NHS Sustainability Roadshow Cardiff

Editor's Notes

• #36: Tackling wasteful spending on health - a significant share of health spending in OECD Countries is at best ineffective and at worst, wasteful. Is VBHC a solution to support this? The path to sustainability - How can we use VBHC to help close the gap
• #43: STOP spending on things that do not improve health for example unnecessary surgeries and clinical procedures SWAP inputs and change approaches when less pricy alternatives of equal value exist e.g. by encouraging the use of generic drugs, developing advanced roles for nurses o ensuring that patients who do not require hospital care are treated in less resource consuming settings such as primary or community care.
• #46: Considering outcomes instead of quantity, partners instead of source and cost instead of price
• #48: So here are some of the early examples of where Wales is attempting to put outcomes at the heart of the procurement decision process Stomacare - an opportunity to provide an equitable service across Wales, limit variation and understand the financial flows, building outcome collection into the contract. ERAS - opportunities to look at reduced length of stay and post-op complications, with payments based on % return and improved outcomes after Year 1. And finally an outcomes based contract, which looks to collect outcomes for patients suffering with severe faecal incontinence - which we believe is working ‘Backwards’ starting with what matters to the patient - a partnership with Industry ‘doing the right thing’ I want to share with you a short video that describes our approach to this challenge, I am delighted to share the stage with Dr Julie Cornish who has been a pioneer in this work. This video is delivered by patients who have given their consented to share how this contract will help to support their future quality of life. But before I do just to say that we are passionate in Procurement to improve care together, Wales has the right climate and we are PROUD - thank you
• #50: So what are we talking about when we say ‘Value Based Procurement’ - procurement professionals amongst would say that we have always provided Value in Procurement, and what procurement services in Wales have tried to do is devise a framework that evidences value in its different guises. Product - traditional well proven methodology and still appropriate allowing best quality above price - examination gloves as an example (This is Value) Process - looks at resource utilisation in addition to best quality above price, and eliminating unnecessary costs, ultimately decreasing the efficiency and effectiveness of care e.g. wound care - not only cost of product, but usage, right place, right person
• #53: A million plastic bottles are sold every minute around the world– a figure that’s expect to grow by 20% by 2021 Over 13 billion plastic bottles are used every year in the UK – that’s more than 35 million a day. Just over half (57%) of all plastic bottles are recycled in the UK and 15 million plastic bottles are littered, landfilled or incinerated every day. Landfill and incineration of plastic bottles from the UK produces approximately 233,000 tonnes of CO2e emissions a year.
• #54: Refill is an award-winning campaign to prevent plastic pollution at source by making it easier to reuse and refill your water bottle on the go than buy a single-use disposable plastic bottle. The campaign works by connecting people who are looking for water with thousands of local business, transport hubs and public spaces where they can refill for free via a location based app. Participating cafes, bars, restaurants, banks, galleries, museums and other businesses simply sign up to the app and put a sticker in their window – alerting passers-by that they’re welcome to come on in and fill up their bottle.
• #55: 85% of us are concerned about plastic pollution. 32% of people feel guilty about buying plastic bottled water. 64% of us would stop buying bottled water if tap water refills were freely available. 65% of people would be more likely to use a reusable water bottle if tap water refills were freely available.
• #56: Give ‘everyday activists’ a simple way to create lasting change by setting up a Refill scheme. Make sure people can quickly and easily find free tap water refills through our app. Make free tap water more widely available in public spaces like transport hubs, shopping areas and civic venues.
• #57: If all our Refill stations are used just once a day, we're stopping around 5 million plastic bottles at source in a year.
• #62: Just a third of people own and regularly use a reusable water bottle. 13% think reusable bottles are becoming fashionable. 66% of people are using a reusable bottle to reduce the amount of plastic they use. 67% of people said knowledge of the Refill Scheme made them more likely to carry a reusable bottle.
• #109: Welcome to Plastipak here in Wrexham. Thank you for joining us. Has everybody signed in? We will take some photos in the meeting room but strictly no photos during the site tour. Toilets, fire alarms and emergency exits. Phones turned off please Competition Law statement Quick round of introductions
• #110: Don’t forget your own role!
