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NSLHD PLANETARY HEALTH FRAMEWORK 2021 - 2023
Disclaimer Please be advised that this document may contain images of deceased Aboriginal and Torres Strait Islander people.
ACKNOWLEDGMENT OF COUNTRY
Northern Sydney Local Health District (NSLHD) would like to acknowledge the Traditional Custodians of the lands on which our health services have been built, the Gaimaraigal, Guringai and Dharug peoples and we honour and pay our respects to their ancestors. NSLHD also acknowledges and pays respects to all Aboriginal and Torres Strait Islander peoples and to Elders past, present and emerging. We acknowledge that past, current and future Aboriginal and Torres Strait Islander peoples are the continuing custodians of this country upon which we live, work and meet and that it is from their blood, courage, pride and dignity that we are able to continue to live, work and meet on this ancient and sacred country.
PLANETARY HEALTH IMPACT STATEMENT
Northern Sydney Local Health District Aboriginal Health Service Save Our Sacred Country Statement
We have lived continuously on Mother Country as custodians for more than 75,000 years, the Ancestors have loved, and cared for Her, they have listened to Her since before there was time Those Ancestors trod on Her as the First Peoples, they baked bread from wild sown seeds, drank from unpolluted waters, fished and caught turtle and crocodile, hunted kangaroo and cleansed themselves in pristine rivers They cleared Her to farm, and planted trees where trees wouldn’t grow, they burned bush to stimulate Her so she would give them shade and shelter and keep them from destroying all that she had created, all that was and will be, and taught us to be resilient and to love her
But we have forgotten Her; She is whispering to us that she is sick; She withers and She will die if we do not care about her any longer Listen to what She is saying;
You aren’t very good at this are you? Understand that the earth you walk on, the trees that bear fruit for you, the fields that give grain to bake bread, the rivers that quench your thirst, the animals that give food, the gardens that give up their vegetables are finite, as are you. What will they reap? Mother Earth will soon tire of us In fact I think She already has. She will soon tire of giving us chances to learn how to love her and nurture her She spirit will die, and our spirit will die with her Love her, she loved us since before time, and we owe that to Her and our children
EXECUTIVE contents
Foreword
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Executive Summary
7
Introduction
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About Northern Sydney Local Health District 9
12
Structure and Accountability
Our Environmental Performance
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17
Priority Domains
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Sustainable Organisation
Waste Management and Resource Recovery
20
Capital Works and Procurement
22
People and Places
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Models of Care
25
Reference List
27
FOREWORD
Over the past century, significant advances in medicine, technology and urban development have increased our quality of life immensely. However, achieving these gains has led to negative impacts on the health and wellbeing of our planet. As healthcare professionals, we are uniquely placed to contribute to significant and sustainable change in the field of planetary health. NSLHD has a responsibility to reduce our environmental impact whilst achieving the highest standard of health, wellbeing and equity for our patients, our workforce and our community. We know that our current levels of resource consumption are unsustainable. The impact of significant consumption of energy, water and generation of waste on human health and the health of our planet is immense. By focusing on the political, economic and social systems that shape planetary health, we have an opportunity to increase the resilience of our health system whilst reducing our impact on climate change. Part of our responsibility as a local health district is to help and improve the health conditions affecting our community. As healthcare moves towards a more virtual experience, we will continue to leverage the sustainable benefits of technology and new models of care. The decisions we make today when designing and delivering clinical services and implementing sustainable business practices, will continue to affect the health and wellbeing of our patients and our community for many generations to come. Our inaugural NSLHD Planetary Health Framework 2021 – 2023 sets out our commitment to improving and reducing our environmental footprint and subsequent impact on the planet and climate change. Five priority domains have been identified to achieve this: sustainable organisation, capital works and procurement, people and places; models of care; sustainable organisation, and waste management and resource recovery. I look forward to working with you to ensure NSLHD continues to provide world class healthcare whilst actively seeking opportunities to become an environmentally sustainable organisation.
