The programme of regional road shows allows NHS staff around the country to participate in the national campaign whilst minimising their travel time and carbon footprint. Each roadshow will identify key aspects of sustainable development within healthcare practice addressing the challenges and achievements along the way.

1. Welcome to the NHS
Sustainability Day
Cardiff Roadshow
@dayforaction #sustainability

2. Morning Session
09:30 – Welcome and Introduction
09:45 - Up-date on the UK Plastic Pact
Speaker- Susan Jay, Sector Specialist Circular Economy lead,
WRAP Cymru
10:05 - Refill Wales
Speaker- Hannah Osman, National Coordinator, Refill Wales
10.30 - Recycling and Repurposing Hospital Aids
Speaker – Paula Massey, Director, Motorcyle, LGV, Mobility
Training, Health Aids and Recycling, Social Enterprise
10:50 – Refreshments and Networking

3. Susan Jay – Circular Economy
Sector Specialist WRAP UK
March 2020

4. 4wrap.org.uk/ukplasticspact
WHAT
WRAP
DOES
Global
Sustainable
Development
Goals
Governments &
Cities
BusinessNGO’s
Citizens
WRAP is a
not-for-profit
organisation
working with
partners in 26
countries

5. 5wrap.org.uk/ukplasticspact
WRAP’s work on Plastics….

6. 6wrap.org.uk/ukplasticspact
Blue Planet effect…

7. 7wrap.org.uk/ukplasticspact 7
A world where
plastic is valued and
doesn’t pollute the
environment

8. 8wrap.org.uk/ukplasticspact
Tackling at a global and national level
Global issue that requires global and national
level action
UK Plastics Pact is the first of a global network
of national initiatives
UK Plastics Pact is supporting Ellen MacArthur
Foundation’s global initiative – New Plastics
Economy.

9. 9wrap.org.uk/ukplasticspact
• Plastic packaging focus
• Plus single-use non-
recyclable items
• All plastic packaging
placed onto the UK market
• All polymers and formats
• Whole plastics value
chain
• Citizen participation is key
Scope

10. 10wrap.org.uk/ukplasticspact
Targets - By 2025:

11. 11wrap.org.uk/ukplasticspact
80 businesses across the value chain
+ 41 supporter organisations
Members are responsible for approx. 85% of the
plastic packaging on products sold through UK
supermarkets

12. 12wrap.org.uk/ukplasticspact
Taking
Action

13. 13wrap.org.uk/ukplasticspact
Roadmap developed

14. 14wrap.org.uk/ukplasticspact
New Guidance published

15. 15wrap.org.uk/ukplasticspact
Members taking action …
See : http://www.wrap.org.uk/content/uk-plastics-pact-progress-against-targets

16. 16wrap.org.uk/ukplasticspact
Citizen engagement
https://clearonplastics.com/
http://walesrecycles.org.uk/

17. 17wrap.org.uk/ukplasticspact 17
Guidance and support from WRAP Cymru
Public Sector Procurement
http://www.wrapcymru.org.uk/public-sector
Supply Chain demonstrator projects
http://www.wrapcymru.org.uk/recycled-content/pp-trial-medical-
sector-houseware-product-sector
Survey in England to determine
current support for NHS
recycling.
Any ‘gaps’ identified – WRAP
will develop tools and guidance
for NHS across the UK.

18. 18wrap.org.uk/ukplasticspact
• Embedding guidance on recyclability (across all
sectors and citizens)
• Recycling capacity growth
• Increase use of recycled materials in products
and packaging
• Improve collection of all plastic
• Lots more!!
What next…..

19. 19wrap.org.uk/ukplasticspact 19
Thank You
ukplasticspact@wrap.org.uk
www.wrap.org.uk
Susan.jay@wrap.org.uk
+44 (0)7711199964

20. Hannah Osman:
Refill Wales Coordinator
Refill
Empowering organisations to take
positive action against plastic
pollution

24. The Problem with Plastic
Over the last 20 years we’ve
produced more plastic than the
whole of the last century – only
9% of which has ever been
recycled.

