Sustainability in Healthcare Children's University Hospital 29/09/2011

1. Importance of Sustainability in
the Healthcare Sector ?
Helen Maher
Estates Mgr,
Health Service Executive

2. Healthcare Sector Sustainability?
Speaking to the Converted……
Procurement
Energy & Transport
Waste Management
Water & Wastewater

3. Healthcare Sector Sustainability
Health Budget €14 Billion
Health Employees 106,000+
Health Procurement 52%
Goods & Service €7 Billion
New Buildings €337 Million

4. Property Portfolio
HSE Properties = 2,730
50 Acute Hospitals
Non Acute
Community Hospitals
Psychiatric Hospitals
Community Nursing Units
Health Centres
Support Services
Procurement Stores
Maintenance Stores
Offices

5. Healthcare Transport
Daily
Commuters = 106,000+
Goods Deliveries/Contractors
Patient 6 Days Average in Hospital
Visitors
Annual Healthcare
3.5m Outpatient Treatment
1.3m Day Care Treatment
1.1m Accident & Emergency Treatment

6. HSE Procurement
5 Categories of Goods & Services = €5 Billion
Drugs & Medicines
Medical & Surgical Supplies
Primary Care - GP’s, Pharmacists
Healthcare Services - Nursing Homes, Foster care etc.
Healthcare Agencies - Voluntary Hospitals etc.

7. HSE Procurement
Other Significant Categories < €100m
Catering
Cleaning
Bedding & Clothing
Laboratory Consumables
Blood Products
X- Ray Consumables
Office Supplies
Furniture (Medical & Office)
Office Stationary & Printing
ICT Equipment
Energy & Utilities
Transport Fleet

8. Carbon Foot Print
NHS Carbon Footprint
Goods & Services
Building Energy
Transport
60% C02

9. Green Public Procurement
Draft National Green Procurement Action Plan
6 Priority Green Procurement Categories;
1. Construction
2. Cleaning Products
3. Food
4. Uniforms/Textiles
5. Paper
6. Electricity
HSE Procurement Officers & Estates Mgrs

10. Energy Efficiency
Value for Money; Energy Expenditure €85 Million
2010 HSE Consumed 1,268 GWh
2010 Procured Renewable Energy - 8 GWh
Public Sector Renewable Energy 15%
National Energy Efficiency Target
33% by 2020
Regulatory Compliance
Display Building Energy Rating > 1000m2

11. HSE Energy Efficiency
Energy Concession
Energy Services Company
Invest Energy Plant & Equipment Upgrades
No HSE capital funds required
Key Performance Indicators – BER Ratings
HSE continue Procure & Pay Energy Supply
Energy Savings Benefit to HSE
Pilot HSE South - €6 million
60 Non Acute Healthcare locations
Year One Target Savings = 3 GWh

12. Sustainable Building
Life Cylcle Costs
Design
Construction
Occupation

13. Green Transport
Healthy Options - Cycle to Work Facilities
Secure reliable Bus services, links Rail/Bus Stations
High fuel costs, opportunity provide commuters options
Maps & Information i.e. Travel ways Map
NTA Carshare.ie – CUH, UCHG, Letterkenny etc.
Free Preferential parking for Carshare.ie users
Acute Hospitals income from visitor parking

14. Healthcare Waste
Value for Money; Waste Expenditure €23 Million
Regulatory Compliance
Food Waste Regulations 2009
Ban Food Waste Landfill & Macerators
Engage Food Waste Recycling
HSE Waste Awareness Handbook
HSE Waste E-Learning Slides
www.HSELand.ie Register & Download

15. Healthcare Waste
EPA’s Green Healthcare Programme
22 Hospitals: Waste & Water Audits
Benchmark waste generation per Hospital
Quantify Waste Prevention Opportunities - €1.5m
Typical Acute Hospital Healthcare Non Risk Waste
Recyclable Paper
Recyclable Plast ic
Recyclable C'Board
Organic Food
Recyclable Met al
Recyclable Glass
Landf ill Wast e

16. Healthcare Risk Waste
National Healthcare Risk
Waste Contract (SRCL)
Volume healthcare risk
waste reduced 3%.
Expenditure reduced
10% to €8.6m
2011 New rate per ton–
20% Discount
70% Treated waste
diverted to Recovery as
fuel

17. Healthcare Hazardous Waste
Electronic & Electrical Photographic Fix & Dev
Batteries Heavy Metal (Amalgam/Pb)
Fluorescent Tubes Laboratory Chemicals
Paints / Weed Killers Waste Oils
White Goods Other as Identified…

18. Healthcare Non Risk Waste
Mixed Recyclables Mixed Glass Biodegradable
Cardboard Wood Vegetable Oil
Plastics Metals Textiles
Confidential Residual Landfill
C&D Waste Records

19. Healthcare Waste Contract
HSE Framework Contract for all other Wastes
Currently 40+ Waste Service providers
V4M determined by local competition
Landfill Cost varies from €120 - €250 per ton
Not all HSE locations pay by weight
Framework Tender advertised on e-tenders April
One Primary waste contractor per Region
Mini Competition for HSE Dublin Nth East
Dublin, Cavan/Monaghan, Louth, & Meath
Maximize recycling rates

20. Water Consumption
Value for Money; Water Expenditure €8 Million
Increased 48% between 2006 – 2010
Change from Flat Charge to per m3
HSE Water Costs per Region
€3,500,000
€3,000,000
€2,500,000 2006
€2,000,000 2007
€1,500,000 2008
Euros
€1,000,000 2010
€500,000
€0
WEST STH DNE DML
Regions

21. Water Costs per M3
Local Authority Combined Water Charge per M3 2010
3.50
3.00
2.50
2.00
E u ro s
1.50
1.00
0.50
0.00
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22. Accounting for Water
Water Expenditure per Acute Hospital, and per county
Identify locations above Average Expenditure
C&AG Report 2010 - Unaccounted for Water
Local Authority Average UFW 41 %
ForFAS Assessment of Water Services 2008
58% UFW on consumer side i.e. healthcare pipe work
Routine water shortage by 2013; Athlone, Dublin, Galway,
Letterkenny, Limerick, Tralee, Waterford & Cavan
Leak Detection surveys & water conservation

23. H2O Consumption
Health Technical Memorandum 04-01 (NHS UK)
Water Consumption per Hopsital Type
600
500
400
300 Litres per Bed per Day
200
100
0
Acute Maternity Long Stay Phychiatric Elderly Care

24. Waste Water Discharge
Local Authority Wastewater Discharge License
Oil Fats & Grease - Catering Facilities
Organic Loading – Sewage, Milk etc.
Alter pH Neutral - Chemicals
24 Hour Sampling System
Annual Monitoring Charges
Monitoring Results

25. Health Impact Assessment
Health Sector Resources
Economic, Social
Impact on Health of & Environmental
Population
Impacts
Health Sector Impact on Health
Capacity to Deliver of Population
Quality Services
Demand for Health Services

26. Sustainable Healthcare
Regulation Compliance is important
Value for Money is the Key Driver
Government Funding allocated to Healthcare
Procurement - Green Procurement Criteria
Infrastructure - Environmental Assessment
Information is Pow€r, value of sustainable choices
Key Healthcare budget holder support

27. Importance of Sustainability
in the Healthcare Sector
Helen Maher
helen.maher2@hse.ie
021 492 7210
THANK YOU !