Online forum: Sustainability in healthcare

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Climate change

Energy

Sustainability and health

Governance and management

Sustainable procurement

Resource recovery and waste management

Water

Q: I’ve had upper management tell me that climate change is a facilities maintenance issue in a hospital, but the community role (around cleaner air rooms for community, for example) is for local government. How do we change that view?

There is significant evidence that climate change is a health issue and is outlined in the department’s Pilot health and human services climate change adaptation action plan 2019-21. In its foreword, the Chief Health Officer says:

'Climate change is a global economic, social, environmental and public health issue that poses significant consequences for our health and wellbeing. The World Health Organization has described climate change as the greatest threat to global health in the 21st century. Victoria is not immune to its increased intensity and frequency of extreme weather events, the potential spread of disease, effects on mental health, and threats to food and water supply.'

Q: Australia was carbon neutral what effect would it have on climate change considering Aus Co2e emissions are <1% of world emissions. Is our role one more of setting an example for the world, and concentrating on local health issues and resilience?

Australia’s emissions are 1.3 per cent of the global total but our population is 0.3 per cent of the global total. This means that while overall as a country we might not emit a lot of emissions relative to the world, our individual contribution is among the highest in the world.

A report on Health care’s climate footprint: How the health sector contributes to the global climate crisis found that if the global healthcare sector were a country, it would be the fifth-largest greenhouse gas emitter on the planet. Healthcare’s climate footprint is equivalent to 4.4 per cent of global net emissions, or 2 gigatons of carbon dioxide equivalent.

The Australian healthcare system was the tenth highest emitter by total emissions, contributing five per cent of Australia’s total emission. Australia was the second highest emitter per capita at 1.29 tonnes per person, or nine per cent of total per capita emissions.

The health of Australians is increasingly being threatened by climate change through more frequent bushfires, heatwaves, and algal blooms that threaten drinking water and floods, which drive mosquito-borne disease outbreaks and threaten food security. It is therefore imperative that Australia, and our health systems reduce emissions, inspire others to reduce emissions and provide fewer excuses for others not to act.

Q: What strategies do you recommend to offset carbon emissions? What companies do you purchase carbon credits from to offset your carbon footprint?

The hierarchy of reducing carbon emissions can be broadly categorised as avoid/reduce (e.g. passive design, energy efficiency), onsite renewable energy (e.g. solar), fuel switching (e.g. purchasing renewable energy) and finally purchasing carbon offsets. The department is focussed on the first three actions and has not yet investigated the use or procurement of offsets.

Q: What's happened to the first interim emissions reduction plan? Are we going to acknowledge the fact it's substantially overdue?

The release of the first emissions reduction plan was delayed as a result of the COVID-19 pandemic. However, the Government’s commitment to climate action is unchanged and we have continued to roll out emissions reduction initiatives in 2020.

Through the 2020-21 State budget, the Victorian Government have made an unprecedented investment in climate initiatives. This includes $797 million for the biggest household energy efficiency package in any state’s history- to help Victorians cover the cost of their power bills and make homes more energy efficient. It also includes $40 million for energy upgrades for our public health facilities, such as solar power and high-efficiency LED lights, to deliver energy cost savings for Victoria’s public hospitals and lower emissions for the state.

Q: Are there any plans to improve the capturing of scope 3 emissions across the health sector?

The primary focus of whole of government emission reporting is Scope 1 and Scope 2 emissions. VHHSBA does report on Scope 3 carbon emissions of the health sector from waste and air ambulance.

The sector-wide environmental data management system allows health services to report on Scope 3 emissions, such as air travel and non-emergency patient transport, should they choose to upload data into the system.

Q: Globally hospitals are already achieving 100% renewable electricity supply. Locally Canberra hospital extension will be powered by 100% renewable electricity, with other local economic sectors such as Universities also achieving 100% RE. Why is it that Victorian healthcare continues as a laggard in energy transition?

On 2 September 2020 the Victorian Government announced a market sounding process to gauge industry interest in a second Victorian Renewable Energy Target (VRET) auction. The second auction is expected to deliver at least 600 MW of new renewable energy capacity, which is enough energy to power Victorian hospitals and schools, Melbourne’s train network and other government infrastructure and services.

The second auction is an important step towards supporting investment in new renewable generation to create jobs in Victoria’s renewable energy sector and support the state’s economic recovery from the COVID-19 pandemic.

The market sounding process will obtain industry and community input on key auction design issues, including the option of procuring renewable energy for the government’s energy consumption, including public hospitals. The design of the second VRET auction will be finalised following the market sounding process. The Victorian Health and Human Services Building Authority (VHHSBA) is participating in the working party overseeing the market sounding process and will represent the interests of public health services throughout the project.

Q: Is it too early to electrify our new health facilities - when will the electrical grid be sufficiently 'carbon neutral' to justify stepping away from natural gas?

VHHSBA’s Guidelines for sustainability in capital works provide advice on the electrification of health facilities. Sectors involved in the design and construction process are working towards the electrification of hospitals, however the scale and demand of electrical energy for a hospital presents both logistical and physical challenges and will take time to move towards reduced and no emission status.

