NHS Sustainability Day London Roadshow

Welcome to NHS Sustainability
Day London Roadshow
#Dayforaction

Award entries open from today
Enter at
nhssustainabilityawards.co.uk

Morning Agenda
09.30 Chairs Introduction
Professor Anthony Kessel, Honorary Professor and Co-ordinator of the International
Programme for Ethics, Public Health and Human Rights (IPEPH) at the London
School of Hygiene & Tropical Medicine (LSHTM)
09.45 Opening address: One Public Estate
Joe Garrod, Regional Programme Manager, One Public Estate, Local Government
Association
10.05 FM in 2026: How we made Sustainability matter
Sunil Shah, Chair, BIFM, Sustainability Special Interest Group
10.25 Leadership strategy: engaging clinicians
Dr Sarah Hammond, Anesthetic Consultant, St George’s University Hospital Trust
10.45 CSR as Economic Futureproofing: What can we learn from the private sector?
Robert Barnard-Weston, Founder, Groundswell
11:10 Question and Answers
11.30 Refreshments & Exhibition

Chairs Introduction
Professor Anthony Kessel, Honorary Professor and Co-
ordinator of the International Programme for Ethics,
Public Health and Human Rights, The London School of
Hygiene & Tropical Medicine

Sustainability Day
London
October 4th 2017
ProfessorAnthonyKessel
PublicHealthEngland
LondonSchoolofHygiene&TropicalMedicine

Introductory Remarks
• Sustainability and climate change inter-related
• Current levers: air pollution, Sustainable
Development Goals (SDGs)
• Effecting change: psychological considerations
6

“Theworldaswehavecreateditisaprocessofourthinking.Itcannotbechanged
withoutchangingourthinking”(AlbertEinstein)

Direct and indirect health effects of
climate change
• Impacts on health and
wellbeing
• Impact on health services –
demand, business continuity,
supply chains
• Impact on infrastructure
(utilities)
• Economic impacts
• Community
resilience/cohesion
8

Mortalitylinkedtooutdoorairpollution
(Lelieveld et al, 2015)

Estimates of annual air pollution deaths
(WHO 2014)
Air pollution mortality: outdoor and indoor

HealthEffectsof AirPollution
“New estimates from the
Global Burden of Disease
project and the World Health
Organisation state that
between 5.5 and 7 million
people die from air pollution
every year. That’s more than
die from malaria and
HIV/Aids put together; more
than the population of
Scotland. In the next 10
years we can expect as many
people to die from breathing
poisonous air as were killed
in the second world war.”
http://gu.com/p/4gnnx/sbl
[2016]

LANCET / ROCKERFELLER COMMISSION ON PLANETARY HEALTH
Integrating Planetary Health with the Sustainable Development Goals

Transformation towards Sustainability
Key challenges, and psychological considerations
1. Am I ready for change?
2. Is the organisation / institute ready for change?
13

We know climate change is happening
There is now no scientific doubt. Emissions from burning fossil fuels are driving global climate
change, warming our atmosphere and oceans, melting ice and driving an increase in extreme
weather events. Some of the greenhouse gases we emit can last for thousands of years in the
atmosphere; if we continue this way, life on earth will change dramatically.
We know the consequences of climate change
As a result of climate change, infectious diseases may spread; heat waves, droughts, wildfires, floods
and sea level rise will disrupt communities, harm health and kill people. Climate change is also a
driver of starvation, migration, poverty and conflict. A business-as-usual approach will lead to global
warming that is incompatible with any reasonable characterisation of an organised, equitable and
civilised global community. We need to act now to protect the planet and with it our health.
What can you do to help?
We can all contribute to improving our family’s health and wellbeing and that of future
generations. Your actions do count; to minimise environmental impacts, to slow down our
personal contributions to climate change and to protect public health. Specific examples are
suggested below.
This is how: One Small Step
The Director General of the World Health Organisation has raised the alarm on climate change, so
what can you do? Here are a few suggestions, each a small step, that you may want to adopt to
make a real difference:
- Consider switching to a greener energy supply that offers energy generated in a renewable or
sustainable manner.
- Eat fresh locally produced foods and fewer processed foods for a month
- Get out and enjoy your local green spaces – aim to go for a walk with a friend once a week
- Try walking or cycling for short journeys, instead of using your car
- Buy energy efficient products – check the energy efficiency labels when purchasing new
appliances
- Reduce, reuse, recycle – see if you can cut down on one bag of rubbish each week
Investigate how you can make your home more energy efficient – can you insulate and get smarter
about energy use?
Further information about energy suppliers and other ways you can be more sustainable are
highlighted in the websites below:
http://www.ethicalconsumer.org/buyersguides/energy/greenelectricitysuppliers.aspx
http://www.energysavingtrust.org.uk/domestic/content/buying-green-electricity
http://www.sduhealth.org.uk/areas-of-focus/carbon-hotspots/travel.aspx
‘One Small Step’ To protect our planet and our health
http://www.nhssustainabilityday.co.uk/one-small-step/

Change (or the idea of change) and uncertainty
• Problematic area for humans
• Big challenge for organisations
• Some people manage better than others
• Premised on fear and insecurity (about the future)
15

Uncertainty and change: how does it appear?
• Memory and imagination (drawing on the past)
• We live in a thought-generated experience of reality
• Insecurity: expectations about the future
• Human beings cope well with EVENTUALITIES but
poorly with POSSIBILTIES
16

Effecting change: letting go (of resistance)
• Connection / Rapport / Trust / Authenticity
• Pointing in the direction of understanding the
nature of resistance to change
• Avoid enforced ‘positive thinking’
• Prudent preparatory planning and responsiveness
• Letting go (of resistance to change) allows fresh
thinking, hopefulness, creativity, a feeling of what
is possible rather than impossible
17

One Public Estate
Joe Garrod, Regional Programme Manager, One Public
Estate, Local Government Association

One Public Estate
Joe Garrod, Regional Programme Manager, Local Government
Association

