Sustainable Development Management Plan

Sustainable Development
Management Plan
2015/16
Foreword
Our Sustainable Development Management Plan…
…or how to get more from what we do.
City and Hackney CCG is proud to be taking sustainability seriously.
Clare Highton
CCG Chair
As a commissioning organisation we hold huge responsibility for the
communities for which we provide healthcare services. It is our duty to
ensure we capitalise on the positive impact we can make on these
communities in the way that we design and procure services. To reach
the goals of our five year plan, and also those of the NHS Five Year
Forward, we must consider the wider impact of the money that we
spend.
This Sustainable Development Management Plan (SDMP) sets out our
principles and vision to consider the impact on our communities, on
equality and the on the environment, in every decision that we make.
We have set ourselves strong, yet achievable targets, and have taken a
staged approach to delivery – seeking to build on our achievements
year on year. Embedding this way of working into our ethos, and that of
our providers and partners, is essential to our success.
1. Introduction
What is sustainable development?
“...development that meets the needs of the present,
without compromising the ability of future generations to
meet their own needs...”
The Brundtland Commission, United Nations, Our Common Future, 1987
Sustainable development is when an organisation acts positively and
achieves long term positive outcomes, in all aspects of how it operates:
National drivers, including: the National Sustainability Strategy for Health
and Care 2014-202, the recently reviewed Social Value Act, the NHS
Five Year Forward, and CCG Assurance processes, all bring with them a
focus to our development as a sustainable organisation.
These drivers need not create „additional‟ streams of work. If we manage
and align our agendas carefully, meeting these national requirements will
also help us to deliver our operational plan. In order to achieve this we
need to be clear in our approach to sustainable development…

Economic sustainability: our organisation and its activity is
financially viable in the long term.
…Sustainability is not a bolt-on exercise that will allow us to meet
legislative requirements.

Social sustainability: our organisation is making a positive net
contribution to society.
…Sustainability is a strategic tool that we will embed into our
operational plans to help us meet the long-term health and wellbeing
needs of the people of City & Hackney.

