Cleanmed Europe 2013 - Latest News

New CleanMed video: The Real Cost of Healthcare

2014-01-16T22:01:09+00:00

Mahmood Bhutta, an ENT Surgeon and co-founder of the BMA Medical Fair and Ethical Trade Group, explains why the surgical instruments he uses for his work must be sourced ethically – why it’s a human rights as well as a health issue. After his conference presentation he spoke to Anuradha Vittachi about why he is so committed to action on this issue.

BMJ Blog: Hugh Rayner - An Example from Kidney Care

2013-11-08T20:52:15+00:00

Read on the BMJ website

Dialysis treatment for end stage kidney disease is a burden on patients, taxpayers, and the environment. The carbon cost of dialysis is estimated to be seven tonnes CO2 equivalents per year. Although we can make the improvements to reduce this, the ideal is to prevent people from reaching end stage kidney disease.

Traditional systems of care do not always mean that kidney patients get the right care at the right time to avoid losing kidney function. A recent paper from Cardiff described the organisation of care for patients with diabetes and chronic kidney disease. It showed that many patients who should be seeing a nephrologist had not been referred. Conversely, many patients continued to attend a specialist clinic when they could be followed in primary care. Age seemed to play a big part in this, older patients being more likely to be in the “wrong” place. However, if all patients who merited seeing a specialist were referred, would the system cope?

I faced this problem about 10 years ago when I found the number of patients attending my diabetes-renal clinic was growing exponentially. I was definitely struggling to cope. And yet I realised that if I was going to make a difference to the natural history of kidney disease, I needed to see more patients at an earlier stage of their chronic kidney disease (CKD).

The answer was to take a step back and implement a system of care that worked across the local population. It is based on an IT system that allows me to track the kidney function of patients with CKD without them attending the clinic in person. This is done from a graph of the estimated glomerular filtration rate (eGFR) over time. I select those patients with deteriorating function who do need to come in person. Those with stable function continue under the care of their GP or in the general diabetes clinic. Discharging patients from clinic became easier and safer; indeed they are never completely discharged from my care. The appointments freed up are available for new referrals.

The graph of eGFR over time is invaluable for patients as well as clinicians. It allows everyone to see what is happening and whether the treatment is making a difference. A letter is written directly to the patient after each consultation, including the eGFR graph. This is also copied to the GP. The single most important issue is blood pressure control. Seeing the GFR stop falling when the BP comes under control is very motivating to continue taking the tablets.

The details of this service have been published in BMJ Quality and Safety. We showed that the number of patients with diabetes who started dialysis fell significantly after the service was introduced. Since then, thanks to funding from the Health Foundation, we have extended the way of working to cover all tests requested by GPs by incorporating it in the pathology service.

After a peak in 2005, we have continued to see a decline in patients needing to start dialysis. This year we are on track to start the same number as we did 10 years ago, despite the 10% growth in population that we serve. This is great news for patients, clinicians, and the wider NHS—one patient’s dialysis can cost £35 000 per year. However, because money flows to those parts of the NHS that do more activity (so called payment by results) I was blamed by some for cutting the income to the department by reducing the number of patients coming to outpatients and starting dialysis. Introducing a payment system that encourages people to do fewer rather than more low value activities would make it easier to persuade others to adopt this system.

Competing interests: I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Hugh C Rayner is a consultant nephrologist, Heart of England NHS Foundation Trust. He spoke on these issues at the CleanMed conference, which was held from 17 to 19 September, 2013.

Past BMJ CleanMed Europe blogs

Rachel Stancliffe and Mahmood Bhutta: Should doctors lead on sustainability?
Frances Mortimer: Sustainable Clinical Practice
Isobel Braithwaite: Sustainable healthcare education - what is it and why does it matter?
Sonia Roschnik: Why Sustainability is core to health
Prof Ian Gilmore: What is good for environmental sustainability is good for health
Stirling Smith: Ethical procurement of NHS medical supplies
Marcus Grant: Radical transformation or bust

CleanMed Conference films available online

2013-10-21T21:48:43+00:00

We were lucky enough to secure the services of experienced filmmakers Peter Armstrong and Anuradha Vittachi before and during the conference. Below are two videos they made for the Centre for Sustainable Healthcare to show at the conference and follow-up videos. More videos will be appearing soon.

Videos Shown at the Conference

Sustainable Specialties

The Centre for Sustainable Healthcare is pioneering new initiatives in sustainability, starting with kidney treatments and extending to other specialties like mental health. Dr Frances Mortimer introduced the video during her plenary session.

Greening the NHS

The Centre for Sustainable Healthcare in Oxford runs a programme called NHS Forest. It promotes the planting of tens of thousands of trees around UK hospitals and clinics – showing how green spaces can promote wellbeing and shorter recovery times.