Deb Willcox Chief Executive Northern Sydney Local Health District
EXECUTIVE SUMMARY
nslhd planetary HEALTH FRAMEWORK 2021-2023 The Framework outlines Northern Sydney Local Health District's (NSLHD) vision to be become a more environmentally aware and sustainable organisation in the field of planetary health. The Framework is underpinned by five priority domains: sustainable organisation, waste management and resource recovery, capital works and procurement, models of care and people and places. A range of targeted strategies have been aligned to each priority domain. For each strategy, we have outlined how we intend to achieve these targets and an executive sponsor has been nominated to ensure robust governance and oversight. The Framework has also been developed to help deliver on three strategies outlined in the NSLHD Strategic Plan 2017-2022 : Evidence-Based Decision Making Responsive and Adaptable Organisation Engaged and Empowered Workforce
NSLHD VISION: Leaders in healthcare , partners in w ellbeing
NSLHD AIMS TO FOCUS ON THE FIELD OF PLANETARY HEALTH BY ADVOCATING FOR THE HIGHEST
STANDARDS OF HEALTH, WELLBEING AND EQUITY
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Introduction
Planetary health is defined as the “highest attainable standard of health, wellbeing, and equity through judicious attention to the human systems – political, economic, and social – that shape the future of humanity and the earth’s natural systems [1].” Planetary health recognises the inextricable link between the health of our planet and the health of human civilisation. As we alter the earth’s natural systems, we are impacting our own social and environmental determinants of health including clean air, safe drinking water, sufficient food sources and secure shelter. Planetary health is a priority for NSLHD due to the impact on the health and wellbeing of our patients, staff and community. This includes the impact of the spread of infectious diseases such as severe acute respiratory syndrome, the risk of non-communicable diseases intensifying due to warmer temperatures and the impact of climate change on mental health. In Australia, the healthcare sector contributes to seven per cent of Australia’s total emissions output [2]. According to the World Health Organisation (WHO), the health sector plays an essential role in working to reduce its climate footprint whilst strengthening public health systems to respond to the effects of climate change [3].
Globally, healthcare’s climate footprint is equivalent to approximately four per cent of global net emissions [4]. There are a number of related health co-benefits of addressing climate change: reducing the environmental burden of disease; reducing the number of life years lost; and decreasing overall hospital admissions. The NSLHD Planetary Heath Framework 2021-2023 aims to provide direction for the monitoring, development and implementation of planetary health related initiatives across NSLHD. The Framework identifies NSLHD’s commitment to the sustainability of its services, through addressing waste and water management, and energy use, and encouraging local efforts that focus on the design and delivery of clinical services. This Framework builds on the NSLHD Clinical Services Plan 2019-2022 in identifying that the environmental sustainability of resource use and design and delivery of clinical services is one of NSLHD’s major drivers of health service change. The Framework has also been developed to give consideration to a range of guiding principles and policies. These include the NSW Health Resource Efficiency Strategy 2016-2023 [5]; NSW Government Resource Efficiency Policy 2019 [6]; NSW Climate Change Policy Framework 2016 [7]; NSW Modern Slavery Act 2018 No 30 [8]; and the United Nations Sustainable Development Goals [9].
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About Northern Sydney local health district NSLHD Clinical Services are organised across:
NSLHD covers an area of approximately 900 square kilometres, located across nine local government areas and almost one million people, which represents 11.7 per cent of the NSW population. In the Financial Year 2019/20, the district performed more than 25,000 operations (based on 25,620 episodes of care), saw more than 153,146 Emergency Department presentations, delivered around 4,000 babies and cared for 571,279 occasions of service to nearly 160,000 patients in outpatient clinics. NSLHD has an expense budget of approximately $1.7 billion. There are a number of planetary health related initiates already underway across NSLHD. Some of these include: large solar panel installations at Hornsby Ku- ring-gai and Mona Vale Hospitals, recycling and waste management systems in place at multiple facilities and the NSLHD Active Transport Framework that aims to reduce car dependency in both in NSLHD workplaces and across Northern Sydney. NSLHD also reports annually on resource efficiencies in compliance with the NSW Government Resource Efficiency Policy (GREP).
