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It was slightly early to start. We have one presenter that unfortunately couldn't make it today. Um And that's Robert. So his abstract is available for you to view. Shereen is going to take up the slot and do a little bit of 10 minute presentation and she's going to be talking about the role of health professionals in supporting the shift towards a sustainable food system. So, is everybody ok, everybody got access. Shereen, would you like to share your slides and the ches is yours? Great. Thank you very much. Thank you very much for the opportunity and I hope you can all see my um slides. Um Yeah, it was very efficient in the back room. So, um thank you. Um I've got the pleasure of talking about my favorite topic and I've been told I've got 10 minutes rather than seven. So um I won't talk as fast as usual. Um So why are we talking about food today? Well, it won't have escaped you that our food system is a key driver of all of these interrelated crises which affect our individual population and sort of planetary health. So, um unhealthy diets are now the leading cause of chronic ill health and premature death around the around the globe and in the UK as well. Um Food and farming system is a leading cause of climate breakdown. It contributes to more than 30% of greenhouse gas emissions whilst also using a huge amount of land polluting land waterways and the air. Um it's a leading driver, bio diversity loss. The large March for nature this weekend, highlighting the impact of the food system by various groups. Our use of antibiotics in farming is driving resistance pandemic risk going to have escaped to anyone. Industrial, industrial factory farming is a real problem and producing new and emerging pandemic risks, air pollution. We don't talk about enough but the farming sector produces around 30% of air pollution that we experience in our cities. And of course, it's a justice issue. We produce enough food to feed um over 10 billion people yet more than a billion remain hungry globally. Um And it um it should be self evident, but I think we don't talk about it enough, but the global food system alone will stop us, achieving our targets. We've already missed the chance for 1.5. But if we don't address the food system, we won't even meet our targets of keeping warming below two degrees. And that, that's if we eliminate fossil fuels today. So we really have to make a change in the way we food um produce and consume food So what degree of change do we need to make? Well, this is from the report from the W WF um back in last year called Eating for Net Zero. We basically need to halve the emissions of our current diet to meet the IPCC 2030 targets. Um And so what does a healthy sustainable diet look like a diet that will keep us within inflamatory boundaries and prevent all of those diet related conditions. Mainly cardiovascular disease, type two, diabetes, overweight and obesity and certain cancers. Well, it says eat lancet planetary health plate or planetary health diet that you see here is predominantly plant based, more than 85% of energy from whole plant foods. That's fruits, vegetables, whole grains, beans, nuts and seeds, animal source foods is not considered essential. Um but if they're consumed, then it should be limited to one portion of red meat, two portions of poultry, two portions of fish and three eggs per week. And together this could save um an estimated 11 million people from premature deaths that are caused by dietary risk factors currently. And what's really interesting is when you look um at an analysis um of quite a large number of studies that um ask the question about motivations for following a plant based diet. People who identify as plant based, who are reducing meat consumption are mainly doing it for health related reasons. So, as health professionals, I think we're in a key position to be able to support patients, families, communities to move to a plant based diet. So how can we lead the change? Now? I haven't got all the answers. Um And we've got a lot of collective work to do, but for me, I think it's about educating ourselves. Um like we're doing today. Um And my organization um along with a dedicated team, plant based health professionals UK have produced courses and textbooks. We write articles. We've got numerous fact sheets you can use in your clinical practice. And most of this is freely available on the website which is cited there. Um I think we then need to when we're comfortable with the data, um provide this education wherever we can. So at universities in our hospitals, in our primary care practices, we need to role model. We can only be genuine and support this change. If we ourselves eat a planet friendly diet, which is a plant based diet, we can then really support through our choices in plant based catering and just like the fossil fuel treaty, we can sign the plant based treaty. Have a look at it today. It's, it's fantastic and provides lots of tools for supporting us to transition away from animals, animal farming, use your networks, we can do shared campaigns, have shared learning of good practice. Um And of course, using our workplace is a great place to start and I'll come back to some initiatives that we've done at King's college hospital. Um but we need to work on patient and staff menus um community um uh catering within our sort of networks. And we need to work towards normalizing plant based meals as the default rather than currently that animal based meals are the default. So our theory of change at plant based health professionals is that in order to witness this plant based food system transition, we need healthcare professionals to accept and adopt a plant based diet and lifestyle as one that can benefit themselves their patients and the planet we inhabit. Until we get to this point, we're not going to see the widespread change that we all desire. And so it comes down to this. And these are some of the things I've done with my organization, Plant based Health Professionals. We provide CPD accredited courses. I've been running this course. It's in the fifth year at the University of Winchester. We've taken through over 1000 health professionals and it's recommended by GPS in England and in Ireland, we've produced credible resources for you to use in your libraries and your courses. If you haven't seen our textbook, please take a look. Plant based nutrition in clinical practice is very affordable. Um Compared to most medical textbooks, we provide student selected units for universities. If you're working in a university, please reach out to us because we're happy to extend our programs. We're currently within four