Menu of actions

Introduction

This menu of actions is designed to be used in conjunction with the West Yorkshire Health and Care Partnership climate change strategy. It highlights some of the actions that individuals and organisations could take in order to reduce the environmental impact of health and social care, and to prepare the system to deal with the extreme weather events which are becoming more frequent and more severe. It is not intended as an exhaustive list or a mandate, more a starting point because each person and each organisation across the Partnership is starting from a different point and has different priorities and opportunities. It is intended as an illustration of how much work needs to be done and how urgent the situation is. We will review the strategy, the menu of actions, and plans that derive from it, regularly, with planned revision every two years to reflect achievements and dynamic challenges in sustainability and the climate emergency.

What can I do?

Sustainability is the responsibility of us all. Here’s how we can get involved:

As a citizen:

● Transition to a diet that is plant based and seasonal

● Ensure that your energy supplier is providing 100% renewable electricity

● Switch to an ethical bank that has divested from fossil fuels

● Switch to surface travel. Can you take a maximum of one return flight every 5 years?

● Take moderate, outdoor exercise for 30 minutes three times a week

● Reduce plastic use aiming for zero by 2030

● Walk or cycle journeys less than two miles

● Use public transport instead of a car

● Lobby politicians to do more to reduce the impacts of climate change

● Consider donating to charities that promote sustainability

● Talk about sustainability to your family and friends

● Be appropriately sceptical about carbon offsets. They have a reputation for taking your money and failing to deliver on their promises

. . .and as a patient or service user:

● Ask your caregiver if different treatments have different environmental impacts

● Make a will, advance directive, and powers of attorney in order to reduce unrequired intervention

● Use antibiotics as little as possible and always follow the instructions

. . .and as non-clinical staff:

● Ensure you use windows, heating and water appropriately

● Use resources such as stationery as sparingly and as efficiently as possible

● Embrace the transition to digital

. . .and as middle management:

● Introduce sustainability in all personal development reviews (PDRs), annual reviews, appraisals and job descriptions

● Assess the environmental impact of procurement decisions

● When designing pathways, minimise travel/repeat appointments

. . .and as clinical staff/carers:

● Inform your patients about the environmental impact of their treatment

● Ensure good waste segregation

● Lobby your organisation to do more to reduce its environmental impact

● Prioritise oral over intravenous medication

. . .and as a senior leader:

● Consider sustainability in every board meeting agenda item

● Create decision making mechanisms that allow consideration of long term impacts and long term problems

● Ensure that your organisation is no longer buying virgin paper

● Ensure that your organisation only buys electricity from renewable sources

● Ensure your organisation has an adaptation plan so that it can function during the disruption ahead

● Ensure funds and pensions are invested sustainably

● Phase out payment for air travel, and short car journeys in your organisation

● Establish quarterly updates on progress towards net zero

● Fund sustainability teams to help ensure that everyone is playing their part

● Talk about sustainability frequently in order to normalise the conversation

● Lobby other leaders and politicians to ensure that climate change is in the forefront of their minds

