Welcome to Sustainable Health Scotland

#sushealthscot

Chair's Welcome & Introduction

Jim Leiper, Strategic Facilities Director, Health Facilities

Scotland

#sushealthscot

Housekeeping

• Fire Alarms

• Toilets

• Mobile phones

• Timekeeping

• Refreshments and lunch

• Workshop locations

• Feedback

• Twitter (#sushealthscot)

• Help and Support

Sponsors, Exhibitors and Supporters

Morning Programme

• 09:30 Chair’s Welcome and Introduction

• 09:45 Keynote Address: Securing Scotland’s Health

Dr Gregor Smith, Scottish Government

• 10:00 Q&A

• 10:10 Climate Change and Public Health Impacts: Adaptation, Mitigation and Their Consequences

Dr Emily Stevenson, SMaSH

• 10:30 Energy Efficiency and Fuel Poverty

Lisa Glass, Shelter

• 10:50 Resilient Cities

Alastair Brown, Glasgow City Council

• 11:10 Healthy Eating: The Route to Health and Well-being

Louise Needham, Quorn Food

• 11:30 Q&A

• 11:40 Refreshments and Networking

Workshops

12:10

Clyde Suite

Climate Change and Public Health: Achieving Co-Benefits (NHS Health Scotland)

Dalhanna Suite

Sustainable Travel (Cenex)

Ramillies Suite

Utility Cost Recovery (PCMG)

12:50

Clyde Suite

Supporting Organisations to Tackle Fuel Poverty (Home Energy Scotland & NHS Greater Glasgow & Clyde)

Dalhanna Suite

Green Space: Delivering on the Wider Sustainability Benefits (Green Exercise Partnership and NHS National Services Scotland)

Ramillies Suite

Lighting for Health and Well-being (Arup)

Securing Scotland's Health

Dr Gregor Smith, Deputy Chief Medical Officer, Scottish

Government

#sushealthscot

Sustainable Health ScotlandSecuring Scotland’s Health

Dr Gregor SmithDeputy Chief Medical Officer for Scotland

Healthy Life Expectancyyears

Years in Poor Healthyears

Total Life Expectancyyears

MenRichest 10% 76 5 13Poorest 10% 57 11 68Difference 19 6 13

WomenRichest 10% 78 6 84Poorest 10% 61 15 76Difference 17 9 8

Jordanhill

Charing Cross

Hyndland

Partick

Anderston

Exhibition Centre

CENTRAL

Argyll St.

Bridgeton

QUEEN STREET

Govan

Hillhead St George’s Cross

Buchanan Street

Life expectancy data refers to 2001-5 and was extracted from the GCPH community health and well-being profiles. Adapted from the SPT travel map by Gerry McCartney.

Males - 75.8y

Females - 83.1y

St Enoch

Males - 61.9y

Females - 74.6y

Ibrox

Cessnock

Each stop on the Argyll line travelling East represents a drop of 1.7 years in male life expectancy

Leading causes of attributable global mortality, WHO 2004

%

1. High blood pressure 12.8

2. Tobacco use 8.7

3. High blood glucose 5.8

4. Physical inactivity 5.5

5. Overweight and obesity 4.8

6. High cholesterol 4.5

7. Unsafe sex 4.0

8. Alcohol use 3.8

9. Childhood underweight 3.8

10. Indoor smoke from solid fuels 3.3

59 million total global deaths in 2004

COSTS TO THE NHS

Comparative level of importance varies depending of figures used – message is the same – physical inactivity is a major issue

In 2006–07, costs to NHS in UK for behaviour related ill health:

• poor diet £5.8 billion

• smoking £3.3 billion

• alcohol £3.3 billion

• overweight and obesity cost £5.1 billion

• physical inactivity was £0.9 billion

Scarborough et al 2011

The Choluteca Bridge

Building on Public Health Successes

“...everyone in healthcare really has two jobs when they come to work every day: to do their work and to

improve it.”

