sustainable health scotland 2017

Welcome to Sustainable Health

Scotland 2017

Chair’s introduction

Phil Mackie, Lead Consultant in Public Health, Scottish Public Health Network

& Head of Knowledge and Research Services, NHS Health Scotland

Housekeeping

Fire AlarmsToilets

Mobile phonesTimekeeping

Refreshments and lunchWorkshop locations

FeedbackTwitter #sushealthscot

Help and Support

Workshop session 1 rooms

How to set up or improve your Furniture reuse Programme: Scott 1

Place Making: Scott 2

Climate Change Plan: Implications and Opportunities for Healthcare: Caledonia room

Workshop session 2 rooms

Energy efficiency: Scott 1

Post Occupancy Evaluation: Scott 2

Natural Environment and Greenspace: Caledonia room

Sponsors and supporters

Morning programme09:30 - Delegate Registration & Networking

10:00 - Chair's Welcome & Introduction: Phil Mackie, Lead Consultant in Public Health, Scottish Public Health Network & Head of Knowledge and Research Services, NHS Health Scotland

10:10 - Keynote Address: Securing Scotland's Health: David Crichton, Chair, NHS Health Scotland

10:30 - Our Natural Health Service: Cath Denholm, Scottish Natural Heritage Board Member and Director of Strategy, NHS Health Scotland

10:50 - Active travel – walking and cycling our way to a healthy, sustainable, future: John Lauder, National Director, Sustrans Scotland

11:10 - Health, housing and fuel poverty – what next?: Lisa Glass, Partnership Officer for Health, Shelter Scotland

11:25 – Energy Analysis: Adam Tuck, Energy Analysis Team Leader, PCMG

11:45 - Question & Answers

12:00 - Refreshments & Networking

Securing Scotland's Health

David Crichton, Chair, NHS Health Scotland

Scottish Natural Heritage Dualchas Nàdair na h-Alba


All who visited the outdoors in the last 4 weeks (1,155)

Benefits gained from outdoor visits – SPANS 2013/4


Our Vision for the Future

• …for stronger,

coordinated effort

across sectors and for

‘win/win’ solutions for

people and nature to

be the norm

• ...for our natural heritage to play its full

role in developing better places for people

to live, work, play and learn in

• …for the value of nature to people’s

health and wellbeing, to sustainable

economic growth, and to people’s sense

of community to be recognised around the

world

• …for more involvement by people in

decisions which affect the long-term care

of their environment (because people

feel the benefits)


Scotland’s Outdoors - our

Natural health service and

Placemaking for health


Our Natural Health Service 1:

NHS Greenspace Demonstration

Project

• Improving infrastructure &

activating more use of NHS

estates

• Demonstration projects

• Good practice developed

• Impacts evaluated


Our Natural Health Service 2:

Green Health Partnerships

• area-wide, co-ordinated, cross-sector

action to mainstream green exercise

into local health delivery

• co-ordinate & up-scale cross-sectoral

action

• shaped around local health priorities

and outcomes

• targeted approach, responding to

inequalities


Development planning,

place-making and

health


Spaces delivering multiple benefits to people and nature


What does success look like for us?

• Greater public and professional awareness of the

benefits & opportunities for contact with nature as part

of everyday lives

• An increase in the number of Public Health and Health

& Social Care initiatives routinely embracing nature-

based interventions for prevention, treatment and

care

• An increase in the number of people being active

through contact with nature and actively caring for

nature

• An increase in places being developed or redeveloped

to connect and benefit people and nature


Our offer

• Information and

communications

• Product and pathway

development

• Cross-sectoral partnerships

to demonstrate the benefits

• Research, evidence, expert

knowledge

Our challenges

• Knowing where we can add

most benefit

• Getting in early enough

• Acknowledging there are

other agendas

• National, regional or local?


WEALTHIER

& FAIRER

SMARTER HEALTHIER SAFER &

STRONGER

GREENER

National Performance Framework

We live in a Scotland

that is the most

attractive place for

doing business in

Europe

We live longer,

healthier lives

We live in well-designed,

sustainable places where

we are able to access the

amenities and services

we need

We have strong resilient and

supportive communities where

people take responsibility for their

own actions and how they affect

others

We value and enjoy our

built and natural

environment and protect

it and enhance it for

future generations

Our public services are high

quality, continually

improving, efficient and

responsive to local people’s

needs.