● £31m to reach 95% by March 2018
● Working with:
○ 255 councils in 63 partnerships
○ 13 main government departments
○ 400 projects – over a quarter involve
partnership working with health bodies
● Already delivered:
○ £27.6m capital receipts
○ £20m running cost savings
○ Over 5,500 jobs
○ Land released for over 550 homes
Where we are now

£615m £158m
44,000 25,000
Land released for housing
Running cost savingsCapital receipts
Jobs
What we will deliver
by 2020

● The essentials
○ Asset mapping
○ Shared vision
○ Bring public sector partners
together
○ Partnership with senior buy-in
○ Seed funding and ongoing
support
○ Clear vision and programme of
work
How we work
● Partnership support
○ Funding
○ Support from LGA and GPU
○ Access to central government
○ Best practice and case studies
○ Opportunities workshops
○ Support to change policy
○ Support on benchmarking and
data

● Nearly 20% of the acute estate predates the formation of the NHS
● Backlog maintenance presents a £5bn liability to the system
● £10bn extra capital is required to enable the delivery of STP plans
● Estate highly fragmented - NHS PS and CHP own 15% of total land
● 7,600 GP practices – many small and ill-equipped for the shift to out of
hospital care
● Commercially executed disposals could generate between £2bn and
£5.7bn for reinvestment
● Lack of strategic leadership in place to deliver the changes required
The Naylor challenge

London Health Devolution
National/
Regional
Stakeholders
London Estates
Board
LEDU Steering
Group
STP/CCG
Estates
Groups
London Estates
Delivery Unit
Key Themes
• £2.7bn reinvestment in health estate
• Release of surplus land for homes
• Co-location and service integration
• New primary care provision
• Rationalisation of GP estate
• Upgrading, and closure, of acute care settings
• Step down housing / community based care
• Feasibility studies / masterplans to facilitate
the above
Key Challenges
• Tension between maximising initial capital
receipts and the lowest cost overall solution
• NHS LIFT expensive, inflexible and ties up
revenue in the long term i.e. 30 years

Bedford Town Centre
Regeneration
● c£900k development funding
● 2,300 new homes and 1,400 new
jobs
● Town centre regeneration: Station
Gateway/Ford End Road,
Riverside, Hospital South and
North sites
● Health hubs – unlocked £2.33m
Estates & Technology
Transformation Fund

Mixed-use redevelopment of the CCG
HQ and an adjacent mental health unit
• Impact to date:
o CCG has saved c£300k pa due to
co-location
○ £3m receipt plus overage to NHS PS
• Future impact:
○ Trust will save c£300k pa due to exit
from mental health unit PFI deal
○ New GP surgery
○ 150 new homes
221 Erith Road Options
Strategy, Bexley

● NHS bodies, councils and central government need to work together
in an open and transparent way to be successful
● Strong governance/ leadership and joint decision making with a broad
range of public partners
● Your strategic objectives should be the driver for your work, your
assets the facilitator
● Take a portfolio approach – include system-wide, strategic and tactical
initiatives
● Integrated health and social care, community based services and new
housing are key themes being delivered by OPE partnerships
Lesson learnt

Funding round open
One Public Estate
● £9m revenue funding
● £7m grant funding
● £2m loan fund for
established partnerships
DCLG Land Release Fund
● £45m capital fund
● Release local authority owned
land by 2020 for housing
Partnerships can apply for either or both pots of funding

FM in 2026: How we made Sustainability matter
Sunil Shah, Chair, BIFM, Sustainability Special Interest
Group

Sunil Shah, Chair,
Sustainability Special Interest Group
FM in 2026:
How we made
sustainability matter
NHS Sustainability Roadshow
4th October 2017

BIFM Sustainability SIG
Aims & Objectives
> Act as a centre of excellence for
knowledge and opinion within the FM
sector
> Promote best practice, awareness,
participation and learning
> Inform the facilities community and other
stakeholders about the importance of
effective sustainable development
practice to create a framework that allows
an active business contribution

What do we do?
> Collaborate with others
 Regions/Other SIGs
 IET Energy Group Member
 Fairplace Award
 MEUC
> Consultations
> Annual Sustainability Survey
> Good Practice Guides
> Events
> Articles & Newsletters
> Follow us on twitter @BIFM_Sust

What happened in 2007
> 11 people died in UK January storms -
container ship ran aground in Devon
> Kryptonite was discovered – its white
and doesn’t glow
> Summer flooding - Teweksbury
> Madeleine McCann disappeared
> Tony Blair handed over power to
Gordon Brown
> Bank rates up to 5.25%
> iPhone launched

Looking Back on the First 10 Years

Global Influences
REGULATION
- Energy & Carbon
- Social & Human
Rights
GOVERNANCE
- UN Sustainable
Development Goals
- Paris agreement
INVESTORS
- CDP, DJSI
- Ethical funds
BEHAVIOURAL
- Business culture
- Leadership

Today’s Emerging Themes
Technology
> use of BIM, diagnostics and personal information provides
real time information to inform the building lifecycle
Social Factors
> synonymous with sustainability as environmental factors
> include pay, diversity, human slavery and social value
Informed Decisions
> evidenced based approach to wellbeing, productivity and
lifecycle

Technology in 2026
Business As Usual
• Sensors, off-site building
management systems,
diagnostic tools standard in
new and refurbished
locations
• Real time information
available to make decisions
and understand performance
• Build in occupant and
customer feedback
• Off-site management and
support – removes local need
for expertise
Dependencies
• Increased reliance on correct
design, installation and set-
up
• Need to understand systems
during moves and small scale
changes
• Potential overload of data –
need to sort out what is
important

Social Factors in 2026
Business As Usual
• Regulatory disclosure and
tracking for staff and
supply chain activities
• Social value built into
contracts and performance
measurement
• Adaptability to understand
and encompass local
requirements
• Integrate wellbeing into day
to day activities
Dependencies
• Procurement models to
reflect sustainability
measures and culture
• Mapping of local social
requirements – community
led

