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SOUTHWARK PRIMARY CARE TRUST BOARD
Date of Trust Board meeting: June 10th 2009

Name of Report:

NHS Southwark Carbon Reduction Strategy

Author(s):

Chris Baker, Head of Premises Development

Approved by

Robert Park

Audit trail:

None

1. Recommendation to the Trust Board

Agree the formation of a working group to co ordinate the PCT’s response and development of an implementation plan.
2. Background / Context (to include Relevant Core Standard / Development Standard) The NHS has recently published ‘Saving Carbon, Improving Health’ the NHS Carbon Reduction Strategy for England. The PCT will need to develop its response to the strategy and the targets set, some of which are legally binding and develop its implementation plan to take forward the recommendations. 3. Key issues for consideration The PCT need to:    Develop a Board-approved sustainable development management plan containing a commitment to reduce its 2007 carbon footprint by 10% by 2015 Signing up to the good corporate citizenship assessment model Monitor, review and report on carbon and actively raise awareness at every level of the organisation

4. Policy and performance implications (including link to Fitness for Purpose, Commissioning Strategy Plan and performance indicators)

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Design standards covered as part of C21 Healthcare Standards 5. Risk implications and Actions Taken (to include financial, legal and human resources) Legally binding, UK Government targets to reduce carbon emissions by 80% by 2050 compared with 1990 levels. 6. Impact statements (Public and User involvement and implications and Equality and Diversity implications)

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NHS Southwark Carbon Reduction Strategy
Scoping paper

Recommendation 1. The NHS Southwark Board are asked to note the requirements of the recently published NHS Carbon Reduction Strategy and agree the formation of a working group to co-ordinate the PCT’s response and development of an implementation plan. Background 2. In January 2009, the NHS published ‘Saving Carbon, Improving Health’, the NHS Carbon Reduction Strategy for England. The Strategy sets out a number of requirements for all NHS bodies in taking action to reduce their carbon emissions. These include:     A Board-approved Sustainable Development Management Plan containing a commitment to reduce each organisation’s 2007 carbon footprint by 10% by 2015; Signing up to the Good Corporate Citizenship Assessment Model; Monitoring, reviewing and reporting on carbon; and Actively raising carbon awareness at every level of the organisation.

3. The strategy sets out six key reasons why NHS organisations need to act now to understand, manage and reduce their carbon footprint:  Legally-binding, UK Government targets to reduce carbon emissions by 80% by 2050 compared with 1990 levels. Governance arrangements of all NHS organisations will need to demonstrate how this is being measured, monitored and managed. The strength of scientific evidence that climate change is resulting from increased carbon emissions and that this is destabilising the world’s climate and adversely affecting the population’s health. The health benefits for patients, populations and the health system in reducing carbon emissions through increasing levels of active travel, reducing road traffic accidents and improving air quality. Reducing costs through improved energy efficiency and increased resilience towards fluctuations in the price and availability of energy. This should be a part of each organisations risk register. A strong willingness by NHS organisations and staff to take a lead. 95% of NHS organisations responding to the draft consultation supported the NHS being at the forefront of reducing carbon emissions. The NHS should set an example to partner organisations and the population and be the public sector exemplar, demonstrating that healthy people depends on a healthy environment.

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4. Analysis undertaken for the strategy estimated the NHS carbon footprint in England at 18 million tonnes of CO2. This represents 25% of all public sector emissions and 3.2% of total emissions. Despite increases in efficiency,

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emissions produced by the NHS rose 40% between 1990 and 2004. Reversing this increase to achieve the 10% target reduction by 2015 and meeting the requirements of the Climate Change Act (2008) to reduce emissions by 26% by 2020 and 80% by 2050, will be a considerable challenge. 5. The source of emissions forming the total existing NHS carbon footprint comprise:    building energy use (22%) - heating, hot water and electricity consumption travel (18%) - patients, visitors and staff procurement (60%) - supply chain activities of companies producing goods and services procured by the NHS in England including the waste generated and its management