25. Bottled Water
Over 13 billion plastic bottles are used
every year in the UK – that’s more than 35
million a day.

31. 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.
About Refill

32. How it works?

33. Headline Stats
25,000 Refill Stations
120,000 App downloads
200+ Refill Schemes across the
UK

34. Where can I Refill?
PLUS at THOUSANDS of
independent businesses,
cafes and restaurants

35. How we started….

36. Who we’re working with
Our Partners
Our Supporters

38. Refill Across the NHS- Lets provide better options

39. Step 1: Put your taps on our map!

40. Step 2: Get more taps for our app!
Refill can
introduce
Trusts to our
product
partners
who have
fantastic
solutions.
Making it easier for
people to Refill their
water bottle is one of
the most effective
ways to prevent the
use of single-
use plastics.

41. 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.

42. Step 4: Display signage to raise awareness

44. Step 5: Work Based Refill Champions
•Refill is a grassroots, community-
led campaign with over 160
local Refill schemes.
•Help to raise awareness in your
hospital or office and become a
Work Based Refill Champion.

45. World Refill Day 2020

46. NHS WALES – have you got
the bottle?!
For any more information on bringing Refill to
your Trust, please contact me
via hannah@refill.org.uk

47. Paula Massey
Director

48. • In 1980 I Joined the ARMY and served for
18 years as a medic and driver. Over 30
years experience in the training industry
running two companies, motorcycle
training & LGV, PCV.
• In 2012 I started driving end-of-life fire
engines to Serbia which were loaded with
aid.
• 2015 my mother bought a second hand
mobility scooter. Out of duty of care for my
mums safety and the general public I would
take her out to ensure she was safe.
• 2015 to the present date was the beginning
of a new chapter of my life.

49. Experience
My Experience

50. Unacceptable Waste

53. Donations
All equipment was offered back to the NHS but was not wanted!

54. Donations from local
companies

55. Refurbishing

56. Repurposing

57. Projects
Thornhill Primary
School
Shire Hall Care
Home
Pink Beach club

58. Introduction to Carl
Carl is homeless, he has severe arthritis
from sleeping on cold floors. His
wheelchair was taken by youths and
badly damaged.
He asked for help but was told he would
have to buy a wheelchair!
We sourced a wheelchair in less than an
hour that was going to be scrapped!

59. UMT Upcycling & Mobility Training & Cefndy medequip are
work together to reduce mobility equipment waste

60. Medequip instigated the Return, Reuse, Recycle campaign in
partnership with West Suffolk NHS back in 2017 and has seen
recycling rates increase significantly in line with this initiative.
“Our vision is t

61. In the last three years Medequip
have;
Implemented - Lancashire, North
Yorkshire, Gwent, Waltham Forest,
Rotherham, Tower Hamlets, City
of London and Shropshire
Renewed - Derby City, London
Consortium, Kirklees, Suffolk,
Waltham Forest and Birmingham
Extended – Wiltshire,
Durham&Darlington, Derby City
Derbyshire and Staffordshire
• Economies of scale drive reduced equipment cost.
• Broader pot of best-practice
• Growth = investment in people, property, infrastructure, vehicles
• Financial robustness – a family owned Company
In the last three years Medequip
have;
Implemented - Lancashire, North
Yorkshire, Gwent, Waltham Forest,
Rotherham, Tower Hamlets, City
of London and Shropshire
Renewed - Derby City, London
Consortium, Kirklees, Suffolk,
Waltham Forest and Birmingham
Extended – Wiltshire,
Durham&Darlington, Derby City
Derbyshire and Staffordshire
• Economies of scale drive reduced equipment cost.
• Broader pot of best-practice
• Growth = investment in people, property, infrastructure, vehicles
• Financial robustness – a family owned Company

62. Maximising Recycling
• Highly trained recycle/refurbishment staff
• Productivity is incentivised
• Pressure on manufacturers to increase equipment life and
recyclability
• Best possible use of CTEs
• High volume low value items MUST be made from recyclable
materials
• Paediatric Specialists (OEM Trained)
• Shared Recycled Specials
• Ordering by Attribute

