sustainable development management plan 2019-2021 · web viewsustainable development management...

Sustainable Development Management Plan 2019-2021ContentsIntroduction.................................................................................................................3What is sustainability?.................................................................................................3Drivers for Change......................................................................................................4Organisational Vision..................................................................................................4Our Results So far.......................................................................................................5UN Sustainable Development Goals...........................................................................7Areas of Focus............................................................................................................8

Green Space and Bio Diversity................................................................................8Sustainable Care Models........................................................................................9Procurement..........................................................................................................10Working with Staff, Patients and Communities......................................................10Key actions in other sustainability areas................................................................11

Adaptation Planning..................................................................................................12Adaptation Plan – Services...................................................................................12Adaptation Plan – Buildings...................................................................................13

Links with The NHS Long-term Plan and DCHS Operational Plan...........................13Tracking Progress.....................................................................................................14Governance...............................................................................................................15Reporting...................................................................................................................15Risk...........................................................................................................................16Finance.....................................................................................................................16Communication.........................................................................................................16Appendix 1 – Current Progress on Energy, Waste and Water..................................17Appendix 2 – Sustainable Care Models....................................................................20Appendix 3 – Sustainability in the NHS Long Term Plan..........................................21Appendix 4 – Sustainability in the DCHS Operational Plan......................................22

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Introduction Derbyshire Community Health Services NHS Foundation Trust is one of the largest providers of specialist community health services in the country. We serve a population of over one million people in Derby and Derbyshire, delivering over 3,500 patient contacts every day and employing more than 4,300 staff. We care for patients in 10 community hospitals and more than 30 health centres, as well as in clinics, GP practices, schools, care homes and, increasingly, in people’s own homes. Being able to provide greater levels of care out of hospitals and closer to people’s homes in their own communities is a cornerstone of our future plans.

What is sustainability?Most people understand what sustainability is, but find it difficult to define. This definition below talks about ‘needs’, not about “the environment”, “being green” or “saving the planet”:

The health service needs to be resilient and capable of delivering quality care both today and tomorrow. Sustainability is about using our resources sensibly and striking the right balance between ‘Economic’, ‘Social’ and ‘Environmental’ considerations.

However, sustainability for us in the NHS is much broader than this – amongst other things it is about how we deliver care, how we create a healthier, happier population and how we ensure we can afford to continue delivering care in the future. This will, of course, include ensuring our plans enable us to develop a sustainable workforce for the long term.

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“Sustainability is about meeting our needs today without compromising the ability of

others to meet their needs tomorrow”

Drivers for Change There are numerous NHS, local, national and international drivers for sustainable development, but in order to help focus our attention on key elements we believe the key drivers for us are to:

Improve our services in a way which is sustainable environmentally, socially and financially

Reduce carbon emissions in order to slow climate change, improve local air quality and support public health

Improve social value to benefit the communities we serve, live in and work in Meet organisational financial targets Meet the NHS Long Term (10 Year) Plan Meet key local, national, European and international health and sustainability

targets

Organisational Vision Our vision requires us to think sustainably:

Amongst other things, to deliver this vision we need to achieve the threefold sustainability objectives of:

Reducing costs Reducing our environmental impact Increasing social value

To meet these sustainability objectives, we will Put our patients, staff, communities and other stakeholders at the centre of

our sustainability plans Ensure sustainability is a core element in everything we do Work with, develop partnerships with, and use best practice from, NHS and

non-NHS organisations Have a robust process for planning, measuring, monitoring, reporting and

progressing our sustainability ambitions that focusses on real outcomes, not ‘words’ or ‘ticks in boxes’

Identify elements within our organisation where a focus on sustainability could significantly improve our ability to provide high-quality and sustainable local healthcare.

Improve our services by concentrating resources on making sustainable changes in these areas while monitoring and supporting other areas to maintain (or improve) their performance.

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“We aim to be the best provider of local healthcare and to be a great place to work”

Our Results So farTo measure overall progress across a range of sustainable development areas we have been using the NHS Sustainable Development Unit Good Corporate Citizenship Toolkit. This consists of a series of questions on what we are doing, with answers of ‘yes’, ‘no’ or ‘in progress’. The scores for answers of ‘yes’ or ‘in progress’ are added to give a % score in each area and an overall % score. This has helped us assess how sustainable we are and provided a benchmark to measure our progress by evaluating sustainability across a range of areas. Our scores, using this toolkit, continued to improve across all areas during the last few years.

