Sustainable health and social care

Connecting financial and environmental performance

Chris NaylorJohn Appleby

Clinical perspective

A focus on the individual patient-professional encounter

Public health perspective

A broader responsibility towards the whole population

Sustainability perspective

Sustainable development theory

The two-way relationship between environmental change and health care

The scale of the problem

Knowns and unknowns

We know that– the NHS has a significant environmental impact– environmental change is likely to have effects on health and social

care needs, particularly among socially marginalised groups.

We know less about– the environmental impact of social care, non-NHS health care, and

particular organisations, pathways or population groups – exactly how health and care needs will be affected by

environmental change, who will be affected most, or how service delivery will be affected.

Connections with other system objectives

Sustainability and QIPP

Both agendas call for a re-focusing on efficiency, value and prevention of avoidable activity

‘Anything we can do to achieve the QIPP agenda, which is all about reducing waste and inefficiency, is likely to improve sustainability at the same time.’

Consultant renal physician

‘Whenever there is wasted expenditure, there is avoidable environmental damage as well.’

Sustainability consultant

Sustainability and public health

Growing evidence base on a number of potential co-benefits

– Promoting active travel– Reducing meat consumption– Improving insulation in housing– Improving access to green spaces

Sustainability and quality of care

The link between effectiveness and sustainability:

‘Evidence-based interventions by their nature should be greener – because they actually work.’

Director of health care charity

Would a more integrated system, providing well-co-ordinated support for people’s multiple needs,be more sustainable from both an environmental and financial perspective?

“A lot of the policy aspirations that we have about reducing duplication, joining up services, offering more integrated services, would also produce sustainability benefits”

Social care policy expert

Opportunities to improveenvironmental sustainability

Changing service delivery

WhereSustainable facilitiesMinimising ‘care miles’

Changing service delivery

WhereSustainable facilitiesMinimising ‘care miles’

WhatLow carbon pathwaysPreventionEvidence-based care

Changing service delivery

WhereSustainable facilitiesMinimising ‘care miles’

WhatLow carbon pathwaysPreventionEvidence-based care

HowIntegrationPharmaceutical & technologiesPreparedness for environmental change

Changing service delivery

Making it happen

Driving sustainability within organisations

Evidence from other sectors suggests staff engagement & senior leadership is criticalDeveloping a learning culture within organisations – devolving responsibilities & permitting experimentationUsing procurement and commissioning processes to drive sustainable practicesWorking with patients and the public

A supportive policy framework

Redesigning payment systems to remove perverse incentivesUsing regulatory mechanisms & other leversCreating a policy framework that permits a long-term focus in organisationsHolding organisations to account for performance on sustainabilityDevelopment of metrics for sustainability

A framework for future researchResearch on innovative approaches to health & social care

Research on behaviours, attitudes and cultures

Systems-level and policy research

Research on future needs and pressures

Direct

Co-benefits of sustainable approaches

Measuring environmental costs

Barriers to change in organisations

Procurement & commissioning

Engaging professionals & the public

Building resilient communities

Embedding sustainability in existing policies

Identifying policy levers to promote sustainability

Developing & evaluating metrics & methods

Modelling risks to the system

Health impacts of environmental change

Indirect

Prevention Prescribing &

medicines management

Cost-effectiveness research

Self-management

Individual and community-level behaviour change

Creating ‘learning organisations’

Supporting preventative approaches

Encouraging a longer-term focus

Supporting integrated care

Forecasts & scenarios for the future

Conclusions