Informed Decisions in 2026
Business As Usual
• Real time information
allows sustainability to be
part of core leadership role
• Increasingly automated
responses being provided
to the operation of
facilities, set-points
• Ability to interrogate and
identify optimum solutions
for capital projects
• Value add response rather
than compliance based
Dependencies
• Structured sustainability
framework throughout the
business
• Reliance upon third party
data – will require
validation

How do we get there?
Procurement
> Focus on lifecycle benefits and outcome measures rather
than bottom line costs
> Measures and metrics aligned with organisational culture
Professional Standards
> Used to embed skills reflecting tomorrow’s business
Initiating Change
> proactive role in the organisation to identify and drive
innovation
Value Add
> Identify and deliver solutions that benefit the financial and
non-financial bottom line - not just “compliance”

0%
20%
40%
60%
80%
100%
0% 20% 40% 60% 80% 100%
Management
Implementation
1
2
3
Top group characteristics of:
> Clear leadership and accountability;
> Networks of opportunity and
engagement;
> Investing in the future of energy
and people;
> Long-term strategic planning, and;
> A culture of sustainability
> Emerging groups with distinct
characteristics
> How well value of sustainability is
understood
> How well this value is communicated
http://www.acclaro-advisory.com/sustainable-fm
SFMI Key Findings

Sustainability Strategy
> Developing a 3-5 year programme with BIFM,
Government and related bodies
> Drive data capture, embed practices and
demonstrate value
> Focus areas on:
> Lifecycle environmental impact in buildings
> Social Impact
> Opportunities to support the programmes

CSR as Economic Futureproofing: What can we learn
from the private sector?
Robert Barnard-Weston, Founder, Groundswell

Corporate Social Responsibility
as Economic Future-Proofing
What can the NHS learn from the
private sector?

…but could this be an opportunity in disguise: the evolutionary entrepreneurs’
chance to shine?
The NHS: in a vicious circle …or not?

Some Notable CSR Successes:
• M&S Plan A
• Body Shop
• Tesla

Some Notable CSR Disasters:
• BP
• VW
• NatWest

Some notable community-focused CSR
successes:
• Asda and Urban Poverty
• National Grid
• The Thoughtful Coffee Company

“What makes or breaks consumers'
experience with a brand is… these five
things:
• Transparency;
• A deep understanding of customers;
• Respect;
• Authenticity; and
• A willingness to be open and honest
about both its strengths and
weaknesses.”
Customer Quotient Analysis, 2016 - Adage

Brand Equity = TRUST
Body Shop re-examined

…and the Number One brand of which
the British people are most proud is…

Unless…
However, the Catch-22 remains…

Q: What is the difference between Corporate Social
Responsibility and Corporate Social Investment?
A: A well-planned investment is designed to make a
specific difference AND pay a measured return to its
investors.
CSI does this by measuring and reporting not only
inputs but also outputs and outcomes, tangible and
intangible, in all significant areas.
CSR vs CSI

THE BOOTSTRAP MODEL:
• Quick Wins
• Win-Wins
• Pioneering Wins

• Estates/FM
• Waste
• Water
• Energy
• Transport
• Food
• Procurement
• Partnerships
• Employee Engagement
• Patient/Community Engagement
High ROI Areas:

Integrated CSI Communications
INTERPERSONAL
COMMUNICATIONS
ARTEFACT-BASED
COMMUNICATIONS
INTERNAL COMMS
Stakeholder Engagement I
Qualitative Research
Quantitative Research
Learning & Coaching
Intranet
Staff Magazines
Management Briefings
EXTERNAL COMMS
Stakeholder Engagement II
Seminars
Conferences
Events
Annual Reports
PR
Website
Social Media
• Dialogue replaces monologue
• Iterative, evolutionary process

A Shared, Uniting Agenda that:
• Connects together existing projects
• Maximises Return on Investment
• Links partners across STPs
• Activates Sustainable Development
Management Plans
• Advances 5-Year Forward View performance
• Supports Carter, QIPP, CIP, CQC 5 Key Questions
Joining up the Dots…

Finally:
GOAL GROUPS and the
HEWLETT PACKARD
STORY…

Reuse as a gateway habit for behaviour change
Alexander Ford, Sustainability Co-ordinator, The
Shrewsbury and Telford Hospital NHS Trust

• 6,000 staff
• 2 main sites, 19 miles apart
• Plus 6 satellite areas

• To use current resources in a sustainable way.
• Encourage staff to recycle and reuse
equipment rather than sending it to landfill.
• Save £££
Why Warp-it

Warp-it Timeline @ SaTH
2015 Launch
• Membership peaks at 50 staff
• Few items listed
2016 Re-Launch - November
• Corporate Social Responsibility committee asked to reinvigorate Warp-it
• 120 staff joined the Warp-it community
• 205kg of Co2 saved
• £589 saved
2017 To date
• 433 staff members joined the Warp-it community
• 5179kg of Co2 saved or 7 trees
• £9,470 saved

How we used a
“warp drive” for Warp-it
Involve all departments:
• Procurement – Warp-it link added to purchasing system
• IMT – Warp-it links on the Intranet page & “sticky topic” on Trading Post
• Facilities – Liaised with porters and external transport provider
• Estates
• Kaizen Promotion Office
Promotion:
 Launched targeted Warp-it poster campaign
• Ward clerks
• Department managers
 SaTH global email campaign

An Extra Boost!
Offered free one to one staff training:
• How to add a picture
• Add a meaningful description
• Adding an item to your wish-list
Creating a feel good effect:
• Offering staff a reward for a successful posting

Continuous Updates
Dear Colleague,
Our Trust has implemented an equipment re-use and management system called
Warp-it.
Warp-it makes it very easy for you to loan or give surplus items that you no longer
need to other staff in the Trust.
The scheme helps the Trust to save money and reduce disposal costs, carbon
emissions and sending waste to landfill.
Some items listed on Warpit on 17.08.2017

Add Feedback
to your message
“I found using Warpit very easy and straight forward to use and it has worked very
efficiently. I will be recommending it to my colleagues within the department. Many
thanks again for popping over and assisting me in the initial set up, I will have no
problems using this again in the future.”
(Healthcare Science Support Worker).
“It is my first port of call if we need anything for the offices. It is always worth
seeing of any pre-loved items could be given a home before spending unnecessarily
on new items. The system works for us.”
(Legal Services).
“Woo Hoooo ;-) Now I know how to do it, I am going to add our other items.”
(Clinical Trials Dept).

