Carbon Assessment. Shaping a Healthier Future. June 2012 North West London NHS

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1 Shaping a Healthier Future June 2012 North West London NHS

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3 EVT EES 1 A P:\Birmingham\ITB\ NW London HIA\Carbon\Sent to Client\North West London NHS Carbon June 2012 Shaping a Healthier Future June 2012 North West London NHS Mott MacDonald, Demeter House, Station Road, Cambridge CB1 2RS, United Kingdom T +44(0) F +44(0) , W

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5 Issue and revision record Revision Date Originator Checker Approver Description A 08/06/12 JD TE IS 1st Draft B 12/06/12 JD IS IS 2nd Draft This document is issued for the party which commissioned it and for specific purposes connected with the above-captioned project only. It should not be relied upon by any other party or used for any other purpose. We accept no responsibility for the consequences of this document being relied upon by any other party, or being used for any other purpose, or containing any error or omission which is due to an error or omission in data supplied to us by other parties. This document contains confidential information and proprietary intellectual property. It should not be shown to other parties without consent from us and from the party which commissioned it. Mott MacDonald, Demeter House, Station Road, Cambridge CB1 2RS, United Kingdom T +44(0) F +44(0) , W

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7 Content Chapter Title Page 1. Introduction Overview Policy context 1 2. Shaping a Healthier Future proposals Overview Reconfiguration options 4 3. Methodology Overview Project scope Carbon calculation methodology Supporting data Assumptions and limitations Option Analysis Overview Changes from the current situation Option Five Option Six Option Seven Conclusions and recommendations Overview Travel emission management opportunities and mitigations Wider carbon reduction initiatives 20 Appendices 22 Appendix A. Journey Time Analysis 23 A.1. Option 5 23 A.2. Option 6 26 A.3. Option 7 29

8 1. Introduction 1.1 Overview North West London (NWL) is proposing a new configuration for health services to create high quality, sustainable services for the population. In recognising the need to review the clinical case for change in how services are organised and delivered across North West London to best meet the needs of its residents, NHS NWL have been assessing the future sustainability of services and have now developed proposals for public consultation on the reconfiguration and redesign of primary, community and acute hospital care services to create high quality, sustainable services for the population. NHS NWL has commissioned Mott MacDonald to undertake a Carbon Assessment of its proposed reconfiguration programme Shaping a Healthier Future. This document reports the output of the carbon assessment. Based on the outcomes of this assessment evidence based recommendations are produced outlining measures to maximise the positive impacts and minimise any negative impacts for each option. It s also worth noting that the objective of this assessment is to inform the decision-making process rather than determine a preferred option for implementation. The term carbon footprint is normally used to define the net balance in the amount of greenhouse gases emitted by an organisation, product or process measured in units (or tonnes equivalent) of carbon dioxide (CO 2 ). In order to determine a carbon footprint, a structured approach is taken to calculate emissions associated with a range of sources (such as travel or building energy generation) in order to produce a figure which represents a complete picture of an organisation s impact. 1 The principles of carbon footprinting can also be applied on smaller scales, for example when an organisation undertakes a discrete proposal or project. This can allow the carbon impact of the proposal to be judged, often in the context of wider policy objectives, to aid decision making. Applying these principles within an impact assessment can allow for the identification the extent of change for projects or proposals from a current baseline. 1.2 Policy context Carbon reduction is a priority for the NHS. The UK Government has committed to take action now and has introduced the Climate Change Act with a target to cut carbon emissions by at least 80% by 2050, with a minimum reduction of 26% by 2020 across the UK. The NHS aims to at least meet these targets and to demonstrate early success on the way. The reorganisation of health services has the potential to affect the way staff, patients and visitors travel to health centres. Changes in the location of health services will predominately influence the distance travelled by these groups. In turn this is likely to result in changes in emissions associated with accessing particular health services. It is therefore important that the impact of proposals on the carbon emissions is assessed. 1 Defra (2009) Guidance on how to measure and report your greenhouse gas emissions 1

