Dr.FrancesMortimer,MedicalDirectorCentreforSustainableHealthcare

Medact annualforum9th December2016

TheSustainableClinician

“Ourvisionofsustainablehealthandcare:Asustainablehealthandcaresystemworkswithintheavailableenvironmentalandsocialresourcesprotectingandimprovinghealthnowandforfuturegenerations.”

Protectinghealthoffuturegenerations

CENTRE forSUSTAINABLEHEALTHCARE

Sustainabilityasadomainofquality

SustainablePatient CentredEquitable

Efficient

Effective

Timely

Safe

Dr Donal O’DonoghueNational Clinical Director

for Kidney Care

Seealso:Atkinson,S.etal.Defining QualityandQualityImprovement.Clin Medvol.10,no.6537-539(2010)

Sustainable value in healthcare:

Academy of Medical Royal Colleges, 2016 (with CSH)

(goods – harms)

Informedbypatientvalues

outcomesValue =

environmental + social + financial costs(the “triple bottom line”)

CENTRE forSUSTAINABLEHEALTHCARE

EstatesClinical

Carbonfootprint– NHSEngland

Procured(pharmaceuticals,equipment,everythingelse)

Travel

Buildingenergyuse

Commissioned

CENTRE forSUSTAINABLEHEALTHCARE

NHScarbonfootprint– goodsandservicescarbonhotspots

CENTRE forSUSTAINABLEHEALTHCARE

Summaryofprogress

Sustainableclinicalpractice

Reducecarbonwithoutreducing

health

Reduceactivity

Prevention

Selfcare

Leanpathways

Reducecarbonintensity

Lowcarbonalternatives

Sustainableestates

Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11

Outcomeneeded

Secondarydrivers

Primarydriver

Primarydriver

CENTRE forSUSTAINABLEHEALTHCARE

Sustainableclinicalpractice

Reducecarbonwithoutreducing

health

Reduceactivity

Prevention

Selfcare

Leanpathways

Reducecarbonintensity

Lowcarbonalternatives

Sustainableestates

Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11

Outcomeneeded

Secondarydrivers

Primarydriver

Primarydriver

CENTRE forSUSTAINABLEHEALTHCARE

CENTRE forSUSTAINABLEHEALTHCARE

Fiveyearforwardview

• ‘Gettingseriousaboutprevention’

• ‘Empoweringpatients’

• ‘Newcaremodels’

Sustainableclinicalpractice

Reducecarbonwithoutreducing

health

Reduceactivity

Prevention

Selfcare

Leanpathways

Reducecarbonintensity

Lowcarbonalternatives

Sustainableestates

Mortimer-F.TheSustainable PhysicianClinicalMedicine2010,Vol10,No2:110–11

Sustainableclinicalpractice

Outcomeneeded

Secondarydrivers

Primarydriver

Primarydriver

Infrastructure&processCENTRE for

SUSTAINABLEHEALTHCARE

e.g.drypowderinhalers(1/18xcarbonofMDI)

Thesustainableclinician

Advocacy

Qualityimprovement

Resourcemanagement

Clinicalpractice

Academy of Medical Royal Colleges, 2014 (with CSH)

Clinicalpractice?

Dr.HughRayner

QueenMargaretHospitalRenalUnit,FifeGreenNurse:MaryThomson

2009

14,000dialysistreatmentsperyear– 2.9kgwasteeach

40.3tonnes /year

100%incineratedasclinicalwaste

Resourcemanagement

CENTRE forSUSTAINABLEHEALTHCARE

• Normalsalinebags,togetherwithprimingsetsanddrainagebags,replacedwithonlineinfusion

• Dressingpacksreplacedwithindividualitems

• IVinfusion>bolus(6,175antibioticdoses/yr)

• Introducedwastesegregation

Queen Margaret HospitalNHS Fife

Resourcemanagement(2)

Saving:£45,000/yr

CENTRE forSUSTAINABLEHEALTHCARE

SustainableQI

Mortimer, F.,insubmission 2016

SusQI:improvingpre-oppathwaysAprimarycareteamnoticedthatsomepatientswhowerereferredforhipand

kneereplacementswerebeingreferredbacktotheGPsurgeryafterpre-operativeassessmentatthelocalhospital.Thiswasbecauseparameters,such

asbloodpressure,wereeitheroutsidethetargetrangeorwerenotcommunicatedproperlyinthereferralinformation.Anauditrevealedthat1in

6patientsloopedthroughthesystem– 10/year.

Activity Outcome £’s CO2e Social

ExtraGPconsult [delaytosurgery]

£451 18kg2 Patient&carertime/stress

ExtraHospitalconsult

[delaytosurgery]

£1121 23kg2 Patient&carertime/stress(parking…)

Total (for 10loops) £1570 410kg

1. Unit CostsofHealthandCare,PSSRU,December2015.Availableat:http://www.pssru.ac.uk/project-pages/unit-costs/2015/index.php

2. Carbon Hotspotsupdate forthehealth andcaresectorinEngland2015,SustainableDevelopmentUnit, January2016.

CharlieKenward,SevernGPST3SustainabilityScholar2014-15

Advocacy

Advocacy

http://networks.sustainablehealthcare.org.uk

http://sustainablehealthcare.org.ukfrances.mortimer@sustainablehealthcare.org.uk