Sustainability Plan Progress Update - January 2017

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1 Sustainability Plan Progress Update - January 2017 Item No 29/16 Meeting Title and Date Joint Crawley CCG and Horsham and Mid Sussex CCG Governing Body Meeting Paper Author Alison Hempstead, Head of Planning and Governance Lead Executive Geraldine Hoban, Accountable Officer Amit Bhargava-Clinical Accountable Officer Date paper completed Time required in 5 minutes meeting Paper summary For Information Associated papers Associated Committees How does this work link to the CCG Operating /Strategic plans? How does this work support the NHS Constitution/NHS Outcomes framework /KPIs Patient and Public Engagement to date Equality and Diversity Assessment Legal Implications Risk Register implications The CCGs recognise the importance of managing its environmental impact and energy consumption as efficiently as possible to ensure the best use of resources is prioritised for patient care. Indeed, through reduced carbon emissions, better staff awareness, better procurement practices and improved waste management, this plan complements those wider strategic objectives of the CCGs. Discussed at Senior Managers Team Meetings (SMT) The Sustainability Plan reinforces the CCGs strategic direction of travel and provides a framework for implementation of national standards and local priorities. This Plan outlines the requirement to sustain achievement of constitutional standards, and deliver sustainability. None specifically identified at present but sustainability will be part of consideration in all service design and engagement. None specifically identified at present. None specifically identified at present. There is an NHS commitment to cut carbon emissions. None specifically identified at present.

2 NHS Horsham and Mid Sussex CCG NHS Crawley CCG Sustainability Plan 2017 to 2019 Page 1

3 Foreword People may be wondering what the CCGs as commissioning organisations can do about climate change and sustainable development. At a time of many competing management and financial challenges why would the CCG be prioritising this area? The answer is simple; our starting point is improving patient care. It may not be immediately obvious, but carbon reduction runs through everything we do. It is about improving the patient experience in NHS estate, improving patient pathways to remove unnecessary steps, improving our resilience in the face of climate change and managing our cost base against a background of ever increasing energy prices. For us as commissioners, the carbon reduction itself is not the sole driver, it is what a change in approach and a philosophy of sustainable development can deliver for the benefit of patients. The Sustainable Development Strategy for the Health and Social Care System 2014 to gives a clear vision: 'A sustainable health and care system works within the available environmental and social resources protecting and improving health now and for future generations. This means working to reduce carbon emissions, minimising waste and pollution, making the best use of scarce resources, building resilience to a changing climate and nurturing community strengths and assets. As commissioners we understand the value of carbon reduction in the commissioning cycle and embedding it within clinical change remains valid and will be a legacy we can be proud to pass on. As is made clear in the Sustainable Development Unit publication A Route Map for Sustainable Development (Feb 2011), this is not limited to financial sustainability but must focus too on social and environmental sustainability so that the NHS of the future remains in the best possible position to improve quality and to limit its impact on the environment within which it works. This is reinforced by the requirements of the Social Value Act Geraldine Hoban Chief Officer NHS Horsham and Mid Sussex CCG Dr Amit Bhargava Clinical Chief Officer NHS Crawley CCG 1 Launched January 2014 and available here: Page 2

4 Introduction The needs of our Populations The local context to this Sustainable Development Management Plan (SDMP) is our role as commissioning organisations. We are a relatively small organisation of approximately 125 staff (including office holders and lay members but excluding CSU) but we spend on behalf of our population a health budget of approximately 408 million across the two clinical commissioning groups of Horsham and Mid Sussex CCG and Crawley CCG. Our Strategic Commissioning Plan, which is based on a Joint Strategic Needs Assessment, outlines how we will use those resources to improve the health of our population. The vision of our organisations are: Working together to deliver the best possible healthcare for the communities of Horsham and Mid Sussex. Horsham and Mid Sussex CCG Working together to deliver health and well being for you and your community - Crawley CCG The CCGs recognise the importance of managing its environmental impact and energy consumption as efficiently as possible to ensure the best use of resources is prioritised for patient care. Indeed, through reduced carbon emissions, better staff awareness, better procurement practices and improved waste management, this plan complements those wider strategic objectives of the CCGs. The Sustainable Development Unit Module on Commissioning and procurement makes clear that Commissioners across social care, public health and in the NHS have the power and responsibility to seek maximum economic, environmental and social value in the commissioning of services. The increasingly diverse range of providers of health and social care makes this more critical than ever. What is Sustainable Development? Sustainable development is about meeting the needs of today without compromising the needs of tomorrow. In the health and care system, this means working within the available resources to protect and improve health now and for future generations. In practice this requires us to: Focus on preventative, proactive care; Involve patients in the planning and design of services; Build resilience whilst protecting and developing community assets and strengths; Make the best use of scarce resources; Improve efficiency and reduce waste; Minimise carbon emissions. The case for sustainability in healthcare is clear. There is sound evidence that taking action to become more sustainable can lead to cost reductions and immediate health gains. It helps us to develop a health system that is sustainable by reducing inappropriate demand, reducing waste and incentivising more effective use of services and products. Key drivers for sustainable development in the NHS include: Developing sustainable models of care There are an increasing number of older people with multiple health problems, the cost of new medical technology is rising and people have higher expectations around clinical outcomes and user experience. However, the NHS budget is not rising in line with increasing costs. By delivering healthcare in a more sustainable way, for Page 3

