Nhs Sustainability Day 2016 London Road Show

Welcome to the London NHS
Sustainability Day 2016 Road Show
#Dayforaction

Chair’s welcome and introduction
Fiona Daly, Associate Director of
Sustainability and Patient Transport,
Barts Health NHS Trust
#Dayforaction

Inspiring us in all that we do
Duncan Selbie, Chief Executive, Public
Health England
#Dayforaction

Filling the gap
Options for a sustainable UK
health and social care system
Adam Roberts
Head of Economics
February 2016

5
Public spending on health in the UK, in real terms
and as a percentage of national income (GDP)

6
Publicly funded health care spending as a share of
GDP
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
Luxembourg
Ireland
Portugal
Greece
Finland
Spain
Italy
UnitedKingdom
Austria
Belgium
Germany
France
Denmark
Sweden
Netherlands
2000 2012 2012 average

Annual change in total NHS spend in England
2009/10 to 2020/21 (2015/16 prices)
7

Estimated public spending on health in the UK as
a percentage of GDP, 2015/16 to 2020/21
8

9
Annual change in hospital productivity index

10
Total reported surplus / deficit of NHS trusts, 2012/13 to Q3 2015/16

11
Number of NHS trusts in deficit in 2012/13 to Q3 2015/16

12
Number of Training Places commissioned for
clinical staff 2004/05 to 2014/15
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
trainingplacescommissioned
adult nurses
AHP
undergraduate medical
Source: NAO

13
The public-private hourly pay differential for
workers with similar characteristics

14
Social care spending 2009/10 to 2019/20, real
annual changes

15
Number of clients receiving services (community-based services,
residential care or nursing care) provided or commissioned by local
authorities with social services responsibilities, by client type,
2009/10 to 2013/14, England
Physical Disability,
841,645
Mental Health,
257,540
Total,
1,273,280
-
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2009/10 2010/11 2011/12 2012/13 2013/14
Source: NASCIS; Referrals and Packages, module P1

16
Need for and receipt of help with ADLs in the
last month, by equivalised household income
and sex, HSE 2014

17
Relative growth in projected spending pressures
and budget for UK publicly funded health and
adult social care
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
2022/23
2023/24
2024/25
2025/26
2026/27
2027/28
2028/29
2029/30
2030/31
Index
NHS spending pressures
NHS budget
Adult social care spending pressures
Adult social care budget (assuming falling by 16% by 2019/20)

18
Relative funding gap for health and
adult social care in 2030/31

19
Potential funding gap for adult social care in 2019/20

21
Total tax revenue as a percentage of GDP in 2012
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Ireland
Portugal
Spain
UnitedKingdom
Greece
Netherlands
Germany
Luxembourg
Austria
Sweden
Italy
Finland
Belgium
France
Denmark
Tax to GDP ratio
Median

22
Cost of closing gap through taxation
Lower income tax rate
Higher income tax rate

23
Cost of closing gap through taxation
VA
T20%
23%

Keep in touch
24
Visit our website at www.health.org.uk
Subscribe to our monthly email newsletter at
www.health.org.uk/newsletter
Register for email alerts to be notified about our latest work at
www.health.org.uk/updates
Take part in conversation and debate about current healthcare
issues on our blog
Follow us on Twitter, Facebook or LinkedIn.
For all the latest news and developments
from the Health Foundation:

C
Working together in the Public Sector
to improve Carbon & Energy Performance
Martyn Jeffery CEng MIHEEM
CEF TRUSTEE

C
The Carbon and Energy Fund
“Launched by Greg Barker MP at IHEEM in 2011 the Carbon and Energy Fund
(CEF) is a co-creation with the NHS for the NHS. Originally set up via a
collaboration agreement with the NHS via NHS SBS it has subsequently been
procured by the Countess of Chester Hospital and is a partner of Oxford
Academic Health Science Network delivering infrastructure upgrades that
guarantee energy, carbon and cost savings. With a proven track record and
in-depth experience of procurement, engineering, legal and finance, CEF is
the only organisation that successfully guides Public Sector clients through
the complex processes involved.”

C
CEF has been created for the Public Sector to:
 Transfer risk to whom is best to manage it, principally the Private Sector
 Enable the Public Sector to realise the benefits of large scale procurement
via a framework of 17 of the UK’s top ESCO/DH contractors
 Make competitive and task specific funding (15 -30 year energy
infrastructure finance) available for the NHS
 Provide a fast and robust procurement route for the Public Sector therefore
reducing overall risk and costs
 Provide the Public Sector with the necessary task specific technical, legal
and project management resources and on-going support for the project
 Prove and audit savings annually for whole contract period, with
reimbursement for savings not achieved
In partnership with

C
The Carbon and Energy Fund
In contract:
 Capital committed: £118m
 Guaranteed savings per annum: £24m
 Guaranteed carbon savings per annum: 111,000T
In procurement:
 Capital: £90m
 Guaranteed carbon savings per annum: 52,000T
Total expected by end of 2015:
 Capital committed: £208m
 Guaranteed carbon savings per annum:
163,000T
CEF Track
Record

C
Introduction The CEF are more than just a provider of funding
• Nifes
• Jacobs
• Attest
• SKM
• Carbon Trust
•Renew Legal
• Hill Dickinson
• DAC Beachcroft
• In-house
• TEC
•NHS SBS
• PFPM
• WT
• Millbridge
• Internal
• Lending Banks
• Pension Funds
• GIB
• ECB
• Equity
Investors
Commercial
and
Financial
Project
Management
TechnicalProcurement
and Legal