9 1.2.1 National Policy and Legislation The Climate Change Act is the entering in to statute of the Climate Change Bill and was enacted in November There are two key aims underpinning the Act: To improve carbon management and help the transition towards a low carbon economy in the UK; and To demonstrate strong UK leadership internationally, signalling that it is committed to taking the share of responsibility for reducing global emissions in the context of developing negotiations on a post-2012 global agreement at Copenhagen. Legally binding targets are set in the act. The Act specified a long-term target reduction cut of at least 80% by 2050, and reductions in CO 2 emissions of at least 26% by 2020 (changed to 34% by subsequent legislation), both against a 1990 baseline. The targets will be reviewed and adjusted according to the advice of the Committee on Climate Change in line with new evidence and data. The Low Carbon Transition Plan 2 is the white paper which sets out the strategy of the Government to achieve the emission reduction targets specified in the Climate Change Act As a part of this it also details the measures relating to how the first three five-year budgets will be met. Under the Plan, each sector has been set a budget with specific policies to contribute to the overall target. These are mainly focussed on achieving the targets up to the end of the third carbon budget (2022). Some Government departments have also produced separate, more detailed plans on how these will be achieved, notably the Department for Energy and Climate Change (DECC) in implementing change in the power sector, and the Department for Transport (DfT) for implementing change in the transport sector NHS Policy Through its own carbon footprint work 3, the NHS in England has identified that it was responsible for 21.2 million tonnes of CO 2 equivalent emissions in 2007, representing around 25% of total public sector emissions and over 3% of total carbon emissions in England. This carbon footprint was calculated for all NHS related activity taking into account all NHS organisations in England from Strategic Health Authorities to GP practices, pharmacies to NHS Blood & Transplant. It gives a better understanding of both the direct and indirect emissions associated with the NHS. A preliminary study carried out by the NHS and the Stockholm Environment Institute indicates that by 2020 emissions could increase up to 22.8 million tonnes 4. The NHS has produced a carbon reduction strategy which establishes a target of reducing its 2007 carbon footprint by 10% by and assesses the potential options to reduce emissions in line with the targets now in place through the Climate Change Act. 2 DECC: The UK Low Carbon Transition Plan: National Strategy for Climate & Energy (2009) 3 NHS Sustainable Development Unit, January 2010 Baseline Emissions Update 4 NHS Sustainable Development Unit, Sustainable Development Commission & Stockholm Environment Institute (2009): NHS England Carbon Emissions: Carbon Footprint modelling to NHS Sustainable Development Unit (2009): NHS Carbon Reduction Strategy for England 2

10 A recent update of the NHS carbon footprint 6 identified that carbon emissions for NHS England have stopped rising and are levelling off, however meeting the carbon reduction targets will still be a significant challenge. Figure 1.1 illustrates that establishes the latest carbon footprint at 20 million tonnes of CO2e (MtCO 2 e), projecting a 5.4% (1 MtCO 2 e) decrease by A further cut of 4.6% (0.9 MtCO 2 e) is therefore required if the NHS is to reduce its emissions by 10% by 2015, as proposed in the NHS Carbon Reduction Strategy. Figure 1.1: NHS Emissions Reduction Target Update Source: NHS SDU, Update NHS Carbon Reduction Strategy, February 2012 Three primary sectors of CO 2 emissions within the NHS are identified as emissions associated with travel (16%), building energy (19%) and procurement (65%). Procurement has remained as the largest sector associated with NHS emissions, with steady growth increasing this proportion from 60% in 2004 to 65% in Building energy use emissions have decreased, predominantly as a result of the move from coal and oil to a greater reliance on gas. Emissions associated with travel have remained fairly constant. 6 NHS Sustainable Development Unit (2012) NHS England Carbon Footprint 3

11 2. Shaping a Healthier Future proposals 2.1 Overview The aim of Shaping a healthier future programme is that the right care is delivered in the right places, addressing the inconsistencies and variation of the current system, the changing demands and lifestyle of the local population and the need to respond to medical advances and rising national standards. In doing so, this has recognised that the current configuration of hospital and primary care services will not meet the needs of the future and that whole system change is needed; with the emphasis on investing more into primary care and other local healthcare to ensure quality and consistency and providing more proactive services in the community and close to patients home. A consequence of shifting care from traditional acute hospital settings to providing more care for patients in a community setting, primary care or in the patient s own home is the impact on the future requirement and clinical sustainability and financial viability of acute hospitals. There is good evidence which suggests that delivering sustainable acute hospital services to provide care which is safe and delivers optimum outcomes for patients requires a minimum medical workforce to deliver safe working practices and a critical mass of patient admissions to justify this medical workforce investment; allowing the medical workforce to practice and maintain their professional skills and competencies. Therefore, Shaping a healthier future has been developed based on three key principles: Localising routine medical care; Centralising specialist services where necessary; and Integrating services across primary and secondary care, with involvement from social care to give patients seamless care. 2.2 Reconfiguration options Out of Hospital Care The central principle underpinning out of hospital services is to localise routine medical care. Clinicians within each of the eight CCGs have developed a vision for out of hospital care which provides proactive planned care and supports the shift of activity from hospitals to community care. The five core themes on how to transform Out of Hospital care are: Easy access to high quality, responsive care to make out of hospital care first point of call for people; Clearly understood planned care pathways that ensure out-of-hospital care is not delivered in a hospital setting; Rapid response to urgent needs so fewer people need to access hospital emergency care; Providers working together, with the patient at the centre to proactively manage long term conditions, the elderly and end of life care out-of-hospital; and Appropriate time in hospital when admitted, with early supported discharge into well organised community care. 4