5 example using integrated models of care, promoting prevention and supporting people to stay in their own homes as long as possible, we can reduce emergency admissions and ensure that our resources are focused on delivering the best possible health outcomes. Reducing carbon dioxide emissions is the law in the UK. The Climate Change Act 2008 sets legally binding targets for the UK to reduce its carbon dioxide (CO2) emissions by 80 per cent by All public sector organisations in the UK have a responsibility to put in place plans to meet this target. There is a strong business case for taking action to become more sustainable as this can lead to significant financial savings. The NHS must help to mitigate the negative impact of Climate Change on health. A further aspect of sustainable development is the need to be aware of the impact of climate change and plan for adaptation and resilience. Climate change impacts on lives and human health through extreme periods of heat and cold, storms and deteriorating air quality. As one of the world's largest organisations the NHS has a national and international duty to act and to set an important example to the business community and to the public. In 2009 the NHS Sustainable Development Unit published the first Carbon Reduction Strategy for the NHS. This showed that the NHS has a carbon footprint of 21 million tonnes CO2, making it the largest public sector emitter of Greenhouse Gases in the country. Around 60 per cent of the total footprint is from the procurement of goods and services, with the rest split between energy consumption in NHS buildings and travel. The challenge facing the NHS is to reduce its emissions in line with the Climate Change Act target of an 80 per cent by What can the CCG do? Our Low Carbon Vision We have developed a vision that reflects the evolving priorities of the NHS and promotes a culture of carbon management for healthcare in our area: Our vision is to maximise carbon reduction through our actions as a commissioning organisation and as a system leader The CCGs can support sustainable development in the local Health economy in three ways: Sustainable Commissioning - Using our Commissioning function to influence and shape the activities of our providers. Understanding the value of carbon reduction in improving patient pathways, improving system resilience in natural disasters and using the contracting function to support change. Optimise Existing Systems and being a sustainable organisation - Carbon Reduction within NHS Estate including physical improvements to building services and infrastructure and working in partnership with property services. This includes delivering our service plan objectives while achieving estates rationalisation. Page 4

6 Changing Behaviours and stakeholder involvement - Reducing carbon emissions from our own direct activities and behaviour change in our staff. Adopting policies and action plans as a CCG that enhance the environmental and social sustainability of the organisation. Where appropriate, promoting sustainability amongst our GP members promoting and supporting action on sustainable development across our member Practices These three areas are explored further in the following sections. 2. Sustainable Commissioning Direct procurement of products is a relatively very small part of a CCG s activities and our ability to calculate our own carbon footprint is limited (see box). It is as a commissioner of health services that the greatest shift of understanding will be required to truly embed carbon management and sustainability principles. As an organisation that annually administers more than 400m public funds we need to make sure we are taking a sustainable approach. We also need to use our commissioning and contracting processes to embed principles of sustainability into our provider organisations, ie: Planning pathways of care which promote preventative, proactive and self care. Co-designing pathways of care and agreeing outcome measures with patients and the public. Ensuring all pathways of care integrate physical and mental health. Ensuring services are efficient, i.e. avoid duplication and waste (within and across agencies). Ensuring services are effective and based on sound evidence. Using the mechanism of procurement to ensure service provision adds social value. Awarding contracts for services which provide the highest quality care at best value. Awarding contracts for services which have the least impact on the environment. Using contract monitoring mechanisms for ensuring providers of services continue to meet these standards. Decommissioning services that do not meet these criteria. The 2012 health reforms and subsequent developments such as the Better Care Fund means that there are opportunities for joint working and for embedding sustainability principles within health improvement. The NHS Strategy notes that: Health and Wellbeing Boards are well placed to take a leadership role in developing a strong and inspiring local vision for sustainability. They have a responsibility to act in the interests of local people to improve health and wellbeing, local accountability, membership from across the health and care system and the ability to align and reinforce activity. They can integrate issues that are core to this agenda including the redirection of existing services to address issues such as the causes of ill-health, life styles, service infrastructure, models of care, health protection and resilience. The current health and wellbeing strategy has clearly embraced this through the adoption of its priority of Wellbeing and resilience. Actions we will take: Page 5