We reduce the local and

global environmental

impact of our

consumption and

production

We realise our full

economic potential with

more and better

employment opportunities

for our people

We have improved the life

chances for children,

Young People and families

at risk

Our children have the

best start in life and

are ready to succeed

We have tackled the

significant inequalities

in Scottish society

Our young people are

successful learners,

confident individuals,

effective contributors and

responsible citizens


snh.gov.uk

Let’s work

together

more

Active travel – walking and

cycling our way to a healthy,

sustainable, future

John Lauder

National Director – Sustrans Scotland

Sustrans is the charity making it easier for

people to walk and cycle. We connect

people and places, create liveable

neighbourhoods, transform the school run

and deliver a happier, healthier commute.

Active Travel and the NHS

• Existing travel patterns – impacts on health and

sustainability

• How can active travel help?

• How can we make active travel an option for more

people?

• Our activities and the NHS

| September 17Walking and cycling our way to a healthy, sustainable, future © Sustrans

Existing travel patterns – impacts on

health and sustainability


Inactivity


Weight

gain

Type 2

Diabetes

Cardio-

vascular

health

Mental

health

issues

Increased

risk of

cancer

Environment


Air / noise

pollution

Resource

depletion

Climate

change

Space


Car parking

problems

Congestion

Loss of

community

Other problems


Lost

time

Town

centre

decline

Road

collisions

How can active travel help?


Everyday activity

| September 17

“For most people, the easiest and most acceptable forms of

physical activity are those that can be incorporated into

everyday life. Examples include walking or cycling instead

of travelling by car, bus or train.” Start Active, Stay Active

56% of GB car journeys < 5 miles – but cycling only 2% of

all journeys (Netherlands = 26%, Denmark = 19%, France

= 5%)

Walking and cycling our way to a healthy, sustainable, future © Sustrans

Health benefits


“30 mins of moderate intensity physical activity 5 days a

week helps to prevent and manage over 20 chronic

conditions, including coronary heart disease, stroke, type 2

diabetes, cancer, obesity, mental health problems and

musculoskeletal conditions.” Start Active, Stay Active

Health benefits

| September 17

University of Glasgow study of 250,000 people found that

cycling to work lowered the risk of cancer by 45% and

cardiovascular disease by 46% (walking 27%).

Danish levels of cycling in urban England and Wales would

save the NHS £17bn within 20 years


Health benefits


“Physical activity can reduce the risk of depression,

dementia and Alzheimer’s and enhance psychological well-

being, by improving self-perception and self-esteem, mood

and sleep quality, and by reducing levels of anxiety and

fatigue.” Start Active, Stay Active

Reduced air /

noise pollution

Cleaner air = improved health

| September

17

Space efficient

60 cars = 16 buses = 600 bikes


Fun!!!


How can we make active travel an option

for more people?

To achieve behaviour change you need:

• Information

• Engagement & Capacity building

• Facilities & Built Environment

• Policy and Practice

• Social Proof


Information


Maps

Route

planning

Advice

Engagement & capacity building


Training

Co-design

Sharing

best

practice

Facilities & Built Environment


Walking &

cycling paths

Showers

Cycle parking

Lockers

Signage

People-

focused

streets

Policy & Practice


Bicycle

User Groups

(BUGs)

Standards

for new

facilities

Incentives

Social proof


Led

walks /

rides

Travel

challenges

Hands-up

Survey

Scotland

Bicycle

accounts

Working with the NHS

| September

17


Community Links


50% match-funded grants (capital)

To create facilities that make it easier for people to choose

walking and cycling for their everyday journeys

Expert support from our ‘Community Links’ officers

Guidance / application:

www.sustrans.org.uk/communitylinks


Before After

NHS Ayrshire & Arran

Workplace challenges

Annual, Scotland-wide, challenge in March or bespoke

challenge for your organisation

Creates healthy competition between individuals, teams

and organisations

Contact:

[email protected] / 0131 346 9787

Walking, cycling and public transport

mailto:[email protected]

Workplace engagement officers


50% match-funded posts (revenue)

Liaise with staff, create travel plans, deliver activities

Expert support from our Workplaces team

Contact:



Active Travel Champions


Supported with training, materials and funding activities

Recruit enthusiastic volunteers within your organisation

Coordinate activities (e.g. Dr Bike, led walks / rides, travel

challenges)

Contact:



Working in partnership

• How can we work together to bring about the benefits of

more people travelling actively?