Repeat your message
What items can be reused through Warp It?
• Reusable furniture
• Electrical equipment
• Fixtures and fittings
• Office consumables (such as stationery, ink jet cartridges, new clothing)
So, if you have an item that is taking up space that you do not need, put it on Warp It.
Or if you are looking for an item check Warp It before you buy new!
How do I register?
Visit our homepage here: https://www.warp-it.co.uk/company/sath Best viewed in
Google Chrome.

Challenges & Opportunities
 A community of 500 SaTH Warp-it users
 How do we tap into the global resource of Warp-it
• Collection and external transport costs
• Temporary storage facilities
 Health & Safety / Infection control concerns
 An online forum of NHS Warp-it champions
• To share successes
• What didn’t work?

Funding energy efficiency to create a sustainable NHS
Vikas Ahuja, Energy Manager from Imperial College
Healthcare NHS Trust, Laura Couldrey and Sameen
Khan Client Support Officers, Salix Finance

Laura Couldrey
Client Support Officer, Salix Finance
Vikas Ahuja
Energy Manager, Imperial College
Healthcare NHS Trust
100%
INTEREST
FREE
@SalixFinance #SalixFunded

Opportunity for savings in the NHS
Knowledge sharing and case studies
Salix Finance and Imperial College
Healthcare NHS Trust
To demonstrate how Salix can help Trusts
and Foundation Trusts
Summary of the loan application process
Our aims for today

Benefits of Energy Efficiency
Reduced revenue expenditure
Improved patient, visitor and staff comfort
Maintenance savings
Estate backlog
Improved resilience
Over the next 10 years the Department for Business Energy
and Industrial Strategy (BEIS) estimate that:
Electricity prices will increase by 5p per kWh (46%)
Gas prices will rise by 1.75p per kWh (71%)

Introduction to Salix funding

Who we are
Not-for-profit company established in 2004
Funded by BEIS, Scottish and Welsh Government, EFA and DfE
100% interest-free capital finance for the public sector
Over 100 technologies funded
Supports public sector bodies such as local authorities, educational
establishments and NHS Trusts and Foundation Trusts
NHS Improvement approve of Salix’s Invest to Save model

Our innovative funding model
Client
contribution
(were
applicable)

Salix’s work with the NHS
* Calculated using emissions
factors published by government
for carbon footprinting
Figures as of April 2017

Top 10 Salix clients within the NHS*
Total Fund
Imperial College Healthcare NHS Trust Above £8 million
Wrightington, Wigan and Leigh NHS FT Above £5 million
George Eliot Hospital NHS Trust Above £3 million
Northern Devon Healthcare NHS Trust Above £2 million
University Hospitals Of Morecambe Bay NHS FT
Lewisham and Greenwich NHS Trust
Hinchingbrooke NHS Trust
Bradford Teaching Hospitals NHS FT Above £1.5 million
St Helens & Knowsley Teaching Hospitals NHS Trust
The Princess Alexandra Hospital NHS Trust
* By loan value up to financial year 2016-17

Case Studies
Project Knowledge
Slides
Social
Media
@SalixFinance
#SalixFunded
News &
Blog
Best Practice
Calculations

Salix Events
Salix host free annual regional meetings for the public sector
Queen Mary University, London, 13th October
University of Manchester, 20th October
Hampshire County Council, 10th November
Gateshead Council, 17th November
Nottingham City Council, 1st December
CHP workshops
University of Liverpool, 10th November
University of Birmingham, 24th November
London, 6th December
Private Sector workshops
London, 28th November
Manchester, TBC

Salix Finance and Imperial College Healthcare
NHS Trust
Hammersmith Hospital
Queen Charlotte’s and Chelsea HospitalCharing Cross Hospital St Mary’s Hospital
Western Eye Hospital

Achievements of Imperial so far

Imperial’s projects since 2010
Project Type Value
No. of
project
Annual £
Savings
Lifetime £
Savings
Annual
CO2
savings
(tonnes)
Boilers £599,664 1 £154,660 £1,674,968 792
Building management systems £2,949,301 6 £832,971 £7,159,133 5,234
Heating £193,339 1 £63,970 £972,358 394
Heating and hot water £954,769 4 £267,770 £5,956,919 2,377
LED lighting £886,250 3 £221,343 £2,877,469 1,075
Lighting upgrades £673,260 6 £159,988 £3,199,775 1,090
MPS £219,108 1 £117,877 £1,032,042 906
Street lighting £190,950 1 £43,142 £862,853 294
Transformers £177,414 1 £54,729 £1,641,883 373
Ventilation and cooling £106,000 2 £22,498 £256,901 129
Voltage Management £640,007 1 £150,491 £2,859,343 1,027
VSDs/Motor Controls £816,280 6 £183,876 £1,886,571 1,147
Grand Total £8,406,344 33 £2,273,322 £30,380,220 14,837

Benefits to Imperial
Patient and staff comfort improved
Reduced revenue expenditure
Lighting/LED upgrades have seen a reduction in labour costs on
reactive maintenance
Improved resilience
Supported in capital investment when internal is not available

Lessons learned
Timescales
Stakeholder management
Next steps
Condensing flue gas economiser at Charing Cross Hospital
Draught proofing
Burner upgrades
Lighting improvements

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

Feasibility
Internal
Consultation
Procurement Mobilisation Installation
Business case
checks
Meet with finance
department
Offer reservation of
funding for Trust Board
Workshops and calls with
other Trusts for advice
Interim Payments
Phase works over
financial years
How Salix can support your application

Key Application Steps
1. Visit our website at www.salixfinance.co.uk
2. Simple on-line application process
Application in five easy steps
Download a project compliance tool
For projects valued over £100,000 – business case template
3. Public Sector Body or supporting body submits application
4. An automated email is generated and sent to the authorised official
which they need to reply to confirm their approval
5. Application assessed & decision made typically within two weeks
1
2
3
4
5