Environmental sustainability: our organisation has a neutral or
minimal impact on the environment,
Commissioning for sustainable development: Saves money; Saves
resources; and Benefits staff and patients
There are financial co-benefits, for example; greater efficiency of
resource use, or services that improve social outcomes alongside health
outcomes,
There are health co-benefits, for example; promoting active travel
reduces environmental harm, while the physical activity improves health.
There are quality co-benefits, for example; minimising duplication and
redundancy in care pathways improves both quality and health
outcomes.
1.1.
Local & National Context
1.2.
Our Approach
The vast majority of our social and environmental impact sits within our
supply chain – our providers; so this is where we will focus the majority
of our efforts within 2015/16. To help us understand where we could
make the most impact, we ran an engagement and gap analysis exercise
with key providers.
We are taking a staged and supportive approach to ensure that, step by
step, we work in partnership with our providers and peer commissioners
to maximise the value and the positive impact of the health services we
design and commission.
To help our staff and stakeholders understand our approach to
sustainable development we have focused our activity on three „values‟
areas:
Local; Equal; Green.
It allows us to ask the question through any activity that we undertake:
“Can we improve the local community and economy; can we improve
the equality felt among our residents; can we improve the environment
and green spaces with our communities”
2. Our Sustainable Development Management Plan
We have focused our plan on five key areas: Being Accountable; Service Design; Contracting & Procurement; Support; and Evaluation.
Focus
Objective
Plan
Time
Lead
Clear and
Clear and accountable
 Board approves Sustainable Development Management Plan Board
April 2015 KT
Accountable governance arrangements
appoints Lead for sustainability
for sustainable
development
 Key performance indicators are reported to the board every six months. Oct 2015 /
Mar2015
 Report sustainability performance via the annual report.
Mar 2015
Clear and
Our GP members will
Accountable support us to walk our
talk
 Engage with our GP Members and ask for their support as a Governing June 2015 KT
body to help us to set a standard for sustainability.
Clear and
Sustainable progression  Report back to key staff and stakeholders (providers / partners) on a
Accountable is communicated regularly
quarterly basis on progress and activity
within the organisation
Service
Design
Equality & Diversity
delivery system
 Deliver Equality & Diversity training for:
- Programme Directors,
- Clinical Leads,
- Patient & Public Involvement
every 3
months
KT
June 2015 (tbc)
Measurement
Board approval and
reported to SDU
(Sustainable
Development Unit)
KPIs targets achieved
/ on track
GPs supporting
sustainability agenda
from own practice
perspective.
Quarterly reports
3 x training sessions
delivered
 Identify further areas for training as required
 Use of Equality Impact Assessment (EIA) Toolkit when designing and
redesigning services
July 2015
 Embed Equality Impact Assessment delivery system into the design and Dec 2015
redesign of services - suggested at Business Case Template (BCT)
EIA toolkit beginning
to be used in BCT
processes
EIA toolkit embedded
into BCT processes
Focus
Objective
Plan
Time
Service
Design
Assess social and
environmental impact of
services at design or
redesign stage.
 Develop social and environmental impact assessment to encompass
social and environmental elements alongside „equality and diversity.
Sept 2015 DM
 Where impacts are assessed as negative build in a structure for
improvements measures
Lead
Sept 2015
 Identify where change can be measured (e.g. a reduction in £100,000 a
pharmaceutical budgets = estimated reduction of 43 tonnes CO2)
Dec 2015
Contracting Improving environmental  Commit to sustainability requirements into 2015/16 contracts for large
&
and social impact from
providers around Service Condition 18 including: Having an SDMP,
Procurement spend on services with
using the Good Corporate Citizen Tool and Sustainable Procurement.
Large Providers
 Review Provider Sustainable Development Unit Returns, SDMPs and
Good Corporate Citizen Scores
April 2015 (tbc)
 Agree expected sustainability standards for 2016/17 contracts including Sept 2015
Good Corporate Citizen improvements, procurement standards, Patient
Transport Services and other / integrated transport services / plans.
 Explore the opportunity for developing a Sustainability CQUIN
(Commissioning for Quality and Innovation) for 2016/17.
March 2016
Contracting Improving environmental  Develop a Sustainability Framework for small / third sector providers, in Sept 2015 (tbc)
&
and social impact from
collaboration with One Hackney, to highlight CCG priority improvement
Procurement spend on services with
areas (e.g. carbon reduction, renewables, social value, procurement).
Small Providers & GP
Practices
 Providers will agree their improvement areas with the CCG for each
contract negotiation that is proportional to contract size and
March 2016
organisational capacity. This will be a continual improvement from the
previous year / contract
Contracting Challenge innovation
 Within new Invitation to Tender opportunities utilise opportunities to
Dec 2015 (tbc)
&
challenge innovation, including questions such as „how would you add
through the Invitation to
Procurement Tender (ITT) process
social value?‟
Measurement
Tool developed and
approved by
Programme Directors
Process developed for
improvements
Case studies to show
benefit
Providers agree to
commitment and
Expectation set out in
October contract
negotiations letter
Proposal taken to
(EMT / Board)
Framework agreed by
One Hackney &
approved by EMT /
Board
Improvement areas
agreed within
contracts
Social value accepted
as regular
requirement in ITT
Focus
Objective
Plan
Time
Lead
Measurement
Support &
engage
Support our staff to
engage with and embed
our ‘local’ ‘equal’ ‘green’
ethos.
 Add sustainability achievements as a regular agenda item at team
meetings
May 2015
KT
Sustainability as
regular agenda item
 Communicate successes regularly and opportunities for improvement.
Ongoing
SS
Case studies
 Identify areas in the organisation where staff will benefit from briefings / Sept 2015 / (tbc)
training around sustainability.
ongoing.
 Embed sustainability into induction process and include in job
description
Approved by EMT
Board and actioned
Sept 2015
 CCG to support community cohesion through Volunteering / Business in
the Community activity
March 2015
Support &
engage
Support our Providers to
engage with and embed
our ‘local’ ‘equal’ ‘green’
ethos.
 Continued engagement with providers on sustainability agenda.
Staff support local
cause / volunteering
(tbc)
Regular engagement
 Engage with leads in City & Hackney Council, neighbouring CCGs who Ongoing
commission same providers
Regular engagement
 Set up a quarterly (?) forum for combined engagement with providers / Sept 2015
peers / partners.
Quarterly meeting
occurring with
partners
 Identify / develop a procurement benchmark to support providers to
reach a mutual standard for sustainable procurement.
Support &
engage
Ongoing
Training need
identified and relevant
sessions underway
Support our GP Members  Support Sustainable procurement opportunities for GP Practices as a
network / within the confederation
to engage with and embed
our ‘local’ ‘equal’ ‘green’
 Offer GPs guidance on:
ethos.
- Resource efficiency
- Renewables
- Sustainable procurement
March 2015
August
2015
Dec 2015
 Research opportunities for community renewables opportunity within a Sept 2015
GP locality network.
(tbc)
Benchmark agreed
among providers
GP‟s benefitting from
joint procurement /
network opportunity
% of GP taking up
sustainability
measures
Recommendations
and opportunities
presented to GP
network / EMT / Board
Focus
Objective
Support &
engage
Communicate our
 Develop a poster to communicate our sustainability message to our GP July 2015
Patients and involvement groups. The poster should:
sustainability message to
o Include the „Local, Equal, Green‟ message and an outline of the
our involvement groups
activity
and wider public.
o Give an opportunity for people to give feedback or comment
o Be displayed at the 43 GP practices and shared with practice
based patient participation groups and the NHS Community
Voice groups.
o Be sent out to all the CCG based involvement groups including
PPI committee, Maternity Services Liaison Committee, Disabled
Children‟s Forum, Mental Health service user group (People‟s
Network), Older People‟s Reference Group, Healthwatch
Hackney and City.
o Circulated to all community and voluntary sector groups, and
included in the internal as well as external newsletters.
National reporting and
 Reporting to the SDU on resource returns
Annually
benchmarking
 Achievement of criteria in Metrics module
Evaluate
Plan
Time
Lead
Measurement
EH
Number of places the
poster is sent
Feedback received
from
(tbc)
% improvement from
previous years
% of measures
achieved
 Measuring reductions and improvement from provider information
% improvement from
previous years
 GCC score – own and large providers
Evaluate
Evaluate
Evaluate Social
 Run „community connection‟ events to gather feedback on social
prescribing services
Prescribing programme
and recommendations for
 Run „capturing learning‟ events to feed into evaluation report
continuation
 Evaluate programme against control group and develop
recommendations report for potential continuation
 Engagement exercise with PPI forum to share SDMP
Oct 2015
CF
Develop qualitative
April 2015 Eva /
Feedback Systems for
BP
 Develop feedback system for „local‟ „equal‟ „green‟ measures and agree July 2015
patient and public
/ test with PPI
engagement to include
sustainable development
 Develop route for Healthwatch to feed into „local‟ „equal‟ „green‟
Aug 2015
evaluation
x events delivered
Decision on
programme
continuation
Exercise delivered
Format agreed
Format agreed
Focus
Objective
Plan
Time
Lead
Measurement
Evaluate
Quantify improvement in
E&D and S&E Impact
 Develop measurement process to assess the improvements made
through the S&E and E&D impact assessment and delivery systems
Dec 2015
(tbc)
x pathway design /
redesign measured for
improvements
 Sample of pathway changes developed into case studies to show
improvements delivered.
March 2015
Case studies
developed.
3. Appendices: Background and Context
3.1.
What is sustainable development?

