Sustainability in Healthcare online forum 2020 transcript

The Sustainability in Healthcare online forum was held on 19 November 2020 and focused on sharing environmental sustainability best practice across the Victorian health sector. A full transcript is included below. You can also view the video recording on the main forum page.

 Introduction

 Delivering sustainable and resilient health facilities - VHHSBA

 Climate change adaption planning

 Moving towards sustainability - Ambulance Victoria

 Overview of the Innovation Grants Program - VHHSBA

 Removing plastic bags in the pharmacy journey - Monash Health

 Piloting a regionally relevant climate resilient greening initiative - South West Healthcare

 Establishing a specialist recycling service in a rural health service - West Wimmera Health Service

 Recycling theatre packs and laparoscopic instruments - Peninsula Health

 Examining the potential for the re-use of unopened shelf stable food waste in the hospital environment - Eastern Health

 Carbon footprint of pathology testing - Austin Hospital/Sunshine Hospital

 Question and answer session

Tiernan Humphrys - I'd like to acknowledge the traditional owners of the land on which we are meeting today and pay my respects to their Elders past, present and emerging. We have a great line up of presenters for our first session. Robert Fiske CEO of the Victoria Health and Human Services Building Authority, Dr. Angie Bone as Deputy Chief Health Officer and Sally Mangan from Ambulance Victoria, and I'm Tiernan Humphrys, Manager Environmental Sustainability at the Victoria Health and Human Services Building Authority. I'd first like to introduce Robert Fiske CEO, Victorian Health and Human Services Building Authority who will open the forum and speak to us this morning about delivering sustainable and resilient health facilities. Over to you, Rob.

[00:00:48] Robert Fiske
Thank you very much, Tiernan. Hello everybody. I would also like to acknowledge the traditional owners of the land on which we're gathering today and pay my respects to Elders past, present and emerging. And I'd like to welcome you all if not virtually any way to our 2020 Sustainability in healthcare online forum - best practice in environmental sustainability. I'd also like to extend a warm welcome to our guest speakers from across the Victorian health sector who have generously given us their time. Everybody in health at the moment seems to be working awfully long hours and going above and beyond given the nature of the year that we've had. But I'd like to thank you for giving up your time generously today.

Despite the many restrictions resulting from COVID-19 it is good that we can come together for an annual forum and continue to collaborate. I'm honoured today to be able to share with you at least a little bit of our progress in delivering sustainable and resilient health facilities, and also get to introduce some of the speakers and topics today, and obviously speakers that know way more about this subject matter than I do. It's terrific to be able to have spot in your agenda.

Hopefully over the course of the forum and beyond, the various speakers today will at least provide a stimulus to conversations and action on sustainability. Moving online obviously has its pros and cons, but you know, certainly in this instance, at least we're able to reach a wider audience. Some of those people from interstate, for example, and we're also able to obtain a more diverse range of speakers from further afield. So that's one advantage, even though we can't all be together to hear everybody in person. I'm pleased that we're joined by folks who are not only from metropolitan Melbourne, but also regional Victoria. I understand that we've got some people from Castlemaine Bendigo, the West Wimmera and also interstate. We've got people from the Sunshine Coast, Gold Coast, New South Wales. And even I understand from my home state over in Western Australia, even that must be very early for you over in the West. So welcome everybody.

Now turning to resilience in our infrastructure there has been a great deal of change and upheaval this year as a result of COVID-19 and it seems everybody's been focused on COVID-19, but one aspect of our world and of our life that hasn't changed, hasn't gone away has been the immense risks posed to our infrastructure through climate change. It only dawned on me as I was watching the news a few days ago whilst we've all been busy with COVID and consumed with COVID and the issues that, that hang off it, we sort of forget that it was only earlier this year as a nation that we were consumed by the devastating bush fires, which took lives, devastated property across the country, destroyed communities, impacted livelihoods - there's one real tangible outcome of climate change and it takes us back to the need to focus on sustainability in everything we do, improving our efforts in terms of environmental performance and adaptation and improving resilience to climate change. It will have to continue even through COVID. And in fact, it's going to have to actually increase in coming years if we're going to in fact be able to move the dial.

While it's not a health example, some of you may in fact have seen an article that appeared in the Financial Times about three days ago, about what that sort of increase in effort and adaptation actually looks like. There's a very small article from the UK where it appears that the UK government are actually proposing to ban completely the sale of petrol cars in the UK by 2030 and the European Union bringing it forward to 2025 which is not that long a way. It's a really big example to us here in Australia of some of the things that are starting to occur in the rest of the world. And the fact that you can envisage a time very soon where we very much are going to be needing to look at very material modifications to the things that we do just to tackle this very, very important issue.

Climate change is resulting in a higher frequency and intensity of bush fires. It can and does affect energy supply. And you know, they're the sorts of things that throughout diesel generator replacement program here in Victoria, we're already going ahead and removing diesel generators in a couple of our hospitals. Omeo and Orbost are two - they experienced severe power disruptions during the bush fire season. And you know, what we're hopeful for is that our works will enable them to continue to provide services when they're needed the most and not necessarily rely on fossil fuels to do it.

So climate change is also one of the three pillars in VHHSBA's Environmental Sustainability strategy. In December our department DHHS here in Victoria released a pilot Health and Human Services climate change adaptation action plan. And those are sort of the first steps really for us in embedding climate change into our policies, planning and operations from the very, very start. So it's a good step and I know that today, Dr. Angie Bone who's Deputy Chief Health Officer is going to share the department's broader climate change adaptation planning from a policy perspective and the roadmap for the coming years hopefully designed to tackle the impacts of climate change. And I think it's that roadmap piece that will really help enable a lot of action downstream in terms of implementing and improving our performance in terms of sustainability.

Research has proven that sustainable and resilient healthcare buildings do offer many benefits, lower environmental impacts, of course, greater resilience when they're needed most. But, uh, the other things that we don't often think about is generally, they're also lower to operate in terms of cost. And very often they're also a healthier healing and working environment for patients, visitors, and staff.

And so to that end in May this year at VHHSBA, we released the Guidelines for sustainability in our capital works to really set sustainability principles as a foundation piece within the delivery of our capital programs. Addressing such things as passive design minimising resource use and making sure that the end designing facility was resilient to climate change. We also went to the step of setting minimum, minimum energy and water design targets, mandatory sustainability requirements, and maintaining the two and a half percent sustainability allowance in all of the project costings to allow us to implement various initiatives above the business as usual. The Guidelines are really about providing practical guidance on integrating climate adapt adaptation into our projects. And we're also looking at embedding climate adaptation into our engineering design guidelines as well.

We've embedded sustainability and climate adaptation into the project management framework that guides the delivery of our infrastructure program to ensure that sustainability is front and centre throughout the planning, design and delivery stages, and literally remove the optionality of pursuing sustainability from the downstream project teams that ultimately are the ones that work on designing, procuring and supervising the building of our infrastructure. So we're conscious that in the past, not being clear on, on what we require and when it comes to sustainability has meant that very often it's one of those first things that's cut out of projects, and we're making sure that that's no longer going to be the case, certainly in VHHSBA projects moving forward.

VHHSBA's always been very clear that when it comes to our infrastructure and new projects, we've always used the expression design matters because it does. Moving forward it will also be the case that sustainability matters. Now I think we have up until this point always thought of sustainability is as a subset of design. And of course it is. We're probably going to take that next step very shortly with our new foundation documents to really put it front and centre and force the designers to make sure that sustainability is a major component of our new infrastructure at least that we are looking at renewing a lot of our portfolio going forward.

Addressing our existing infrastructure, which hasn't had such thinking embedded at the build stage because it's either old or it was going to a different time is also increasingly a focus for us. During 2020, we continued to implement and our Regional Health Solar Program, we installed 3,364. We've got to get the four right - kilowatt peak of solar panels at 35 health facilities across the Hume, Loddon Mallee and the Grampians. And once completed the arrays are estimated to generate around 5,000 megawatt hours of electricity per annum, and more pleasingly leverages emissions by more than 5,000 tons. We are progressing works on 46 other health services to install the final arrays throughout the program. And that allowed a further nearly 4,000 kilowatt peak of solar panels to the Victorian public health system.

This last year just gone, we've also supported energy efficiency and solar projects in public hospitals by providing not a lot of funding, moderate funding, just shy of 600, a thousand dollars in grant funding for such things as LED, retrofits, hot water upgrades, and the installation of solar PV and variable speed drives at a number of health services across Victoria. And I'm proud to share that the combination of these investments, good and improving facility management by our health services and the continued greening of the national grid has actually meant that carbon emissions from hospitals is reduced by nearly 6% or 50,000 tonnes.

And probably the other point to note here is, you know, we've started, we're having an improvement, but we want to go further. So we're actually very hopeful that we'll be successful at extending and in fact, increasing the funding towards programs such as this, in particular LED coming in the Victoria budget, which is next week. So fingers crossed some more funding that we can allocate to these very important programs nationally.

We're working with our interstate colleagues through the Healthcare Infrastructure Alliance to drive development use of the Australian built environment rating scheme on NABERS for hospitals and Victoria, along with South Australia and Queensland are continuing to generate energy and water NABERS ratings of its hospitals as a way to manage overall performance. What's the expression - you can't manage, what you don't measure. That's part of the DNA of our thinking at least is understanding what our performance so that we can start to set some measurable targets and hold ourselves to account in terms of how the portfolio is performing. All jurisdictions have committed obviously to develop a NABERS for hospitals waste rating tool with an aim to rate 200 hospitals in the first half of 2022. And we're really pleased that of those 200, nearly a hundred of them are actually here in Victoria. We've recently released the clinical and related waste guidance supplement for healthcare staff to provide a practical decision-making process for managing clinical waste. And we've held actually a very well attended waste in healthcare workshop to assist participants develop plans for improving waste stream separation and recycling in our hospitals.

And I think the thing that we see is, you know, hospitals, folks who work in the system, they want to do the right thing. They want to actually reduce waste. Uh, some of it is actually about joining people up, joining the technical experts up, and actually, helping people to understand what are the right strategies and what are the innovative things that people are doing across the system that others can adapt and, and, you know, the power of, of those ideas being transmitted through the system is, is really where we'll have a really meaningful impact. It's important to acknowledge the immense work of health services. You know, this isn't actually about VHHSBA.

We're trying to throw a little rock in the pond and stimulate things, but it's actually really about the health services leading the charge on environmental sustainability. You know, the advances by Ambulance Victoria, as an example over the last few years, have been really impressive - a testament to what can be achieved with, with strong leadership, strong executive support and a bit of commitment and passion with a team. And so, you know, again today, Sally Mangan, Director of Sustainability, she's going to share some of their innovative approaches that they've been pursuing later this morning.