Videos from the Conference

Climate Health Check

Just how bad is the climate change crisis and its impact on human health and the health of the planet? And what is the best way to get the message out about what can be done?

At the 2013 CleanMed Conference in Oxford Prof. Hugh Montgomery brings his wide experience in the health service to bear on the environmental issues that face us all, and goes into more detail in a follow-up discussion with Anuradha Vittachi from the Hedgerley Wood Channel.

Politics of Alcohol

What happened to the UK government's plan to set a minimum unit price for alcohol to help combat binge drinking? At the 2013 CleanMed conference in Oxford for medical professionals the question is put to the man who should know - Prof. Ian Gilmore, who led the key study for the government when he was President of the Royal College of Physicians.

CleanMed conference photos available online

2013-10-08T19:27:14+00:00

The photos from the CleanMed conference are now available to view.

We would like to thank our photographer John Cairns, who has an unerring eye for a good photo.

Plenary Speakers slides are up

2013-09-26T23:15:14+00:00

Plenary speakers presentations are available here:
http://cleanmedeurope.org/speakers/plenary-speakers-slides

Session Speakers presentations coming soon.

CleanMed Europe 2013 accelerates the push towards a sustainable European healthcare system

2013-09-24T17:48:00+00:00

Oxford 19/9/2013 — The fourth CleanMed Europe conference, Europe’s leading conference on the intersection between environmental sustainability and healthcare, took place this week, organised by the Centre for Sustainable Healthcare (CSH) and Health Care Without Harm Europe (HCWH Europe). The conference drew together more than 300 leaders from the healthcare, public health and environmental sectors, including many people who have been working on healthcare sustainability locally and nationally.

Experts speaking during the four plenary sessions included Gary Cohen of HCWH, Professors Ian Gilmour and Hugh Montgomery, and Dr. Bettina Menne of the World Health Organisation, on a range of subjects - from the impacts of biodiversity loss and climate change on health to specific ways in which healthcare systems can become part of the solution. Delegates had the opportunity to share their examples of best practice and to discuss the role of the health sector in modelling the transition all sectors need to make for a healthier, more resilient and more liveable future.

Alongside six plenary sessions, 26 parallel sessions and workshops enabled attendees to discuss pressing contemporary issues in healthcare sustainability: technological innovations; ethical procurement of equipment; education and culture change; prevention through policy change; the role of clinicians; improving access to green space through commissioning and much more.

A focus on patients, clinical care pathways and implementation research were defining features of the conference, reflecting the focus of the Centre for Sustainable Healthcare’s work. The days’ themes moved from ‘making the exceptional normal’ via ‘improved models of care’ to ‘radical transformation’. Whilst the first day focused on scaling up current best practice and focusing on priority areas and ‘carbon hotspots’, the second day saw presentations on innovations in models of care in areas such as mental health and kidney medicine, including quantified carbon emissions reductions, financial savings and improvements in health outcomes.

The final day brought in discussion about the need for a greater emphasis on upstream disease prevention, for example through policy change and work to create healthy and sustainable communities. The core message was that keeping people healthier results in fewer expensive, environmentally harmful and often risky medical treatments being required, and should be considered integral to a vision of sustainable healthcare.

The Director of The Centre for Sustainable Healthcare, Ms. Rachel Stancliffe, stated, “CleanMed Europe 2013 really pushed the urgency to transform healthcare systems and to engage healthcare professionals to drive this transformation”. This message was strongly resonated throughout the conference with participants calling for doctors and nurses to come together and demand their governments to stop solely thinking about economic prosperity and to focus more on the growth of well-being as a measure of national success.

A newly produced video on CSH’s Sustainable Specialties initiative was launched along with another new film about their flagship NHS Forest scheme, both by award-winning director Peter Armstrong. The conference also included a poster exhibition, with case studies of best practice from all around the world. Major sponsors included Johnson & Johnson, Construction Specialties, KPMG, the Oxford Academic Health Sciences Network, BD and nora systems with other exhibitors from healthcare, academia and industry. A group of students coordinated by Healthy Planet UK helped delegates to make the most of the conference, as well as tweeting and interviewing throughout.

Emergent themes included collaboration across sectoral boundaries and the importance of putting patients at the centre and of stepping back from daily routine in order to find ways to improve established practices.

Mr. Gary Cohen, Founder and President of Health Care Without Harm, which is also the founding organisation of the CleanMed conference, commented in his closing plenary speech, “there is a growing consensus that the healthcare sector needs to transform itself to become an anchor for healthy communities and a sustainable economy rather than being exclusively focused on managing diseases in individual patients”.