universities or four medical schools. But another 40 to conquer. So do email me if you want to provide this in your medical curriculum and we call it cooking for the climate, providing information on the practical skills and knowledge associated with sustainable diets. We do dozens of presentations. So invite us grand rounds, um seminars, webinars like today. Um sustainability days, um sustainability weeks in workplaces. Um We write and do research. So we write in peer reviewed journals. Um and we um write up cases, case studies, surveys and um editorials and opinion pieces. So please do, do look at our publication record and then we've got loads of free resources. So our podcast, we've marked a one year on our podcast today. So in a nutshell run by two of our GPS, really talking through the fundamentals of how to a healthy plant based diet and the numerous benefits it brings to society and ourselves. We've got a free email based 21 day challenge and which we can demonstrate that people who go through this are more likely to be sticking to a plant based diet in the future. And as I say, we've got numerous fact sheets on various conditions on how to adopt a plant based diet for preventing the disease and managing chronic conditions. And I talked about workplace advocacy. Um And for the last four years, um myself and colleagues have been running healthy eating initiatives. We do center it around for January and January and no Meet May in may we have free lunches. We've got a cookbook, we've got a whatsapp group. Um, we bring our staff along with us, um, ask our canteen to provide more planet friendly um, meals for those months, hoping that these will, this will lead to behavior changes more widely. And if you would like to support our work more fully. And as I say, using our shared passion and networks, we need to come together on campaigns and the campaign that's taking up a lot of my time at the moment is called Plants First Health Care. Please use the QR code to download um the, the, the website and you can read the, please assign this. So we've got a lot of organizations endorsing this and we're aiming to get over 1000 healthcare professionals as a minimum before we take this um publicly. And we're really excited that we'll be working with greener by default to make default um plant based meals the norm within healthcare settings. And I want to leave you with this um analogy. I mean, I think, you know, the food system currently is reflective of where we were 5060 years ago with the tobacco industry. Um and they're using the same playbook to keep us um wedded to the fact that um they want us to keep consuming meat and dairy. So you'll remember that over 50 years ago, doctors used to smoke um quite openly and advertise cigarettes on behalf of the um industry. But then we caught up with the science a bit too late, but we did and we are in a stage of smoke free hospitals now. Um And then we moved on to supporting our patients to quit smoking because we know how impactful it. That is. Sadly, when it comes to the analogy with food stuck here, this is my canteen every day at King's College Hospital. It's an embarrassment. Not only is this a group, one carcinogen, but um red meat is the leading driver of biodiversity loss and greenhouse gas emissions when it comes to the food system. What I hope is that we emulate what's being done in New York City hospitals which have worked with green by default. And in at 11 city hospitals, plant based meals are the default. 60% of patients stick to this. They've reduced emissions from catering by 36% and have saved 59 cents on each meal. So there's a cost saving. And I really hope that we'll we'll together support our patients to shift away from a meat, heavy, this diet to one that is centered around healthy plant foods is better for health and the planet. So I think this is where we are. We need to embrace change. And I love this, this editorial, the moral imperative of the medical profession to promote um plant based nutrition. The medical profession can help to move the needle by embracing radical change. Um We owe it to our patients, to our um profession and to the planet we share. Thank you very much. Wow. Thank you, Shereen. That's absolutely amazing. I personally love your comment in relation to um leading the change. I managed the leadership programs here at the University of Brighton. So leading the change is absolutely key, isn't it? So, and I wondered if you had a comment on that and also the second around normalizing plant based diets, that whole key word of normalization, I thought they were the two really powerful things that you presented. Did you want to add anything there? Well, only to the last point about normalizing, we kind of know how to do this. The science is out there, we know these behavioral techniques work much better than just imparting the knowledge. So knowing what to do isn't enough to shift behavior, we need to shift the environment and this is what green by default has done so well that the 1st and 2nd and 3rd meals that patients are offered every day in the hospital are nutritious, healthy plant based meals. And when you do this, so nothing is taken off the menu. So it's genius, no limitation of choice. But when you offer it and prioritize it and describe it in those ways that we know, allow people to make the better choice, um people stick with it. So 60% are now consuming a plant based diet. That's way above the stats when it comes to general population. And yeah, I think we need to be talking the talk, walking the wall. We know the science. We don't need more studies to demonstrate what a healthy, sustainable diet looks like that's done for us. So we need to role model. You know, we're all quite happy to buy our electric car and move away from fossil fuels and, and change our banks. Well, we need to change. Our diet is the single most impactful action we can take as an individual plant based diet has 25% of the impact of a meat based diet. So we could vastly impact the planet's health. Um Just by our, our daily diet choices, all I can say is wow, thank you so much. It was really, really interesting. Are there any questions in the chat, Rebecca just having a look and seeing? Um So Dean was saying, thank you sh I was thinking about using New York City hospitals model in my project for my third year of study in my dietic degree at Cardiff. Did you have any comments on that? Do you know about that? II don't, but I know everyone. There's a great desire to, to implement that model and I'm really excited to be able to reveal cos I don't think it's a secret that we are about to appoint Green by default health care manager in the UK. So their first international post, the