This virtual conference examined the impact Covid19 will have on sustainability within the NHS and wider healthcare field. We explored the solutions already being adopted by the NHS to combat carbon emissions whilst addressing how the ramifications of Coronavirus may impact sustainable methods. The conference provided the opportunity for NHS Trusts to discuss their concerns, ideas and plans around embedding sustainable development with fellow peers. Topics that were discussed on the day included: How will Procurement be impacted by the virus? Will Infection Prevention Control stop carbon reduction initiatives? How important will sustainable transport be in a Covid19 society? How do you maintain environmental behaviours whilst dealing with Covid19? How will the virus impact spending in the NHS?

1. Welcome to - NHS
Sustainability and the
Impact of Covid19
Virtual Conference
@dayforaction #sustainability

2. Morning Session
10.40 What can we learn about Procurement from Covid-19 PPE
experience?
Speaker: Neil Hind, GM NHS Procurement Director & Stephen
Pickard, Category Manager, NHS Wales Shared Services Partnership
10.55 Can Reuse support NHS budgets when financial impact hits?
Speakers: Paul Broadberry, Country Manager UK, Vanguard Medical
Devices & Daniel O Connor, CEO, Warp-It
11.10 The important role of sustainable transport for social
distancing
Speaker: Will Blair, Sustainability Manager, The Christie NHS
Foundation Trust
11.25 Can recycling survive against Coronovirus?
Speaker: Oli Slaughter, Sustainability Officer, Care Without Carbon,
Sussex Community NHS Foundation Trust
11.40 How do we keep up with clinical waste demands?
Speaker: Fiona Daly, Sustainability and EFM Workforce Lead, NHS
England
12.00 Total Waste Management - Improving Waste Practices,
Deliver Cost Savings and Protect the Environment
Speaker: Ben Williams, Waste Contract Manager, Kings College
Hospital Foundation Trust

3. Afternoon Session
12.20 Supporting the NHS carbon journey
Speaker: Andrew Smith, Lead Research Environment and
Sustainability, Crown Commercial Service
12.40 Reacting to the new world of water in 2020
Speaker: Nigel Codman Director, Novaloo Ltd
13:00 Decarbonising the NHS through the use of renewable fuels
Speaker: Colin Duke, Head of Sales, Argent Energy
13.20 Are clinicians the new sustainable champions?
Speaker: Frank Swinton, Climate Change Lead & Anaesthetic
Consultant, West Yorkshire and Harrogate Health and Care Partnership
13.45 elemental Healthcare
Speaker: Geoff Miller, Regional Sales Manager, North, elemental
Healthcare
14:00 Panel session & Q&A- How do we sustain this carbon-free
culture for the future?
14.15 Conference close

4. 2020
IMPACT
REPORT
What is it all about Scott?

5. 38 CASE
STUDIES

6. 2020 AWARD
WINNERS &
HIGHLY
COMMENDED

7. DETAILED CASE STUDIES
INCLUDING HOW, WHY AND WHAT
NEXT?

8. DOWNLOAD FROM
JULY 6TH, COPIES
FOR TODAY’S
ATTENDEES CAN
BE ACCESSED VIA
THE HANDOUTS
THANKS TO
SHARPSMART FOR
SPONSORING

9. PROCUREMENT & COVID-19:
WHAT CAN WE LEARN?
Neil Hind: GM Procurement Programme Director

10. Greater Manchester Health
and Social Care Partnership
THE STORY PRE COVID-19
▪ GMHSCP Sustainable Development Leadership Group created April 2019
▪ Aug 2019 GMHSCP Declared a Climate Emergency covering all areas of GM NHS
▪ Sept 2019 joint GM and NHS England working confirmed with air quality focus
▪ Sector support for 5-Year Environment Plan For Greater Manchester (19 – 24)
▪ Sustainability Lead and SRO identified for each GM NHS Organisation with regular
meetings
▪ A member of the “Nordic Centre for Sustainable Healthcare”
▪ Speciality groups created to look at waste, fleet, estates, energy, logistics, theatre
gases, inhalers and clinical procurement.
▪ All GM NHS Organisations were aiming to have a Sustainable Development
Management Plan (SDMP) by April 2020
COLLABORATIVE
PROCUREMENT

11. Greater Manchester Health
and Social Care Partnership
WHAT DID WE LEARN?
COLLABORATIVE
PROCUREMENT
▪ Fragile supply chain
▪ Heavily reliance on far east manufacturers
▪ Unprecedented increase in demand – over 4000% in some cases
▪ Trusts used to regular “Just In Time” ordering process
▪ Logistics & storage quickly became an issue for some
▪ New areas/users needed PPE – and lots of it
▪ Programme/change work (rightly) suspended
▪ Data is key – what stocks do we have & where
▪ Majority of PPE is single use
▪ Massive benefits in regional working!

12. Greater Manchester Health
and Social Care Partnership
WHAT CAN WE DO DIFFERENTLY?
COLLABORATIVE
PROCUREMENT
▪ Look to invest in more re-usable PPE
o Masks, gowns, visors etc
▪ Need to invest in UK manufactures – but need to look at raw
materials too
▪ Localised logistics & storage is needed
▪ Further investment needed in inventory management & MI
o Time for Scan 4 Safety (again?)
▪ Take the opportunity to build in social value, carbon, climate
requirements and concerns into new tenders & requirements!

