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 Alarms
Toilets
Mobile phones
Timekeeping
Refreshments and lunch
Workshop locations
Feedback
Twitter #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

Morning programme
09:30 - 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:
jenny.muir@sustrans.org.uk / 0131 346 9787
Walking, cycling and public transport

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

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.

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:
lisa_glass@shelter.org.uk
Policy Officer
0344 515 2469
To sign up to our latest homelessness: far
from fixed campaign, visit
shelterscotland.org/farfromfixed

Energy Cost Recovery
Adam Tuck, Energy Analysis Team
Leader, PCMG

Welcome Back
Brian Swanson, Chair, NHSScotland
Sustainability Steering Group

Afternoon programme
15:00 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 CommunityRight 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

Further Information
Community Ownership Support Service
www.dtascommunityownership.org.uk
0131 225 2080
Linda Gillespie
Linda@dtascot.org.uk
0131 225 2080
07579 008467

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

Governance
Climate Ready Clyde
Board
Executive Sub-group
Impact, Influence
and Engagement
Sub-group
Risk and Vulnerability
Assessment Sub-
group
Secretariat (1.45 FTE) Advisory Panel

Source: Climate
Action Tracker

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.

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
Annualdealthsper100,000population
Mean estimates of all-age heat-related deaths in Scotland per
year per 100,000 population
Source: Hajat
et 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 Manager
T:0141 229 7738
E: kit@sniffer.org.uk
@kitengland / @ClimaReadyClyde

Closing comments
Brian Swanson, Chair, NHSScotland
Sustainability Steering Group

Sustainable Health Scotland 2017

Recommended

Recommended

More Related Content

Similar to Sustainable Health Scotland 2017

Similar to Sustainable Health Scotland 2017 (20)

More from 4 All of Us

More from 4 All of Us (20)

Recently uploaded

Recently uploaded (20)

Sustainable Health Scotland 2017