post closed on the 19th of June. And let's hope we appoint so watch this space. So please Dean reach out to me because hopefully in a few months time, we'll have a member of the team in the UK working with all of us to really implement what we can see as a kind of gold standard now. Perfect. Thank you. What, what an offer, Dean, I hope you take it. Um And Charlotte, have you tried? Uh So it's gone off the thing. Have you tried adding the carbon footprint to items also encouraging patient choice? That's a good point. Yeah, it's interesting, isn't it? And um so I'm on the same campus and site as King's College London, the University and they have gone down that road route and it, it is amazing to see. Actually, I haven't seen any outcome data from whether it changes choice, but they've already moved their menus to 65% plant based anyway. Um I guess, you know, for the hospital food, um we adhere to the BDA um guidelines in terms of health is the BDA digest and they don't necessarily encourage carbon labeling. It doesn't necessarily, hasn't necessarily been shown to support um the extent of change that we know these kind of nudge behaviors do. Um So I think what we know is that the way we describe the meal, the way we highlight it on the menu that not using the words veggie and vegan, um you know, making it sound delicious, normalizing it with dishes that people will recognize is much more impactful. And I think in the hospital setting, dieticians tend to not want to kind of go down that carbon labeling route. It sort of in a way, it is sort of pressuring the individual to make, make that choice in a way that feels um you know, that it's not necessarily um uh allowing them to make that healthful choice or their desired choice in a way, but II, II haven't seen any stats and II do know that actually guys from Thomas's is working with Clima CTO or Clito, the company and are going to be adding that. So it would be useful to see whether that changes behavior. The main problem for me in my hospital is that the food service delivery people go into the patient's room and say, would you like the beef chicken or fish? Right? Interesting language, isn't it? Which reminds me about which I mean, obviously there's a whole variable array of different models that we can use as practitioners. But in terms of a particular model, you talked about nudge theory there. You alluded to it. Do you use it in your practice or would you recommend it? Oh, I absolutely would. And so we've worked quite hard with compass, our catering partner at King's College Hospital to a get rid of the vegan and veggie labels um to put all the um plant based dishes first and foremost on the menu. So they're highlighted. Um and, and, and, you know, reduce the proportion in more um plant based versus animal foods. But as I say, or, you know, it, it goes to pot, doesn't it? If, if the person goes into the room and says, do you want beef, chicken or fish? So I think the key individuals, it's not about the menu. It's how about, you know, somebody saying I tried this yesterday. It's delicious. Why don't you have a go? Um And so yeah, I'll be happy to share our menus. But I think the key comes down to those people who are literally going around the hospitals. I think we need to do better with the staff catering and we certainly tried that, but we're in a little bit of a vicious cycle of the people that use the canteen want to go and eat the food that I showed you a picture of. So I don't go to the canteen. So when you change it around and have a veggie sausage or, you know, move it to a porridge or something, those people go into the canteen and go, oh and I haven't got my food and leave again. And so then the takings um drop by 50% on days that we've done meat free days because you can just cross the road and go to, you know, retailer across the road and get your and bacon and sausage. If that's what you wanted to do. So, we, we've got a lot of work to do incremental steps to greater things, isn't it? Yes. But we haven't, we haven't got time. That's the thing you're gonna, you know, spend four years trying to get more meals on the menu. Um, but, um, yeah, it's slow, isn't it? Yes. Well, thank you. Fantastic. Um, discussion and introduction, important things. Thanks. She can I please invite Cathy to present Cathy will be talking about nutritional care of older people. And thank you. Thank you very much. Thank you, Deborah. And thank you Shereen for that very interesting presentation that preceded mine. Um And in fact, what I'm gonna do um is um, oh, it's not the first time. Um What I'm going to be doing is starting at the workplace. Ok. And I'm going to be talking to you about a way in which we can foster the interest of our students and in particularly our nursing students in this context. So, previously I've worked with medical students, I mean, very instrumental in help in the development of the nut tank and some of our um other um medical student led issues, but this is particularly talking about a piece of work that's running with nursing students um to get them to think about food in the context of their uh clients they're caring for. So the nut capt project then um is about looking at nutritional care of adult people. Um It used to talk about adult patients. But increasingly, I'm working in settings outside of a hospital and therefore we've reframed it to think about adult people. And it really is about getting students to think about not just the nutritional needs of the population that they're caring for, but also how we can provide them um with um sustainable food um and have equitable access whilst they're feeling unwell in a variety of different care settings. So why nurses um if you look at the literature around um sustainable diets, if you look at the literature about nutrition, education, if you look at the literature about improving nutritional care, I'm often struck by how nurses are often absent from many national discussions. So in recent years, I've worked extensively in medical education around nutrition. Um and there's a clear advocacy voice from the medical students about what they want to see changing in their curriculum, how they want to see more plant based diets, for example, in the provision for their patients that they're caring for and they're much more vocal in calling for this change. But when you look for the voices of nurses, they largely are absent. Ok, certainly there's less written by nurses about the nursing role um in terms of nutritional screening assessment and care and many nurses despite being this being covered in their curricula, do not always consider the wider social determinants of health, including secure housing, good food