6. The strategy identifies the need to take action in each of the following areas: Energy and carbon management Every organisation should review its energy and carbon management at Board level; develop more use of renewable energy where appropriate; measure and monitor on a whole life cycle cost basis; and ensure appropriate behaviours are encouraged in individuals as well as across the organisation. Procurement and food Every organisation should consider minimising wastage at the buying stage; work in partnership with suppliers to lower the carbon impact of all aspects of procurement; make decisions based on whole life cycle costs; and promote sustainable food through its business. Travel and transport Every organisation should routinely and systematically review the need for staff, patients and visitors to travel; consistently monitor business mileage; provide incentives for low carbon transport; and promote care closer to home; telemedicine, and home working opportunities Water Because water usage and heating has a direct impact on carbon, every organisation should ensure efficient use of water by measuring and monitoring its usage; by designing it into building developments; by quick operational responses to leaks; by using water efficient technology; and by avoiding the routine purchasing of bottled water Waste Every organisation should monitor, report and set targets on its management of domestic and clinical waste, including minimising the creation of waste, including minimising the creation of waste medicines,

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food and ICT and review its approach to single use items versus decontamination options. Designing the built environment Built environments should be designed to encourage sustainable development and low carbon usage in every aspect of their operation. This includes resilience to the effects of climate change, energy management strategies, and a broader approach to sustainability, including transport, service delivery and community engagement. Organisational and workforce development Every member of the NHS workforce should be encouraged and enabled to take action in their workplace. NHS organisations should support their staff by promoting increased awareness, conducting behavioural change programmes, encouraging home working, low carbon travel, the use of ICT and ensuring sustainable development is included in every job description. Partnerships and networks Every organisation should consolidate partnership working and make use of its leverage within local frameworks including Local Area Agreements, Local Strategic Partnerships and through Comprehensive Area Assessments. Governance Every NHS organisation should sign up to the Good Corporate Citizenship Assessment Model and produce a Board approved sustainable development management plan. Carbon reduction and sustainable development are corporate responsibilities and should be an inherent part of each organisation’s performance and governance mechanisms. Healthcare regulators will ensure that sustainability and the environmental impact of services are an integral part of quality standards. Finance Every organisation should become carbon literate, carbon numerate and ensure appropriate investment to meet the commitments required to become part of a low carbon NHS and in preparation for a carbon tax regime. Partnership working will be required to deliver appropriate incentives, economies and training to support this shift in culture and for the local economy. NHS Southwark current position 7. A position statement outlining the current work being undertaken in each area is set out as Appendix 1. While there has been progress in a number of areas, this has been not been through a co-ordinated and planned approach. In order to facilitate further progress on each area and develop a Sustainable Development Management Plan, it is proposed to establish a PCT working group to take forward the response to the NHS strategy. The proposed membership of the group is:

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Proposed member Director of Performance Robert Park, Non-Executive Director Chris Baker, Head of Premises Development

Area Governance Partnerships and networks Energy and carbon management Designing the built environment Water Project support

Southwark Provider Services representative Lyn Demeda, Head of Human Resources Finance representative

Food Waste Organisational & workforce development Travel & transport Finance Procurement

8. The Terms of Reference for the proposed working group are attached as Appendix 2.

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Appendix 1. Carbon Management in NHS Southwark – position statement May 2009 Energy and carbon management 1. Historic data on building energy consumption in the PCT’s estate is poor, with figures based on estimated bills, taken across inconsistent time periods and not including all PCT premises. Work is now on-going to determine actual energy use of PCT buildings to provide a reliable baseline for energy management. Gas, electricity and where applicable, water meters, are now measured monthly by FMS and information from bills is monitored and recorded by an energy consultancy company STC Energy. Further work is still required to ensure the figures are comprehensive as the data continues to exclude a number of premises where current and historic consumption information is not yet available (in particular, Mabel Goldwin House and the Woodmill Building) and thus understates full building energy consumption. 2. From October 2008, all public sector bodies are required to have Display Energy Certificates (DECs) for all buildings over 1000m2. On behalf of the PCT, FMS commissioned DECs for all operational PCT premises in this category (Artesian Health Centre, Lister Health Centre, Bowley Close Rehabilitation Centre, Sunshine House and Dulwich Community Hospital). The PCT is working with FMS to resolve a number of queries with the DECs. However, while the DECs help provide a baseline they cover only a number of PCT properties, with many being below the 1,000m2 limit. The analysis and information they contain is also limited in helping informing where best to target capital resources to improve energy efficiency. To provide more comprehensive and useful information across the whole estate, the PCT is has commissioned an organisation to carry out specific energy audits of the PCT estate in April / May 2009. 3. In terms of implementing capital works measures to improve the energy efficiency of the existing estate, the current approach is restricted by the competing pressures on the PCT’s limited capital resources. That having been said, the shift towards trying to use PCT capital in a more strategic way over the last few years has enabled some specific energy efficiency works to be incorporated into larger refurbishment works projects, for example, the additional insulation, boiler replacement and new windows to Bermondsey Health Centre in 2008/09. Further capital works will be informed by the energy audits. In the medium term, the potential additional capital resources available from the site sales of St Giles, Wilfred Sheldon and potentially St Olaves Nursing Home and Surrey Docks Health Centre, and improved information available from the audits, will facilitate a more strategic approach to improving the energy consumption of the residual estate. 4. In the short term, the major benefit to the PCT in terms of reduction in energy use is likely to come from the relocation of administrative support and headquarters staff to the new office accommodation at Tooley Street. The high performance of the new premises was one of the key criteria used in the selection of the building by the Council. Although the choice of cellular office accommodation at the front of the building has necessitated additional air conditioning, the building’s overall performance should significantly reduce existing consumption.