Four acute hospitals – Royal North Shore Hospital, Hornsby Ku-ring-gai Hospital, Ryde Hospital, Northern Beaches Hospital and one sub-acute hospital at Mona Vale. Two clinical directorates – Mental Health Drug and Alcohol and Primary and Community Health which delivers services from a network of community health centres and in people’s homes. Clinical and other support services, including Medical Imaging, Pharmacy and Allied Health, Aboriginal Health and Carers Support. Pathology services are provided by NSW Pathology. Affiliated health organisations providing sub-acute care at HammondCare (Greenwich and Neringah Hospitals) and Royal Rehab at Ryde. Eleven Clinical Networks that advise on the strategic development of services and the profile and configuration of services across the hospitals and directorates.
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OUR CORE VALUES
C O R E
Collaboration
With colleagues, we share our ideas and knowledge, offer assistance and work together to identify opportunities for sustainable development. With patients, consumers, carers and family members, we take the time to talk and listen. We aim to improve the patient experience by promoting planetary health and engaging stakeholders in environmental improvement initiatives.
Openness
With colleagues, we communicate transparently and honestly, participate in constructive feedback and take time to listen to each other's ideas on how to become an environmentally aware and sustainable organisation. With patients, consumers, carers and family members, we take the time to answer questions about our hospital or service's commitment to planetary health and environmental sustianability.
Respect
With colleagues, we are inclusive and treat each other with fairness, resolving issues constructively with each other and ensuring our work environment is safe. With patients, consumers, carers and family members, in addition to ensuring that you get safe, high quality care, we take your sustainability concerns seriously and follow up with to ensure you get the most up to date information about NSLHD's environmental commitment.
empowerment
With colleagues, we acknowledge strengths and complementary skills in others, we support and mentor each other to provide the highest quality care whilst being mindful of environmental sustainability. With patients, consumers, carers and family members, we enable communication and participation, ensuring your suggestions for a more sustainable healthcare system are considered, recorded and implemented where suitable.
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NSLHD
Greater Sydney
Mona Vale
Hornsby Ku-ring-gai
Neringah
Northern Beaches
Ryde Macquarie Royal Rehab
Royal North Shore
Greenwich
NSLHD HOSPITALS AFFILIATED HEALTH ORGANISATIONS PUBLIC-PRIVATE PARTNERSHIP
HORNSBY KU-RING-GAI SECTOR NORTHERN BEACHES SECTOR
LOWER NORTH SHORE SECTOR RYDE - HUNTERS HILL SECTOR
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Structure and accountability
The NSLHD Planetary Health Committee will drive the agenda of the NSLHD Planetary Health Framework and maintain oversight of its implementation. The five priority domains and focus areas including sustainable organisation, waste management and resource recovery, capital works and procurement, people and places and models of care will underpin decisions made in relation to the implementation and endorsement of new planetary health related initiatives. Each hospital and facility across NSLHD have implemented, or are in the process of implementing, a planetary health/environmental sustainability governance structure. At Royal North Shore Hospital, they have developed a Sustainability Plan and Action Plan aimed at embedding sustainability within all hospital operations. Progress against this plan is reported to the RNSH Innovation and Re-design Committee, that is a sub- committee of the NSLHD Planetary Health Committee. Other reporting sub-committees include the Hornsby Ku- ring-gai Hospital Sustainability Committee, Ryde Hospital Sustainable Future Committee, Mona Vale Hospital Sustainability Committee, Macquarie Hospital Wellness at Work Committee and Primary and Community Health Sustainability Network. A Planetary Health 'Staff Ideas' Portal will be launched across the District in 2021.The portal will give staff a platform to be able to suggest improvement initiatives related to planetary health in their department and/or hospital. In addition, opportunities for planetary health initiatives requiring additional funding are available to staff through the NSLHD Innovation Program.