and wellbeing. And yet as a population group, working with the in health and social care. Um We have the most consistent contact with patients families and their carers. We are the people that are often the first person who's seen on admission into a hospital. And we're routinely supporting the most disadvantages in our community and society, many of whom will have non communal diseases, very much influenced by food consumption. So picking up on what she had previously say, the, we know the impact that diet has on health, we know that the impact um the choices people may have on their long term health. And we know that making simple changes and making positive changes towards more plant based diet is going to be good for individuals health and for population health. And yet often those conversations around the diet that people are consuming um aren't being had and so that they're not being led by um nurses who who could do so much more in the practice that they're actually delivering. For example, we are leading the discharge planning and transfer care between primary and secondary care, private and voluntary organizations. So in this work that we're doing with nut CP, we are working across all care, health and social care settings from the homeless and insecure housing right through to the acute trust. So we're working in a variety of different settings and we're trying to improve nutritional care um at all points of contact as of anything we need to build on what is known. So I've alluded to the fact that nurses are key. We are also the largest health official group in the UK. Um, and yet we don't do as much as we could and we could possibly do a lot more. Why is that? There's certainly a lot of pressure to do other things. Nurses tell us that they are often being asked to, um, fill in the shortfall of staffing. They are encouraged to be more hands on that. They're not always um asked to think about what it isn't that they're doing in terms of their nursing role. Certainly, nutrition and food is not necessarily valued as a core essential by the health and social care system. We've known for some time, the importance of a good diet, both in preventing of health, ill health and the promoting of recovery and um wellness. And yet when you look at its provision um particularly in um health and social care settings such as hospitals, what you find is it's not necessarily valued or it's not seen as essential core to the recovery of, of people. And partly that's due to the fact that the immediacy of benefit is not necessarily obvious. So you feed somebody well in the hospital that will have an impact on their recovery and that might lessen their time in hospital and it certainly might have an impact on the readmission rates. But that immediacy that instant um benefit that you see by having a better dad is not always evident and it also requires there to be um harmonization of budgets. So we need to be thinking about what it is we're spending on our food and nutrition and our uh in an inpatient setting and not the benefit that does to the inpatient setting, but the benefit that does to the community setting, to the secondary care setting, to the private and voluntary sector. So we need to have a harmonization of food budgets across systems. Um So that individual benefits from a good diet are not measured by what is happening in that um environment. It's clear that there's a lot of uncertainty about roles and responsibilities. Um We have medical staff, we have dietetic staff, we have allied health professional staff whose responsibility, whose role it is to foster a positive and ongoing conversation around good food and for health and wellbeing. Um And I would ask that nurses start champion, this is a role that they can undertake not in isolation to the other health care professionals, but alongside the other health care professionals and certainly in working in close contact with their dietetic and medical colleagues, there are few positive role models and those positive role models tend to be quite disparate. So what we need to also do is create a culture. We talking about food in all health and social care settings and talking about good food. And the shift was a plant based start it becomes part of that normalized conversation. As Shereen was talking about normalizing it in terms of the food that's being offered, we need to normalize it in our daily conversations in health and social care settings. And we need to ensure that all of our health professionals and in particular, our nurses for the purposes of this have good education and training around the positive benefits of having a healthier diet. So, one of the principles of against um why NCAP was founded? Well NC was originally funded through an external grant and has some founding principles. One of the things that we noted was that all health professionals says that food and fluid are important. I've yet to meet a doctor, a nurse, a dietician, a physio podiatrist, a nutritionist who doesn't tell me that food and fluids are important. But as I've already said, is not always a pre a priority in health and social care settings. Despite that, there is a general consensus about what foods are better for health. She quite nicely illustrated this in her previous talk when she talked about the benefits of a plant based diet. I don't think anybody is now in disagreement with that, that a plant based diet um is what will support you both to, to be well and to stay well into the future. However few people consider the multiple global challenges that impact food production and the impact by environmental issues and global ecom have on food provision in health and social care. We do have to change the way that we're thinking. We do have to change the way that we as people, not only look after our client groups, but also consider how in looking after our client groups that will have an impact on our wider environment and on our planetary health, we do need to start that conversation because this isn't going to change quickly If we want to support our health and social care systems to invest the thinking, the time and the money to shift towards a plant based start, then we do need to have some very difficult conversations and we do need to think about the impact that this change will have and the time frame within which this change needs to take place. It is clear that we need to act quickly but changing food production is not necessarily a quick thing to do because systems are geared up for the future. And so if we need to change the way that that food production systems are thinking, we need to be thinking about what we're doing now to impact on that in 2345 years time and how we can