NHS Sustainability Day Liverpool Road Show

Welcome to the Liverpool NHS Sustainability Day 2015 Road Show
In association with the Royal Liverpool and Broadgreen University Hospitals NHS Trust
#Dayforaction

Chairs Welcome and Introduction
Professor Maureen Williams
Deputy Chair, NHS Liverpool Clinical Commissioning Group
#Dayforaction

Creating Social Value & Sustainable Communities

4
Company Profile
•Leading Integrated Support Services partner –public & private sector
•Principal markets –UK, Canada & Middle East
•40,000 employees –(high & growing servicesprofile)
•Sustainability –cornerstone of business strategy

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Leadership achieving..
•Specific Board accountability –drive it, measure it!
•6 outcomes (social, economic & environmental targets)
•Employee ownership –6 paid days volunteering
•Health Like Safety Campaign & Global Corporate Challenge
•Sustainability Investment Fund -£720k since 2012
•Funding partner –Supply Chain Sustainability School
•CSO represented on Parliamentary Sustainability Commission
•Climate Performance Leadership Index –No187. 99A Rating

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Community Engagement
•Supporting NHS Sustainability Day since inception
•Long term relationships with NHS customers ( up to 30 years)
•Community Needs Plans
•Business In The Community
Why do it?
−Living our values
−It makes great business sense!

Sonia Roschnik
Head of Unit, SDU
#Dayforaction

Food in the NHS:
Promoting sustainability and
public health
Susannah McWilliam,
Hospitals Project Manager,
Food for Life Partnership

This morning
•Set the context
•Introduce the Food for Life Partnership
•Introduce the pilot hospital work

What is sustainable food?
is kind to the environment, protecting biodiversity, minimising resource use and minimising carbon impacts
Has high animal welfare standards
Contributes to thriving economies and livelihoods, including locally
Provides social benefits, such as good quality food, safe and healthy products, and educational opportunities
Source: adapted from Sustain, 2014

is kind to the environment, protecting biodiversity, minimising resource use and minimising carbon impacts
Has high animal welfare standards
Contributes to thriving economies and livelihoods
Provides social benefits, such as good quality food, safe and healthy products, and educational opportunities
Should sustainable and healthy food be an NHS priority?
Spending power:
£500 million
Staff health and wellbeing:
1.2 million staff
Scale:
300 million patient meals
Public health responsibility:
every contact counts
Leadership & responsibility
Improved outcomes
Cost to the NHS of diet related ill health: £5.8 billion (and rising)
Public expectation

A Clear case for change
•The campaign for mandatory food standards for English hospitals
•3out of 10 patients ask their family or friends to bring in meals
•2 out of 3 hospital staff would not be happy to eat the food that they serve their patients
•30 million hospital meals left uneatenp/a
•Diet-related ill health is currently
costing the NHS £5.8bn
•Only a third of NHS Trusts offer staff help to keep to a healthy weight
•Three-quarters do not provide healthy food for staff working night shifts

CQUIN rewards better hospital food
"Our new commissioners, the Clinical Commissioning Groups and their leaders, will need to take the new quality incentive and kite mark seriously for two reasons.
Firstly, because they are not only about good nutrition but also about knowing where the food has come from and about supporting British farmers, the local economy and sustainability.
Secondly, the catering mark is independently audited by the Soil Association so that Clinical Commissioning Groups can easily check whether their local hospitals are actually doing what they say they are.“
Michael Dixon, Chairman, NHS Alliance
CQUIN number 295 in NHS England pick-list, ‘Improving Hospital Food by achieving compliance with recommended or best practice standards’

Food for Life Partnership: A settings-based approach to healthy and sustainable food
A setting is “a place or social context in which people engage in daily activities in which environmental, organizational and personal factors interact to affect health and wellbeing”
(WHO 1998: 19).
3 key elementsof settings approaches:
1.creating supportive and healthy working and living environments
2.integrating health promotion into the daily activities of the setting
3.recognizing that people do not operate in just one setting and that any one setting impacts outside of itself—developing links with other settings and with the wider community. (UWE Report, 2014)

The history: a whole school approach
•Leadership
-The Headteacherleads the change
•Great school food and a positive lunchtime experience
-Providing fresh, responsibly-sourced food
•Education
-Practical cooking and growing, farm links,
pupil engagement
•Extending reach
-Engaging parents and community
-New project working with Age UK
•Long-term programme working at the population level
-Working to change systems

FFLP in schools: the results
TWICE as many primary schools received an Outstanding Ofsted rating after working with the Food for Life Partnership
13% increase in free school meal uptake
28% more children eating 5 a day
45% of parents eating more vegetables
43% of families changed their shopping habits
For every £1 invested in Food for Life menus, the social, economic and environmental return on investment for the local authority is
improved performance
local economic benefits
£3
Increased meal uptake
Children and families:
healthier eating habits

FFLP now
•From March 2012 schools programme commissioned by local authorities (currently 13 in LAs)
•2014: FFLP track record in 5000
schoolsand delivering on School Food Plan
•May 2013: awarded £3.6 million by Big Lottery to extend to workplaces, early years, universities & hospitals.
•Hospital pilots runs to March/June 2015

New settings: a life course approach
with the cost of diet and overweight/obesity related disease to the NHS at almost £11 billion, hospitals should lead by example and promote a positive food culture
Hospitals
Universities
developing a healthy food culture for those that work there, and for life in and beyond further education
Care homes
many older people in residential care homes are not supported to meet their nutritional needs
early years award is in development
Early years
food as a key part of workplace wellbeing
Workplaces

The hospital pathfinder pilots
& Mapping

The hospital pathfinder pilots
Sharing the learning
Testing the framework
Evaluation & next steps
Learning together..
& Mapping
Developing a framework
Multidisciplinary steering group
Mapping and taking selected actions forward throughout the Trust
Events, internal and external coms, sharing with policy makers
Evaluation by UWE, legacy plans, developing training packages

FFLP hospital pilots: stakeholder groups
Chief Executive and Board level buy in
•Senior facilities management
•Catering leads
•Foodservice reps
•Nursing leads
•Dietetics
•Community dietitians
•HR (health and wellbeing)
•Sustainability leads
•Patient representative
•Occupational therapy
•Communications
External:
•Public Health
•CCG reps
•Healthwatch
•Care home links
Plus FFLP partners, Catering Mark team and Local Authority commissions

