Sustainable Development Unit

ROUTEMAPFOR SUSTAINABLEHEALTH

Foreword
This document is a collaborative effort across the NHS and its partners to describe a sustainable health system and the components that are needed to achieve it.

By its nature, the NHS must be sustainable we must meet the needs of our patients today, while ensuring we have a service fit for tomorrow and beyond. At a time when we are driving forward significant change to improve outcomes and meet the financial and practical challenges of increasing demand for our services, we have the opportunity to create a truly sustainable NHS. This is not limited to financial sustainability, but must focus too on social and environmental sustainability, so that the NHS of the future remains in the best possible position to improve quality and to limit its impact on the environment within which it works. This document sets out a number of ways for organisations to progress towards a sustainable healthcare system and builds on the progress already made to reduce carbon emissions since the launch of the NHS Carbon Reduction Strategy in 2009.1 We would like to thank everyone for the work already underway to drive real improvements locally and welcome this Route Map to a sustainable future.

Simon Burns MP Minister of State for Health

Sir David Nicholson KCB CBE, NHS Chief Executive

NHS Sustainable Development Unit - Route Map for Sustainable Health

Vision for a Sustainable Health System

Imagine a time when going to hospital is seen as a failing of the health and social care system. Where most of the care and support you need can be offered at home. Where you can get instant medical help online, by phone or at a local health centre. Where health inequalities are low and well-being is key.

Imagine a place where the few buildings that support the health system are in tune with the environment. They use almost no carbon and are integrated into the community and with nature. They are inviting for patients and a pleasure to work in.

Im a g i wev ne know e i impr done ou ng that o mini ve healt r best to m h an on th ise our d impa e en viron c men t t.

Imagine a world where friends, family and society help promote healthy living. Where we all support the local health and social care system to recycle, re-use and minimise waste. Where we know that delivery of services takes the long term financial, social and environmental costs into account. Imagine knowing that we have done our best to improve health and minimise our impact on the environment.

What does the NHS Sustainable Development Unit (SDU) do?

The NHS SDU works in close collaboration with NHS organisations, the Department of Health (DH), the Department of Energy and Climate Change (DECC) , the Department for Environment, Food and Rural Affairs (DEFRA), and environmental groups to support policy direction, recommend research and convene leaders to address opportunities and barriers in the system. The unit consults widely within the NHS and with its partners. It has published the NHS Carbon Reduction Strategy1 and many supporting tools to support improved commissioning, procurement, leadership and staff engagement in sustainable services. The NHS SDU is the sustainable voice of the NHS and has international recognition for its groundbreaking work.

ustainable What does s mean? of being

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NHS Sustainable Development Unit - Route Map for Sustainable Health

ITS NOT UTOPIA

Its a reality
The Route Map is built on the actions described in the NHS Carbon Reduction Strategy,1 ideas developed in the health scenario publication Fit for zthe Future2 and our collaboration across the regions in England. It reflects the great work that is already taking place in many NHS organisations. The Route Map is a framework for action to develop a sustainable health system. It identifies the areas that require progress in order to save money and resources, improve health and make changes future proof. It describes the roles we need to play and where we can continue to make a difference. Above all, it forms the basis for highlighting opportunities and coordinating action so sustainable healthcare can be implemented at a local, regional, national and international level. The NHS cannot move to a truly sustainable health system on its own. It needs the support of all organisations associated with health and social care. It also needs the backing of society, patients and staff. Working together, we can create opportunities by maximising resources and minimising duplication. This is the reason why your help and leadership is crucial. This document has been developed in a pioneering and collaborative effort by a wide range of organisations and experts in various fields including healthcare, sustainability, business, local government, the economy, education, future thinking and world affairs. It clarifies what a sustainable health system is and tells you the things you need to do on the way. This document is a high level summary of all the aspects that need to be considered and our website3 hosts more detailed information. The intelligence for this document was gathered during a series of day long workshops where participants reviewed the health system today, then considered what it would need to be like in a high population, low carbon, low oil world of 2050. The situation is grave. The graph (Figure 1) illustrates the difference between where we need to be in 2020 and where we are likely to be if we continue business as usual. If we are to prepare for the significant cuts required then we need to start acting now.