• #122: Pizza Hut Restaurants, Marks & Spencer, Morrisons and Lidl have all stopped selling or giving away plastic straws. Pizza Hut Restaurants’ customers now have to request a straw, resulting in a 90% reduction in straws being used. Asda and Morrisons are starting to remove some of the single-use packaging on their fresh produce ranges. Asda have removed the plastic from six million swedes, resulting in a 14 tonne reduction of plastic. Morrisons are trialling the effect of removing plastic packaging from fresh fruit and veg in a number of their stores – replacing the single-use plastic bags with paper versions.  Asda, Morrisons and Lidl have all removed plastic stemmed cotton buds from their stores, replacing them with paper or biodegradable alternatives The majority of Quorn’s in-store packaging has changed from black to white or clearer alternatives, saving 300 tonnes of black plastic from entering the value chain each year.  Coca-Cola European Partners (CCEP) has launched smart Coca-Cola fountain dispensers in partnership with the University of Reading and at Summer festivals. The refillable containers are micro-chipped to interact with the dispenser technology, allowing students and staff to buy all their soft drinks in reusable bottles. This refill system will test new technology and consumers’ adoption of refillable types of packaging. Braiform developed the first-ever closed loop hanger solution. By partnering with retailers and garment manufacturers they have created a reuse system for hangers that dramatically reduce the number that ends up in landfill. In 2017, they reused over 1 billion items, representing the same reduction in carbon emissions generated from manufacturing over 4 billion plastic bags. Both Coca Cola and Highland Spring have made all their packaging, including the bottle caps and labels 100% recyclable.  Ecover’s bottles are designed to be re-usable and Ecover has offered refill solutions for a number of years. They offer consumers 5 litre ‘drums’ to buy online that can be used to refill their bottles at home and 15 litre bag in box refills in selected health food stores across the UK in washing-up liquid, laundry liquids and all-purpose cleaners. To make bottles more recyclable Ecover do not use bright colours – the white or transparent plastic they use is easier to recycle because it is easier to re-dye and re-purpose.  Morrisons has pledged to ensure 100% of the plastic in its own-brand packaging is recyclable by 2025 and the retailer is currently 82% of the way towards this aim. Tesco's organic bagged prepared salads are the first to move to PE film plastic to increase recyclability. The PE film can be recycled into their 10p bags for life that are made from 94% recycled plastic, 80% of which is recycled material from recovered Tesco packaging waste.  Lidl has replaced all black plastic in their fresh produce range, replacing with recyclable alternatives, saving an estimated 50 tonnes of black plastic waste per year.  Aldi have switched the packaging for a range of cooked meat from non-recyclable packaging to clear, recyclable alternatives to save more than 1,000 tonnes of plastic annually. Novamont have collaborated with the Co-op to create compostable dual use carrier bags, replacing their current 60 million single-use plastic carrier bags with an EN 13432 certified compostable alternative. After carrying shopping home, consumers are encouraged to reuse the bags to line food caddies which will be accepted by over 150 local authority food waste collection systems.  Alternatively, they can be home composted. Nestlé have changed the colour of their Nescafe Original caps from dark brown to red and their Nescafe Gold Blend Barista Style lids from black to gold as they are widely recyclable, and this ensures that they will be detectable in the recycling system. Asda have moved from black polystyrene pots to green polypropylene pots for their 'Growing Herbs' range, as well as changing the SRP trays they sit in from black plastic to clear. 2.7 million trays and 48 tonnes of plastic are now fully recyclable.
• #128: Slide comments: This slide can be used for initial introductions and for introducing Centrica Business Solutions. Speaker notes: This presentation will talk through the current issues that are facing the leisure industry today, how to address these challenges, what organisations should be focused on and how Centrica can help solve these challenges.