13. Greater Manchester Health
and Social Care Partnership
Contact us
If you have any queries about these slides please contact
gmhscp.theme.4@nhs.net.
www.gmhsc.org.uk
@GM_HSC
COLLABORATIVE
PROCUREMENT

14. NHS Sustainability Day
Virtual Conference
2nd July 2020
What can we learn about Procurement
from the COVID-19 PPE experience?
Stephen Pickard
Category Manager, NHS Wales Shared Services Partnership
Acting Chair, NWSSP Sustainability Group

15. NHS Wales Shared Services Partnership (NWSSP) provide
dedicated shared services support for all NHS Health
Boards and Trusts in Wales.
NWSSP's Sustainability Group works across functions
such as Procurement Services, Corporate Services and
Estates; to lead the way in making NHS Wales
economically, socially, and environmentally sustainable.
About NWSSP – Procurement Services & Sustainability Group

16. Sustainability Defined
Figure 2: As per e.g. Elkington (1998) and Carter & Rogers (2008).
Carter, C.R. and Rogers, D.S. (2008) A framework of sustainablesupplychain management: moving toward new theory. International Journal of PhysicalDistribution& Logistics Management, 38(5),
pp.360-387.
Elkington,J. (1998) Accountingfor the triple bottomline. Measuring BusinessExcellence, 2(3), pp.18-22.
Merriam-Webster (no date) Sustainable [Online]. Available at: https://www.merriam-webster.com/dictionary/sustainable (Last accessed: 01/07/2020).
Montabon, F., Pagell,M. and Wu, Z. (2016) Making sustainability sustainable. Journalof Supply Chain Management, 52(2), pp.11-27.
Figure 1: As per Merriam-Webster (no date).
Figure 3: As per Montabon,
Pagell & Wu (2016).

17. Sustainability Focus Areas & Themes for NWSSP
Energy
Waste
Transport
Emissions Natural
Resources
Business Ethics
& CSR
Ethical Employment &
Modern Slavery
Health &
Wellbeing
Wales & The
Welsh Language
Community
Benefits
Circular
Economy
SMEs, Third Sector &
The Foundational
Economy

18. NWSSP Sustainable Procurement Code of Practice - Objectives
• The Well-being of Future Generations (Wales) Act
2015
• Sustainability for Patients & Service Users
• Sustainability for NHS Wales

19. Procurement is strategically
important.
What can we learn about Procurement from the COVID-19 experience?

20. Procurement can be flexible.
What can we learn about Procurement from the COVID-19 experience?

21. There are opportunities within
our supply chains.
What can we learn about Procurement from the COVID-19 experience?

22. We can make our supply chains more
risk resilient.
What can we learn about Procurement from the COVID-19 experience?

23. We can make our supply chains more
sustainable.
What can we learn about Procurement from the COVID-19 experience?

24. We can learn about Procurement from the COVID-19 experience?
In Summary:
Procurement is strategically important.
Procurement can be flexible.
There are opportunities within our supply chains.
We can make our supply chains more risk resilient.
We can make our supply chains more sustainable.
Thank you,
Stephen Pickard (Stephen.Pickard@wales.nhs.uk)

25. | 25
THE LEADING EUROPEAN REMANUFACTURER OF
MEDICAL DEVICES
Paul Broadberry

26. | 26
Objective
❖ To offer an option for reducing single use plastics in theatre and the
cath lab via remanufacturing.
❖ To talk through what remanufacturing actually is.
❖ To think about when to introduce remanufacturing into your hospitals
sustainability/savings workplan? How about now!
❖ As an example… Leeds General Infirmary Cath Labs diverted 36.8 kg of
single use plastic devices, earned £5,000+ and saved 50% on some line
items expenditure last quarter.
cost saving
safety and
quality
sustainability

27. | 27
What is Remanufacturing?

28. | 28
What is Remanufacturing?
❖ Quality assured.
❖ Savings.
❖ Reducing healthcare’s environmental footprint.
❖ Reduced waste to landfill and incineration
❖ Reduced demand for raw materials
❖ Reduce CO2
cost saving
safety and
quality
sustainability

29. | 29
❖ Commonplace in the EU, US, Canada, Israel, Japan.
❖ Over 20 years of world wide experience.
❖ Fully regulated.
❖ Vanguard is the leading EU provider.
❖ 800 customers in Germany.
❖ 28 University hospitals.
❖ All main GPOs purchase Vanguard devices.
❖ MHRA guidelines 2016.
❖ 25 UK hospitals on-board.
Remanufacturing Overview
cost saving
safety and
quality
sustainability

30. | 30
The network of AMDR medical device remanufacturers provides a platform to
promote the highest standards in remanufacturing.
While reprocessors
saved their hospital and
surgical center partners
$20 million in 1999, the number
grew to $471 million by 2018 —
more than doubling savings
every year for 20 years. In
2018, over 8,000 hospitals and
surgical centers in the United
States, Canada and Europe
partnered with commercial
reprocessors.
dollars saved in 2018 by hospitals and surgical
centers in the United States, Canada and Europe,
thanks to AMDR-member reprocessors.
percent of reprocessed devices are inspected
and/or function tested. Reprocessors spend
millions of dollars to meet or exceed FDA and
European medical device manufacturer
requirements.
Remanufacturing Overview - AMDR

31. | 31
❖ Initially reverse engineered.
❖ Full product identification and traceability.
❖ Thorough cleaning and decontamination.
❖ Material and performance testing.
❖ Electrical integrity testing.
❖ Packaging and sterilsation as per industry standards.
Innovative Proprietary Process
cost saving
safety and
quality
sustainability

32. | 32
End to End Volumetric Monitoring
Our patent protected cleaning and disinfection machines
have automated monitoring of the processing media flowing
through the lumen for each individual medical device and in
each process step of the cleaning and disinfection process
Microbiological testing
procedure with the reference OPA method
according to EN 15883 implemented as
standard practice to ensure and document
the effectiveness of the cleaning
procedure
Standardised testing of each device
for integrity and function: ensures device is
fully functional and meets specifications
Innovative Proprietary Process

33. | 33
❖ “Single use” applied by OEMs.
❖ Supported by key regulatory bodies.
❖ EN ISO 13485 EU MDD 93/42/EWG compliant.
Regulatory
cost saving
safety and
quality
sustainability

34. | 34
❖ Clinical efficacy.
Regulatory
cost saving
safety and
quality
sustainability