• How can we embed walking and cycling in to the

everyday thinking and planning of the NHS?

• How can we ensure that we reach the areas of highest

health deprivation?


Sustrans is the charity making it easier for people

to walk and cycle. We connect people and places,

create liveable neighbourhoods, transform the

school run and deliver a happier, healthier

commute.

Join us on our journey. www.sustrans.org.uk

Twitter @sustrans

www.sustrans.org.uk

http://www.sustrans.org.uk/

52Friday, 22 September 2017

Until there’s a home for everyone

Health, housing and fuel poverty – what next?

Lisa Glass, Policy Officer

53

Structure

1. Housing issues in Scotland today

2. What is the link with health?

3. Why should the NHS help?

4. What form can prevention and early intervention take

in Scotland’s health services?

54

Shelter Scotland helps over half a million people a year

struggling with bad housing or homelessness – and we

campaign to prevent it in the first place.

Our work includes policy and front line services to public

campaigns and training housing professionals so that we

improve housing in Scotland in a wide variety of ways and

increase access to a safe, secure and affordable home.

56

‘Housing’ issues in Scotland today

57


58


59


What do you need from a house?

60


▪ 34,100 homeless applications in 2016-17

- 28,247 assessed as homeless

▪ Some of the best homeless rights in the

world, yet…bottleneck in temporary

accommodation

- 10,873 households; 6,041 children, 1 in 10 > 1 year; 23

weeks on average

▪ 142,500 households on council waiting lists

▪ 70,000 living in overcrowded accommodation

▪ 748,000 households in fuel poverty

61

What is the link with health?

62

Not just housing issues…

▪ Commission on Housing &

Wellbeing, 2015: www.housingandwellbeing.org

Looked at housing across 5 areas of

wellbeing, including health

47 recommendations, 1 year on

report

▪ Fuel poverty and ‘cold

homes’ are one of the more

obvious areas where

housing links to health.

http://www.housingandwellbeing.org/

63

Not just housing issues…

▪ Poor housing increases the risk of severe ill-health or

disability by ^25% during childhood and early

adulthood

▪ 41% of the homeless population will suffer long term

health difficulties, compared to 28% of the general

population

▪ Children living in cold homes are twice as likely to

suffer respiratory problems.

▪ Research shows higher attendance at A&E amongst

the homeless population, as well as more admissions

relating to alcohol and drug misuse and self-harm.

64

Why should health services be

concerned with these issues?

65

Why should health services be

concerned?

• Public health and moral argument

• Money• Estimates of £48-80million savings to the NHS in

Scotland (fuel poverty)

• Every £1 spent tackling fuel poverty saves the NHS

42p

• Wider strategies and principles, & today!Prevention

Sustainability

Making Every Opportunity Count

66

What form can prevention and

early intervention take in

Scotland’s health services?

• How can the NHS help?

67

How can the NHS help?

▪ Partnership working

- Co-location of services

- Funding

▪ Training and awareness raising

- Not expecting staff to be experts

- Signposting

▪ ‘Social prescribing’

▪ Remember your staff are people, too

68

Case study – outreach

▪ Advice and support work in NHS locations

1. Family Nurse Partnership

2. NHS Fife Intervention Project

3. Primary health services in Dundee and

Glasgow

69

Case study – training

▪ Upskilling health practitioners to better

identify housing issues and take appropriate

action

1. Welfare reform training, NHS Fife

2. Healthy Homes Project – training on fuel

poverty

70

• Online training course

• Pilot (151 places free)

• Transitional Learning Evaluation

• pre (120 responses)

• post (136 responses)

• 3 month (43/98)

Healthy Homes project

Job titles Number of

trainees

Occupational

therapists

32

Physiotherapist 6

Support workers 37

Nurses 50

Health improvement 3

Other (including health

visitor, midwife)

23

Total 151

“This is an excellent source of

information and has given me confidence

to offer advice to vulnerable clients”