• #131: Slide comments: This slide sets the scene and demonstrates that we understand the broader market trends impacting healthcare operators Speakers’ notes We know from our work with several NHS trusts that a number of significant market trends are creating new challenges for healthcare organisations in the UK: Increased demand for services An ageing population, more chronic conditions and costly new treatments all create increased demand Life expectancy is 13 years longer today, compared to when the NHS was established An average 65 year old costs the NHS 2.5x more than the average 30 year old and an 85 year old costs >5x more. Partly as a result, pressure on a budgets is at an all time high: Funding shortfalls and increased input costs are creating budget pressures In the UK, it has been estimated that the NHS will face a funding shortfall of £22 billion by 2022/ 23 (Joint statement on health and social care, Nuffield Trust/ The Health Foundation/ The Kings Fund, November 2017) Many healthcare providers are operating within tight financial constraints and can’t absorb the costs of lost output Funding/margin pressures are forcing healthcare providers to diversify and look for new revenue streams as there is an additional strain through increasing input costs and expensive new treatments Staff shortages and skills gaps are creating pressures across all areas of healthcare, including operational management Analysis in December 2017 shows the NHS in the UK has at least 36,000 full-time equivalent nursing vacancies, and the number could be as high as 42,000 (Health Service Journal 4/12/17 as referenced by Nuffield Health The funding squeeze, the impacts of under-investment in NHS estates, and the staff shortage are all contributing to a worsening performance against government targets. In December 2018 the number of A&E admissions seen in 4 hours or less dropped to 77.3% in Type 1 A&E departments, way below the target standard of 95%. (March 2018 Quarterly Monitoring Report from The King’s Fund) With limited capex available for healthcare organisations to invest in operational estates, they are having to rely on ageing equipment and hope that it holds together Ageing infrastructure can put the quality of care at significant risk - failures of vital equipment, have a serious impact on patient care and satisfaction. The demand from politicians and patients for 24/7 access to many services is creating new pressures on resources and infrastructure As is the desire to move towards a paperless NHS and take advantage of digital healthcare (Regulation and security)
• #132: Slide comments: This slide focuses more specifically on the specific challenges that healthcare organisations face in relation to their energy usage Speakers’ notes Against this backdrop, we know that there are very specific challenges that healthcare organisations like yours face relating to their usage of energy: Continuity of energy supply is critical – a power outage can have catastrophic consequences A far greater reliance on digital technology in all aspects of healthcare is increasing the impact of power outages. For example, digital patient records, which contain critical information to ensure appropriate care, need to be accessible at all times. The impact of system outages can be catastrophic, leading to wasted resources and lost revenues, and ultimately endangering patients. In a recent survey by Centrica, 77% of healthcare/medical respondents agreed that the cost of being energy resilient is far less than the impact of an energy failure Compounding the issue, the increasing frequency of extreme weather events is leading to greater risk of grid failures. In the Centrica survey, 46% of healthcare/medical respondents stated that their organisation had suffered an interruption of energy supply due to external factors in the last 12 months. There is increasing pressure from government and regulatory bodies to meet new energy targets The European Energy Performance of Buildings Directive (EPBD) requires hospitals over 1000m2 to display energy performance certificates The NHS has committed to a target of reducing carbon reductions by 80% by 2050, in line with the 2008 Climate Change Act. Sector-specific regulations in areas such as airflow and cooling, is putting additional pressure on operational functions Alongside this, consumers are increasingly concerned about the green credentials of service providers, including within the healthcare sector. As patient satisfaction and attitudes are likely to have a greater impact on future funding, it’s becoming more important to build a brand with strong green credentials Many UK hospitals have published carbon reduction targets - E.g. the world renowned Great Ormond Street Children’s hospital has a target of 34% reduction in its Carbon Footprint by 2020 against a 2012/13 baseline Many healthcare providers are running ageing and inefficient energy estates – this is leading to unnecessary wastage and consuming budget that could be better invested in patient care. With older estates it can be difficult to see where energy is being wasted and therefore where to start when looking for inefficiencies. Skills and resource gaps in operational functions mean that many providers are not effectively managing their energy estates, and lack the time or the expertise to address inefficiencies In the Centrica survey, 58% of healthcare/medical respondents agreed that “we do not have enough internal expertise to monitor and implement efficiency improvements”
• #135: Slide comments: This slide introduces Centrica Business Solutions' point of view about the areas we believe healthcare organisations should be focusing on, where energy has a vital role to play in helping them achieve their broader goals Speakers’ notes If healthcare organisations are to effectively manage their risk, compete in a changing market and deliver a quality of care, then we believe it’s essential they can: Maximise operational efficiency to enable investment in improving patient outcomes Ensure the resilience of critical health services to protect patient care Harness the potential of energy to build a more sustainable healthcare future Energy has a key role to play in supporting each of these objectives. I’d like to look at each of them in a bit more detail.