12 The integrated care pilot 7 also forms part of the proposed improvements to out of hospital care and it is reported that the pilot is already operational is inner NWL and is due to commence shortly in outer NWL. As part of these proposals, integrated care will be delivered within five networks of practices and there will be one integrated health and social care team aligned to each network. These teams will be physically based in a centralised network location and will have a role in both the commissioning and provision of care Hospital care Using the latest evidence and research, clinicians have identified that there are significantly improved outcomes for patient and improved patient experiences when certain specialist services are centralised. Clinicians involved in developing the proposals have focused on three clinical areas: Emergency Surgery and A&E, Maternity and Paediatrics. Due to the clinical interdependencies between these specialties, these three specialties drive the design of the acute clinical service models and therefore the reconfiguration of acute services. Accordingly, in collaboration with patients and their representatives, the public, commissioners and providers, clinicians from across North West London have developed the following vision for hospital services for the future. Proposals have now been formalised for public consultation which set out how services will be organised and delivered across North West London. These proposals envisage: Out of hospital services being expanded and improved across all areas; All nine current hospital sites remaining as Local Hospitals continuing to provide around 75% of all patient activity; All Specialist Hospitals being retained; and Elective care provided at Central Middlesex Hospital remaining. Of the nine current hospital sites some will only provide Local Hospital service whilst others will be designated as Major Hospitals providing access to emergency and specialist care services. There are three options being considered during the public consultation and the table below sets out these options for the acute hospital service reconfiguration. Further detail on the services provided at each type of hospital can be found in the report - Shaping Healthier Future. 8 7 North West London Integrated Care Pilot: Business Case, NHS North West 8 NHS NWL (2012) Shaping Healthier Future: Progress Review 5

13 Table 2.1: The Options Hospital Site Option Five Option Six Option Seven Northwick Park Major Hospital Major Hospital Major Hospital Hillingdon Major Hospital Major Hospital Major Hospital West Middlesex Major Hospital Major Hospital Elective/ Local Hospital Ealing Local Hospital Local Hospital Major Hospital Central Middlesex Elective/ Local Hospital Elective/ Local Hospital Elective/ Local Hospital Charing Cross Local Hospital Major Hospital Local Hospital Chelsea & Westminster Major Hospital Local Hospital Major Hospital Hammersmith Specialist Hospital Specialist Hospital Specialist Hospital St Mary s Major Hospital Major Hospital Major Hospital 6

14 3. Methodology 3.1 Overview The following section outlines the approach used to determine the change in carbon emissions for each of the hospital reconfiguration options and, for transparency, sets out the data sources and assumptions used in the assessment Project scope The reconfiguration proposals have the potential to change CO 2 emissions from the following three primary sectors (consistent with sectors defined in the NHS s own carbon footprint work 9 ): Travel (patients and visitors); Building energy use (heating, hot water, electricity consumption and cooling); and Goods and services (medical supplies and equipment). This assessment focuses on the changes in emissions associated with changes in travel patterns for patients, visitors and NHS fleet vehicles as a result of different hospital reconfiguration options for health care services in NWL (Figure 3.1). These changes are determined in relation to a change from baseline. Although changes in emissions associated with buildings and procurement are relevant the impact of the hospital reconfiguration on carbon emissions, these factors are not considered in this assessment due to the availability of data. Therefore, carbon analysis presented in this report is based on an examination of changes in travel patterns for different scenarios, and calculation of predicted future carbon emissions for each option. 9 NHS Sustainable Development Unit, Sustainable Development Commission & Stockholm Environment Institute (2008): England Carbon Emissions; Carbon footprint study (and 2009, 2010 update) 7