harness that change into the food and food product uh provision for our health and social care settings. And we also need to think about food waste, food, waste of our existing provision of food is quite high and the cost um is substantial and yet the cost of malnutrition in our healthcare settings is is somewhere around 20 billion lbs per year and that is also unsustainable. Are you always done? Yes, I am perfect. Thank you. So, focus on hylax to good food in health and social care. We recognize that each health and social carer has its unique set of challenges and issues to address a one size fits all approach won't work. There have been recommendations for many years about what are what we should be giving people and we know that that's not working. So we're using student nurses to harness their enthusiasm and drive for change. They are keen to learn and we're using this in the form of um setting up a series of clinical placements that students will have um to meet their NMC requirements and to help them to develop as nurses for the future. And so our aim then in terms of nut CAPP is to initiate food conversations that are actively contribute to discussions relating to the provision of food from production to consumption, to better understand the food and nutrition experience of patients during times of illness, to identify and understand the barriers to plan nutrition care within identified settings. Identify gaps in knowledge, improve professional working and most importantly identify sustainable cost effective solutions that can be implemented and sustained to improve nutritional care in the constraints of the individual settings and their patient population. So as nut cat what we're aiming to do then is to try and address on a multifaceted level, the issues of what food we're actually giving our clients and our patients in the settings in which you're working. And how does that align with a sustain sustainable diet as advocated through a plant based approach? Thank you. Thank you, Cathy. Fantastic. Really, really interesting information. And I'm really curious about, you've talked about several things, but in terms of joined up systems, it's absolutely vital, isn't it? And thinking about our own roles and responsibilities and I think people do, we know what to do and what to say and how to bring this about because it's our own. We're all leaders, aren't we and all that we do. Um So it's like, how do we lead for this? How do we also influence strategically because it has to come from the top, doesn't it? It has to be strategic decision making here to enable this to happen and we seem to be talking about this over and over. But where are we gonna get the shift? I think, I think we can learn a lot from some of the things that medical students have been doing. Actually, the medical students have, have become a very strong, a efficacy voice for improving the diet and nutrition with a strong focus towards plant based diets and those sorts of things. You are right. We do need a strategic top down approach, but we need a we need a top up approach as well because actually, it's only when both those approaches are having a common language around food production, food production, food consumption. And what we actually mean are we going to get any um sustainable change going forward all the time? It is siloed into particular groups of people speaking on their own. Then the chances of getting any sustainable change is going to be negligible. I think the key thing to always think about is that food production is a long term strategy. Had a long term strategy since the 19 thirties, 19 forties about increased food production, which is premised on a meat based diet. We now need to have a long term strategy that's premised on the fact that we need a plant based diet before so that we can instigate that needed to make food availability and access of food availability to all of our people in our nation. Um And at the same time, a top down approach to drive forward these changes um in all settings where there is public money involved. So we need, we can use the public funding initiative. Um We're all spending public funds. We could use that initiative to drive forward um a plant based agenda. And at the same time, we can harness enthusiasm from our students coming forward, all of our students to try and instigate that change at a at a local clinical patient, patient benefit level. Thank you. Great answer. Rebecca. Are there any questions that we in the group? Uh Anyone there anyone like to ask a question of Cathy? You can always pause and think about it and come in at the end. I just thought it was an opportunity here. Cos II find this all fascinating. It's about also how we work together is what you're saying, isn't it Cathy? How we bring people together in this? We do. And I think the start is to have a food conversation, not a nutrition conversation, a nutrition conversation is around science as is. And as she said, we do know a lot of the science. But what we need to have is that it's a food conversation. So we're comfortable to talk about the sorts of foods people might be eating, um, and possibly not become sidetracked by the science, the nutrition of it because actually what we do know is that a plant based diet is a healthy diet. And I was really heartened by what she said about is we don't want to talk about veggie or vegan. We want to talk about a plant based diet which is, uh, far more of a traditional diet than most people are probably aware of. Yeah. Thank you. Excellent. Really fascinating session. Did you want to add anything Cathy? I think we could talk about this forever, couldn't we? Not really? I think from my perspective, um, there is so much work that needs to be done in this arena. Um And I think one of the joys of having opportunities to talk about it is that we take it from the, the periphery. So we take it from the sidelines of health and social care and we try and place it central to all the things that we're actually doing. I mean, food in of itself is a fantastic normaliser. Um in conversation with a wider range of people there, everybody needs to eat food and that, you know, as healthcare professionals, as nurses, as doctors, we can use food as a therapeutic tool to engage in those conversations. And at the same time, we can start those conversations around what is a healthier diet without making it feel like it's insurmountable, unobtainable or for only for a select few with lots of resources and means. Great point. Thank you, Cathy. Brilliant, very impressive. So thanks very much normalizing it. Having that conversation being really, really key well done. So shall I bring in Charlotte? As our last speaker, as