However, this toolkit has now been replaced by the Sustainable Development Assessment Tool (SDAT). This works in much the same way as the old toolkit, but with different questions and a wider range of areas to assess. Going forward we will use this new tool to assess our overall progress across all sustainability areas.

The chart below shows our new benchmark from which we will measure our progress. This benchmark was taken in July 2018.

One output from the SDAT is a chart which identifies the key areas which need attention. It is split into 10 ‘modules’ and 4 cross-cutting themes. The output for DCHS is shown below. It is from this that the suggested two modules of ‘Green Space and Biodiversity’ and ‘Sustainable Care Models’ plus the two cross-cutting themes of ‘Procurement and Supply Chain’ and ‘Working with Staff, Patients and Communities’ were identified as our areas of focus.

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The Sustainable Development Assessment Tool asks a total of 296 questions against these 10 areas. Each question can score up to 3 points (if we are fully doing that action). The scores achieved in each section are shown as a % of the total score available. The overall score is also shown as a % of the total score available across all sections.

It should be noted that the ‘Corporate Approach’ and ‘Governance and Policy’ scores will improve as we move through the process of approving the strategy and SDMP, publish these and monitor their implementation, so these do not need to be specifically targeted within the strategy and plans.

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Governance & Policy 72% 50% 40% 100% 33% 19% 50% 100% 23% 70%

Core responsibilities 75% 50% 60% 79% 0% 21% 52% 41% 33% 67%

Procurement and Supply chain

75% 27% 0% 50% 50% 50% 33% 33% 42% 26%

Working with Staff, Patients & Communities

44% 6% 100% 67% 0% 58% 83% 0% 8% 8%

Overall Module score 70% 38% 54% 75% 17% 28% 54% 29% 27% 51%

Carbon ReductionAs well as using the SDAT to measure our wider sustainable development progress, we also specifically measure total carbon emissions from our travel, energy, waste and water. We continue to meet or exceed our ongoing sustainability targets, making excellent carbon and cost reductions and putting us on target to achieve 34% carbon reduction emissions by 2020, using 2007/08 as our baseline.

Travel Our travel and transport emissions have been difficult to compare year-on-year due to the large number of changes to our organisation, staff numbers, services and sites in use. We know that our fleet has been getting more efficient as the average carbon emissions per mile is dropping, we have a lease fleet which has average emissions much lower than the UK average and we have been investing in electric vehicles. For this SDMP we have carried out a new baseline assessment using the Sustainable Development Unit’s Health Outcomes Travel Tool (HOTT). The overall results from this assessment are shown below and we will be using these figures to baseline our progress during the lifetime of this SDMP.

Element ValueBusiness miles 6,536,670 milesStaff Commuting (estimated) 12,650,000 milesPatient and Visitor miles (estimated) 7,685,000 milesTotal CO2 6,162 tonnes

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Energy (Gas and Electricity), Waste and WaterEnergy is one of the most difficult assets to manage in a large, complex and diverse organisation like ours. In addition, increasingly unpredictable seasonal temperature changes and oil price volatility make it extremely challenging to stay on course to meet our targets. Despite this, we are making good and persistent savings year on year and staying on target. We have achieved this through capital investment schemes to enhance energy efficiencies, innovative use of information management and technology in agile and mobile working, teleconferencing, back office efficiencies, effective estates management and space utilisation. Encouraging people to adopt good habits in areas of energy usage and waste management has also been crucial to our sustainability plans. Below is a summary of our progress between a 2007/8 baseline and 2017/18.

Item Reduction (CO2) Reduction (£)Gas 1325 tonnes (24%) £169,098 (20%)Electricity 1200 tonnes (26%) £188,036 (18%)Waste 172 tonnes (37%) £45,000 (18%)Water 27 tonnes (40%) £48,000 (22%)

More detailed charts and tables can be found in Appendix 1. These show our overall trends and savings made year on year.

UN Sustainable Development GoalsThe 17 United Nations Sustainable Development Goals (SDGs) officially came into force on 1 January 2016. They apply to all countries and aim to end all forms of poverty, fight inequalities and tackle climate change.