63. Generating Retrieval
• Focus on equipment recycling (24 Point RAG Plan)
• Return Recycle Reuse initiative
• Amnesty bins at key locations
• Agreements with local waste/recycling plants
• “Spread the word” with the Mobile Unit

64. CIRCULAR ECONOMY

65. Volunteering
& Job
Opportunities
• Future job opportunities for veterans
• Volunteer and job opportunities for
disabled and less able bodied and
people furthest from the workforce
• Volunteering opportunities for
veterans suffering with PTSD and
mental health
• Training & re-training opportunities
• Workshops

66. Partners &
Supporters

67. Contact Details
Paula Massey
UMT Up-Cycling and Mobility Training
36 Treforest Industrial Estate
Treforest
CF37 5UR
www.umtcare.org.uk
Tel: 07811 591771
Email: paula@umtcare.org.uk

68. Refreshments and
Networking
@dayforaction #sustainability

69. Mid-Morning Session
11.10- Reducing plastic waste and packaging in clinical
environments
Speaker - Nigel Armstrong, Armstrong Medical
11.30 Plastics and Sustainability
Speaker - Mark Ellis, UK Sales and Marketing Manager,
Intersurgical
11.50- Reduce single-use plastics in laparoscopic surgery
Speaker - Hannah Shepley, Elemental Healthcare
12.00- Lunch & Exhibition

70. #NHSClimatechange
Thank you for the opportunity to
present.
#NHSClimatechange
Nigel Armstrong

71. #NHSClimatechange
• Background to Armstrong Medical
• Culture Change
• How Can Armstrong Medical assist with the
reduction of plastic waste

72. #NHSClimatechange
2% (590,000 tonne) of all UK industrial and commercial
waste is generated by the NHS
20% from Theatres (118,000 tonne)
5% of NHS CO2 emissions generated by Inhalation
anaesthetic gases

73. #NHSClimatechange

74. #NHSClimatechange
Precision Engineering
Manufacturing
Cleanroom assembly
80%

75. #NHSClimatechange
Projected Cashflow

76. #NHSClimatechange

77. #NHSClimatechange
Reduce, Reuse, RecycleReduce, Reuse, Recycle

78. #NHSClimatechange
Respiratory Care
Pathway

79. #NHSClimatechange

80. #NHSClimatechange

81. #NHSClimatechange

82. #NHSClimatechange
Rogers innovation adoption curve

83. #NHSClimatechange
A - Accountable
C - Consultative
E - Explain (Inform)

84. #NHSClimatechange
Hearing what you
say

85. #NHSClimatechange
Seeing what you
mean

86. #NHSClimatechange
“Tell me, and I will forget.
Show me, and I may remember.
Involve me, and I will understand”

87. #NHSClimatechange

88. #NHSClimatechange
The Power of Marginal gains

89. #NHSClimatechange

90. #NHSClimatechange

91. #NHSClimatechange

92. #NHSClimatechange
X
2g

93. #NHSClimatechange

94. #NHSClimatechange
Inhalation anaesthetic gases
contribute to climate change
and account for 5% of NHS CO2
emissions

95. #NHSClimatechange

96. #NHSClimatechange

97. #NHSClimatechange
Price to Value focused
procurement
Value = Price + benefits - costs

98. #NHSClimatechange
Thank you for the opportunity to
present.
Nigel Armstrong

99. Marketing Update 2020
Intersurgical and Sustainability

100. Environmental Management System
Intersurgical recognised that implementing an
Environmental Management System (EMS) was
important and can improve the way we work
and reduce the Company’s environmental
impact.