C
Procuring with the Carbon and Energy Fund
The CEF Process has been developed through pilot projects and
provides a robust methodology to procure projects
Stage 1
Membership
Stage 2
Invitation to
Mini-
Competition
Stage 3
ITT and
Contract
Close
Stage 4
Construction
Stage 5
Monitoring
and
Verification
4 weeks 8 weeks 20 weeks Project Dependent

C
Typical CEF Project
Acting as the clients advisor/partner the CEF provides the component parts necessary to
make an energy project happen and transfer risk.
Energy
ProjectBuild
These services are
either provided by
the client or are
outsourced
Client Advisors
• Feasibility
• Outline Design
• Procurement
• Technical Support
• Legal
• Monitoring and
Verification
Funded by
ClientDesign
Operate Funded by
CEF
Funded by
Contractor
Funded by
Contractor
Framework

C
CEF Contract Overview V4
Unitary or Fixed
Guaranteed
Energy
Savings
Potential
Uplift in Savings
Time (Yrs)
Value(£k)

C
Funding options and balance sheet treatment
“The CEF is 90% of the NHS Energy Efficiency Finance Market” say The
Green Investment Bank
With the UK the CEF is the only organisation to provide Hospitals with
independent access to 3rd Party finance. A Trust may use its own capital, (inc
FTFF or TDA Finance) or 3rd Party Finance via a funding round that will include
the Governments Green Investment Bank and Salix
We currently have rates from our panel of funders that are in the region of
1.5% real
The CEF contract has been deemed as off balance sheet and bankable. *Each
project should be subjected to an accounting review to establish balance sheet
status

C
Tranche 5
The Contractors on the Framework
• Ameresco (previously ESP)
• Bilfinger
• Bouygues
• Breathe (part of MCW)
• Cofely
• Cynergin
• Doosan Babcock
• eDF
• ENER-G
• EON
• Imtech
• Kier
• Mitie
• SSE
• Veolia (previously)Dalkia
• Vital

C
Tranche 5 remaining
• March Mater Hospital; Hull
• April Nottingham City Hospital; Dorchester
• May Basildon and Thurrock
• June Buckinghamshire
• July
• Queued/ tranche 6: Huddersfield; Southern Health;
Basingstoke; UCLH; Hillingdon
• Already in progress – Manchester City DE, Barnet & Chase Farm,
Sheffield Childrens

C
Chase Farm Hospital
External view – end of phase 1

C
Chase Farm Hospital
Long Term Expansion Opportunities

C
The Trust Vision
• An energy services partner that will support the development
• Long term strategic management of the site energy and utility
infrastructure
• Risk transfer
• Financial savings
• Carbon savings
• Continuous improvement
• Enable compliance with Enfield Council planning requirements, the
Building Regulations and the London Plan

C
Energy Supply Strategy
• Suitable technologies
• Partnership / opportunities / access to expertise
• Reducing impact of energy / fuel price increases
• Carbon targets and costs
• Risk transfer
• Resilience and increased security of supply
• Good Corporate Citizenship
• Self funding using external capital

C
Investment Objectives
• Robust infrastructure, security of supply and resilience
• Meet a tight timescale for completion of new hospital
• Risk transfer to the ESCo
• Flexibility to support future development of the site
• Deliver the Trust’s commitment within its Carbon Management
Plan
• Third Party Investment
• Deliver Guaranteed Savings in terms of energy costs

C
The NHS Improvement (“TDA”) &
Energy Service Performance Contracts
“Energy Services Performance Contracts (“ESPCs”) are contracts that are typically 15 to
25 years long with an energy services company delivering an organisation’s energy and
carbon strategy. Funding is usually, but not exclusively, provided by a third party
investor. The NHS Trust pays a unitary payment to the supplier but gains the benefit of
guaranteed savings. In developing this type of investment proposal NHS Trust’s should
consider issues such as the accounting treatment, the development of a robust public
sector comparator, the realisation of guaranteed savings and rates of return.”
The CEF has made a proposal to NHSI for the streamlined approval of all EPC’s. This
matter is under central discussion with NHSI and the model hospital programme

C
NHS Trust Approval Pathway & NHSI
These services are
either provided by
the client or are
outsourced
Financial Value of the
Proposed Scheme
Key Stage
Documentation
Capital and Quality
Business Case Checklist
Required
Up to £5m or 3% of turnover
whichever is the lower
NHS Trust internal
governance process
No
Between £5m, or 3% of
turnover whichever is the
lower, and £15m
Outline Business Case and
Full Business Case required
Yes
£15m to £35m
Strategic Outline Case, OBC
and FBC required
Yes
£35m to £50m
and FBC required
Yes
Over £50m
and FBC required
Yes

C
NHS Project Governance and CEF Fit
Membership
Contract Close Construction
Invitation to Tender (“ITT”)
Performance Contract
Management
SOC
OBC Divisional
Exec
OBC NHS Trust
Management
Executive
OBC NHS Trust
Board
OBC NHS NHSI
FBC Divisional
Exec
FBC NHS Trust
Management
Executive
FBC NHS Trust
Board
FBC NHS NHSI
Post Project
Evaluation

C
Changes to the 2015/16 Capital Regime and
Investment Business Case Approvals Guidance
• A recognition of Energy Service Performance Contracts (“ESPC”) as a type
of service contract. This follows the increase in ESPC investment
proposals being received by NHSI.
• Increased guidance on how to calculate Whole Life Costs
• Reinforcing the requirement to demonstrate compliance with relevant
accounting standards and to obtain audit advice where schemes are
novel or contentious
• A requirement to clarify treatment of VAT
• An expansion of the traditional 5 Case Model to include the
consideration of a Clinical Quality Case
• More detailed Post Project Evaluation considerations

C
Contractual arrangements
• Started life based on NHS Standard Form PFI contract v3
• Second CEF framework updated it to make it SOPC4 compliant and to
incorporate lessons learnt from further projects
• Latest CEF framework incorporates further lessons learnt and makes
the contract easier for NHS Trusts to use
• Has been found to be off balance sheet as an operating lease
(including under more strict Scottish accounting rules)
• Currently taking advice as to whether it will continue to meet latest
Eurostat guidance with regards to balance sheet treatment
• Incorporates Willis insurance advice honed over several recent NHS
projects.