They are unique in that they call for action by all countries, poor, rich and middle-income, to promote prosperity while protecting the planet. They recognize that ending poverty must go hand-in-hand with strategies that build economic growth and address a range of social needs including education, health, social protection, and job opportunities, while tackling climate change and environmental protection.

As part of the NHS we need to identify how we can help meet the United Nations Sustainable Development Goals (SDGs). Our action plan therefore identifies which of these goals we will be supporting as we carry out our plans.

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Areas of Focus Much of our sustainability work to date has been focused on carbon reduction. Although very successful in these areas, we now need to redirect our sustainability efforts into meeting future challenges by balancing economic, environmental and social value impacts. The economic impact of projects and initiatives is under great scrutiny now (as it has always been). We now need to improve the assessment of all projects and initiatives with regard to carbon reduction and, in particular, start assessing them in terms of social value impact.

Based on our SDAT assessment, our priorities for this SDMP are: Areas:

o Sustainable Care Modelso Green Space and Bio Diversity

Cross-cutting themes:o Working with Staff, Patients and Communitieso Procurement and Supply Chain

We will specifically target actions in these areas during the 2-year lifetime of this plan. This doesn’t mean other areas of sustainability won’t be addressed, but that attention will be focussed on these areas where we feel more progress should and can be made with the limited resources we have available. Below is an outline of the key actions we will take in each of these areas and themes to meet our objectives.

Green Space and Bio Diversity

We will: Look into opportunities to create and promote Green Health Walks at

locations across Derbyshire Look at opportunities to support the work of food banks across Derbyshire Building on the success of the staff allotment at Walton Hospital, look at

opportunities to increase use of our green space for further allotments and other beneficial uses

Maintain and develop the green space on our own estate – including the use of green infrastructure (green walls, hedgerows and green set backs) to support reductions in air quality.

Promote:o health benefits of green spaceo volunteering to protect and enhance green space across Derbyshireo the benefits of local food sourcingo reduction in single use plastics to help protect the environment

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Sustainable Care Models(See Appendix 2 for the key components of a sustainable care model.)

We will: Ensure our Board and staff understand what sustainable care models are and

how they can be developed as part of our ongoing strategy and plans Test ways to identify and measure sustainable care models, for example by

including financial, health, social and wider economic benefits in our operational plan service-self-assessment

Review our current Quality Impact Assessment and Public Health Prioritisation tools to ensure they support and strengthen the sustainability of our emerging care models

Further develop the Public Health Prioritisation Tool to support the embedding of prevention in our models of care

Continue to develop flexible working policies, roles which include elements of flexible working and multi-skilling, and services/pathways which are resilient to skill shortages.

Roll out ‘Quality Conversations’ programme to engage patients in self-care Use patient involvement methodologies to engage patients as we redesign

services

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Procurement

We will: Implement a risk management process so key procurements undergo an

assessment of the sustainability impacts and opportunities, and manage these sustainability risks during the procurement process.

Identify which products pose a high ethical and labour standards risk and implement mitigation processes.

Identify which key resources have scarcity issues (such as medical gas supply and vaccines) and implement mitigations and contingencies to ensure this doesn't affect business continuity and delivery of care.

Working with our major suppliers, understand the resilience and contingencies within their supply chain during any extreme weather events.

Identify which products and services we source have a big contribution to our overall carbon footprint (in use and/or embedded) and implement interventions to reduce their impacts.

Identify our strategic suppliers and work with them to reduce the overall carbon impacts of the goods and services that they provide to our organisation.

Build on the work we currently do using Whole Life Costing by investigating how circular economy assessments could be used within procurement decision making.

Working with Staff, Patients and Communities

We will: Engage our staff, patients and communities in developing our sustainable

development objectives and implementation plans Create a DCHS ‘Transition Community scheme’ Provide advice about, and promote, various sustainability issues to staff,

patients and visitors:o Low carbon travel and transporto Green space and food growingo Energy and warm homes adviceo Waste and recycling, including food wasteo Sustainable products and single use plastico Volunteering

Work with and support local communities and organisations to improve sustainability across Derbyshire

Key actions in other sustainability areas

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We will: Run quarterly communications campaigns giving advice and information, and

promoting positive behaviours in the following areas: o Winter - Home energy saving, waste reduction and recyclingo Spring - Green space, food and local food sourcing o Summer - Volunteering and local sourcing of productso Autumn - Travel and transport

Continue with our ongoing carbon reduction actions: o Continuing capital investment in energy saving schemeso Implementing further waste and water management initiativeso Improving space utilisationo Extending agile workingo Widening use of teleconferencing, videoconferencing and use of these

technologies in providing healthcareo Continuing with travel and transport initiatives – promoting more

walking and cycling or use of public transport, pool cars and electric vehicles

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Adaptation PlanningWe have carried out a Climate Change Risk Assessment (CCRA), The main outcomes and our plans for adapting to climate change are summarised here.