35. | 35
Diagnostic Catheters
Fixed Curve, Loop, Steerable
Ablation Catheters
Non irrigated, Irrigated
3D Mapping Catheters
Loop Diagnostic, Irrigated SF
Surgical and Orthopaedic
Instruments
Endoscopic and
Further Medical Devices
Biosense Webster, Boston Scientific, Abbott, Biotronik
Webster, Lasso 2515, Dynamic XT/ EP-XT, Viking, Inquiry,
Inquiry Optima/AFocus, Multicath, AcuNAV
Biosense Webster, Boston Scientific, Abbott, Medtronic
Celsius, Navistar, Celsius/EZ-Steer Thermoccol, Thermocool,
Blazer, Intella TIP/NAV, Therapy, Arctic Front
Biosense Webster, Boston Scientific, Abbott
Lasso 2515 NAV, Navistar, Thermocool Smarttouch,
FlexAbility, Advisor SE, IntellaNAV, SoundStar eco
Ethicon, Medtronic, Smith & Nephew, DePuy Synthes
Harmonic ACE+/+7, HD1000i, Sonicision, VAPR Electrodes,
Arhtro Wand Electrodes
Carl Storz, Richard Wolff, Olympus, Abbott
COBRA, OES Viber, Transseptal Needle BRK/BRK-1,
Agilis Introducer
Not all listed products are available as CE products.
Portfolio

36. | 36
■ Diagnostic Catheter: Webster, Dynamic XT, EP-XT, Inquiry, Inquiry
SoftTip/ AFocus, Optima, Lasso 2515, Viking, Webster CS, AcuNAV
■ Ablation Catheter: Celsius, Celsius DS, Celsius/EZ-Steer
Thermocool, Thermocool SF, AlCath, Artic Front, Flexability
■ 3D Mapping Catheter: Navistar Thermocool, Thermocool SF NAV,
Lasso NAV eco, Navistar, Flexability SE, Thermocool Smarttouch,
SoundStar eco
■ Surgical Products: Harmonic ACE+/+7
■ Further Products: Transeptal needle BRK, Cables
Expected availability from mid 2020
80
43
44
4
Current number of CE products
Diagnostic Catheter
Ablation Catheter
3D Mapping Catheter
Surgical Products
147
71
82
4
20
Number of CE products mid 2020
Diagnostic Catheter
Ablation Catheter
3D Mapping Catheter
Surgical Products
Further Products
171
324
Portfolio

37. | 37
Headline figures from DH research on cost savings from
remanufacturing for selected cardiology devices:
Over £30mn saving p.a. for NHS England
❖ £8.8mn p.a. – from Class II and III devices
❖ £1.7mn p.a. – from OEM price deflation
❖ £10.8mn p.a. – from Class 1 devices
❖ £9.4mn p.a. – with use of SUDs harvested from other CE
countries
❖ £1mn p.a. – avoided waste disposal costs
This is just phase 1. The savings grow significantly as our portfolio of
available CE products expands.
❖ EP catheter lines are due to expand 2x in May 2020.
❖ Tower 2 has already identified £4m savings p.a. via using
remanufactured devices (available now) within the surgical
direct energy market.
Savings Analysis UK

38. | 38
Savings Analysis
❖ Up to 50% savings per line item!
❖ Plus OEM price reduction.
❖ Plus waste reductions savings.
cost saving
safety and
quality
sustainability
OEM Product Code
Annual
Volume
OEM Price
Total OEM
Expenditure
Volume to
VG
New OEM
Expenditure
VG Price VG Expenditure
New Overall
Expenditure
Saving
36N57R 42 410.00£ 17,220.00£ 50% 8,610.00£ 170.20£ 3,574.20£ 12,184.20£ 5,035.80£
M0042011010 80 204.00£ 16,320.00£ 50% 8,160.00£ 115.00£ 4,600.00£ 12,760.00£ 3,560.00£
M0042011030 101 181.00£ 18,281.00£ 50% 9,140.50£ 78.20£ 3,949.10£ 13,089.60£ 5,191.40£
35Q53R 97 734.00£ 71,198.00£ 50% 35,599.00£ 257.60£ 12,493.60£ 48,092.60£ 23,105.40£
D134301 162 706.00£ 114,372.00£ 50% 57,186.00£ 368.00£ 29,808.00£ 86,994.00£ 27,378.00£
D133601 60 1,345.00£ 80,700.00£ 50% 40,350.00£ 694.60£ 20,838.00£ 61,188.00£ 19,512.00£
D133602 299 1,345.00£ 402,155.00£ 50% 201,077.50£ 694.60£ 103,842.70£ 304,920.20£ 97,234.80£
D132705 48 1,345.00£ 64,560.00£ 50% 32,280.00£ 694.60£ 16,670.40£ 48,950.40£ 15,609.60£
D134701 15 1,345.00£ 20,175.00£ 50% 10,087.50£ 542.80£ 4,071.00£ 14,158.50£ 6,016.50£
D134702 83 1,345.00£ 111,635.00£ 50% 55,817.50£ 694.60£ 28,825.90£ 84,643.40£ 26,991.60£
D134805 56 1,345.00£ 75,320.00£ 50% 37,660.00£ 694.60£ 19,448.80£ 57,108.80£ 18,211.20£
34A-35M 54 720.00£ 38,880.00£ 50% 19,440.00£ 492.20£ 13,289.40£ 32,729.40£ 6,150.60£
M004 400035 0 578 186.00£ 107,508.00£ 50% 53,754.00£ 115.00£ 33,235.00£ 86,989.00£ 20,519.00£
900,933.00£ 450,466.50£ 240,221.20£ 690,687.70£ 274,515.90£

39. | 39
Collections
❖ Establish account.
❖ Collection materials supplied.
❖ Training.
❖ Ongoing support.
❖ Quarterly payments.
❖ Waste reduction gains.
cost saving
safety and
quality
sustainability

40. | 40
❖ 25 locations.
❖ 595.4 kg in Q1 or 2.38 tonnes projected for 2020 of single use devices diverted.
❖ £57,262 in Q1 or £229,048 projected for 2020 paid for collected devices.
❖ 50% cost down on remanufactured line items used in Trusts.
Working Examples
❖ 36.8 kg
❖ £5,000+
❖ 40.0 kg
❖ £4,000+

41. | 41
Remanufacturing in your hospital
❖ Quality assured.
❖ Savings.
❖ Reducing healthcare’s environmental footprint. cost saving
safety and
quality
sustainability
Stakeholders
Procurement Lead
Sustainability Lead
Lead EP Physiologist / Theatre Manager
Physicians
Lab / Theatre staff
Infection Control
Waste Manager

42. | 42
Establishing Collections 1
cost saving
safety and
quality
sustainability
Discuss with Procurement and
Sustainability Lead.
Engage Lead EP Physiologist or
Theatre manager.
Ensure Infection Control are
happy.
Waste manager needs to be
versed.
Paperwork completed with
Vanguard.