Our local sector partners – Hackney Borough Council, the Police,
Ambulance and Fire services, and those wider than City and
Hackneys borders in East London and beyond.
Sustainable development is when an organisation is acting positively
and achieving long term positive outcomes, in all three aspects of how it
operates:




Economic sustainability: our organisation and its activity is
financially viable in the long term. Duplication is eliminated and
efficiencies are realised through strong partnership working. Our
activity supports the local economy.
Other NHS organisations, including peer CCGs and NHS providers.

The local economy in City and Hackney‟s and how jobs,
employment and training opportunities are impacted by our health
service provision.
Social sustainability: our organisation is making a positive net
contribution to society. Staff, community and wider stakeholder
relationships are strong, equality is robust among communities
and engagement and support is widespread for long term
success.
3.2.
Environmental sustainability: the organisation has a neutral
or minimal impact on the environment, CO2 emissions are
mitigated, low carbon and renewable technology is embraced,
greenspaces are increased
Each aspect will have an impact on the other two. For example, if we
buy or commission something purely on a low cost basis, without
considering the longevity, the quality, and the wider impact of „social‟ or
„environmental‟ factors, there are often negative consequences, or at
the least, do not convey any additional positives.
However, flip the coin around and consider social and environmental
factors when making financial decisions and it will very often lead to a
positive financial return on investment and/or long term financial benefit.
Think of the added value a service could bring if it helped, for example,
tackle social isolation or improved air quality in addition to the original
specification.
As a public sector organisation we must also consider alongside our
own economic situation, how our activity and decisions effects that of:
Why Commissioning for Sustainable Development?
There are clear benefits in applying sustainability as part of our
business as usual approaches within City & Hackney CCG:

Financial co-benefits: where developing environmentally
sustainable approaches to the delivery of health and social care
also reduces direct costs – for example, by promoting greater
efficiency of resource use, or services that improve social
outcomes alongside health outcomes.

Health co-benefits: where approaches that reduce adverse
impacts on the environment also improve public health – for
example, promoting walking or cycling instead of driving, or for
mental health services that provide access to exercise or
outdoor activity.