101. We are accredited with ISO 14001
• Our Environmental Management System is certified to
ISO14001:2015
• Audits, communications, labelling, compliance, staff
training and awareness, risk management etc.
• Until 2018 there were only 300,000 certificates issued
in 171 countries* (11,201 UK)
• ISO 14001 is voluntary
• We expect our suppliers to have ISO 14001
• All leading to us reducing our environmental impact
*Source, https://www.iso.org/iso-14001-environmental-management.html

102. It is possible to recycle all
Intersurgical products and the
majority of our packaging
However, the disposal of Intersurgical products
depends on the customer’s waste disposal policy and if
the product has become infectious in use.
Local waste policy guidelines must always be followed.

103. Being aware of plastics
• Not all plastics are bad for the environment…
• If these are disposed of correctly
• Intersurgical products are made from a range
of polymers which ensure the products are
effective and safe in use
• We review our materials to make sure they
are as sustainable as possible.

104. PVC (polyvinyl Chloride)
• When incinerated PVC may form highly toxic
dioxins (these can cause cancer and harm
immune and reproductive systems).
• *This makes PVC the leading contributor of
chlorine and accounts for an estimated 80% of
dioxin air emissions.
* Reference http://www.pulpworksinc.com/dangers-of-pvc.html

105. Why do medical companies
produce products in PVC?
• From a manufacturing perspective it is a great
material to work with
• Clarity & transparency, durable, inexpensive,
sterilization, chemical stability.
• For the patient, the introduction of PVC
medical devices in the 1960s revolutionised
healthcare.

106. PVC is recyclable
• If classed as non clinical waste there are some
schemes that can recycle PVC

107. But there are alternatives to PVC
Polypropylene
shell
TPE* seal
* Theroplastic elastomer (rubbers)
Kinder to the
environment-kinder to
the patient
The technology is
in the bonding

108. Total approx. amount of oxygen
masks and anaesthetic masks used
in the UK
• 4.7m Oxygen & Aerosol masks
• 3.1m Anaesthetic masks

109. EcoLite masks
• Oxygen
• Aerosol
• EC02
• Venturi
• Nebuliser
• Tracheostomy

110. When incinerated non PVC
products will give of Hydrocarbons
• Water and CO2

111. Facts
• Many of our products are produced in
Lithuania where energy is produced from our
own hydro electric power station
• We pay a PRN (Packaging recovery note) to the
Environmental Agency. (currently £35,000 p.a.)
• Our own product waste material is recycled

112. What, no hook ring?

113. ClearLite = less waste
2.1g of
polypropylene
43g of PVC
19g polypropylene & TPE

114. i-gel
*SEBS
Why is this
needed?
* Hydrocarbons

115. Disposable or reusable?
There is a choice.

116. Product kits = less packaging, less
waste and often a more cost
effective option

117. =

118. =

119. =

120. =

121. ** The Intersurgical UK manufacturing plant
and offices produced 338,312 kg of carbon in
2019.
** Source http://www.carbon-calculator.org.uk/
*The NHS is the UK’s biggest public
greenhouse gas emitter, responsible for ~5%
of all UK environmental emissions with
over 20 million tons of carbon from NHS
England alone. One in every 20 journeys on
UK roads is healthcare-related.
* Source https://sustainablehealthcare.org.uk/

122. EcoLite, as approved by…
Morgan Freeman!
ClearLite, as approved by…
Shaun The Sheep!

123. Reduce, Reuse, Recycle, Resposable™
ELEMENTAL HEALTHCARE

127. WHY NOW?
 A Global Issue
 Personal and Professional Responsibility
 Commercial Responsibility
 NHS England Direction

128. WHAT IS RESPOSABLE™?
 Unnecessary PlasticWaste Production
 Quality
 Cost saving

129. RESPOSABLE™

130. STERILISATION
Category Description Average
Price £
1 Supplementary or any quantity of the same supplementary
single wrapped in peel pouch
1.06
2 Supplementary or any quantity of the same supplementary
double wrapped in peel pouch
1.38
3 Anaesthetic accessories or other limited life items 1.28
4 Power tools and endoscopes requiring manual hand washing 7.44
5 Ward/department type trays 3.19
6 InstrumentTrays with up to 10 items 5.32