What is ‘‘quality improvement’’ and how can it transform healthcare? Batalden,P; Davidoff.F Qual Saf Health Care. 2007 February; 16(1): 2–3

Question & Answer Session

#sushealthscot

Climate Change and

Public Health Impacts:

Adaptation, Mitigation

and their consequencesEmily Stevenson

Public Health Specialty Registrar

Co-chair Scottish Managed Sustainable Health Network (SMaSH)ScotPHN is hosted by

Outline of presentation

How does climate change threaten public health gains?

What is the public health role in mitigating and adapting

to climate change?

What are the health benefits and disbenefits of climate

change adaptation and mitigation?

COP21

“the increase in….temperature

to well below 2…. and to

pursue efforts to limit the

temperature increase to 1.5”

Department for Environment Food and Rural Affairs (Defra). Adapting to climate change. UK Climate Projections. London, 2009.

Available at: https://www.gov.uk/government/uploads/attachment_data/file/69257/pb13274-uk-climate-projections-090617.pdf

“Climate change is the biggest global health threat

of the 21st century”

Watts et al, Health and climate change: policy responses

to protect public health. The Lancet 2015; 386 (10006);

1861-1914

Who bears the burden of disease?

Costello A et al. Managing the health effects of climate change:

Lancet and University College London Institute for Global Health

Commission. The Lancet 2009; 373 (9676); 1693-1733.

What does Climate Change look like in Scotland?

Adaptation Scotland. Risk Management Plan

• Rise in temperatures

• Increase in flooding

• Increase in sea level

• Increased frequency and

intensity of storms

• Warmer wetter winters

• Warmer drier summers

Projected changes in summer and winter temperature and

precipitation for Scottish climate regions (2050s – medium

emissions scenario)

•Security of global food

production

•Population migration

•Changes in vector borne

disease distributions

•Changes in agriculture

•Changes in fishing

•Coastline flooding,

erosion and coastline

retreat

•Quality and availability

of potable water

•Food safety

•Species extinction, new

species

•Air pollution

Damage to infrastructure –

buildings, transport

Affects on the wider determinants

of health in Scotland

Barton and Grant. A health map for the local human habitat. The Journal for the

Royal Society for the Promotion of Health, 2006; 126 (6): 252-253

Health impacts of climate change in Scotland

Climate change effects Examples of related health risks

Temperature changes Cardiovascular, cerebrovascular and respiratory disease

Extreme weather, changes in precipitation Injuries, diarrhoeal disease, malnutrition, respiratory

infections, depression, anxiety

Air pollution Respiratory, cardiovascular disease

Microbial contamination and transmission Vector borne disease

Food safety

Pollen production Allergic diseases

Reduce crop yield Malnutrition, increases in food prices

Displaced populations Poverty, depression, anxiety, malnutrition

Haines and Patz 2004; Seguin 2008; Friel et al 2011

Examples of Scottish Public Health Actions (1)

Key area of Public Health Public Health Actions

Surveillance and assessment of

the population’s health and

wellbeing

Tracking of diseases and trends related to climate change

Assessing the evidence of

effectiveness of health and

healthcare interventions,

programmes and strategies

With consideration of procurement, energy efficiency, cost analysis including indirect costs to

health through environmental impacts, waste

Policy and strategy development

and implementation

Ensure health policy/plans/strategies have sustainability as a core value running through

Strategic leadership and

collaborative working for health

Ensuring health is included in climate change plans

Build climate change into cross sector plans e.g. through CPP

Informing public of risks to health from climate change

Health impact assessments of adaptation and mitigation strategies to ensure maximise health

co-benefits and minimise disbenefits

Examples of Scottish Public Health Actions (2)

Key Public Health Area Public Health Actions

Health Improvement Prevention of mental health problems as a result of climate change

Community empowerment with particular attention to vulnerable communities

Behaviour change knowledge – ?application to sustainable behaviours

Health Protection Mitigate the effects of extreme weather events e.g. warnings/threshold for boil notices with

private water supplies following intense rainfall/floods

Monitor trends in vector borne diseases, food and water borne diseases, chemical

contamination with respect to seasonality and extreme weather events, and

control/communicate with population accordingly

Health and Social Service Quality Support/provide leadership in the development of financially and environmentally

sustainable health services. Support/link between facilities and other health professionals.