After three days of interaction between European hospitals, healthcare systems, medical associations, healthcare professionals, local authorities and health and environmental organisations, solutions to create a healthcare sector that does no harm were abundant. Whether it was the implementation of carbon footprint measurements or standards for a shared European framework for healthcare systems, Mr. Cohen commends the CleanMed Europe 2013 conference as it “showcased the islands of hopeful innovation in service of the radical transformation needed”.

CleanMed Europe is the only European conference on sustainability within the healthcare sector, addressing the environmental impact of the health care sector on a local, regional, and global level. Next year’s CleanMed Europe will take place in Brussels, Belgium. For more information about CleanMed Europe 2014, please contact Health Care Without Harm Europe.

For more information, visit please www.cleanmedeurope.org.

The Centre for Sustainable Healthcare focuses on the interface between health and the environment in order to put health messages at the centre of the climate change agenda. Through our research and our work with clinical communities we are supporting the transition to a healthcare system which is both economically and environmentally sustainable.

Health Care Without Harm is an international coalition of more than 500 organizations in 53 countries, working to transform the health care sector worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment.

BMJ Blog - Marcus Grant: Radical transformation or bust

2013-09-16T21:39:13+00:00

Read on the BMJ website

To an average UK citizen, an outsider to public health, “Health” (with a capital “H”) is viewed as a basic function of government: the government pours shed loads of money into the “system” and out pours better health for the population. Sometimes this might be delivered in an inefficient manner, but overall, better health pours out anyway: mainly from hospitals, but also from GPs. Everyday access to good quality air, water, and essential services, having parks and countryside on tap, and, for many in this generation, living in environmental conditions which are on the whole pretty habitable is taken for granted. But what about the influence of the everyday environment, our neighbourhoods, towns, and cities, on our health?

I used to be an outsider. However, for the past 10 years I have been working close to colleagues, mainly in public health, on aspects of sustainable healthcare. Specifically, I have been involved with the complexities of the rise in non-communicable disease in urban populations—through healthy urban planning. My outsider naivety has been lost. I now distinguish a continuum in “Health” (still with a capital “H”); a continuum from tackling disease and caring for sick people at one end, to improving people’s health and supporting wellbeing at the other. Incredibly, we seem to have produced a system whereby these ends are now so far apart that they are no longer recognisable as both belonging to a single continuum. Even worse, they fight. Conflicts arising over prioritisation and resources obscure our overall understanding of what the “Health” project should be about at national level. The false dilemma: do we prioritise curing the sick, or supporting a population in being healthy—to stop them getting sick in the first place. Is there anyone looking strategically at how we can best support a healthy population across the whole life course, not just the intervention (or treatment) when people fall ill?

As a designer, I could use my skills to assist “Health” through the design of hospitals and health products, or I could turn my attention to the design of services and healthcare. But there is more to be gained, with less drain on resources, from the re-design of health itself. We need to provide incentives for health and not just curing illness. With projected rationing of care, rising demand and increasing economic burden of disease the current system is not fit for purpose now and certainly not for the predicted future.

There are proven and evidenced stalwarts of salutatory health, such as good food, green space, and community cohesion. How can we harness these as essential assets of sustainable healthcare?

The language of prevention includes primary, secondary, and tertiary prevention—none of them receiving the prioritisation needed to really reduce the economic burden of disease.

I suggest that there are three approaches that we all need to discuss and develop to extend our practice so that we can address all tiers of prevention. These approaches start to define a role for healthcare in influencing the social determinants of health. Firstly, we need to provide health evidence to other sectors where it supports changes in policy direction that have co-benefits. Examples can be found in the series of WHO policy briefings on the health co-benefits of climate change mitigation and expected health impacts. We need to harness a wider health workforce made up of the expertise of town planners, transport engineers, and urban designers. Secondly, we should not shy away from using health resources in non-health sectors where a health outcome can be evidenced. For example public health may want to assist in supporting well maintained and accessible green spaces, especially in areas of deprivation.

Finally, we need to ensure that health facility investments themselves are designed not only to cure disease but also to improve people’s health. The design ethos of these investments should be that of an intervention. In addition to paying attention to the delivery of health in the interior of the facility, heed must be paid to the potential for delivery of increased health and wellbeing externally, to the surrounding communities using all the levers of the social determinants of health. Let’s allow health to flow out from future healthcare facilities, blending lessons from the Peckham Experiment with the brave new world of healthcare possibilities described by in Fit for the Future.

