Sustainable Development Masterclass

Jerome Baddley SDU Head of Unit

SD in health and care report

• 2016 - State of the system • 2012 - last SD in health

and care report • Looking back to how

we’ve done and forward to opportunities

Progress to date

Cost and Carbon 2007-2015

• Energy efficiency alone savings C£190m pa. • Over 1Mt CO2e • Cumulative from measures ‘07- ‘15 C£1.85Bn. • Over 10MtCO2e • Expected from measures ‘15- ‘20 over £95m pa • Over 0.5MtCO2e

Challenge

• Human health is the measure of Sustainable Development across all sectors.

• Operating in constrained budgets • Also operating in a constrained carbon and

resource environment (now to meet 1.5oC)

202020

By 2020 • Need to achieve £22bn savings • Cut emissions to 20Mt These are mutually supportive- interdependent.

Required progress

Public opinion IPSOS MORI

National Health and Care footprint

• Now need to be thinking broader than NHS.

• Across the whole Health and Social Care Sector.

• Local health and social care communities.

• Costs and emission saved across communities

How do we get there?

Eg. • Grid decarbonisation • Vehicle efficiency • Supports 30% reduction

Eg. • Energy and travel efficiency • Anaesthetic gases • Models of care • Public health • Supports 58% reduction

Sustainable healthcare community

‘how’ as important as ‘what’ in healthcare delivery. • Local leadership and example on

resource efficiency • Public health protection • The design of models of care • Goods and services procured • The impact of staff as citizens

Health and care context -Leadership

• The SD strategy and Health Check 2016 cover whole Health and Care System

• DH, PHE, NHSPS now have Sustainable Development Management Plans

• NHSI (Monitor/TDA) NHSE, NICE are developing SDMPs, other eg CQC to follow

SDMPs and SRs -Leadership

Sustainable Development Management Plans: • PHOF and NHS SC clause 18 • 70% of providers, 30% of commissioners.

Sustainability Reports: • FReM guidelines, • 100% provider and commissioner coverage • 44% classed as ‘good’ or ‘excellent’ in SDU assessment • SDU good practice guidance published

Models of care in SDMP • Best SDMPs and SRs include commitment to

low impact models of care. (Nottm. City CCG) http://www.nottinghamcity.nhs.uk/images/stories/docs/GoverningBody/2015-16/April2015/117_15_Sustainable_Development_Management_Plan.pdf

Areas with significant reporting in SRs

Reporting area National score

G) Energy - Direct consumption (kWh/CO2e) [0 - 3] 71% E) Partnerships [0 - 2] 66.7% I) Waste – Production of waste (weight/emissions) [0 - 3] 58.6% H) Water – Direct consumption (m3/CO2) [0 - 3] 50.3%

Q) Adaptation of infrastructure and/or services to develop resilience against climate change [0 - 2]

46.8%

Areas with some reporting in SRs

Reporting area National score

B) Staff engagement in sustainability agenda / supportive of wellbeing in the workforce [0 - 2] 32.7% A) Sustainability vision and lead from the Board and Senior Management [0 - 2] 26.2% L) Staff travel plans [0 - 3] 24.6% M) Travel impact reduced from service delivery (e.g telehealth / care closer to home) [0 - 3] 20.8% P) Social value considered in supply chain (e.g. local economy / community/ ethical) [0 - 2] 20.7%

Areas with less reporting in SRs

Reporting area National score

J) Energy from renewable sources / renewable technology onsite / 100% renewable tariffs [0 - 3] 16.6% N) Patient transport services / operational logistics [0 - 3] 14.9% F) Good Corporate Citizen assessment tool [0 - 3] 14.7% K) Energy from CHP [0 - 3] 14.7% R) New models of care are developed with sustainable objectives in mind [0 - 2] 8.5% D) Employment practices [0 - 2] 4%

Models of Care

• Often unaccounted environmental and social co-benefits- need to be quantified

• Accounting for the environmental benefits from better care- Vangards, Rightcare etc.