Promoting health
Hospital pathfinder pilot framework: creating a health promoting setting
LEADERSHIP FOR A HEALTH PROMOTING SETTING
COMMUNITY AND PARTNERSHIPS
CATERING QUALITY
FOOD RETAIL AND VENDING
PATIENT FOOD EXPERIENCE
STAFF HEALTH AND WELLBEING
Supporting rehabilitation
Enhancing patient care

LEADERSHIP FOR A HEALTH PROMOTING SETTING
‘The Panel recommends that all NHS hospitals should develop and maintain a food and drink strategy. This should include:
• the nutrition and hydration needs of patients
• healthier eating for the whole hospital community, especially staff
• sustainable procurement of food and catering services’
board level accountability for
food and drink policy

FOOD RETAIL AND VENDING
Making the healthier choice the norm
£
"Obesity is the new smoking, and it represents a slow- motion car crash in terms of avoidable illness and rising health care costs"
Simon Stevens , Chief Executive NHS England,
Annual conference of Public Health England, Sept ’14
Stevens wants its 1.3 million staff to stay healthy and become health ambassadors in their own communities

CATERING QUALITY
Meeting nutrition and sustainability standards,
investing in skilled catering staff

PATIENT FOOD EXPERIENCE
Ensuring multi-disciplinary support for patient- centred meal times
providing rehabilitative
cooking and growing skills
Patient food experience

STAFF HEALTH AND WELLBEING
Support eating well in the workplace and promoting food skills
1.2 million people work in the NHS:
the fifth largest workforce in the world
‘organisations that prioritised staff health and well-being performed better, with improved patient satisfaction, stronger quality scores, better outcomes, higher levels of staff retention and lower rates of sickness absence’
The BoormanReview,
Department of Health, 2009
Although 75% of NHS Trusts offer their staff help to stop smoking, only a third offer help to keep to a healthy weight.
Three-quarters do not provide healthy food for staff working night shifts.

COMMUNITY AND PARTNERSHIPS
Harnessing food as a way to involve and benefit the wider community
Ensuring nutritional support travels with the patient on discharge
Involving the community
and volunteers in supporting
food

FFLP hospital pilots: highlights
•£20,000 of Public Health funding allocated for the pilot
•Produced a food policy and principles document
•Staff loyalty card introduced in the canteen
•Scoping for the CM –staff and visitor restaurant
•Healthier vending to be introduced
•New patient dining going well
•Food education and skill questionnaire sent out to staff
•CQUIN secured for improving the patient food experience with the potential to extend over the next few years
•Food contact mapping undertaken
•ISS: applied for a Catering Mark for staff and visitor catering
•Food growing project planned
•Action plan developed
•Vending trials in development
•Patient communal dining review underway
•Growing space scoping by Eden Project undertaken

FFLP hospital pilots: highlights

What can hospitals do now?
CQUIN
(no. 295 in NHS England pick-list), ‘Improving Hospital Food by achieving compliance with recommended or best practice standards’

Susannah McWilliam Hospitals Project Manager,
Food for Life Partnership
smcwilliam@soilassociation.org
questions

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Presented by: Maya de Souza
Date: 13thNovember 2014

Contents
•Background
•Our approach
•The toolkit
•How does this link with the Hospital Food Standards Panel?
•The Balanced Scorecard - explained
•Measuring success
•Embedding change
•Our ambition
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Question to the audience
What is the challenge for you in terms of good procurement of food & catering services?
…………..let’s see how well our tools address these challenges.
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Background: Purchasing Power
•The Plan was commissioned to make “excellent procurement” the norm across the country. The spend of the sector at £2.4bn per annum enables the public sector to lead the way.
•Effective public procurement can deliver a range of benefits:
–a thriving local economy,
–quality nutritious food for its customers
–sustainable/resource efficient farming, food production and catering services. 38

The Approach
Peter Bonfieldwas appointed to lead this review, building on his experience of procurement for the 2012 Olympics, which successfully developed and applied a balanced scorecard for all procurement.
His preferred approach was to:
a.simplify and make procurement more consistent –making it easier for procurers and SMEs (often more locally embedded) to respond
b.give the market a clear set of messages so that it could respond to the public sector need, innovating and investing as necessary
c.make it easy to source from local suppliers through making the supply chain more visible.
d.work in partnership with public sector and business to create the tools and create a movement to use them.
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The Plan
•Plan launched on July 21st.
•Includes:
–A revised Government Buying Standard for food and catering
–A balanced scorecard
–A food procurement portal
–Access to centralised contracts
–Case studies and information to help good procurement.
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GBS for food and catering
•Nationally-recognised baseline standard
•strengthened:
–the commitment to buy to UK standards of production (or equivalent) and
–to ensure that procurers or catering companies have systems in place to check on the authenticity of food.
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The Balanced Scorecard: How does it work?
•5 headings under the balanced scorecard:
–mandatoryrequirements (either technical specifications or contract performance conditions) –mirrors the GBS.
–award criteria.
•Simple, transparent set of criteria
•Greater consistency across the public sector
•Sets out what is satisfactory to excellent.
•More developed award criteria to help procurers to compare bids
•Gives opportunities for suppliers to be rewardedfor operating to higher standards, and spurs improvement. 43

Access to centralised contracts
•Framework contracts shortly to be put in place for Crown Commercial Service, which incorporate the principles of the balanced scorecard
•CCS will offer a dynamic purchasing system, which will allow smaller suppliers to register for government contracts.
•Not the only frameworks –working with other providers too.
45

Case studies and information
CASE STUDY: Sussex Partnership
NHS Foundation Trust
•CASE STUDY: Food Company 46
Title: Leading the way in Sustainable Food Procurement
Date: January 2012 Durham University Procurement Services
Summary
Durham University’s (DU) Procurement Service and Catering Department have worked in unison to provide a range of services to its 10 fully catered colleges and other catering outlets. The aim has been to maximise buying power (£2.7m annual food spend) whilst taking into account environmental, social and economic values and responsibilities. DU heavily considers the sustainability of supply chains in relation to food and as a result sustainability is now embedded within DU’s food procurement and production.