Support healthcare adaptation and mitigation measures.

Emergency preparedness.

Training of health care professionals on the health aspects of climate change

Health services which are reactive to changes in disease distribution as a result of climate

change

Early warning systems

Public Health Intelligence Monitoring of trends of morbidity and mortality relating to heatwaves

Academic Public Health Research considering the relationship between climate change on health inequalities

Benefits and disbenefits of climate change mitigation and

adaptation – a need for Health Impact Assessments

Mitigation/Adaptation Action Benefit Risk

Increase greenspace in

cities/towns to reduce urban

island affect

Mental and physical benefits Skin cancer, cataracts

Aeroallergens

Air conditioning Reduce morbidity and mortality

secondary to heatwaves

GHG with consequences for health

Re-housing at risk coastal

communities

Reduce risk of depression and

anxiety

Impacts on mental health – social

capital disruption, poor housing

Increase community resilience Empowered, better connected

communities

Widening of inequalities

Sustainable diets Sustainable communities, reduced

colorectal ca, improved

cardiovascular health

Nutritional deficiencies

Health co-benefits

Lancet Commission’s report from

June 2015 - “Tackling climate

change could be the greatest

global health opportunity of the

21st century”

“Recognizes the social, economic

and environmental value of

voluntary mitigation actions and

their co-benefits for adaptation,

health and sustainable

development”

Adoption of the Paris Agreement:

Adoption, para 109.

Thank you

“The era of procrastination, of half-

measures, of soothing and baffling

expedients, of delays is coming to its

close. In its place we are entering a

period of consequences”

- Winston S. Churchill

32Monday, 26 September 2016

Until there’s a home for everyone

Health, fuel poverty and energy efficiency

Lisa Glass, Partnership Officer for Health

33

Structure

1. Housing issues in Scotland today

2. Fuel poverty: an introduction

3. Health implications of fuel poverty

4. Why the NHS should be concerned with fuel poverty

5. How can the NHS help tackle fuel poverty?

34

Shelter Scotland helps over half a million people a year

struggling with bad housing or homelessness – and we

campaign to prevent it in the first place.

Our work includes policy and front line services to public

campaigns and training housing professionals so that we

improve housing in Scotland in a wide variety of ways and

increase access to a safe, secure and affordable home.

35

‘Housing’ issues in Scotland today

36

‘Housing’ issues in Scotland today

34,666 homeless applications in 2015-16

- 28,226 assessed as homeless

Some of the best homeless rights in the

world, yet…bottleneck in temporary

accommodation

- 10,555 households; 5,224 children, 1 in 10 > 1 year; 23

weeks on average

150,000 households on council waiting lists

74,000 living in overcrowded accommodation

37

Not just housing issues…

Poor housing increases the risk of severe ill-health or

disability by ^25% during childhood and early

adulthood

41% of the homeless population will suffer long term

health difficulties, compared to 28% of the general

population

Dr Neil Hamlet’s research, Fife, compared ‘secure’ and

‘insecurely’ housed

- Emergency admission rate 244/1000 vs 64/1000

- Multiple attendance, alcohol/self harm/psychiatric

admission rates, DNAs

38

Not just housing issues…

Commission on Housing &

Wellbeing, 2015: www.housingandwellbeing.org

Looked at housing across 5 areas of

wellbeing, including health

47 recommendations, 1 year on

report

Fuel poverty and ‘cold

homes’ are one of the more

obvious areas where

housing links to health.

39

Fuel poverty: an introduction

40

Fuel poverty: an introduction

• More than 10%

income on all fuel

use

• Focus generally on

cold homes,

heating and efforts

to ensure

‘affordable warmth’

– but wider than

just heating costs

• 229,000 (9.5%)

are in extreme fuel

poverty

• 55% in rural areas

vs 32% urban

• 58% single

pensioners,

44% households

with 2 pensioners

41

Causes of fuel poverty

42

Health implications of fuel poverty

43

Useful referencesHills 2012

WHO 1985

Marmot Review 2011

Energy Action Scotland

NICE guidelines 2015/16

Health implications of fuel poverty

EWDs • At least 1 in 10 EWDs 400 people (2014/15)

Other fuel use? • Heat or eat? Hot shower?