131. A MOUNTING PROBLEM…

132. REDUCING PLASTICWASTE INTHEOPERATINGTHEATRE – POWER ET AL 2020
88,000kg
3.8 million
Plastic Bottles

134. PACKAGING
THE
PROBLEM?!

135. THE ICING ON THE CAKE?

136. “If a surgical instrument is equally effective,
costs less than what is currently used and
has the crucial benefit of dramatically
reducing plastic waste produced, then it is
important to consider this change”

137. Lunch and
Networking
@dayforaction #sustainability

138. Afternoon Session
13:05 - WelLPRES - An effective greener Digital Healthcare
Solution
Speakers - Smita Shetty, Digital Project Manager, Healthier
Lancashire and South Cumbria Integrated Care System &
Zan Virtnik, Implementation Specialist, Parsek
13:25 - Sustainability in the NHS – Aneurin Bevan Health
Board
Speaker- James Griffiths, Senior Project Manager Value
Based Procurement, NHS Wales Shared Services Partnership
- Procurement Services
13:45 - Sustainability in the NHS – University Hospitals
Bristol NHS Foundation Trust
Speaker- Alexandra Heelis, Sustainability Officer, University
Hospitals Bristol NHS Foundation Trust
14.05- Conference Close

139. Parsek © Confidential do not duplicate

140. BACKGROUND
▪ Health System Led Investment
▪ Aligns with ICS Digital strategy, NHS Five
Year Forward Plan, NHS Long Term Plan
(2019)
▪ Topol Review (2019), Health Education
England
▪ NHS Sustainability, Climate Change and
other national, global agendas

141. Parsek © Confidential do not duplicate
OBJECTIVES AND BENEFITS
▪ Reducing unwarranted variation – improving/supporting co-ordinated
care
▪ Improving patient experience
▪ Offering citizens access to their Personal Health Records and
delivering personalised care
▪ Enabling clinicians to access their patients’ records and their
personalised care plans, safely and securely
▪ Reducing paper-based transactions (also aligning to the broader
national aim of achieving a paperless NHS)
▪ Reducing travel for clinicians and patients
▪ Reducing unnecessary out-patient appointments

142. WORKING COLLABORATIVELY WITH STAKEHOLDERS
▪ 5 Integrated Care Partnerships
▪ Number of suppliers
▪ NHS England and NHS Digital

143. Parsek © Confidential do not duplicate
▪ Vitaly Managed Care and Vitaly Patient
▪ Patient centric solution
▪ Co-designed with our citizens, clinicians and other stakeholders
▪ First Use Case – WelLPRES Managed Care: Breast Cancer Follow-up
Pathway – 25 Oct 2019
WelLPRES
PROJECT MANAGEMENT APPROACH
▪ Smarter ways of working
▪ Cloud based Project Management System
▪ Virtual Project Board meetings

144. MILESTONES ACHIEVED
25
October
Change
Management
Technical
Support
User
group/forum
Post
Implementation
workshop

145. ▪ Colorectal and Prostate Cancer Pathway implementation
▪ Benefits Realisation - building a reporting capability to capture
benefits and measure outcomes
▪ Local Person Record Exchange Service (LPRES) integration
▪ WelLPRES: Patient Portal
▪ NHS Login
▪ Other clinical pathways interest generated
LOOKING AHEAD

146. The need of
Continuity of
care out of
hospital walls
“
”

147. FACTS
Up to 80%
information is lost
when a patient leaves
the doctor‘s office
50 %
of medication being
taken incorrectly or
not being taken at all
33% - 69%
of drug-related
adverse events result
in hospital re-
admissions
Source: Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96(5):219-22

148. Digitally supported care
coordination
WelLPRES Breast Cancer SSMFU
”

149. Vitaly Managed CareVitaly Patient
Patient access
Professional access
WelLPRES
A comprehensive
ecosystem of collaborative
solutions on top of the
interoperable platform.