How does this link to Hospital Food Standards Panel?
47
This Hospital Food Standards Panel report recommended that the Government Buying Standard for Food and Catering Services be a required standard across NHS Hospitals.
It flagged up the Scorecard as a useful tool for procurers.
It recommended that Defra work with the HCA to put in place a number of pilots and review progress in March.

Scorecard: Production standards
Supply chain management: systems for the selection, approval and management of food and drink suppliers by catering and food service contractors.
Animal welfare: food supplied is produced to acceptable standards of animal welfare
Environment: food supplied is produced to acceptable standards of environmental management; seeking opportunities to improve environmental aspects of production.
Variety and seasonality
•supports greater engagement of the public with food and its production.
•varying menus to reflect seasonal production -reduces on-farm food waste and keeps costs down by benefiting from seasonal gluts.
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Scorecard: Health and wellbeing
•Nutrition: To ensure that the specific nutritional requirements of different public sector bodies are met, and that the public sector encourages and enables healthy eating habits.
•Food safety & hygiene: To improve food safety, and ensure that consumers and public health is protected, by ensuring that all food supplied to the UK public sector meets food hygiene requirements.
•Authenticity & traceability: to encourage a risk-based, proportionate approach to ensuring the authenticity and traceability of food supplied to the UK public sector. Shorter supply chains encouraged.
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Scorecard: Resource efficiency
•Energy Management: To ensure that formal energy management policies are in place, and to encourage best practice
•Water: To promote the efficient use of water; to reduce the environmental impacts associated with consumption of bottled water in the UK public sector; to encourage and enable people to drink a healthy amount of water.
•Waste: To ensure that the negative environmental and economic impacts of waste from food and catering services procured by the UK public sector are minimised, and to encourage best practice.
•
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Scorecard: Social –economic value
•Fair & ethical trade (supply chain): labour rights in the supply chain for certain commodities.
•Equality & diversity: satisfying UK legislative requirements and duties in relation to equality.
•Inclusion of SMEs: encourage use of small and medium-sized enterprises (SMEs)
•Local & cultural engagement: engagement with food related issues to encourage people to understand and value the food that they eat, Employment & skills: To promote opportunities for employment and skills development.
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How to get involved –procurers
•Procurers should seek to use the balanced scorecard, GBS and portal as tools to let contracts, manage contracts and to source food.
•Suppliers should register themselves onto the food procurement portal to ensure they are visible to public sector contractors.
•Volunteer to be a pilot or frontrunner, and Defra will support you!
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Pilots
How do we embed change … pilots and front runners?
53
Will you be one?

Measuring success
•Key Government Departments to provide data on a quarterly basis
•For the wider public sector, a baseline survey to be conducted later this year.
•Encourage suppliers to monitor progress and hold relevant information, including data on provenance of food.
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Our ambition
•Our ambition is for the food industry, public procurers, researchers and farmers to get behind this approach –not only for now, but into the future.
•We want to create an expectation around public procurement. We want excellence to be the norm so that:
–Public authorities expected to source healthier and tasty food produced to the high standards expected
–Food and farming sector is geared up to supply the public sector to the standard that it demands.
–Entry to the market for SMEs is made easier
–Excellence in the supply chain rewarded
–R & D funds support the innovation we need.
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Useful links
•A Plan for Public Procurement: https://www.gov.uk/government/publications/a-plan- for-public-procurement-food-and-catering
•The toolkit, including the balanced scorecard: https://www.gov.uk/government/collections/food- buying-standards-for-the-public-sector-the-plan- toolkit
•Online procurement portal:
https://sid4gov.cabinetoffice.gov.uk/gbfood
Contact: food.procurement@defra.gsi.gov.uk
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Compostable packaging & food waste recycling
Reducing carbon
Reducing waste
Reducing costs
Lucy Frankel
Communications Director
Vegware

the problem
Mixed materials, mixed recycling streams
•plastics
•paper, card
•polystyrene
•metals, foils
•films
•In use = adding food
•So…landfillor incineration?

before use
after use
in
use
the key to zero waste
diner experience
low impact
Compostable packaging

before use
low impact
Low carbon, recycled or renewable materials

www.sduhealth.org.uk/areas-of-focus/

“NHS organisationsshould explore every opportunity to improve their energy and carbon performance in a cost effective way.
NUH are to be commended for providing an opportunity to the supply chain to bring forward innovative and effective solutions to these aims which may subsequently benefit the NHS as a whole.”
-Department of Health

in
use
diner experience
Presentation enhances dining experience
Adds value at every level

Breathable performs better
Hot food
stays crispy

after use
the key to zero waste

Only compostablepackaging can break down quickly enough to be recycled with food waste
terminology
Compostable =
biodegrade, but fast!
Biodegradable
=
can break down naturally, with microbes, warmth
& moisture
Compostable
=
can biodegrade
in under
12 weeks

You can't recycle foodwith plasticin it…
…and you can't recycle plastic with foodon it.
recycle withfood waste
other bins now cleaner & easier to recycle

economics
landfill is expensive
£0
£10
£20
£30
£40
£50
£60
£70
£80
£90
£100
2008
2009
2010
2011
2012
2013
Waste disoisal gate fee per tonne
Figures from WRAP's annual Gate Fees Report. Food Waste Recycling figure is the average for in-vessel composting (IVC) and anaerobic digestion (AD)
The rising cost of Landfill vsFood Waste Recycling in the UK
Landfill
Food Waste Recycling

£102 / tonne
£94 / tonne
£40-46
£0-10

case study
•Switched to compostable packaging
•Zero waste to landfill
•Part of sustainability communications
•8.8 tonnescarbon saved
•5.1 tonnesvirgin material saved
•13 tonnesused packaging diverted from landfill
Quantifying the benefits
In 2013, Royal Bournemouth Hospitalmade these eco savings:

case study
than incineration
(energy from waste)
Organics recycling is
70%cheaper

Free impartial service
Matchmaking any UK foodservice site with local food waste recycling
•all UK food waste collections
•on-site options
•legislation & relevant info
www.foodwastenetwork.org@foodwasteuk

Environmental cost
•higher energy and carbon emissions than regular collections
•Wastes drinking water –dispose of far more water than the food waste
•Hidden infrastructure costs -increase the risk of:
•sewer blockages
•sewer flooding
•environmental pollution
•odours
•rodent infestations
food waste
to sewers?
Maintenance costs
•Electricity
•Water
•Call-out charge for blockages
Banned
in Scotland
from 2016