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4 NHS Sustainable Development Unit - Route Map for Sustainable Health

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Figure 1 This graph represents NHS financial shortfall, oil production shortfall and carbon reduction requirements until 2020.3

Its a Reality

Transformation

The Route Map highlights the scale of the challenge before us. Helping the NHS to become a sustainable health system will require transformation and a new way of thinking. It envisages many shifts, moving:

From From From From From From From From From From From

health care as an institution led service curative and fixing medical care sickness professional isolated and segregated buildings decision making based on todays finances single indicators and out of date measurements sustainability as an add on waste and over use of all resources nobodys business

To To To To To To To To To To To

health and social care as part of the community early intervention and preventative care health and well-being personal integrated and in partnership healing environments an integrated value of the future which accounts for the impacts on society and nature multiple score card information and in real time integration in culture, practice and training a balanced use of resources where waste becomes a resource everyones business

ED ACROSS THE HEALTH SYSTEM SUSTAINAB ME SO EVERY RESOURCE IS ACCOUNTED FOR CHSOCIETAL BEHAVIOURS AND ATTITUDES IN ARE TECHNOLOGY SYSTEM GOVERNANCE US DING SUSTAINABILITY TAKING OWNERSHIP TA
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ROUTEMAPFOR SUSTAINABLEHEALTH
Reading the Route Map
The Route Map covers six themes and runs over three time periods: 1. Getting started where understanding the context and what needs to be done is vital, and where action needs to begin; 2. Transition phase where there is an expectation that sustainability is becoming the norm and we are definitely on the way to a sustainable health system; 3. Transformation occurs where sustainability has become totally routine, culturally embedded, and self regulating. These three phases are designed as a journey from where we are now, to where we need to be. It is important to note that despite some of the phases being set in the future, work needs to begin on all of them today.

Sustainable Development Unit

NHS Sustainable Development Unit - Route Map for Sustainable Health

NHS Sustainable Development Unit - Route Map for Sustainable Health

What does the Route Map tell us?

Leading Transformation
The Route Map clearly highlights that the leaders of today and tomorrow are key to transforming the NHS into a truly sustainable health system. These leaders, you, need the power and skills to take the long term view and make decisions based on sustainable principles whenever services are planned, developed, commissioned and delivered.

Innovation
Models of Care this refers to the core business of any health system including its purpose, mission and the manner in which services are delivered. Investment in prevention is considered paramount and all sectors work more closely together to provide appropriate care. This means housing, education, support to early years and community networks provide a fully integrated health system. For instance, vulnerable people receive integrated health funds to insulate their homes better. This minimises ill health during winter, reduces hospital emissions and enables savings and a better standard of living. Technology investment in low carbon and health technologies will help to drive and deliver some of the transformations required for a more sustainable health system. The Government and financial institutions can help to reduce the risk of investment and adoption of new technologies. This will further improve opportunities for telemedicine and more sustainable and preventative healthcare. We cannot, however, rely on efficiencies and technological progress to save the day as they will not be sufficient to meet the carbon reduction challenge. Indeed, the health sector needs to partner with all its stakeholders to achieve sustainable goals and invest in low carbon technologies.

Vision: Models of care where health is less a medical matter and more about us having control over our well-being.

Vision: Technology is an enabler of positive societal and environmental change.

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Standards
System governance - this requires a standardised approach to measuring and monitoring sustainability, and minimising the use of resources across the health system. A legislative framework is needed, with consistent public reporting as a core organisational indicator. Accounting for sustainability becomes a component of good governance as well as whole life cycle costing. This information is visible to all, in real time, and is incorporated into operational and strategic planning. Use of resources - this includes all types of resources e.g. human time, commitment and the natural environment - not just oil, carbon and water. Research clarifies how best to use resources. This will help in making appropriate decisions, particularly in business terms. The methodology includes appropriate weightings for the future so the true value and cost of resources are fully taken into account. This will ensure items are reused, waste and packaging minimised, and human time and services are used more efficiently.

Vision: Health and sustainability agendas drive policy which support individuals, society and organisations to behave in a sustainable, fair and healthconscious way.

Vision: We live with the resources that the environment can support, instead of the 2.5 planets that we are currently using.

Behaviours
Societal behaviours and attitudes this represents the influence that society exerts as we progress towards a more sustainable health system. It reflects on the public engagement with climate change and sustainability, and anticipates society learning to fully appreciate the true value of sustainable products, services and places. This means society recognises the long term financial and social benefits of addressing health inequalities, improving green space and running low carbon services. Individual behaviours and attitudes every person now knows what they can do to be healthier and more sustainable. People expect greater personal choice and information so that individuals can make decisions based on both health and sustainable criteria. People exert influence on others with an expectation that everyone makes sustainable choices. This change in behaviour is similar to the peer pressure and acknowledgement of individual culpability that made drink driving unacceptable.

Vision: A compassionate society living in a high quality environment with reduced health inequalities.4

Vision: Values are redefined to encompass health and well-being linked to an acceptance of finite resources.

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NHS Sustainable Development Unit - Route Map for Sustainable Health 9

Next steps?