Secondary consequences • Dampness, trip hazards, burns & scalds

44

Why the NHS should be concerned

with fuel poverty & energy efficiency

45

Why the NHS should be concerned

with fuel poverty & energy efficiency

• Links with health

• MoneyEstimates of £48-80million savings to the NHS in

Scotland

e.g. 2009 Chief Medical Officer’s report

Every £1 spent tackling fuel poverty saves the NHS 42p

Prof Liddell, Save the Children 2008

• Wider strategies and principles, & today!Prevention

Sustainability

Making Every Opportunity Count

46

How can the NHS help tackle fuel

poverty?

47

Awareness and signposting to available support; there

is a huge amount of support available for people in fuel

poverty, centred around all 4 causes:

• Grants, loans and independent advice for installing

energy efficiency measures in the home (insulation, new

boilers, etc)

• Money and debt advice to increase household income

• Information and support on energy tariffs and switching

supplier to reduce energy costs

• Advice on how to use energy in the home more efficiently

Home Energy Scotland, local services, Shelter Scotland

How can the NHS help tackle fuel

poverty?

48

Ashley (22), lives in Dundee with her two children Ayla (4) and Lily-May (2).

It's been really hard in the last few months with it being so cold. I’ve

spent a fortune on heating, but no matter how much I spend or how long I have the heating on for, it doesn’t seem to

make any difference.

There’s mould crawling up the walls, around fuse boxes and electrics. I’m bleaching it as often as I can but the kids are always ill no matter what I do. We’re

constantly at the GP surgery and recently I had to take Lily-May to hospital things got so bad.

The children are either on antibiotics or steroids at any given time, and my little one has an inhalerbecause all of this damp has got to her lungs. The other day I found a rat in the flat and I’ve been told

that’s because they seek out damp places to nest. It’s disgusting. How long can I live like this?

I buy the kids two beds each a year because I’m chucking out furniture that’s been totally destroyed. Sometimes it’s so

bad the bedding they sleep in is wet by the middle of the night from all of the condensation.

49

• Training and awareness raising

• Not expecting staff to be experts

• Pilot training course

• ‘Social prescribing’, a holistic approach to

medicine, and making every opportunity count

• NHS staff are households too…

• Culture change

• Partnership working

• More information in this afternoon’s workshop

What can you do? Be our advocate!

How can the NHS help tackle fuel

poverty?

50

For any more information:

lisa_glass@shelter.org.uk

Partnership Officer for Health

0344 515 2469

To sign up to our latest homelessness: far

from fixed campaign, visit

shelterscotland.org/farfromfixed

• Resilience is the ability to survive and thrive in the face of

shocks and stresses

• Membership of the Rockefeller Foundation’s global 100

Resilient Cities network

• Engagement with partners

• A conversation with 3,500 Glaswegians

• Initial focus on climate change issues soon broadened

Glasgow | City of Transformation

Drawing oncultural assets

Resilient Glaswegians

Economicdiversification

Regenerationprogrammes

Pillar 1 | Empowering Glaswegians

Inclusive

Integrated

Prepared

Pillar 2 | Unlocking Place-Based Solutions

Integrated

Inclusive

Creative

Pillar 3 | Innovating for Fair Economic Growth

Innovative

Resourceful

Flexible

Pillar 4 | Fostering Civic Participation

Robust

Empowered

Reflective

• Strategy launch

• Two year action plan

• Monitoring and evaluation

• People Make Glasgow Resilient

…becoming experts in delicious, healthy

and sustainable alternatives to meat

Louise Needham

Environment & Sustainability Manager

Source: FCRN Food

Source, 2016

The 1960s was a time of

huge achievements...

Quorn in context

....And growing concerns

Quorn in context

A man with a big idea

Remember the history…

“What we need is a new and greener

revolution, like the one we saw in the

developing world in the 1960s, but which

tackles BOTH food security and climate

change.”

