home waste disposal costs and potential carbon emissions and were analysed in some detail. It is clear that, if available locally, disposal by incineration with energy from waste, is by far a better option in terms of carbon emissions, than landfill.
Moving all care home offensive waste from landfill to Energy from Waste (EfW)
would save at least 66,750 tonnes of CO2 every year. This is equivalent to the annual carbon footprint from energy use of 13,350 houses in the UK.
Support and funding for continence care, to move residents off continence pads, along with better care in hospitals to ensure residents stay off pads when admitted, has benefits for resident dignity, health and wellbeing. This also represents a significant potential for carbon and cost savings across the whole lifecycle of continence product manufacture procurement, delivery and disposal. Procurement of continence contracts that favour more sustainable, lower weight products with user controlled delivery, to avoid over supply, also has a huge potential to cut waste and emissions. Clinical Commissioning Groups (CCGs) will take on this responsibility from Primary Care Trusts (PCTs) and should consider employing sustainable procurement practices in addressing these contracts.
Commercial waste Currently, most care homes are serviced by their Local Authority as the cheapest waste management provider. Care homes and nursing homes fall under Schedule 2 of the 1992 Controlled Waste Regulations, as such to date councils have only been able to charge for removal of waste but not disposal, meaning that council waste services for care homes have been subsidised. As of April 2011, these wastes are now classed as commercial waste (The Controlled Waste (England and Wales) Regulations 2011, 2011) and as such, councils can charge for both collection and disposal of waste (DEFRA, 2011). This change could, and in some cases already has, lead to increases in the costs to homes for using the local council waste disposal route. It is now an opportune time for care homes to explore the potential for alternate collaborative arrangements around waste management to realise economies of scale, possibly in partnership with GPs or local health centres.
Where possible, use these contracts should look to favour providers that : • Offer good data on bin weights
collected, rather than number of collections and volumes.
• Additional off-site
segregation and recycling of municipal waste
• Energy from Waste for offensive waste
Community, environment and food
The links that each home had formed with their local community were found to have helped improve the care home grounds and environment and ensured that residents had regular and varied external contact and the capacity to undertake tasks or activities that kept them physically and mentally active. These sorts of relationships are a critical part of a health sustainable care home and should be valued and encouraged. Three of the homes visited were reducing food costs, through reducing the amount of food bought and growing food onsite. This approach involved engaging residents, staff and external community groups. In one case a city farm supported the home by cultivating the grounds. The use of care home grounds to grow food, particularly in raised beds, animals and use of suitable tools provides both diversion and stimulation for residents, maintaining an active lifestyle. To a small extent the produce from the grounds also reduces the amount of food required, the distance the food needs to travel and the potential for pesticides and fertilizers, thus costs, health and carbon emissions.
The cost saving from food production are fairly small, however the health and wellbeing benefits are clearly more significant. Producing food onsite also provides an incentive to compost uncooked food wastes rather than dispose of them to landfill or incineration.
CONCLUSION From this assessment of the national picture, a study of the case study homes and the wider and information with regards to sustainable care homes, it is clear that there is a significant shortfall in support and information for this sector to contribute to the UK carbon reduction targets. This is also increasingly critical when considering the need to protect the sector and vulnerable older people from rising natural resource costs. Pockets of good practice notwithstanding, even where they are keen to contribute, care home managers do not seem to be regularly encouraged by operators, Local Authorities or
health trusts to engage with environmental sustainability. The costs and carbon emissions associated with residential care are high. The benefits of addressing these issues are not just financial and environmental, but a key component of high quality care. CQC inspection reports deal with quality of care, life, environment and management. While recent issues raised by the CQC around medicines management and record keeping have some cross over, there is little that clearly addresses the issues of environmental sustainability dealt with here. Consideration could be given to broadening inspection criteria to also include resource efficiency and environmental impacts of care. A home that manages its natural environment and its environmental impacts, through extending the concept of care to a more holistic approach, can benefit residents in terms of wellbeing and home operators in terms of running costs while reducing impacts on the local and global environment.
It is fair to suggest that in
commissioning and monitoring of care provision, Local Authorities, Health and Wellbeing boards and Clinical Commissioning Groups, should place environmental impacts of care home provision in a prominent position. Support services to help homes cut bills and emissions through energy use, waste management, food supply and prescription goods will reduce the cost of care, borne across a whole range of agencies and improve health and wellbeing for residents.
With an aging population and rising natural resource costs, it is essential that this sector is supported and encouraged to take an active role in resource efficiency and carbon reduction. This will be critical in both safeguarding affordable care for vulnerable elderly people, maintaining dignity and social participation in old age and in achieving carbon, waste and energy targets.
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PUBLIC SECTOR SUSTAINABILITY • VOLUME 2 ISSUE 6 19
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