The UK climate change projections (UKCP09) suggest the UK will face: Higher summer temperatures with less rainfall and more heatwaves likely Higher winter rainfall and more flooding likely Higher winter temperature, but some prolonged extreme cold periods possible

These are likely to result in the following impacts for our organisation and communities:

Reduction in cold-related deaths Increase in heat-related deaths and illnesses Increase in air quality-related illnesses Increase in hospital admissions and deaths caused by ground-level ozone Increase in people affected by flood-related mental health issues Increase in injuries and deaths due to flooding and storms

From our CCRA we have identified the key priority risks that need an adaptation response as:

The risk from increased health problems causing an increase in patient numbers at a time when staff recruitment and availability is an issue.

The risk from flooding and higher temperatures due to climate change will need new buildings to be planned in such a way to meet these changes over the next 30+years.

Adaptation Plan – Services

We need to support the move to Care Closer to Home to make services more efficient and effective. Also, improving integrated working, so when staff are absent other staff can cover, will provide more resilience. Care Closer to Home and the NHS direction of travel for services will help to support the changes required to adapt to climate change. However, in moving care into the community, close attention is required not to increase travel using fossil fuels which will increase the risks.

It will be necessary to identify ways to minimise travel and, where travel is needed, to move to alternative fuelled vehicles. Reducing the need to travel will also save time and allow staff to be more productive. This will include more flexible working, use of telehealth, mobile working, improved appointment bookings and route planning, and community-based clinics in appropriate locations rather than home visits

As the climate changes and we potentially have more hot summers our staff need to be aware of the vulnerability of some patients living at home. Suitable training may be needed to ensure staff know how to help these vulnerable patients stay safe in their own homes when temperatures rise, as heat related deaths and illnesses increase rapidly with rising temperatures.

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Adaptation Plan – Buildings

We should consolidate buildings, services and facilities. As services change and new facilities are built, it should be possible to ensure these are fit for future climate change by appropriate siting and design. We need to ensure buildings are in non flood risk areas, are more efficient buildings adapted for higher temperatures and are located in town centre locations with good transport links

Proper assessment is needed to ensure climate change risks are taken into account. Little can be done to current facilities, but climate change risks can be assessed if any future decisions are to be made on suitability of facilities for continued healthcare delivery.

The adaptation required for new building should not be great, but often such requirements can add to initial costs. The longer-term adaptation needs must be considered carefully and possible long-term cost implications from climate change considered against simply taking short term savings.

These climate response strategies can be built into our current mainstream activities and plans. The costs of adaptation will be minimised if it is factored into:

The early steps of planning new service developments Facilities that are being upgraded or newly built anyway Routine maintenance that is being conducted Plans that come up naturally for review Our routine work plan rather than being dealt with as an emergency situation.

Links with The NHS Long-term Plan and DCHS Operational PlanAlthough this plan is specifically highlighting actions which will improve the sustainability of DCHS, it hasn’t been planned in isolation. There are many links between this plan, the NHS Long-term Plan and our operational plan. Appendix 3 gives an overview of how sustainability is a central pillar of the NHS Long Term Plan, with elements of prevention, person-centred care, environmental sustainability, air quality interventions and reduction in water, waste and carbon, all of which this sustainability plan supports.

Appendix 4 shows some of the key sustainability links within our Operational Plan, including how the new Model of Care is more sustainable, the changes required to make our workforce more sustainable, how we are improving our buildings, making system efficiencies and reducing unwarranted variation, and how we will use technology to become more efficient.

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Tracking Progress To monitor our overall progress we have agreed the following SDAT targets:

Note that between July 2018 and March 2019, while this SDMP was being drafted, our scores have increased from the baseline. This is due to a) creating our new plans and engaging relevant stakeholders in the process and b) our continued improvements in sustainability across a number of the modules.

