Transcript for Climate risk and net zero unit 

Kate Charlesworth (Northern Sydney LHD): Well, thanks so much for having me, everyone. I'm Kate Charlesworth. I'm from the new Ministry of Climate risk and Net zero unit. As you can see, there actually have two roles three days a week at the Ministry and two days a week at Northern Sydney, LHD.

Firstly, I'd just like to add my acknowledgement of country. I'm on camera gauland today and to note that Aboriginal people have been tremendous stewards of this land for more than , years and that these themes of stewardship and caring for country are particularly relevant to what will be talking about today. You'll see there that I've referenced the Louiche Institute report, climate change is compounding historical injustices.Which speaks to the fact that Aboriginal people and of course many other groups within society. I've been disproportionately impacted by climate change. So for me today there are three key points. I'm the first one is that climate change is a health issue. Certainly it's an environmental issue. It's a social issue, it's an economic issue, but fundamentally this is about health and about care. 

Secondly, that as a health system, health NSW Health now is required to respond to two types of climate risks, transition risks and physical risks. We'll talk st and then lastly the climate risk and Net zero unit at the ministry and what our roles and responsibilities are in the main sort of programs that we're setting up.

OK, so climate change is a health issue.

There is now overwhelming scientific evidence that climate change is supercharging the climate. It's making more frequent and more severe storms, floods, droughts, bushfires, extreme heat and the Australian Academy of Science report has us on track now for a  degree temperature rise this century. That would mean that  degree days would be common in Sydney and Melbourne. It would mean black summer bushfire events most years. And it would mean that storms and floods had violently reshaped our coastlines so that most coastal ecosystems, including the Great Barrier Reef, would be long gone.

This is the really key point.

Climate change is not going to be a linear process. Earth is not a line. It's a system that it's a series of interconnected ecosystems, and we have now left this so late. We have ignored scientists warnings for decades, but we are now dangerously close to hitting tipping points. The carbon sinks of the world, the oceans, the mangoes, the permafrost, the full once they're full and they're exceeding their capacity, then we hit tipping points. And in that situation, rather than a three degree temperature rise.

We're looking at temperatures ratcheting up to five or six degrees above pre industrial temperatures and in that situation, of course, much of the planet would not be habitable. That's what IPCC report the latest one in March this year, has said that we need to rapidly reduce emissions this decade i.e. By  to avoid catastrophic climate breakdown. So every sector is going to have to get to net zero energy, transport, agriculture. The health system has a particular responsibility to do so. Because globally we are part of the problem, we use huge amounts of resources. We produce vast amounts of waste, we still use fossil fuel energy sources. We have a big carbon footprint globally. The health system or a country, it would be the fifth biggest polluter on the planet. So there's a strong imperative for us to get to net zero and equally.

We're going to have to adapt, yeah, because even if we stopped blurting, even if the societally, we stop polluting tomorrow, there are already climate changes baked into the system for some decades to come. So we will need to be as health system prepared and resilient for those changes. And this slides in. The CDC sets out the range of impacts of climate change on human health. So as you can see there, it's not just about extreme heat and severe weather, but also shifts infectious diseases rather than allergens. Food and water insecurity, forced human migration and civil conflict. And the key point here is that these impacts are not being equally distributed.

It is the most vulnerable people in society, babies and children's, the elderly, Aboriginal communities, people on low incomes, rural and remote communities, people with disabilities, for a whole range of physiological, social, environmental, economic reasons. These are the people who have been hit the 1st and hardest. So climate change is an issue of social justice and health inequity. And so then and this is set-up by the New South Wales government, this is a diagram from the New South Wales government. These are the two requirements for us now addressing our transition risk. So transition risk is saying we have big as a health system. We have big carbon footprint. We need to transition to net .

Next need to decarbonise, so that's our first task, and secondly, adaptation to physical climate risks and those two, the two things are equally important. And there are now whole range of imperatives for us to get to a net zero climate resilient health system. There is, of course the government policy, so NSW government has their target now of halving emissions by .

National standards. The Australian Commission on Safety and Quality in Healthcare is developing a sustainable healthcare module that will be optional for the first couple of years, but then with a view to it becoming a mandatory part of hospital and healthcare accreditation standards regularly requirements those of you who are on boards would be aware the Australian Institute of Company directors has identified climate risk as a material and foreseeable risk for boards and actually in their recent guidance they're specifically called out climate risk as being relevant to Health and Human service organizations. The negation risks, of course, have been successful cases now against fossil fuel companies and superannuation funds, but also in some cases governments. There was a recent successful case from bushfire victims against the New South Wales EPA.

As an example, health and ethical reasons we've talked about financial, I think it is a myth that in all cases sustainability costs more and a good local example is Hunter, New England local health district, which last year saved nearly $,, from their sustainability program. OK. And finally, this is an issue that many of our staff care deeply about and that increasingly our Community expects us to act on.