In starting to round out, we're really, we're really proud to be supporting best practice, providing the environment where innovative thinking can take place, supporting health services, supporting health services, to understand that it is the norm to start thinking about sustainability. None of us clearly have all the answers, but forums such as this, the waste forums and others that we are starting to run and participate in, are part of the answer in terms of sharing best practice thinking. We see that there's a definite thirst across the system to embrace sustainable practices. And it comes to organisations like ours to try and unlock it, and also help along the way in terms of pursuing some funding and support from government as well.

At our last forum last year, Deanne Leaver, who is our EGM of Asset Strategy VHHSBA announced the 12 successful applicants of our Innovation Grants program. It's really pleasing today that we have the pleasure of hearing the results of a couple of those projects that have been undertaken at a number of our health services, Monash West, West Wimmera, Southwest HealthCare Peninsula, Eastern Health and Austin. So, we’re really, really pleasing to get the results and see what innovations and solutions have been developed. And again, the sharing of the pros and cons of each of these grants, I hope I hope will be the catalyst for ongoing conversations and considerations of similar approaches across the health services.

So, in starting to close, I'd like to thank you for your participation and your commitment to work with us, to deliver a more sustainable and climate resilient healthcare system. Maintain the passion, drive your leaders and continue to make a tangible difference. I sort of look at it that folk like Tiernan and the others in the team at VHHSBA, they are my conscience. They help drive as in terms of implementing and going down paths to improve sustainability outcomes without within our system. And I'd encourage others to, to help drive the leaders. Tiernan drives me, I'll drive the Secretary and the ministers, and together hopefully we'll make a, a tangible difference.

In closing, I'd like to show you a short video montage of our Regional Health Solar Program. We've done some pretty cool drone footage on the completed work at a couple of health services, including Sale, Portland and Bendigo. So, thank you and I hope you enjoy the rest of the forum.

[00:19:40] Tiernan Humphrys

Thank you for that Rob. Great to hear that sustainability matters. I'll make sure that's in my PDP for this year. And the Regional Health Solar Program is packed full of the initiatives that I am most proud of. It's a real physical commitment to improving our sustainability. In 2019 2020 Victorian public hospitals generated more than 5,000 megawatt hours of electricity from behind the meter solar. And you would have heard from Rob earlier that we are in the process of installing more that we'll do, um, that amount again, on top of that. To put that into context, when I had a look at my solar array at my home this morning it generated 24 megawatt hours since it was installed in 2012. So, the actual scale of what we're of what we're putting in is impressive.

Before I introduce Angie. I'd like to mention a few people behind the scenes who made this happen. So, Jacqueline Shields has done an amazing job putting everything together, but I feel she fell short a bit on the catering because I've got no donuts here. Katie Henderson is producing the event so no-one notices all my mistakes. And James and Michael in Comms did the slide deck and the video and Trent organised all the socials to promote the event and get close to 300 registrations. And of course, to all of our presenters.

I'd now like to welcome Dr. Angie Bone, our Deputy Chief Health Officer Environment, she has a wide portfolio of responsibilities relating to reducing the impact of environmental hazards on Victorians' health, including work to both mitigate and adapt to the far reaching impacts of climate change on health. So over to you, Angie.

[00:22:01] Dr Angie Bone

Thank you Tiernan. And I'm hoping everybody can see the right screen here. I'm just pulling up my notes here as well, so yes, thank you for that Tiernan and good morning, everyone. I'm really delighted to be here to be able to speak with you today. May I also begin by acknowledging the traditional custodians of the land on which we're each joining from today. I'm joining from the land of the Boonwurrung peoples of the Kulin Nation. I pay my respects to Elders past present and emerging and all Aboriginal people who may be joining us today. I'd also like to acknowledge the deep connection to country of first peoples and how valuable that is, particularly for the subject of environmental sustainability.

As you will all be aware, we are already experiencing the impacts of climate change. We're seeing direct climate impacts such as higher average temperatures, more, very hot days, longer fire seasons and more intense downpours. Climate change is also indirectly affecting our health by changing water quality, food, safety, air quality, and ecological and land use. And all of those also have significant associated health impacts and climate change also affects the social determinants of health, the sort of social structures that we've put around ourselves, and the, and the infrastructure. So housing, transportation, et cetera, which also has flow on impacts to health and health care. And it's already very clear that climate change will be an amplifier of social disadvantage and health inequalities just as we're seeing with the current COVID-19 pandemic.

And I think it is also worth noting that people who are most disadvantaged are often the most resilient, and there is a lot to learn from them, but there is also a sense that resilience can only go so far and we all need to be able to support each other. The department has obviously been very consumed with responding in multiple ways to the pandemic. And I'd really like to take this opportunity to acknowledge the tremendous work that colleagues have been doing to support the community through this time and to thank you for that this work will continue for some time inevitably, but as we head into summer, we will all be very aware of the risk to physical and mental health from things that we tend to associate with summer heat waves, Bush fires, floods, thunderstorm, asthma and it's really very important that we now really focus our minds on preparing and responding to these and adapting those responses to this new context while still trying to remain resilient ourselves.

So as these challenges mount and noting that the WHO and the Lancet have described climate change as the greatest threat to public health in the 21st century, it's vital to remember that if we tackle climate change in the right way, it could also be the greatest global health opportunity. I'd like to highlight, our key focus on recognising and factoring in the health co-benefits of emission reduction initiatives, which is a central component of our climate change and public health work. Action to mitigate climate change is critical to lessening the impacts, both mitigation and adaptation focused activities can create conditions for health co-benefits to be realised. There's already a huge amount of great work that's happening to deliver action on climate change, but it's clear that we still need to do more. Further work is needed to ensure that action is delivered at the scale and pace required to prevent the most significant impacts that could arise as a result of climate change.

So, what is Victoria doing in terms of climate change? So, Victoria's climate change act 2017 provides us with our authorising environment. It provides a legislative foundation to manage climate change risks and drive our transition to net zero gas emissions by 2050. It includes requirements for the development of Victorian climate change strategies, adaptation action plans, whole of government and sector emission reduction pleasures, and interim targets for every five years. And I'd like to thank my colleagues at DELWP, the Department for Environment, Land, Water, and Planning for this slide because before I go into more of the work about what we're doing in the department, I thought it would be helpful to provide some context for climate change adaptation, which is happening across Victoria.

So DELWP's climate change adaptation program is being delivered at state regional and local scales and is supported at each scale by an authoritative and up-to-date climate science and information program. At the state scale, DELWP is supporting the development of sector-based adaptation action plans for key systems that are either vulnerable to climate change impacts or really essential to ensure that Victoria is prepared. You can see those seven systems there. I don't need to read them all out, but you can see that health and human services is one of those seven. And these adaptation action plans are due in October, 2021.

At regional scale, DELWP is supporting the development of regional adaptation strategies to provide regional stakeholders with a framework to identify, prioritise, and deliver place-based adaptation action which has been informed by local knowledge and expertise. And these are due in June of 2021. The strategies will vary in their priorities, according to the regional context, of course, but as I understand it, the impacts of climate change on health has been highlighted as a priority in each of these regions. Advisory groups have been formed in each region to help inform the development of the strategies and these groups include representatives from DHHS.

At a local scale, they'll be supporting strategic actions to build the adaptive capacity of Victoria and local governments and locally based stakeholder groups to understand and address the place-based risks from climate change. Supporting adaptation interventions at each scale is something called the climate data and information program, which is providing up-to-date science, communication tools, vulnerability assessments, and local scale projection data for all of Victoria to build a detailed understanding of exposure to potential risks and impacts.

As I mentioned through the climate change act, Victoria has legislated a long-term target of net zero emissions by 2050. This is consistent with the Paris agreement goal of holding the increase in global average temperatures to well below two degrees celsius above pre-industrial levels and to pursue efforts to limit the temperature, increase to 1.5 degrees celsius. Victoria is on track to meet its 2020 emissions reduction target of 15 to 20 per cent below 2005 levels. The Victoria government has a really ambitious energy agenda, which is intended to drive down emissions, create jobs and put more power into the energy grid. And I'm sure you will be aware of the series of announcements we've had this week of quite, you know, fundamental investment in a lot of this. As I said, the Act requires five yearly interim emission reduction targets to keep Victoria on track. The Victorian government has been consulting with Victorians to further inform the decision on what those interim targets will be and to identify priority actions, to further reduce Victoria's emissions.

So, turning now to what we're doing in the department, in short, we're developing a climate change strategy which encompasses an adaptation action plan, which Robert referred to earlier on and an emissions reduction plan. So, in December of last year, we published our pilot adaptation action plan in advance of the statutory requirements for these plans. The department was one of two departments with DELWP to prepare a pilot plan. And the plan has 21 actions in each of four domains. These domains are governance and regulation, community and engagement, knowledge building and asset readiness. The plan has been developed in consultation across the department and funded agencies with areas, contributing actions through a series of facilitated workshops.

The department's now preparing it's 21/26 health and human services adaptation action plan, which is required under the climate change act to be developed by the 31st of October next year. The department's also developing an emissions reduction plan which will be finalised pending the government's decision on what the interim targets will be. And then moving on to what we've been doing in public health, you'll be aware perhaps that Victoria has to have a public health and wellbeing plan every four years. It's part of our public health and wellbeing act. And the latest one was released in 2019. For the first time it included tackling climate change and its impacts on health as one of four key focus areas.

And I'm really pleased to see it up there, along with those other areas that you might think more traditionally applied to public health, they're all interrelated in my mind. And where we're trying to focus on are, are pretty straightforward. And I would think obvious that really what we wanting to achieve is resilient and safe communities that are adapting. We want to be reducing the health impacts that are happening and will happen with climate change. And we want much more action around reducing greenhouse gas emissions because we recognise the benefits for health more broadly by that transition. There's also further web-based guidance on the department's health dot Vic dot gov website to supplement this plan. There, it does highlight that the health and human services sector, encompasses many professionals who are trusted by the community to provide accurate information, and advice, and actually are uniquely positioned to encourage Victorians, to adopt behaviours that are not only good for their health, but subsequently also good for the environment. And this slide here just provides some of the example actions that are provided in that guidance, but I won't go through them in detail now.

Moving on I'd also like to highlight some new guidance that my team published this year. So firstly, earlier on we published some new guidance to assist local governments, EHOs, environmental health officers, building engineers and emergency management professionals to plan for community respite for cleaner air when local air quality becomes heavily impacted by smoke from large scale or prolonged bushfire activity. The size and prolonged nature of the 2019 2020 bushfires created really long periods of very poor to hazardous air quality across several rural and urban locations with many well away from the actual fires. In some cases, these prolonged conditions led to significant increase of harmful fine particles called PM 2.5s from smoke into homes and substantially reduced indoor air quality. These conditions were challenging, but particularly so for vulnerable members of the community, you had no real practical options for temporary relief in the form of cleaner air respite.