On-site
Big Hanna
Options for food waste
& compostable packaging

www.vegware.com
www.foodwastenetwork.org
Thank you
Lucy Frankel
Communications Director
Vegware
Lucy@vegware.co.uk

adsm.com
© Advanced Demand Side Management 2014.
AquaMarkUK’s National Water Benchmarking Project
3 years’ fully-funded services

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AquaMark/ UK’s National Water Benchmarking Project
Who we are
Water efficiency experts for over 20 years
Government advisors since 1999
On a mission to save Britain’s water

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Why save Britain’s water?
Population growth
Climate change
Water scarcity

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Benchmarking for sustainability
•Why worry about benchmarking?
•Measure our performance
•Compare our performance
•Identify inefficiencies
•Save money and waste by
using less water
“You can’t reduce what you can’t measure”

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Current Benchmarking
•WaterMark
•HM Treasury
•Typical and best practice benchmarks

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Water consumption in an NHS Trust

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Water Consumption per Hospital vs Industry Published Benchmarks
0
50,000
100,000
150,000
200,000
250,000
300,000
Hospital 1
Hospital 2
Hospital 3
Hospital 4
Hospital 5
Hospital 6
Hospital 7
12 months Water Consumption m3
Consumption in 2013

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AquaMark
•£500m of water is going to drain each year through the lack of benchmarking data
•Largest and most in-depth project in the UK
•Establish 500 different building benchmark classifications
•Robust, complex and more sophisticated benchmarks

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AquaMark
•Putting Britain at the forefront of commercial water benchmarking
•Greater sustainable water supplies and increased water security for thousands of organisations
•10,000 sites already taking part in the project
•We need you

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Fully funded for you
•Three years’ free bill validation by award-winning bureau service
•Monthly consumption reports
•Identification of high consumption anomalies
•Benchmarking toolkit
•De-regulation of the water market
•Save a 1/3 on water bill

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How do you take part?
•ADSM provides you with an email to send to your water supplier, then we take care of all the rest
•Future bills are sent to us for assessment & validation
•Within 24 hours we send them back to you
•Participation is completely anonymous
•Data completely secure
•Absolutely no cost to you what-so-ever

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How benchmarking can help the NHS?
•If all of the UK participated we could save an estimated £500 million per annum
NHS alone could save 1/3 on it’s water costs

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Your participation
ask@adsm.com
01753 833 880
www.adsm.com
Thank you

Creating the world’s leadingmeat-alternative business

Who is Tim Finnigan???
•Married, two children (grown up)
•Likes running up hills and likes a pint
•30 years R&D in Food and Drink
•PhD Oilseed rape protein, Government food research, APV, General Foods and...

The 1960s was a time of huge achievements...
Quorn in context

....And growing concerns
Quorn in context

A man with a big idea
Quorn is born

+ a large number of ducks, rabbits, horses, turkeys…
..3 camels and one unfortunate mule
Chickens
110,000
Pigs
2,630
Sheep
922
Goats
781
Cows
557
The scale of livestock production is driven by our desire for cheaper and more plentiful meat, but there are damaging consequences, which at the moment are forecast only to intensify
The current context…

Dramatic changes are shaping the future of food policy

http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf
http://www.tristramstuart.co.uk/FoodWasteFacts.htmlhttp://ecowatch.com/2014/04/11/agricultures-greenhouse-gas-emissions-2050/
Challenge
Consequence
Tofeed 9bn in 2050 FAO say we need
a 60% increase in food productionsome of the true costs of cheap and plentiful animal protein
Challenges for a scalable meat basedsustainable food future

“The need for new business models that help address the 9bn challenge -including a healthy new protein with a lower environmental impact….”
Prof. Alan Knight Single Planet Living
Big steps toward small footprints

At the heart of all Quorn foods ismycoprotein…
So, what is it?
Natural appeal
..Our 50 year ‘overnight success’

111
Additional Interest
SCFA production
Fibre (chitin and ẞ-glucans)
Mycoprotein as a food ingredient
Physical Properties (shape)
Denny, A, Aisbitt, B and Lunn, J (2008) Mycoprotein and health. BNF Nutrition Bulletin 33:298 –310.
Bottin, J. (2014) Nutrition and Surgical Influences on appetite regulation in obese adults. PhD Thesis Imperial College London
BENEFITS
Texture creation
•Authentic meat-like texture
•Creation of fibrosity through fibre assembly
General Nutrition
•High quality protein
•Low fat content (membranephospho-lipids)
•High fibre (cell wall)
•Low energy density
Clinical Research Programmes
•Lowering serum cholesterol
•Satiety
•Insulinemia and glycemia in diabetics
Composition

112
No other protein can create the meat like textures achieved by Quorn
Unique attributes

SpaghettiBolognese
Meat
Quorn
Calories
516
314
Fat %
26.6
8.6
Saturated Fat %
10.1
1.4
Switching from using beef mince to Quorn mince in a Spaghetti Bolognese once a week is equivalent to running 4 marathons a year*
Meals are healthier with Quorn
113
Source: Lucy Jones C4 nutritionist using METS data

•Livestock represent 18%+ of greenhouse gases issue*
-Quorn environmental footprint –90% lower than beef
•Land and Water are becoming in short supply
-Quorn uses 90% less land and water than beef
•Livestock is inefficient at producing protein
-Beef converts grains –protein at 10 –1 ratio
-Quorn converts at 2 –1 ratio (wheat–protein)
* UN report ‘Livestock’s Long Shadow’ 2006
Estimates that livestock (meat production) makes up 18% of Greenhouse gas emissions
Quorn Foods is the first global meat-alternative brand to achieve third-party certification of its carbon footprint figures
Excellent sustainable credentials
114

What If………..
What if all Beef mince served within the NHS were replaced by Quorn mince

Future Food -playing a leading role
How can diets rich in mycoprotein contribute to health and wellness?
What is the impact of our food and of our organisation on the environment and how do we compare?
How can we make Quorn irresistible?
How can we collaborate to address these key issues and contribute to the debate?