C
Contractual arrangements (cont.)
• Standard route is restricted route procurement, shortlisting at least
three bidders and asking them to provide final bids
• Alternate investment grade audit route available if considered
preferable.
• Easily altered to cater for multiple-site projects
• Can deal with multiple-site, staggered-start projects (as on
Cheltenham and Gloucester):
• Outline scope of the project is set in the contract
• Procedure for bid and prices to be updated
• If the re-priced bid meets a pre-agreed NPV calculation, that part
of the Project Agreement is triggered.

Your supply chain
Your responsibility

Your
company
Customer Customer Customer

Your
company
Customer Customer Customer
Investors
Guidelines
Legislation

Your
company
Customer
Investors
Guidelines
Legislation
Customer Customer
Show
compliance

Your
company
Customer
Investors
Guidelines
Legislation
Customer Customer
Your
responsibility

Your
company
Customer
Investors
Guidelines
Legislation
Customer Customer
Human Rights
Labour(child)
Environment
Anti-Corruption

Does this concern
your company?

In a Survey from 2012,
Deloitte reported that an
estimated 85% of global
supply chains had
experienced at least one
hyper-critical supply
disruption over the past
12 months.
85%

A study by Ernst & Young
from 2014 shows that 45
percent of all the
proposals that were
asked by investors to
company boards, were
about sustainability.
45%

The global
sustainability agenda is
formed by mega drivers
and will significantly
impact all companies
All

A recent international study
by the danish bank Nykredit
shows that companies given
the highest sustinability
score, on average achieved
a gain of almost 23 percent
of their investments, which
is more than twice as high
as the companies with the
lowest score.
23%

Several studies indicate,
that it is much easier to
attract skilled labour for
companies that
downplays the economic
aspect in favour of the
employer brand.
Employer
Branding

From control to collaboration
From legal disclaimer to proactive performance
management
From reputation to innovation
New agendas

CSR issues are moving to business innovation
Partnership building between business, governments
and NGOs.
Due diligence studies and impact studies. Ensuring
license to operate.
New agendas

New opportunities
Creating better sustainability
performance will create value
to your business
Demonstrating transparency
and compliance will build public
trust and credibility
Improved collaboration within
your supply chain will build
relationships with confidence

That is why we have created
the Aperitas solution

Challenges identified by our
customers
Excessive resources are spend on
collecting sustainability data from
supply chains
No measurements to validate
sustainability initiatives
Weak internal organising of CSR
requirements

Weak integration
of QA and CSR
requirements
Limited knowledge about
QA and CSR facts in
supply chains
QACSR
Procurement
Suppliers
Sustainability strategies don’t get into work.
You can just show policies – but no results.

Procurement
CSR QA
Aperitas
Platform
Suppliers
RSCM
must be an integral part of the
company

Procurement
CSR QA
Aperitas
Platform
Suppliers
Efficient operationalization of strategies
Easy and efficient gathering of
sustainability information
Easy to show compliance and
manage risk

Concluding remarks
The global sustainability agenda is formed by mega
drivers and will significantly impact all companies
RSCM is vital to strategic sustainability
RSCM must be an integral part of the company
Aperitas can make RSCM profitable

aperitas.com
ks@aperitas.com
Learn more on:

Chris Large
Partner at Global Action Plan

Changing Lives in
East London
• Largest NHS Trust in the
country
• Serves 2.5M people

We help people to limit
environmental damage
Schools Businesses Communities

Brendan Rouse – Estates Manager, Energy & Sustainability
Operation TLC at GOSH

Why Operation TLC suited Great Ormond Street
• Staff and visitors expect GOSH to be a resource efficient
organisation
• Effective behaviour change campaigns have great potential but
are difficult to get right
• GOSH didn’t have the expertise to create a bespoke campaign

Gaining support
• Traditional business case presented to Finance Board -
0.8 year payback.
• 6 ward trial set up after gaining support from core team and
the wards involved
• Results of this trial presented to Trust Board to get sign-off on
full roll-out of programme

Year 1 – Three Projects
• Lighting project carried out in all 26 inpatient wards
• Heating campaign in all areas of the Trust
• Switch-off for Christmas and high usage areas (Labs)

Understand
Change
Evaluate
Share
• Feedback results
• Celebrate success
• Barriers &
motivators
• Training
• Embedding
activities
• Stakeholder engagement
• Baseline measurement
• Prioritise
• Measure & evaluate
• Energy/waste/water data
• Experience

Motivator - The child
first and always

Evaluate
Energy Data - 5% reduction in ward energy use
Surveys – 19% more staff turning lights off
17% increase in lighting satisfaction
Observations – 9% improvement in observed behaviours

Our Volunteers
Peter and Val
Observing & Training

"I felt like an angel! I was so concerned with one of the senior nurses,
she was in a tiny room and it was so hot inside!...I was able to tell her
how she could take more control of the temperature.“ - Peter
"We were around able to see the improvements first hand on the wards.
It became more evident when you went and you saw the lights dimmed
or off, you would see a calm and peaceful atmosphere.“ - Val

Feedback & Sharing Results
Roundabout
Carbon Culture
Newsletter
Posters & Flyers
Screensavers
Face to face

SUCCESSES - Cost and Carbon Savings

• Increased natural light in mental health patient rooms
resulted in 3.7 day shorter hospital stay on average (AHRQ, 2005)
• Cervical and lumar spinal surgeries patients who received
more natural light saw a 22% decrease in painkilling
medicine use (Joseph, 2006)
Behaviour change in action
Increasing natural light exposure
Reduction in artificial light
• Darkening hospital rooms at night – reduced sleep
disturbances by 38% (Bartick et al,. 2009)

SUCCESSES
Better patient experience and staff fulfilment

Design of a behaviour change programme
What can staff do to save energy?
How often do staff do those actions already?
What is the value of doing those actions more often?
What stops people acting and how can we help uptake?

