Leaner and greener health and social care

Guest post by Catherine Max. Catherine Max is a specialist in sustainable development in social care and health.  She is supporting the NHS Sustainable Development Unit to engage with social care colleagues in developing their new strategy.

Local authorities will be familiar with legislation and policy requiring public bodies to consider the social and environmental consequences of their decisions as well as the economic ones.  For example, the Climate Change Act 2008 and the Public Services (Social Value) Act 2012 which came into force at the end of last month.  In the NHS, the new Clinical Commissioning Groups were asked to demonstrate their commitment to social and environmental sustainability as part of their authorisation process – as corporate bodies and as commissioners.  This reflects an increasingly sophisticated conversation about sustainability in the health and social care arena, one which goes beyond carbon reduction and health improvement/prevention to include health protection, integration of health and social care, and less wasteful use of resources.  It has become a conversation about doing better things, not just about doing things better.

In January also, a consultation and engagement exercise was jointly launched by Sir David Nicholson, NHS Chief Executive, and Duncan Selbie, who will lead Public Health England. The NHS Sustainable Development Unit (SDU) is inviting local authorities, and colleagues across health and social care, to help shape a new ‘Sustainable Development Strategy for the Health, Public Health and Social Care System’ for 2014-20.  The SDU’s consultation asks:  Should we widen the scope of our activity beyond the NHS to the wider social care and public health system?  Should we widen our approach from carbon reduction to include other areas of sustainable development?  If the answer is ‘yes’ to either of these questions, then local authority engagement is critical.  In particular, it presents an opportunity to showcase the contribution of social care to sustainability, through its orientation towards community-based provision, emerging good practice in personalisation, and longstanding experience of managing risk on a day to day basis.

LGiU and its members have been leading players in articulating what sustainability means for social care, in its own right and as a complement to health.  The report of the LGiU Learning Network, commissioned by the Social Care Institute for Excellence (SCIE), concluded:  ‘Many of the principles used in social care, such as risk assessment, harm reduction, resilience and the importance of early intervention, are equally useful when we think about the environment.’  (Bradshaw, Sillett and Walker, ‘Independence, Community and Environment’. SCIE 2010).   Community engagement work with Bristol City Council took some of these ideas a step further and explored how personalisation could stimulate the market for more sustainable care services: at lower cost, with a smaller carbon footprint, better adapted to environmental change, and contributing to local economic development.

Meanwhile, another year of floods in 2012 followed by this winter’s snow add weight to the recommendation of The Cold Weather Plan for England (DH, 2012) that Health and Wellbeing Boards consider resilience to weather events in their Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. This doesn’t have to mean adding another ‘priority’ to an already long list.  In London, and no doubt elsewhere, the top environmental issue for councils is fuel poverty, a health and welfare challenge best addressed by the smart alignment of existing public health, social care, housing, energy efficiency and climate change adaptation commitments.

The SDU’s consultation proposes three priorities:  (1) focus on the highest impact carbon reduction areas, such as commissioning; (2) understand what transformational changes are needed to move towards sustainable models of care; (3) broaden the focus (of the previous NHS strategy) from carbon reduction to other areas of sustainable development, such as climate change adaptation and incorporating social value into plans.  It also sets out some possible metrics for a sustainable health and care system, namely:  awareness, governance, use of resources, and health outcomes.

Local authority expertise is essential to making real progress on these priorities, or any other objectives to achieve sustainable health and wellbeing in our communities.  If you have a view on what the priorities should be, how best to achieve them, and especially on how social care can show leadership in this area, then do respond to the consultation.  It comprises a set of propositions and poses just seven questions.  One of these is ‘Should the health and care system set itself challenging ambitions with regard to sustainability?’  You have until 31st May 2013 to shape what those ambitions should be.

Further information and useful resources

The SDU has produced a suite of resources to help stakeholders respond to the consultation and manage local engagement events.

Naylor C. and Appleby J., ‘Sustainable health and social care:  connecting environmental and financial performance’ (King’s Fund 2012)

Max C., Sustainable health and social care:  A briefing for commissioners and health and wellbeing boards (SCIE and NHS SDU 2012).

Joseph Rowntree Foundation microsite What are the social impacts of climate change in the UK?