150. Fundamentals of
Vitaly Platform

151. Through an intuitive interface, Vitaly
eHealth Platform enables patients
and healthcare professionals a
secure access to relevant data
when and where it is needed.
USER-CENTERED CARE

152. Vitaly collects relevant clinical
data from various healthcare
information systems in a
standardised form. ATNA
XDS XUAFHIR
PIX
INTEROPERABILITY AND ARCHITECTURE
Our platform is fully healthcare IT
compliant. Core of the platform is
FHIR (Fast Healthcare
Interoperability Resources)
HL7

153. ARCHITECTURE

154. ▪ Automated security scanning
▪ Manual penetration testing
▪ Static analysis
▪ Manual code review
▪ GDPR
▪ OWASP Secure coding practices
▪ Common weakness list
IEC 60601-1
ISO 13485 IEC 62304
ISO 14971
ISO/IEC 27000
IEC 60601-1-6
SECURITY & STANDARDISATION

155. Using responsive design, Vitaly
offers the same user experience on
all devices – smartphones, tablets
and PCs.
OPTIMAL USER EXPERIENCE

156. Room for improvement
EASE OF USE

157. Room for improvement
EASE OF USE

158. WCAG
“WCAG is a set of guidelines for making content accessible for all
users, including those with disabilities.”
WCAG 2.1 for ICT (info. comm. tech)

160. Vitaly Patient
Solution

161. Reminders
Educational materials
NHS Login
PATIENT ACCESS

162. Tasks
Questionnaire
s
Appointment
s
MY TASKS

163. QUESTIONNAIRES

164. DOCUMENTS

165. MESSAGING

166. HEALTH JOURNAL

167. Vitaly Managed Care
Solution

168. Developed with and for care professionals
▪ Better quality of treatment.
▪ Increased compliance with the therapy.
▪ Less unnecessary hospital visits.
▪ Increased overall satisfaction of the patients.
▪ Continuity of care for patients involved in long
term therapy.
▪ Increased patient engagement through joint
decision making.
▪ Tailor-made healthcare services for all
involved in the care process.
▪ Reduced number of complex cases due to
faster responses allowing preventive action
and better decision making.
▪ Healthcare professionals are no longer limited
to hospital walls to provide the same, or even
better, quality patient-care.
Vitaly Managed Care

169. ▪ NHS guidelines
▪ Flexible
DISEASE-SPECIFIC CAREPLAN
Parsek © Confidential do not duplicate

170. ▪ All in one place
▪ Smart filtering
▪ Up to date
Parsek © Confidential do not duplicate
ORGANISED DATA

171. Other follow up programmes
▪ Colorectal cancer pathway
▪ Prostate cancer pathway
FURTHER DEVELOPMENT
Parsek © Confidential do not duplicate

172. Inclusion in active treatments
More tasks
More patient engagament
OPTIONS FOR THE FUTURE
Video collaboration (PP-HC, HC-HC)
Remote patient monitoring
Parsek © Confidential do not duplicate

173. healthcare@parsek.com
Thank you.
Parsek © Confidential do not duplicate
smita.shetty@nhs.net
@HealthierLSC @parseksolutions
@imsmitashetty

174. James Griffiths
Senior Project Manager Value Based Procurement
NHS Wales Shared Services Partnership - Procurement Services
Email: james.griffiths@wales.nhs.uk
Tel: 01495 300808 / 07870 484672
NHS Sustainability Day Cardiff Roadshow 5th March

175. Capacity
Why a Value Based Approach ?
Our Challenges?:
• Rising costs
• Ageing population
• Variation in care
• Increasing demand
whilst trying to
• Improve quality of care
for our population

176. Prof Sir Muir Gray’s “transforming healthcare by delivering triple value”:
PERSONALISED VALUE – base decisions on the best current evidence, careful
assessment of an individual’s clinical condition and an individual’s value.
TECHNICAL VALUE – improve the quality and safety of healthcare to increase
the value derived from resources allocated to particular services.
ALLOCATIVE VALUE – allocate resources to different groups equitably and in a
way that maximises value for the whole population.
Michael Porter’s definition for “value:”
“The health outcomes achieved that matter to patients
relative to the cost of achieving these outcomes.”
VALUE = OUTCOMES / COSTS
Personal
Technical Allocative
Value Definition Recap
A sustainable solution?

