Sustainable healthcare: the NHS launches a new strategy As one of the world's biggest employers, there can be no better sector or better time to set out examples of the NHS's responsibilities for the future, writes David Pencheon.
Some of the key players in the public sector are coming together this month to launch a joint approach to sustainability.
Emerging approaches to health, care and wellbeing need to be increasingly environmentally sustainable, financially sustainable, and also make far smarter use of our virtually unlimited social and human capital. Most health is won or lost outside formal health and social care settings. How we eat better, how we move our own bodies more, how we develop new ways of protecting and improving health, and how we build more resilient communities can all provide significant short-term and priceless long-term benefits for our health and communities.
Key challenges to embedding sustainability in the health system include reducing its huge environmental impact, while remaining within increasingly tight financial limits. For the health and care system, a large sweet spot exists where environmental and financial sustainability coincide. Avoiding unnecessary environmental harm and reducing waste can also save money (witness how many hospitals are changing to ultra-low energy lighting).
At the same time, the system needs to help build resilience into people, families and communities, particularly in light of the increasingly frequent extreme weather. This depends on supporting effective networks within communities, locally and globally, that enable the health system to provide support and services with people rather than just to people.
The strategy, launched jointly by leaders from the NHS, the social care system, local government, and Public Health England, is based on three principles.
Firstly, a healthy society depends on a healthy environment: clean air to breath, green spaces for children to play in, safe places to walk and cycle, and a radical reduction in our greenhouse gas emissions.
Secondly, the health and care system is increasingly aware of the benefit of helping to develop resilient communities: resilience that is fundamental to health and wellbeing, both in times of relative stability, and in times of crisis.
Thirdly, the health and care system can take every opportunity to work with people to prevent the preventable and manage the manageable. This means helping us all improve our understanding and control over our own health, illnesses, and life chances, within our homes and communities. The traditional model of us being well, then ill, then treated, then better, is increasingly outdated. Most of us will live with multiple conditions that we will largely manage ourselves with the support and guidance of the health and care system using improved information, integration, collaboration and technology.
This third plank requires a cultural shift for public, patients and particularly professionals. We may need more diverse business models for providers of care. We could reward care providers for the amount they reduce death rates or health inequalities or survival times or for simply improving the experiences of patients.
Those who commission healthcare are increasingly choosing to pay for outcomes. Examples include the way substance misuse is managed and reduced in Milton Keynes, and how musculoskeletal care is paid for in Bedfordshire, or even how we avoid care being less focussed on a hospital setting and more in the community as is being considered in Oxfordshire, Cambridgeshire and Croydon. This can be through more community based programmes, interventions in partnership with the voluntary sector, or even care in the home using newer technological opportunities like mobile phones. Rewarding providers of care for outcomes rather than just activity might untap more creative, cost effective, and appropriate ways of keeping people informed, independent, and healthy.
This transition, partly technological, but mainly economic, social and cultural, will only happen through honesty, collaboration, public involvement and the innovative use of business models and technology widely used elsewhere in society to deliver a safer, fairer future.
This strategy for the future has been shaped and supported by partners across the system, not just by a single organisation. This is vital because, although we know much about what needs to be done, we really are not yet certain how to do it together, ensuring our collective efforts add more value than the sum of our individual approaches. Forging all these approaches into a sustainable, system-wide approach avoids the trap of false choices, thinking, for example, that a growing economy is more important than a liveable community for our children.
The health and care system should not consider itself immune from the challenges (and opportunities) that a rapidly changing world presents. A future-focused health and care system is the most obvious representation of a collective effort for the common good.
But we need to be both positive and realistic about the scale and pace of what is needed, learning from other large-scale changes. Creating the right conditions for a fair and sustainable future needs change on the scale of abolishing slavery, or eradicating cholera and smoking.
There can be no better sector, and no better time, to set clear examples of our collective responsibility to the future. What is being proposed is good for the purse, good for our families, and good for the future.
