Sustainable Specialties Green Nephrology Dr Frances Mortimer Centre

Sustainable Specialties Green Nephrology Dr. Frances Mortimer Centre for Sustainable Healthcare February 2013

“Health and social care services must be planned, financed and delivered in ways that allow them to meet the needs both of today’s population and of future generations. ” Naylor & Appleby. Environmentally sustainable health and social care: Scoping review. NIHR (2012)

Triple Bottom Line Financial sustainability Social sustainability Environmental sustainability “Sustainable healthcare delivers the highest possible value to patients from a radically reduced resource input. ” Green Nephrology Summit 2012 – position statement

Results of Public Opinion Survey: Source: Ipsos MORI http: //www. sdu. nhs. uk/documents/publicatio ns/Ipsos_MORI_Survey. pdf

NEWS NHS could save £ 1 bn by adopting green strategies used in kidney units BMJ 2013; 346 doi: http: //dx. doi. org/10. 1136/bmj. f 588 (Published 28 January 2013)

NHS England CO 2 e footprint 1990 -2020 with Climate Change Act targets

Carbon footprint – NHS England Transport 16% 19% 65% Energy use Supply chain (pharmaceuticals, equipment, everything else) CENTRE for SUSTAINABLE HEALTHCARE

Models of care Secondary drivers Prevention Primary driver Reduce activity Self care Outcome needed Reduce carbon without reducing health Lean pathways Primary driver Reduce carbon intensity CENTRE for SUSTAINABLE HEALTHCARE Low carbon alternatives Sustainable estates Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110– 11

Models of care Secondary drivers Prevention Primary driver Reduce activity Self care Outcome needed Reduce carbon without reducing health Lean pathways Primary driver Reduce carbon intensity CENTRE for SUSTAINABLE HEALTHCARE Low carbon alternatives Sustainable estates Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110– 11

Models of care Secondary drivers Prevention Primary driver Reduce activity Self care Outcome needed Reduce carbon without reducing health Lean pathways Primary driver Reduce carbon intensity CENTRE for SUSTAINABLE HEALTHCARE Low carbon alternatives Sustainable estates Sustainable clinical practice e. g. dry powder inhalers (1/18 x carbon of MDI) Infrastructure & process Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110– 11

CSH Sustainable Specialities Fellowships 1. Network • Local champions • Case studies • Summit & Awards 2. Research / demonstration project CENTRE for SUSTAINABLE HEALTHCARE

Case studies - infrastructure Salvage of reject water from RO plant (Ashford, Canterbury, Stevenage) • 3+ million litres water & £ 6, 000+ saved per year Central delivery of acid for haemodialysis (Bradford) • 16 tonnes CO 2 eq & £ 22, 000 saved per year Energy-efficient lighting (Bradford) • 2. 3 tonnes CO 2 eq & £ 600 saved per year, improved environment for staff and patients CENTRE for SUSTAINABLE HEALTHCARE

Case studies – process (1) Paperless reporting of routine lab results (Doncaster) • 0. 4 tonnes CO 2 eq & £ 120 saved per year; patient safety Improved waste segregation (Fife, Glasgow x 6, Leicester) • 50 -85 tonnes CO 2 eq & £ 11 -15, 000 saved per year Reduction in dx consumables (Cornwall, Fife, Glasgow) • 10 -26 tonnes CO 2 eq & £ 15 -30, 000 saved per year CENTRE for SUSTAINABLE HEALTHCARE

Case studies – process (2) Coordination of dialysis transport (Cornwall) • 17 tonnes CO 2 eq & £ 18, 000 saved per year, improved patient experience Linen reduction (Cornwall) • 2 tonnes CO 2 eq & £ 5, 000 saved per year Bolus administration of IV antibiotics (Fife) • 10 tonnes CO 2 eq & £ 17, 000 saved per year; increased nurse -patient contact CENTRE for SUSTAINABLE HEALTHCARE

Case studies – models of care Telephone follow up of transplant recipients (Coventry) • 2 tonnes CO 2 eq saved per year; cost: neutral; improved patient experience / ? empowerment Electronic consultation as alternative to referral (Bradford) • 2 tonnes CO 2 eq saved per year; potential cost reduction from avoided referrals; potential benefits to patient exp/out Remote monitoring in CKD (Cornwall, Sheffield) • 0. 5 -0. 8 tonnes CO 2 eq saved per year; potential cost/patient benefits CENTRE for SUSTAINABLE HEALTHCARE

“Thanks to Green Nephrology, sustainability is now the seventh dimension of Quality. The work over the past couple of years has caught the imagination of the whole kidney community and has launched a social movement to provide better, greener and leaner kidney care. ” Dr Donal O'Donoghue, National Clinical Director for Kidney Care CENTRE for SUSTAINABLE HEALTHCARE

Does your Green Nephrology Local Representative have…? • Senior support • Time • Access to finance Green Nephrology Survey of Local Representatives 2010 CENTRE for SUSTAINABLE HEALTHCARE

http: //sustainablehealthcare. org. uk/green-nephrology