Peter Averill
Managing Medical Devices
JPen Medical
Part of the PHS Group

Some Background
• JPen Medical established over 10 years ago
• Working with the Hospitals, GP’s, Care Homes, Occupational
Health, Dentists...
• Testing and calibration of a range of medical equipment
• Meeting best practice standards as laid down
by the MHRA

What the MHRA says
There should be a system in place for:
• The purchase – Is it fit for purpose?
• Acceptance – Does it work properly?
• Maintenance – Testing and calibration – Traceability
• Repair – Qualifications - Verification
• Disposal – Approved method

Food for thought
• How do you ensure the equipment in the community is fit for
purpose?
– Implement a programme of regular testing and calibration as set out
by MHRA
– Use a qualified engineer who can test and calibrate the appropriate
equipment
– Implement an asset management and effective tracking system
– Receive free impartial advice and quick response

Equipment Training - To improve sustainability?
• Is the equipment fit for purpose – BP Monitor
– Does the patient have an arrhythmia?
– Is the cuff the right size?
– Is it placed correctly?
– Could other equipment interfere with the unit?
– Patient shouldn’t speak whilst reading is being taken

Community Equipment
• Variety of equipment used
• Medical equipment should be fully maintained and in efficient
working order.
• Doing so can:
– Increase longevity of equipment
– Reducing pressure on budgets
– And ultimately improved patient diagnosis and survival rates

Community Issues
• Medical staff are in the community every day
• Opportunity to have equipment tested is limited
• No replacements for existing equipment

Community Equipment
• Defibrillators
• Blood pressure Monitors
• Nebulisers
• Body Fat Monitor
• Syringe Driver / Feed Pump
• Wheelchairs
• And many more.....

The Facts
• Did you know that there are 82,000 cardiac arrests each year
in the UK?
– Most businesses who have a defibrillator rarely have them regularly
tested
– In the time it takes to call the emergency services and for them to
arrive on site, it could be too late for the victim
– Having a well maintained defibrillator on site should be as common as
having a fire extinguisher.

Budleigh cricket team member heart attack
• A cricketer was very fortunate when he played cricket with
friends in July 2011
• There was a doctor on the team that had a defibrillator in his
car boot.
• The cricketer survived to play another day, proving:
– Not just medical practitioners should have a fit for purpose medical
equipment such as defibrillator available in case of an emergency

Bereaved mother backs defibrillator campaign
• The mother of a boy who did from a heart attack while
playing rounder’s is backing a campaign for defibrillators to be
installed in schools
• Eight-year-old Charlie Morettes died in 2007 after collapsing
during a PE lesson at his school in Kent.
• For every one minute delay, the patient’s survivability goes
down by 10% so the quicker the better really.” (DfE)

Lunch and Networking
#Dayforaction

Keynote Presentation
Luciana Berger MP
Shadow Public Health Minister
#Dayforaction

Social Value
Dave Antrobus
NHS Liverpool CCG
Lay Member
Governing Body

Social ValueSustainability
Why important to LCCG
What we aim to do
Barriers and issues
Progress so far

About NHS Liverpool CCG
•Commissioner of health care
•Duties to
–improve health
–reduce inequalities
–engage people in health care planning and decisions
–promote equality

Healthy Liverpool
Our vision is for a health care system in Liverpool that is person-centred, supports people to stay well and provides the very best in care
Dr Nadim Fazlani, GP & Chair of Liverpool CCG

•Marmot Review –Fair Society Healthy Lives
•CCG Health Inequalities Report –All Equal All Different
Health Inequalities
Create an enabling society that maximises individual and community potential.
Ensure social justice, health and sustainability are at the heart of all policy-making.
•Reduce health inequalities
•Improve health outcomes
•Increase value from commissioning investment
•Use commissioning influence to improve health outcomes
Social Value -Sustainability
Strategic Opportunities

Creating Social Value =
increasing the social, economic and environmental wellbeing of the people we serve
•Public Services (Social Value) Act 2012 –all public bodies to consider social value can derive from their large procurements.
•Climate Change Act (2008) -UK legally bound to cut CO280% against a 1990 baseline by 2050. NHS largest emitter of carbon in UK, 34% by 2020 current target.
•Civil Contingencies Act (2004) requires organisations in the health system to prepare for emergencies and risks including climate change events.
•CCG Assurance re Capability and organisational health and Domain 4(e) Environmental & Social Sustainability
•NHS Sustainability Strategy Nationally –sets standards and framework
Legislative and corporate requirements

Social Value Aims
Place Social Value at the centre of our thinking and policy, commissioning and practice
Ensure the way LCCG invests and acts achieves maximum benefit to the population we serve now and in the future
•maximizing impact of clinical services
•supporting non-medical solutions
•positively influencing social determinants of health
Creating Social Value to Improve Health Outcomes by…

SOCIAL VALUE – ECONOMIC WELLBEING GOALS Improve health outcomes for adults and children by reducing poor health associated with low income 1. Support employment of Liverpool residents to reduce experiences of poverty and hardship 2. Support a Living Wage and moves towards this to reduce low incomes 3. Support good working conditions to relieve health problems associated with employment 4. Support education, skills and training of Liverpool residents as a means to improve incomes and resilience as well as health literacy and participation. 5. Support a reduction in the effects of debt on physical and mental health. 6. Seek to maximise other investment in the local economy and communities

SOCIAL VALUE – SOCIAL WELLBEING GOALS Improve health outcomes by creating an enabling society that maximises individual and community potential reducing poor health associated with social context 1. Reduce social isolation and associated health risks by including social contact as a valued outcome. 2. Support development of social capital in order to foster healthy communities in which participation is widespread. 3. Increase upstream prevention activity 4. Improve quality of life particularly for people with long term conditions 5. Increase public, patient and carer empowerment, health literacy and self-care by building these into everything LCCG commission. 6. Increase integration of services so patients are better and more easily supported 7. Reduce emergency admissions and readmissions which have negative impacts on patients and their carers.

SOCIAL VALUE – ENVIRONMENTAL WELLBEING GOALS Improve health outcomes through approaches which reduce health inequalities and mitigate climate change, creating healthy places and communities now and for the future. 1. Improve access to and consumption of fresh, healthy food in order to support better mental and physical health and a local food economy. 2. Improve neighbourhood environments by increasing provision, access and quality of green space in order to improve mental and physical health 3. Increase active travel (walking and cycling) in order to increase physical activity, reduce traffic emission related respiratory illness and carbon emissions. 4. Reduce carbon emissions in order to mitigate against climate change and its negative consequences for health and health inequalities 5. Improve housing conditions and energy efficiency in order to reduce health conditions associated with poor housing and fuel poverty. 6. Minimise use of hazardous substances in order to protect health.