Summary
100% interest free funding available for NHS
Trusts and Foundation Trusts – no maximum
loan amount
Cost neutral - repaid through savings to the
energy bill
Helping the NHS achieve energy and carbon
reduction targets
Supporting long-term funding plans, SDMPs,
estates strategies
Reduce energy bills at your Trust

Smart Cities and how they have the potential to be an
integral part of Health & Social Care- Mark Griffiths,
Regional Director, Bouygues E&S FM UK Ltd

Mark Griffiths
Regional Director
Bouygues Energies & Services

Smart technology - can it be an integral part of
Estates & Facilities in Healthcare?
AGENDA:
• Introduction
• What is Smart
• Delivering Smart
• Delivery
• Drivers and Benefits

The Bouygues Group: Building Smart Cities
Communications Construction Power
£36 B turnover

Bouygues’ French Headquarters - Challenger
First building in the world to achieve triple certification (2011)
• LEED® “Platinum” (US)
• BREEAM® “Outstanding” (UK)
• HQE® “Exceptional” (FR)
Delivery Challenge
• Phased works from 2010 to 2014, Shifts over 67,000m2
• Occupied site
Energy
• 90% Energy and CO2 savings
• Ventilated, double skin façades
• Geothermal energy from heat pumps
• 100% of available BREEAM energy credits achieved
• 25,000m2 photovoltaic panels on roofs, terraces and solar farm
Water
• Rainwater harvesting
• 60% water savings
• 100% of sewage will be treated and re-used on site (phyto-filtration garden)

Process – Identify the needs
Public Spaces
Infrastructures
Housing
Public amenities
Commerce and
business
New
usages
Local
services
Nature in the
city
Water Energies Wastes Mobility Digital

GreenCity – Zurich
2000W Community
Today
5.000 W/hab
Accomodation
1.500 W
Transportation
900 W
Consumption
1.100 W
Infrastructure
900 W
Electricity
600 W
Goal
2.000 W/hab

The Art of the possible….
• 700 bed hospital
• 1,800,000 sg ft of GIA
• Automatic tinting windows using IP
technology
• Full fresh air ventilation systems
• Gains in efficiency of Healthcare
staff
• Real time data available both
clinically & estate wise
• Efficiency in bed utilisation /
optimisation
• 50% reduction compared to a
typical model hospital
• A single source of data & benefits…

Scheduling
Data
(HIS)
Staff
Locations
(RTLS)
Nurse Call
System
Unified
Comms
Real Time
Audit /
Analytics
Nurse / Bed
Assignments
(HIS)
Agent keeps track
of people, locations,
Schedules, Roles,
Beds, Assignments
Nurse Agent receives
notifications for the
attached user and
interacts with them…
Nurse Assist
Agent identifies the
right nurse and notifies
them
Track everything
in real time
Capture Nurse
Call Events
Intelligent
Alerting
Voice call
initiation
Workflow
Management
End Users and
Computing Devices
Data, System and
Healthcare Things
Interaction InterconnectionIntelligence
ThoughtWire makes everything smarter…Nurse Assist - Receive and respond to nurse call
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Drivers for now and the future…

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Easing Parking Pressure and Encouraging Active Travel
Bernard Stebbing, Account Manager, Basemap

Easing Parking Pressure and
Encouraging Active Travel
Bernard Stebbing, Account Manager
Basemap

PARKING PRESSURES IN NHS
• Pressures of hospital car parking constantly in
the news
• Reduce the number of car parking spaces &
introduce a sustainable parking permit system
• Parking very emotive
• Complaints about lack of spaces
• People who could travel by alternative means or
park somewhere else
• Need fair system for monitoring and controlling
to ensure spaces allocated in the best way

ENCOURAGING ACTIVE TRAVEL
• Active travel relieves parking pressures &
encourage staff health and wellbeing
• Promote cycle to work and car share scheme
- Provisions for cycle racks & showers
• Communicate the benefits of walking/cycling
• Highlight public transport options & routes
• Collaborate with local transport
partnerships/companies
• 2030 target of reducing carbon emissions by
40%

OXFORD HEALTH NHS FOUNDATION TRUST - THE PROBLEM
• Needed to introduce sustainable car parking permit system following increase
pressure on parking
• Increase due to business growth, changes in services & staff travelling further
• Health & safety issues - cars blocking emergency access
• Wanted to increase active travel & reduce congestion around hospital
• New car parking management system needed to be fair to all
• Manage over 100 sites
• Straight line or circle approach not sufficient - important to look at travel time &
consider all variables

▪ Quick easy analysis of travel time and distance
• Public transport (all modes)
• Car
• Cycle
• Walking
▪ Can adjust the transport network
• Add new roads, exclude dangerous roads
• Add or remove a bus service
WHAT IS TRACC?
• Outputs
• Travel time contours maps
• Origin to destination
time/distance spreadsheets
• Origin to destination path report
• Demographic data reports
• Catchment maps

OXFORD HEALTH NHS FOUNDATION TRUST: THE SOLUTION
Get the union to decide to cut off travel times
• 25 minute Cycle
• 25 minute Walk
• 45 minute public transport outbound – morning peak
• 45 minute public transport Inbound – afternoon peak
Analyse every postcode within a 2 hour buffer
• New and Existing Staff
• Results outputted as a large CSV file
• Results imported linked into existing HR system
• Gave a score where travel time was an element
Change in travel behaviour after system went live
• Increase in active travel
• Reduction in congestion
• Robust evidence for appeals

OXFORD HEALTH NHS FOUNDATION TRUST: THE SOLUTION

“If we hadn’t had TRACC, our only alternative would
have been a system that wouldn’t have considered public
transport options and we wouldn’t have been able to
achieve these very detailed results”
“We have seen an increase in people travelling a
different way & finding different solutions as a result”
Tanya Street, Estates & Facilities Business Change Manager at Oxford
Health NHS Foundation Trust
www.basemap.co.uk/oxford_nhs