● Put yourself forward as a Board Level Net Zero Lead

What could my organisation do

Group	2022-2024	2025-2027	2028-2030	2031-2035	2036-2038
Leadership	Governance and leadership to deliver the Climate Change Strategy are developed and functioning The Partnership has an agreed climate and sustainability action plan, evaluation and monitoring plan, and funding approach Sustainability is embedded in every board paper, strategy, and decision We start decommissioning on grounds of impact to the environment We implement an integrated sustainable decision-making tool Sustainability is incorporated into every impact assessment tool	Each organisation understands its own contribution (through e.g., carbon foot printing) and has a plan to reduce it by 50% by 2030 and zero by 2038. First annual interim evaluation report informs refinement of timeline and future action First biennial climate and sustainability strategy refresh More decisions are made with our communities We identify and implement ways of influencing upward and outward on climate and sustainability We develop models of inclusive, shared leadership among and within Places	Sustainability (social, environmental, and financial) is the prime discriminator when commissioning Carbon emissions are reduced by 50% across the partnership (per benchmarked figures) We regularly influence regional and national policy to support our ambitions We foster transformational leadership, including making difficult decisions about the last unsustainable practices. People most affected by climate change have key leadership roles on this agenda	Decisions are made collaboratively with stakeholders including our populations by default	Life-of-strategy summative evaluation report informs next round of strategy and action planning We act as credible international influencers on climate and sustainability policy
Networks and connections	We establish networks e.g., communities of practice to support key areas of this work	We have active networks to support learning and action in all areas of this work across West Yorkshire We establish a citizen and youth jury to guide climate and sustainability work We hold an annual summit on climate and sustainability progress	Our climate and sustainability networks enable and collaborate with community networks by default	We support resilient and dense local networks to withstand climate displacement
Water, food andlocal procurement	Organisations introduce plant-based diet at least one day a week Organisations benchmark food and water waste and develop zero food and water waste plans	Food and catering, etc. are 80% plant-based and animal-free Obesogenic (that may influence or promote obesity) advertising is no longer tolerated in West Yorkshire Food waste is reduced 50% from baseline Water waste is reduced 50% from baseline New buildings have grey water capture and recycling	Food we buy and serve is in line with the EAT-Lancet’s Planetary Health Diet We achieve food waste zero All food and 80% of equipment are sourced from within the UK We achieve water waste zero All buildings (retro)fitted with grey water capture and recycling	We have an evidence-based tool to ensure food is sourced to get the best balance of low harm and as local as possible Food poverty is eliminated in West Yorkshire	All our people can access sustainable, healthy, affordable diets and clean water Health and social care settings have a week’s worth of water-independence capability
Air quality	We implement a robust plan to reduce our known air pollution emissions	We understand exactly how and where we emit all of our air pollution We have robust air quality improvement plans in line with World Health Organisation (WHO) air quality guidelines for indoor and outdoor air	Air quality public health indicators in our Places improve 50% against 2022 baseline Our settings and Places meet indoor and outdoor WHO air quality targets	We beat WHO air quality targets
Natural capital and biodiversity	Natural capital investment is understood to be a core intervention for public good	We scale up funding greenspace projects in areas of high social deprivation	Funding for natural capital, greenspace and biodiversity projects account for 1% of organisational spend Green and blue spaces and biodiversity corridors are linked into active travel routes	Biodiversity and greenspace are increasing across all our sites from a 2022 baseline	Biodiversity and green and blue spaces reach levels that evidence shows are necessary to protect human health
Travel, transport, NHS supply chain and logistics	West Yorkshire Combined Authority (WYCA) and local authorities continue to invest further in active travel infrastructure and community engagement initiatives to support active travel behaviour change Organisations move away from internal combustion engines in their fleets Fleets begin to incorporate pedal power, including e-cargo bikes	Parking permits are not issued to people who live less than three miles from their place of work except in cases of disability or accessibility Subsidised public transport for all, with expanded coverage across our Places New pathways and models reduce need for travel and transport Suppliers must provide evidence of sustainable practices	Parking permits cost 10% of your salary except in cases of disability or accessibility First and last mile logistics are almost completely achieved by e-cargo bikes Car journeys reduce to 30% of their 2022 baseline Suppliers are willing and active partners in ensuring environmental impact is minimised	Road traffic has reduced by 60% from a 2022 baseline. Car ownership is rare 100% of our travel and transport is electric and/or pedal powered – no more legacy internal combustion engines	100% of our supply chain and logistics are electric and/or pedal powered
Waste, single use plastic, reusable equipment and infection prevention	Waste streams are standardised across the organisation Zero waste is sent to landfill Research translation on reusable equipment begins and accelerates	Waste reduces in volume due to reduced variation, 3D printing on site, and increased use of reusable equipment where possible	Biodegradable single use items become mainstream with biodigesters on site to create compost and heat Proportion of reusable versus disposable equipment increases 40% from 2022	Zero single use plastic items are purchased by health and social care Proportion of reusable versus disposable/ recyclable equipment increases 60% from 2022 baseline	All waste is re-used in some way, most as raw material for new manufacture of products. Circularity is the norm
Dentistry and medicines	Desflurane free by 2023 Focus on deprescribing opioids and reducing polypharmacy is enhanced by systematic incentives	Nitrous oxide and entonox is no longer used without cracking technology Intravenous medicines are replaced by oral alternatives Deprescribing is widespread and normalised	Patients and service users refuse to accept polluting chemicals in their care and treatment Metered dose inhaler use is less than 10%	Pharmaceutical companies publish extensive information about the environmental impact of their products through their whole lifecycle, enabling true transparency in all our supply chains	Medicines are grown in labs using plants and fungi rather than industrial chemistry