7 The CCG has a medicines management optimisation plan which aims to optimise medicines use in the community. A key part of the plan will include reduction of pharmaceutical waste. The main focus of the CCG s commissioning plans are on delivering local communities of practice around local populations usually of around 30,000 to 50,000 registered patients in size. By commissioning services that provide care closer to patients homes, this will help to reduce carbon emissions by reducing the distance that patients need to travel to appointments. As commissioners of services, the CCGs have already adopted a procurement strategy that includes a Strategic objective of: To ensure the CCG purchases health and social care in a way that supports the UK sustainable development agenda and contributes to environmental improvements, regeneration and reducing health inequalities And embedded within the procurement policy: Ensuring Sustainability and Social Value 5.33 The CCG will use its procurement activities to build sustainable supply chains and procurement routes, and to take account of the impact of the CCG activity on the environment. The Public Services (Social Value) Act 2012 places a duty when procuring services to consider how what is proposed to be procured might improve the economic, social and environmental well-being of the relevant area and how in conducting the process of procurement, it might act with a view to securing that improvement. On an annual basis, the CCG will reflect in its annual report on the impact of its procurement, and on the extent to which it has used its purchasing capacity to implement change. In terms of implementing this, the CCG has amended its tendering processes to ensure that there is an assessment of health service providers sustainability strategy within the tender documentation (see box below). This ensures that there is an active assessment of carbon reduction as part of the procurement process Current AQP tender documentation includes the following clauses: Sustainability The new Service will be required to show how it will deliver a sustainable service. The Good Corporate Citizenship is a NHS tool to help the Service on how it can contribute to a sustainable development.. There are 5 principles which need to be taken into account: Living within environmental limits; Ensuring a strong, healthy and just society; Achieving a sustainable economy; Using sound science responsibly; Promoting good governance. The Service must: Have a Board-approved sustainable development management plan; Be signed up to the Good Corporate Citizenship Assessment Model; Page 6

8 Have in place measure monitors and try to reduce carbon where possible in the organisation; Be an organisation which has an awareness of sustainability at every level of the organisation and works to change the behaviour of all employees to improve sustainability; Have a Nominated Sustainable Development Champion; The new Service will be required to show how it will deliver a sustainable service. Social Value The Public Services (Social Value) Act 2012 requires commissioners of public services to consider how their commissioned services might improve the economic, social and environmental wellbeing of the relevant area; and how in conducting the process of procurement, they might act with a view to securing that improvement. Social value describes the wider social benefits achieved from high quality public services. It aims to generate wider benefits from investment in health services. It promotes the wellbeing, health inclusion and employment of local people and communities. Adopting an approach based on social value principles requires a change to the traditional mind-set of the care system from one which sees communities and people having needs, to one which understands and empowers them as having assets that contribute to our health and wellbeing. Social value benefits could for example include improved community resilience, increased training and education opportunities or reduction in demand for public services. There have been practical steps in promoting the sustainability agenda but the CCG has made less progress in proactively monitoring or reporting on our providers progress. To develop our next steps the CCG will take the following actions: For all main providers we will ask that they report on performance against their Sustainable Development Management Plans (SDMPs) as part of quality monitoring. Linked to this will need to be the active monitoring of provider s compliance with, and achievement against their carbon management as part of contract monitoring. When we monitor the performance of providers via contracts we include measures of sustainability as determined via the procurement processes. 3. Optimise existing systems and being a sustainable organisation As an organisation that employs approximately 125 people, as well as our hosted CSU staff, based in Crawley we have a responsibility to behave in an ethical and sustainable way, this includes: Raising awareness amongst our Governing Body and staff around sustainability issues. Making sure the working environment promotes health and well-being. Paying our employees an appropriate amount in this case signing up to the city s Living Wage. Optimising our impact in our areas (Crawley, Horsham and Mid Sussex) by forging strong and enduring partnerships with other agencies and taking an active role in our neighbourhoods. Page 7