HOW IS TRACC USED IN OTHER NHS DEPARTMENTS?
• Distance: staff and patient
access to NHS sites
• Travel times to NHS sites for
staff and patients using postcode
data
• Have an educated look at bus
subsidies
• Looking at public transport
access to NHS sites
• Impact on service cuts

HOW IS TRACC USED IN OTHER NHS DEPARTMENTS?
• Look at new developments and
impact of site/unit closures on staff
and patients
• Use TM-Speeds data to look at car
driving times
• Look at catchment areas of
hospitals and services
• Look at commissioning of new
and existing health services

NHS STROKE SERVICES: CASE STUDY

WWW.BASEMAP.CO.UK/NHS-STROKE-SERVICES

NHS Sustainability Day Case Study: Guy's and St
Thomas' NHS Foundation Trust
Teresa Agudo, Sustainability Officer, Guy's and St
Thomas' NHS Foundation Trust

NHS Sustainability Day Case Study: Manchester
University NHS Foundation Trust (MFT)
Claire Igoe, Acting Head of Environmental
Sustainability, Manchester University NHS Foundation
Trust

Delivering Sustainable
Healthcare at MFT
our story so far…
Claire Igoe
Acting Head of Environmental Sustainability
Manchester University NHS Foundation Trust

Background
Large multi-site Acute NHS
Trust
18,500 members of staff
New city-wide hospital Trust
was formed on the 1st
October 2017

Key delivery areas
Sustainability
Behaviour
change and
staff
awareness
Waste
reduction
and reuse
Sustainable
Travel
Energy &
water
efficiency
Sustainable
Development
Management
Plan (SDMP)

Context
412,000 m3
175,000 MWh 4,300 tonnes
26 million
miles

Energy and water efficiency
Rolling programme of day and night
energy audits
Maintain active pipeline of schemes
• Housekeeping projects
• Refurbishment enhancements
• Lifecycle programme upgrades
• Stand alone energy saving schemes
Delivered so far in 2017/18;
• Car park LED lighting scheme
• Upgraded Catheter Theatre controls
• Steam Infrastructure Audit
• Variable Speed Drives
• Plant room insulation

Waste reduction and reuse
• Rolling programme of waste
audits to check segregation
• Improved bin labelling and
developed waste e-learning
• Engage staff
• Introduced offensive waste
stream in 2014

Waste reduction and reuse
Warp It - saved over £100k in
18 months
At source waste segregation
and recycling – e.g. chewing
gum, theatre masks, paper,
food, coffee cups
Public area recycling trial

Staff Engagement
Events programme Dedicated email account Monthly E-Newsletter
Staff Groups Green Impact

Green Impact
Most successful staff
engagement channel
Environmental accreditation
and awards
Started in 2013 - now in our
4th cycle
Student support

Sustainable Travel
Target: 10% shift in single
occupancy car travel
Focused on;
• Improving our sustainable
travel infrastructure
• Providing staff with
information on their travel
options
• Engaging staff with
sustainable and active
travel

0
50
100
150
200
250
2009/10 2013/14 2014/15 2015/16 2016/17
Carbon
Emissions
(tCO2)
Thousands
Year
Total Carbon Emissions by Source
Procurement
Travel
Water
Waste
Energy
0
50
100
150
200
2009/10 2013/14 2014/15 2015/16 2016/17
Carbonemissionsperpatientcontact
(kgCO2/Pc)
Year
Organisational Carbon Footprint
per Patient Contact
Procurement
Travel
Water
Waste
Energy

Lessons learned
Work with PFI
constraints
Engaging staff is
key
Be flexibleHave a plan
Takes time and
patience!

What next?
• Developing new approach to
environmental sustainability in the merged
Trust
• Opportunity to innovate
• Sustainable communications strategy
• Further delivery areas – e.g. climate change
adaptation, air pollution monitoring
claire.igoe@mft.nhs.uk

Creating the environment where close engagement and
collaboration are the norm
Dawn Chamberlain, London Productivity Director, NHS
Improvement

Making Lord Carter’s Review
a Reality
Dawn Chamberlain, London Productivity Director
October 2017

Who we are:
165
Patient Safety
(NHS
England)
NHS TDA
ACT Academy
(from NHS
Improving
Quality)
Monitor
Intensive
Support
Teams
(from NHS
IMAS)
NHS
Improvement
Operational
Productivity
(Carter,
GIRFT, Model
Hospital)

NHS Improvement’s Objectives
166
Quality of
care
Continuously
improving
quality of care,
helping to
create the
safest, highest
quality health
and care
service
Finance &
use of
resources
Balancing
provider
finances and
improving
productivity
Operational
performance
Improving and
sustaining
performance
against NHS
Constitution
standards
Strategic
change
Ensuring every
area has a
clinically,
operationally
and financially
sustainable
pattern of care
Leadership &
improvement
capability
Building and
maintaining
capability to
deliver
sustainable
services
NHS Improvement will support providers in
continuously improving in these five areas

Our Role
167
NHS Improvement is responsible for overseeing NHS
foundation trusts, NHS trusts and independent providers.
We offer the support these providers need to give patients
consistently safe, high quality, compassionate care within local
health systems that are financially sustainable.
By holding providers to account and, where necessary,
intervening, we help the NHS to meet its short-term
challenges and secure its future.

169
NHS Provider Performance - Q1 2017/18
5.51m
Attendances at England’s
A&E departments
£520 million
Savings achieved through cost
improvement programmes
347,860
Bed days lost due to
delayed transfers of care
109,469
Patients waited more than
4 hours for a bed
£736 million
Year-to-date deficit
88%
Providers agreed ambitious
control totals for 2017/18
22%
Reduction in agency spending
compared to same period last
year
£
0.8%
Increase on the same period
last year

Background: the Carter Review
• Lord Carter was commissioned to lead a review into operational productivity in the NHS. This
focused on acute non-specialist trusts and found that high-quality patient care and good value go
hand-in-hand.
• He identified £5bn of efficiency opportunities by 2020-21, if unwarranted variation can be removed.
This consisted of:
• The Operational Productivity directorate has been set up within NHS Improvement to support trusts to
understand their productivity relative to others and what good looks like across every area of a
hospital.
• The scope is now expanding to include new sectors: mental health and community.