• Potentially using new (Oct 2015) SDU guidance on foot printing care pathways.

Example-Social Isolation

• Risk in reduction of LA social care budgets • Day care centre closure? • Community ‘meals on wheels’ cuts? • Shorter less frequent home visits? • Home care, rather than care home or sheltered housing? • Increase in isolation risk • Potentially increased risk of more acute health issues • Risk of missed early intervention opportunities

Impacts of social isolation

• Impact of isolation on mortality equivalent to 15 cigarettes a day

• Isolation and loneliness, linked to depression, anxiety, declining mobility, high blood pressure and increased mortality rates.

• Loneliness reduces older people’s immediate quality of life. • Cost of being chronically lonely to the public sector is C£12,000 per

person, based on GP visits, A&E visits, unplanned admissions

Social Isolation

July 2015 Worcestershire CC and 3 CCGs awarded the country’s first ‘payment by results’, Social Impact Bond to help 3,000 older people overcome loneliness in the county.

• Delivered by Age UK, with local community orgs. • Conservative annual savings C£2.2m (avoided healthcare,

NPV) + 244 QALYs (£14m in avoided social cost) • Avoided admissions and bed days alone would save 217 tCO2.

(equivalent to emissions from heating 136 homes all year)

Unit Costs of Health and Social Care 2015:

http://www.pssru.ac.uk/project-pages/unit-costs/2015/index.php

Social Cost of QUALYs

• Quantifying health impacts of government policies- A how-to guide to quantifying the health impacts of government policies.

5.21 ‘The Department of Health estimates that a QALY has a monetised value to society of £60,000’

Isolation- extrapolated 6% of isolated older people

• http://www.sduhealth.org.uk/delivery/engage/health-returns-infographic.aspx

Telecare 2% of people with long term conditions - CHD, diabetes, COPD

Avoided Social Cost

• 5,671 QALYS-@£60,000 = £340m Quantifying health impacts of government policies • 67,446t CO2e @£62.42/t = £4.2m DECC Carbon price, Non Traded Sector

Wider social benefits Additional benefits • Reduced air pollution-particularly near sensitive care facilities • Reduced ‘Care Miles’ • Reduced traffic and congestion • Reduced fuel costs • Reduced time for healthcare staff • Reduced disruption for patients • Less missed appointments? • Better resilience and adaptation to climate change.

Air pollution

• Air pollution from traffic kills C40,000 people per year. • Impact on public health estimated costs to UK economy over

£20bn pa, just under 16% of the NHS budget of C£116bn. • NHS conservatively responsible for 5% of all road traffic… • 5%= 2,000 deaths, £1Bn social cost Integrating sustainable travel, telecare, reduced care miles etc in to all models of care has multiple cost, carbon and health wins. But we must quantify and value and report them!

SDU Guidance Care Pathways Guidance on Appraising Sustainability Published Oct 2015 Developed by SDU with the Coalition for Sustainable Pharmaceuticals and Medical devices (CSPM) Complements: Pharmaceutical and Medical Device Carbon Footprint Guidance Give guidance on carbon and water foot printing for pathways.

Low carbon economy

• 20% LEP investment in local growth- low carbon. More in Innovation.

• Low Carbon economy now worth £26Bn • Bigger than Pharma, 2nd to Food and Drink.

Support for innovation

• Low carbon economy can mean a more healthy economy- eg less air pollution, warmer homes etc

• Heath economy S.Notts alone <£1Bn • Support exists from universities on environmental

management, resource efficiency and innovation, LEP funded ERDF projects and academic interest

• Time to expect more and ask for year on year improvement from providers and suppliers.

Best value?

‘Sustainable’ healthcare that doesn’t include

social and environmental sustainability may just push costs elsewhere or later.

Jerome Baddley CEnv MIEMA Head of Unit Sustainable Development Unit (SDU) 0113 8253217 Jerome.baddley@nhs.net www.sduhealth.org.uk Follow us on Twitter @sduhealth