43. | 43
Establishing Collections 2
cost saving
safety and
quality
sustainability
Vanguard provide collection
materials.
Vanguard train relevant staff.
Collections begin.
Collection materials continually
topped up. Ongoing training as reqd.
Reports sent and monies for
collections paid.

44. | 44
Establishing the use of remanufactured devices
cost saving
safety and
quality
sustainability
Approval from Procurement and Lead
EP Physiologist or Theatre Manager.
Physicians versed and onboard.
Paperwork completed, devices on
ordering catalogue.
Vanguard support Physicians with first
cases.
Vanguard send savings reports and
provide ongoing support as reqd.

45. | 45
Objective + Next Steps
❖ To offer an option for reducing single use plastics in theatre and the
cath lab via remanufacturing.
❖ To talk through what remanufacturing is.
❖ To think about when to introduce re-manufacturing into your
hospitals sustainability/savings workplan? How about now!
cost saving
safety and
quality
sustainability
1. Contact me for more details.
2. Opportunity assessment.
3. Build an implementation plan together.

46. | 46
Thank you.
Vanguard Medical Devices Ltd.
paul.broadberry@vanguard-healthcare.com
www.vanguard-healthcare.com
+44 (0)7976313530

47. Can Reuse Help With Budgets
Post COVID 19?
Warp It
DANIEL O’CONNOR | daniel@getwarpit.com

48. Yes!
Extending lifespan of assets
Manage surplus furniture, equipment better.
Reduction in logistical movements
Reduction in building clearance/ decant charges
Reduction in procurement spend
Reduction in procurement admin
Reduction in waste costs
Free up space
Happier staff- can access surplus quickly, even
from external.

49. These should never
become waste

50. One place on line
Presents surplus
Available now
Available in future
Procurement planning
Easy = participation

51. External
Collaboration
University Large Business
Government Municipal Council

52. What impact
is our system
having?
£25 million in cost avoidance in the
UK University and Healthsector
Link

53. What are our
customers
saying?
• Our customer happiness monthly average
score has never been below 8 out of 10
• 1800 customer have given us a 10/10 in
last 2 years!
More here

54. NEXT STEP
Join scheduled
web session
Link
Invite
Procurement
Facilities Management
Sustainability
Space Management
Logistics
Or get in touch for a
121 by clicking link in
description below!

55. Warp It
Reuse Network
DANIEL O’CONNOR | daniel@getwarpit.com

56. NHS Sustainability-Impact of
Covid-19:
Sustainable Transport and Social Distancing
Will Blair- Sustainability Manager

57. Background Statistics
Sports England
• As much as 16 per cent of the population of England have been
cycling per week during the pandemic.
Greater Manchester
• Before lockdown, around 5% of people cycled to work in Greater
Manchester and 14.1% of people walked
• TfGM data shows walking and cycling now accounts for 33% of all
journeys in GM, with cycling up 42%

58. Reasons for change
• Social Distancing
• Reduced public transport services
• Less traffic on roads
• Exercise/recreation

59. Supplying Cycles
• Cyclescheme launched 2009 (£1,000
cap)
• Transport for Greater Manchester -
NHS Bike Loans and refurbish bikes
(2020)
• The future – Freedom to ride

60. Improved Cycle to work scheme
Purchase a bike up to the
value of £6,000. Through the
new scheme staff can access
cycles which had often been
precluded due to the cost:
• Electric Pedal Assisted
• Cargo Cycles
• Inclusive Cycles.

61. Cycling Infrastructure
• Secure cycle spaces
• Short stay spaces
• Changing facilities (including hair dryers, mirrors
and seating)
• Showers
• Lockers
• Drying areas
• Bicycle maintenance points

62. Cycling Services
• Free training
• Free monthly maintenance
• Free monthly cyclist breakfast
• Bicycle User Group mailing list
• Free pool bicycles
• Partnership with local cycle shop

63. Walking
• Social distancing -
Engage with local
authorities
• Promote health
benefits
• Recommend local
walks

64. Maintaining Change
• Increased frequency of cycle maintenance
• Segregated Cycle lanes – Circa 13% of staff requested safer cycle lanes (2019 survey)
• Expansion of secure cycle parking
• Additional changing facilities
• Staff Engagement - Continued partnership with Ken Foster's Cycle Logic
• Developing a package of walks

65. Any Questions?

66. Sussex Community NHS Foundation Trust (SCFT)
Wheelchair and Specialist Seating Service
People with a permanent disability or long-
term medical condition affecting their
mobility, are eligible for assessment for the
loan of an NHS wheelchair and/or pressure
relieving equipment.
Overview

67. Services 4 localities
• Brighton & Hove
• Horsham
• Bognor Regis
• Worthing
The service has a
total of:
10,503 clients,
of whom 9,816 have
been prescribed a
wheelchair.
As part of the contract, the maintenance contractor agreed to refurbish
wheelchairs at a cost which is far less than a new wheelchair.
Scale

68. The service is also commissioned to provide
pressure-relieving cushions and other
accessories to help reduce the risk of
wheelchair users developing pressure
injuries.
This is a priority for the wheelchair service, and
prevention of pressure injuries is key to
avoiding treatment and possible hospital
admission following a pressure injury.
So education and the issue of preventative
equipment can be an investment in protecting
against pressure injuries and the associated
costs of additional healthcare required to
manage them.
Wheelchair cushions range from simple foam
cushions to more complex fluid or air
cushions.
Cushions

69. Some wheelchair services in other parts of the
UK discard cushions after they have been
issued once.
The SCFT wheelchair service check all pressure
cushions and accessories following collection
of the equipment, to assess if they may be
suitable to be re-issued, following a
decontamination process.
Cushions

