresite resilienceandunlock newsourcesof valuewith
There are three key areas where energy can support healthcare’s
Harnessing the potential
of energy for a
Ensuring the resilience
of critical health services
to protect patient care
efficiency to invest in patient
• Insight & analytic solutions to identify efficiency
• On-site generation and Energy efficiency solutions to
reduce consumption and costs
• Flexible funding models to overcome capital constraints
• Fully managed service options to free up resources
Maximise operational efficiency to enable investment
in improving patient outcomes
• Improve energy and asset efficiency to free up
opex/capex and meet regulations
• Enhance energy management to overcome constraints
and free up resources
58%Of healthcare respondents have stated that they “do not
have enough internal expertise to monitor and implement
energy efficient solutions”
of healthcare respondents listed “managing cost and
providing comfortable care” as the number one challenge
facing healthcare professionals over the next 12 months
• On-site generation and storage to reduce exposure to
• Sensor solutions to enable early detection of
• Full operations & maintenance to maximise reliability
• Expert advice and Energy Management Systems to
ensure safe and compliant environments
• Resilience-as-a-Service to overcome resource/
Ensure the resilience of critical health services
to protect patient care
• Ensure security of energy supply to avoid serious
• Effectively maintain energy estates to prolong
equipment life and avoid compliance breaches
• Replace outdated infrastructure to improve resilience
of healthcare/medical respondents thought that
sources of back-up supply in the event of a power
outage were very important77%
of healthcare/medical respondents agreed that the
cost of being energy resilient is far less than the
impact of an energy failure
• Demand Side Response and energy trading solutions
to deliver new income streams
• Low-carbon generation to reduce environmental impact
• Insight and analytics solutions to identify efficiency
• Expert advice to develop a sustainable energy strategy
• Flexible funding models to enable deployment of
Harness the potential of energy to build a more
sustainable healthcare future
• Improve energy sustainability to meet regulator
and patient demands
• Generate new revenue streams from under-
• Transition to a flexible energy platform to support
diversification and digital healthcare
of Healthcare sector respondents agreed that
there were opportunities for energy strategies
to help enable a sustainable business model 2,000 tonnes
The annual reduction in CO2 emissions
by Shrewsbury and Telford NHS Trust by
installing a CHP unit
We can help drive energy efficiency to enable the future of the
Drive down energy costs and
improve patient outcomes
Ensure the resilience of
critical health services
Powering the Future
Build a sustainable modern
CHP helps hospital cut carbon emissions
to the equivalent of removing 1,000 cars
• Offer healthcare services for three million
• Make cost effective energy decisions
• Produce sustainable energy
Centrica Business Solutions installed a brand new
Combined Heat & Power (CHP) unit that:
• Reduced electricity consumption
• Cut energy spending
• Slashed energy-related concerns
• Created healthcare investment opportunities
University Hospitals of the North Midlands (UHNM)
“We chose Centrica Business Solutions because their
product offered the best fit for our needs. It offered the
best savings in consumption, cost and carbon over the 15
year life of the installation. I would definitely recommend
them for CHP installation and maintenance.”
University Hospitals of the North Midlands, NHS Trust
£500K 2,000 20
CHP unit saves
Carbon emissions cut
by 2,000 tonnes
hiring 20 nurses
British Gas Business Services
Specialist in designing bespoke heating
and hot water solutions using
• Access to a range of funding options
• Support in accessing Government
Incentive Schemes (ECO/RHI)
Commercial Service and Repair
• Ensure energy efficiencies of existing
• Ensure compliance with environmental
Air Source Heat Pumps Ground Source Heat
Micro CHP Biomass Boilers
Convert outside air to use
as a heating source
Fully scalable and able to
work independently or in
conjunction with other
High levels of efficiency,
cutting running costs as
well as CO2 emissions
Absorb underground heat
to use as a source of
High levels of efficiency,
cutting running costs as
well as CO2 emissions
Convert natural gas into
electricity and heat
Highly Energy Efficient
Reduces gird dependency
Helps to meet CRC targets
Uses organic materials to
Reduces energy costs
The rising cost of non-commodity charges
Capacity market subsidy
A subsidy to encourage flexible
generation to meet peak demand.
Contract for difference
Subsidies for large scale low carbon
generators, to replace the closing
A subsidy for small scale renewable
generators, e.g. solar panels.
Transmission network charges
Paid to National Grid to cover build and
maintenance costs of Britain’s high
Distribution network charges
Paid to regional networks to cover
the cost of transporting energy from
National Grid to customer meters.
Subsidies for large scale low carbon
generators, e.g. wind farms.
Balancing Services Charge
Paid to National Grid for their work ensuring
supply and demand are always equal.
Debt costs, operating expenses and
Wholesale energy costs
Energy purchased on the wholesale
market plus the cost of any ‘imbalance’
caused by changes to our forecast
Note: British Gas forecast 2018 costs for sample customer
Tracking the continuing rise of non-commodity costs in the UK
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Transmission Network Charges
Distribution Network Charges
Wholesale Energy Costs
31% 57% 64% Non-Commodity cost as % of total
Optimising the value of onsite generation
e.g. Bord Gáis, British Gas
and Direct Energy
e.g. back up-generator
e.g. solar panels, LED lighting,
heating, ventilation and
Our key solutions for the healthcare sector
Combined Heat &
sensors and analytics
(incl. Solar) & storage
End-to-end delivery &
LED Lighting and
Visualising Energy Usage
• Detailed energy data
• Advanced analysis
• Data export option
• Data integration with 3rd party SW
• Alert setup
• Report scheduling
• Account configuration
• User management
• Implementing advanced machine learning
• Identify device state in real time
Mobile App provides easy access to real-time energy
data enabling an immediate action
• Manage and monitor critical assets
• Real-time energy and operational alerts
• Off hour energy consumption
• Historical analysis and benchmark data
• View daily, weekly and monthly energy spend
• IOS and Android Support
record in the
Improved patient outcomes
More resilient patient care
A more sustainable future
Why is Centrica the right partner for healthcare organisations?
Business Development Manager
Bouygues Energies & Services
Smart technology – are we being SMART enough
with Estates & Facilities (in Healthcare)?
• Why be Smart
• Our Leadership challenge
• Delivering Smart
• Our drivers
• The art of the possible
The Bouygues Group: Building Smart Cities
Communications Construction Power
£36 B turnover
Bouygues’ French Headquarters - Challenger
First building in the world to achieve triple certification (2011)
• LEED® “Platinum” (US)
• BREEAM® “Outstanding” (UK)
• HQE® “Exceptional” (FR)
• Phased works from 2010 to 2014, Shifts over 67,000m2
• Occupied site
• 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
• Rainwater harvesting
• 60% water savings
• 100% of sewage will be treated and re-used on site (phyto-filtration garden)
The Art of the possible….
• 700 bed hospital
• 1,800,000 sg ft of GIA
• Automatic tinting windows using IP
• Full fresh air ventilation systems
• Gains in efficiency of Healthcare
• Real time data available both
clinically & estate wise
• Efficiency in bed utilisation /
• 50% reduction compared to a
typical model hospital
• A single source of data & benefits…
Nurse / Bed
Agent keeps track
of people, locations,
Nurse Agent receives
notifications for the
attached user and
interacts with them…
Agent identifies the
right nurse and notifies
in real time
End Users and
Data, System and
ThoughtWire makes everything smarter…Nurse Assist - Receive and respond to nurse call
events on any desktop or mobile device.Health