Quality co-benefits: where changes to health or social care
services simultaneously improve quality, reduce inequality and
reduce environmental impacts – for example, by minimising
duplication and redundancy in care pathways
3.3.
National Context
National Sustainability Strategy
The National Sustainability Strategy for Health and Care 2014-2020
sets outs its requirements on the health and care system to incorporate
sustainable development into its ethos. Health and wellbeing
themselves are both elements of a sustainable society.
of its objectives and using social, environmental and economic
sustainability as routes to achieving this.
The strategy seeks to not only reduce the negatives (CO2 emissions,
inequalities and the burden of disease) but it also acts as an enabler for
enhancing communities with social assets, improving the natural
environment and encouraging independence and wellbeing.
Delivery Modules
There are now eight delivery modules sitting underneath the strategy,
designed as a practical approach to implementation:








An integrated approach to metrics
Carbon hotspots
Commissioning and procurement
Creating social value
Healthy, sustainable and resilient communities
Innovation, technology and R&D
Leadership, engagement and workforce development
Sustainable clinical and care models
This year we will focus on the „commissioning and procurement‟ and
„creating social value‟ modules – while taking on aspects of the others
to a lesser extent. We will endeavor to work our way through these
modules as we develop this SDMP document year on year.
It incorporates previous NHS strategies on carbon reduction, and is
aligned to the targets within the Climate Change Act; requiring UK
organisations to reduce CO2 emissions by 80% in 2050.
The strategy stretches much deeper into sustainable development than
previous versions, putting „a healthy resilient community‟ at the heart
Aligning our own Sustainable Development Strategy to this national
strategy is crucial to our development as a sustainable organisation and
this holistic approach will not only allow us to meet our sustainable
objectives; but will help us to meet our organisational objectives to.
Authorisation
4. What does it mean for City & Hackney CCG?
The recent authorisation framework required CCGs to “declare that at
the point of authorisation our CCG will demonstrate commitment to
promoting environmental and social sustainability through our actions
as a corporate body as well as a commissioner.” Our ongoing
assurance continues to place this responsibility onto our organisation to
develop sustainable activity and year on year improvements.
Above all it is important that we do not see these national and legislative
drivers, and our resulting SDMP, as „additional‟ streams of work. If we
manage and align the agenda carefully; working in a way which helps
us to meet these requirements will also help us to meet and deliver the
objectives of our operational plan:
Continued assurance links strongly back to the National Sustainability
Strategy for Health and Care.
1. Reducing premature mortality
The Social Value Act
Under the Public Services (Social Value) Act 2012, commissioners and
procurers must show due consideration on how their activity will
improve the social, environmental, and economic wellbeing of their local
area.
A recent review of the Social Value Act has been undertaken and a
report with the findings of the review has been released. The review
findings continue to place increasing emphasis on maximising social
and environmental benefit through the spending of public funds.
The Five Year Forward
The Five Year Forward itself has the foundations of a healthy resilient
community at its heart: local services for local people, choice, managed
healthcare, prevention, innovation, embracing technology, reducing
inequalities, reducing duplication and inefficiency…
All of the above will have a positive impact on the three pillars of
sustainability: Financial, Social, and Environmental.
The Five Year Forward View articulates why change is needed, what
that change might look like and how we can achieve it; our sustainable
activity has been designed to help us deliver it.
Health &
2. Managing demand
3. Developing primary and
community services
4. Ensuring safe high
quality hospital services
Long-term
=
Wellbeing in
City &
Hackney
5. Addressing mental health
needs
In order to achieve this we need to be clear
in our approach to sustainable development…
Sustainability is not a bolt-on exercise that will allow us to meet
legislative requirements…
Sustainability is a strategic tool that, as we build it into and embed it
into our operational plans, will help us to meet our organisational
objectives, and those of our NHS and UK evaluators.
5. Our approach
5.1.
Language
The term "sustainable development” is often used interchangeably with
terms such as corporate social responsibility, social value, triple-bottom
line and an array of other terminology.
But terminologies and meanings are often be ambiguous – the world
sustainability itself has many connotations… often leaving people
thinking about financial or environmental in isolation
“Can we improve the local community and economy; can we improve
the equality felt among our residents; can we improve the environment
and green spaces with our communities”
5.2.
Keeping it simple
To reduce misunderstanding, and to help our staff, stakeholders,
partners and the public engage with our sustainability plans we are
using a language that we hope all can relate to.
In the theme of keeping the language simple, we want to keep the plan
itself simple too. This will help us to focus on the action that staff and
stakeholders need to embed into their individual roles and
responsibilities.
We have developed our sustainable activity to focus on the
improvement of three „values‟ within our communities: Local; Equal;
Green;
It allows us to ask the same question through any activity that we do:
This year we are focusing on five priority areas where we believe we will
make the biggest impact, where we can build on existing activity and
where we know that we have the current resource within our
organisation

How we will be accountable for our activity?

How we design services to social & environmental value?

How we procure and contract services that maximise social
and environmental value?

How will we support and engage our staff, providers and GP
members to improve our sustainable outcomes?