15 Figure 3.1: Current configuration 3.3 Carbon calculation methodology Greenhouse gases are emitted from transport activities through the burning of fuel, with the quantity of these gases emitted dependant on the amount of fuel consumed and the content of these gases in the fuel used. Emissions associated with travel were calculated based on the combination of changes from baseline in the distance travelled, mode of travel and the associated emission factor for patients and visitors to and from the point of care. This information is then used to provide an annual estimate for the change from a typical current situation to the first fully operational year in 2016/17 10 for each reconfiguration option. It is worth noting that this assessment focuses on travel associated with hospital care as outlined in section due to the availability of travel data. Travel associated with out of hospital care (section 2.2.1) is not considered within this assessment. 10 NHS NWL (2012) Shaping Healthier Future: Progress Review 8

16 Calculations to inform the assessment are undertaken within a series of matrices which combined the following factors to determine the changes in travel emission within each option individually: Patient numbers Journey times Modal split Vehicle emission factors Journey speed Visitor frequency This methodology is illustrated in Figure 3.2. Figure 3.2: Carbon Assessment Methodology 3.4 Supporting data Due to the predictive nature of the assessment, it is necessary to include a number of proxy data measures to estimate the impacts relating to sources for which information is not currently available, or where suitable resolution is not available. Therefore the following sub-sections explain assumptions relating to data accuracy and sensitivities which must be considered when viewing the assessment results Patient data The 2010/11 NHS patient data for London boroughs within NHS NWL was used to determine the estimated number of patients travelling to individual hospital sites for different services for each option. This information was factored down to the Lower Super Output Area (LSOA) level to support the evaluation against journey time data Journey times Journey time data was outputs from the HSTAT model provided by NHS NWL. This data was provided in the form of change in journey time from baseline for each hospital reconfiguration option at the LSOAs level. 9

17 3.4.3 Modal split Modal split is defined as the proportion of different methods of travel used in which to access health services for patients and visitors. Table 3.1 summarises the assumed modal splits used in support of this assessment. It s important to note that modal split varies depending on accessibility and the health care service accessed. For the purposes of this assessment model split has been set an assumed at a level that is representative of services accessed as a whole and the general accessibility of different travel modes to hospitals within NWL. Table 3.1: Service Assumed Modal Split To Site From Site BLA Private Transport Public Transport BLA Private Transport Public Transport Patients 20% 62% 18% 0% 78% 22% Visitors 0% 78% 22% 0% 78% 22% Source: Based on assumptions used in A Picture of Health Accessibility Assessment Emission factors Transport mode emission factors used in this assessment are summarised in Table 3.2. These factors where developed from a combination of Department for Transport (DfT) vehicle occupancy statistics and public transport use and Department for Environment, Food and Rural Affairs (DEFRA) vehicle emission factors. Table 3.2: Travel Emission Factors Mode gco2/per km Source Private Transport Blue Light Ambulance (BLA) Public Transport kg CO 2e per passenger km kg CO 2e per passenger km kg CO 2e per passenger km Source: Defra (2012) GHG Conversion Factors for Company Reporting 13 Factor for Unknown Car (unknown fuel) divided by average occupancy for trip purpose. 12 Factor for Rigid t vehicle, average load The combination of factors for bus, overground and underground services in London based on use Travel speed Table 3.3 summarises the assumed travel speeds emission factors used in support of this assessment. Data was unavailable for public transport modes, therefore average road vehicle speeds were used as a proxy. It was also assumed that Assumes ambulances travel 33.3% faster than normal vehicles DfT (2010) National Travel Survey

18 Table 3.3: Assumed Travel Speeds Road Type Average Speed All Vehicles (km/hr) 14 Average Speed Ambulances (km/hr) All Roads Source: London Atmospheric Emissions Inventory Visitor frequency Emissions associated with visitor travel have been estimated based on the assumed number of visits for patients in certain types of care. The number of visits is assumed at 1.5 times the average length of patient stay, with average patient stay varying depending on the service area. Table 3.4 summarises the assumed average number of visits for patients as a whole within this hospital reconfiguration. As the majority of patients affected by the hospital reconfiguration are A&E patients, assumed visitor numbers for this service area has been used as proxy for the hospital reconfiguration as a whole. Table 3.4: Service Assumed Visit Frequency Assumed visits All Patients 6 Source: Based on assumptions used in A Picture of Health Accessibility Assessment Assumptions and limitations The purpose of this assessment is to inform the decision-making process rather than determine the decision. This assessment is strategic in nature and is designed to consider the impacts carbon emissions as a whole under each option. Impacts on specific service areas are not considered individually. The assessment was undertaken through the review and analysis of available secondary data inputted into a carbon calculation matrix such as patient numbers, travel times and emission factors. There has been limited consultation or primary research undertaken in the production of this assessment; therefore recommendations made are general to the issue of carbon management within the NHS. The feasibility of such recommendations within the context of this reconfiguration will need to be considered before interventions are implemented. A number of assumptions have been made in respect to the development of the estimated change in travel carbon emission, as outlined above. However, calculations under these assumptions are still likely to provide an accurate estimate of the likely change in travel carbon emissions under different hospital reconfiguration options. 14 It is important to note that due to a lack of available data for rail travel, this figure has been used as a proxy for public transport travel speeds