I mentioned, Robert's not joining us today. His abstract is available. He wasn't able to at the last minute. Unfortunately, Robert was talking about reducing the amount of wasted food in Hampshire's Hospitals Foundation Trust. So that is available to you to view the presentation, Charlotte. I think you'll be talking about rethinking food waste at Froome. I hope I'm saying it right? Medical practice. Um I was there not so long ago. A beautiful place, isn't it? Um I was just uploading my slides. Thank you for having me. Yes. And I didn't realize Richard wasn't presenting. Sorry, I was kind of that everyone's got slightly longer. So that's absolutely fine. We just, ah, interesting. So, yes, we're talking about food waste as well. So, hello, I'm Charlotte Carson and I'm the community sustainability leader for your medical practice. We're a small market town and our patient population is around 30,000. So I work within the medical practice. But our funding for my role and my other sustainability colleague, our role is funded by the National Lottery and we're part of a project called Green and Healthy Firm. So uh we have uh different parts of our project that we work on looking at um key carbon hotspots. And the unique part of our project is that we are partnered with Frome Town Council, our local Council and Adventure, which is a social enterprise school. So we have a really unique position and lots of capacity and resource among us. This project is actually something that's just developed over time is that was, was never really clearly laid out within our targets and outputs. Um And they're always the lovely ones. So we have um rece we received money for our COVID vaccinations at the practice and built raised beds in our garden area at the back of the practice. And these were raised beds for staff who didn't have growing space or who wanted outside time, outdoor time. And we realized that we were generating quite a lot of waste from our raised beds. And also we have the food waste from staff in the kitchen areas. So, oh, I need to click here for the slide, sorry. So we realized the potential for of composting. And the reason we invest in, invested a bit of extra time into this is because we know it achieves many different things. So saving money for staff when they're putting compost on their raised beds, saving money for the practice in terms of the waste. So our compost, our food waste in inverted commas was put into landfill, our general general waste initially. So we're saving money there and also sustainability is one of our core values. So this really, this project really brought um all of these, these things that we were talking about together. We're obviously reducing our landfill, supporting biodiversity and uh supporting the education of nutrition and growing food and understanding our, our, our connection to our, our soil and our, our growing ourselves. We um so we did an audit of the food waste from the, from the staff kitchens and realized that we had a significant amount that we, we could start processing ourselves on site. So we went to I keep using the, the keyboard. So we went to aura which is our landlord of the building. So you can see the top images of the building before we put the raised beds in and the bottom images is what it looks like. Now, this was last summer. So we filled the space with a wonderful area for staff to go and have a break. So we went to Aura with the savings that we predicted and said we could, we could save this amount of money. We could really demonstrate the potential for other sites because Assura has quite a few medical practices across the country. And we could really start communicating to patients. You can see there's large windows. Um So, so the large windows you can see at the end of the path are where the patient waiting rooms are. So they can see right out into the garden. They can see the composers, they can see that we're growing food and they can see staff sitting and having their lunch on the benches outside. So we proposed this to assure and they gave us a generous amount of money that bought us two hot composites and the, the gos that go with it, the, the wood chip and the sawdust to process it. And we generated a bit of interest from volunteers around the practice and we uh we were so successful. We had to go back to the suppliers and Loop Froome, who's the community organization that we, we had support from and we had to request another compo this year. So they, they gave us another compo. We have three hot composers on site where we put all of our stuff, food waste into that. Some extras from the garden and outcomes. Yes, we have had it tested some really wonderfully nutritional and rich compost. So yeah, we got it tested, we sent it off and it's so much better than the best compost you can get from uh the the local retailers. So we costed it and we think we um have saved staff who were using the gardens 380 lbs and then 100 and 20 in not going to general waste. So then in terms of emissions, ah yes, I forgot to say we did. We have actually started weighing all the composts that we uh that we uh get rid of. So we, we have a patient weighing scales area downstairs or reception and we take our caddies out and each volunteer measures the weight and we calculate out how much we've uh how much compost we've, how much food waste we've saved. And uh we have calculated that we've saved up to 12,400 kg of um carbon each year. So when it says the C two of, of me, that's obviously the equivalent most people know. But the um in terms of food waste, we calculate that 1 kg of food waste emits 8 kg of methane. So that's how we've, that's our um measure that we've used in this. And then of course, we know that we've been talking about this uh in the first two sessions, we know that ill health is, is um is costing the N HSA lot along with our poor health as individuals and as a medical practice, we want to recognize that this has a root in um in where our food comes from and that understanding that education. So this project really, although maybe doesn't have necessarily a direct impact on or it's hard to measure that direct impact. We're wanting to make those nudges from various directions. So having this project outside and having staff being outside growing their food, talking about it on social media, turning up to other projects to support them to do the same along with our group session, our diabetes group sessions and having this is something that, that the clinicians maybe can use as, as being role models in our community is really important to us. We obviously have seen a huge increase in biodiversity in the staff area outside. We um before we just had plain grass