How did people
save energy?
Natural Light

QUIET
TIME
NIGHT
MODE
HIGH
ENERGY
AREAS
BUILDING
AWARENESS
How did people save energy?

What encouraged and enabled people to act?
PATIENTS
PEOPLE
PLANET POCKET

Patient – Staff – Estate
Triangle
What encouraged and enabled people to act?

How did we measure the impact and savings?
PATIENT
SURVEY
METER
DATA
LIGHT
METERS
SPOT
CHECKS

From energy saving to better relationships

Help is at hand to run your own Operation TLC
Scope
• Quantify
energy waste
• Create
business case
• Engage clinical
leaders
Change
• Face to face
engagement
• Personalised
comms
materials
• Coaching for
champions
and project
leaders
Measure
• Improvements
in staff taking
energy action
• Cost and
carbon savings
• Patient
experience
benefits
• Staff benefits

What advice would we share?
Top 3 tips
Be specific. Saving energy is abstract.
Opening the curtains and turning off the light is real.
Make energy saving genuinely meaningful for staff.
But don’t kid yourself that saving money is that meaning.

Chris Large
Partner at Global Action Plan
chris.large@globalactionplan.org.uk
@chrislarge1

Refreshments and
networking
#Dayforaction

Welcome back
David Pencheon OBE, Director, SDU
#Dayforaction

‘Buying for the Long Run’
Sustainable Procurement
David Picton
25 February 2016

• Tarmac Group – De-Merged in 1999
− Tarmac, Wimpey, Cubitts and Mitchell Construction
• Further Acquisitions:
− Mowlem (2006); Alfred McAlpine and Vanbots (2008)
− EAGA (2011); John Laing Integrated Services (2013)
− Rokstad Distribution (2014) and Outland (2015)
− Ask Developments (2016)
• 40,000 employees
• UK, Middle East, Canada
• £4.1Bn turnover (2014)
• 2015 results – March 2016
• FTSE 250 PLC
Who Are We ?

123
Maintenance
Utilities
Facilities
Defence Infrastructure
Rail
Health
Education
What Do We Do ?

Carillion’s 6 Positive Outcomes
Sustainability 2020

Challenges
• ‘Triple Bottom Lines’
• Economic Responsibility
• Environmental Responsibility
• Social Responsibility
• Reputation
Sustainable Procurement

Reputation – Role of the Supply Chain
Delivery Through Other Companies
• Supplier accreditation and risk management
• Audit, relationship management and development
• Key area for:
− Spend
− Risk
− Brand reputation
− Customer opinion
• Small – Medium Enterprises – a critical ‘tail’
• Government initiatives – core to economic recovery
• Niche skills, innovation, flexibility – but stretched

Supply Chain Risk
“… firms are placing not only their financial security, but their reputations in the
hands of suppliers they have little understanding of … negative news can now
spread around the world almost instantly …” (Bureau van Dijk)
Costs of Supply Chain Failure ?

Supply Chain Sustainability School
Collaboration (noun):
… working with another or others on a joint
project to achieve shared goals
… co-operating as a traitor, especially with an
enemy occupying one’s own country

Supply Chain Sustainability School
Skills Focus for the Full Built Environment
• Free Virtual Learning Environment
− Support resources
− Multi-media – videos, articles, webinars
• Non-mandatory and confidential self-assessment
• Action Plans focused on Continuous Improvement
• Develop sustainability knowledge and competence
• Supplier Days / Workshops – networking and best practice
• Developing 5-year Business Plan for School
• Full Leadership Council and Focus Groups

• £335M capital cost, 3 year build – plus £100M support services, 30 year concession
• One of the largest all single-bed hospitals in UK (646 beds, 40-bed CCU, 18 theatres)
• One of the UK’s 'greenest' hospitals:
• Dedicated cycle centre and 10 electric car charging points
• Renewable energy systems
• Low carbon materials, systems
• Water meters, leak detection
• £240M to local economy
• 750 full-time jobs during build
• 60% to local people
• 60% materials locally-sourced
• 15% workforce from priority areas
• 100 apprenticeships created
Opportunities – Royal Liverpool Hospital
Royal Liverpool Hospital

• Phased and staged packages of procurement
• Preferred supplier base – pre-accredited suppliers
• ‘Meet the Buyer’ events
• Trust and City Council – links to ‘priority wards’
• Community Engagement Officer
• Previously a Business Connector
• Business in the Community regional management team
• Charitable trusts – managing applications and allocations
• Specific delivery against Community Schedule in pre-contract agreements
• Supply Chain Sustainability School – Supplier Day
• Apprenticeships and Work Placements
• Supplier engagement and planning
Process – Royal Liverpool Hospital
Buying for the Long Run

Nottinghamshire University Hospitals Trust
• Nottinghamshire University Hospitals Trust
• Patient Meals – App and tablet based food ordering system
– Developed in partnership with catering supplier
– Food waste reduction from 18% to 10% (target 6%)
– Elderly lady in her 80s – not eaten for 2 weeks
• Gold Soil Association ‘Food for Life’ Catering Mark
– Buying local wherever possible
– Purchase of organic produce (% depends on operation)
– 75% meals freshly prepared on site
– No fish products from MSC ‘fish to avoid’ list
– Use of only free range eggs
– Use of Farm assured products

Sustainable, nutritious
and tasty hospital
food?
Alexandra Hammond
Associate Director, Sustainability

Food recycling
• Partnership with waste team to eliminate waste
• Locally reprocessed into compost
• Collected from wards, kitchens and nurseries

Weighing and understanding waste
an NHS first

Award winning waste management programme

The best healthcare runs
efficiently, uses resources
wisely, fosters healthy living
and provides patients with the
best possible care.
Sustainability Strategy 2013 - 2018
Guy’s and St Thomas’ NHS Foundation Trust

Special thanks to the catering and hospitality teams!