70. In 2019, including basic and
more complex manual and
powered wheelchairs.
• The reconditioning fee for a basic wheelchair is £97.
• A new specialist powered chair costs between £3,000 to £5,000. The cost to refurbish and recondition is £488.
• The wheelchair service assess the financial viability of a refurbishment on a chair by chair basis.
This represents an estimated saving of 56% based on what has been spent by the service on new equipment to date
this financial year.
Wheelchairs in numbers
1,426
wheelchairs refurbished
(excluding VAT, refurbishment
fees deducted) against the cost
of buying new wheelchair stock.
£347k
Estimated savings
£130-200
New basic wheelchair

71. A basic pressure-relieving cushion may only cost £7, but a specialist high-
risk cushion can cost between £400-£500.
The wheelchair services do record each cushion which has been
reconditioned, but based on records of equipment returned to the
wheelchair services,
It is estimated that cushion reuse saves the services approximately
£125,000 (excluding VAT) per annum against the cost of purchasing new
pressure cushions.
Cushions in numbers

72. Recycling this equipment can benefit service users as it can reduce the
time it takes to meet their needs, especially in the case of cushion
recycling which the teams do on-site.
This also has associated benefits in terms of the reduced carbon
footprint and environmental impacts associated with reducing new
purchases of equipment, and keeping usable equipment in use for as
long as is appropriate.
Benefits

73. Our service’s ability to reuse may have been slightly affected, due to
additional infection control safeguards slowing these processes, and also
some staff being redeployed.
However we are still following the same basic processes so there hasn’t
been a significant limitation in terms of capacity to maintain reuse.
One difference is that use of single-use/disposable PPE and wipes during
these processes will have increased, but I’m not sure to what extent.
Impact of COVID-19

74. Reuse
Redistribute
User
Distributor
Product Manufacturer
Extraction
Reduce
Natural Resources
Recycle
Incineration
Energy
RecoveryLandfill
Disposal / Leakage
Circular Economy in
Healthcare
Energy and
Labour

75. NHS England and NHS Improvement
Clinical Waste – Service and Demands
NHS England and NHS Improvement
02nd July 2020

76. 76 |76 |
NHS Landscape
NHS Sustainability Day – Clinical Waste

77. 77 |77 |
Data
NHS Sustainability Day – Clinical Waste

78. 78 |78 |
Impacts of Covid
NHS Sustainability Day – Clinical Waste
Non-Covid Bed
Covid Bed
35KG
50KG
10.5kg/bed/day
3.5kg/bed/day

79. 79 |79 |
Operational Impacts
NHS Sustainability Day – Clinical Waste

80. 80 |80 |
Key Areas of Focus
NHS Sustainability Day – Clinical Waste
Area of Focus Current Situation
Data Lack of consistent, high quality data. This impairs informed and proactive
decision making and the ability to respond effectively to disaster recovery
situations
Compliance Broad lack of understanding and awareness of compliance requirements and
accountabilities throughout healthcare organisations, with limited adherence to
correct segregation, tracking and transportation methods for waste
Workforce Insufficient resource, a lack of clarity around roles and responsibilities for NHS
employee. An absence of training for those with legal accountabilities, has led to
misallocation and mismanagement of waste disposal
Commercials Poor transparency of contracting arrangements and inadequate contract
management capability, alongside a concentrated waste management market
means that the NHS is commercially vulnerable to excessive costs and service
failure risk
Infrastructure Inadequate and under invested in waste management infrastructure drives
inefficiencies
Sustainability Current waste management processes and arrangements are driving excess
emissions

81. 81 |81 |
• Strategy is second draft
• Steering Group: Department for Environment, Food and Rural Affairs, Environment Agency, Department for Health and Social
Care, Cabinet Office, Royal College of Nursing, Industry Experts
• Waste Advisory Group: 10 active waste managers form across the system plus and infection control nurse
• Data Collection – spend data has been collected from across the system. A huge thank you to all of those who responded
• Comprehensive waste managers survey – survey of all waste managers across the system (81% response)
Clinical Waste Strategy
Accelerating toward net zero carbon
Drafting
Final Draft
due July 2020
MarketplaceTransition
Marketplace
Analysis and
transition
plan
CommercialreviewbyCO
Cabinet Office
will review
the strategy
NHSE-ISign-Off
NHS England
and
Improvement
will sign off
Publication
Anticipated
publication
Autumn 2020

82. 82 |82 |
Fiona.daly1@nhs.net
@Dalyfionadaly1
07519 293013
www.improvement.nhs.uk
Contact details
NHS Sustainability Day – Clinical Waste
Fiona Daly
Honorary Professor UCL
MsC CBIFM MIHEEM FEMA

83. Total Waste Management: Delivering
Improvements, Protecting the Environment

84. • Introduction of Kings NHS and Bywaters
• Timeline from 2018-present day
• Changing of Routine
• Impact on the Trust
• Engaging the staff
• Future projects
• Conclusion
Contents

85. The Bywaters & KCHFT Partnership
Our Goals
Since January 2018, our combined targets have included:
One of the biggest trusts in London
primarily serving the boroughs of
Lewisham, Southwark, Lambeth and
Bromley
Bywaters provides one of London’s largest
Materials Recovery Facility, with an NHS
portfolio that includes: GSTT, GOSH,
UCLH, RNOH and Moorfields
Introducing
recycling to
the PRUH
Delivering
Long-term
Engagement
Improving
Service &
Contract
Efficiency
Introducing
Offensive
Waste

86. Timeline from 2018-present day
Increased
offensive
waste at
PRUH and
Orpington
by 3.7
tonnes since
2018
Food and
Coffee bean
waste as well
as crisp and
coffee pod
recycling at
PRUH
Introduced
Green
Champions
scheme across
the trust
Increased
Recycling at
Princess
Royal
University
Hospital by
18 tonnes
since 2018
Increase of
Recycling at
Orpington
hospital by
4.4 tonnes
since 2018
Compactor
and
Equipment
upgrades in
August
2018
resulting in
a reduction
of 8 vehicle
movements
a month