Adaptation, risk and resilience	Organisations have risk and resilience plans in place to help them to deal with climate disruption through reduced vulnerability and increased resilience	Large health and social care organisations are the first port of call as community anchors during extreme weather events (which are now happening at least once a year) Inequalities in Places reduce, reducing vulnerability	Organisations can function in a self-sufficient manor for several days during the worst climate events Health and wellbeing of Places are increasingly resilient through improved population health/prevention	Public buildings are used as ‘cool refuges’ during summer and regularly house flood victims Productivity lost through extreme events is minimised	Risk and resilience are much more dynamic than 2022 baseline Change and uncertainty are the norm but can be weathered more comfortably
Heat decarbonisation, energy management and construction	No further purchasing of fossil fuel technologies (including vehicles or heating)	Retrofitting of insulation and heat pumps to all buildings	No further purchasing of fossil fuels Traditional cement and other carbon-intensive materials no longer used in construction	Plan for atmospheric carbon removal agreed	Carbon removal to be deployed
Urban design, housing, public spaces and planning	Planning laws change to ensure net biodiversity gain from all projects Healthy Places is a core work strand of the Partnership	All building is now net carbon zero throughout its full lifecycle	Retrofit of housing stock to ensure thermal stability in both warm and cold is now complete	Retrofit of public spaces to prioritise active travel and 20-minute communities is now complete Buildings and spaces are climate positive (e.g., sequester carbon, eliminate water waste)	Everyone in West Yorkshire has a healthy, sustainable, safe home
Social care and voluntary, community and social enterprise (VCSE)	Social care and the VCSE are welcomed as true partners with healthcare	Integration is now seamless with healthcare providing expertise, and funding to allow retrofit and transition to zero carbon travel and a sustainable and continued shift of investments into prevention and decision making within communities with the VCSE sector at its heart	Demand for social care falls as communities become closer knit and resilient Sustainable, resilient, innovative, and vibrant VCSE sector with longer term funding arrangements providing a holistic offer to our diverse communities going beyond green social prescribing to a community powered NHS approach	Public expectation of chronic care and end of life is dramatically different as resources are constrained but communities are more supportive Volunteering becomes the norm, helping Places increase climate resilience
Mental health, green social prescribing and communities	Focus on building strong communities that are resilient and local Work with the VCSE sector in rolling out green social prescribing practices which are known to have huge return on investment	People are choosing to live and work in regions that have strong 20-minute communities Green social prescribing is the default therapy for increasing numbers of conditions We implement a trauma-informed model to address climate anxiety and grief Climate anxiety, grief, other mental health care, and green social prescribing are linked to activate positive community climate action	20-minute communities are the norm, incorporating green and blue spaces Green and blue space access and quality are equitable regardless of e.g., deprivation		Demand for mental healthcare starts to fall because people are leading lives which are more fulfilling
Our teams	All organisations have a sustainability training package for staff and volunteers, and all complete mandated sustainability training e.g., Building a Net Zero NHS More staff and volunteers are encouraged to become climate and sustainability champions	Role descriptions empower staff to make climate and sustainability their business in ways relevant to their work	All role descriptions incorporate an element of climate and sustainability competency We influence professional bodies to develop their training to incorporate climate and sustainability competencies
Publications and communication	We engage all stakeholders including our communities on this Strategy and Menu of Actions	Environmental impact is communicated internally and externally at regular intervals (quarterly) Sustainability metrics are standardised across West Yorkshire and nationally to allow direct comparison	Standardised, comparable annual reports are published in the public domain	Sustainability training and consideration are given the same weight as finance is in 2022
Technology, digitisation and data management	Electronic patient notes become the norm Digital design prioritises sustainability and adaptability	3D printing of equipment is the norm All Places close their digital divides to enable equitable digital-by-default	Data centres and hardware are now demonstrably net carbon zero	Data allows us to see the remaining areas of environmental impact and prioritise changes
Finance and professional services	Environmental sustainability is considered in every capital decision Organisations develop sustainable procurement/spending policies and procedures We accelerate divestment from climate harm (e.g., banks, suppliers)	Sustainability is the prime consideration when deciding how to allocate resource 80% of contracts and investments comply with sustainable procurement strategy and policy	West Yorkshire is an established hub for green med-tech and local and national financial disparities are diminishing 100% of expenditure and investment comply with sustainable procurement strategy and policy	All our financial activity is climate positive	We influence for a just transition so every job in West Yorkshire is a good, green job West Yorkshire has a wellbeing economy

Incorporating sustainability in impact assessment tools

Different organisations have different impact assessment tools and different priorities when it comes to mitigating impact. It is therefore not possible for the climate team to mandate a single impact assessment tool. On the website are a couple of sustainability impact assessments to demonstrate different approaches – see the climate change training pages on the website. c). These should not be stand-alone documents but embedded in the rest of the decision-making process.

Published plans

Climate change plans that are already published are available from organisations or on the climate change team’s website.As examples, summaries of the pharmacy and medicines optimisation plan, primary care green plan and the Partnership’s green plan are also included on the website with their action points mapped to the Menu of Actions. Again, this is not intended to be definitive but to give a flavour of the work and ambition which is already happening in West Yorkshire.

Conclusion

In a system as large and complex as health and social care in West Yorkshire, it is not possible to capture all the nuance of what needs to be done to move us towards sustainability. This action menu is therefore not an exhaustive list but, if we do everything here, we’ll be much closer to where we need to be than we are at the time of writing. With regular updates and planned strategy revision every two years, we can refine and enhance our ambitions and achievements in sustainability over the life of the strategy.