By now you should have a clearer vision of what a sustainable health system might look like. We would like your help to achieve it. Every person, every organisation and every network has a role to play. We would like you to be part of a growing collaboration to help the NHS become fit for the future. We are proposing work streams that start straight away so that everyone can engage with the journey. The process will evolve over time, and a page of our website3 is dedicated to the Route Map and its work streams. The website will be updated on a regular basis so that everyone can assess progress and contribute further ideas and actions. It hosts a complete list of partners, timelines and progress and we would welcome your contributions, ideas and support in taking these forward. The following is a summary of some of the work streams that you can take action on, starting today.

Standards:
Sustainability through the reforms Every health and social care system can identify the best ways for sustainability to fit into existing and future governance structures. The Department of Health, with our support, are considering how best to position sustainability at a national level. Efficiency first Every person and every organisation can be more efficient with their use of resources. This includes energy, carbon, water and peoples time on an ongoing and incremental basis. Organisations can report progress systematically and publicly. Metric development Every organisation can ensure that the impact on resources and their future value and cost are included in business decisions. These mechanisms need to be refined over time and we suggest setting up a steering group of interested parties to make sure that this element is progressed in a streamlined manner.

Innovation:
Appropriate models of care Every organisation can identify ineffective health processes and foster sustainability through commissioning arrangements at a local level, and by helping build some nationally agreed standards. Research organisations can support this work by developing the evidence base required to encourage shifts in models of care. Technology development Every innovation board, every procurement process, every business case and every strategic planning procedure should include references to the use and development of sustainable technologies. This should relate to the ways in which technology will improve health and well-being and reduce health inequalities. Jointly we can develop criteria to judge success and share progress.

Behaviours:
Public, patient and societal engagement Every organisation can engage with the public and their patients about sustainability and the future of healthcare. We are working nationally on some ways of developing this agenda across England. For every individual Every organisation can encourage staff to actively participate in shaping the future by making sure structures and incentives are in place. We can all support this journey by taking steps in our own lives today.

SELF REGULATION AND FEEDBACK ENSHRINE LIFE ALL RESOURCES INCLUDING PEOPLES TI PROFILED TO ENABLE A NO WASTE APPROAC BEHAVIOURS AND ATTITUDES MODELS OF CA RESOURCES GETTING STARTED UNDERSTAND
10 NHS Sustainable Development Unit - Route Map for Sustainable Health

Many NHS organisations have already begun the journey that this Route Map sets out. Their efforts prove that the health system does have a will to be more environmentally friendly and more sustainable for the future. The increasing number of organisations with Sustainable Development Management Plans is just one testament to the hard work going on in the NHS. But we need to think bigger, and the Route Map does just that. It adopts a systems wide approach to achieve the transformational change required for the future. This document gives a broad framework and context to the NHS at a time when the momentum must be maintained and enhanced. The Route Map aims to be more than a document. It aims to become a living programme of work, gathering momentum and facilitated by the SDU and its website.3 Thank you for supporting this approach and please continue to share your contributions, thoughts and any further case studies with us. The following documents, available on our website3 will help you with your sustainable journey alongside those listed in the references. NHS Sustainable Development Management Plans (SDMP) P4CR: Procuring for Carbon Reduction Creating a Sustainable NHS 5 To Survive series Save Money by Saving Carbon Sustainable Finances Commissioning for Sustainable Development Sustainable Development for GP Commissioners

Glossary
Carbon: In the document, the word carbon is used as a generic term for greenhouse gases. Health System: Refers to all the components that contribute to supporting health and social care including the NHS, social services and public health. Life Cycle Costing: Also called Whole Life Cycle Costing, this is a costing methodology to establish the total cost of ownership. It is a structured approach that addresses all the elements of this cost and can be used to produce a spend profile of the product or service over its anticipated life span. Telemedicine: Delivery of health services via remote telecommunications.

References
1. NHS Carbon Reduction Strategy for England: Saving Carbon, Improving Health, 2009. Cambridge: NHS Sustainable Development Unit 2. Fit for the Future: Scenarios for low-carbon healthcare 2030, 2009. Cambridge: NHS Sustainable Development Unit & Forum for the Future 3. www.sdu.nhs.uk 4. Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010, 2010. London: The Marmot Review

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NHS Sustainable Development Unit - Route Map for Sustainable Health 11

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Thank you to all the organisations on this page who have helped develop the Route Map and are supporting this work into the future. The responsibility for the final product however lies with the NHS Sustainable Development Unit for England.

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NHS Sustainable Development Unit Victoria House, Capital Park Fulbourn, Cambridge CB21 5XB Tel: 01223 597 792 Web: www.sdu.nhs.uk Published February 2011
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