So, this guideline essentially highlights that clean air spaces could usefully build on planning and development of cool spaces. It might be for respite during periods of extreme heat and that planning for and promoting cooler and cleaner air spaces or alternatively, the designation of cleaner air rooms inside publicly accessible buildings, is going to be a really important adaptation strategy as Victoria faces changes to its climate. Secondly, in September, this year, we published our new tackling climate change and its impacts on health through municipal, public health and wellbeing planning. This guidance is for local governments. So, while this guidance is directed, mainly at councils, the information in the guidance will be useful to many other organisations I would hope that are providing services to the community. And the guidance was developed through a really significant engagement process with local councils and members WHO collaborating centres and other community groups, and also includes examples of a large number of strategies, case studies and resources that could be useful to you in your work. And perhaps more particularly in how you engage with your organisations to advocate for change.

Just move on to the next slide. Two screens going here. So, this is about some research conducted by Sustainability Victoria who have found some useful information into community perceptions about climate change and health. And this is an infographic that's been adapted from their research report. You can see some of the key findings there. Most Victorians haven't thought about whether health is affected by climate change, but when they're prompted, the connection is readily accepted and 58 per cent recognise health is one of the main ways they are likely to be affected by climate change. Victorians want to know more about the health impacts of climate change, how to reduce emissions and what behaviours will benefit health and mitigate climate change. And lastly, here two-thirds of Victorians think it’s cheaper to act on climate change now than to pay the price later.

There were also a range of findings from surveying of healthcare professionals as part of this research that it's worth reflecting upon. They found that 84 per cent believe climate change is already harming health and 57 per cent believe the incidents of climate change related health conditions will significantly increase over the next 10 years. This is going to put pressure on our health services and our infrastructure as well as our community's health. Only one third of healthcare professionals currently feel well-informed and confident in talking about these issues with their patients and over 80 per cent believe climate change and health should be part of undergraduate and ongoing training and less than a third are having any discussions with their patients about this.

Despite this knowledge and skill gap, most healthcare professionals believe they could be doing more, 76 per cent of them believe their own practice or organisation could be doing more. So, coupled with the desire from the public to learn more this suggests healthcare professionals could have a really great role in communicating the health effects of climate change and what to do about them. I just really wanted to very quickly, as I'm winding up, show you a couple of the other things that we're doing in the department.

So, in August last year, we also updated our climate change and health webpage on the Better Health Channel. And that includes four animations on topics of staying healthy in a changing climate, extreme weather events and actions we can all take to reduce our impact and stay healthy at the same time. A key aim of the new resource is essentially to highlight the health risks associated with climate change and support the community. This also links with a whole range of other resources that are pre-existing that we have for our seasonal campaigns and you may already be familiar with them.

So, the continued promotion of risks and actions community members can take to protect themselves and those they care for are going to be increasingly important as the magnitude and frequency of risks increases with climate change. I'm sure you'll recognise a lot of the topics listed here and you have a really important role in supporting the community to reduce the impact, associated with these issues here.

So finally, many organisations are calling for a healthy and green recovery from COVID-19. And these are the statements that have been made by the World Health Organization. With the current focus at the moment of recovery, it's a really important time to think, to consider how we can build back better. And I really think we're at a crossroads here now, and we have an opportunity to guide short and long-term recovery. The decisions and investments made in the coming months have the potential either to escalate damage or to promote a healthier, fairer and greener world.

So, I would like to wrap up by saying climate change is the defining health issue of the 21st century and the health effects are being felt today. There are risks of course, but there are also opportunities if we tackle it right. And while progress has been made much, much more work is needed. The health sector has a critical role to play in reducing emissions and supporting community adaptation to the impacts of climate change. And I would encourage you all to use your expertise and experience on the ground to drive action in your communities. And so, with that, I will thank you very much.

[00:39:00 ] Tiernan Humphrys 

Thank you, Angie. That was a great presentation, and, wonderful to hear what's happening on climate change and health. And I think a key thing for the health department is to understand that climate change is a health issue and not an environmental issue, and therefore it must be core business for our department. And it's great to hear that coming from you.

So, thank you. I'd now like to introduce Sally Mangan. Sally Mangan is Ambulance Victoria's is Director of Sustainability and recently led the development of Ambulance Victoria's first social and environmental responsibility framework and action plan. In the last 12 months, Sally has established a dedicated sustainability team and commenced work to implement priorities from Ambulance Victoria's plan. So over to you, Sally.

[00:40:00] Sally Mangan

Well, thank you all for having me here today. I'd like to acknowledge the traditional custodians for all the lands in which we make virtually today and acknowledge the Elders past, present and emerging. I'm here today to talk to you all about some work that we've been doing at Ambulance Victoria. And I think Rob gave us a fantastic introduction before in our move towards sustainability as an ambulance service, but as a wider part of the Victorian health network as well.

So for context, about two years ago, we set up a project where we didn't have a lot of focus on sustainability in the service, and we set up a strategy for both social and environmental responsibility. So, we were conscious of taking a balanced view across that environmental projects can also realise social benefit and that it's important to look at both sides. So our vision started at 2050 and we looked at full key principles, so priority areas of a framework around our people being happy, healthy, and delivering great service, at the community itself, the supply chain and procurement or purchasing practices, taking more of a sustainability lens as well as the traditional environmental sustainability area.

So, these four core pillars or priority areas are what has framed our vision for sustainability into the future. And when we think 2050, we think about a net zero ambulance service, there's probably a lot more tech out there that's going to be around that none of us can imagine right now but we also think about the notion of being a lower carbon model of care. So, I starting to think about, our practices around that and its totality around a health and an ambulance service that is low carbon. It obviously jumps out as an ambulance service to a zero emissions fleet, but also considers elements of our waste profile, our significant property portfolio across the state, as well as I mentioned before, sourcing responsibly.

So, our vision is that if we're sustainable or socially and environmentally responsible, that enhances the delivery that we provide to our patients. In terms of that's great as a vision but moving towards that to hold us to account in the next five years, we have an action plan in place. We've now delivered on the first year of the plan and set up a dedicated team. So, there's two of us here at ambulance focused on sustainability, but we also have a network state-wide of champions. And really it's not just two people's job at ambulance to lead this change it's everybody's role.

We have focused in the first year or so particularly on climate change. I'll talk to a few case studies this morning about that, and we've linked activities to the UN sustainable development goals too. So, we always come back to - is our strategy as a health service linked to the wider priorities of VHHSBA and the department of health sustainability priorities, as well as the global priorities and methods. So, one year in, we've got a fair way into our climate approach. So, for climate mitigation or our emissions reduction, we've now set a pathway to net zero, and we did a significant amount of modelling and engagement with our executive and board. So, looking at our base data, our profile as a health service is probably a little bit different to the hospitals in that it's quite spread across building and energy usage as well as our road fleet and air fleet. Though it's not a significant volume of our service the air emissions are quite significant.

Unfortunately into the future, we can't see zero emissions aircraft anytime soon so that's going to be part of our challenge with the transition, however, what we have done in the period to 2025 and 2030, similar to, I think it was Angie who talked us through the Victorian approach, in that five yearly approach and looked at some specific targets that we can set ourselves as an agency for the next five and 10 years. So, the impact we're really wanting there is that we do lower our practice per patient of our model of care as well as communicating those pledges more broadly in line with announcements from the Victorian government and timing around that. So, watch this space. We're quite excited to be able to share those things specifically. And I think I saw this come out in the advertising for this conference.

We've done a lot of work on energy. So, we've looked at our vision for energy and being able to source in the next five years a hundred percent renewables. We had a great outcome in July this year where we were able to transition some of our largest sites to renewables from a Victorian wind farm. So, this included the headquarters for Ambulance Victoria, which was nice symbolically as well as helicopter bases in regional Victoria and other large sites across the state. So that resulted this year in a 7 per cent reduction in our emissions. And then with a full energy transition would be approximately 27 per cent in the next five years, which will be a great outcome when that occurs, but obviously a lot of work in the next few years to make that happen and really of not for as with all of our fleet this is seen as a stepping stone to enable transition to zero emissions vehicles that we have the renewable energy sources to make sure that our charging is truly green as well.

In the efficiency space for our building portfolio, call out to the VHHSBA team here, we have been working in the last one or two years on building improvements. So, putting in solar, improving some of our lighting and this year we're also trialling for an energy resilience perspective of site with batteries to see how does a battery as a climate resilience perspective work in conjunction with a solar array. So, we're looking to do that as a trial site, and then look at the feasibility into the future as the cost efficiencies come down with batteries in our vulnerable locations to really look at both from an efficiency perspective but also the climate resilience, the buildings. The bushfire season last year is a great example where we had a few of our ambulance branches lose power for consecutive days. And that really showed us that the resilience of some of those buildings is tested in those periods and we need to look at alternative options.

In addition to that it's great in conjunction with the sustainability guidelines that have been updated for capital works, we started to think around the concept of we have more than 300 branches across Victoria so how do we start thinking about building them better? You know, this potentially is net zero branches going forward so we've been doing some work and a project with Melbourne University this semester about what does the zero emissions branch look like for ambulance? How does it future proof from a climate resilience, but also the environmental impact of the building's operating efficiency? So that's something that we've also started work on and certainly we'll look to in the next year or two, and what can and what does that mean for us and how do we build different styles of branches.

From a climate adaptation perspective our vision really is that we're a health service that's not only socially and environmentally responsible but it's resilient to the impacts of climate change. So, in parallel to my work to reduce emissions, last year's bushfire season as I mentioned, impacted us in various ways. One night we had a 51 per cent spike with hazardous air quality in apples to OOO in the Melbourne metropolitan region as an example. So, what we have done as an organisation is added climate change to our risk register. It's now in the top 10 enterprise risks. We're working on a risk assessment piece ongoing with our functions across AV and really trying to understand where those climate impacts and the different hazard events will impact us as a business and plan for that including taking that that forward looking data of likelihood of different events happening and what that would mean for us. And that work will really culminate into, inspired by the department of health's early adoption of the adaptation plan, to look at us developing our own climate adaptation action plan that picks up on the themes coming out of health as a network but also incorporates the emergency service element for ambulance.

So, we're really looking at into the future, we're planning for our resilience and we're putting in strategies to manage that specifically on fleet. And I think it was interesting to hear Rob talk about the UK and the EU. Our fleet is a massive part of our asset and infrastructure so, our first phase of the flight transition, though, it doesn't realise as much emissions benefit is to start the change to some hybrid vehicles in the administration and the corporate fleet. So that started already with updated policy to remove more traditional vehicles from that choice set for staff. And as we speak, I think as CEO either this week or next week is picking up his new hybrid car.