87. Recycling rates combined (all sites)
0%
10%
20%
30%
40%
50%
60%
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Recycling % 2018 Recycling % 2019 Recycling % 2020

88. 0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec
Offensive % 2018 Offensive % 2019 Offensive % 2020
Combined offensive waste %

89. 0%
10%
20%
30%
40%
50%
60%
70%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Recycling percentage 2019 Recycling target 2019 Recycling percentage 2020 Recycling target 2020
PRUH Recycling vs target

90. Fixing the Problem
Mixing of waste streams Training of clinical and non-clinical staff,
Non-Conformance form
Removing of office bins Centralised bin system
Increasing offensive waste Monitoring and training, working with
ISS (FM supplier)
Getting staff to training
sessions
Perseverance and rapport with matrons
and ward managers
Confusion amongst staff
especially doctors
Face to face meetings, posters, bin
labelling, working with ISS
Recyclable items being
disposed at a higher cost
Restickering of bin labels to allow for the
items to be disposed of correctly
Issue Resolution

91. Impact on the hospital
PRUH Impact
Since 2018
Recycling
13
tonnes
25
tonnes
300kg
4000kg
50
tonnes 30
tonnes
Offensive Waste
Domestic Waste
Wider Trust Impact
Since 2018
Recycling
13
tonnes
35
tonnes
4
tonnes
9 tonnes
71
tonnes 41
tonnes
Offensive Waste
Domestic Waste

92. Green Champion Scheme
• Volunteer scheme
• Regular engagement meetings
• FM and staff collaboration
Staff Engagement
Training on waste streams
• Bespoke training for clinical
staff & Domestic Teams
• Delivered in shifts to
accommodate flexible schedules
• Impact of waste on wider Trust
and climate
Communication
• Direct point of contact at all times
• Surveys and incentive schemes
• Feedback for better performance

93. Clothes
Recycling
Food Waste
Expansion
Recycling
waste
improvements
ReYooz
Offensive
waste
improvements
Re-useable
Sharps
Future Projects

94. 60%
New
Recycling
Rate
New
Reusable
Sharps
Scheme
Measure,
analyse and
report
Conclusion
• Restart the Offensive Waste
Programme
• From 18% - 52% Recycling,
New 2020 target set at 60%
• Implement Reusable Sharps
• NHS Sustainability Awards
2021

95. Thank you

110. One hygienic flush at a time

111. A Changing World
• On the record
– Water demand exceeding supply – Water UK
06/20
– Severn Trent Residents without water – 1/6
– British Toilet Association requests public
toilets to be reopened – Radio 2
– Public told to cut water use – BBC News 2/6
• Commentary by industry
– 25% greater demand for water since
pandemic – hand washing etc – CEO Water
UK
– Sustainable economy and environment is
critical to every community – CEO Y Water

112. A Changing World
• What this means
• Increased hand washing – 25% increase in water use
• Climate changes – water demand exceeding supply
• Demand for better hygiene – to reassure staff and
customers this is a safe site post COVID
• Increased water demand means increased costs, so
reducing flush volumes is even more important
• Businesses in some markets will fail – the
ways to ensure you are not in that group
are different now

113. Global water shortage
* OECD (2012), OECD Environmental Outlook to 2050, OECD Publishing
https://dx.doi.org/10.1787/9789264122246-en
Demand
to increase by
55%
between 2000-2050*
1 in 10
have no
access to
clean water
today
Toilets flush away huge amounts of scarce drinking water
40%
shortfall
by 2030

114. Reacting to the new reality
• We have been considering what the
business world may look like when we
restart after this devastating virus.
• It would seem that people who were
reviewing the use of new sustainable
energy and water saving technology may
respond differently given the past months
and those to come’s impact on their
businesses
• YET Companies do want to get people
back – but with a clear message that
hygiene and safety is improved

115. Reacting to the new reality
• On the positive side people are more
likely to demand that all new
infrastructure investments are:-
– Total lifetime cost inclusive – no
hidden extras
– Long term maintenance to be
included
– HSE bombproof
• On the negative side Companies
have other major demands on
capital – water saving may have
gone down the priority list for capital
expenditure

116. Hotels Education
Healthcare
Retail & Leisure
Offices
Toilets waste scarce drinking water
90%
Washrooms
Other 48%
Toilets
Urinals
Washing
High maintenance costs
Poor hygiene
Water usage in commercial premises*
*Source: North Staffordshire Water, UK Water Company
Slow refill / toilet queues
Other challenges
All of which lead to increased costs, a drop in productivity & user dissatisfaction.

117. Propelair - the world’s lowest water flush toilet
120l of air propels just 1.5l of water into existing drains,
fully cleaning the bowl and removing all waste
Flushes in only 3 seconds
– powerful and reliable,
leaving a clean bowl
The transparent lid is
closed to form a seal
Refills in only 20-30
seconds
A two-section cistern;
one for air and one for water
Flushes in only 3 seconds
– powerful and reliable,
leaving a clean bowl
The transparent lid is
closed to form a seal
Refills in only 20-30
seconds The anti-microbial
latch sits away from
the toilet

118. Rapid business savings & positive user feedback
84% less water
80% carbon footprint reduction
Lower maintenance costs, eg £300k pa
Superior flush performance
Shorter queues
95% fewer germs flying around the cubicle
84% less water
80% carbon footprint reduction
Lower maintenance costs
60% lower water & sewage bills –
Payback < 1 – 3 years
Superior flush performance
Shorter queues
95% fewer germs in the cubicle
81% of users value water saving

119. Reacting to the new reality
• We have been considering what we can
do to help in that scenario. What if:-
1. There was no capital expenditure
2. By spreading the costs over 5 years,
savings can pay for the monthly costs
through that period
3. No payment for 6 months, so savings build
up in advance
• Many organisations will fail in the next
few months – we all need to adapt to
move forward
• We need to Build back better and change
“the old normal”
• You can make the difference for
your patients/customers and staff to
help ensure your place in your
market

120. One hygienic flush at a time
Any questions?
ANY QUESTIONS?

121. 12
An Argent Energy presentation
NHS Sustainability Day
2nd July 2020
Colin Duke
Head of Sales