~Professor Sir John Beddington

2009 as UK Chief Scientific Advisor

At the heart of all Quorn foods is

mycoprotein…

So, what is

it?

Natural appeal

Our 50 year ‘overnight

success’……….

So it can be done

Belasis Process Overview

Fermentation

To grow the

organism

RNA

Reduction

To meet

specification

Centrifuge

Separate

solids and

liquid

Chillers

Harvesting of

Mycoprotein

paste

Despatch

Chilled to

Stokesley for

onward

processing

Raw

Materials

Utilities

Deep shaft

fermenter

to process waste

Clarifier

to separate

Clean Water

To River Tees

Sludge

to land injection

67

No other protein can create the meat

like textures achieved by Quorn

Unique attributes

Micrographs reveal unique fibrosity

Quorn has a unique meat like texture

Soy

Poultry

Mycoprotein

Additional InterestSCFA productionFibre (chitin and ẞ-glucans)

Mycoprotein as a food ingredient

Physical

Properties (shape)

Denny, A, Aisbitt, B and Lunn, J (2008) Mycoprotein and health. BNF Nutrition Bulletin 33: 298 – 310.Bottin, J. (2014) Nutrition and Surgical Influences on appetite regulation in obese adults. PhD Thesis Imperial College London

BENEFITS

Texture creation• Authentic meat-like texture• Creation of fibrosity through fibre assembly

General Nutrition• High quality protein• Low fat content (membranephospho-lipids)

• High fibre (cell wall)• Low energy densityClinical Research Programmes• Lowering serum cholesterol• Satiety• Insulinemia and

glycemia in diabetics

Composition

Source: FCRN Food Source,

2016

Growing population: 9-10bn by 2050

Changing population: Africa & Asia

urbanising fastest

Rising incomes =

• Changing lifestyles

• Dietary change – “Western diet”

• Changing burden of disease (e.g.

obesity, heart disease, stroke,

diabetes, some cancers.)

The bigger picture…

‘Greenhouse Gas emissions from the

livestock sector account for

15% of the global total…

…more than direct emissions from the global transport sector’

Chatham House Report, 2014

Challenges for a scalable meat based

sustainable food future

Our biggest lever globally is to eat less

meat

GRAPHIC: N. CARY/SCIENCE

Changing the food system to provide sustainable healthy diets

Italy, 2013

EFSA: “Overcrowding is a risk factor for disease

expression and other causes of poor welfare

and should be avoided”

Regular antimicrobial use facilitates high animal densities:The Lancet Infectious Diseases Commission, 2013

“Urgent action is needed to ... reduce antibiotic usage in animal husbandry”, WHO, 2014

“Use of antibiotics as growth promoters should be banned worldwide as has happened in the EU”: The Lancet Infectious Diseases Commission, 2013

“Routine preventative use of antibiotics is unacceptable” UK AMR Strategy:

Annual progress report and implementation plan, December 2014

“failure to address

antibiotic overuse in

agriculture and its role in

drug resistance is like

trying to stop lung

cancer without factoring

in smoking…..”

Urgent action is being called for, but who is

listening?

Unique recipe of benefits…

Health &

nutrition

Taste &

texture

Versatility &

familiaritySustainability

Behaviour Change

The importance of evidence base…

Over 30 years of clinical research into

the benefits of diets rich in

mycoprotein

An exciting programme for 2016

ANABOLIC PROPERTIES

OF PLANT PROTEIN

BEHAVIOUR CHANGE

Quorn Environmental Footprint

Key Comparisons vs

Quorn

GHG LAND WATER

Beef Mixed

x9 more GHG

x9 more land

x10more water

Beef Grazed

x36 more GHG

x12 more land

x11 more water

Chickenx3 more

GHGx2 more

landx2 more

water

By working closely with Carbon Trust we have established that

Quorn Foods offer significant environmental benefits relative to

meat.

Quorn is the first and only meat free brand to have carried out

such a systematic third party analysis of its environmental

footprint.