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governance structure
nslhd executive
nslhd planetar y health
NSLHD Planetar y
NSLHD Innovation
committee
health portal
Program
Ro y al north
hornsb y ku - ring - gai
r y de hospital
primar y and communit y health sustainabilit y net w ork
mona vale
macquarie
shore hospital
sustainable
hospital sustainabilit y
hospital w ellness at w ork
innovation and re - design
hospital sustainabilit y
future
committee
committee
committee
committee
committee
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our environmental performance
Energy consumption
Total consumption by energy type (GJ)
2015/16
2016/17
2017/18
2018/19
Electricity
222,415.58
223,140.24
225,393.66
215,935.92
128,648.33
111,002.54
94,398.58
85,975.61
Natural Gas
334,142.78
301,911.53
Total gigajoules (GJ)
349,063.91
319,792.24
Energy consumption (GJ) per 1000 bed days
2015/16
2016/17
2017/18
2018/19
Electricity
408.31
399.28
397.16
422.25
Natural Gas
230.2
198.63
166.34
168.12
Fleet
2016
2017
2018
2019
Total fuel consumption (litres)
440,624
426,759
395,959
366,815
Total fleet
489
484
475
459
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water consumption
Total water consumption (kL)
2015/16
2016/17
2017/18
2018/19
776,210
505,530
485,468
497,546
Water consumption (kL) per 1000 bed days
2015/16
2016/17
2017/18
2018/19
1,437.91
904.58
855.44
972.92
Waste generation
Total waste consumption (Tonnes)
2015/16
2016/17
2017/18
2018/19
Clinical Waste
422.3
425.6
382.6
374.4
General Waste
3,058.6
3,228.4
3,203.60
3,266.6
Recycled Waste
343.4
323.5
378.6
385.5
Total tonnes
3,824.3
3,977.5
3,964.8
3,964.8
NB: The following tables present NSLHD's energy, fleet, water and waste consumption and generation over the past five years. Energy and water consumption has been measured against per 1000 bed days to provide a method for measuring energy consumption against activity of patients admitted for an episode of care. This is for the purpose of adding meaning to the data and does not include total activity across the district. Please note data prior to 2018 includes Manly Hospital, decommissioned in 2018, and Mona Vale Hospital, that decreased in size after ceasing provision of acute care. 15
2019/20 Statistics
More than 153,146 Emergency Department presentations
25,000 operations
(based on 25,620 episodes of care)
Healthy Children’s initiative actively engaged 123,684 children Delivered around 4,000 babies
occasions of service to nearly 160,000 patients in outpatient clinics 571,279 Cared for
TOTAL WORKFORCE 11,539 (8,156FTE)
50 Aboriginal and Torres Strait Islander Workforce (0.6% of total workforce) Aiming for 3% of workforce in 2020-2021
1,256 (987 FTE)
(from 153 schools and 398 childhood services) and found innovative ways to continue to provide support to these vulnerable populations throughout the COVID-19 period
Allied Health Professionals
178 (153 FTE)
Clinical Nurse Consultants / Clinical Midwifery Consultants
533 Staff Specialists (281 FTE) and 673 Visiting Medical Officers
943,908 residents (11.7% of the NSW population) in 2019;
5,503 (3,560 FTE) Nurses / Midwives / AIN’S
over1million residents by 2026 (a growth of 7.6%)
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priority domains
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governance
sustainable organisation
Ensuring organisation wide sustainable development through governance structures, measurable performance indicators and effective partnerships
How this will be achieved
Executive Sponsor
Strategy
Timeframe
1a. Ensure consideration of the connection the Aboriginal and Torres Strait Islander people have with the environment and the importance of showing cultural respect 1b. Establish Planetary Health/ Environmental Sustainability Committee and/or governance framework at all hospitals and services
Work with Aboriginal Health to ensure consideration is ingrained in all organisational decision making
General Managers/ Service Directors General Managers/ Service Directors
Ongoing
Ensure relevant staff are identified to lead implementation and drive planetary health initiatives
6 months
Include planetary health as a standing agenda item to relevant meetings Encourage executive leadership of planetary health across the District Develop an annual Planetary Health Report to be uploaded to the NSLHD Website and provided to the Board
1c. Monitor and report on environmental performance and initiatives underway across NSLHD
1 year, ongoing thereafter
Chief Executive
1d. Executives to include planetary health initiatives as a goal in their Performance and Talent (PAT) agreements
3 years
Chief Executive
1e. Address planetary health related issues at regular performance and/or third party partnership meetings
1 year, ongoing thereafter
Chief Executive
Commit intent and work towards at least two of the GGHH Sustainability Goals
1f. Ensure NSLHD joins the Global Green and Healthy Hospital (GGHH) network