So it really starts for us as the focus of having got the senior leadership on board and also role modelling the adoptions or the changes as well as a lot of out bottom bottom-up work with a lot of our staff that are frontline or out in the regions. So, we have various consultative groups. The vehicle group is one example that will help us transition and trial new things and certainly trials or innovation in the what's the zero emission ambulance space, or even a hybrid ambulance is a piece of work that we'll be working on in the background so we have planned that transition for the ambulance in a later period so not in the next five years.

Another example, though not probably directly climate change related, but for our broader work in sustainability is change management. So, as I mentioned before, we've done a lot of work with our managers of departments and the senior leadership, so our Board and executive are very much on board compared to probably a year or two ago when we started this journey. But we've also developed probably about 150 champions across the state in different locations now, as well as the social media presence internally, where we have a working group where people post ideas and questions and feel that it's a safe environment to raise queries or even challenges and what we've started to do is Sustainability Matters is the term of our newsletter. So that was quite interesting hearing Rob use that terminology earlier. We put out newsletters twice a year, we've created a checklist for changing to sustainable practices both at work and at home to give people ideas of what they can do locally to feel that they have ownership of change because some of the wider organisational changes do take longer. So, we're conscious of balancing the longer time pieces of work for change versus the quick wins. And we we're also starting to measure in our People Matters survey adding a question on sustainability to baseline where we at are and look at that trend over time from an employee opinion survey perspective.

The latest thing we've also done is also to release an internal podcast. So a few of you out there, if you're keen to join and have a chat to us about your practices at the wider health network, let us know, but we release a monthly podcast to our staff of our and we interview people about what they're doing in their sustainability practices, as well as sharing external best practice. So, it's really been a broader piece of work to build that up. And we'll continue to do that to the future because we've got great engagement from staff on it to date.

What have we learnt to date? I think it is that engaging with all levels is key and bringing them along. But it's also working across organisations. So, with people like yourselves listening in today across health we recognise the climate change, particularly it will be a shared risk as a health network. It's not necessarily just what AV does or what one agency will do for climate that will make a difference. So, it'll be about us understanding our place in a wider network. And, that there are duel drivers for sustainability business cases that you do realise co-benefits, or multiple benefits.

Challenges for us are being state-wide. It's quite difficult with such a spread and also the transition with where market technologies are available will continue to be something that we'll have to address as we move forward to make sure that the transition is planned, but also that it's realistic. So, I wanted to thank you all today for having me along. I'm certainly available for questions I think at the end, or if not offline after this presentation or another day, please feel free to contact me or put questions in the chat about what we've gone through today. Thanks, Tiernan.

[00:54:14 ] Tiernan Humphrys

Thank you Sally. That was a wonderful presentation. And, great to hear that sustainability matters at AV well as here at VHHSBA. So, I'd now like to start with a bit of background about the Innovation Grant Program that Rob Fiske mentioned in his talk this morning. So, at our 2019 Sustainability forum, Deanne Leaver, Executive General Manager Asset Strategy, announced close to $150,000 of grant funding to support 11 innovation projects across 10 health services.

Today, we're going to hear back on the outcome of six projects with speakers from Monash Health, South West Healthcare, West Wimmera Health Service, Peninsula Health and Eastern Health. And we're going to start off with Monash health who are going to talk to us about removing plastic bags in the pharmacy journey. Unfortunately, Sharon McNulty can't make it this morning, but Susanne Sturm is a Senior Pharmacist and the dispensary manager at Monash Medical Centre. She holds qualifications in pharmacy and health services management. And she's going to talk to us about this interesting project. So over to you, Sharon and Susanne.

[00:55:35] Susanne Sturm

Thank you very much Tiernan. Sharon couldn't attend so I would like to, first of all, acknowledge the traditional owners of the land on which we are gathered and pay my respects to the elders past and present.

So a quarter of Victorian government's energy related carbon missions is caused by public hospitals and health services. And this is due to the nature of the services that hospitals provide, which is significant amount of energy and water, and produce lots of volumes of waste. And if we can reduce this waste, we have a positive impact on our carbon admissions. So, this is the overview of what I am going to present, how Monash Health developed a sustainability strategy, and which was approved by the board this year. And now we're developing an action plan to support this plan.

So, going back one slide we developed a sustainability strategy and that was approved by the Board mid this year and now we're developing an action plan. Monash Health is Victoria's largest public health service, and it consists of six campuses. We provide care to a quarter of Melbourne's population. And during 2018/19, we provided 4.1 million episodes of care, Monash Health uses six guiding principles one of which is we manage our resources wisely and sustainably to provide value for our community. And this is the one that we were addressing with our project.

Now with COVID restrictions eased in most States is this what we want to see when we finally can go outside? Supermarkets are recycling a lot of the plastic bags, we can drop them off. A lot of the plastic bags still go to landfill or waste and they land in our waterways. And when we look at environmental sustainability, generally people refer to the three RS reduce, reuse, and recycle, but should we be thinking about a fourth one as well, which is refuse? So, refusing plastic bags.

Our pharmacy services is provided by five pharmacy departments and we have dispensary services, clinical services, a compounding both aseptic and non-aseptic compounding, quality use of medicines, drug information, hospital outreach, and clinical drug trials. So, for the project, what we first did is we conducted this project only at Monash Medical Centre, which is the largest site. And it's also the one that I work at mostly.

So, we did an audit of all the different types of plastic bags that we were using. We also engaged stakeholders, we did a convenience sample of patients who presented to the outpatient pharmacy and offered them to complete a survey. Pharmacy staff were surveyed, Infection Control was consulted and nursing and midwifery staff were consulted. And we also looked at what alternatives to plastic bags we could use. So from this audit, we identified that single type plastic bags were used in most cases, we found that they were actually degradable, but not biodegradable. And so, do you know what happens when plastic bags degrade? Hundreds of years later, they often end up as microplastics and are swept into our waterways and have been found by researchers to be found in our aquatic food chains.

So, we use those plastic bags, usually for dispense medicines, for both patients to hold the discharge medications and for out-patient prescriptions following appointments. We also use those bags to supply medicines to the wards that weren't routinely kept on the wards as usual stock. And we also use those to hold temperature sensitive items to protect them from the moisture of ice bricks when sending items to other sites. Another use we had for the plastic bags, they were actually black ones, was to protect light-sensitive infused medicines, which were as part of infusions.

When we looked at activity per annum, just at Monash Medical Centre, we provided over 25,000 discharge prescriptions, over 25,000 outpatient prescriptions and over 20,000 non-imprest items. All of those use these types of plastic bags that you can see. The results from the patient survey indicated that 65 per cent were returned and all patients approved to the endeavour to get rid of plastic bags. And, they agreed or strongly agreed to bring their own bags. And some of the feedback we got was its urgent to get rid of plastic bags for the future generation, and it's a terrific move to save the environment. So, we were quite pleased about that.

From the pharmacy staff results, 42 per cent of pharmacy staff reported that they used plastic bags multiple times a day of which 84 per cent were being were used to take medicines to the wards. Six months after the introduction of alternatives, only 14 per cent of staff used bags, those plastic bags. Some of the feedback we got from the staff was 'well done, a fantastic initiative' and use of paper bags has been well received by patients. Some patients who only received one medicine are happy to not take a bag at all.

So with this change just in July, we had 4,000 patients who received outpatient or discharge medicines, and we had 900 episodes of non-imprest medicines supplied. So we prevented those from going into landfill as the change had occurred in June. Unfortunately, infection control recommended not to use an alternate for the infusions as it could have introduced infection control risks.

So, what were the alternatives that we implemented? So we saw some polyvinyl satchels, and these were used for delivering non-imprest items to the wards and they're reusable. And we sourced paper bags or varying sizes to hold the medicines for supply to our patients and discharges. It also led to some process changes as well. Patients were informed to bring their own bags for collecting of outpatient prescriptions, and dispense prescriptions were kept in baskets if the patient was waiting. So that way we could take the basket to the window and the patient could put it straight into their bag rather than using a paper bag. Unfortunately, this can't be done for discharge prescriptions as they are often prepared in advance. And it would lead for us to let patients take their own bags into the department and leave them there, which could introduce some infection control risks.

Some of the unexpected outcomes of the project was that, a number of disadvantages, especially with COVID, there was an increased need for cleaning of satchels on return from the wards; the cost of the satchels which is quite a large; the cost of the paper bags which vary on the type between 1.5 to 10 times the price of a plastic bag. Satchels aren't always returned from the wards, especially on weekends, but we've come up with a solution. So, we do an exchange as soon as they pick up one, they need to return one. And paper bags aren't as easy to close as plastic bags, because plastic bags, you can tie up. But we've also overcome that by using bulldog clips which can just be returned and recycled for the next patient.

Some of the unexpected advantages was that there was an increase of awareness by staff of their impact of the activities. It also led to a compliance of an external audit which had required us to remove the pharmacy logo from their plastic bags. So that was a good positive. The satchels can also be sealed and so when controlled medicines such as S8s and S4Ds are stored in the bags in the department they maintain their integrity. Items can't fall out. And it also allows us to use support staff to deliver those satchels to the wards or departments because there's a seal that can be accounted for.

So, what are we doing in the future? So, we're going to transition all Monash Health pharmacies to reusable or paper bags, and currently Casey, Moorabbin and Monash Children's Hospital have already transitioned to paper bags for their prescriptions. We're going to look at sourcing of alternatives for covering light-sensitive infusions, those that can be infection control compliant. And we're going to try and utilise the fourth R - Refuse by encouraging patients to bring their own bags.

So, this project has led to an elimination of almost 4,900 plastic bags from going to landfill in one month by one site. This extrapolates to almost 59,000 bags per year saved by one site. Such a small step can reduce the carbon footprint of healthcare. Although the cost of paper bags is higher than plastic - what is the cost of healthcare? And to quote Debra Roberts, coach of IPCC working groups 'The decisions we make today are critical in ensuring a safe and sustainable world for everyone'.

I'd like to acknowledge the generous grant we received. Otherwise, we wouldn't have been able to purchase the satchels without this generous grant. And, I'd like to thank Christine Han, the former Sustainability Officer Monash Health, for her support. Thank you.

[01:06:11] Tiernan Humphrys

Thank you, Susanne. That was a wonderful presentation and great to see some real tangible outcomes from the Innovation grants we gave out. So that is a brilliant outcome. Thank you. And 59,000 bags reduced is super.

I'd now like to move on to South West Healthcare down to wonderful Warrnambool where Elvira Hewson is going to talk to us about piloting a regionally relevant climate resilient greening initiative. Elvia is the Environmental Sustainability Officer at South West Healthcare. Since starting the role four years ago, Elvia has greatly valued the support, collaboration and sharing of ideas and strategies from the Sustainability Committee at South West Healthcare other sustainability officers, and VHHSBA's sustainability team, and we greatly value her work and passion. So over to you Elvira.