Past BMJ CleanMed Europe blogs

Rachel Stancliffe and Mahmood Bhutta: Should doctors lead on sustainability?
Frances Mortimer: Sustainable Clinical Practice
Isobel Braithwaite: Sustainable healthcare education - what is it and why does it matter?
Sonia Roschnik: Why Sustainability is core to health
Prof Ian Gilmore: What is good for environmental sustainability is good for health
Stirling Smith - Ethical procurement of NHS medical supplies

Registration via the website has now closed

2013-09-14T15:02:08+00:00

Places are still available, just come and register on the day. Allow at least 15 minutes to do so before sessions start.

We look forward to seeing you on 17th September

Your 3-day registration fee includes:

Three days of conference talks, networking opportunities, workshops
Poster exhibition (opportunities to submit abstract)
Lunch and refreshments throughout the three days
Drinks reception at the Ashmolean Museum on Tuesday 17th September
Gala dinner on Wednesday (additional charge)
Preferential rate at recommended hotels
Opportunities to attend social events such as walking tours around Oxford

Your 1-day registration fee includes:

A day of conference talks, networking opportunities, workshops
Stalls and posters (opportunity to exhibit)
Lunch and refreshments
Drinks Reception at Ashmolean Museum on Tuesday 17th September

	Standard rate ex VAT	Standard rate inc VAT
3-day Standard Delegate	£500	£600
3-day Corporate Delegate	£675	£810
3-day Student Delegate	£100	£120

1-day Standard Delegate	£225	£270
1-day Corporate Delegate	£325	£390
1-day Student Delegate	N/A	N/A

Pre-conference workshop: Sustainability Profiling of Healthcare Products & Pathways

2013-09-12T04:35:16+00:00

Join Environmental Resources Management (ERM), GlaxoSmithKline (GSK) and Johnson & Johnson (J&J) for a lively discussion on how healthcare products can be made and used more sustainably.

Topics covered during this free workshop will include

Understanding the environmental impacts of how products are made and the materials and energy consumed in their production
The value in carbon footprinting and existing methods and guidelines
Potential pitfalls when procuring sustainable products
Understanding and minimising supply chain risks
Adapting care pathways to improve resource efficiency
Reputational benefits of sustainability and communicating with stakeholders

To tailor the workshop to the audience size, the organisers would appreciate anyone interested to register through the link below.

Registration: https://feedback.erm.com/survey.asp?sid=2013962083284

Title: Sustainability Profiling of Healthcare Products and Pathways

Time: 9:00am to 10.30am, 17^th of September 2013

Location: Oxford University Examination Schools

Cost: Free (if registered at CleanMed)

Speakers: Mark Rhodes (GSK), Phil Dahlin (J&J), Simon Aumônier (ERM) and Tom Penny (ERM)

This event will also discuss the greenhouse gas accounting guidance developed to appraise pharmaceuticals and medical devices. http://www.ghgprotocol.org/feature/pharmaceutical-and-medical-device-sector-guidance-product-life-cycle-accounting

Gold Sponsors J&J on supporting CleanMed

2013-09-11T19:03:38+00:00

Finding balance

As we get excited to explore the opportunities of sustainability in healthcare at CleanMed Europe and network with people passionate about discovering sustainable solutions, I wanted to offer some insight into why Johnson & Johnson is honoured and proud to be a gold sponsor. This year we celebrated the 70^th anniversary of Our Credo, a foundation to the way Johnson & Johnson conducts business. The Credo outlines our responsibilities to various groups of stakeholders and guides our behaviour. Although written in 1943 it has citizenship and sustainability as a part of its core, a testament to sustainability being part of our heritage.

“We must be good citizens – support good works and charities and bear our fair share of taxes. We must maintain in good order the property we are privileged to use, protecting the environment and natural resources.”- Johnson & Johnson Credo

My hope is that J&J, and the healthcare industry as a whole, can be active participants in the conversation and process of redefining healthcare and healthcare systems for today and for future generations.

Achieving sustainability in our healthcare systems is by no means a small undertaking. During a time of economic constraints and shrinking resources, there are global challenges in meeting the needs of the growing middle class, ageing populations and rise of chronic diseases, and increasing demands for access to quality health care. Though there are no easy solutions, I believe that we should start by looking at healthcare as an investment for societies as opposed to the price tag for treating sickness. This is an investment that can improve productivity, reduce current and future costs and enhance quality of life. At Janssen and Johnson & Johnson we are focusing on three areas as we evolve our way of thinking and way of working for the 21^st century, through:

Innovation
Collaboration
Prevention

At CleanMed, I will expand more on the above, and look forward to discussing with you how focusing on sustainability in the healthcare system could help us achieve more with fewer and finite resources. Working along with other organizations, we have a chance to change our healthcare environment in a big way. The conversation starts now.

Jane Griffiths

Company Group Chairman of Janssen in EMEA, Johnson & Johnson

Jane is speaking at the opening plenary on Tuesday, 17th September