122. 13
▪ Overview of Argent Energy
• Who are we?
• What do we do?
• How can Argent help the NHS and it’s partners decarbonise their operations?
Vision: To reduce the worlds carbon footprint using sustainable resources

123. 14
• John Swire & Sons Ltd is the Parent Company of Argent Energy.
• JSSL has a Global presence and is involved in Trading & Industrial, Marine Services, Beverages & Food Chain,
Aviation and Property.
• JSSL has an annual turnover in excess of $32,000m and more than 133,000 employees worldwide.
• Argent Energy is the UK’s leading waste based biodiesel producer, specialising in processing degraded
wastes and oils and converting them into High Quality Biodiesel.
• With the recent acquisition of BDA and creation of Argent Energy NL, Argent Energy is now Europe’s leading
Waste Based producer of Biodiesel.
Argent Energy / John Swire & Sons Ltd
Who are we?

124. 15
Operations in UK and Netherlands
BIODIESEL PRODUCTION AND STORAGE
ARGENT ENERGY IN BRIEF
3 locations across UK
and Netherlands
240,000 MT of waste-based
biodiesel production
capacity
145,000m3 of tank
storage capacity
Cleaning and pre-
treatment facilities
Motherwell
Biodiesel
plant
Pre-treatment
facilities
Stanlow
Biodiesel
plant
Pre-treatment
facilities
Tank
storage
Amsterdam
Biodiesel
plant
Pre-treatment
facilities
Tank
storage
Cleaning
facilities
What do we do?

125. 16
How can Argent help?
Transport • High Blend Biodiesel / B100
Heat
• Replace fossil fuels with
Renewable Fuels
Power Generate Electricity using Biofuels

126. 17
Biodiesel blends

127. 18
Argent Energy Biodiesel’s Inherent Advantages
• AE Biodiesel has many advantages and benefits in its use within the Road Transport Sector
• AE Biodiesel is a ‘polar’, ‘surface active’ substance this leads to biodiesel having natural detergency and
anti-wear properties – leading to fewer additives being required in high bio-blends
• AE biodiesel is a small natural molecule which means that it burns more cleanly than fossil-fuel derived
ULSD leading to less or no coking in engine parts
• AE Biodiesel is made from 90% biogenic feedstock – being a near ‘circular’ product within the bioeconomy
• AE biodiesel gives around 88% GHG savings in its manufacture compared to ULSD and this can be twice the
savings of a crop-derived biodiesel
• AE biodiesel is distilled, meaning it has a very high quality which exceeds the current European standard
– EN 14214
• AE biodiesel is totally produced from waste based materials and has no negative impact on the Food or
Feed chain

128. 19
Biodiesel Challenges become Argent Biodiesel Unique Selling Points
• Biodiesel (like fossil-fuel derived ULSD) may have some challenges in its use as a transport fuel – these can be
overcome by the use of performance enhancing additives
• Oxidative Stability – over time the fatty acid component of biodiesel can degrade in the presence of
oxygen/air. To reduce this, anti-oxidants are added to AE biodiesel immediately after manufacture. Due to
AE biodiesel’s high quality it has been shown that our product is oxidatively stable for over 12 months.
Most other biodiesels are recommended to be stored for up to 6 months
• Cold Flow Properties – due to the different chemical structure of biodiesel compared to fossil-fuel derived
ULSD, additives are required (cold flow improvers) to improve the performance of biodiesel/ULSD blends in
the winter period. AE has shown blends of over 20% biodiesel (B20) in ULSD can be reliably used in road
transport over the winter period.

129. 20
1,000,000 3,000,000 5,000,000 10,000,000 15,000,000 20,000,000 25,000,000 50,000,000
Blend
%
M/Tonne
CO2 Saved
Equiv No
of Cars off
Road every
Year
M/Tonne
CO2 Saved
Equiv No of
Cars off
Road every
Year
M/Tonne
CO2 Saved
Equiv No of
Cars off
Road every
Year
M/Tonne CO2
Saved
Equiv No of
Cars off
Road every
Year
M/Tonne CO2
Saved
Equiv No of
Cars off
Road every
Year
M/Tonne CO2
Saved
Equiv No of
Cars off
Road every
Year
M/Tonne CO2
Saved
Equiv No
of Cars off
Road every
Year
M/Tonne CO2
Saved
Equiv No
of Cars off
Road every
Year
10% 285 137 855 412 1,425 686 2,851 1,373 4,276 2,059 5,702 2,745 7,127 3,431 14,254 6,863
15% 428 206 1,283 618 2,138 1,029 4,276 2,059 6,414 3,088 8,553 4,118 10,691 5,147 21,381 10,294
20% 570 275 1,711 824 2,851 1,373 5,702 2,745 8,553 4,118 11,403 5,490 14,254 6,863 28,508 13,726
30% 855 412 2,566 1,235 4,276 2,059 8,553 4,118 12,829 6,177 17,105 8,235 21,381 10,294 42,763 20,589
100% 2,851 1,373 8,553 4,118 14,254 6,863 28,508 13,726 42,763 20,589 57,017 27,452 71,271 34,314 142,542 68,629
Argent Energy High Biodiesel Blends - Greenhouse Gas (CO2) reduction calculator
Annual volume

130. 21
Biodiesel….
• Is renewable and therefore a sustainable energy resource
• Can reduce greenhouse gas emissions and hence help tackle global warming
• Is clean burning and produces less noxious emissions
• Can be used in most diesel equipment with no, or only minor, modifications
• Is compatible with the existing fuel infrastructure
• Is compatible with new technology diesel engines and emissions control equipment
• Is non-toxic, biodegradable, and suitable for use in sensitive environments
• Can be produced locally providing a degree of energy security
• Is somewhat immune to the fluctuations in crude oil price
• Improves fuel lubricity – less wear and maintenance
• Improves fuel cetane number - better cold starting, lower engine noise and reduced emissions