✓ 100% = improved knowledge

✓ 92% = improved confidence

✓ 133/134 = training worth it

✓ 131/133 = thought relevant to their

role

71

Impact on patients:

• 27 (out of 43) staff had used knowledge from the training

to support their patients

Healthy Homes project

• 26 had provided their patients with ‘low-level behavioural

advice’

• 15 had referred a patient

• Home Energy Scotland (7 staff referred to this service)

• Shelter Scotland (4),

• a local energy advice provider (4), and

• an energy company (1)

• 23 out of 26 felt the advice they had provided had benefitted

their patient’s health

72

• 16 hadn’t used their training to benefit patients….• Not relevant to patients (2)

• Internal barriers e.g. time (1)

• External barriers e.g. off sick (2), changing role (1)

• Not seen any patients with fuel poverty issues (10)

Impact on patients

• But• Only 3 months

• No winter…

• Need to help staff reflect on

day to day work?

73

▪ What can you do? Be our advocate!

74

For any more information:

[email protected]

Policy Officer

0344 515 2469

To sign up to our latest homelessness: far

from fixed campaign, visit

shelterscotland.org/farfromfixed


shelterscotland.org/farfromfixed

Energy Cost Recovery

Adam Tuck, Energy Analysis Team Leader, PCMG

Question and Answers

Refreshments & networking

Welcome Back

Brian Swanson, Chair, NHSScotland Sustainability Steering Group

Afternoon programme15:00 Welcome Back: Brian Swanson, Chair, NHSScotland Sustainability Steering Group

15:05 - Community Empowerment: Linda Gillespie, Community Ownership Support Service

15:20 - Delivering a Low Emission Zone: Cllr. Anna Richardson, Glasgow City Council - Confirmed

15:35 - Creating a climate ready action plan – Climate Ready Clyde: Kit England, Project Manager, Climate Ready Clyde

15:50 - Question and Answers

16:00 - Chair’s Concluding Comments: Brian Swanson, Chair, NHSScotland Sustainability Steering Group

16:05 - Event Close

Community Empowerment

Linda Gillespie, Community Ownership Support Service

Other examples

Community Ownership Linda Gillespie

Community Ownership Support Service

COSS is a Scottish Government funded programme, delivered through the Development Trusts Association Scotland since 2011.

An Adviser led service across Scotland which:▪ Helps community-based groups take ownership

of public assets for community benefit .▪ Supports local authorities and other public

bodies in the sustainable transfer assets into community ownership.

Community Ownership in Scotland

▪ > 560,000 acres in community ownership

▪ 75,891 assets (2,740 community assets)

▪ Most common uses: housing, community halls/centres, amenity space (e.g. parks), business lets, cafes/restaurants, educational, grocery shops, heritage, renewable energy, sports and fitness

▪ Two thirds in remote rural (excluding housing)

▪ 1 in 20 in urban areas (38.9% of population)

Source: Community Ownership in Scotland: a baseline study, DTAS, 2012

: Scottish Government 1M Acres Research

Community Empowerment Act Part 5: Asset Transfer Requests

What assets can community bodies request?▪ The right to request to purchase, lease, manage or use

land and buildings belonging to local authorities and other Scottish public bodies

▪ The assets do not have to be on a “surplus to requirements” list

▪ Communities state the amount they are prepared to pay – below market value.

▪ Presumption is in favour or communities unless there are reasonable grounds for refusal.

▪ Review and appeal to Scottish Ministers

Recent Developments to Community Right to Buy

Community Empowerment Act 2015

▪ Original 2003 Community Right to Buy with

broadened eligibility / tweaked criteria

▪ New Community Right to Buy Abandoned/

Neglected/ Detrimental Land (Dec 2017)

Land Reform Act 2016

▪ New Community Right to Buy land to further

Sustainable Development (2018)

Why do communities do it?