[01:07:13] Elvira Hewson

Thanks Tiernan. So, the title of our Innovation grant was piloting a regionally relevant climate resilient greening initiative. And our grant was really about starting our climate adaptation journey. So the VHHSBA Environmental sustainability strategy had a strengthened focus on climate change adaptation. And at Southwest Healthcare, we'd done work particularly in the mitigation area and waste and recycling, but climate change adaptation was quite new to us.

So we've seen that by 2023 at an agency level, we needed to have a developed understanding of vulnerability. And so we really started doing some thinking about how we might start that journey here at Southwest Healthcare. So we looked at the regional adaptations snapshot that Barwon South West developed. So they profile different adaptation activity across major industries in our region and a key learning from that report was that organisations are more likely to undertake climate adaptation planning if they had already done a previous project.

So getting going was the main game. So this project for us was about getting going. So when the innovation grants came out in 2019, one of our Sustainability committee members suggested we have a landscaping focus at our Warrnambool campus and an emphasis of the grants was on collaboration. And we'd already been looking towards local government for their capacity and climate change planning. And we saw clear links with our idea. So, as I said, previously, we set out to do a greening project. And what we hoped for out of it was really to develop some learning, to have a plan, and then a planting of a small area.

We had a project working group, which comprised three members of our Sustainability committee, our gardener and we had regular input throughout our project from Warrnambool City Council. In terms of the city council we primarily met with their sustainability team. However, we also had a one-off meeting with their Parks and gardens team through the project. In terms of sustainability, they've got a Green Warrnambool plan and a significant component of that is an urban forest strategy. And they were looking to increase their canopy cover across the municipality by up to 10 per cent and looking to increase biodiversity and locally appropriate plantings by 2026. And up to 30 per cent by 2040. And the underlying thinking behind an urban forest strategy is to reduce the heat island effect. So that is the capture and reradiating of heat from significant unshaded concrete and buildings. And, most people working in a hospital will say that that's an idea that's really relevant to a high density building and below of a hospital. Other benefits of urban forest strategies are increasing amenities, reducing storm water flows, nutrient loads, lowering ground temperatures, absorbing emissions, providing habitat and enhancing levels of biodiversity.

So at the start of the project, we set out to build our knowledge in terms of how our planting might develop. So we started off thinking about our site and the constraints and challenges and opportunities of our sites. So as Tiernan mentioned, we're in windy Warrnambool so any planting that we had to do has to cope with frontline coastal conditions. And we're sitting on limestone. We needed to think about trees that wouldn't encroach on the high voltage power lines or interrupt access for building facade maintenance. We also just have a part-time gardener at our wonderful campus. So any plantings that we needed to do had to be low maintenance into the future. Our second piece of knowledge was really to look at the climate projections for our region. And although there's uncertainty about exactly how the climate is going to unfold, we know that temperatures are going to increase, there'll be harsher fire weather with more frequent and intense downpours and more hot days and warm spells amongst other factors. So, these are conducive to trying to increase plantings around our hospital.

We also look towards Melbourne City Council who've developed an urban forest strategy, and they used some guidelines that are listed in the references and the organisation who produced them looked at 10 criteria to rate tree species in terms of their overall adaptability to climate change. And they looked not just at drought tolerance, but things like wind tolerance potential as an allergen, how susceptible they were to pathogens and pests, their shade cast, the maintenance that was required from them and the type of tree litter. And they developed a ranking of low, moderate to high adaptability trees. So, we had a look at what trees could suit our site, but also fell within that moderate to high adaptability list. We also drew on indigenous plant lists and the experience of local plant nurseries, particularly when we're thinking about our limestone soils.

And the final part about building knowledge base was site visits. So we visited the Victorian Comprehensive Cancer Centre and the Bendigo Hospital, and they were sites that, to the North of us and experiencing drier harsher weather than us already so we were really interested to go and see what was working in those sites to give us a bit of an understanding about the kind of conditions we might be facing in the future and what might work at our site. Okay. Because of the actual place that we were going to do, the planting at South West Healthcare, we consulted a range of stakeholders and in any hospital settings, there's a lot of people who it's good to run something past and what we found was there was broad agreement for us to focus on a particular corner of our site. Two street frontages. South West Healthcare is hoping for a redevelopment project sometime in the near future. And these two street fronts were both, you know, main kind of access, but also they were places that weren't going to be affected in any future redevelopment. And as we looked back through the planning, they were sites that had been earmarked in the master planning process as places that could really do with some old trees. We were hoping to plant both hospital land and council land and to really integrate those plantings together.

So we've brought in the Parks and gardens team just to get them to have some input into our planning and to give them, to give us their thoughts about street, tree recommendations. In terms of the plan we engaged a local landscape designer to really try and put down some of our ideas as well as to give their own recommendations, particularly for the trees and how they would work near buildings and on street fronts. We were keen to keep the healthy plantings that were on the site. A lot of our plants were salt damaged and looking quite dilapidated, but some of them were coping really well. So we'd ask that the plan integrate and keep anything that was looking good.

We sent this plan with the company notes to our Executive sponsor and then the planting was managed by our gardener and it includes an additional 10 trees on, on that corner in the four to 10 meter range and a range of not previously used indigenous plant species and lots of coastal shrubs, Banksia and Allocasuarina. All up there's about 350 to 400 plants and then we re-mulched and we had to repair and upgrade some of our irrigation so that it was all supported by a manually control drip irrigation system.

In terms of lessons learned the positives. The real positive to me was conversations about climate and a changing climate with staff at South West Healthcare, with nurseries, with the council. And I think that was, that was key to thinking about how we might approach other climate adaptation planning. It was a project that met mutual targets for other stakeholders. And we tried to partner with Warrnambool City Council, and it's beautiful that this planting will eventually support their own targets for canopy cover for our area but also be a beautiful planting site. It's still immature, but it will fill the ground space within a few years. And there's already been birds in the garden which is wonderful. Yeah. So, as I said before, it was a real process for us of moving towards big picture climate risks and how to think about them and then actual concrete, tangible projects and how to incorporate that kind of thinking. That was a real positive in my mind.

In terms of the challenges, the landscaping plan was really spot on in terms of identifying key trees. It was great to get real consensus about that, but in terms of the experience of the landscaper using a real diverse range of indigenous species it probably wasn't right on what we were thinking. So we really used the plan as a face and moved from there. We've decided to plant stock as small seedlings, and this was really to give them the best chance of developing roots to cope with the wind. So you know, the initial bang is not quite as pronounced as if you using the truer trays, but the result is better over the longer term.

And then finally there was a difference of views of the existing street tree health with a senior parks and gardens team. They were keen to keep some of the existing trees there going and see if they could nurture them on for a few more years before making a call on changing them. So that to me was a conversation that was opened up, but we didn't resolve it within the timeframe of the project.

And in terms of the next steps in building our adaptive capacity South West Healthcare participated in six regional workshops led by DELWP and they were focused on building climate change capacity in key industries in our region. So there was a big emphasis on collaboration and how the planning overlaps in different sectors. We've got an item in our new 2020 to 2024 Environmental management plan focused on commencing climate change planning. We're basically thinking we'll have two areas of focus in developing our understanding of vulnerability and the first is the people that we look after. So really trying to understand the health impacts on vulnerable members of our community. And then the second focus is really on incorporating a lot of the work that's coming down through VHHSBA on understanding the potential impacts and how to make our health system as resilient as we can. So that, that ranges from things like looking at services and built assets and how to provide continuous care, but also thinking about impacts of climate events on the workforce and changing climate demand and how we might cater for that into the future.

So next year with our work plan, we're really trying to get an understanding from both clinical areas and service development areas, what people are already experiencing and what they know, and to see if there's a potential project that we can do in each of those areas to continue to build momentum in our planning process. And there's already fantastic synergies popping up. There's a new climate and health pathway in the workplace achievement program which is a program that South West Healthcare is signed up for and is a key health promotion platform that is pushed by the Victorian government. So it's fantastic to see real six climate actions that organisations can think about taking on. And it's another way that we might be able to work towards, you know, understanding the impacts on the health system, on the workforce and thinking about how we might move forward in that area.

And then finally, I've just included a list of references in case anyone would like to read up more about that. And people are very welcome to get in contact with me outside of this time. I'd love to talk more about this, we're certainly learning in this area and really keen to develop our thinking and our strategies in this area. Thanks everyone for your time.

[01:19:57] Tiernan Humphrys

Thanks Elvira and everyone else at South West Healthcare who is on the line. Now we're going to move even further west in Victoria up to the West Wimmera Health Service who are going to talk about establishing a specialist recycling service in a rural health service which is a real issue for our small rural hospitals because often the demand isn't even enough in those areas to warrant a collection. We're now going to be joined by Darren Welsh who has 31 years’ experience in health encompassing clinical settings, quality and corporate services in aged community and acute care, primarily in regional and rural Victoria. Darren is currently the Executive Director of Quality and Safety and Beau Lovett is the Maintenance Administrator for their nine sites. He maintains updates the architectural plans, manages the medical assets, assists with recycling and waste management. So over to you, Darren and Beau.

[01:21:27] Darren Welsh

Thank you very much Tiernan. It's my pleasure and thank you very much for the opportunity for West Wimmera Health Service to speak at this online forum. As the executive lead for our specialists recycling service it's my pleasure to introduce Beau Lovett. Beau has been instrumental in the success of our waste recycling program and its through his tenacity and drive that the essential elements of our waste recycling program has succeeded. So over to you Beau.

[01:21:55] Beau Lovett

Thank you, Darren. So firstly, apologies if it sounds a bit scratchy in here it's the best room I could find. But greetings and salutations everyone. I am Beau Lovett the Engineering Service Officer for West Wimmera Health Service. The project we focused on was the collection of e-waste from our 12 facilities which are spread across nine rural towns. The project was also planned to be expandable to incorporate other recycling that may have been difficult or even impossible for some of our health facilities to manage alone.

For those of you who have never heard of us West Wimmera Health Service is a conglomerate of nine towns and health services. These towns vary in size from only a few hundred people to nearly 2000. As our name suggests we located in Wimmera and many of our health services hope to generate enough of this recycled material by themselves to make any initiatives worthwhile. But through teamwork, we make this dream work.

Our health facilities offer a range of services from acute wards, we have an operating theatre, occupational therapists, physio department, home nursing, disability services, rural nursing services and community health clinics. We cater to quite a wide range of needs in our rural communities. Back in 2016, we amalgamated with the Dunmunkle Health Service for Rupanyup, Minyip and Murtoa, and while these towns are somewhat close to the city of Horsham they are still quite remote and they are far from our base hospital here at Nhill.