How we evaluate our activity?
5.3.
Provider Engagement
Over 99% of our environmental impact (CO2 emissions) sits within our
supply chain. Although yet unmeasured we believe that this figure will
be similar for our social impact too.
Our providers, therefore, must be an integral part of our Sustainable
Development Management Plan if we are to make a positive difference.
In order to decide how we can improve our performance through our
providers, we must first understand how and where the impact lies,
what is already being achieved, and which areas can make the most,
and the quickest, improvements.
We engaged with five of our key providers to learn more about
sustainability from their perspective and how they can help us to meet
our objectives. The providers were:





Homerton University Hospitals
East London Foundation Trust
One Hackney (Tavistock & Portman)
CHUSHE
GP Confederation
To keep the engagement honest and impartial we employed an
independent sustainability advisor to begin the discussions and to dig
deep into the possibilities of what we might be able to achieve. This
engagement exercise has now developed into a „Provider Engagement‟
work stream within this Sustainable Development Management Plan.
There are other providers too for whom we contract services from….
Through our engagement we needed to understand:




What are their challenges, goals and ambitions?
How does their sustainability agenda align with ours?
What level of requirement is contractually appropriate from a
CCG, and what is being asked of them elsewhere, and
What support do they need to help us all reach the end goals?
We can see in the graph below that, by contract size, the majority of our
impact will sit among four key providers. Pound for pound this where the
most of our environmental or CO2 impact will lie, and in their own supply
chains and procurement activity they will have a significant opportunity
to influence social value and further carbon reduction. These four
providers are the contracts where we should put the most pressure and
be stricter with our expected outcomes.
Provider by contract size
Homerton UH
ELF
Barts Health Trust
UCL
Tavistock & Portman
Camden and Islington
CHUSE
GP Confederation
(David – can we add a sentence on why these were chosen above the
others – some are obvious but maybe not so for St Barts and UCL)
But this does not mean we should forget the smaller contracts and
providers, as here we are likely to achieve far more social value for
every pound spent. However with the smaller providers we will take a
more supportive approach to help them to achieve our desired
outcomes.
5.4.
Provider Overview
Homerton University
Hospital
Contract size: +100M
Provider size: Large
Engagement with: Roger Thomas, Director of Estates, Facilities &
Capital Projects
SDMP: Awaiting Board approval
10% CO2 reduction by March 2015: Yes
Good Corporate Citizen Tool: No
Climate Change Adaptation: No
Current Position
Recent installation of a Combined Heat and Power system has had a
significant impact on the Trusts energy use; reducing the use of oil and
in consequently the CO2 footprint. The boilers are in place but some
work is still to be carried out to bring them to maximum efficiency.
As of March 2014, the Trusts energy footprint is set out below. Data is
still being collated for 2014/15 to assess meeting the 10% target.
Carbon (tCO2e)
Carbon Emissions - Energy Use
Although this Trust looks set to meet its CO2 reduction target, largely
due to the capital investment in the boilers, the current Director of
Estates who joined mid-way through 2014/15 suggests the Trust is not
quite where it is expected to be with regards to energy efficiency
improvements.
There are still a number of opportunities around the „low hanging fruit‟
including: fitting low energy lighting and PIR or movement sensors, and
a significant opportunity with staff engagement and behavior change.
Also, the Trust‟s carbon footprint is not just related to energy – and
waste and water have both increased slightly.
There is currently no sustainable transport or sustainable procurement
plans, or further carbon reduction plans past the installation of the
boilers. Work is being undertaken to develop the Carbon reduction Plan
as part of the Sustainable Development Management Plan.
Actions Agreed:



Opportunities for the Trust to work towards in 2015/16
20000

15000

10000


5000
0
2012/13
Gas
Oil
2013/14
Coal
2014/15
Electricity
Agreed to share SDMP once board approved
Agreed to share Eric / SDU returns as completed for 2014/15
Agreed to use Good Corporate Citizen Tool and share findings
Development of a strong Carbon Reduction Plan as part of the
SDMP
Development of a Sustainable Procurement Plan – including
use of Procuring 4 Carbon Reduction Tool
Development of a Sustainable Travel / Transport Plan
Increased staff engagement with the SDMP
Support / Partnerships

A supportive provider / CCG network to drive forward
sustainability across care pathways
 A carrot and stick approach form CCGs would be welcomed
 Clear guidance on expected achievements.
East London Foundation Trust
Tonnes of CO2 by Resource Type
104.55
58
Contract size: 0.43 M
Provider size: Large
Engagement with: John Hill,
Director of Estates, Facilities and Capital Development & Adam Toll,
Sustainability Officer
Gas
2553
There has been a significant push on sustainability over the last two
years with improvements across the estate on energy reduction. It is
hoped they will achieve more than a 15% reduction by March 2015
(from the 2008 baseline). Energy is a significant proportion of their
footprint as shown in the utility data below for 2013/14 – although travel
and procurement figures are not included.
Electric
Water
4116
SDMP: Completed and in review by C&H CCG
10% CO2 reduction by March 2015: Still finalising data but likely <15%
Good Corporate Citizen Tool: Yes
Climate Change Adaptation: No
Current Position
4.60
Waste
Recycling
Further plans include an „Energy Performance Contract‟ refit which will
go out to tender in the near future.
The Trust has outlined sustainable procurement as a key improvement
area for 2015/16 and the lead for procurement was consulted as part of
this review. There are a number of strong opportunities to increase
social and environmental value from the £25 million spend on good and
services and the Trust would welcome guidance from the CCG on goals
and ambitions.
There is a travel policy, but the Trust is yet to develop a sustainable
travel plan. Integrating sustainable travel and transport would be
beneficial for further CO2 reductions and financial efficiencies.
Sites in the estate that are not owned by the Trust have proven difficult
in the past to implement resource efficiency measures. Increased
engagement and partnership working with NHS Property Services is
likely to be beneficial.
Actions Agreed:

Agreed to share SDMP once board approved


Agreed to share Eric / SDU returns as completed for 2014/15
Agreed to use Good Corporate Citizen Tool and share findings
Opportunities for the Trust to work towards in 2015/16




Development of a Sustainable Procurement Plan – including
use of Procuring 4 Carbon Reduction Tool
Development of a Sustainable Travel / Transport Plan
Increased staff engagement with on sustainability
Increased Partnership working with NHS Property Services
Support / Partnerships



In agreement to Homerton‟s suggestion of sustainable forum
Would welcome guidance from the CCG on targets
City & Hackney CCG sustainability priorities align with Newham
/ Tower Hamlets CCGs




They will discuss and agree priorities with the CCG as to see
how they can improve environmental and social value over
2015/16.
They are working towards a business continuity plan and are
keen on climate change adaptation.
They can provide resource and CO2 data as part of their annual
and FSA reporting
As a tenant to Homerton University Trust property they will
abide by policies with regard to energy and resource
management.
Opportunities for 2015/16




Working in partnership with other small providers
Setting goals for improved sustainable development
Assessment of social value
Opportunities with 450+ members to develop wider social value
initiatives
CHUSE
Contract size: tbc
Provider size: Small
Engagement: Julia Brown, Interim CEO
CHUHSE
GP Confederation
Contract size: tbc
Provider size: Small
Engagement: Laura Sharpe, CEO GP Confederation
Current position
CHUSHE have a good ethos are a low impact service with active travel
favored among staff and the service itself reduces patient travel with its
local support function. They are willing and supportive of this
sustainability agenda as long as requirements are proportional to the
contract size.
Developing a full Sustainability Strategy, extensive data reporting and
compiling Good Corporate Citizen reviews are likely to be a step too far
for a small organisation like CHUSHE, so lighter measures have been
suggested.
Actions Agreed:
Current position
GO Confederation are in a similar position where the size and activity
within the contract will not warrant extensive reporting for GP
Confederation as an organisation – so proportional and fair expectation
on sustainable development in terms of good practice
However there is an opportunity here to influence the GP network of 43
practices, and set out an expectation as to how they, as providers,
should also be addressing sustainable development.
It is suggested that further engagement work is necessary with the GP
practices themselves as to what level of expectation is appropriate,
alongside a supportive approach over the first year to instigate activity.
providers – including third sectors and GP practices – to encourage and
set expectation for sustainable activity.
Opportunities for 2015/16
Opportunities for 2015/16








Centralised Sustainable Procurement / Buying: from renewable
energy tariffs to low carbon technology (e.g LED lighting)
Resource use / CO2 emissions data reporting
Resource management and efficiency
Renewables opportunities – including community renewables
and local energy networks.
Social Prescribing - continuation of CCG project following
review
Local employment
Education initiatives
Working in partnership with other GP Practices
One Hackney Initiative
Contract size: 190k Provider size: Small
Engagement: Paul Jenkins, Chair
Using One Hackney as an engagement mechanism with providers, we
will develop a framework for sustainability. This will include guidelines
for activity and set out expectation levels for small and large providers.
The Framework will cover a range of Sustainable activity that‟s fits
within our „Local, Equal, Green‟ ethos and cover areas such as: Energy
Efficiency, Procurement, Social Value, Renewables, Equality & Diversity
Travel, Employment, Community Development and Patient Outcomes.
The larger providers will be bound more strongly by Service Conditions,
in the national contract, but the effort from smaller providers needs to be
proportional to contract size and organisational capacity. For smaller
providers, reporting progress should be part of the approach, but it
should not be cumbersome, and there should be less emphasis on
reporting sustainable activity back to the CCG and more emphasis on
the actual activity taking place.
5.5.
For our large providers we will be enforcing requirements that are
already laid out in the Standard Contract; including:
Current position

The One Hackney initiative itself is an example of sustainable
development – a partnership approach between providers to deliver
person centered care that will reduce duplication and have a positive
impact on the individual.