• Long-term social, economic and environmental transformation of communities

• Protect / enhance key local services

• Creates opportunities to be enterprising, create jobs, business opportunities, further investment

• Give independence and control over the future- allows for major developments

• Encourage exploration of opportunities to move toward self – sufficiency

• Build community confidence, pride, identity and cohesion

Kyle Centre

Applecross Community Company

Maud Village Trust

Further Information

Community Ownership Support Service

www.dtascommunityownership.org.uk

0131 225 2080

Linda Gillespie

[email protected]

0131 225 2080

07579 008467

http://www.dtascommunityownership.org.uk/


Glasgow Low Emission Zone

Councillor Anna Richardson

91

www.glasgow.gov.uk

In the news…

92

www.glasgow.gov.uk

Glasgow’s People

• Population approx. 615,000

• 34% of children living in poverty

• Life expectancy lower than Scottish Average

• Fewer than half of all households own a car

(Glasgow Centre for Population Health)

93

www.glasgow.gov.uk

Air Pollution and Health

• Disproportionally affects children, the elderly and those

with underlying conditions

• 300 premature deaths in Glasgow each year attributable

to air pollution

(Estimating local mortality burdens associated with particulate air pollution - PHE 2014)

94

Urban Air Pollution

• Sources – varied

however like most large

urban authorities

transport dominates.

• Canyon effect of high-rise

buildings prevent

dispersion.

• Pollutants of concern –

Nitrogen Dioxide and

Particulate Matter.

95

Local Air Quality Management

• 3 Air Quality Management Areas (AQMAs)

• Actions taken already include :

o Idling and Emission - enforcement + awareness raising.

o City Trees

o MACH Bikes

o Cycling infrastructure improvements

o Electric vehicles and charge points

o Eco-stars Fleet Management Scheme

o Electric buses

o Car Clubs

o Travel planning

o Planning Guidance

• City-wide AQMA revoked and East End AQMA to be revoked due to success of actions taken.

• Over £1m invested over the past 3 years

96

Air Quality results

2016 Results

• PM10 levels not exceeded.

• NO2 1 Hour Mean was not exceeded.

• NO2 Annual Mean Objective exceeded in

parts of city centre and small part of

Dumbarton Road.

• The trend across the city is generally of air

quality continuing to improve – NOT QUICK

ENOUGH !!

• All other LAQM pollutants – which are

carbon monoxide, sulphur dioxide, ozone

and benzene continue to be within the

human health based objectives.

(Data taken from Scottish Air Quality Website)

97

Position statement

Scotland’s 2016 Programme for Government :-

“We will take forward the actions set out in the Cleaner Air

for Scotland Strategy to reduce air pollution further. With

the help of local authorities, we will identify and put in place

the first low emission zone by 2018”

Glasgow Council :-

“We will establish Scotland’s first Low Emission Zone,

reduce congestion and work to remove the most polluting

diesel engines from our streets”

(Cllr Anna Richardson - Scotsman 23/5/17)

98

Low Emission Zones?

• An LEZ is a defined geographical area in which vehicle entry is restricted (ANPR), based on the level of engine emissions.

• 200 across 10 countries in Europe – largest being in London – most trucks/vans

• Glasgow would need highest standard (Euro VI/6 diesel IV/4 petrol) to reduce NO2

• This is not a revenue raising policy.

99

www.glasgow.gov.uk

Glasgow LEZ works

• Partnership working – SEPA Transport Scotland and SPT

• Assessment works identifies biggest polluters

• Modelled several scenarios to assess impacts

• Substantial improvement possible by cleaning up the bus fleet.

• Assumes all buses upgraded to EURO VI and or retrofitted

100

LEZ Challenges

• Costs – infrastructure and backroom support plus costs for fleet upgrade will be

in the millions – do not want to reduce bus service/increase costs.

• Legislation - statutory processes needed for council to enforce restrictions will

not necessarily be fully in place for 2018. Transport Bill may allow enforcement

of an LEZ as a decriminalised offense. Bus only phase LEZ may be possible

through Traffic Regulation Conditions

• 2018 Timescales - Traffic Regulation Orders required for all other vehicles

lengthy process not likely by 2018 - Bus procurement (24 months) or retrofit may

be difficult by 2018. Adequate consultation and notice period for commerce /

transport/ residents

101

www.glasgow.gov.uk

What next

• Not just LEZs

• Public realm improvement

• Clean, pleasant enjoyable destination.

• Active travel prioritised.

102

Creating a Climate Ready Action Plan

Sustainable Health Scotland, Sep 2017

Climate change is among the greatest health risks of the 21st Century. Rising temperatures and more extreme weather events cost lives directly, increase transmission and spread of infectious diseases, and undermine the environmental determinants of health, including clean air and water, and sufficient food.