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5. In the longer term, despite the availability of some further capital resources, the age and poor condition of much of the PCT’s operational estate (Dulwich, Townley Rd, Consort Rd, Aylesbury HC etc) means that major reductions in energy usage will only be facilitated by investment in new LIFT or other third party buildings and the decommissioning of inefficient existing premises. In recent years, the PCT has made significant progress in this area with the development of new energy-efficient facilities such as Sunshine House and the Artesian Health Centre. This in turn has facilitated the closure of the energy inefficient buildings such as St Giles Hospital and the Wilfred Sheldon Centre. Similarly the investment in new boiler plant, rationalisation of services and associated demolition works to Dulwich Community Hospital undertaken as part of the Procure 21 project in 2005/06 have significantly reduced energy costs. Procurement and food 6. The PCT needs to review its approach to procurement of goods and non clinical services to assess the extent to which environmental considerations are taken into account. Most purchasing of goods is via the NHS Purchasing and Supplies Authority (PASA) but the extent to which ‘green’ factors are systematically considered within the options available is unknown. The PCT only makes very limited food purchases (Dulwich Intermediate Care Unit) and will have a very minimal impact on the PCT’s carbon footprint. Travel and transport 7. The PCT has limited information about how staff travel between home and work and between work locations, and how patients travel to and from health centres and other PCT sites. For staff, the need to provide care within people’s own homes and for staff to travel between sites means that the number of journeys is likely to be significant. The PCT will need to undertake work to review travel patterns of staff and patients to assess its impact in this area. 8. In terms of staff travel, a lease car scheme has been in operation since the inception of the PCT, administered across Lambeth, Lewisham and Southwark by FMS. There are currently 71 staff with lease cars and this number has been stable for a number of years. A recent review of the lease car scheme within Lewisham PCT recommended a reduction in the subsidy provided to staff dependent on the engine size of the vehicle with larger reductions being made for staff choosing cars with larger engines. There is currently no direct financial incentive within the lease car scheme for staff to opt for low emission vehicles. A review of the lease car scheme will be required to assess the potential for encouraging use of lower emission vehicles and whether the procedures for determining entitlement to a lease car are adequate. 9. In addition to lease cars, the PCT has 40 pool cars based at a number of sites. The NHS target for carbon emissions from vehicle use is 160 grams per kilometre. The average for PCT pool cars is well within this at 139 grams given the majority of vehicles are comparatively small pool cars. The PCT will need to asses whether, given the composition of its vehicle fleet, a more ambitious target should be set.

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10. FMS, on behalf of the PCTs has reviewed the potential for using electric and hybrid powered vehicles as an alternative to petrol or diesel for the pool car fleet. Unfortunately it is not currently possible to lease these vehicles through lease car companies with NHS PASA contracts and thus the PCTs would need to purchase vehicles (currently £15,000) or lease through a small number of more specialist lease companies. The estimated lease cost is £6,000 per year plus the cost of replacement batteries. Some grant funding has been available to support the cost of purchasing vehicles, but their minimal resale value and high capital cost mean that this is still considered an unaffordable option at present. Developments in technology are moving quickly in this area and it will be important to keep reviewing alternatives to the current pool fleet at regular intervals. 11. To encourage alternatives to car use the PCT has developed a pool bike scheme. However, this scheme has not been evaluated and it is unclear whether it is operating effectively. In June 2007 the PCT changed its travel expenses policy to increase the cycle allowance to 20p per mile (the limit above which tax is payable). From a survey undertaken of NHS Trusts in 2008 this is more generous than the majority, with most still paying the AfC minimum of 6.2p per mile. However, a small number of Trusts, who have made a positive decision to support cycling and shift away from car use, pay 40p or 50p per mile. 12. In the longer term, the PCT Asset Management Strategy will have implications for the number and type of journeys made. Reductions in the number of GP and other clinical sites may mean patients have further to travel to see a primary care clinician, although collocation and a wider availability of services may reduce the number of subsequent journeys required. Location of facilities will be critical – especially the 4 resource centre hubs – to ensure they are easily accessible on public transport, especially buses, and close to other amenities to potentially reduce the number of special trips made to health facilities. Currently sites are sort that have some access to car parking for operational although the amount of actual car parking required is very difficult to calculate and current practice is to seek wherever possible 20 car parking spaces for the hub sites. Water 13. Few PCT sites have separate water meters and significant work will need to be done to estimate water consumption and assess what practical measures can be put in place to monitor and review water consumption in the existing estate. The Tooley Street design incorporates water recycling of grey water and the PCT Design Statement also includes provision for rainwater harvesting and water recycling. Waste 14. It is unknown what information is recorded about waste volumes and further work needs to be done to assess current waste production. FMS have recently rolled out provision of recycling across all PCT sites. This includes paper, plastic, metal and glass. Support is needed to ensure staff make full use of this facility and increase the amount of waste recycled. 15. Particular issues apply to redundant furniture and IT. The move to Tooley Street and associated relocations will mean the PCT will have large amounts