177. Exercise

178. 178
Procurement
tasked with
product
price
reduction.
Encouraged to
look at
innovation to
improve
process
efficiency
without being
sure of efficacy.
Great
effort
and
resource
…but a
disconnect
from
outcomes that
matter to the
patient!
Value Based Procurement – in
support of WG Value Based
Healthcare agenda – Patient
focussed Efficiency and Efficacy
need to be at the heart of what
we do to deliver sustainable
procurement solutions.
Value Based Procurement 3Ps

179. A Value Based approach LNW Wales.

192. OGEP – On the Ground Community
Educators Project.
Overview:
• 2 dedicated Lymphoedema educators
working directly with community nurses
• Upskilling of community nurses
To improve the service provision Lymphoedema Network Wales (LNW) , informed by
patient need, has initiated value based initiatives on a project basis in different Health
Boards across Wales:
Benefits:
• Decreased GP contact
• Decreased cellulitis episodes
• Reduced hospital admissions
• Decreased dressing costs
• Measured improvement in patient QoL.

193. Super Micro Surgery – Lymphatic Venous Anastomosis (LVA)
Overview:
• Innovative minimally invasive micro surgery
• Offered to patient cohort to treat Lymphoedema / slow progression
Benefits:
• Episodes of cellulitis decreased from almost 500 to 20
• Hospital admissions reduced from 50 to 2 in targeted pop
• Almost 600 days off work reduced to less than 60
• 50% less patients on prophylactic antibiotics

194. Procuring versus prescribing of compression garments
Overview:
• Compression garments are the mainstay of treatment
• Collaboration with SMTL, Procurement Services and Medicines Management
• National procurement contract and formulary moving away from prescribing
• Local stock kept closer to nurses and patients
Benefits:
• 65% or patients receive their garments on the day (rather than up to 3 weeks later)
• Right garments , right time, right place – reduced harm
• Reduced demand on GPs (no GP appointment required for prescription)
• Reduced errors due to streamlined process (previously 35% incorrect)
• Reduced travel for patients to collect prescriptions
• Significantly reduced cost of garments vs Drug Tariff

196. Why a Value Based Approach ?

197. Why a Value Based Approach ?

198. Why a Value Based Approach ?
Process PatientProduct
Capacity
Demand

199. Why a Value Based Approach ?
Process Patient PopulationProduct
Capacity
Demand

200. Rapid Respiratory Diagnostic Service
• One test replaces many - PROCESS
• Quicker diagnosis and treatment decision - PROCESS
• Detects more pathogens in one test - PROCESS
• Less nursing time – PROCESS
• Reduced patient displacement – PROCESS/PATIENT
Open Access Engagement
• Targeted interventions for over 18s based on individual need - PATIENT
• Recovery and harm reduction strategies - PATIENT
• Development of transition protocols with other services - PROCESS
• Supplier supporting data collection - PROCESS
• Patient centred KPIs inform contract e.g. number of users entering education, training
/ no return to service after 1,2,3 years - PATIENT
VBP Case studies from across Wales

201. Non Invasive Prenatal Testing
• Invasive test replaced by non invasive blood test – PROCESS / PATIENT
• Increased result accuracy – PROCESS
• Significantly less risk of foetal harm – PATIENT
• Rapid results delivered - PROCESS
• Earlier diagnosis aids decision making reduces harm – PROCESS/PATIENT
Dementia Friendly Community Project
• Early diagnoses and awareness – PROCESS/PATIENT
• Accessible local services and transport - PATIENT
• Independent living prolonged – PATIENT
• Potential to enhance QoL - PATIENT
VBP Case studies from across Wales