“WHO Global Health and Climate Change Programme”

Key risks / opportunities for people

Risks to:

• Health and wellbeing from high temperatures

• Passengers from high temperatures on public transport

• Health and social care delivery from extreme weather

• Health from changes in air quality

• Health from vector-borne pathogens

• Food-borne disease cases and outbreaks

• Health from poor water quality

• Viability of coastal communities from sea level rise

Opportunities:

• Increased outdoor activities from higher temperatures

• Potential benefits to health and wellbeing from reduced cold

Climate Ready Clyde

• A 3 year initiative to support Glasgow City Region to meet the challenges of changing rainfall, and rising temperatures and seas.

• Aims to build a shared understanding across public, private and voluntary sector of climate risks and opportunities, and collaborate to implement actions and share responsibility

• Support the City Region to achieve economic prosperity, make great places to live, reduce inequalities and avoid costs to organisations

Who’s involved

Governance

Climate Ready Clyde Board

Executive Sub-groupImpact, Influence and Engagement

Sub-group

Risk and Vulnerability Assessment Sub-

group

Secretariat (1.45 FTE) Advisory Panel

Source: Climate Action Tracker

Future rainfall

Wet

Dry

Wet

Future temperature

Hot

Mild

Mild

Hot

Mild

Mild

Health impacts of climate change in Glasgow City Region

1. Climate change will directly and indirectly affect the scale, scope and distribution of health conditions presenting to NHS services and wider social care –changing patient demand, and increasing vulnerable communities

2. Climate change will affect NHS Boards’ day to day operations – need to adapt and improve business continuity

A key focus on partnership working to address future social vulnerability, and supporting all members to adapt their assets and services.

Source: Clayton et al. (2015)

Climate change will also modify causes of health inequalities

A difficult place to start from – but also a reason to focus on this issue

-30

-20

-10

0

10

20

30

40

All ages Children(aged 0 to 15)

Working age Pensionable age and over

Projected percentage change in population (2014-based), by age structure in Glasgow City Region, 2014 to 2039

Inverclyde West Dunbartonshire North Lanarkshire Renfrewshire

South Lanarkshire East Dunbartonshire Glasgow City East Renfrewshire

0

1

2

3

4

5

6

7

8

2000s 2020s 2050s 2080s

An

nu

al d

ealt

hs

per

10

0,0

00

po

pu

lati

on

Mean estimates of all-age heat-related deaths in Scotland per year per 100,000 population

Source: Hajatet al. (2014)

Fluvial and Coastal

Pluvial

2050s (2 degree pathway)

Present Day

2050s (4 degree pathway)

Operational implications

• Significant challenges for NHS Greater Glasgow and Clyde in terms of:

– Patient demand

– Vulnerable communities

– Business continuity

• Good range of options that can begin to prepare the service for these challenges

• Partnership working to manage risks outside of control: e.g:• Public health interventions– e.g. climate resilient parks• Maximising benefit take up through Local Authorities• Shared business cases with Local Authorities and SEPA on Flood

Risk Management

• Work to ensure services and assets are climate ready:• Inclusion of climate changes as part of wider NHS demand

planning

• Training and awareness raising

• Incorporating adaptation into building renovation – design and materials

• Identifying risks in existing buildings

• Adding in clauses into supply chains/procurement

Possible adaptation options

Our next steps

• Support partner actions whilst progressing the strategic approach

• Consultation on methods / call for evidence

• Agree the scope of risks / opportunities from climate change locally and score their likelihood / urgency

• Map existing plans and activities to reduce risk / realise activities

• Use the findings to inform the development of strategy / action plan

1. Assess Risks and Opportunities (Apr 17 -

Sep 18)

2. Develop Strategy and

Action Plan (Sep 18 - Mar -'20)

3. Delivery (Apr 2020 onwards)

4. Monitor, review and

evaluate

Kit England LLB Hons. MA. MIEMA CEnv.

Climate Ready Clyde Project ManagerT:0141 229 7738E: [email protected]@kitengland / @ClimaReadyClyde


Closing comments

Brian Swanson, Chair, NHSScotland Sustainability Steering Group

sustainable health scotland 2017

Health & Medicine