Q: 'Why wouldn’t you take the opportunity to also look at power quality issues like power factor and harmonics issues simultaneously with energy consumption?  These quality issues are a largely unconsidered in many sustainability projects. However, most systems like BMS do not understand these elements well. Your thoughts?'

Power faction correction and harmonics is regularly installed in hospitals. VHHSBA’s Engineering guidelines for healthcare facilities requires power factor correction and the minimum requirement for harmonics is a total maximum harmonic distortion of five per cent current (THDi) at point of common coupling for the facility.

Q: What about harmonics?

See answer above.

Q: Does VHHSBA look into funding assistance for "retro-fitting" existing healthcare buildings and structures? Or only adapting new building plans to lower carbon emissions?

The department has invested $26.4 million through the Greener Government Buildings program on energy efficiency and solar in existing public hospitals. This has included the installation of solar, building tuning, installing high-efficiency LED lighting and mechanical upgrades. It is estimated this will reduce annual carbon emissions by 21,775 tonnes.

In addition, in 2019-20 VHHSBA gave health services grants of $0.73 million to install:

• LED retrofits at Albury Wodonga Health, Alfred Health, Ambulance Victoria, Beechworth Health Service, Dental Health Services Victoria, Northeast Health Wangaratta, NCN Health and Yarram and District Health Services
• solar arrays at Alpine Health (60 kWp), Ambulance Victoria (70 kWp), Colac Area Health (20 kWp) and Southwest Healthcare (55 kWp), and 
• hot water upgrades and installation of variable speed drives at Southwest Healthcare.

The 2020-21 State budget provided $40 million of no-interest loans to support the installation of LEDs and solar arrays across Victoria’s public hospitals.

Q: How can we share NABERS energy benchmarking data and best practice?

VHHSBA has historic NABERS ratings for Victoria’s public hospitals which it is using to assess performance of the health portfolio and inform the design of energy efficiency and solar programs. VHHSBA’s Environmental sustainability strategy 2018-19 to 2022-23 to publish NABERS ratings and we are working to publish them within the timeframe of the strategy.

Q: I'm interested in the role of prevention to keep people out of health care. Can better primary health care reduce health costs?

Hospitals are the second most energy intensive buildings in Australia and are expensive to build. Reducing patient numbers through primary health and treating more people in the community, or through telehealth, will reduce the environmental impact of the health services. Utility costs only make up a small proportion of health costs and most savings would be from people not getting sick in the first place and the avoided costs of not having to treat them.

Q: How is the connection between environmental sustainability and health and well-being of staff/ patients/ visitors recognised in healthcare?

VHHSBA's Guidelines for sustainability in capital works has a key principle of 'hospitals as healing environments'. The indoor environment quality has a key role to play in occupant well-being and the guidelines require eleven indoor environment quality initiatives as business as usual. They are also requirements around supporting active transport, maximising use of sensory and well-being gardens and the use of outdoor spaces for patient rehabilitation.

Q: Using the example of a national Sustainability Development Unit in place for the National Health Service in the UK, demonstrating effective strategies to reduce emissions and save money (90 million pounds/yr or AUD166m). Could we implement this for Australia and expand the legislation that is working well in VIC with DHHS asking the health sector to pledge emissions reduction targets and action plans every 5yrs? This move to set up a SDU is widely supported by the Australian Medical Association and medical colleges as well. How can we move forward on this?

VHHSBA has a dedicated sustainability team that does the same types of activities as the NHS Sustainable Development Unit. We are working with the Department of Environment, Land, Water and Planning on the health sectors contribution to the Victorian whole of government emission reduction pledge required under the Climate Change Act.

Through its Policy and Funding Guidelines, the department requires public hospitals and health services to have an environmental management plan. More information is available at the health.vic website.

Q: Could we lobby for a National Sustainability Unit like the NHS which since its inception in 2008 has saved the health sector $166 million/year?

See answer above.

Q: My workplace has not had an environmental department since it became defunct in 2016. I've enquired numerous times regarding sustainability related questions and usually get sent around in circles, eventually leading to a dead end. How can I best suggest the need for an environmental sustainability department is advantageous for our hospital?

It is a local decision by health services on how they manage and implement their environmental requirements. Several large metropolitan health services have a dedicated sustainability officer, while others support this through a committee-based structure.

There may also be a lot happening across the organisation that you are unaware of. You could also ask management for a copy of the health services environmental management plan and how it is being implemented.

Q: Are there any plans to make sustainability officers a mandatory position to all health services? How is this been considered in the strategy to deliver NZE 2050 for the health sector?

The provision of resources and management of sustainability initiatives is determined at a health service level. Some health services have dedicated sustainability officers, while others manage sustainability through a committee-based structure with nominated leads for specific initiatives. For smaller health services, there is often not the budget or availability of positions to support a dedicated sustainability officer.