Alexandra Hammond
Associate Director, Sustainability
alexandra.hammond@gstt.nhs.uk
@alexandrajhr
156

www.trakeo.com
Supply chain
carbon and
sustainability
platform

www.trakeo.com
➢ Rationalisation and consolidation of freight.
➢ Purchasing efficiencies.
➢ Cooperative solution propositions (consortia)
Collaboration Network

Sustainability
Resource Efficiency through Segregation
Presented by Jide Lawal and Earl Mensah
Aggressive on Waste
For a sustainable future

Who are we
 Established in 2008
 Kwik Sweep is a waste management company
specialising in the removal of junk and bulky
waste. We ensure the reduction of general
waste sent to landfill.
 We offer a bespoke on-demand service to
public sector and commercial customers.

“Aggressive on Waste for a Sustainable Future”.

Our services
 Home, office and junk clearances
 Refits clearance
 Construction/canteen waste removal
 Events clearance
 WEEE recycling
 Fly tipping clearance and hazardous waste
collection

Our commitment to our
client
 Health and Safety
 Customer service
 Quality
 Flexibility
 Reliability

Clients
NHS Erith demolition
Brent Council
Amazon Westway Development Trust
Cluttons

Policy
Key Environmental Objectives
 To reduce the amount of waste sent
to landfill
 To promote the 3 R’s (reduce, reuse
and recycle)
 To meet the requirements of quality
and environmental system

Our service work within the
Health Sector
 Great Ormond Street Hospital (GOSH) is an
international centre of excellence in child
healthcare.
 Formed in 1852
 Over 255,000 patient visits to the hospital
each year
 Epsom and St Helier University Hospitals
NHS Trust provides a range of medical
services to approximately 420,000 people
living across southwest London and northeast
Surrey.

Segregation
 Toolbox talk
 On site Training
 Staff engagement
 Safety

Segregation
Environment Manager Epsom and St Heliers
Hospital Trust
“One of the benefits that we have gained is that as
Kwik Sweep is responsible for loading the waste,
we can ensure that there is no inappropriate waste
(i.e. hazardous WEEE) in the load. Previously we
had 40 yard skips on site which were often loaded
with flytipped waste, including TVs and
refrigeration equipment which would subsequently
be incorrectly consigned with the general waste”

Great Ormond Street Hospital
Before and after picture

St Heliers Hospital
BEFORE AND AFTER PICTURE

GOSH waste composition
 Waste composition 2014
The following diagram below shows breakdown of materials
collected in 2014
34.92 tonnes of bulky waste collected
Wood: 22.62 tonnes
Metal: 9.08 tonnes
Waste: 2.48 tonnes
Paper & cardboard: 0.74 tonnes
93% recycled

Breakdown of resources
1.37
20.42
9.45
0.65 0.05
GOSH 2015 resource tonnages
Waste
Wood
Metal
Paper/card
Soil

GOSH waste composition
 Waste composition 2015
31.94 tonnes of bulky waste collected from GOSH
Wood: 20.42 tonnes
Metal: 9.45 tonnes
Waste: 1.37 tonnes
Soil: 0.05 tonnes
Paper & cardboard: 0.65 tonnes
96% recycled

Comparison
0
5
10
15
20
25
Waste Wood Metal Paper/card Soil
Tonnages
Resources
2014/2015 Comparison
2014 2015

Approved Facility sites
 Waste Material Type
Wood, paper & cardboard,
rubble and general waste
Wood, mattresses, paper &
cardboard, rubble and
general waste
 Approved Facility Site
McGovern Brother
(Haulage) LTD
26-27 Brent Terrance,
Claremont Ind Estate,
Hendon, London, NW2 1BG
HTL Recycling & Waste
Management Services
Deptford Recycling Centre
Landmann Way Deptford
London SE14 5RS

Way forward
RDF/SRF
With technology such as Refuse derived fuel and Solid
recovered fuel, Kwik Sweep Ltd can now ensure higher
diversion of resources from landfill.
These new technologies for the treatment and disposal of
waste will help the Trust reduce carbon emissions and save
money.

SOCIAL RESPONSIBILITY
 Donation
 Community engagement

Waste Collection Reinvented
 Kwik Sweep is using mobile technology to reinvent the bookings process.
 Kwik Sweep app is a valuable platform which allows the user to send
pictures/videos for an instant quote.
 Make an instant booking for collection at a day and time that suits you.
BENEFITS
 Instant booking
 Submit images for an accurate quote
 Removes the need for on-site assessment, reducing carbon footprint and
improving time management
 Helps management/porter to deal instantly with the removal of waste

The business
case for reuse
Daniel@warp-it.co.uk
@WarpIt_

Overview
 Financial
 Environment
 Social

Overview
 Free resources
 How to set up your own
 Business case templates
 Legal templates

Value
“It is only a
waste when it is
in the wrong
place”