83

Sampling Quorn to over

2000 NHS Staff and Visitors

Great Ormond Street Hospital

Guys Hospital

St Thomas Hospital

St Barts Hospital

ULC Hospital

Whipps Cross Hospital

Newham University Hospital

Royal London

Mile End Hospital

Nottingham City Hospital

Nottingham QMC Hospital

Sheffield Teaching Hospitals

84

Quorn fits easily into everyday life and makes meat reduction simple…

louise.needham@quornfoods.com

Tel: 01642 717306

Mob: 07891 484256

Thank you

Question & Answer Session

#sushealthscot

Refreshments and Networking

#sushealthscot

Welcome back

Brian Swanson, Chair of the NHSScotland Sustainability

Steering Group

#sushealthscot

Afternoon Programme

• 14:30 Welcome Back

• 14:40 The Circular Economy Will Benefit Scotland’s Economy and Its Environment

Claire Guerin, Zero Waste Scotland

• 15:00 Inhalational Anaesthesia: Case Study

Dr Frank Swinton, Airedale NHS Foundation Trust

• 15:20 Healthier Catering and Retail in Hospitals

Peter Faassen de Heer, Scottish Government

• 15:40 Q&A

• 16:00 Sustainability in NHSScotland: A Core Priority

Colin Sinclair, NHS National Services Scotland

• 16:20 Q&A

• 16:40 Concluding Remarks and Close

Claire Guerin

Sector Manager – Sustainable Procurement

zerowastescotland.org.uk

@zerowastescot

A Circular Future for Scotland

Overview

• About Zero Waste Scotland

• Scotland’s Circular Economy

Ambitions

• Examples within NHSScotland

About Zero Waste ScotlandWe exist to create a society where resources are valued and nothing is wasted.

Our goal is to help Scotland realise the economic,

environmental and social benefits of making best use

of the world’s limited natural resources.

Setting our sights

We’re funded to support delivery of the Scottish

Government’s circular economy strategy, Making Things

Last. We receive additional funding to support the EU’s

2020 growth strategy.

Scotland’s Circular Economy

ambitions

The Circular

Economy

Green Alliance

‘Making Things Last’

• Scottish Government priorities in moving to a Circular Economy

• Builds on Zero Waste and Resource Efficiency agendas

• Benefits to:

– The environment

– The economy

– Communities

Priorities

• Food & drink & the

bioeconomy

• Manufacturing &

remanufacturing

• Construction

• Energy infrastructure

• Increasing reuse & repair

A Manufacturing

Future for Scotland

• 8 work streams – including Circular Economy

• Innovation & new marketopportunities

• Remanufacturing potential

£620 million turnover and 5,700 new jobs

80%of a product’s lifetime

environmental impact is

decided by its design

ZWS – Circular Economy

Programme

• Business support for SMEs & networks

• Grant support through CE Investment Fund

• Academic & industry partnerships through

support of Scottish Institute for

Remanufacture

• Changing behaviours on purchasing & using

products

NHSScotland Examples..

Benefits through Procurement

Including Circular Economy Outcomes….

• Enhancing Economy

• Security of Supply

• Cost Savings

• Environmental Improvement

• Socio-Economic

• National & Organisational Outcomes

• Reuse – Instruments, sharps bins, furniture

• Reposable products – trocars

• Take Back Service – pumps

• Redeployment – furniture, stationery

• Remanufacture – Single Use Devices

NHSScotland Examples

Thanks

Claire Guerin

Sector Manager – Sustainable Procurement

Mobile 07816 224368

Email: Claire.Guerin@zerowastescotland.org.uk

An Anaesthetists Perspective

Frank.swinton@nhs.net

@frankswinton

Frank.swinton@nhs.net

@frankswinton

Disclosure:

4AllofUs have provided some travel funding to

me for this event

NHS SDU, Lancaster University, AAGBI,

have previously provided travel funding

I received an honorarium from Sagetech

Medical in 2015.