OK, so how do you get to net zero to get to net zero health system, you first have to understand what your baseline is. Where are your carbon emissions coming from? What are your carbon hotspots? What are things that you can do? We have done some of this work in Australia and indeed in New South Wales, but it looked a lot to the NHS National Health Service in England, which has been doing this now for more than a decade because they have the most up to date and comprehensive analysis that I've seen. So on the left there, that pie chart is the NHS carbon footprint.

So it can stay in the green section is travel so patients, staff and visitor travel. It's 10% of the NHS footprint.

The red section is delivery of care, so you can see the usual suspects, fleet and business travel, water and waste and building energy but also anaesthetic gases and MDIS meter dose inhalers now specific carbon hot spots.

And then of course, the key point is that blue section more than half of the NHS is carbon footprint is from the the things, the items that it buys and uses everyday pharmaceuticals and chemicals, medical, medical equipment down to business services, food and catering.

OK, so the key point here is that travel is important energy in building design is important, but we also need to look at clinical care. And then the chat, the diagram on the right is the NHS pathway to net zero. They have the ambition to be the world's first carbon neutral health system to be net  0 by 2040. And this chart sets out how they would get there. So on the X axis is time, so it goes from  up to  and on the Y axis is carbon emissions in kilotons of CO, E kilotons of carbon dioxide equivalent. So that's our carbon footprint. So you can see that over the past ten years, they've reduced their emissions by about 30% and actually almost saved almost a billion pounds. And then all those different colored wedges add up cumulatively to how they would get to net  by. As of the top, purple wedge is decarbonising the grid. Obviously that's out of their hands, but the rest of them are health service specific, so the green digital care pathway redesign, low carbon models of care preventive medicine. In the blue specific carbon hotspots, anesthetic gases, low carbon inhalers, nitrous oxide. In the yellow is about travel. The next two purple ones about building efficiency and onsite renewables and design, and then the Grey section, research, innovation and offsetting. So the key point here is that there is no silver bullet, OK, getting to net zero is going to require changes across pretty much every area of the healthcare system.

And with the precinct perspective, I just wanted to draw attention to that bottom Grey section research innovation offsetting because these are key things areas that we need to address if we're going to get to net zero and fill that gap. There is now growing research based in the medical literature about the carbon cost of so many things in healthcare. In this example, the carbon cost of diagnostic imaging. So it's X-ray CTS, ultrasounds, Mris, OK, also, carbon costs of blood tests, carbon costs of cataract surgery, the carbon costs of different modalities of childbirth, the carbon costs.

Of different reflux treatments. OK, this is important information, not only for our clinicians, but also in thinking about how we design and build hospitals and precincts, for example. And then, of course, the innovation challenge, we need to be partnering with industry and private sector to look at filling that gap. OK, so solutions that we require things in Med tech and digital advances in circular economy, green solutions in healthcare and indeed we could be studying some of our own innovation and research challenges. In this example, this from the NHS, the Greener NHS program they've recently put up £,, on  different projects,  different innovation areas which were support the delivery of a net zero and NHS.

I think there's a real opportunity there for us.

OK. So what's our unit doing? So as you would be aware, in the future health strategy sustainability is one of the six strategic outcomes and NSW Health now has committed and . committed to an environmentally sustainable footprint.

We're setting up, as you know, this new climate risk and net zero unit. We sit within system purchasing branch. You can see there and of note that's not purchasing as in procurement that's purchasing as in the service agreements. So that's one of the key things that our branch does and these are our core responsibilities as a unit and the first one is about collaborate and coordinate. So just wanted to call out, there is great work already away underway across the system.

Umm, in terms of, you know, assets and energy in the finance division, the sustainability team within health infrastructure sustainability team within health share and so on, our task is to sort of lead and coordinate and scale out help to scale up some of those approaches and our particular focus is on clinical care, which as we've seen is more than half of the the footprint. I'm the next one's about objectives and performance, and this is a really key focus area for us for the next  or  to  months because for us to get to net zero, we first have to have very good baseline for New South Wales Health and then develop a system for measuring, monitoring and reducing emissions over time. OK, so the metrics is the key area for us.

Umm, research and innovation. We would love to do, but we don't have the capacity yet for that. That's a a critical area as we've seen and then in power. So we're setting up a sort of staff engagement program. We're set-up a sustainability network which meets monthly. We're sending staff on carbon accounting courses and board members on board. Leadership Net Zero Board leadership courses setting up a web page and so on. So that's some of the work underway in that space.