The SDAT will be our primary method for tracking overall progress and we will continue to monitor our progress in reducing carbon emissions. We also need a range of measures to ensure we can demonstrate the success of our initiatives and projects. These need further work, but potential measurements could include:

Element Possible measures or processOverall progress SDAT assessmentsSocial value and sustainability impact

Newly developed Sustainability Impact Assessment template

Travel Health Outcomes Travel ToolAir quality Mileage figures

QALYs (quality of life measurement)Energy, water and waste

Annual CO2 figures (per patient contact)

Use of Resources % occupancy in DCHS-owned or leased buildingsKgs waste (per patient contact)Litres of water used (per patient contact)Food waste (Kg or £ value)Number or amount of hazardous chemicals used

Procurement Carbon Measurement using the SCO2PE toolFood milesAverage delivery distances

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Procurement Social Value

% spent on SMEs, social enterprises and local sourcing% number of contracts with SMEs, social enterprises and local sourcing

Local Economic value £ spent on locally sourced goods (agreed radius for ‘local’ required)

Social Capital Getting It Right First Time measures% staff locally recruited

Green space/biodiversity

SDAT assessment

Governance This table shows our key roles and the leads for this work. These people and groups will ensure the outcomes from this plan are realised through either day-to-day management or by overseeing the work that is taking place.

Role NameOversight group responsible for supporting delivery and providing direction to this plan.

Plan Delivery Group

Sustainability and Adaptation Programme Manager: Mark Armstrong-Read

Board Executive Lead for Sustainability: Tim BroadleyBoard Lead for Sustanable Care Models: DCHS Medical DirectorBoard Non-Executive Lead for Sustainability TBC

Governor Lead for Sustainability Governors’ Strategy Subgroup

Sustainability Leads (Areas of Focus):Corporate ApproachTravel and LogisticsGreen Space and Biodiversity Sustainable Care ModelsSustainable use of Resources

Mark Armstrong-Read

Asset Management and UtilitiesCarbon/Greenhouse Gases (GHG’s) Sid Siddiqui

Capital Projects Peter WestOur People Amanda Rawlings

Reporting The following key reports will be used for sustainability reporting.

Board updates on SDMP progress (6-monthly) Governors update (copy of Board updates every 6 months) Annual SDAT completion Trust Annual Report Estates Return Information Collection (ERIC) (annually) Premises Assurance Model (PAM) (annually)

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Risk Risks will be assessed in line with the standard DCHS risk assessment guidance using a 5x5 matrix of likelihood and impact. These risks will be managed by the appropriate project lead or service manager. If deemed sufficiently high, the risk will be escalated through the relevant groups or board and ultimately to the main DCHS risk register if deemed serious enough.

Finance Identifying costs associated with sustainability is difficult due to it not being a separate service or identifiable physical item. There are some high-carbon, high-cost activities for which figures are available: gas, electricity, water, waste and travel. These activities have been a key element of our sustainable development for a number of years and we continue to focus on ways to reduce these as part of this SDMP. The current costs of these elements are shown in the table.

However, sustainability is about looking at ways to change services and operating models in order to reduce costs and environmental impact, and improve social value. Therefore costs and savings will be assessed for individual projects and initiatives as they are identified, allowing them to be assessed across all three domains (economic, environmental and social) before any decisions are made to proceed.

Communication We will engage our stakeholders so they feel a part of the sustainability journey. We will do this journey ‘with’, and not impose it ‘on’, our staff, patients, visitors and communities, identifying actions and desired outcomes by a combination of internal formal assessment and working with our stakeholders. We will:

Engage stakeholders throughout the process:o Seeking viewso Developing planso Implementing the planso Evaluating our outcomes

Communicate regularly with our stakeholders Develop and use robust measuring, monitoring and reporting to evaluate our

engagement and communication plan to:o Allow improvement to the engagement and communication process o Show that our engagement and communication has benefitted our

organisation, stakeholders and local community.

We are committed to being a sustainable organisation and with the support of our staff, patients, visitors, communities and other stakeholders we can achieve long-lasting changes that will benefit everyone.