Frank.swinton@nhs.net

@frankswinton

In the begining

Frank.swinton@nhs.net

@frankswinton

In the begining

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Don't

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Don't

Get patients to do it for you

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Don't

Get patients to do it for you

Talk about money

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Don't

Get patients to do it for you

Talk about money

Don't talk about money

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Don't

Get patients to do it for you

Talk about money

Don't talk about money

Listen and show that you've heard

Frank.swinton@nhs.net

@frankswinton

How to engage clinicians:

Don't

Get patients to do it for you

Talk about money

Don't talk about money

Listen and show that you've heard

Push their buttons

Frank.swinton@nhs.net

@frankswinton

Frank.swinton@nhs.net

@frankswinton

First, Do No Harm

Frank.swinton@nhs.net

@frankswinton

First, Do No Harm

(To the patient in front of you)

Frank.swinton@nhs.net

@frankswinton

First, Do No Harm

Frank.swinton@nhs.net

@frankswinton

Frank.swinton@nhs.net

@frankswinton

It’s not good healthcare if it costs

the health of someone else,

irrespective of geography, social

standing or time

Frank.swinton@nhs.net

@frankswinton

It’s not good healthcare if it costs

the health of someone else,

irrespective of geography, social

standing or time

Frank.swinton@nhs.net

@frankswinton

Healthier Retail & Catering

Peter Faassen de Heer

Health Improvement

Scottish Government

Healthier Retail and Catering

Overview

• Why are we doing this?

• Policy context

• What has already been done?

• What do we still need to do?

• Who is involved?

Why are we doing this?

Healthier Retail and Catering

In general:

Scottish Health Survey 2015

Why are we doing this?

Healthier Retail and Catering

Type 2 Diabetes:

Scottish Health Survey 2015

276,430

people by

end 2014

5.2% of the

Scottish

population

Cost of Type 2 diabetes

NHS Cost£1 bn

Scottish Economy Cost

£2.37 bn

Sources: Diabetes UK, 2013,Scottish Food & Drink Federation, 2015Audit Scotland 2015

NHS Board Spending 14/15

£11.4bn

Why are we doing this?

Healthier Retail and Catering

Other Diet Factors:

Why are we doing this?

Healthier Retail and Catering

In the NHS:

Kyle et al, 2016; Scottish Government

• 69.1% are overweight or obese (measured)

• 61% of nurses think they are overweight (self-reported)

• 28% of dietitians think they are overweight (self-reported)

• 96% of nurses feel they have a professional responsibility

to advise patients on diet and nutrition

BUT HOW MUCH DO WE KNOW?

Why are we doing this?

Healthier Retail and Catering

Knowledge test:

CNN

Why are we doing this?

Healthier Retail and Catering

Knowledge test – How many Oreos worth of sugar?

CNN

Why are we doing this?

Healthier Retail and Catering

Knowledge test: How many real donuts’ worth of sugar in

an iced caramel latte

CNN

Why are we doing this?

Healthier Retail and Catering

Knowledge test:

What are the reference (daily) intakes for kilocalories for

adult men/ women in Scotland?

Scottish Government, 2016

A. 3,500/3,000

B. 3,000/2,500

C. 2,500/2,000

A. 3.5%

B. 27.2%

C. 69.3%

Why are we doing this?

Healthier Retail and Catering

Or should we be doing this?

Why are we doing this?

Healthier Retail and Catering

• To improve the population’s diet

• To prevent dietary ill health

• To improve the wellbeing of NHS staff

• To back up patient information

• To save the NHS money

• To improve the Scottish economy

• “It’s the right thing to do”

Policy Context

• A successful Healthyliving Award

• A Commitment for public sector to excel

• A successful Healthy Living Programme

• Scottish Dietary Goals

• Health Promoting Health Service

• National Food & Drink Policy & Good Food Nation

• Supporting Healthy Choices

Healthier Retail and Catering

• Revised Patient Food Specifications – “Food in Hospitals”

Healthyliving Award Plus

• 70/30 split on healthier food & drink

• Applies to catering

• 129 sites across Scottish NHS

• All public sector and majority

voluntary sector compliant

Healthier Retail and Catering

• All including private sector must

comply at contract renegotiation

Healthcare Retail Standard

• A set of criteria for provision and promotion

What is it?