9 Ensuring we are resilient and able to adequately respond to adverse events and serious incidents. Building a workforce for the coming years by promoting opportunities for General Practice to engage with clinical commissioning, provide opportunities for graduate trainee placements, apprenticeships, GP Registrar placements etc. Ensuring the CCG business processes are improved so as to continually reduce our carbon emissions (see below for details). Consideration of adoption of the Good Corporate Citizen Standards. Page 8

10 The CCG s carbon emissions The CCG is a tenant occupying office space on the lower ground floor of Crawley Hospital spread across one main office and two smaller offices. Crawley Hospital is a 1960s build with a current Display Energy Certificate (DEC) rating of F (where the scale is A to G). In 2011, when the predecessor organisation, NHS West Sussex, was the landlord of the estate the building was rated as follows for the site schedule of stationary emissions for baseline year. Crawley Hospital Postcode Gross internal energy consumption (kwh) Site emissions tn CO2 Area (m2) Gas Elec Oil RH11 7DH 32,347 11,011,613 4,080,667-4,234 As an individual tenant in a multi-occupancy site the CCG s individual carbon footprint (from energy consumed in its offices) cannot be calculated. There is no individual metering or allocation of fuels costs to the CCG s activities. When the CCG moved from the third floor hospital accommodation into the current offices, motion activated lighting was introduced as an energy saving in the refurbished offices: Further opportunities for the CCG to reduce its carbon footprint are outlined below (not all of which will be directly measurable): 1. Encouraging energy conservation behaviour amongst its staff. For example, turning off equipment when not in use; 2. Considering energy efficiency and space requirements if planning a move to new accommodation. For example, ensuring space is utilised efficiently ( right sizing ) and promoting agile working and hot-desking and by using Display. Energy Certificates and /or Energy Performance Certificates (EPCs) to stipulate minimum energy efficiency expectations for new premises (i.e. a DEC or EPC rating of C or above).nb: no move is currently planned. 3. Reducing waste and consumables The CCG produces small volumes of general waste (i.e. office and kitchen waste), most of which is recycled via a mixed recycling system provided to the CCG and other tenants in the building through its facilities services contract. However, the CCG consumes a significant volume of paper in carrying out its work. In 2014/15 we used 5175 reams which is over 280 trees and 15.6 tonnes of CO2. Our forecast out-turn for 2015/16 (as at Dec 2015) is 4050 reams which would represent a decrease of approximately 20% if achieved. However the CCG still uses a considerable amount of paper and more needs to be done. The CCG can take action on this issue in two ways: By implementing paperless working practices (see below) and other paper reduction initiatives (e.g. defaulting all print devices to duplex printing); By specifying high recycled content (or even 100 per cent recycled) paper The CCG has already taken a number of actions to reduce paper consumption including a system of proactive printing release rather than automatic generation. The CCG will commit to measuring, and exploring addition means to reduce paper consumption annually and increasing the percentage of recycled paper product it consumes. 4. Promoting green, low-carbon travel The CCG s office is situated within reasonable walking distance of Crawley mainline train station and has limited parking facilities on site. We encourage staff to walk, cycle or use public transport and wherever possible teleconferencing and videoconferencing will be used to minimise travel to meetings. Cycle storage and showering facilities are available for staff use. 5. Paperless and Paper-lite. The CCG has rolling IT upgrade programme, and the majority of desk top computers have been replaced with laptop devices. This will support a move towards greater agile and flexible working practices as well as paperless or paper-lite working. Page 9