As I said, metrics is critical. It probably will take us some time to get a good baseline footprint for the whole of New South Wales health, so we're starting with carbon footprinting two hospitals we've recently run a statewide EOI process, and the two successful sites where the PN Hospital and Lismore based hospital that work is underway at the moment with the consultant and with a team from the sustainable government team in New South Wales, Treasury and ourselves obviously and the starts and it should be completed by the end of the year and the aim of that is to provide. An in-depth carbon footprint assessment for those two hospitals and to provide actionable information for the staff and for those hospitals which should be comparable enough to compare across different hospitals across the state. And then the other program main program is in net zero leads program. So we will be funding ten of our staff. So there's an existing NSW health staff who will be each be funded one day a week to lead and coordinate net zero programs in their service or in their specialty, OK. So you can see them listed there. We also have pathology and medical imaging at the other two to make up the Chan.

OK. And for those net zero leads, these are the principles of sustainable healthcare as developed as you can see there by the Centre for Sustainable Healthcare, which is in Oxford in the UK. So when I'm speaking with our nurses and doctors and physios and pharmacists, I say this is the most important slide for you. These are the principles that we need to apply.

And the first principle is about prevention. And that's because one type of carbon neutral system would be system in which we didn't have any patients. Everyone was healthy and well and independent in their homes, in their communities. OK, so that's always the first consideration. We need to keep in mind. The second one is about minimizing low value and harmful care. You know that the substantial amount of overdiagnosis and overtreatment in the system and those things have harms and risks for patients and also costs not just financial costs, but also carbon costs. And then the third principle is OK, where we do have evidence based and effective care, how do we decarbonise that? And so just to illustrate the second point, this is from a paper that we published in the Medical Journal of Australia last year. Just talk you through it. So the pie chart on the left is a simplified version of the Australian Health Systems carbon footprint. The can see that that energy and electricity and gas about 20% and they've related about 80%. Anything related to clinical care 80% there, and they're then extrapolated that over to the right and said that, OK, based on the literature, we know that about 10% of care is harmful and 30% is low value care.

So the key point that we're making here is that we are currently wasting if you add together the two in the eight, we're currently wasting more than  million tonnes of carbon on harmful or low value cap. That's why it's the second principle. And then you come to the third principle and really the task for our net zero leads is to rethink and reimagine their service or their specialty with a net zero lens. So for example, for our surgical net zero surgery laid, that's their task. How do we do a net zero operation? And this is an example from the UK a couple of weeks ago, some surgeons in the UK said we've done the first net zero operation was a  hour colorectal surgery. If you actually read the fine print. I didn't quite get to net zero. They reduce their emissions by about 80% and they said, oh, we offset the rest by the the surgeons cycling to the hospital and then we planted a few trees on hospital grounds, so it didn't quite get there. But it's a great story and it's a good effort. And this is exactly the sort of thinking that we need.

Himalayan aesthetics. As many of you would know, anesthetic gases are 5% of our hospitals carbon footprint and the next example anesthetist that Royal North Shore Hospital have shifted away from Dez Fluorine, which is a very polluting and expensive gas to clinically equivalent server floraine and incidentally saved their department about $, in one year. I'm just a few notes about adaptation. This is equally important for most urban populations in Australia, extreme heat is the number one climate health risk, and of course a significant challenge in Western Sydney. But also storms, floods, droughts, bushfires are equally important. So as a health system we need to be prepared and resilient for these impacts. The impacts of these sorts of events on our workforce, on our services, on our supply chains and on our infrastructure and NSW government has recently.

Umm, released its adaptation strategy, in which it sets out that it will be developing a series of metrics series of adaptation metrics, including things like some health related ones, for example, the number of hospitalizations due to extreme heat, the number of bad air quality days due to bushfires and so on, and we will be required to report on those going forward and also every agency by the end of next year will be required to identify its own list of climate risks as well. So substantial amount of work that has to be done in the in the adaptation space and then just to finish, I'd like to finish with these twin messages of risk and opportunity, think the risk part there is pretty well summed up by John Kerry. But also this is a huge opportunity for health and for health systems. So many of the changes that we need to meet make within our system are so well aligned with things that we're trying to do anyway, no stronger first focus on prevention and keeping people healthy and well, much more community based care, digital advances focusing on value, all of these things will help us to build a better healthcare system and of course more broadly, there's so many climate actions would have huge public health benefits.

As set out on that court cartoon, it would mean, you know, cleaner air, healthier diets, greener and cooler cities, more connected communities, and so on. So it really is just a win win situation for health and for the climate. And this actually is my final slide. As we have seen, there is a huge challenge ahead of us. Now we are not just talking about solar panels on hospital grooves and stuff cycling to work. We are talking about transformational change of the health and care system, which needs to happen in the next  to  years. The world is going to be a very different place. Potentially quite soon now, and the health system needs to be part of that. So that's going to mean that changes are required across pretty much every area of the health system and from all of our , staff. So it really is going to be all hands on deck. Thank you.

Current as at: Tuesday 19 July 2022
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