The Enemy
 Time
 Space
 Distance

Priority?
Reuse has a
much greater
impact than
recycling

Purchase &
Waste costs
Staff time

SupplyChain
Impacts
60% NHS
Carbon from
supply chain

Procurement
& waste
avoidance
benefits

External
Collaboration
Aber Uni save
£10K in 1st
trade!! (audio
room)

Metrics
Value of reuse
Audit
Management

Examples
warp-it.co.uk/nhsggc
warp-it.co.uk/gmh
warp-it.co.uk/CWP
warp-it.co.uk/lthtr

Take home tip
Explore developing a
reuse target
>Track your savings
>>Put more resources
into reuse

Free resources
Freegle
Warp It (is free really)
Legal document for
donation to 3rd parties
Business case for reuse
system

100%
INTEREST
FREE
ENERGY EFFICIENCY AT
FRIMLEY HEALTH NHS
FOUNDATION TRUST
Tim Morozgalski
Programme Manager
Gillian Brown
Environment Manager Frimley Health NHS
Foundation Trust

Introduction
Salix Finance and Frimley Park Hospital
Summary of the loan application process
To demonstrate how Salix can help NHS England
Our goals for today

Introduction to Salix funding model

Who we are
Established in 2004
Independent, publicly funded, not-for-profit company
100% interest-free capital finance for the public sector
Funded by DECC, Scottish and Welsh Government, EfA and DfE
Support public sector bodies such as local authorities, educational
establishments and NHS Trusts
Working throughout England, Wales, Scotland and N. Ireland

Minimise wasted energy – controls
and awareness raising
Efficient conversion –
installing energy
efficient technology
Salix focus
capital investment to
reduce energy and
save carbon
Energy hierarchy
Onsite
renewable
energy

Loan funding by public sector body type
40%
30%
12%
10%
4%
3%
1%
England between April 2010 - March 2015
Local Authority
Higher Education
Institute
National Health Service
School
Further Education
Institute
Academy
Emergency

Energy usage in the NHS
245 eligible organisations spend over £634m on energy and utilities 1
Average of £2.5m per hospital 1
Typically 3rd largest expenditure
Our NHS clients have saved on average £200k per year 2
1. Health and Social Care Information Centre, Hospital estates and facilities statistics 2015
2. Salix Finance – loan applications since 2008

Knowledge sharing and case studies

Knowledge sharing and case studies
Case
Studies
Project Knowledge
Slides
Social
Media
News &
Blog

Salix Finance and Frimley Park Hospital

Background
Frimley Park Hospital Salix application approved 2006
Motivation: Energy Efficiency
Carbon Management Plan starts 2010
Frimley Health created October 2014
Heatherwood Hospital Frimley Park Hospital Wexham Park Hospital

Achievements of Frimley Park so far

Plant room insulation
Automatic doorsLED lighting
Boiler optimisation

Energy consumption
1. New ED / CCL – full running year
2. CHP engine rebuild
3. CHP running 24/7 – exportation
4. Increased patient activity
5. Long hot summer – additional cooling required
Potential
emissions
without
Salix
funding
0
5,000
10,000
15,000
2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
Frimley Park Hospital energy emissions (tCO2e)
Salix Finance £450k
CMP starts
Salix Finance £260k

Benefits
Patient & staff comfort improved
Links into operation TLC
Simple process
Salix team on hand to help through every
stage – including technical support
Supports energy reduction where capital
investment is not available
Lessons learnt
Don’t forget to use the cost + vat on compliance tool!

Next steps
Produce a new Frimley Health SDMP & Carbon
Reduction Plan.
Re-baseline Frimley Health CO2 emissions
Replicate Frimley Projects at Wexham & Heatherwood
Work closely with Capital Projects team
EPC - utilise Salix Finance for Energy Efficiency projects
Salix Finance – next step if internal capital is unavailable

SOLVING ENERGY EFFICIENCY FINANCE IN THE PUBLIC SECTORWWW.SALIXFINANCE.CO.UK
Salix application process

Online application process

Six simple steps to apply
1. Log on to the Salix website salixfinance.co.uk/loans
2. Select the NHS loans page
3. Complete the compliance tool with project details
4. Complete an online loan application
5. Submit your application online
6. Salix will do a technical assessment

Summary
NHS Trusts and Foundation Trusts – no maximum loan amount
Help achieve energy and carbon reduction targets
Long-term funding plans, SDMPs, estates strategies
Reduce energy bills at your Trust

Thank you
Tim.morozgalski@salixfinance.co.uk
020 3102 6910

Lunch and networking
#Dayforaction

Welcome back
Professor Hugh Montgomery MB BS BSc
FRCP MD FRGS FRSB FRI FFICM
UCL Professor of Intensive Care Medicine
Consultant Intensivist, Whittington
Hospital
#Dayforaction

NHS Sustainability Day: London
Roadshow
Awards2013Building
Finalist
Awards2014
Finalist
Building
Finalist Finalist
www.virtus-consult.co.uk
Energy Sustainability Project

Contents
 Introduction
 HEFT Background / Targets
 Client Brief
 HEFT Energy Profile
 Delivery Process
 Initiatives
 Achievements
 Project Review
 Questions
Jan Ponsford
Director, Virtus Consult

Introduction
 Virtus deliver exemplary results;
ensuring every stage of a project’s
life is meticulously planned and
perfectly executed
 Respond to the unforeseeable with
innovation and pragmatism
 Save money and minimise risk
 Have a team of passionate and
driven industry specialists
Virtus Consult is an award winning
construction and management
consultancy firm offering tailored
solutions to our broad range of
clients
“I can’t remember ever working with such dedicated and
personable people with such integrity”
Rolls-Royce