11 Actions we will take: i. We will provide training on our sustainable commissioning strategy and processes for all staff and incorporate information and advice about sustainability and the responsibilities of staff into the staff handbook and appraisal process. ii. CCG to sign up to Living Wage. iii. CCG to update Business Continuity Plan and lead on improvements to system wide escalation processes. iv. Extend opportunities for GP training and development and placements for GP Registrars, City College Apprenticeships, MTS Graduates and others. v. Reduce the carbon footprint of the CCG in line with NHS targets and, in particular, reduce the amount of paper we consume by a further 15 per cent over the coming three years through the role-out of our Agile Working Policy and adoption of high recycled content paper in our facilities contract. vi. Reduce colour printing usage vii. Engage with staff patients and the public to promote sustainable health economies. 4. Changing Behaviours and stakeholder involvement - Adopting policies and action plans as a CCG that enhance the environmental and social sustainability of the organisation and our local environment. Now that GPs have responsibility for commissioning healthcare services it is vital that practices develop carbon management skills and awareness in order to improve efficiency and reduce carbon emissions in the future. Many carbon saving initiatives also have a positive impact on the health and wellbeing of staff and local residents. The third and final dimension of this plan therefore focuses on promoting and supporting sustainability within the local environment and the CCG s member practices in Crawley, Horsham and Mid Sussex. The CCG can also have an important role to play in working with our local authority partners and through the local health and wellbeing hubs to strengthen local communities. The local area is fortunate to enjoy surrounding areas of green space and urban park space and the CCG can encourage the use of the natural environment to promote health and particularly mental health, obesity prevention and low carbon nutrition. Actions we will take Specific actions we will take are: Promoting one-stop clinics and phone consultations; Encouraging and supporting practices to promote active travel (using physical activity such as walking and cycling rather than driving) amongst practice staff and patients; Linking up and promoting council based initiatives in partnership with the relevant local authority on home insulation to support vulnerable patients, access to green space and flood and heatwave resilience; Linking up and supporting council based initiatives through the health and well-being hubs, such as promoting health walks, dementia friendly towns and use of allotments; Working with practices to roll out electronic prescribing to reduce paper use; Supporting action to reduce unnecessary prescribing and reduce pharmaceuticals; Page 10

12 Supporting action to reduce packaging, for example coil fitting sets; Reporting progress with sustainability across GP members to the CCG Governing Body.; and Incorporating a sustainability section in the Primary Care Strategy. 5. Delivering our commitments The responsibility for scrutinising how the drive for sustainability is working will be embedded within the CCG s core business processes, practices and revised constitution. The CCG will provide an annual report on progress against our Sustainability Plan which will be brought to the Governing Body by the Chief Operating Officer. Page 11

13 CCG Action Plan Area Actions Lead Target Date Sustainable Commissioning Appoint a Sustainability Lead for each CCG Appointed Geraldine Hoban, HMS Amit Bhargava, Completed Sustainable Commissioning Sustainable Commissioning Optimise Existing Systems and being a sustainable organisation Changing Behaviours and stakeholder involvement For all providers we will ask that they report on performance against their Sustainable Development Management Plans (SDMS) as part of quality monitoring process. When we monitor the performance of providers via contracts we include measures of sustainability as determined via the procurement processes. We will provide training on our sustainable commissioning strategy and processes for all staff and incorporate information and advice about sustainability and the responsibilities of staff into the staff handbook and appraisal process. CCG to sign up to Living Wage. To be confirmed with remcom. CCG to update Business Continuity Plan and lead on improvements to system wide escalation processes. Extend opportunities for GP training and development and placements for GP Registrars, Apprenticeships, MTS Graduates and others. Reduce the carbon footprint of the CCG in line with NHS targets and, in particular, measuring, and exploring addition means to reduce paper consumption annually and increasing the percentage of recycled paper product it consumes, through developing our paperless and paper-lite working practices. Providing our GP members with a simple carbon footprinting tool and encourage them to calculate a carbon baseline from which to plan emissions reductions. Producing a code of practice or charter for sustainable development in GP practices along with structured support and advice about energy efficiency and Crawley Julia Layzell CSU?? Alison Hempstead HR Recruiting managers Alison Hempstead????? Page 12

14 Delivering our Commitments carbon reduction actions and renewable energy opportunities. Linking up and promoting council based initiatives in partnership with the relevant local authority on home insulation to support vulnerable patients access to green space and flood and heatwave resilience. Linking up and supporting council based initiatives through the health and wellbeing hubs, such as promoting health walks, dementia friendly towns and use of allotments; Working with practices to roll out electronic prescribing to reduce paper use. Supporting action to reduce unnecessary prescribing and reduce pharmaceuticals (pharmaceutical waste). Supporting action to reduce packaging, for example coil fitting sets. Promoting one-stop clinics and phone consultations. Encouraging and supporting practices to promote active travel (using physical activity such as walking and cycling rather than driving) amongst practice staff and patients. Reporting progress with sustainability across GP members to the CCG Governing Body. Incorporating a sustainability section in the Primary Care Strategy. Annual update on progress to be produced for Governing Body Amit Bhargava/ Minesh Patel Amit Bhargava/ Minesh Patel Jay Voralia Jay Voralia Jay Voralia All programmes Clare Allcock Clare Allcock Clare Allcock Rachel Harrington/ David King Page 13