131. 22
Benefits of AE Biodiesel
• AE manufactures biodiesel of a superior quality which has inherent advantages over fossil-fuel derived ULSD
• Performance enhancing additives exist that can overcome challenges of using biodiesel/ULSD in road transport
• Field trials have proven there is no detrimental effect in using high bio-blends long-term in road transport applications
• Other forms of renewable fuel can be difficult to resource (HVO, Hydrogen, GTL)
• Some “alternative” fuels do not deliver Greenhouse Gas reductions
• Electrification of HDV engines and fleets is some way off
• CNG/LNG/Methane powered vehicles currently cannot offer the range (KM’s) or the CO2 reduction
• Post Covid-19 the world is planning on a Green Recovery and Biodiesel will be a key factor in that recovery

132. 23
www.argentenergy.com
Our Services:
• Higher biodiesel blend supported by a variety of OEM’s
• Drop-in replacement with 10% biodiesel content, 90% mineral diesel.
• 7.4% carbon savings versus average blend levels in the UK
• Competitive pricing
EN16734 – B10
• Up to 30% biodiesel content, 70-80% refinery grade diesel
• Drop-in replacement
• Currently in use with major coach and bus operators at more than 50 sites
across the UK as well as numerous Transport Operators nationwide
• Up to 28% well-to-wheel carbon savings
EN16709 - B14-30
• 100% biodiesel
• Minor engine modifications required + storage tank modifications
• 86% well-to-wheel carbon savings
• Competitive pricing
EN14214 - B100
Our Fuels:
• Founded in 2001, Argent Energy produces more than 240mt of high quality
distilled biodiesel annually, meeting the EN14214 quality standard
• All biodiesel produced solely from the most sustainable waste-based
feedstocks, fully compliant with the latest RTFO legislation
• Manufacture takes place at our 2 biodiesel plants in Motherwell & Stanlow
with distribution terminals at Ellesmere Port and Motherwell, and also at our
newly acquired biodiesel refinery and storage facility in Amsterdam
• In-house blending facilities to blend diesel to meet your sustainability
requirements using refinery-grade mineral diesel
• Winner of 2016 LowCVP ‘Low Carbon Fuel Initiative of the Year’ & ‘Winner of
Winners’ Awards
The UK’s leading waste to biodiesel company, supplying
carbon-saving fuel direct to truck, bus and coach fleets
www.argentenergy.com
Contact:
Colin Duke colin.duke@argentenergy.com / 07889 416789
Craig Cowman craig.cowman@argentenergy.com/ 07889 418363

133. 24
Heavy Fuel Oil
Gas Oil
Gas
Renewable
Biofuel
X
CO2 reduced by
circa 90%

134. 25

135. 26
Thank You

136. 27
ARGENT ENERGY Ltd
Suite 1 Sycamore House
Lloyd Drive
Cheshire Oaks Business Park
Ellesmere Port,
CH65 9HQ
27
colin.duke@argentenergy.com
Mob: 07889 416789
craig.cowman@argentenergy.com
07889 418363
jordan.roberts@argentenergy.com
0151 305 8294
www.argentenergy.com

137. Frank Swinton
Consultant Anaesthetist and Climate Change
Lead

138. Clinical sustainability from
your perspective, what you
have achieved, the pitfalls
and any project plans

139. My Perspective

140. My Perspective(s)
● Anaesthetist
● Climate change lead
● Father, husband, son
● Member of society

141. What I’ve achieved
● Lots
● Not nearly enough

143. What I’ve achieved
● Lots
● Not nearly enough
● Thick skin

144. Pitfalls
● Gain sharing
● Not pushing hard enough (maybe)
● Understanding the role of leadership (& embracing it)

145. Be bold and
great forces
will come to
your aid

146. Project Plans
● Local and regional
● West Yorkshire as a global leader
● Keep smiling :-)

147. My three messages
We need a new
narrative which
makes it easy for
people to do the
right thing
We have all the
technical
solutions we need
We are lacking in
political will (this
might be
changing)

148. Frank Swinton
@frankswinton
frank.swinton@nhs.net

149. Frank Swinton
@frankswinton
frank.swinton@nhs.net

150. SUSTAINABILITY INTHE OPERATINGTHEATRE

151. ELEMENTAL HEALTHCARE
 Introduction
 What is the Problem
 Setting the scene – Pre Covid-19
 Impact of Covid - 19
 Sustainable solutions for the OperatingTheatre
 A Review of the Data
 Case Studies – illustrative example of a large NHSTrust
 Open ForumQuestions & Answer session

152. WHAT IS THE
PROBLEM?

156. IMPACT OF COVID-19
 UK Manufacture
 Climate Change recognised due to the impact of lockdown
 Procurement hold the key to change
 Considerable interest in sustainable solutions
 Supporting the NHS – Climate emergency will help prevent illness, reduce
pressures on A&E and help to save the lives of tens of thousands of people in the
UK

157. THE PROBLEMWITH PLASTIC

158. THE SOLUTION

159. WHAT IS RESPOSABLE™?
 ATrade Mark of Surgical Innovations
 Sustainable
 Surgeon Designed
 UK Manufacture
 Clinical Excellence
 Global wide
 20 years InThe Market
 Cost Saving
 A Hybrid

160. THE PROBLEM

161. MICROLINE CLIP APPLIER & INSTRUMENTS

162. THE PROBLEM

163. A MOUNTING PROBLEM…

164. REDUCING PLASTICWASTE INTHEOPERATINGTHEATRE – POWER ET AL 2020
44,000Kg of
Plastic
Waste
88,000KG of
CO2

165. 3.6 MILLION PLASTIC BOTTLES!

166. CASE STUDY
 An NHSTrust performed 900 LaparoscopicCholecystectomies (one procedure)
 Saved 567kg in plastic
 40,000 plastic bottles
 £73,000 before the cost of waste

167. “If a surgical instrument is equally effective,
costs less than what is currently used and
has the crucial benefit of dramatically
reducing plastic waste produced, then it is
important to consider this change”

168. THE DATA

169. Panel session & Q&A
How do we sustain
this carbon-free
culture for the
future?
@dayforaction #sustainability

170. Thank you for joining
us today, we hope
you enjoyed the
virtual event!
@dayforaction #sustainability