Introduction
“You make us think differently”
John Sellars, Director of Asset Management, HEFT
 Do not shoehorn our solutions to
fit, we listen to our clients to tailor
the perfect solution
 Are trusted partner to a number of
blue chip organisations
 Build long term relationships
Services
 Cost Consultancy
 Project Management
 Development Management
 Energy Consultancy
 Principal Designer
 Construction Claims Consultancy
Sectors
 Education
 Energy
 Healthcare
 Hotels & Leisure
 Industrial
 Nuclear
 Offices
 Residential
 Retail

HEFT Background / Targets
5
 One of the largest Trusts in England, employing approx.
11,000 people
 Annual budget of £650m
 General and specialist hospital care for the people of
East Birmingham, North Warwickshire, Sutton Coldfield,
Tamworth and South Staffordshire; in excess of 1,800
beds
 Continually striving for excellence and efficiency
Targets and Constraints:
 CIP Targets of 5% year on Year
 Carbon Reduction - 34% 2020 / 50% 2025 / 80% 2050
 Spend to Save / Guaranteed Savings
 Introduce Market intelligence and competition
 Compliance with OJEU Guidance

Client Brief
5 www.virtus-consult.co.uk
 Current Energy Spend £5.2m
 Carbon reduction targets
 5% year on year cost savings
 OJEU compliant solution
 No disruption to the Trust’s core activity
 Option for 3rd party funding
 Continued improvement
 Low implementation costs

HEFT Energy Profile
HEFT energy spend profile
2008 - 2013
 Energy cost has risen
consistently across the
HEFT estate due to energy
price and estate volume
increases
 Increasing energy demand
due to more energy
intensive clinical equipment
 HEFT joined EU ETS and
CRC

Delivery Process
 Site Survey, Interviews and Questionnaire
 OJEU Competitive Dialogue
 9 month process
 Project management of
the installation
 Monitoring of
performance to ensure
HEFT receives
guaranteed savings
 Estimated Demand Side Reductions of c20%
 Energy Cost and Carbon Reduction c£1m p/a

Initiatives
 LED Lighting & Controls
 Pipework Insulation
 Variable Speed Drives
 Pump replacement
 Display energy meters
 Refrigeration Control
 Solar PV
 Energy Manager

Achievements
 Guaranteed savings of circa £900k per annum (18%
of annual spend)
 Payback of 4.3 years
 Low implementation costs – 0.05% of savings
 Speed of implementation – 9 months
 Options for 3rd party funding
 Continued improvement over 4 year framework
 Combined with CHP, exceeded Carbon Target

Project Review

Questions
B I R M I N G H A M O F F I C E
The Penthouse
Lancaster House
67 Newhall Street
Birmingham B3 1NQ
t 0121 200 2855
O X F O R D O F F I C E
267 Banbury Road
Summertown
Oxford OX2 7HT
t 01865 339 439
L E E D S O F F I C E
Ground and First Floor
1200 Century Way
Thorpe Park Business Park
Colton Leeds LS15 8ZA

How to reduce your energy
costs without reducing
comfort or safety
NHS Sustainability Day 2016 – London
25th February 2016
Phil Marris, Managing Director, Jaga Heating Products (UK)

Kier Hardie Health Park, Merthyr
Architect: BDP
Building Services Engineer: AECOM
Main Contractor: Laing
O’Rourke
M&E Contractor: Crown House
Technologies

Air to water
heat pumps
Low
temperature
convectors
Integrated
heating &
ventilation

“With obstructions like fixed furniture throughout the health park,
we knew it would be a challenge to find radiators that would work
efficiently the low-temperature system without over-sizing, we
found the answer in the Maxi LST radiators which are compact and
therefore relatively unobtrusive — yet met the heat loads”.
Sarah Gealy, AECOM

“The use of properly-controlled DCV
systems can provide improved internal
environments while saving operational
costs”
Prof. Tim Dwyer, UCL
Demand Controlled Ventilation (DCV) measures the CO2
level in a space, and brings in just the right amount of
fresh air to maintain good indoor air quality

“It was important to find a solution that
would provide effective ventilation to the
space as well as heating it,”
Sarah Gealy, AECOM

In summary
 Using heat pumps to power a low-temperature heating system
saves money and reduces emissions
 Low mass, low water content “radiators” get the best out of
the system and maintain heating comfort most effectively
 LST radiator casing design should be safe to avoid injury and
treated to help infection control
 Integrated, demand-controlled heating and ventilation
ensures a healthy indoor air quality, maximises comfort and
saves money

How to reduce your energy
costs without reducing
comfort or safety
NHS Sustainability Day 2016 – London
Barts Health NHS Trust, 25th February 2016
Phil Marris, Managing Director, Jaga Heating Products (UK)

Vasco Dimitroff
Corporate Affairs

Mission:
To reduce global water
consumption by
1%

 Water efficiency experts for 20 years
 Advisors to the Government since 1999
 Lead consultants of Watermark

 Major improvements
 Metering
 Billing
 Reporting

 Wider ranging
 Greater detail
 Robust

£500 million per annum in lost
revenue, which if saved coincides with a
30% reduction in water use

London’s Total Annual Water Consumption

…or filling this room 1 million times over

What this means for the NHS
 10 million m3 per year
 £24 million

500Different Building
Benchmark
Classifications

 3 years free bill validation
 Electronic water consumption profiles
 Identification of high consumption anomalies
 A benchmarking toolkit

 More accurate reporting on water
 Prepare for deregulation from 2017 and;
 Tools to potentially reduce your water bill by a
third

 We provide you with an email to send
to your water supplier
 They send your future bills to us for
benchmarking assessment and
validation
 Within 24 hours of receiving them, we
send your now validated bills onto you

 Climate Change
 Rapid Population Growth
 Economic Development

True water management
- comprehensive approach

@adsmUK
#AquaMark
Your Participation
AquaMark@adsm.com
01753 833 880
www.adsm.com
Thank you