Chief Executive
1 year
Work with the chair of the NSLHD Consumer Committee to facilitate engagement
1g. Engage consumers, carers and families in the implementation of strategies outlined in the Framework
1 year, ongoing thereafter
Chief Executive
Promote initiatives and achievements widely across all NSLHD communication platforms
Director Media and Comms
1h. Increase promotion of initiatives and achievements related to Planetary Health
Ongoing
ESU mail allocations to encourage utilising electronic records management system to document approvals Review and prepare plan/ options following release of new State Government Fleet contract in March 2021
Director Strategic Operations
1i. Minimise printing associated with documentation requiring approvals
1 year, ongoing thereafter
Director Finance and Corporate Services
1j. Increase the number of hybrid/electrical vehicles in the NSLHD Fleet
1 year
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governance
case study: sustainable organisation
NSLHD Planetary health committee
Chaired by the NSLHD Chief Executive, the NSLHD Planetary Health Committee is the peak decision making body for planetary health related decisions across NSLHD.
The purpose of the Committee is to ultimately develop and supports strategies that promote planetary health and environmental sustainability in NSLHD. The Committee provides leadership and direction for the development and implementation of initiatives and maintains oversight of each hospital and service planetary health/sustainability Committee or network. The Committee gives members the opportunity to share local initiatives underway in their respective Directorates and to engage with external stakeholders to promote and expand Planetary Health activities at a District level. The Committee comprises representation from across all hospitals and services, Health Promotion, Clinical Governance, People and Culture, Research Strategy, ICT, Allied Health, Corporate Communications, Corporate Services, Health Services Planning, Strategic Operations, Aboriginal Health and a Consumer Representative. The Committee meets monthly and reports to the NSLHD Executive via the Chief Executive.
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economic
waste management recovery Integrating effective waste management processes in all NSLHD hospitals and facilities by promoting practices amongst staff, improving segregation and increasing recycling opportunities and resource
How this will be achieved
Executive Sponsor
Strategy
Timeframe
Develop a process for further segregation of waste. Provide education to staff in relation to waste segregation. Roll out identified waste stream projects Identify potential opportunities to engage with SMaRT in developing circular economy solutions Communicate opportunities in place with staff and identify opportunities to map current services in place for each waste stream
2a. Promote reuse and redistribution opportunities for waste in areas such as furniture, ICT equipment, medical products, medical equipment and linen 2b. Explore collaborating with the University of New South Wales, Centre for Sustainable Materials Research and Technology (SMaRT)
General Managers/ Service Directors
Ongoing
Chief Executive
3 years
General Managers/ Service Directors
2c. Identify strategies to increase segregation of waste and recycling
2 years
6 months, ongoing (quarterly) thereafter
Director Finance and Corporate Services
Regularly report on waste audit results conducted by waste contractor
2d. Ensure annual waste audits are conducted at all facilities to monitor progress and compliance
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ECONOMIC
case study: waste management and resource recovery
Royal north shore hospital operating theatres
It is estimated that a hospital's operating theatres are between three to six times more energy intensive than other departments and contribute approximately 20-30% of a hospital's total waste output [10]. After identifying a need to become more sustainable, the Royal North Shore Hospital operating theatres reviewed a range of opportunities to increase the number of waste streams to reduce landfill and non-usability of clinical waste. This was achieved by implementing metal salvaging recycling from laparoscopic procedures, introducing dry mix recycling that allows high-quality plastics to be turned into Processed Engineered Fuel (PEF), increasing battery recycling initiatives and focusing on managing pharmaceutical waste by diverting waste from being collected in sharps bins and incinerated off- site. This ensures that pharmaceutical waste is disposed of via energy efficient combustion. The operating theatres have also moved to use of biodegradable kidney dishes and trays made of 100% bagasse, a sugarcane fibre that is both compostable and biodegradable and suitable for incineration with less carbon emissions.