However the One Hackney initiative also provides an opportunity to
develop and deliver a shared approach to sustainability among
providers. This outlet will be especially beneficial to reach out to smaller
Working with Large Providers
Maintaining a Sustainable Development Plan in line with
National Guidance, which will mean;
 Board approved plans,
 CO2 reduction measures in place to meet 2020 targets
 Utilise the Good Corporate Citizen as an evaluation tool
Give due regard to the impact of its expenditure on the
community in line with the Social Value Act.
We will also be asking providers to share their Sustainability plans, their
ERIC / SDU resource returns, and their Good Corporate Citizen Scores
to help us to align our strategies and achieve more by working together.
Initial engagement has proven to be an efficient tool and we plan to
continue this regularly throughout the year – increasing partnership
working and sharing of best practice. We will develop Sustainable
Procurement guidance as part of the overall sustainability framework for
City and Hackney to support and influence providers to achieve the
standards we require when purchasing good and services.
5.6.
If we are asking our providers to step up to the sustainability mark, then
our staff team and board members should be leading the way. We have
engaged with our staff and executive teams in the development of this
plan, looked across our organisation at the activity already happening,
and identified how we can build upon it through the coming year. This
plan will set an expectation for how staff and board members will
support its delivery.
Working with Small Providers
Smaller providers will need a more supportive, and proportional,
approach. From the framework they will be able to select specific target
areas of sustainable activity to focus on during the year. Activity can be
discussed and agreed within the contract and providers will be expected
to have a continual improvement approach.
We also feel that a significant part of „walking the talk’ can be found in
how we support others to achieve the goals we are setting for them.
We must also look to our own sustainability as a CCG, and we should
seek to promote and share all the good work that we are undertaking,
both in the sustainability arena and elsewhere.
We will identify areas were support and guidance is needed and provide
this appropriately.
5.8.
5.7.
Walking the talk
Equality & Diversity
We have recognised a significant overlap between the Equality Agenda
and with many aspects of social value and sustainability. For this
reason we have taken the decision to bring our Equality and Diversity
work stream into our Sustainable Development Management Plan.
We believe that this will not only help our staff and stakeholders
understand this important work stream in the wider context of
sustainability, it will also help us to widen the reach of the Equality
agenda and avoid duplication.
We are conscious to ensure this action will not to dilute the importance
of this agenda, and have developed a structured approach to implement
our Equality Delivery System with this SDMP.
5.9.
Patient and Public Feedback
5.11. NHS Standard Contract
We already gather feedback from Patient & Public Involvement Forums,
from provider evaluations and from organisations such as Healthwatch.
Rather than create a whole new criteria for which we will measure and
evaluate our sustainable achievements, from a public and patient point
of view, we will work with existing outlets to identify the best way to
utilise communication channels and gather feedback and intelligence.
We have engaged with our Patient and Public Involvement Forum and
given them an opportunity to comment on our activity plan and have
begun conversations with local Healthwatch organisations to explore
feedback opportunities.
5.10. Partnership
Strong partnerships, sharing best practice, and the alignment of
priorities are important elements of sustainable development.
We have a vast range of potential partnerships that will support, align
and develop our sustainable ambitions: GP members, our local
authority, other local CCGs (especially those with which we share our
providers) the police, fire brigade, and ambulance services, and private
sector businesses both in the local area, and those who contract to us
or within our supply chain. Throughout our planed activity we will begin
to engage, understand, and align our priorities in the areas where we
can make the biggest difference.
Service Condition Clause 18 of the NHS Standard Contract provides a
contract clause for commissioners to use to embed sustainability
principles at a contract level.
“SC18 Sustainable Development
18.1 In performing its obligations under this Contract the Provider must
take all reasonable steps to minimise its adverse impact on the
environment.
18.2 The Provider must maintain a sustainable development plan in line
with NHS Sustainable Development Guidance. The Provider must
demonstrate its progress on climate change adaptation, mitigation and
sustainable development, including performance against carbon
reduction management”
City and Hackney CCG is recommending the inclusion of a range of
KPIs to facilitate this and are asking all programme boards to ensure it
is including in contract negotiations.
These KPIs in draft format are below.
Outcomes
Reduce
CO2
Emissions from
2007 Baseline.
How delivered
Reduction in CO2 emissions though resource use: energy, waste, travel, and water
through a strategic carbon reduction plan.
Providers must submit CO2 emissions as far back as data allows to 2007.
Preferred
method
is
SDU
reporting
template
http://www.sduhealth.org.uk/delivery/measure/reporting.aspx by 30th June 2015 (or give 4
weeks from when request is sent) to allow accurate reduction target to be set.
Providers SDMP or Carbon Reduction Plan should set out clear targets and actions to not
only meet the CCG target but also the future 2020 Climate Change Act target of a 28%
reduction from a 2013* baseline.
Corporate
Sustainability is
measured.
The Good Corporate Citizen (GCC) self-assessment tool is completed and submitted
online by March 2016.
If there is no baseline year for the GCC then an interim assessment should be undertaken
in Q1 and again in Q4
Organisations should be aiming for a minimum score of 75% achieved in each area by the
end of Q4.
They should also provide an action to suggest how they will achieve a score of 95% in
each area by 2020.
Procurement
considers social
& environmental
impact
Baseline measure
National
Legislation
/
Guidance: Climate Change
Act / National Sustainability
Strategy for Health and Care
Target measure
15% reduction in Provider
CO2 emissions from energy,
waste, travel, and water from
2013* baseline
CO2 emissions measured
from 2013* baseline year.
(*If a closer date for the
baseline is agreed the target
may change)
National Guidance: National
Sustainability Strategy for
H&C
http://www.sduhealth.org.uk/
gcc/about.aspx
“By 2015, your organisation
should achieve a score of
50%
in each area.”
Complete the GCC at the end
of Q4 scoring >50%
Provide an
showing
trajectory
action plan
improvement
‘Social Value’ is included as an assessment measure in tenders.
Currently no tenders are
utilising
this
scoring
mechanism
20% of new tenders include
social value as part of the
tender scoring mechanism.
The Procuring for Carbon Reduction toolkit is utilised
Currently no procurement
process utilises procuring for
carbon reduction
Benchmark your procurement
activity against the P4CR
Flexible
Framework
to
achieve baseline
Purchasing decisions include a social and environmental assessment
Currently no procurement
process
utilises
this
assessment
20% of purchasing decisions
have been made inclusive of a
social and environmental
assessment.
Payment
The
refreshed
Equality Delivery
System for the
NHS – (EDS2) is
utilised through
service delivery.
EDS2 assessments are carried out for services delivered by the Provider using the A baseline of:
guidance document http://www.england.nhs.uk/ourwork/gov/equality-hub/eds/ Through - number of services
the process services and pathways should be assessed to :
currently being
assessed and;
1. Confirm governance arrangements and leadership commitment
- grading of services
2. Identify local stakeholders
currently being
3. Assemble evidence
assessed;
4. Agree roles with the local authority
using EDS2 to be reported
5. Analyse performance
back the CCG by 30th June
6. Agree grades
2015 (or give 4 weeks from
7. Prepare equality objectives and more immediate plans
when request is sent).
8. Integrate equality work into mainstream business planning
9. Publish grades, equality objectives and plans
10% increase on baseline of
number services assessed.
Option 1
Service redesign
in
delivering
sustainable
models of care
The below measurements to be taken by Provider across all services and pathways to
identify a snapshot of ‘where they are now’. Where data already exists on any of the
points below from previous years this should be included in the report.
Measures to form a baseline
for the provider are to be
reported back to CCG by