• #136: Speakers’ notes With budgets under intense pressure, it’s essential that healthcare providers eliminate avoidable spend and optimise operational performance – so that they can devote more resources to frontline healthcare activities By becoming more energy efficient, healthcare organisations can reduce energy costs and free up opex and capex for investment in front-line patient care activities 35% of healthcare respondents listed “managing cost and providing comfortable care” as the number one challenge facing healthcare professionals over the next 12 months Reducing the dependence on in-house operational staff frees up the maintenance team to work on generating new efficiencies rather than shoring up creaking equipment. To maximise their operational efficiency to enable investment in improving patient outcomes, healthcare providers should take advantage of new technologies and new approaches to managing energy. Specific opportunities for healthcare organisations include: Insight and analytics solutions help identify opportunities to improve energy efficiency across disparate healthcare estates On-site generation (CHP, Solar) and Energy Efficiency solutions (e.g. Energy Audits, LED lighting) enable reductions in energy consumption and cost Flexible funding models remove barriers to deploying new technologies and free up capital to invest in enhancing patient outcomes End-to-end delivery capability and fully-managed service options help alleviate skills and resource shortages, and enable healthcare providers to focus on frontline services Centrica research found that: 35% of Healthcare respondents listed “managing cost and providing comfortable care” as the number one challenge facing healthcare professionals over the next 12 months 58% stated that they ‘do not have enough internal expertise to monitor and implement energy efficient solutions’
• #137: Speakers’ notes The impact of system outages within a healthcare facility can be catastrophic, leading to wasted resources and lost revenues, and endangering patient care Ensuring the resilience and compliance of all parts of their operation should be of paramount importance for any healthcare provider, to ensure they meet their duty of care to patients and other stakeholders Too many healthcare facilities are dependent on outdated environmental and energy systems, which are increasingly prone to failure, shorten the life of expensive medical equipment, and create a risk of compliance breaches. To effectively manage their risk, healthcare providers need to ensure they have a resilient and compliant energy strategy, which: Reduces exposure to grid failures or natural disasters, by taking advantage of on-site generation and storage technologies to achieve greater security of supply Ensures their energy estate is effectively managed and maintained, and enables outdated infrastructure to be replaced To ensure the resilience of critical health services to protect patient care, healthcare providers should take advantage of distributed energy technologies. Specific opportunities for healthcare organisations include: On-site generation (inc. CHP and Back-up generators) and storage solutions ensure a secure and scalable supply, and reduce exposure to grid failures Sensor solutions enable early detection of potential equipment failures, and inform preventative maintenance programmes Full Operations & Maintenance support of energy assets ensures the reliability of on-site infrastructure Expert advice and advanced Energy Management Systems help ensure a safe, secure and compliant environment Resilience-as-a-Service to overcome resource/ capex constraints Centrica research found that: 77% of healthcare/medical respondents agreed that the cost of being energy resilient is far less than the impact of an energy failure 66% of healthcare/medical respondents thought that sources of back-up supply in the event of a power outage were very important (26% quite important)
• #138: Speakers’ notes Regulatory and consumer pressures mean its essential for healthcare providers to have a strong focus on environmental sustainability At the same time, funding pressures mean that providers need to find new revenue streams to ensure their long-term viability Many healthcare facilities have under-utilised real estate (e.g. roof spaces) that could be used for renewable energy generation, however they are often held back because of the perceived capital investment required By taking advantage of low-carbon technologies, and supply-side incentives, healthcare providers could simultaneously improve their environmental performance, reduce energy costs and generate new revenue streams to invest in front-line services. Healthcare providers should focus on: Exploring opportunities to generate new revenue streams from existing assets and real estate Improving energy sustainability – by transitioning to more efficient, low-carbon technologies – to satisfy the demands of both regulators and patients Transition to a more flexible and resilient energy infrastructure that will provide a platform for digital healthcare and potential diversification -enabling providers to realise the full potential of technology to transform their organisations Specific opportunities for healthcare organisations include: Renewable, low-carbon technologies (eg CHP, Solar) help reduce your emissions and generate your own energy supply Demand Side Response and energy trading solutions enable you