What is the CCG doing?
•Strategy
•Embed into documents
•NHS contracts
•Tender documents
•Investment plans
•Community grants
•Working with providers
•Own GCC assessment…

Social Value: Economic Wellbeing –Improving Incomes and Education to Improve Health Outcomes
Liverpool CCG Objective
Relevant Outcome Domains
Relevant Outcome ambitions
Liverpool CCG
Internal performance measure
Potential measures for suppliers
Metrics
To improve health outcomes
To maximise value from our financial resources and focus on interventions that will make a major difference
To build successful partnerships which promote system working and integrated service delivery
To hold providers of commissioned services to account for the quality of services delivered
Preventing people dying prematurely
Improving quality of life of people with Long Term Conditions
Helping people to recover from episodes of ill health or following injury
Ensuring people have a positive experience of care
Secure additional yearsof life for people with treatable mental & physical health conditions
Improving health related quality of life of people with LTCs/mental health
Increasing the number of people having a positive experience of hospital care, GP care & community care
LCCG investment in local economy through contract spend.
Proportion of supply chain spend that is with Liverpool based businesses/ SME/ social enterprises/constituted community groups.
Proportion of supply chain spend that is with SMEs / social enterprises/ constituted community groups
% of supply chain spend
0-10% / 11-20% / etc…
LCCG contribution to local people in employment
Number of FTE jobs created / sustained
Number of new FTE jobs / FTE sustained
LCCG reducing debtstress, low pay and poor working conditions.
Employees paid a Living Wage throughout the supply chain.
No zero hours contracts in the supply chain
Accreditation to workplace wellbeing charter
Support for financial advice
0-79% / 80% +
0-79% / 80% +
Accreditation –level attained –bronze 30, silver 60 gold 100 etc..
LCCG contribution to skills development and employment of local people
Number of (relevant) people supported into employment (relevant could mean to the procurement/priorities could be unemployed people, young people, disabled people etc..)
Numbers
LCCG contribution to skills development and employment of local people
Number of work experience/apprenticeships/formal training opportunities provided
Numbers
Additional investment leveraged in to Liverpool communities
Amount of investment brought in to communities through grants, private sector investment and reinvestment of profits…
% of contract value

Proportion of supply chain spend that is with SMEs / social enterprises/ constituted community groups
Number of FTE jobs created / sustained
Employees paid a Living Wage throughout the supply chain.
No zero hours contracts in the supply chain
Accreditation to workplace wellbeing charter
Support for financial advice
Number of (relevant) people supported into employment (relevant could mean to the procurement/priorities could be unemployed people, young people, disabled people etc..)
Number of work experience/apprenticeships/formal training opportunities provided
Amount of investment brought in to communities through grants, private sector investment and reinvestment of profits…

Social Value: Increase Social Wellbeing and Capacity for Healthy Communities
Outcome Domains
Outcome ambitions
Liverpool CCG
Internal performance measure
Metrics
Treating and caring for people in a safe environment and protecting them from avoidable harm.
Improving health related quality of life of people with LTCs/ mental health
Reducing time spent avoidably in hospital - better & more integrated care in the community
Increasing the proportion of older people living independently at home following discharge from hospital
Increasing the number of people having a positive experience of hospital care, GP care & community care
Making significant progress towards eliminating avoidable deaths in our
hospitals.
Reduced social isolation / increased social capital
Increase in self-care
Improved recovery from illness / injury
Increase in understanding of health issues, prevention and self-care among patients, staff, service-users, carers, families and community egliteracy, peer support programmes, physical activity…
Proposalto achieve included?
Baseline and tracking to be proposed.
Enhancing quality of life for people with LTCs including mental health
Number of patients/service-users finding/sustaining subsequent meaningful employment, training, voluntary roles
% finding…
% sustaining at 12months…
EQ5D scores
Reduced social isolation / increasedsocial capital
Proportion and frequency of patients, service- users and other community members engaging in community / social activity and physical activity
% >1 pw
% > 1 pcm
EQ5D scores
Physical activity level
Reduced social isolation / increased social capital
Number of new volunteer roles created, and/or volunteer roles supported and sustained
Numbercreated / sustained at 12 months
Enhancing quality of life for people with LTCs including mental health
Proportion of service-users/carers developing own care plans
% with active care plans in implementation
Increase in patient involvement
Increase in positive experience of care
Number of service-users and carers involved in design and delivery of services
Provision /linktonon-medicalserviceswhich improve patient choice / experience/ outcomes
Number,scale score
Increase in integration of services
Number of community initiatives supported and number developed into longer term contracts/services
Number of sustained and meaningful relationships with other providers that support integrated care,including clinical and also social and economic parameters affecting health.
Number and description of proposal

Increase in understanding of health issues, prevention and self-care among patients, staff, service- users, carers, families and community egliteracy, peer support programmes, physical activity…
Number of patients/service-users finding/sustaining subsequent meaningful employment, training, voluntary roles
Proportion and frequency of patients, service-users and other community members engaging in community / social activity and physical activity
Number of new volunteer roles created, and/or volunteer roles supported and sustained
Proportion of service-users/carers developing own care plans
Number of service-users and carers involved in design and delivery of services
Provision /linktonon-medicalserviceswhich improve patient choice / experience/ outcomes
Number of sustained and meaningful relationships with other providers that support integrated care,including clinical and also social and economic parameters affecting health.
Reduction in attendances for urgent care by patients and service-users.