% of time / resource spent on preventative measures.
% increase in early intervention and diagnosis.
% of appointments with reduced waste (patient reappointments/telephone
appointments)
% of functions integrated with service delivery from other pathways including
statutory social care, independent and third sector provision
% pathways of care using a process methodology (for example Lean systems, Six
Sigma, Total Quality Management) to identify and eliminate waste.
% pathways actively reducing prescriptions and steering towards evidence based
therapies and lifestyle changes
% of services improving the use of technology, innovation and self-help approaches
to enable people to take charge of their own health and life care planning.
Baseline to be developed
during
assessment
of
services during 2015/16
10% improvement on grading
of services during next
reassessment phase.
Option 2
Service redesign
in
delivering
sustainable
models of care
NHS Outcomes Framework is utilised to measure:
1.7 Reducing premature death in people with a learning disability
2 Health related quality of life for people with long-term conditions In
development
2.1 Proportion of people feeling supported to manage their condition
2.2 Improving functional ability in people with long-term conditions
2.2 Employment of people with long-term conditions
2.3 Reducing time spent in hospital by people with long-term conditions
i Unplanned hospitalisation for chronic ambulatory care sensitive conditions
ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s
2.4 Health-related quality of life for carers (ASCOF 1D**)
2.5 Enhancing quality of life for people with mental illness
I Employment of people with mental illness (ASCOF 1F** & PHOF 1.8**)
2.6 Enhancing quality of life for people with dementia
i Estimated diagnosis rate for people with dementia (PHOF 4.16*)
ii A measure of the effectiveness of post-diagnosis care in sustaining
independence and improving quality of life
3a Emergency admissions for acute conditions that should not usually require
hospital admission
3.6 Helping older people to recover their independence after illness or injury
Baseline take from previous
years reporting of outcomes
https://www.gov.uk/governm
ent/uploads/system/uploads/
attachment_data/file/256456
/NHS_outcomes.pdf
Suggesting a % increase from
previous year