to generate new revenue streams from your on-site energy assets Energy insight and analytics solutions help you identify opportunities to reduce energy consumption and lower carbon emission Expert advice helps you deliver and execute a sustainable energy strategy Flexible funding models remove the barriers to deploying new, lower-carbon technologies Environmental reporting solutions help you demonstrate the results of your sustainability programme to patients, employees and regulators Centrica research found that: 90% of Healthcare sector respondents agreed that there were opportunities for energy strategies to help enable a sustainable business model Centrica Business Solutions enabled Shrewsbury and Telford NHS Trust to install a CHP unit that reduced their CO2 emissions by 2,000 tonnes per year with zero capital investment. The unit is remotely monitored in real-time by our service centre engineers, and backed by a comprehensive service package
• #139: Slide comments: This slide introduces the three core Centrica Business Solutions propositions and their relevance for the healthcare sector. The are intended to link to the existing Proposition slide modules as appropriate Speakers’ notes Centrica Business Solutions can help healthcare organisations meet today’s challenges and take advantage of tomorrow’s opportunities through our three core propositions: Powering Performance – enables Healthcare operators to drive down energy costs and improve patient outcomes Powering Resilience – ensures the resilience of critical health services Powering the Future – helps build a sustainable modern healthcare sector (Lead into relevant proposition and/ or product slides depending on customer’s main areas of interest)
• #145: Slide comments: This slide is intended to introduce the main Centrica Business Solutions products that have a relevance for the Healthcare sector. They show how Centrica Business Solutions has the solutions to help Healthcare organisations capitalise on the opportunities highlighted on the previous slides. The slide modules for each of the products can then be used to provide additional detail as required. Speakers’ notes Combined heat and power (CHP) generation: Reduce energy costs and carbon emissions in facilities where there are combined heat, power and cooling requirements Renewable generation (incl. Solar) & storage: Take advantage of un-used real estate to reduce carbon emissions reduce costs, and improve site resilience Panoramic Power sensors and analytics: Identify energy efficiency opportunities across healthcare facilities, and highlight potential equipment failures that could compromise patient care or staff safety Flexible funding models: Enable deployment of new, more efficient energy technologies, while freeing up capital to invest in new health systems End-to-end delivery and energy management: Reduce dependence on limited, in-house, operational resources, and ensure the security and resilience of your ongoing energy supply Demand Side Response: generate revenues from your on-site generation assets that you can invest in patient care
• #147: Slide comments: This slide summarises Centrica Business Solutions proposition to the healthcare sector, the main differentiators and positions them as specifically relevant for the healthcare sector Speakers’ notes: So to summarise why Centrica is the right partner for the healthcare sector: Centrica Business Solutions innovative and flexible energy solutions, end-to-end delivery model, and proven track record of solving healthcare firms’ energy challenges, means that we’re ideally placed to meet your long-term energy needs – helping you reduce costs, improve patient outcomes, ensure the resilience of patient care and enable a sustainable future.
• #149: Hello thank you for your time today…
• #150: Ice breaker for announcing the name… For those of you who do not know us that well - We deliver services to over 5000 patient beds in the uk, employ over 3000 staff etc etc
• #151: With the squeeze on budgets, local authorities are looking at ways to reduce costs by introducing efficiencies in local services, reducing energy consumption and natural resource wastage. This has to be achieved without disenfranchising the local citizens. The ‘Smart City’ deploys and utilises technology and data to introduce these efficiencies and improvements. However, to truly realise these benefits, a software platform is required to interact with the other systems to drive the behaviours which can run autonomously without the need for a complex operations centre. Like all partners involved with Smart Cities, Bouygues Energies & Services believe that their role is to integrate all the technology seamlessly. We know from our experience how to achieve the optimum solution for a city. We all know that by introducing a Smart City approach there will be new ways to add value. This will drive economic growth which in turn drives employment, and provide residents with a better place to live. By making the city smarter it automatically becomes more attractive to businesses and occupants, becomes desirable and gives the city a competitive edge. However what we hope will be clear from this presentation is efficiencies and improvements that can be achieved in the provision of local services can easily transmit to healthcare…
• #152: Reference the BYSA investment in innovation (50m euro) the 3 primary lines of the group geographical locations of work...