19 It is expected that emission factors associated with travel use will decrease over time and changes in modal split could also occur. This will therefore affect the total emissions associated with the future scenarios, leading to a reduction in overall changes emissions compared to the baseline. Again, this sensitivity is likely to affect all the future scenarios equally and is unlikely to affect the overall outcome of the assessment when comparing the future scenarios. This assessment is focused on the change in emissions associated with trips to and from major hospital centres. The assessment therefore doesn t take into consideration changes in journey times associated with supporting proposals, such as proposals for the provision of some services locally. However, it is worth noting that proposals such as this have the potential to influence the scale of impact on carbon emission associated with the hospital reconfiguration. In this case there is a potential for significant reductions is emissions associated with travel from the implementation of this supporting proposal. In addition to this assessment does not consider the travel associated with BLA services to patients due to the availability of data. Patient data used in this assessment is representative of the most recent year from which information is available (2010/11). Within this assessment it is therefore assumed that these patients are retained within the hospital care system. However, as outline in the hospital reconfiguration proposals, some patients are expected to receive care services locally reducing the number of patients within the hospital care system. 12

20 4. Option Analysis 4.1 Overview Currently a range of health services are provided across a number of hospitals across NWL (Figure 3.1). This section presents the predicted changes in carbon emissions for the three hospital care reconfiguration options. 4.2 Changes from the current situation Each of the hospital reconfiguration proposals will see the reclassification of hospitals within NWL and the reconfiguration of the services they provide. Therefore, patients and visitors within areas of NWL may have to travel to a different hospital to access certain health services. These changes are expected to have an impact on the distances travelled by these groups, in turn affecting carbon emissions associated with travel. The following section summarises the results of the carbon assessment in terms of the change from baseline for the three hospital reconfiguration options. The current situation is known as the baseline scenario. Under this baseline scenario emissions associated with patient and visitor travel in accessing health services associated with this scenario currently 9,412 tco 2 e. 4.3 Option Five Option Five includes five major hospitals, three local hospitals, and one specialist hospital as summarised in Table 4.1. The net change in transport emissions from baseline for Option Five is an annual increase of 1,199 tonnes CO 2 e. This represents a 13% increase from the baseline. Table 4.1: Option Five Hospital Site Northwick Park Hillingdon West Middlesex Ealing Central Middlesex Charing Cross Chelsea & Westminster Hammersmith St Mary s Option Five Major Hospital Major Hospital Major Hospital Local Hospital Elective/ Local Hospital Local Hospital Major Hospital Specialist Hospital Major Hospital As outlined in Table 4.2, this increase is a reflection of the change in journey times as a result of the hospital reconfiguration for this option (Appendix A.1). On average, patients and visitors would have to travel further for health services under this option. In respect to travel mode, private transport accounts for the largest proportion of the estimated increase in transport emissions (733 tonnes CO2e, 61% of the total change). Public transport and BLA travel account for significantly smaller proportions of the change (21% and 18% respectively). For all modes, visitor emission accounts for 51% of the total change (616 tonnes CO2e), where as patient travel represents 49% of the total change (583 tonnes CO2e). 13