As you can see by this map, we have a huge region to cover. If you were to take a very leisurely drive without stopping, and you've had no traffic issues whatsoever you could circulate through all of our towns in just over four and half hours. For those of you that aren't familiar with rural towns, we often measure distances in the number of half hours. Uh, for example Kaniva or Jeparite is just a half hour trip from Nhill which is where I am at the moment. To help put these distances into perspective a drive from our base hospital here at Nhill all the way to Melbourne central is a close to a four-hour trip with the traffic or about 370 kilometres. A round trip to every town we are located in is about 400 kilometres.

To tackle the challenge of distance we had to find a reliable logistical solution to handle any recycling accumulated, finding a suitable method of transport was difficult, and many of them found to be very expensive. We had eventually found our solution when I discovered that our stores delivery van often returned back to Nhill empty. While having our own stores van might be sort of very special to our service, we know many of our rural nurse, physio and OT vehicles travelled around with only one or two people in them.

Logistics was at the forefront of our goals list and we ensured that there were other methods should the van not be available. For example, there was a two-week period where the van was being repaired and we had to substitute the maintenance vehicles that were traveling between our sites for that period. While all of the goals were relatively simple, the remoteness, the long distances, the low population, the lack of facilities, it just makes everything all the more difficult just for us.

The other goals were to upgrade our infrastructure, to handle the changes and any possible future changes that come with recycling, that our staff were educated, to make sure that nothing we're implementing would be expensive or cost prohibitive, that the recycling could be managed easily. And finally, that the entire project could be replicated for the same purpose or a similar or different purpose at other rural health services to start the project.

We planned each site with a small depot of sorts to store any recycling that was not destined for the curb-side. The safest most affordable approach we discovered was to use small garden sheds on a simple slab of concrete. With a storage set up, the issue of where to send the recycling could then be addressed. Some shires charged more for e-waste for example, and others taken theme for free. This was made more difficult when trying to expand recycling from just e-waste to other recycling as some businesses that were operational before we started the project had closed since. We hope this gets friendlier in the future where we are in a better position to accept them.

The management system we use is just a simple sort and store. Speaking of sorting and storing the heart of the project really is the sorting system. At the outer sites, we keep sorting very simple just using recycled cardboard boxes and some of the plastic trays that actually came from our recent theatre renovation. Here at Nhill the recyclable materials are sorted into dedicated trays and tubs for each type. And when they are full, we mark them and send them off in used cardboard boxes we get from our stores department. We also try to make use of any second-hand plastic wrapping when possible.

All of our reception desks are positioned with battery boxes and once a fortnight they are emptied and there will be anywhere from one to three or even four litres of batteries. Where possible we separate the batteries from their appliances. Fluro tubes are sorted into different sizes. And we separate small and large appliances and so forth. Each type goes into their containers and if there is any scrap metal, we remove that metal. We also had to keep the e-waste in small batch sizes to avoid annoying the transport station staff. For example, when we first started this project I was talking to a particular Shire's transport station staff member, and he was quite annoyed because an unnamed supermarket had recently dropped off several hundred fluro lights all at once and filled their bins. So it is important that I conduct the recycling with respect and consideration to our shires and transfer stations.

We're limited in solutions for recycling and it's important that I don't ruin any good relationships that we have with them. Before starting this project I had made some assumptions and faced a few roadblocks. First, I assumed the rollout would be very quick and easy to do, and in truth it was, it's not as quick and easy to set up in just a matter of days, but finding the time to do so, with our maintenance staff was difficult. Education is very important and I'll speak more on that in the failures with education later. But I severely underestimated how difficult this would become.

As mentioned earlier, we have a number of business contacts before 2019. I had intended to take advantage of these with the projects and that they'd still be running in 2019 and onwards. When some of these closed down and moved out of reach or changed their business plans, their scope had to be cut back a bit. I also assumed the mandatory changes to e-waste in 2019 would make it easier to work with our local shires. That was an interesting assumption that I had made.

And the final assumption made is that the business start-ups would be quicker to start filling the void left by bigger companies. They are doing, it's just at a much slower rate in regional Victoria than I had expected. Here at Nhill we started by converting a dirty patch of storage yard into the main Depot. It needed to be large enough and easy enough to access, could be kept clean. And half of the build was actually made from recycled materials those being the fence poles and cycling mesh, the gates and rebar we used for the concrete slab. So only the concrete itself, the shed and the shade cloth were new. It was also placed right across from our clinical waste sheds. And you can just make out the recycling bins in the back there of the final image. While this is not a necessary part of the project it does make sorting and recycling waste a lot easier. It makes it a lot easier if it's all in the one location.

Our achievements to date are the completion of our central sorting depot, as well as our regional ones, our e-waste is being managed correctly. We have, of course our smaller depots all set up. We're in a whole better position to handle any future recycling as along as we can find somewhere to send it. Records are kept on what waste has been measured out, where it ends up and the dates and when it's sent. We also keep an estimation of any savings. We use the local shires rates to calculate how much it would cost if we have taken it to a more expensive shire compared to one that might be cheaper or even free. When this was first implemented we just kept it on paper, but we've transferred all that to electronic. Now, while this wasn't particularly important for our project, it may be a high focus for any projects that you run. It may be difficult getting support for environmental projects. It may be a more effective route to take financial data that represents recycling rather than as an environmental concern as a monetary one instead. We can all sort of think of at least one person who sort of denies environmental changes and dozens more who are more or less just careless about the topic and we found that money can be a big motivator sometimes. So a decent business case for your projects for saving money might be what you need to gain support.

Expansion. In the future, it would be very exciting to use these sites to handle new recycling. For example, if Victoria opens up to bottle recycling, just like South Australia does, we would be in a good position to handle that from all of our different sites. Green waste and garden kitchen compost is something that we're trialling, but we had to put that on pause while COVID. We're excited to get that going again. Uh, we're also eager to see what medical waste recycling possibilities come my way in the future. Uh, just recently we went through all of our theatre and we've started diverting all the single use plastics papers, cardboard, and they're all now being recycled. So, we're excited to see what may have been classified as medical waste before could now be diverted into recycling streams.

Finally, our lessons learned. The project. I hope some of my wisdom can be passed on to all of you. Firstly, the outer site sheds are probably too large at the moment. It was a little unusual when we planned the project that it turned out that the sheds, which are two by three meters large by size are actually cheaper than smaller sheds - the two by 1.5 meters. We could have also saved a bit of money if we had a sourced the materials as second-hand materials and build them ourselves. We have an excellent team of builders here at Western Health Service so more consultation should have happened.

Second. The main depot is in constant need of better sorting. And if I had planned it better, could have saved a lot of time. We've tripled the number of sorting containers that we've started with. And we're probably going to need more in the very near future.

Third. Education. As I touched on before, turned out to be the single hardest element of this entire project. When educating staff, I was surprised by the number of people who were just wrongfully informed on the basics of recycling. There are also staff members that just don't care about the topic. Or sometimes you can come across people that just have wild conspiracy theories.

Fourth lesson was be ready to fail this could be from losing a contact or failing to keep something could within your budget or even just the expectations of your peers. Take all your failures and try to learn at least one thing from them and then throw those failures out of your mind, you do not let the failures poison your mind, keep motivated.

Fifth. I would have liked to have found more opportunities for recycling before we attempted this project. But our distance from Melbourne still makes it very difficult even today.

Six and finally, this sort of project doesn't have to look beautiful or function perfectly. There were times where I was delaying working on part of the project because I wanted the situation to just be perfect. It was unnecessary in hindsight, and some things could have started a lot sooner.

Thank you for listening and thank you to the Department Health and Human Services for giving me this opportunity.

[01:33:45] Tiernan Humphrys

Thank you Darren. Thank you Beau. Great to see where you're overcoming the challenges in rural Victoria in our rural health services because we often take things like that granted in our metropolitan hospitals. But we need to remember once you go outside the ring of steel it's not always the case, so thank you.

I'm now going to pass over to Rachel Ulbrick who is the Sustainability Manager at Peninsula Health. Rachel is responsible for clinical health in environmental management and the action plan and has participated in many projects over the years, including the energy performance contract and embedding sustainability into the Frankston hospital redevelopment and the Mornington Centre Stage 2 capital works project so over to you, Rachel.

[01:34:48] Rachel Ulbrick

Thanks Tiernan. Peninsula Health completed a recycling theatre packs and laparoscopic instruments project focusing on procurement, waste generation and recycling study. Thanks to the Department of Health, VHHSBA, we were very successful in applying for the $15,000 grant that allowed us to appoint Dr. Trevor Thornton from Tandem Solutions to undertake a review of the theatre packs and laparoscopic instruments and the associated packaging.

Basically we wanted to determine what was recyclable, what was reusable and what needed to be disposed all. And this included the analysis of environmental and cost differences between single use and reusable items, recyclability of a range of items and if suitable how the items could be recycled. A provision of a checklist and instructions to evaluate products based on environmental considerations as part of the procurement process and preparation of a report and case study that we could share with the department as well as anybody else that was keen to look at this issue. So Trevor engaged with not only our procurement team, he engaged with a lot of our staff in infection control theatre, CSSD, maternity, in the emergency department staff and ward staff.

The feedback really highlighted some of the following challenges in relation to recycling, just the usual stuff that we come across every day. Where to start, our staff are always raising the concerns around the single use items. And also that established that there was a lot of confusion around the definition of clinical waste. One of the highlights was that staff didn't really understand the difference between reusable and single use items and in maternity, clearly, they were actually throwing out sponge holders because they didn't understand that that was not a single use item and could be reused. So they overcome that issue by actually writing on the pack itself that this is not disposable, please reuse.

So the other standard issues arose like the lack of available space to be able to recycle, the need for more clearly designated bins for a variety of recyclables, lack of available CSSD capacity to wash single use items prior to placing them into recycle bins. So we currently do theatre recycle metal PVC, sterile wraps, hats, and booties through dedicated waste streams at Peninsula Health. And we have been very successful at that. I guess the packs threw up a lot of queries that our staff had. So stakeholder engagement in our health service looked at how we could increase the use of custom packs which we did successfully and the positive outcomes of using custom packs and the cost savings which helped reduce packaging and also helped reduce packaging. So the use of custom packs in theatre it's seeing some time-saving benefits when setting up for procedures, as well as reducing the reliance on CSSD and the resources that we had available to process those items.

However, the standout item here is infection control feedback really confirmed that as long as we do have the capacity to clean and wash sterilised items safely, that they really don't have any preference for single use or reusable items, which is quite refreshing. So, I think the real issue will come down to the CSSD ability to reprocess items for recycling.