that you could see in the, in the first photo and now it's an abundance of wildlife. We've recently had the hedge that's around the outside of the building laid. And this has also um given us a lot more light in the area. And this summer, we've seen the hedge growing and developing and then more birds coming in. And we found, well, a member of staff found a bird's nest but wouldn't tell anyone where it was so that we didn't disturb it, but we've seen a, a lovely bird's nest um on our site as well, which is just gorgeous. There's a little robin that hops around every time I'm there working on my bed. So we um what this has done is it's given us the opportunity to use the space outside. So you can see here some photos of some examples of um sessions that we've held outside. So we've, we've had Carol singing in the outdoor area. We've had a so uh social prescribing service come and um demonstrate the dogs uh that support health dogs for health. We grow flowers for staff when they first arrive in one of the beds and we've had various lunches and events um in the outdoor area as well. Last year. Oh, this year, last year, we also were awarded the NHS Forest Innovative Spaces Award and we've run, we've uh we've won silver in the Froome in Bloom competition, the local, the local er growing competition around here as well. So we're very proud of those 22 awards. So, what we, what we've done here is it started off as a really small idea where I was just measuring compost and seeing what we could do. And it's turned into a, a great project where 14 or 15 volunteers, out of 100 and 40 staff are involved and really keen learning loads more, talking about it all the time. We um we also get questions from patients as they walk through the practice asking us about the the gardens. So we have um we asked the local illustrator to, to put these diagrams together and we have screens next to the windows that look out to the gardens, explaining and starting that conversation with patients. So if they wanted to know more, they can look on these screens and interact with uh with this here. So yeah, this was just like a, a small project that has developed into something really interesting and a lot of people are interested to find out more and um I could talk about compost for a very long time. So if there's any questions, um yeah, we, we, you know, we really recognize that it's, it's looking after our soil and putting nutrition back into the ground and getting people's hands dirty so that they start to feel more comfortable with the outdoors as well. I just do, you know, I actually think what you've done is absolutely brilliant. I just, when Cathy is talking about working together and we need the shift this change. Um And a hands on approach, it's just you're emulating that and I just wonder what that created for the staff. How did, so there's been some interesting feedback, one. I mean, normally the conversations happen in the staff room, right? So we um we, we, you know, if I'm in there, we'll talk about composting rather than checking it in land waste landfill. And someone said, well, I I'm gonna get my compost bin back out at home. I mean, I was really surprised that they weren't composting at home. But uh it, it sort of inspired people to grow, inspired people to spend time outdoors, take a break from the screen um with permission to, to invest in their, in their site and their place as well. It's really interesting and II wonder if that's had an impact on their wellbeing because we often forget to put staff at the center, staff is so crucial that staff is so crucial, we forget and it's often about you're reaching out to other, you're serving other. But actually, in order to sustain everything, you need to look after yourself and staff are really important. So this is doing so many things on so many different levels, isn't it? Yeah, we've had um Yes. So having the space outside, we're trying to now get more staff outside and we're holding workshops out there just or encouraging meetings out there. And uh one lady sat down in a meeting with me on the bench and as soon as she sat down, she s uh she works at the prescriptions team. So they have nonstop phone calls coming in and she was like, this is just what I needed and it was just a really short moment that just reset her and, you know, we need to look after ourselves. Right. Yeah, absolutely. But did you also find that the, you talked a lot about savings and cost savings? You did you find that that was a necessary part of maintaining and growing the project? So we, we did know that at some point, we would have to demonstrate the, the cost savings. I think it was just looking into the future knowing that it would be useful for other sites. So the hospital, the community hospitals right next door to us and they saw our composting project wanted to um to do the same and we were able to give them not just these lovely anecdotes from staff, but we were able to demonstrate the cost savings um of this and the carbon savings as well. So it's we, we we gathered that information. So it was more useful for others. Really. I think, I don't know, Rebecca, please feel free to come in. I don't want to just be talking here, but I've seen some really positive comments in the chat. It's such a great way to start a conversation with patients and colleagues bringing people together is the key thing, isn't it? Um Abigail is saying we're using a community composting scheme in a research hub, just composting staff, food waste, great idea to weigh the waste to it. Yeah. Yeah. It's, it's really funny walking down with our, our compost caddies at the patient. It starts good conversations. We had the, the C QC came to visit us recently. Um and we, they also, you know, we showed them that site as well and they were really impressed, you know, it's so there's been, we've obviously gone through infection control and we've made sure that this, the whole thing is, is suitable for these sort of sites. So I encourage anyone to, to look at this and get in touch if there's any questions or you need any more. I think I'm just checking the chat. One thing I need to ask you, tell me more. Tell us more about hot compos. Yeah. So the reason I don't know about them, the reason there was push back at first is because of the um to the pest infestation risk, but these are a sealed unit. So that's the first thing that's great about them. They also speed up the process completely and they go through two different stages. So any, any um problematic parts of, of like any weeds or any um diseases in the plants will be burnt off essentially when they go through that process. So it's a really safe process for our site in many ways. Mm. So