21 Table 4.2: Change from baseline for Option Five Aspect Total change in emissions Private Transport +733 tco 2e Public Transport +252 tco 2e BLA +214 tco 2e Patient Travel Visitor Travel +583 tco 2e +616 tco 2e Total +1,199 tco 2e (+13%) 4.4 Option Six Option Six includes five major hospitals, three local hospitals and one specialist hospital as summarised in Table 4.3. The net change in transport emissions from baseline for Option Six is an annual increase of 1,244 tonnes CO 2 e. This represents a 13% increase from the baseline. Table 4.3: Option Six Hospital Site Northwick Park Hillingdon West Middlesex Ealing Central Middlesex Charing Cross Chelsea & Westminster Hammersmith St Mary s Option Six Major Hospital Major Hospital Major Hospital Local Hospital Elective/ Local Hospital Major Hospital Local Hospital Specialist Hospital Major Hospital As outlined in Table 4.4, this increase is a reflection of the change in journey times as a result of the hospital reconfiguration for this option (Appendix A.2 ). On average, patients and visitors would have to travel further for health services under this option. In respect to travel mode, private transport accounts for the largest proportion of the estimated increase in transport emissions (775 tonnes CO2e, 62% of the total change). Public transport and BLA travel account for significantly smaller proportions of the change (20% and 18% respectively). For all modes, visitor emission accounts for 51% of the total change (636 tonnes CO2e), where as patient travel represents 49% of the total change (608 tonnes CO2e). 14

22 Table 4.4: Change from baseline for Option Six Aspect Total change in emissions Private Transport +775 tco 2e Public Transport +243 tco 2e BLA +226 tco 2e Patient Travel Visitor Travel +608 tco 2e +636 tco 2e Total +1,244 tco 2e (+13%) 4.5 Option Seven Option Seven includes five major hospitals, three local hospitals and one specialist hospital as summarised in Table 4.5. The net change in transport emissions from baseline for Option Seven is an annual increase of 1,122 tonnes CO 2 e. This represents a 12% increase from the baseline. Table 4.5: Option Seven Hospital Site Northwick Park Hillingdon West Middlesex Ealing Central Middlesex Charing Cross Chelsea & Westminster Hammersmith St Mary s Option Seven Major Hospital Major Hospital Elective/ Local Hospital Major Hospital Elective/ Local Hospital Local Hospital Major Hospital Specialist Hospital Major Hospital As outlined in Table 4.2, this increase is a reflection of the change in journey times as a result of the hospital reconfiguration for this option (Appendix A.3). On average, patients and visitors would have to travel further for health services under this option. In respect to travel mode, private transport accounts for the largest proportion of the estimated increase in transport emissions (660 tonnes CO2e, 59% of the total change). Public transport and BLA travel account for significantly smaller proportions of the change (24% and 17% respectively). For all modes, visitor emission accounts for 52% of the total change (581 tonnes CO2e), where as patient travel represents 48% of the total change (541 tonnes CO2e). 15

23 Table 4.6: Aspect Private Transport Public Transport BLA Change from baseline for Option Seven Total change in emissions +660 tco 2e +269 tco 2e +193 tco 2e Patient Travel Visitor Travel +541 tco 2e +581 tco 2e Total +1,122 tco 2e (+12%) 16

24 5. Conclusions and recommendations 5.1 Overview This section provides a summary of the assessment findings, combining all of the key impacts identified in Chapter 4. The section also highlights any mitigation measures and opportunities that it is suggested should be considered in the decision-making process. Table 5.1 summarises the change in baseline for carbon emission as a result of different hospital reconfiguration options. The key messages from this evidence are: The reconfiguration is expected to result in a net increase in emission associated with patient and visitor travel for all options following the hospital care component of the reconfiguration. This is a reflection of the change in travel and increased journeys for some patients and visitors. The impacts on carbon emissions are highest for option six The impacts on carbon emissions are lowest for option seven Private transport modes account for the largest proportion the net increase from baseline for all reconfiguration options, representing over 59% of the total change. Without mitigation, the net increase in emissions associated with patient and visitor travel is expected to off-set a significant proportion of the targeted NHS emission savings from travel planning. Table 5.1: Impact Reconfiguration carbon emission Net increase in transport emissions from the baseline (9,412 tonnes CO2e). Tonnes CO2e Option Five Option Six Option Seven 1,199 1,244 1,122 % increase 13% 13% 12% 5.2 Travel emission management opportunities and mitigations The benefits of creating an environment that encourages and enables more sustainable travel, such as walking and cycling, can save NHS resources on preventable deaths from illnesses attributed to physical inactivity such as coronary heart disease, stroke and colon cancer. Therefore, the NHS should be leading the way in supporting sustainable travel activities to realise these goals alongside achieving carbon and efficiency savings. Key areas where NHS health and social care organisations can take action to deliver sustainable health 16 include: Changing behaviours - working with staff, patients and the public in relation to sustainability issues (including transport) and supporting the choice of sustainable lifestyles. Changing operational standards embedding sustainability principles into all operational activities driven by supportive governance, together with the measurement and reporting of progress. Innovation developing modes of care where sustainability is a core criteria alongside, health and prevention; and encouraging the use of new technology and processes. 16 NHS SDU (2012) Sustainability in the NHS: Health Check