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economic
capital WORKS AND procurement
Ensuring all capital works projects are completed with the highest environmental ratings and sustainable design principles available and procurement is managed to source environmentally sustainable products where possible
Executive Sponsor
How this will be achieved
Timeframe
Strategy
Work with Health Infrastructure to ensure compliance with Sustainable Design Principals and Resource Efficiency and include in NSLHD Capital Framework
3a. Ensure all new infrastructure and capital developments comply with current sustainability codes, policies and standards
Director Finance and Corporate Services
Ongoing
3b. Develop strategies to incentivise staff to order in bulk volumes and minimise number of deliveries
Director Finance and Corporate Services
Undertake review of imprest levels and other ordering practices
1 year, ongoing thereafter
Director Information Communication Technology
Provide energy data report and financial information to all hospitals Work with Health Infrastructure to ensure inclusion in all new builds and include in NSLHD Capital framework Baseline setting for non-clinical computers (eg. general staff and administrative computers) is to enter sleep mode after 30 minutes of activity
3c. Ensure all computers automatically switch to sleep mode after a period of inactivity
Ongoing
Director Finance and Corporate Services Director Finance and Corporate Services Director Finance and Corporate Services Director Finance and Corporate Services Director Finance and Corporate Services Director Finance and Corporate Services
3d. Investigate opportunities for rainwater harvesting in new buildings
Ongoing
3e. Identify opportunities for energy efficiency opportunities in building operations
1 year
Include in Procurement and Contracts Framework and include information on NSLHD Intranet
3f. Encourage ‘buy local’ procurement for small value items (under $10K) that are not required to be bought on contact
1 year
Work with HealthShare to ensure inclusion in major procurement tenders. Check NSLHD quotation/tender documents to ensure inclusion. Include in Procurement and Contracts Framework
3g. Ensure procurement tenders include sustainable/environmental procurement practices and tender weighting includes a sufficient percentage to encourage sustainable efficiencies
1 year, ongoing thereafter
3h. Include sustainability evaluation criteria for procurement of stationary and janitorial items
Include in current market strategy
6 months
Ensure Health Infrastructure and Ministry of Health Planning, Tender and Contract documents include compliance and include in NSLHD Capital Framework
3i. Consider the safety and wellbeing of staff to manage issues such as noise, Volatile Organic Compounds (VOCs), lighting, ergonomics, noise, hazardous substances and Hazardous Manual Tasks in the design and planning for new builds and refurbishments
Ongoing
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ECONOMIC
case study: capital works and procurement
hornsby ku-ring-gai hospital solar panels
The Hornsby Ku-ring-gai Hospital photovoltaic (PV) solar panels system aims to improve energy efficiencies and reduce the hospital’s overall carbon footprint. The installation at Hornsby is the largest solar PV system on a healthcare facility in Australia. The new system will yield over one million kilowatts of power, saving $250,000 and reducing carbon emissions by 900 tonnes annually. Due to the large roof space and new buildings on the hospital campus, Hornsby was selected to be one of the first hospitals in NSW to have solar energy, with a combined size of 865 kilowatts (kW). NSW public hospitals account for around 85 per cent of NSW Health’s total building energy costs and greenhouse gas emissions [11]. These emissions lead to rising global temperatures and climate change, contributing to serious environmental and public health issues. Widespread solar adoption leads to significantly reduced nitrous oxides and sulfur dioxide emissions, both of which can lead to respiratory and cardiovascular health problems [12].
By harnessing sunlight and converting it into sustainable electricity, Hornsby are reducing their air pollution, lowering electricity costs, and significantly reducing their carbon footprint.