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of redundant furniture and other office equipment. The PCT will need to work closely with the Council to ensure appropriate arrangements are in place to maximise the amount that can be recycled. Confidentiality issues need to be balanced with recycling regarding the use of IT equipment. While data protection requirements may not enable reuse of PCs and other computer hardware, scope for recycling of VDUs, printers, keyboards etc needs to be reviewed. Designing the built environment 16. The PCT is well placed to meet the energy performance requirements for new buildings. Detailed work was undertaken with the PCT’s design advisers, mechanical and electrical engineering consultants in developing a specification for future facilities as part of the PCT design statement and specification for Dulwich. This is based on applying whole-life costing principles to energy usage, facilitating capital investment in energy saving design where this can be demonstrated to result in a likely overall energy cost saving over the length of the lease. At the same time, the assessment tool for assessing the environmental impact of new schemes, NEAT, has been replaced by BREEAM Healthcare. This is a welcome step, with BREEAM requiring independent assessment rather than the self-assessed NEAT, hopefully making the process more robust and equitable. The PCT is working with the local authority to try to make achievement of BREEAM Healthcare ‘excellent’ rating a planning condition for all new buildings to ensure consistency between NHS and local authority requirements. Organisational and workforce development 17. While design and other measures bring the potential to make significant reductions in the PCT’s carbon footprint, these will only be significantly realised if there is a culture of energy efficiency among staff, with senior managers leading by example. The PCT has a well-developed home working policy and has developed a cycle scheme. The move to Tooley Street will also necessitate changes with the adoption of ‘greener’ paper-lite and desk share practices. The PCT needs to review what further work is required to bring about behavioural change in the workforce, especially among the operational workforce. Partnerships and networks 18. The local forum taking a strategic lead on carbon reduction is the Southwark Sustainable Environment Partnership (SSEP). This is led by the local authority but has representation from a range of private, public and voluntary sector organisations. Further work needs to be done through this forum to develop a Southwark-wide approach to carbon reduction and co-ordinate and plan actions. Governance 19. There is no clear formal reporting line to the PCT Board for managing and monitoring carbon issues. The PCT needs to establish a governance framework. A key issue will be calculating the PCT’s carbon footprint as there is no agreed methodology for establishing the baseline 2007 emissions figure against which performance is to be monitored. Further discussion will be

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needed with the Department of Health and guidance about how the PCT’s performance is to be monitored.

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Appendix 2 NHS Southwark - Carbon reduction working group Terms of reference Aim 1. To review and meet the requirements of Saving Carbon, Improving Health the NHS Carbon Reduction Strategy for England Objectives 2. To develop a Sustainable Development Management Plan for approval by the PCT Board. The Sustainable Development Management Plan will set out the implementation plan for meeting the PCT’s target for reducing 2007 carbon emissions by 10% by 2015 and cover the following areas:          Energy and carbon management Procurement and food Travel and transport Water Waste Designing the built environment Organisational and workforce development Partnership and networks Finance

3. To review the Good Corporate Citizenship Assessment model and establish a process for the PCT to sign up to the model. 4. To agree the methodology and calculate the 2007 baseline carbon emissions figure on which future PCT performance will be evaluated. 5. To establish the formal governance arrangements for ensuring the Board monitor, review and report on carbon management

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