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Element Cost 2017/18

Business Travel £4,026,000

Electricity £877,000

Gas £659,000

Waste £200,000

Water £175,000

Appendix 1 – Current Progress on Energy, Waste and WaterGas

2007/08

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

0

200

400

600

800

1,000

1,200

tCO2e (10)Cost £ (000)

Year 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Gas MWh

29487 26647 25913 28737 25211 27634 25651 25187 21287 23995 22399

tCO2e 5514 4983 4845 5374 4715 5168 4796 4710 3981 4487 4187

Cost £(000)

828 944 829 783 863 1050 882 840 845 748 659

Electricity

2007/08

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

0

200

400

600

800

1,000

1,200

tCO2e (10)Cost £ (000)

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Year 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Elect MWh

8677 8012 7332 7590 7558 6781 8013 7347 7449 7209 6387

tCO2e 4546 4198 3842 3977 3960 3553 4199 3850 3903 3778 3347

Cost £(000)

1065 774 711 711 701 702 868 852 856 872 877

Water

2007/08

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

0

50

100

150

200

250

300

Water tCO2eWater Cost £(000)

Year 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

tCO2eWater

80 74 94 60 63 65 66 60 51 53 48

Cost £(000)

223 215 270 187 195 197 203 192 179 186 175

Waste

2007/08

2008/09

2009/10

2010/11

2011/12

2012/13

2013/14

2014/15

2015/16

2016/17

2017/18

0

100

200

300

400

500

600

Total W tCO2eRecycled W tCO2eClinica W tCO2eLandfill tCO2eTotal Cost £(000)

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Year 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Total tCO2e

459 515 472 465 496 474 372 370 324 299 287

RecyclabletCO2e

0 0 155 152 162 146 130 110 215 193 86

ClinicaltCO2e

59 98 52 45 43 43 38 38 34 35 78

LandfilltCO2e

400 418 265 268 291 285 204 222 75 72 122

TotalCost £(000)

244 274 224 251 202 250 196 185 186 197 200

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Appendix 2 – Sustainable Care ModelsComponents of a sustainable care model

Clinically sustainable Prevention and early intervention – addressing the causes of ill health Enablement and support – to be effective in our daily roles Self-management – managing our own conditions Acute and specialist rehabilitation – only the right care at the right time Dying well – according to the individuals idea of a ‘good death’

Socially Sustainable Use our influence to address wider health and social inequalities Ensuring there is equity in the distribution of resources and delivery of

services

Environmentally sustainable Services and activities are designed and delivered in such a way as to

minimise or eliminate negative impact on the environment

Financially sustainable Services are cost-effective – they provide value for money for outcomes

achieved

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Appendix 3 – Sustainability in the NHS Long Term Plan Adapted from Centre for Sustainable Healthcare article https://sustainablehealthcare.org.uk/news/2019/01/sustainability-nhs-long-term-planThursday, 24 January, 2019

Some of the key ideas underpinning sustainability within the first NHS Long-term Plan (greater emphasis on prevention, patient-centred care, and integration across current silos) are central to the 10 year plan. Alongside changing models of care there are also some specific carbon reduction and efficiency targets. All these elements echo the Centre for Sustainable Healthcare’s 4 principles: prevention, person centred care, lean pathways and lower carbon interventions.

On prevention, there are specific targets in the plan for earlier detection of illness. There are also sections on smoking and alcohol with a commitment to making smoking cessation services much more universally available and specialist Alcohol Care Teams (ACTs) to be supported.

Person-centred care is emphasised under personalised care. This includes dedicated support for social prescribing which includes green prescribing and other forms of intervention which are less medical and can be an important sustainable alternative or adjunct to drugs and other carbon-intensive therapies, and also build resiliance and positive health, and therefore contribute to prevention.

Specifically, "link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then."

The plan also includes some specific commitments towards environmental sustainability. The NHS has restated its commitment to the carbon targets in the UK government Climate Change Act (2008), reducing carbon emissions (on a 1990 baseline) by 34% by 2020, and 51% by 2025. A shift to lower carbon inhalers will deliver a reduction of 4%, with a further 2% delivered through transforming anaesthetic practices.

The NHS commits to improving air quality by: cutting business mileage by 20% by 2023/24; ensuring that at least 90% of the NHS fleet uses low-emissions engines (including 25% ultra-low emissions) by 2028, and phasing out primary heating from coal and oil fuel in NHS sites.

The NHS will also ensure that all trusts adhere to best practice efficiency standards and adoption of new innovations to reduce waste, water and carbon, in addition to reducing single-use plastics.