Dr David Pencheon is director of the Sustainable Development Unit (SDU), which works across NHS England and Public Health England to help the public health, healthcare and social care systems develop a healthy, fair and sustainable approach. The Guardian
See also:
Some of the key players in the public sector are coming together this month to launch a joint approach to sustainability.
Emerging approaches to health, care and wellbeing need to be increasingly environmentally sustainable, financially sustainable, and also make far smarter use of our virtually unlimited social and human capital. Most health is won or lost outside formal health and social care settings. How we eat better, how we move our own bodies more, how we develop new ways of protecting and improving health, and how we build more resilient communities can all provide significant short-term and priceless long-term benefits for our health and communities.
Key challenges to embedding sustainability in the health system include reducing its huge environmental impact, while remaining within increasingly tight financial limits. For the health and care system, a large sweet spot exists where environmental and financial sustainability coincide. Avoiding unnecessary environmental harm and reducing waste can also save money (witness how many hospitals are changing to ultra-low energy lighting).
At the same time, the system needs to help build resilience into people, families and communities, particularly in light of the increasingly frequent extreme weather. This depends on supporting effective networks within communities, locally and globally, that enable the health system to provide support and services with people rather than just to people.
The strategy, launched jointly by leaders from the NHS, the social care system, local government, and Public Health England, is based on three principles.
Firstly, a healthy society depends on a healthy environment: clean air to breath, green spaces for children to play in, safe places to walk and cycle, and a radical reduction in our greenhouse gas emissions.
Secondly, the health and care system is increasingly aware of the benefit of helping to develop resilient communities: resilience that is fundamental to health and wellbeing, both in times of relative stability, and in times of crisis.
Thirdly, the health and care system can take every opportunity to work with people to prevent the preventable and manage the manageable. This means helping us all improve our understanding and control over our own health, illnesses, and life chances, within our homes and communities. The traditional model of us being well, then ill, then treated, then better, is increasingly outdated. Most of us will live with multiple conditions that we will largely manage ourselves with the support and guidance of the health and care system using improved information, integration, collaboration and technology.
This third plank requires a cultural shift for public, patients and particularly professionals. We may need more diverse business models for providers of care. We could reward care providers for the amount they reduce death rates or health inequalities or survival times or for simply improving the experiences of patients.
Those who commission healthcare are increasingly choosing to pay for outcomes. Examples include the way substance misuse is managed and reduced in Milton Keynes, and how musculoskeletal care is paid for in Bedfordshire, or even how we avoid care being less focussed on a hospital setting and more in the community as is being considered in Oxfordshire, Cambridgeshire and Croydon. This can be through more community based programmes, interventions in partnership with the voluntary sector, or even care in the home using newer technological opportunities like mobile phones. Rewarding providers of care for outcomes rather than just activity might untap more creative, cost effective, and appropriate ways of keeping people informed, independent, and healthy.
This transition, partly technological, but mainly economic, social and cultural, will only happen through honesty, collaboration, public involvement and the innovative use of business models and technology widely used elsewhere in society to deliver a safer, fairer future.
This strategy for the future has been shaped and supported by partners across the system, not just by a single organisation. This is vital because, although we know much about what needs to be done, we really are not yet certain how to do it together, ensuring our collective efforts add more value than the sum of our individual approaches. Forging all these approaches into a sustainable, system-wide approach avoids the trap of false choices, thinking, for example, that a growing economy is more important than a liveable community for our children.
The health and care system should not consider itself immune from the challenges (and opportunities) that a rapidly changing world presents. A future-focused health and care system is the most obvious representation of a collective effort for the common good.
But we need to be both positive and realistic about the scale and pace of what is needed, learning from other large-scale changes. Creating the right conditions for a fair and sustainable future needs change on the scale of abolishing slavery, or eradicating cholera and smoking.
There can be no better sector, and no better time, to set clear examples of our collective responsibility to the future. What is being proposed is good for the purse, good for our families, and good for the future.
Dr David Pencheon is director of the Sustainable Development Unit (SDU), which works across NHS England and Public Health England to help the public health, healthcare and social care systems develop a healthy, fair and sustainable approach. The Guardian
See also:
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