Bringing Cost into the Carbon Model for dentistry A ... · Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Duane B, Hyland J, Rowan

21/06/2013 Brett Duane Specialty Registrar Dental Public health

• Scottish Managed Sustainable Health Network Dr Adam Pollard Honorary Research Fellow European Centre for the Environment and Human Health

Brett Duane Specialty Registrar Dental Public Health South East and Tayside Dental Public Health Network

Bringing Cost into the Carbon Model

for dentistry A Scottish perspective


Introduction

• Climate change

• Scottish carbon emission targets

• NHS carbon accounting targets


SMaSH

Aims and objectives:

To develop a carbon calculator for all dental services

To pilot the carbon calculator in a healthboard


NHS Fife Dentistry Carbon footprint

1. Travel: Information on 100,000 patient postcodes

2. Energy: Building energy on new and old buildings

3. Procurement: converted from spend


NHS Fife Dentistry: Main findings

• The carbon footprint for the service was 1798.9 tonnes CO2eq per annum.

• Travel was the greatest source (45.1%) followed by procurement (35.9%) and building energy (18.3%).


NHS Fife: Surprise findings

• New buildings have higher energy consumption than their historic predecessors


Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Duane B, Hyland J, Rowan JS, Archibald B. Public Health. 2012 Sep;126(9):770-7. doi: 10.1016/j.puhe.2012.05.032. Epub 2012 Aug 15.

http://www.ncbi.nlm.nih.gov/pubmed/22902137












Conceptualising the Carbon Footprint of a Healthcare Provider

Pollard et al (2013) – Case Study, Cornwall


• Mainstreaming carbon management in healthcare systems: a bottom-up modeling approach.

• Pollard AS, Taylor TJ, Fleming LE, Stahl-Timmins W, Depledge MH, Osborne NJ.

• Environ Sci Technol. 2013 Jan 15;47(2):678-86. doi: 10.1021/es303776g. Epub 2013 Jan 3.













Building on the Carbon Modelling

Pollard et al (2013) – Case Study, Cornwall

The conceptual model outputs costs as well as emissions….





The Cornish Pilot

Scenario Outpatients and Diagnostics Theatres and Beds

Scenario 0: Business as usual Current sites on which

outpatients are seen (13

sites)

Current sites on which all

patient types are treated (five

sites)

Scenario 1a: Expand

inpatient coverage in east

Current sites on which

outpatients are seen (13

sites)

Five sites – replace a westerly

site with one towards east

Scenario 1b: Rationalise

outpatients and diagnostics

Nine sites - including

geographical reconfiguration

towards east and closure of

smaller sites

Current sites on which all

patient types are treated (five

sites)

Scenario 2: Reduction in hot

water temperature No change

Reduction in hot water

temperature of 5 ºC in wards

Scenario 3: Improved theatre

efficiency No change

Optimal use of theatres to

reduce waste

Table 2 A description of the scenarios for which the carbon footprint of delivering

secondary healthcare by RCHT is calculated - taken from Pollard et al. (2013)


Scenarios 0 – business as usual Scenario 1a – catchment expansion for inpatients Scenario 1b – site rationalisation for outpatients Scenario 2 – Reduction in hot water temperature Scenario 3 – Increase theatre efficiency

Mainstreaming Carbon Management in Healthcare Systems: A Bottom-up Modelling Approach – Pollard et al (2013)


In the Fife study what are we modelling?

• Patient travel – Current vs optimised

• Equipment and resources – Treatment time – Dental, rating (kW) and duration of use – Sterilising equipment, rating, capacity and frequency

• Heating and Lighting • Staff

– Rules of deployment, headcount and salaries


Patient travel

• Patient postcodes (100,000)

• Clinic postcodes (22)

• Mode of travel (98% private travel)


Equipment use Appointment Type Examination Fillings Scale

and

Polish

Root Canal

Treatment

Duration (mins) 15 60 19.8 45

Machine Used and Rating Duration of use of equipment per appointment type

(mins)

Dental light (52 W) 15 60 19.8 45

Curing light (3600 W) 0 4 0 0

Amalgamator (70 W) 0 0.5 0 0

Suction (950 W) 0 30 19.8 11.25

Xray (100 W) 0 0 0 0.004

Machines operated by compressor

(850 W)

0 0 19.8 5

Total power consumed (kWh) 0.0130 0.7676 0.6112 0.2880

Rate of power consumption

(kWh per min)

0.0009 0.0128 0.0309 0.0064


Staff deployment

• Dental surgeons

• Dental nurses

• Reception staff

• Cleaners


Operating Capacity Kirkcaldy Oakley Cowdenbeath Glenwood Leslie Dovecot Baseline

22 sites

Working days per year 210 210 210 210 210 210

Lists per day 8 1 6 1 3 1

Hours per List 6.75 6.75 6.75 6.75 6.75 6.75

Hours per year 11340 1417.5 8505 1417.5 4252.5 1417.5

Theatres per site 8 1 6 1 3 1

Lists per site 8 1 6 1 3 1

Hours per day 6.75 6.75 6.75 6.75 6.75 6.75

Baseline Capacity (mins) 680400 85050 510300 85050 255150 85050 5,017,950

Capacity Utilisation Rate 35.93% 82.03% 52.23% 73.29% 55.81% 54.36% 49.79%

Lighting (assuming 200W per theatre) 2352 368 1785 368 935 368 18,575

Theatre instruments (variable, kWh) 2354 672 2566 600 1371 445 24,463

Cleaning (stepped, kWh) 8960 2582 9772 2318 5247 1742 93,778

Autoclave (stepped, kWh) 4381 1260 4775 1132 2566 848 45,770

Total 18047 4881 18899 4418 10119 3403 182,584

(86 T CO2)

Total payable £2,707 £732 £2,835 £663 £1,518 £510 £27,388

Patient travel (km) 196,334 11,247 72,872 12,641 62,394 11,270 1,544,682

(317 T CO2)

HR cost (£) 670,534 81,053 498,181 81,053 249,091 81,053 £4,925,029

What is happening currently?


RATIONALISATION


Assumptions:

• Actual capacity

• Uniform rates of consumption

• As the crow flies travel

• Private travel

• Staff travel


Outcome

• Developed a carbon calculator

• Not only saves carbon

• But reduces cost

• And patient travel, providing care closer to home

• Triple win


Conclusions:

• Appropriate use of bottom-up models can provide significant inputs to carbon decision making.

• The Pollard model estimates the carbon footprint of service delivery and quantifies its change as services are geographically reconfigured.


Next steps - Nationally

• Working with Health Facilities Scotland

• Test the Pollard Model within the SMaSH project “developing a sustainable model of care for older people”


Next steps- NHS Lothian

• Pilot of the Pollard model to: 1. Improve the efficiency of NHS Lothian translating services specifically: • Reduce transport costs through appropriate modeling of interviewer base

postcode and patient postcode • Reduce travel time as above 2. Investigate the appropriateness of the current provision of dental clinics within NHS Lothian specifically: • Mapping the current clinics to ensure patients are provided appropriate

care, as close to home as possible, at the most efficient cost for Lothian


Next steps - Development

Obtain funding to….

• Migrate the Model to a web-based server

• Develop an automated data feed, e.g. using HES for secondary healthcare

• Ready it for use across the NHS

Documents

Bringing Cost into the Carbon Model for dentistry A ... · Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Duane B, Hyland J, Rowan