So, Trevor also engaged with our medical suppliers to try and get a better insight into the challenges that they have in providing better products, locally sourced, increasing recyclable content, and the many transport issues that also arise. So, a lot of our consumable items are sourced from overseas, I think COVID has really highlighted our reliance and the problems that that created for us during that period. And I think we've started to address some of that. Metal instruments that were coming from Pakistan, you know, some plastic items coming from South Australia, but mostly they come from China. So, our suppliers are quite proactive here investigating the use of natural fibres, for example, the issue of sugar cane for trays that a lot of health services are now purchasing and we're of those and other ways of increasing the recycled content of their products. So for example, they'd like to embrace the recycled content of any stainless steel instruments and the theatre packs that they do have they will reviewed four times per annum to minimise any wastage. So if there are items in the packs that aren't being used and that being thrown out, they'll removed from the pack and have it as a separate item so that we're not opening packs and then just throwing them into the bin if they're unused.

So stakeholder engagement with the resource recovery processes also occurred. So we really needed to look at, you know, metal and plastic in co-mingle materials. And the analysis of a typical theatre pack showed that they are mostly single use plastic items and most of these items, well actually all of these items can be recycled as long as you have the appropriate recycling waste stream to do this and a resource recovery centre that can actually take those. So recyclers are already taking some of the our stuff and Peninsula Health is already recycling some of those items as you can see in the images that we've provided of our bins. So, instruments with no other components can be collected at either no cost or rebases or some may pay for metals in some cases. And I think it's very important that you investigate the options around that, but in some cases, metal recyclers require higher volumes before they will collect. And again, that generates a few storage issues for health services and some may have the metal cleaned first, not all require that but it will just depend on your recycler.

A literature review was also completed and it was review of a review of articles from peer reviewed journals, comparing reusable and single use medical products. And the literature was very clear in concluding that reusable products with the subsequent cleaning and sterilising were a better environment choice. So, items such as reusable gowns, drapes, and other equipment and theatre packs provide better environmental outcomes. And this incorporates factors such as cleaning and sterilising. So, developing and implementing solutions to the adverse environmental impacts for health care really requires a holistic approach that looks at all aspects of the supply chain, the use and the disposal.

So, engaging with all the stakeholders in this process really is important to get the good environmental outcomes that you're looking for. So, we developed a purchasing checklist and instructions to improve environmental outcomes and we have provided that to our procurement department to utilise and we also have that online with access for our staff. They might be buying one-off items and that would help assist them in making some decisions with environmental criteria included. So, this is basically our checklist, for our staff to look at and we include environmental sustainability outputs and business practices into the supplier procurement evaluation process at Peninsula health. You know it's probably doesn't get up the high weighting that I would like to see, but I guess, you know, at least it's a start and slowly over time as we have access to higher recycled content and our suppliers get on board, this document will become a lot more relevant. Okay. So, and a supply checklist.

So, it's important for us to make sure that our suppliers, you know, may have environmental policies or they've signed up to the national packaging covenant, you know they might have extended producer responsibility schemes. I know Baxter for one, you know, with their PVC recycling programs sort of have adopted that into the way that they manage their business. We participate in the PVC recycling program and I'd love to participate in more programs provided that our suppliers can start to look at doing those sorts of things, taking the by-products back or parts of the product packaging for reuse or recycling. So, what have we done at Peninsula Health as part of this process? You know, we commenced, or we were looking at various items, but we've purchasing clinical waste bags that are made from hundred percent recycled content and are manufactured locally. We've implemented the re-usable infectious Maxima gowns in Emergency and ICU, aiming to roll out to the other wards and that's through our linen service provider. It was evaluated by Emergency and ICU and our clinical purchasing staff have been really happy with the results and not only that it's extremely cost effective, so they've seen some good cost savings with that.

We've also changed to compostable kidney dishes made from sugar cane which ultimately, we would like to put into, or some into, our guide unit. We'll be trying trialling that to see if that will work. Or we may look at a compostable waste stream setting that up separately. So, we’ve increased educational training across Peninsula Health and we've participated in CEO forums and that will be ongoing. We have clinical education and nurse forums that we also present to, and we've increased access to training material, online education and resources, especially waste management training along with the procurement check lists.

So as a result, we're starting to see increase in our recycling so I looked at a snapshot of September over the last three years to give you an understanding of how this has started to filter through into our recycling efforts. Peninsula Health has set a target of 50 per cent recycling by September 2021. I may or may not get there, but we'll be doing a lot of education in relation to that coming up to try and increase that, and certainly with the help of our procurement team. And I think that's about it. Thank you Tiernan.

[01:47:37] Tiernan Humphrys

Thank you, Rachel. It's great to see work being done both in the hospital, but also with the supply chain as well. That is wonderful. So Anthony Howard is an engineer with experience in the design and delivery of environmentally sustainable systems for built infrastructure and he has worked in commercial renewables and building efficiency for over 15 years, Jorja Collins is a food dietitian and in 2019 she received a Churchill fellowship to explore strategies to improve the environmental sustainability of hospital food services. She's also a lecturer in the Department of Nutrition, Dietetics and Food at Monash University so over to you, Anthony and Jorja.

[01:48:27] Jorja Collins

Thank you for the opportunity to present today. I'm going to kick us off and hand over to Anthony who will take us through the second part of the presentation. To begin I'd like to acknowledge the traditional owners of the lands on which we are gathered and also recognise the long history of creating a nurturing, healthy, and sustainable food systems.

There is a growing social obligation and policy requirement for public health services to utilise environmentally sustainable practices as we have heard lots about today. And this includes the minimisation and effective management of waste, however food waste has not always been front and centre in the waste discussion, but this is something I'm hoping we can see a shift in. We were very pleased to receive an innovation grant to explore the potential for reusing unopened shelf stable food items.

So, this picture here is what a patient's meal tray looks like. And really the thing to take away is the high reliance of food in packets. Some of the food in packets require refrigeration like milk, yogurt, butter, juice, which means it's quite challenging from a food safety perspective to collect and reuse these items. However, there are a number of non-perishable foods in packets that are served to patients such as you have UHT milk, coffee, sachets, sugar sachets, and spreads, as well as biscuits, cereal packets. And so, these actually are a potential target for collecting and reusing. The reason why we would want to look at a strategy such as this is because the volume of packets of unopened non-perishable food that are generated every day across hospitals in Australia is phenomenal.

On one day alone at Box Hill hospital over 2000 packets of non-perishable food go up to the ward where they're served to patients they're not consumed and they come back and they're thrown away. A reuse strategy could have a really big impact on reducing waste going to landfill. Currently no hospitals do anything like this in Victoria and concerns about the bugs that might exist on the packet of the food that has entered the patient zone appears to be one of the biggest challenges.

However this assumption is not necessarily backed up by the literature. A literature review found that there is no scientific evidence that illness or infection from disease transmitted through food packets has been documented. Despite that there is I guess a philosophy that we do need to challenge. Other concerns aside from safety include feasibility, value for money, and reputational risk, and the culture of how things are done.

So there really is a great opportunity for healthcare to get on board in the food waste reduction. Australia has committed to half food waste by 2030 and without healthcare's contribution to this I don't know if we would achieve that. Currently most hospitals send all of their organic food waste and all of their food packaging waste to landfill, but there is an opportunity to move up the food waste hierarchy, including donating, reusing onsite, or even better if possible, reducing food waste in the first place. So, our research asks three questions. Is it safe? Is it feasible? And what do staff and consumers think about collecting and reusing unopened packets of food in a hospital setting.

I'm going to talk about the safety elements and what we did and what we found in terms of the microbiological safety of unopened packets of food. And then I'll hand over to Antony and he'll talk about the feasibility and perspectives. So we conducted a pilot study at Box Hill hospital and basically what we did was we collected samples of food packets from the hospital setting, sent them off to the lab to be analysed, to work out what bugs grow on the packets of food out. Our protocol for sample collection and testing was developed with input and insight from the experts in infection prevention control and microbiology So we collected four different types of samples that came in different packets. We were interested in paper, so something like a sugar sachet, smooth, hard plastic so something like this thickened fluid drink, foil lined plastic like this coffee sachet or ridged hard plastic like this UHT milk. And that's because bugs grow differently on different types of packets.

We got these food packets or our testing samples from eight different locations in the hospital, unserved food items, food items that had been into the room of a patient who was not in precautions, as well as those who were in precautions or isolation, because they had a suspected infectious illness as well as those two, but we also then sanitise them afterwards. So, they were the five test samples. We also sourced samples from three control settings. And these were ones that we really assumed were to be safe or treated in the hospital setting as being safe and every sample we collected in triplicate. So, the lab tested for basically the bad and the common bugs in hospital. And you can read those there.

The elephant in the room is perhaps that COVID isn't on the list. And that's because this research was conducted prior to COVID-19. So, in terms of the results I'd like to orientate you to our data. This really is the crux of our results in terms of safety. Here we have in each column the findings for the control samples from the three different locations and the findings from each different test sample, you can see here is what was tested for and really what we were measuring against was whether the cut-off was appropriate or whether the finding was appropriate in comparison to a cut off. So, plate count needed to be within acceptable limits, listeria and salmonella had to be absent. And the rest of these bacteria also needed to be within acceptable limits. And those acceptable limits were what was determined in the food standards code of Australia and New Zealand. And you can say ticks all over the place there.

So basically, in summary, every single sample that we collected and tested was safe. So, we can see that the assumption that food in packets in the kitchen and the ward, we assume that they're safe and indeed that is correct. Food that is sent up to the ward, but never makes it to the patient, again that is safe as well. Food that has been in patients' rooms, whether they are in precautions or not, that is also safe. Overall, there was a slight difference in the average, number of colony-forming units for patients who were in precautions, but it was not statistically significantly different from any of our other samples. This is a small sample size. So, it is inappropriate to draw a firm conclusion on that. But overall, the total number was safe for food that was in the room of a patient in precaution, which is probably the biggest red flag. Sanitising really made no difference because the number of bugs were well below acceptable limits in the first place. So, Antony's going to take it from here.

[01:56:55] Antony Howard

Alright so what we did was obviously not withstanding the safety that Jorja has just been through, we wanted to work out where the things were feasible to do it. And so we devised a method where we would collect data over a time period, which was 10 days, and we would work out whether it could feasibly be done within the workflows of the of kitchen at Box Hill hospital as a representative example.

So, we broke down the activities into each sub activity involved in collecting and disposing of the food waste. We timed each activity. We took the transit time for the food between returning to kitchen and bin. And we split up and timed the different elements of each part of that cycle. We also then catalogued and weighed the food items themselves. What we got was the results that you can see on the slides in terms of the number in kilograms. Now extrapolating that at, you can see that this is at Box Hill alone, a very large tonnage of waste that we could divert from landfill. So, for that reason alone, the ability to ascertain that the food is safe and the ability to do something with it is a big part of reducing or re-purposing the food waste in the first place, going back to the hierarchy.