• #153: We believe in leading by example at Bouygues - During the first part of this century Bouygues had to decide whether to build a new HQ or take an innovative approach to their current headquarters which was then over 25 years in age…
• #154: I have had the pleasure of talking about the potential of Smart City & the associated technology's being a part of health and social care in the future at the previous set of roadshows, with the publication of the Carter review and the subsequent Naylor report perhaps we should be starting to deliver the possible inE&F in the NHS? With a “Smart culture” we can drive efficiencies in mobility, energy and local services in conjunction with improvements in environment, safety and security and health and wellbeing. Overarching everything is the provision of a connected city, from connectivity of technology, to enable system integration, so perhaps a connected hospital estate is the way forward....
• #155: We can all claim we need to be empowered to effect change but perhaps, and I am challenging all of us here, we also need to step up lead not only those working for us but those around us. Without this change we will not be able to deliver the NHS we all take pride in and care about so much, despite our backgrounds or our paymasters, the NHS is unique and impacts all of our lives
• #156: We have seen recently with Sustainability Day declaration to the government where we wish to go but lets not hide behind this - by building on the networks that Scott and the team have developed here we can start to really tap into what can be achieved .
• #157: By changing the culture and being exemplar leaders we can cast a significant leadership shadow and meet our challenges By utilising all that’s available to us , both big and small, we can genuinely move this issue forward to the point I would say that we treat the whole subject as BAU rather than an exceptional item
• #158: (Skip through this slide) we have many examples of where these benefits in these City’s have been delivered…
• #159: An outstanding example - The average energy consumption is 5.100 W by a Swiss person (July 2008) The fixed goal is to reach an average energy consumption of 2.000 W by 2050.
• #160: Carter & Naylor… Risk-based methodology for managing backlog Innovative methods of funding Sustainability…
• #161: By adopting some of the elements of Carter Report and the Naylor review we could achieve some of what Carter and Naylor are driving at; Risk-based methodology for managing backlog Best practice advice on undertaking a detailed survey to establish backlog. It introduces a model for measuring risk in relation to sub-standard assets King’s Fund: Time to think differently How the NHS estate could help to improve efficiency, move more care out of hospitals and exploit new technologies Sustainable development unit: NHS carbon reduction strategy The strategy shows the scale of reduction in carbon required for the NHS to meet its legal targets set out in the Climate Change Act
• #162: All of what could be available to us is from the IoT so why wouldn’t we want to capitalise on the benefits to all of us. Personally I think good quality data analysts will be required in lots of professions in the future especially E&F and not just in the NHS… Forbes magazine recently identified drivers such as; “Technologies of sensor networks, data collection and storage have made it possible to have real time observations of complex engineered systems. Sensor networks have the power to employ big number of small, cheap, and energy efficient sensors that would collaboratively collect and process data and measure wide range of parameters including temperature, sound, vibration, pressure, water quality, motion, pollutants” Remember BMW… With such innovation why cant an app also monitor E&F workstreams?
• #163: This is Humber River hospital in Canada
• #164: This is a simple depiction of ThoughtWire in action in an Internet of Health Things Scenario supporting nurse call events. In this the platform supports real time interconnection with the health things and system; Leverages our ambiant intelligence (a new form of AI) to intelligently identify the right nurses to alert and our omni-channel interaction capabilities to provide a simple interface on the nurses blackberry device to help them keep track of the tasks assigned to them. In live settings the entire transaction from the original nurse call event to delivery takes less than 200 milliseconds.