Social Value: Better Environmental Wellbeing to Improve Health Outcomes Now and for the Future
Outcome Domains
Relevant Outcome ambitions
Liverpool CCG
Internal Performance Measure
Metric
Treating and caring for people in a safe environment and protecting them from avoidable harm.
Improving health related quality of life of people with LTCs/ mental health
Increasing the proportion of older people living independently at home following discharge from hospital
Improved patient experience
Increased population skills / employment
Increase in proportion of fresh, healthy, low carbon food supply chains and consumption by staff, service-users and communities.
% supply chain fresh food,24hr.
Proposals for programmes and measures.
Improved quality of life forpeople with LTCs including mental health
Increased Self Care
Access to green space
Improvement in provision/access to high quality green space for patients and communities.
PH indicator –description ofquality / hectares
GI Strategy –increase in access / quality
Liverpool CCG contribution to carbon reduction
Reduction in energy use / carbon emissions / increased use of renewable energy
CO2 emissions / energy kwh / renewables
Improved quality of life for people with LTCs/ respiratoryconditions/ Avoidance of unnecessarytime spent in hospital/admissions
Reduction in exceedencesof air quality standards in Liverpool
Carbon reduction
Reduction in goods/staff/patient transport emissions
Increase in staff / patients/service- users walking and/or cycling regularly
Co2 and NOxgenerated and phased reduction
Increase in physicalactivity
Baseline and % increases
Reduction in people living in poor quality housing
Increasein advice and support for housing issues
Plans to address
Numbers of referrals and improvements
Maximise value and reduce carbon emissions
Reduction of waste/cost through application of waste hierarchy
Tonnesgenerated and % to landfill, clinical, recycling…
Maximise value and reduce carbon emissions
Improved medicine management
Reduction in prescribing and pharmaceutical waste
Baseline and % reduction pa
Protecting people from avoidable harm
Reduction in use of hazardous substances
Baselineand % reduction

Increase in proportion of fresh, healthy, low carbon food supply chains and consumption by staff, service-users and communities.
Improvement in provision/access to high quality green space for patients and communities.
Reduction in energy use / carbon emissions / increased use of renewable energy
Reduction in goods/staff/patient transport emissions
Increase in staff / patients/service-users walking and/or cycling regularly
Increasein advice and support for housing issues
Reduction of waste/cost through application of waste hierarchy
Reduction in prescribing and pharmaceutical waste
Reduction in use of hazardous substances

•Sarah.dewar@liverpoolccg.nhs.uk
•www.healthyliverpool.nhs.uk
•twitter: @HealthyLvpool
•www.liverpoolccg.nhs.uk

A Trust in Action
Ian Stenton
Head of Sustainability
Royal Liverpool & Broadgreen
University Hospitals

A Trust in Action
•Overview of Trust & New Royal
•Sustainability Management

Overview of Trust
Royal Liverpool University Hospital
BroadgreenHospital
Liverpool University Dental Hospital

Sustainable Communities Programme
•Local spend & employment targets
•Apprenticeship schemes
•Liverpool Community Fund

Community Volunteering
•Organisations local to hospital
•Offer variety of roles
–Regular time-giving
–One-off decorating project
•Keep record of activities
•Provide case studies

Upskilling
•Support for identifying trainees
•Fully funded by training provider
•Can include Trust involvement
•Have specified roles available

•Local partners have key skills to share
•Larger organisations can provide leadership
•Agree common goals

Sustainable Development Steering Group
Carbon Management
Social Value

Travel
-Promotion of travel hierarchy
-Carbon reduction
Facilities Management
-Meeting NHS / Govttargets
-Carbon reduction through
energy and waste
Procurement
-Local suppliers / spend
-Carbon reduction
Buildings
-New Royal
-Capital schemes
Carbon Management

Models of Care
-Environmental impacts
-Telehealth/ Care from home
-Local suppliers / spend
-Sustainable communities
programme
Workforce
-Health & Wellbeing
-Green Network
Adaptation
-Impacts for staff
-Impacts for care
Social Value

Process
Good Corporate Citizenship Model Assessed Annually
Action Plans Agreed by SDSG
Progress Reported to Board

•Actions have lead
•Reviewed quarterly
•Time to address
•Definite benefits
•Definite vagueness

Issues to consider
•Scale / scope of GCCA
•GCC outcomes not desired
•Healthy Hospitals
•SDU Strategy Documents
•Lack of Carbon Activities
•ERIC

Thank You
•E: ian.stenton@rlbuht.nhs.uk
•T: 0151 706 3637
•W: www.rlbuht.nhs.uk

Sustainable Food City Liverpool
Lucy Antal
Sustainable Food City Liverpool Coordinator
Liverpool Food People
liverpoolfoodpeople@gmail.com

Sustainable Food City Liverpool
Liverpool is part of an amazing national project to support the creation of new sustainable food cities within Britain.
Liverpool is one of only 6 places in the UK selected to receive this support –the others are Belfast, Bournemouth & Poole, Cardiff, Newcastle & Stockport.
Aim: to get public agencies, NGOs, communities and businesses to work together to make healthy and sustainable food a defining characteristic of where we live.
This project is being delivered by Liverpool Food People.
Find out more at: www.sustainablefoodcities.org

Sustainable: a definition
Sustain
To support physically or mentally.
To encourage and assist.
To continue, uphold and affirm.
Able
Having the resources, opportunity and support to accomplish something.
Liverpool Food People would like to see the public sector, NGOs, communities & businesses work together to SUSTAINhealthy food activity so that people are ABLEto live well, eat well & be well.

Who are Liverpool Food People?
Growers
Campaigners
Health workers
Cooks
Environmentalists
Beekeepers
Recyclers
Communities
Farmers
Bakers
Individuals

Why are we working together?
•We’re passionate about creating a positive healthy food culture for Liverpool and its people.
•We want access to easy and affordable healthy food for everyone.
•We want the public sector to lead the way in providing healthy food and supporting the local food economy.
•We want people to have the opportunity to take part in food growing activities to benefit their health and knowledge.

How will we do this?
•Raising the profile of good food and its importance for health.
•Working in partnership across the city to share access to knowledge, skills and networks.
•Campaigning for fairer access to fresh food for all.
•Getting organisations to think more holistically about food and health e.g. availability of healthy food options for staff; signposting to outdoor activity such as community garden schemes.
•Making Liverpool a Sustainable Food City.
•Talking to people like you!

What are the challenges?
•Food poverty or rather, poverty.
•Lack of knowledge about cooking with fresh ingredients.
•Lack of knowledge about nutrition.
•Food swamps and food deserts.
•Access to growing spaces and knowing what to do with them.
•Food waste –over buying e.g. BOGOFS; what to do with leftovers.