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social
People and places
Promoting an environment that considers active transport and healthy place making to support the physical and mental wellbeing of our patients, staff and community
How this will be achieved
Executive Sponsor
Strategy
Timeframe
Integration into the on boarding and orientation process Where possible, undertake a systematic review of site open space with a view to use even small areas to enhance amenity and biodiversity
4a. Maintain existing green spaces and actively seek opportunities develop new open green spaces
Director Health Promotion Director People and Culture General Managers/ Service Directors
Ongoing
4b. Include a copy of the NSLHD Planetary Health Framework in new staff orientation packs
Ongoing
4c. All NSLHD hospitals and services to facilitate active travel through provision of bicycle parking, end-of-trip facilities, public transport options and parking demand management
Monitor, review and report on the NSLHD Active Travel Procedure PR2020_020
3 years
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social
Models of care
Ensuring models of care are sustainable and have a low environmental impact whilst maintaining integration and coordination between clinical areas and providers
Executive Sponsor
How this will be achieved
Timeframe
Strategy
5a. Incorporate environmental sustainability measures when implementing and evaluating models of care
General Managers/ Service Directors General Managers/ Service Directors General Managers/ Service Directors
Develop a process for identifying porcedures of low clinical value. Determine 3 procedures of low clinical value Development of an evaluation report in consultation with the NSLHD Telehealth Steering Committee Map environmental footprint of suggested new models of care and benchmark to best practice Target identified practices to evaluate and complete evaluation of identified models
Ongoing
5b. Evaluate the carbon footprint of existing models of care to identify opportunities to minimise environmental impact
1 year
5c. Aim to reduce healthcare spend in procedures with low clinical value
2 years
Executive Director Operations
5d. Establish a telehealth sustainability plan that measures the reduction in carbon emissions
Ongoing
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reference list
1. Whitmee, Sarah, et al. "Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health." The Lancet 386.10007 (2015): 1973-2028. 2. Malik, Arunima, et al. "The carbon footprint of Australian health care." The Lancet Planetary Health 2.1 (2018): 27-35. 3. World Health Organization. "Healthy hospitals, healthy planet, healthy people: Addressing climate change in healthcare settings." Geneva: WHO (2008). 4. Lenzen, Manfred, et al. "The environmental footprint of health care: a global assessment." The Lancet Planetary Health 4.7 (2020): 271-279. 5. NSW Health. Resource Efficiency Strategy 2016 – 2023. 2016. https://www.health.nsw.gov.au/assets/Publications/resource-efficiency-strategy.pdf. 6. NSW Government. Resource Efficiency Policy. 2019. https://www.environment.nsw.gov.au/-/media/OEH/Corporate-Site/Documents/Energy-savings-and-resource- efficiency/nsw-government-resource-efficiency-policy-180458.pdf 7. NSW Department of Planning, Industry and Environment, NSW Climate Change Policy Framework 2016, https://www.environment.nsw.gov.au/-/media/OEH/Corporate-Site/Documents/Climate-change/nsw-climate- change-policy-framework-160618.pdf 8. NSW Modern Slavery Act 2018 (NSW) s.30 (Austl.) 9. United Nations. Transforming our World, the 2030 Agenda for Sustainable Development, 2015, https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20D evelopment%20web.pdf 10. Kwakye, Gifty, Gabriel A. Brat, and Martin A. Makary. "Green surgical practices for health care." Archives of surgery 146.2 (2011): 131-136. 11. Audit Office of New South Wales. Building energy use in NSW public hospitals. 2014. https://www.audit.nsw.gov.au/sites/default/files/pdf- downloads/2013_Jun_Report_Building_Energy_Use_in_NSW_Public_Hospitals_0.pdf 12. Chen, Tze-Ming, et al. "Outdoor air pollution: nitrogen dioxide, sulfur dioxide, and carbon monoxide health effects." The American journal of the medical sciences 333.4 (2007): 249-256.
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“Without urgent action on climate change, the conditions that underpin the health and well-being of the human population will be greatly diminished in coming decades.” Professor Peter Doherty, Nobel Laureate for Medicine
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