202. Precision Molecular Pathology Services for Cancer Patients
• Reduced number of tests, many replaced by one - PROCESS
• Automated analysis increased reliability and shorter lead times - PROCESS
• Increased ability to predict, better prognosis – PROCESS / PATIENT
• Long term supplier partnership - PROCESS
Framework for Adult Mental Health Learning Disabilities and Care homes
• Information sharing portal across health and social care - PROCESS
• Framework to reduce variation in standards and patient cost - PROCESS
• Focus on patient outcomes linked to contract - PATIENT
VBP Case studies from across Wales

203. Diolch yn fawr iawn
James Griffiths
Senior Project Manager Value Based Procurement
NHS Wales Shared Services Partnership - Procurement Services
Email: james.griffiths@wales.nhs.uk
Tel: 01495 300808 / 07870 484672

205. University Hospitals Bristol
NHS Foundation Trust
Alexandra Heelis, Sustainability Officer
alex.heelis@uhbristol.nhs.uk
0117 342 26360; 07825365520
@AlexandraHeelis

206. In September 2019 UHB were the joint 3rd NHS Trust to
declare a climate emergency in partnership with North
Bristol NHS Trust.
UHB Chief Executive Robert Woolley:
“There is strong evidence about the impact of climate change on
health…..The quicker we can take action on climate change, the
quicker we'll improve the health of people right now as well as for
future generations."

207. Launched in November 2019

208. Specific goals

210. • Anaesthetic gases
• Single-use plastics
– Clinical
– Non-clinical
• LED lighting
• Clean Air Hospital Framework – QI Gold
• Active/sustainable travel
• Green Impact Awards
Existing projects

211. June 2018
• ‘UH Bristol is committing to becoming a more
sustainable organisation by reducing our reliance on
plastics’.
• Commitment to reduce the use of single-use plastics
e.g. straws, cutlery, cups, to only those that are
medically needed by 2020.
Plastic

212. Catering plastic
• The catering department has:
• Stopped buying plastic straws.
• Replaced plastic cutlery and stirrers with wooden equivalent
(beech).
• Brewnel’s - Trust owned cafes:
• Outlets with seating are using crockery instead of disposables.
• Disposable food containers have changed from polystyrene to
recyclable material.
• Discount is offered when using a reusable cup.

213. • Trust water stations are mains fed, not bottle fed.
• Encouraging people to refill their bottles, not buy
bottled water
• Sites to be added to the Refill Bristol website.
Office plastic
• Waste department are repurposing used food containers
(boiled eggs!) as battery recycling containers.
• Printer and toner cartridge recycling across the Trust.

214. • Catering department registered for ‘bread bag’ recycling
scheme.
• Numerous departments collecting:
– Crisp packets
– Writing instruments

215. • NHS England and NHS Improvement
launched pledge.
• NHS trusts who sign up commit to phase
out avoidable single-use plastic items used
in catering services and office spaces.
NHS single-use plastics reduction pledge

216. NHS single-use plastics reduction pledge

217. Gloves off – Liaising with Great Ormond Street Hospital to
emulate their highly successful campaign
• Encourage healthcare professionals to reduce unnecessary use
of non-sterile gloves.
• Reduction in single-use plastics.
• Savings – procurement and disposal.
• Staff health – decreased dermatitis.
• Patient benefits – reduces anxiety & benefits of ‘human touch’.
Clinical plastic

218. Switch from disposable
surgical hats to
washable. Switching in
St Michael’s has already
saved 25,000 hats
£2,700 per year.
Clinical plastic

219. Clinical plastic
Current pack
used for epidural
Items not used
for procedure
Instead use 3 individual items
40% cost saving

220. Clinical plastic
84
94
79
0
168
0
20
40
60
80
100
120
140
160
180
Sep-19 Oct-19 Nov-19 Dec-19 Jan-20
Kilograms
Month of collection
Quantity of UH Bristol clinical plastic recycled by Recomed

221. Thank you, any questions?
Alexandra Heelis,
Sustainability Officer
alex.heelis@uhbristol.nhs.uk
07825365520
0117 342 26360
@AlexandraHeelis

222. Conference Close
Have a safe journey
home
@dayforaction #sustainability