The next important thing we had to do is we ascertain how we go about it. And as part of the feasibility, work out the time and motion characteristics of collecting this food waste. So, one of the important things that we did with that was we worked out how much different the time involved in doing an extra process to recover food was compared with the normal process of simply disposing of the food. By looking at, we took 32 samples and by picking the food samples off the trays at a particular time in the tray cleaning and disposal cycle we worked out that it's about 4.6 seconds in the processing of each tray. So, Breakfast 4.6 Lunch 5. Thanks to this funding, we were able to put a dedicated staff member on that.

One of the things we want to work out and we actually did work out was whether we could absorb that into an existing work schedule to avoid labour costs. So, it was a very important part. What we came up with in the end was that it is indeed possible, and it has no particular effect on the cycle time of the kitchen, or if it does, that you do something sequentially instead of concurrently, that effect is very small and can be picked up by other efficiencies. So, our findings from this is that it is unlikely that an extra physical person needs to be involved in this process to make it occur. And that's a really important point. So that was a good thing we found in Box Hill hospital kitchen.

The last thing that we wanted to do was we wanted to look at the perspectives of the users and stakeholders within the hospital, which is public staff patients. So, we set up a couple of surveys. We set up a detailed survey, which was a small sample, and we set up a larger general survey, which was a larger sample but with less details. And so, the important things came out of that on the larger survey of the question asked what should Eastern Health do with unopened packets of food that patients do not eat? We got 668 responses, And the results overwhelmingly saw people wanting to do something useful with the food.

So, you can see that we have a 1 per cent response, rate of people thinking that we should throw them away. Most other people thought we should do something useful with the food 99 per cent of people to be precise. But what that does is it says that we have all the elements to instigating the potential for a program to make some change. Because we have support from our patients, staff and public. We have the ability to collect food that we have proven to be safe based on the Australian standards. And what, when, when we say that that food could be served without incident in any cafe around the country and any health inspector who went in there would test it and go, that's fine to go. You're good to go. Um, and we also have a system for collecting that food that is on balance, unlikely to contribute to a major cost impost on the service. It does require some organisational change, but overall, we've got three elements that are really important to making a change.

Jorja can we move onto the summary because I realise that we're running a bit late so we'll squeeze through. So, what we can draw from this is a couple of things. I'll start with what we saw at Box Hill Hospital. Food packets, from our rooms who are not in precautions, appear to be safe and they could be collected and used for donation or reuse. Obviously COVID-19 is a different situation, but this research was done prior. And assuming we get on top of it, there's no reason to believe that won't go back to a normal situation, or we modify to redo a bit of this work to make sure that everything is as we were expecting, if you would have found an extra 30 minutes per meal time collecting food packets, you could save six tons annually from landfill, just for 30 minutes a day. That's not a lot of time. And all the people involved who asked about our research thought it was a good idea to do it.

So, where we are left at the end of our preliminary study was what we need to do is repeat with a larger sample size. Now we know where we become statistically significant, and that'll come out in a report that goes through the department of health and I'm sure you'll receive it in time. It's just in our committee structures at Eastern Health that are getting certified. And that basically sums up what we did, what we came up with and the recommendations we make that shows that this is super feasible, not quite as good as coming up with the perfect way of not wasting food in the first place, but considering that while we get there, we might have a really good source of food that we could divert from landfill, do something good with it, and avoid the high methane landfill and the hard plastic landfill that a lot of these food waste provide.

In reiterating with a lot of the other speakers, I too would like to thank the department for funding this. There's no way we would've been able to find the money to fund this internally. And it was really, really good to be able to do this research and thanks to everyone involved, the department yourself Jorja. I think questions come after this, but thanks for listening.

[02:04:03] Tiernan Humphrys

Thank you Antony Thank you Jorja very much for that. It's most interesting. I think it's the second or third time I've seen the presentation and I still find it interesting and I'm so glad that we could support it.

So, this is the last innovation project which was done at Austin Health and Western Health with support from Safer Care Victoria through their Choosing Wisely program. And it is about the carbon footprint of pathology testing and the life cycle assessment was done by Scott McAlister at Eco Quantum Who's done quite a bit of work in this space. Pathology accounts for around 12 per cent of all Medicare tests and around a hundred million Medicare funded tests are performed annually. So around 12 million pathology tests.

This project assessed five common tests at two Victoria public hospitals, Austin Hospital, which does in-house pathology and Sunshine Hospital, which has outsourced pathology, which is important when we get to talk about where the scope of emissions are. So here on the left, we have the six common tests we assessed. ABG (arterial blood gas), FBE (full blood examination), Clotting profile CUE, C-Rp, and urine analysis, and there on the right, we have what the environmental impacts are. And for this presentation, we're just going to focus on the global warming or the carbon emissions of the six tests.

So here's the results. So, doing one of each test would on average emit 1.4 kilograms of carbon at scope one, two and three with urine analysis comprising around a third of those emissions. And we've just kind of compared that to 10,000 urine analysis tests would equate from driving from Melbourne to Texas and back. So nearly 30,000 kilometres. Whereas ABG it's only it equivalent to driving to Perth and back. Overall, this isn't, well, I would think to be material when compared to overall hospital emissions. So, for example, if we do 10,000 of each test in a major Metro hospital over a year, it would equate to less than 0.5 per cent of missions from stationary energy, or around 14 tons. It's interesting to look at where the carbon comes from. So, each test is slightly different, but electricity is common to all tests, and the biggest contributor in three of them being urine, coagulation and urine analysis. The other contributors are medical consumables, gloves, swabs, bags, sample jars, and syringes.

Just some key findings. So, it should not be used as a proxy for all pathology testing because each test as we saw in the previous slide is very different. It accounts for scope two and scope three emissions, depending on the delivery model. So, for example, in-house pathology the electricity would be a scope two emission because it would have been consumed within the hospital whereas for outsourced it would be a scope three emission. There was little opportunity for increasing recycling due to the clinical waste issues but there are three main opportunities to reduce carbon, the carbon footprint of pathology testing.

So, the first is to reduce necessary testing and some studies have shown that up to 44 per cent of tests may be necessary, which is a key focus of the Choosing Wisely program. Use of renewable electricity which by the hospital will reduce the impact of tests done in-house. And similarly, if the outsource provider used renewable electricity that would also reduce the carbon footprint of tests that are outsourced. We can also increase the lab utilisation, which will reduce the environmental impact per test. We have built a calculator so that people can assess what the carbon footprint is of each of these tests. and we are aiming to release that and a fact sheet case study by early 2021.

[02:09:02] Tiernan Humphrys

We've now got a bit of time for questions and answers. And one that's kind of comes up a lot of time and I might get a perspective perhaps from you Sally first and then from Darren is around how important is it to have a dedicated sustainability team? Because Ambulance Victoria didn't used to have one and it has one now. But I do knowledge the health services like West Wimmera it might not have the actual capacity to employ someone full-time. So perhaps you could have a go at that first, Sally.

[02:10:45] Sally Mangan

Sure. I'm happy to answer that one. So we came from a state in putting the strategy together, it was a project and in when we put the action plan to get up for the five years, for action plan item one was for this to be successful we needed to create a team or a department that was ongoing and it wasn't a project based role because we'd seen that in the past, about 10 years ago at Ambulance, we had a person working on sustainability, but then the funding dropped off. So part of the influencing we did in setting up our strategy and then starting to implement actions was having that lobbying at the senior levels to say, this is really important to us. It's not going away and it's going to become more important in the future so we need to recognise it as an ongoing function, as a health service that's modern, and that will set us up for the future. Um, so it took a while I must admit. Um, but it was really important to say we can't have all of these actions and these strategies in place without the resources to support driving it, not to say that one resource or, you know, two resources can do everything at the organisation, but they provide that leadership and that nucleus for the sustainability efforts. So even if it's part time of someone's role, I really encourage everyone. You know, if you don't have one to spend the time doing that and building the case and engaging with your senior leadership on why it's important it, you know, it was well with the efforts. And I think we've seen that now in what we've progressed in the last 12 to 18 months.

[02:12:25] Tiernan Humphrys

Great. Thanks Sally. And Darren, could you give a perspective from a small rural health service?

[02:12:30] Darren Welsh

I can indeed. As a small rural health service, with a number of positions that we have, these things are incorporated in other roles, and that's why we are very fortunate to have an individual who's so passionate about in Beau about sustainability and waste reduction, et cetera. Um, it's certainly part of my function as an executive director and an executive lead that it is really crucial that there's a voice at the executive level, informing the Board, and then through the staff, uh, with Beau's leadership in that area. So that's how we've approached it. We don't have a dedicated role full time but as a component of Beau's role it's been crucial to achieve what we have today.

[02:13:33] Tiernan Humphrys

Thank you. Thank you, Sally too. There's also a question here that's got a fair few likes around whether to electrify our new health facilities. This is something that we have addressed in our Sustainability guidelines that Rob mentioned this morning. So we do push to have complete electrification for all our facilities, below 10,000 square meters. It is still fairly difficult from a technology and cost perspective to do it for our larger acute hospitals but having said that both ACT and South Australia have made commitments in this area and we are closely working with them through the national ESD working group hospitals, which I chair on what that actually means what that actually looks like, from a technology perspective.

Probably just got time for one more question given the time, and I might pass to you Rachel for this is how could procurement bodies like Health Purchasing Victoria be more compelling in improving sustainability in the medical and pharmaceutical supply chains.

[02:14:58] Rachel Ulbrick

Okay. Tiernan that's an excellent question. And rather complex, I think, you know, it's up to health services to really engage with HPV to ensure that they really understand that you are keen to drive change in this area. Look, I think that COVID has certainly been a driver in probably highlighting those issues to HPV. PPE became a big problem for us when the Spotless facility shut down and we had issues with linen supply, there wasn't a lot of other options for us when it came to our infection gowns and things like that because we were running low. So, we really needed to make sure that maybe there are other options available to us as well. So, my recommendation is just being very, very vocal of that, your ability, and maybe that they can look at the documentation within the report from Dr. Trevor Thornton and maybe take some of that on board as well.

[02:16:14] Tiernan Humphrys

Thank you, Rachel. There's one here too that says I've had upper management tells me that climate change is a facilities maintenance issue in hospital, but the community role is for local government. I think as we heard from Angie this morning climate change is a health issue. It's an environmental issue as well but it is a health issue. It's an economic issue. We are seeing defence forces around the world saying it is also a security issue. So, it is an issue for everyone. And a lot of the commentary we are getting from people who work in the health force is that it is really key to them. And it is very much like we do no harm to patients; we should also be aiming to do no harm to the environment.

We are over time now and there are lots of questions so what I'm going to propose is that when we release the transcript and the recording we will attach answers to the 15 questions, three more that have come in too, and we've also got a bunch that came in early on when people registered.

So, thank you everyone for your time. Please do reach out to us or to any of the presenters if you would like to know more about the innovation projects and how you can implement them in your health service. I will now formally close the forum and thank you once again.

The full question and answer session can be viewed here.