25 Reducing travel, particularly from the use of private cars, to access NHS services or on NHS business, is one of the big opportunities to reduce our carbon related to travel. As identified my NHS leader s 17 initiatives associated with promoting and implementing sustainable travel can offer a number of quick wins and high carbon management returns. There are a number of key overarching actions that the NHS Sustainable Development Unit (SDU) advises in support low carbon travel, transport and access: All Trusts should have a Board approved active travel plan as part of their sustainable development management plan - The establishment of a travel plan should form a primary consideration of the management of impacts associated with this hospital reconfiguration, irrespective of the option chosen. The NHS as a whole considers introducing a flat rate for business mileage regardless of engine size or even modal option - Although measures to manage business mileage is considered in respect to NHS policy, such measures could be implemented on a more local level to lead the agenda within the organisation. NHS organisations should establish consistent monitoring arrangements so reductions in emissions from road vehicles used for NHS business can be measured Monitoring and evaluation regimes could be implemented to within NHS NWL to record emission (including those associated with travel), monitor the success of interventions and determine further action. Healthcare delivery must continue to move closer to the home A primary objective of this hospital reconfiguration is for the provision of care closer to home, in turn supporting this action. In support of these actions there are a number of measures that could be implemented, that would manage the impacts associated with hospital reconfiguration options. It s also worth noting that the development of plans and policies are often most effective when integrated within current operational practices and polices. Travel plans Where staff do not need to travel to meet or do their work, there should be every incentive and opportunity available to reduce the time and distance travelled. Such measures can increase productivity, improve safety, save money, and reduce carbon emissions. Travel plans are a package of measures that aim to increase the use of sustainable transport and reduce less sustainable travel, such as single occupancy car journeys. Informed by an annual travel survey of staff, visitors, and patients, these plans will have measurable targets for increasing sustainable transport use and reduction of car use and an action plan to achieve these targets. These plans can be used to identify and implement such measures, in turn supporting the management of carbon impacts associated with the hospital reconfiguration. Each hospital can use the opportunity offered by the proposals to develop a travel plan. Within these plans patient and visitor private transport use should form a primarily target, as this is likely to generate the most significant potential for emissions savings. 17 NHS SDU (2012) Sustainability in the NHS: Health Check

26 Half of all NHS organisations already have Board approved and corporately implemented sustainable travel plans. This includes Hillingdon Hospital NHS Trust and Ealing Health Trust which have already developed and implemented travel plans, presenting the opportunity for other NWL Trusts to benefit from their resources and experience in the development of their travel plans. Siting of services Consideration should be given to the use of hospital premises that are more accessible by public transport and active travel modes when planning the reconfiguration and the use of particular hospital sites. For example, consideration should be taken for services areas with high patient volumes and the siting of those services at hospitals that have good accessibility from more sustainable travel modes. Partnerships The development and implementation of sustainable travel initiatives can benefit significantly from working in partnership with stakeholders such as local authorities. From previous experience NHS organisations have made significant progress by working in strategic partnerships with local transportation planning authorities, planning and regeneration departments and the Department for Transport. Behaviour change Providing incentives for staff and visitors to choose active and sustainable travel modes, will help overcomes barriers to changes in travel modes. For example, the majority of NHS websites include directions. However, these sites should empower patients, staff and visitors to use low carbon travel options. Car Parking Providing and maintaining car parking facilities is costly for NHS organisations, particularly within London. Limiting free and subsidised car parking should be considered to encourage the use of more sustainable alternatives. However, measures such as this need to be supported by feasible alternatives to ensure that staff, patients and visitors can actively travel to and from sites safely and efficiently at all times. Car sharing Car sharing can often be more carbon efficient than bus journeys. Encouraging people who must drive to take advantage of car pooling and providing systems that support such activity can be highly successful in improving access, reliability and staff satisfaction, especially when combined with highly prominent multi occupancy car parking spaces and guaranteed ride home services. Infrastructure for active travel The provision of infrastructure to support active travel modes such as showers, changing rooms, drying rooms, locker facilities, and covered secure cycle storage is essential in encouraging changes in behaviour. As outlined above this should for a key consideration in the development of new buildings. 19