Food Action Plan
Themes:
Food access –make it easier, make it healthier
Healthy communities –grow it, cook it, eat it.
Procurement–make it fairer, buy it locally.
Skills and training–teaching, sharing, helping.
Surplus–don’t waste it, redistribute & use it.
New enterprise –support, encourage, sustain.
How can we tackle these challenges?

Food access
Objective: Easy and affordable access to good food for all.
Outcome: Healthier eating and food culture.
Current activity:
•Supporting the development of the Taste for Health strategy 2015-18.
•Expansion of healthy school food provision by partner Food for Thought.
•Mapping the food access provision for vulnerable families and individuals in crisis.

Healthy Communities
Objective: to engage and enable communities to increase demand for sustainable food.
Outcome: more people are enjoying and cooking good healthy food together more often.
Current activity:
•Working with Liverpool’s poverty, sustainability and healthy food agendas.
•Public engagement programme with events, workshops and debates.
•Linking people from community growing projects with public sector and business.

Procurement
Objective: to increase sustainable food demand and supply through public sector procurement
Outcome: Public sector settings leading the way in providing healthy, good food and supporting a local food economy.
Current activity:
•Development of a social value approach for NHS food procurement.
•Connecting with universities, hospitals and schools around local, ethical and seasonal healthy food provision.
•Sustainable Fish City –ethical, sustainable supplies.

Skills and Training
Objective: increase knowledge and capacity to build demand and raise supply of sustainable food in Liverpool
Outcome: highly skilled food economy workforce across commercial and community settings
Current activity:
•Creating a knowledge network of skills and training offers across the city region.
•Encouraging development of workplace led health activity.

Surplus
Objective: Close the food loop by reducing food waste and making use of surplus and waste from all sources
Outcome: Reduce food waste to landfill and improve social outcomes from surpluses.
Current activity:
•Discussions with LEP, MRWA and others about food waste collection.
•Linking organisations such as Real Junk Food Liverpool and FoodcycleLiverpool with surplus but still edible food.

New Enterprise
Objective: Increase markets for local food enterprise and develop supply chains.
Outcome: A vibrant and resilient local food economy.
Current activity:
•Highlighting the importance of food economy to the Mayoral Commission on sustainability.
•Adding locality to catering tenders for public sector.
•Facilitating meetings between local grower/producers and buyers.

How does this relate to you?
•Liverpool Food People are here to connect and facilitate sustainable food related activity within the region.
•We want to highlight best practice –tell us what your organisation is currently doing to improve its sustainability.
•Can we help? Do you need information/ advice/ support to make changes within your organisation or engage with your community?
•Join us! We want more Liverpool Food People working together.

Liverpool Food People
Current Partners:
Health Equalities Group Squash NutritionPublic Health Liverpool
Faiths4Change Liverpool NHS CCG Food For Thought
Claremont Farm At Home on the Earth Fir Tree Farm
Friends of Everton Park SustenanceSustainable Food Cities
LarkinsFarmFareshareMerseysideHomebakedAnfield
Supported By:
EsméeFairbairnSustainable Food CitiesSoil Association
SustainThe Mayor of Liverpool’s office Food Matters
Public Health LiverpoolLiverpool NHS CCG

NHS Sustainability
Day Liverpool
Robin Ireland
Chief Executive
Health Equalities Group

NHS Sustainability Day, Liverpool
Health Equalities Group main interests:
•Food and Nutrition
•Tobacco control
•Active Travel

Overview:
•The NHS needs to take its own health seriously.
•Overweight matters.
•A local healthy weight campaign.

NHS Five Year Forward View
Simon Stevens, CEO, NHS England, October 2014:
“The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.”

“We need to take our own health seriously”
There’sabroadhealthcampaignthatweneedtotakebecausethefactisifwekeeppilingonthepoundsonourwaistlinewecarryonpilingonpoundsneededtosustainthehealthservice.”

Child overweight (including obesity)/ excess weight: BMI ≥ 85thcentile of the UK90 growth reference
One in three children in Year 6 is overweight or obese(boys 35.4%, girls 32.4%)
Prevalence of overweight in childrenNational Child Measurement Programme 2011/12
One in five children in Reception is overweight or obese(boys 23.5%, girls 21.6%)

Adult (aged 16+) overweight and obesity: BMI ≥ 25kg/m2
More than 6 out of 10 men are overweight or obese (66.2%)
More than 5 out of 10 women are overweight or obese (57.6%)
Overweight and obesity in adultsHealth Survey for England 2009-2011

Local figures for obesity
Percentage of adults classified as overweight or obese in Liverpool
67.2%

Food Poverty
The effect of inequalities

Targeting sugar sweetened beverages to tackle obesity.

Nourish Campaign (2007)
In 2007 we initiated a hospital food project:
•Aimed to increase provision and uptake of healthier and local food by staff.
•Involved six hospital trusts across Cheshire & Merseyside.
•A baseline audit & staff survey of food provision was carried out.
•Interventions were piloted and evaluated.

Nourish Campaign…
•Challenged caterers to think more about how to target customers and the difference positioning of items made.
•Excellent website.
•As a result healthy options have become more of a priority-chefs considering them more and staff requesting them.
•Introduction of new product lines e.g. healthy pasta.
“Important to keep the ball rolling… keep trying new options… encourage staff.”
“…most refreshing and rewarding time I’ve spent here.”

NHS Food Procurement (Groundwork Merseyside)
•NHS food procurement can have a significant contribution in supporting local communities.
•If the sustainability of the economic, social and environmental benefits are built into procurement activities it will considerably support the health, worklessnessand environmental agendas.
•New suppliers have seen an improvement in turnover with jobs created and safeguarded, through improved transport routes and managing stock levels a reduction in CO2 has also been realised.
•An increased awareness of supplier food miles GIS (Geographical Information Systems) were provided, mapping out the mileage from supplier to each individual Trust.
•An identified reduction in waste-due to higher product yield and better quality of product.

Conclusion:
Lead by example!
•Intelligent food procurement.
•Specify the need to encourage a healthy diet in contracts.
•Restrict food and drinks high in salt, saturated fat and free sugars.
•Provide resources and support to help employees make behavioural changes.

Thank you
@robinHEG
@HealthEqualGrp

Closing Comments
Judith Greensmith CBE
Chair, Royal Liverpool and Broadgreen University Hospitals NHS Trust
#Dayforaction

NHS Sustainability Day Liverpool Road Show

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