Improving NHS productivity: understanding acute sector quality and efficiency
171
Understanding Variation
There is substantial variation in trusts’ costs – some will be warranted, but there are clear opportunities. The below chart shows
variation between trusts in Cost per Weighted Activity Unit (WAU), a measure of clinical output. It shows that the most expensive
trusts cost £1,000 more than the least expensive to produce each unit of output.
Total Cost Per WAU
Pay cost per WAU
Non Pay cost per WAU
Pay splits into nursing,
medic, AHP cost per
WAU
Cost per WAU can be broken down to give a more granular picture

What is the Model Hospital?
• Online digital tool provided by NHS improvement to help trusts identify and realise productivity opportunities
• Break down key performance and productivity metrics across all the activity of a trust
• Benchmark information against the whole country or a specific selected peer group
• Nearly 5,000 users have registered so far
Why should providers use it?
The Model Hospital brings together a wide range of data in one place, covering both clinical and productivity themes:
• Peer and national comparison ‘at a glance’ – identify high-performing trusts and build a picture of ‘what good looks like’
• Opportunity Scanner allows easy identification of potential productivity opportunities across a trust – focus and prioritisation
• Clearly themed compartments:
o Clinical service lines including clinical metrics from Getting It Right First Time (GIRFT) programme
o Operational areas including procurement, estates and corporate services
o Workforce and board-level oversight based on CQC and SOF assessments
• Standard, comparable measure of productivity and output – cost per Weighted Activity Unit (WAU)
Register online at https://model.nhs.uk

• Trust used the peer functionality to select
appropriate peer comparator trusts
Five out of Six CIP
plans linked to
Model Hospital
compartments are
all either exceeding
or within 15% of
target at month 5
North Teaching Hospital M5 CIPS show:
• Doctors and Nursing: 20% over plan at M5
• Procurement: 3% under a £1.2m M5 target
• Estates within 15% of target at M5
• Corp and Admin: 150% over plan at M5
• Only Meds and Pharm is behind target at M5
• No Unidentified CIPS, overall on plan
Each Model Hospital compartment has been
matched to a CIP work stream or Strategic
programme within the trust
• Programme management around the CIP
programmes is allied to the Model Hospital
• CIP / Strategy leads are responsible for
interpreting and using Model Hospital outputs
Model Hospital - Example Teaching Hospital

BETTER PRODUCTIVITY,
SUSTAINABLE FINANCES
BETTER PRODUCTIVITY,
UNSUSTAINABLE FINANCES
WEAKER
PRODUCTIVITY,
SUSTAINABLE
FINANCES
WEAKER
PRODUCTIVITY,
UNSUSTAINABLE
FINANCES
174
Relationship between quality, productivity and overall
financial position (England)
– targeting our efforts on trusts in most need of improvement
 Trusts with a lower
cost per WAU
(more productive)
tend to have a
smaller deficit and
more sustainable
finances
 Lower quality
trusts tend to have
weaker
productivity and
unsustainable
finances
 Higher quality
trusts have higher
productivity and
more sustainable
finances
The national programme objectives actions will only be met by specific actions taken within and across trusts –
NHSI and partners need to target our limited support for greatest impact
• Icons: 136 non-specialist
acute trusts
• Size of Icon: Standardised
clinical output (WAU)
• Colour/shape of icon: CQC
rating
• Cost per WAU: is from
Reference Cost 15/16
• Surplus deficit: from trusts
accounts, figure excludes
impact of impairments and
transfers by absorption and
charities (15/16)

Operational Productivity Directorate in
NHS Improvement
175

Regional Structure
176
• Providing direct support to trusts, prioritised with input from regional and other
NHSI teams, as relevant
Regional Productivity
Director
Regional
Productivity
Manager
Regional
Productivity Lead
Regional
Pathology &
Imaging lead
Regional
pharmacy &
Medicine lead
Regional
Procurement lead
Regional
Corporate
Services lead
Regional estates
lead
Delivery Improvement
Director
Dotted line to
relevant
project in
Operational
ProductivityBusiness support
Regionally funded role / team
Operational productivity funded