Lucy Saunders - Public Health Specialist – Transport & Public Realm
Improving the health of Londoners – 1 year into delivery

315
• TfL has duties to improve the health of Londoners
under the Mayor’s statutory duties. Local authorities
in London hold statutory public health duties,
budgets and specialist staff since the Health & Social
Care Act 2012.
• In February 2014 TfL published the world’s first
transport health action plan.
• The plan set out 10 actions that TfL would take over
3 years to more explicitly recognise and demonstrate
our role in improving the health of Londoners.
• This document also sets out the evidence base for
the impacts of transport on health in london, the
policy context, useful tools and resources.
• Each year TfL publishes an annual progress report.
• Lucy Saunders, TfL’s Public Health Specialist,
coordinates TfL’s health work programme including
the delivery of this action plan
lucysaunders@tfl.gov.uk
TfL’s Health Action Plan
The report focuses on the
main health impacts of
transport in London:
• Physical activity
• Air Quality
• Road traffic injuries
• Noise
• Access and severance

316
More than 2 million Londoners
need to build some walking or
cycling into their daily routine.
London’s transport & streets keep people active
4 in 10 adults
7 in 10 children
in London
are not active
enough

London’s transport & streets are central to good health

We can only get more people walking and cycling more often if we change the look and feel
of our streets.
Streets need to feel welcoming places to be, that means tackling air pollution, noise and
road danger too.
10 indicators of a Healthy Street

How do you make a tool valid for all types of street?
321

2014 and 2015 combined data
65 sample sites and 6,702 respondents
City Hub
Local Street Town Square City Place
High Street City StreetConnector
Core Road
11 sites
1,239 respondents
High Road
LocalsignificanceStrategicsignificance
Local significance Strategic significance
7 sites
715 respondents
8 sites
843 respondents
7 sites
705 respondents
10 sites
1,108 respondents
4 sites
348 respondents
8 sites
836 respondents
5 sites
447 respondents
5 sites
461 respondents

Objectives of our survey• One tool that can be applied to all streets in
London
• Asking people about their experience there & then
• Including experience elements – noise, smell,
feelings
• Differences between different types of street?
• Differences between ‘experience’ & ‘expectation’?

Survey summary
• Attractive
• Clean air
• Noisy
• Enjoyable
• Ease of crossing
• Somewhere to rest
• Finding shelter
• Intimidation by traffic
• Stressful experience
• Safe from crime & antisocial behaviour
• Safe from road danger

Questions grounded in the ‘here and now’
Example question: How clean do you think the air on this
street is today?
• Please give an answer between 0 and 10 where 0 means you
think the air on this street is not at all clean and 10 means you
think the air on this street is extremely clean
Not at all Extremely
0 1 2 3 4 5 6 7 8 9 10
Are you finding
this street noisy?
How easy do you think
it would be to cross
this street?
How safe from crime
and anti-social
behaviour do you
feel on this street
today?

Average score for each indicator

Londoners expect the streets to be healthier

Building stronger business cases
331
We are strengthening our systems for setting out the health
benefits in our business cases.
This enables us to build a strong case for many of the projects
in our roads modernisation programme which will improve
‘place’ function and increase active travel.
• Trained over 150 transport and public health practitioners
to use the HEAT tool
• Published a manual for practitioners in London to
monetise health benefits in their business cases
• Identifying new health measures that can be quantified
and monetised for inclusion in business cases
The business case for the
Cycling Vision included the
health benefits from increased
physical activity and reduced
sickness absence.
These benefits made up a third
of all the monetised benefits.

332
We are supporting boroughs to deliver
their new public health responsibilities
through their transport policy, planning
and practice.
• Our public health specialist offers
bespoke input to all boroughs in the
form of advice, presentations to
boards, data and briefings.
• Training is offered to all boroughs
on monetising the health benefits of
transport interventions and writing a
chapter on transport for their Joint
Strategic Needs Assessment.
• Borough-specific data on active
travel was published in a special
health evidence chapter of Travel in
London 7 to support local policy
making.
Supporting boroughs
Average
time spent
walking
per person
per day for
London
residents
by
borough
2013/14
Source:
Transport in
London 7
(TfL 2014)
Launch of ‘Transport & Health in London’ at the Hackney Cycling
Conference
Borough specific data on active travel & health published in Travel in
London 7

333
• Transport & Health in London models the impact on the health of Londoners of a range
of different transport scenarios
• Improving the health of Londoners sets out the evidence base for the major health
impacts of transport in London
• Health Impacts of Cars in London was requested by health professionals to show the
local picture
• Travel in London 7 & 8 each included a special chapter on the role of the transport
system of enabling Londoners to meet their physical activity needs. Car ownership is the
biggest determinant of low activity levels.
Building the health evidence base

334
• Strengthening our Health Impact
Assessments
• Strengthening the London Plan
• Working with government
• Working with academic institutions
• Supporting our staff and other
businesses to travel actively
• Encouraging the NHS to conduct
travel analysis
And plenty more....

Closing comments
Professor Hugh Montgomery MB BS BSc
FRCP MD FRGS FRSB FRI FFICM
UCL Professor of Intensive Care Medicine
Consultant Intensivist, Whittington
Hospital
#Dayforaction

Nhs Sustainability Day 2016 London Road Show

Recomendados

Recomendados

Más contenido relacionado

La actualidad más candente

La actualidad más candente (8)

Similar a Nhs Sustainability Day 2016 London Road Show

Similar a Nhs Sustainability Day 2016 London Road Show (20)

Más de 4 All of Us

Más de 4 All of Us (20)

Último

Último (20)

Nhs Sustainability Day 2016 London Road Show