you'd recommend them. Yeah, absolutely. Thank you. Brilliant. Not any other questions from anyone for Charlotte. Any comments? Can I ask Charlotte something? Of course, you can Cathy um Charlotte. Have you thought because obviously if you're using the hot composting system for generating heat, have you thought about utilizing the heat production for something else? It's just that, um, the beauty about a hot composting system is that you can run, you can run water pipes through the center of it so you actually can get some warm water out and all sorts of other things as well. So I just wondered if you thought about that really. And, and also whether or not you're engaging your patient groups in it because you know, food conversations, um, when you were saying he was looking out the window at your lovely garden and I was thinking maybe going out into the garden is be better therapy than seeing the doctor. Not that I'm saying the doctors aren't great at your practice, but it just made me think about those things. Good point. Good point. So, yeah, I mean, there is one doctor who's, who's part of our team, but there's, there's a whole range. So the social prescribers and nurses as well. So it's all, all staff are involved, which is also the beautiful thing about um this project. But we, because it's a confidential area, we only open it um to on special days. So we do maybe two visits a year um for, for patients and, and you know, they were, they well attended. The last one wasn't so well attended, but they have been in the past patients are interested to come and see our sites, but more than patients, we've had other organizations interested to come and look at what we're doing. So they can close the loop on their own systems as well. And what was the first thing you said? I mean, yeah, there's so many things that we, you know, it's, I was, I was wondering if we could get to a temperature where clinical waste would be safely composted at some point. If we're, if we're looking well into the future, like, is there a way we can generate that heat and safely dispose of clinical waste? Um In that process, we haven't captured the heat. But yeah, in winter, we were opening the hot compos and they were steaming getting up to 80 degrees. Even in winter, we haven't got to that. Our building also has um solar thermal already with the hot water. So, hm, there's such a common theme between the three of you here. I don't know if you've noticed it, but you're all thinking future, you're all thinking ahead. Not just the now, which is such short termism, isn't it? But you've all said it in different guises. So it's fantastic. There's one question here from William. I read, I read such an inspiring book on from medical practice, the Compassion Project. Do you know about that, Charlotte? Yeah. So this was um this was written a few years ago. This was before I started and had this funded role. Helen Kingston and Jenny Hartnell. They, it's quite a mature social prescribing service that we have in room and they've set up the social prescribing service, the complex care team and the admin team, and there's a whole patient, whole patient approach to um to, to the patient pathway. And the compassion project was, was a, was a brilliant project. And we're standing on the shoulders of that essentially our green and healthy room project. Um So in terms of fitting into the wider work, they're very much central and we we chat daily to the social prescribing team. They're very much part of this. So there's a real sense of joined up thinking, joined up working collaboration, a hands on approach to everything that you're doing. Wow, it's impressive, isn't it very impressive in Bristol? Because the Nutri which is the Medical Student Organization Health that originated in Bristol. Um And I'm from that area, so I have a very soft spot for that Southwester area as well. So if there's something about that geographical location, which is quite innovative around um widening this conversation around sustainability, around food, food production, well being and health. So it's, it's um I think it's something about the j something quite special around there. Yeah. And William says, I agree. Go Bristol. I think there's something about what I've noticed is about saying, saying you're doing something and then you have a um a reputation to live up to. And I think we do that consciously so that we have to keep pushing ourselves. Um I don't think there's anything special about from or Bristol, I think there's, there's potential in all these areas. I just think maybe there's a bit more shouting about it. Yeah, but maybe there's an emphasis on being more conscious around what you're doing. And that's a really good thought, isn't it really thinking creatively to join things together? Um Very, very important. Thank you so much. Really, absolutely brilliant. All of you um really inspired talks. We're gonna finish now. It's 1340. The next session starts at uh I think it's 1350 where we go into, let me just check this for a second. Yeah, sorry, 1355. So we're Fi Barner. So we've got the midpoint address. Then at two o'clock, there's the keynote speaker two. So unless anyone would like to add anything, I'll bring the session to a close. Would anyone like to add a final comment as we've got this five minutes to play with if we wish to she Cathy Charlotte? Just some words of wisdom to go away with and let's just keep these conversations going. I think that's the important thing is to keep all these conversations going. Um So that we normalize conversations around sustainability, around food, around health. Um That would be great. Yeah, II agree. I think keeping, keeping it on the table is a topic all the time and yeah, not, not feeling shy about, about bringing it into the conversation all the time being bold, being a bit bold, taking, taking risks. Yeah, taking risks. Thank you so much and, and just to bring it back to ourselves, you know, we can go all commit to taking one action today around what we've learned, whether it's, you know, making a change to our diet, popping, you know, meat out for beans, whether it's going back to our workplace, having a look at the menus and saying, you know, we need to make a change and sort of uh following that through or, you know, um starting something in the, in the community that raises awareness around healthy sustainable diets because it's win, win for, for everyone. Um If we are to, to move this forward. Yeah, what, what, what a perfect ending. Thank you, Shereen. You've all been absolutely amazing. I've really enjoyed it as well. Um Very, very inspired. So thank you so much for joining us. I'll see you next time. Thanks everyone. Take care. Bye.