• 50% of food and 70% of drink must

meet provision

• Promotion is any incentive based on price

or position

• Applies to all retailers and trolley services

• Sets a minimum benchmark that boards

may exceed if they wish to

• Broadly consistent with the HLA for

provision and SHC for promotion to create

a level playing field

Healthcare Retail Standard

How are we implementing this?

• NHS NSS Oversight and reporting

• SGF team to audit & provide guidance

• Supplier list

• Eat Better Feel Better

• Health Promoting Health Service

• Securing retailer buy-in

• Health Board lease management

• 31 March 2017 or contract renewal

• Pilot Stores

Before …

…during..

…and after

Healthcare Retail Standard

What have we done?

• Developed and reviewed nutrition criteria

Healthcare Retail Standard

What have we done since 19 January?

• Developed and reviewed retailer guidance

• Developed and revised assessment protocols

• Established an implementation group to oversee

process (meeting 5 in October)

• Engaged with 4 retailers – RVS, WHSmith, Aroma

and M&S at head office and local level

• Established a Health Board Leads group

• Awarded a tender to evaluate the HRS and

conducted some baseline research

Healthcare Retail Standard

What have we done since 19 January?

• Created NSS Policy Guidance on procurement

incl. vending.

• Conducted 5 pilot evaluations. Two passes for

RVS at:

• NHS Lothian - Edinburgh Western General

• NHS GG&C - West Glasgow Ambulatory Care

Hospital (Yorkhill)

• Determined a process for ‘mixed’ sites

Healthcare Retail Standard

What do we still have to do by 31 March 2017?

• Finalise communication plans

• Finalise all nutrition and retail criteria

• Produce any additional support

materials on request

• Put the remaining stores through

the finalised criteria

• Complete and publish the supplier

list.

Healthcare Retail Standard

Bringing it all together…

StoreCustomer Feedback

SGFGuidance

Retailer business

model

HRS Criteria

SGFAssessment

NHS Board

HPHSTargets

NSSReporting

You

Healthier Retail and Catering

Thank

Question & Answer Session

#sushealthscot

Colin Sinclair, Chief Executive

NHS National Services Scotland

SUSTAINABILITY

IN

NHSSCOTLAND:

A CORE

PRIORITY

Direct Impacts (not including public health)

• >154,000 employees (c. 6% of Scotland’s workforce)

• > 4.6 million m2 estate

• Energy consumption around 1.8 TWh p.a.

• Direct greenhouse gas emissions around 650,000

tCO2e p.a. (c. 1.4% of Scotland’s total greenhouse gas

emissions)

• Annual waste arisings around 50,000 tonnes p.a.

Indirect Impacts

• Supply chain emissions

• Staff, patient and visitor travel

• Biodiversity and greenspace

• Corporate Social Responsibility

NHSScotland’s Sustainability Impact

Poor relative health and persistent inequalities.

Changing demographics. Reducing public sector spending.

The challenges

Legislation and Policy Drivers

• Sustainable

Development Action

Plans

• Public Sector Climate

Change Reports

• Biodiversity Action

Plans

• Climate Change

Adaptation Plans

• Waste Management

Action Plans

• Annual Procurement

Reports

• Asset Management

Strategies

NHSScotland

Sustainability

Initiatives and

Projects

Energy Projects

Energy

Efficiency

Projects

Energy Centre

Refurbishment

Renewable Heat and

Power

Greenspace Projects

Gartnavel CampusPossilpark Health & Social

Care CentreForth Valley Royal

Infirmary

Waste & Resource Efficiency Projects

Circular Economy – Metal recovery

Food Waste Reduction

Waste & Resource Efficiency Projects

Upcoming Challenges and Opportunities

• The 20:20 Vision

• Transformational Change

• Our Approach

• Funding Challenges

• From Mitigation to Adaptation

Looking Ahead

Thank you.

Q&A

Colin SinclairChief Executive – NHS National Services Scotland

Question & Answer Session

#sushealthscot

Chair’s Concluding comments

Brian Swanson, Chair of the NHSScotland Sustainability

Steering Group

#sushealthscot