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https://sustainablehealthcare.org.uk/news/2019/01/sustainability-nhs-long-term-plan

Appendix 4 – Sustainability in the DCHS Operational Plan The DCHS Operational Plan identifies how DCHS will move forward across a broad range of activities to improve services. Sustainability is a key requirement of these plans. Below are a summary of the key parts of the operational plan showing how they will help us meet our sustainable development goals.

Model of CareThe DCHS Operational Plan supports the priorities of ‘Joined Up Care Derbyshire’ in its strategic intent to finance, activity, workforce and our clinical model. Along with our partners we are working to help people take better care of themselves by organising the system through place based care so emergency services are used more effectively, heath and care organisations are working together, and organisations are being more efficient.

Essentially, for the people of Derbyshire we want to keep people: Safe & healthy – free from crisis and exacerbation At home – out of social and healthcare beds Independent – managing with minimum support

...which will be founded on building strong, vibrant communities where we will begin to address lifestyle issues related to poor health, improve access to urgent and routine care and reduce the need for bedded care.

The Derbyshire Model of Care (below) has sustainability built in, with an intention to shift care closer to home, with much more prevention and self-help at its core and services delivered within the community.

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Workforce The new care models will transform care so that people can be supported in their own homes and communities more effectively. We are working with other healthcare providers such as General Practice and Mental Health services to help implement these changes which require new ways of working and new roles to deliver new models of care. The major change is to deliver more healthcare out of acute hospitals and closer to home, with the aim of providing better care for patients, cutting the number of unplanned bed days in hospitals and reducing overall costs. Services will focus on looking after people in their home or local area, so they get better quicker, instead of concentrating services in specific buildings. By tailoring care to people and communities, patients get better, more targeted support to stay well.

BuildingsThe Trust has been successful in securing funding to support two major building schemes in the Belper and Bakewell areas to the value of £5.9m and £8.6m respectively. Our operational plan assumes an additional internal investment of £6.0m in 2019/20. The major areas planned for investment are the redevelopment of the Walton site, early preparatory work regarding the new development in Buxton and continued investment in our IM&T infrastructure and routine maintenance.

We will continue to work with our Derbyshire partners to progress our collective estates strategy and progress the ‘one public estate’ initiative. We will continue to pursue a number of key schemes as we work to deliver safe productive services in line with our clinical strategies. We will ensure we deliver estates efficiencies by maximising clinical estate utilisation and in the acceleration of planned disposals. System EfficienciesDCHS will take as many opportunities as possible to maximise our productivity. We will participate in networked arrangements for procurement, corporate services and diagnostic services, achieving best practice in clinical and other workforce productivity standards. As we develop our system approach to planned care, DCHS will work with our acute partners to support the delivery, where appropriate, of the Getting It Right First Time recommendations. As part of the wider Derbyshire Integrated Community Services we will also consider how to make best use of the digital and technological systems and innovations available in line with the NHS Ten Year Plan.

Following the work that the Trust undertook in 2017 and 2018 with the team sponsored by Lord Carter and NHS Improvement, DCHS will use the data collected to remodel its demand and capacity planning, and work to further improve efficiency and quality in the Community Teams. We will specifically be looking at areas where we can improve the allocation and deployment of clinical work to make best use of clinician and patient time.

Reducing Unwarranted VariationAs part of our approach to delivering the Carter principles and the 10 point efficiency plan, DCHS is committed to reducing unwarranted variation and improving efficiency across all services, ensuring that any variation is planned and understood. Work on

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our business intelligence system continues to support these developments. Through the Outstanding Way initiative we will continually review the quality, effectiveness, productivity and staff experience (Quadruple Aim) of our community therapy, nursing and specialist service provision across the city and county. This approach will allow us to identify and reduce duplication and inefficiency. We will measure the impact of our clinical interventions to ensure we optimise clinical quality, efficiency and productivity. We will also continue focusing on embedding the Outstanding Way programme, utilising benchmarking information, including reference costs to identify opportunities elsewhere such as within pharmacy and catering delivery models to maximise our productivity and efficiency opportunities.

Informatics and Technological TransformationWe will continue to exploit both our existing and new technologies. Our transformation programme covers a range of key themes and whilst most will not necessarily result in cash releasing efficiencies these will be key enablers to the trust achieving our quality and productivity objectives and in line with the objectives of the NHS Long Term Plan

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