Q: Could we arrange a multi-disciplinary working group with sustainability officers, asset managers, engineers, doctors, nurses, business analyst, researchers to tailor real life solutions and guidelines for the health sector?

As part of VHHSBA’s Environmental sustainability strategy 2018-19 to 2022-23 there is a Strategic Advisory Group comprised of stakeholders from the public health care and environment sectors. The purpose of the group is to provide guidance and input into the delivery of the strategy. VHHSBA also engages with health service staff as required to deliver specific projects, such as the Waste Education in Healthcare Project Working Group.

Q: How could Health Purchasing Victoria and similar procurement bodies be more encouraging and facilitate supply chains to be more sustainable? Eg. Recycled paper content and plastics or have policies to improve practice. 

Environmental considerations have long been understood to be a consideration within the requirement that government procurement provides value for money. This has been re-confirmed with the roll out of Victoria’s Social Procurement Framework. Health Purchasing Victoria procurement policy has for the last decade included weighting the environmental credentials of suppliers in its tender evaluations for state-wide contracts, as do (many) hospitals when they run their own tenders.

HPV does have recycled content office paper available on the stationery contract. It is generally priced at a slight premium to paper without recycled content; but hospitals are able to purchase these where additional budget is supported. All office paper on HPV contracts meets third party certification for fibre sourcing.

Given complexity and scale would love to hear the panel’s thoughts on ECI (early contractor involvement) for health projects.

For much of the health portfolio projects there is little discernible benefit from utilising an ECI contract however is some instances where the complexity or uniqueness of a project dictates, we utilise stage 1 or 2 ECI contracts for health capital projects.

Q: Have any hospitals had success recycling glass? What are the barriers to recycling glass drug vials?

Some vials are made of pyrex, which cannot be recycled. It is not possible to identify which vials contain pyrex and so it is not possible to place any vials in the recycling bin. Vials cannot be recycled due to the environmental risk of incorrectly disposing of pharmaceutical containers, as well as the OHS risk of removing the metal lid and rubber stopper (which must be removed or, again, the item cannot be recycled).

Q: National Waste Plan is targeting all packaging to be reusable, recyclable or compostable. Will the Victorian Government be supporting hospitals to initiate the appropriate collection systems for these methods of disposal?

VHHSBA is working with Australian Packaging Covenant (APCO) to identify opportunities to increase reusability and recyclability of packaging. Last year the department invested $25,000 into expanding and improving the PVC recycling program and provided an innovation grant to Bendigo Health to investigate the viability of recycling hospital curtains. As curtains are a soft plastic the findings from this work could be applied to other soft plastic waste streams.

Q: How has the tension between hygiene and environmental sustainability developed as banning single-use plastics have become front-of-mind globally?

In the majority of cases where single use plastics are banned, there has been an exemption for those required for clinical, or patient care. There are still instances where multi-use items provide better overall environmental and financial outcomes with no loss of infection control outcomes; for example multi-use drug trays, or pouches to transport drugs.

Q: The response to COVID19 has involved a significant increase in single use PPE. How can we as a sector in Victoria take stock of the impact and source alternative material and infrastructure to reduce that impact in future?

When it comes to infection control the generation of waste often is seen as a secondary issue. We are making some in-roads, such as trialling the recycling of single-use curtains and single use metal instruments. There are recycling and resource recovery opportunities that we are have not yet been fully realised such as PVC recycling, single use metals, commingled and even better waste segregation. Focussing on realising these existing opportunities should be a primary focus.

Q: Any ideas on what they are doing with the multiple waste from theatres?

A number of recycling programs have been successfully established in theatres. These have included commingled, PVC, Kimguard, and single use metal instrument recycling, as well as collecting unused equipment to be used by veterinary practices. Work has also been done to improve the management of clinical and related waste in theatres.

Q: 'Noting increases in medical waste from Covid19, what opportunities are being realised in this space to create change to reusable products or are there legislative requirements that hinder this? Also, noting there were (and still are) waste issues prior to Covid19 has this expediated any increased government action such as policy or infrastructure support?

VHHSBA’s Clinical and related waste guidance – supplement for healthcare staff is a user-friendly guide, providing a simple and practical decision-making process to help health service staff identify whether items are clinical waste, landfill waste or recyclable.

Q: I've recently heard about compostable IV bags, reusable/antimicrobial/washable bandages, and sharps that use a less-than-average amount of plastic. What are some inexpensive and/or easily feasible ways to limit the excessive physical waste that healthcare inevitably produces (e.g., waste from plastic packaging for sterile equipment, biohazards, surgical towels, etc.)?

The department has a number of resources on-line to assist with recycling, resource recovery and reducing waste to landfill. These are available via the health.vic website.

Q: Stormwater Harvesting – what are the do's and don’ts

There are more optimum sources of recycled water, such as rainwater and reject RO water, so these should be investigated prior to harvesting stormwater. The use of non-potable water to be in line with the DHHS Guidelines for water reuse and recycling in Victorian healthcare facilities: Non-drinking applications.