NHS Improvement Operational Productivity Programme Objectives
Clinical Workforce sub-programmes
Doctor: To ensure that the right doctor is available to patients at all times and they are utilised for delivering efficient and effective care, using effective and
comprehensive job planning, rostering and leave planning for all medical staff. The target productivity gain for 2017/18 is between £116m and £152m.
The target productivity gain for 2020.21 for all of Clinical Workforce will be £1.4bn
Nursing: To ensure the right nurse and support workers staffing levels are available for patients and that they are utilised for delivering efficient and
effective care; optimising trusts’ use of e-rostering tools and systems to match care availability to demand as expressed in Care Hours Per Patient Day.
The target productivity gain for 2017/18 is between £141m and £185m.
Allied Health Professionals: To ensure that patients can see Allied Health Professionals when needed and they are utilised for delivering efficient and
effective care; utilising effective and comprehensive job planning, e-rostering and optimising therapy hours per contact. The target productivity gain for
2017/18 is between £64m and £84m.
Clinical support sub-programmes
Pathology: To improve the quality and efficiency of pathology service provision; establishing up to 28 consolidated pathology networks to reduce
unwarranted variation in the cost and quality of services. The target productivity gain for 2017/18 is between £30m and £50m. The target productivity gain
for 2020/21 will be £211m
Imaging: To improve the quality and efficiency of imaging services; developing a sophisticated understanding of current imaging service delivery and
constructing proposals for revised models of service delivery to deliver quality and efficiency gains. The target productivity gain for 2017/18 will be set in
Q3 of 2017/18 FY.
Hospital pharmacy: To drive the implementation of medicines optimisation to improve patient outcomes and deliver financial efficiencies aligned with the
NHS wide Medicines Value Programme. To improve the efficiency and value of hospital pharmacy services; creating a more clinically-facing workforce and
consolidating pharmacy infrastructure services. The target productivity gain for 2017/18 is between £120m and £260m. The target productivity gain for
2020/21 will be £854m
Corporate sub-programmes
Corporate services: To support trusts in delivering modern, effective, low cost corporate services; setting out the future state and support Trusts and
STPs to consolidate services and to reduce costs. The target productivity gain for 2017/18 is between £70 and £120m. The target productivity gain for
2020/21 will be £266m
Procurement: To improve the value the NHS achieves from its procurement clout; leveraging national buying power, co-ordinating trust-level procurement
and leading larger scale procurement initiatives via central action and local support. The target productivity gain for 2017/18 is between £120m and
£370m. The target productivity gain for 2020/21 will be £809m
Estates and facilities: To ensure NHS providers deliver a clean, safe, appropriate and productive patient environment; reducing unwarranted variation in
benchmarking trust estates use and facilities costs and supporting them to help reduce costs and maximise the use of NHS land. The target productivity
gain for 2017/18 is between £100m and £160m. The target productivity gain for 2020/21 will be £974m
Mission: To support all NHS trusts to improve their productivity, reduce unwarranted variation, and enhance the quality of services for patients. The 2017/18
headline aim is to deliver between £1bn and £1.8bn of productivity gains on the way to delivering overall productivity gains of £5bn by 2020/21.
Getting It Right First Time: A clinically led programme to identify and implement recommendations across 34 medical and surgical specialties to reduce
unwarranted variation, improve patient outcomes and deliver efficiency and productivity improvements between £240-420m in 2017/18 and £1.291bn-
£1.461bn savings over 4 years
Clinically Led Programme

Introducing GIRFT
178
Innovative use of data sets to
identify unwarranted variations in
the way services are delivered
National Joint
Registry
Hospital
Episode
Statistics
HSCIC
NHS
Comparators
NHS
Indicators
Productivity
metrics
Patient
Reported
Outcome
Measures
National Hip
Fracture
Database
NHS
Resolution
NHS Atlas of
Variation
Arthritis
Research
National data
sources
Waiting times
Example data set for
orthopaedics pilot:
• Led by frontline clinicians who are expert in the
areas they are reviewing
• Peer to peer engagement helping clinicians to
identify and deliver changes that will improve care
and deliver efficiencies.
• Support across all trusts and STPs to drive locally
designed improvements and to share best
practice across the country
Agreed savings
targets:
c.£1.4bn per year
by 2020-21,
starting with
between £240m
and £420m in
2017-18
Improved patient outcomes,
experience & safety
Improved bed capacity,
reduced flow to AQP
Overall improvement in trust
balance sheets
Significant taxpayer savings
Re-empowered clinicians

179
Uncemented: £5,300Cemented: £650
GIRFT Emerging Lessons
No evidence that hip on right provides
better outcome for over 70s
Lower back pain
surgery costs
>£100m per
annum with little
evidence of
efficacy
£0
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
Obstetric litigation cost per birth
(5 years)
N = 135, Range = £55 - £6896
England average £1398
Huge variation between trusts in litigation averages:
• General surgery: £17 - £477
• Urology: £4 - £117
• Vascular: £1 - £6,353
• Obs & Gynae: £55 - £6,896

Hospital Pharmacy &
Medicines Optimisation:
Reduced spend (and increased
use) of individual medicines can
be tracked monthly
Monthly spend on 4 high cost
medicines can be shown to
be reducing due to moves to
Biosimilars/generics
The 4 drugs (Infliximab,
Etanercept, Rituximab and
Imatinib) show a reduced
spend but increased usage
Reduction from circa
£47million/month to
£27million
Volume of product
same/higher
£47m
£27m
Cost
Volume

Doctors Productivity Case Study –
Sherwood Forest Hospital NHSFT
181
Issues identified:
• Variable Pay spend in excess of £20 M
• Annual Leave Discrepancies
• Poor Job Planning process, inconsistent approach
• Multiple Manual Templates
Quality Benefit
• 98% of consultants have signed
off job plans
• Transparent and consistent
allocation of tariff for corporate
and mandatory PAs
• Established executive
challenge to all team and
individual job plans ensuring
consistency and transparency
of outputs.
• Reallocation of PAs to daily
Board Rounds and ‘good
practice’ ward rounds
• Management of annual and
study leave to ensure safe
staffing levels – all grades
Efficiency
• Release of posts within the medicine
budget - £300k
• Removal of WLIs incorporated into
standard sessions - £40k and
substantive cost avoidance costs
• T&O job planning to introduce a hot
week, reduction in independent sector
work and an increase in theatre
productivity- £ 675k
• Releasing locum posts by redirecting
activity and ensuring locums are job
planned to 9 PAs - £250k achieved
and further savings in costs expected
• Increased income via outpatient
clinics where demand is high, reduced
WLIs and/or independent sector work
• Review of junior doctor rotas and
ward staffing reducing locum cover -
£200k
Intervention
Introduction of
an electronic
software for
job planning
and clinical
activity
management
(rostering)

The Director of Finance at Bedford hospital had used the Model Hospital
benchmarks for pathology to negotiate an improved deal with the pathology
service provider. As a result, pathology costs have fallen by over £700k.
Case study – Bedford - pathology
Bedford

Managed
Service
Contract
Single LIMS
Project
Process
Improvement
Project
3 Concurrent
Saving
Initiatives
£5,769,122
Savings
Process
FlowsEssential Services Laboratory
DesignOrganisational
structureLaboratory Layout
Design
Context:
• Multi-site acute Trust running
full lab service on multiple sites
What change are they making?:
• Consolidation of specialist and
“cold” pathology on a single site
• Establishing Managed Service
Contract for all lab equipment
and reagents
• Implementing single LIMS IT
platform
• Revising operational processes
across the service
• Restructuring staffing to deliver
24/7 service with new
Benefits:

NHS Sustainability Day London Roadshow

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