NHS Modernisation Listening Exercise
Room 605
Richmond House
79 Whitehall
London SW1A 2NS
Victoria House
Capital Park
Fulbourn
Cambridge
CB21 5XB
Tel: 01223 597792
Fax: 01223 597712
Web: www.sdu.nhs.uk
18th May 2011
Dear Sir/Madam
Re: NHS Modernisation Listening Exercise
The NHS Sustainable Development Unit (NHS SDU)1 welcomes the opportunity to
respond to this Listening Exercise. Our response is in the form of a letter, so that our
suggestions for improvement can be conveyed in a more overarching way.
Background and Principles
The goal of sustainability in health is the creation of a sustainable health system
which meets the needs of today without compromising the health and wellbeing of
future generations. A sustainable health service provides many health co-benefits.
For example, if more people cycle they will create a less polluted environment, enjoy
greater health and improved mental well-being, and be less likely to require NHS
services.
The interpretation of sustainability used in the DH documentation on the reforms
relates in most cases to financial stability. However, this terminology is too narrow,
since the actual definition includes social and environmental considerations in equal
measure.
Embedding the wider principles of financial, social and environmental sustainability
into the NHS modernisation programme will help to:
1. Improve efficiency
For example, better use of ICT by the West London Cancer Network saved
5,500 hours of consultant time in 2009
2. Reduce waste of energy, water, products, services and time
For example, the NHS Confederation calculated that recycling all paper and
cardboard in the NHS would take around 17,000 cars off the road.2
1
The NHS SDU provides leadership, expert support and technical guidance across the NHS in relation to
sustainability. It does this by working in close collaboration with NHS organisations, DH, DECC, Defra and
environmental groups.
The NHS Sustainable Development Unit develops organisations, people, tools, policy and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
3. Meet budget restraints
The NHS SDU has developed analysis which indicates the NHS could save
£180 million a year through sustainable initiatives.3
4. Enhance the QIPP agenda
Quality, innovation, productivity and prevention are all essential parts of a
sustainable health system.
Listening: Choice and Competition
An excellent way of creating choice and competition for the NHS is to ensure the
social and environmental impacts of products/services are reported in a transparent
way by healthcare providers. This will drive up the quality of healthcare by enabling
patients to make ethical decisions and commissioners to purchase sustainable
products/services. For example, contract wording could state: “the Provider will
ensure a process and system is in place to measure, monitor and reduce carbon
significantly across the organisation”.
Procurement in the NHS is responsible for 60% of the entire NHS carbon footprint.
Making sure that carbon reduction is addressed systematically across the service will
help reduce this percentage dramatically, drive up quality and reduce costs.
Measuring and reporting on sustainability4 is an important element to measuring
excellence and quality while providing choice and competition. The more information
and choice patients and commissioners have, the greater the competition. An ability
to assess the sustainability credentials of an organisation means users can choose
services more ethically, something which the public is increasingly demanding.
Accountability and Patients
A sustainable health service allows patients to take greater ownership of their health.
Demand is reduced through prevention, better management of long term conditions
and providing the appropriate care or treatment closer to home. It also provides a
better quality of care by being more accountable to the public it serves.
Adopting sustainability more widely will help the NHS become less of an illness
service, and more of a health service.
Patients will be offered more
lifestyle/behavioural change opportunities, rather than surgery and medication
procedures, enabling demand to be managed in the longer term. Risk preventative
and self management measures should be incentivised and promoted as the default
choice where clinically appropriate. Mandating health and wellbeing boards to
promote actions which meet current needs without compromising the needs of future
generations will be essential for a sustainable health service.
2
Taking the Temperature –Towards an NHS response to Global Warming, 2007 London: NHS Confederation
3
NHS UPDATE Saving Carbon Improving Health: NHS England Marginal Abatement Cost Curve, 2010 Cambridge:
NHS SDU
4
Reporting on Sustainability: http://www.sdu.nhs.uk/publicationsresources/62/NHS-Reporting-on-Sustainability/
[Accessed 17 May 2011]
The NHS Sustainable Development Unit develops organisations, people, tools, policy and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.
Education and Training
The NHS SDU works closely with many NHS organisations and stakeholders to
promote sustainability and carbon reduction as part of core education and training.
Many medical schools have incorporated sustainability into their curriculum, and an
increasing number of human resources departments include sustainability as part of
the organisations’ induction programmes. There is now an opportunity to embed
sustainability in all medical schools and in relevant areas of the NHS.
For sustainability to be embedded into education across the NHS, it is important that
the new education structures encourage multidisciplinary learning and focus on
system wide quality improvement. These changes must not erode current progress
being made to incorporate sustainability into curricula and practice.
Education and training is essential for communicating the great health benefits that
can be gained by increasing sustainability and minimising the impact of the NHS on
the environment.
Advice and Leadership
Creating an excellent health service which provides the best and most appropriate
care for patients relies on the health service being sustainable. A system which is
financially fit, but which ruins the environment where people live, is not socially
acceptable. Getting the right mix between financial, social and environmental
considerations is key to creating a stronger NHS. Achieving this will require great
leadership and the willingness to listen and act on advice.
Clinical leaders are already recognising that sustainability is a key part of providing a
quality health service. For example, the Royal College of General Practitioners has
placed sustainability as one of five foundations for commissioning. The NHS should
support this clinical leadership and recommend that GP consortia are mandated to
incorporate sustainability into the constitution of the consortia as they are set up.
In summary, the NHS SDU strongly recommends that DH considers and truly
embeds an integrated approach to financial, social and environmental sustainability
into future NHS functions and structures. It is our duty of care for the health of
current and future generations.
Please do not hesitate to contact the unit for any further clarifications or questions in
relation to this response, or if you need help to incorporate these ideas into the
reforms.
Thank you for the opportunity to respond to this Listening Exercise.
Yours faithfully
Karl Heidel
Communications Manager
NHS Sustainable Development Unit
The NHS Sustainable Development Unit develops organisations, people, tools, policy and research
to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.