27 Buying power NHS NWL can use its purchasing power to specify significantly low carbon vehicles where leasing or buying vehicles is necessary. This would demonstrate its commitment to a lower carbon society and stimulate the low carbon vehicle market. In addition to this, contracts with transport firms, including taxis, should set ambitious criteria for emission ratings. Alternative fuels There are opportunities for NHS NWL to explore the use of more environmentally sensitive fuels in essential vehicles, including hybrid and electric vehicles. This is expected to have long term economic benefits in addition to environmental. Travel for training Significant amounts of travel are done in the NHS for meetings and conferencing. These activities should be held in places and at times that strongly favour travel by public transport and active transport options. However, there should be a preference for conference and meeting webcasting, podcasting and webinars, and related internet technologies. Air travel should only be undertaken in exceptional circumstances. 5.3 Wider carbon reduction initiatives The development of any new healthcare facilities associated with this reconfiguration would need to be developed according to principles that promote active transport and healthy lifestyles, as recommended by the Commission for the Built Environment. 18 The NHS SDU also suggests that any new buildings would need to reach or exceed excellent in the BREEAM travel and transport criteria (very good for refurbishments). 19 Facilities for home working should be made available where appropriate and where there are adequate organisational and individual competencies to increase productivity and job satisfaction. These opportunities should extend to the ability for patients and the public to access services through mechanisms such as telemedicine and localised management of long term conditions. Although the hospital reconfiguration is only expected to have a significant impact on emission associated with transport, there is an opportunity to also take into consideration the management of emissions associated with wider hospital activities. It is therefore recommended that, as the details of the reconfiguration are progressed, a carbon reduction plan is produced for each hospital affected by the proposals. This would enable the identification of specific mitigation measures to be taken forward through the more detailed design phases specific to each site. Travel planning would be expected to form a primary aspect of such planning. 18 National Heart Forum in partnership with Living Streets and CABE, Building Health A blueprint for action, London: The National Heart Forum 19 Building Research Establishment s Environmental Assessment Method (BREEAM)) Healthcare, 2002 [Online] Available at: 20

28 Robust carbon management plans should focus on the following key areas to be consistent with the NHS wide carbon reduction strategy 20 : Energy and carbon management; Procurement and food; Travel, transport and access; Water; Waste; Designing the built environment; Organisational and workforce development; Role of partnership and networks; Governance; and Finance. The NHS Carbon Reduction Strategy 21 as assessed at a high-level the potential measures that could be adopted to help reduce emissions. These include development of Combined Heat and Power (CHP) plants at many hospital sites, travel planning, improving energy efficiency in general (lighting, heating, insulation and controls) and minimising waste. Efficiencies are expected to be delivered through the cost-saving measures already in place which will help to minimise emissions associated with good and services, and many of the recommended measures lead to cost savings. For example, the Carbon Reduction Strategy has identified that potentially significant savings of CO 2 emissions and money could be made by reducing drug wastage. Any capital development programme that accompanies the proposals provides an opportunity to implement energy efficiency measures that require some up front costs but can be quickly recovered. For example, there may be opportunities to upgrade boilers to fit a modern CHP system, which would deliver efficient electricity and heat to the site and therefore reduce emissions. Examples, from other hospitals in the UK undertaking such actions have led to significant reductions in emissions (e.g. Leigh Infirmary). It may also be possible to seek external funding for such improvements, which can help improve the financial viability of such plans. Water use at site should also be audited as this contributes significantly to overall building emissions. Practices should be reviewed to identify the areas in which water use can be minimised or where alternate sources can be found (for example grey water collection for estate management use). 20 These recommendations are wider than the scope of the carbon assessment to take into consideration the three primary sectors (travel, building energy use, and goods and services) consistent with sectors defined in the NHS s own carbon footprint work 21 NHS SDU, Update NHS Carbon Reduction Strategy, February

29 Appendices Appendix A. Journey Time Analysis 23 22

30 Appendix A. Journey Time Analysis A.1. Option 5 Figure A.1: Change in journey time from baseline for private transport 23

31 Figure A.2: Change in journey time from baseline for public transport 24

32 Figure A.3: Change in journey time from baseline for BLA 25

33 A.2. Option 6 Figure A.4: Change in journey time from baseline for private transport 26

34 Figure A.5: Change in journey time from baseline for public transport 27

35 Figure A.6: Change in journey time from baseline for BLA 28

36 A.3. Option 7 Figure A.7: Change in journey time from baseline for private transport 29

37 Figure A.8: Change in journey time from baseline for public transport 30

38 Figure A.9: Change in journey time from baseline for BLA 31