1. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Creating a Sustainable Health and Care System The role of leadership and HWBs David Pencheon Sustainable Development Unit NHS England and Public Health England May 2014. Peterborough

2. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk If we want: A health and care system that is truly fit for the future A system that is an exemplary leader to meet present and future population needs and demands and build on social assets A system that is fair, participative, integrated and operates within financial and environmental limits – with more efficiency and adding more value We will need: Transformation: to revisit the purpose (and develop better models) for a public health system, a health care system and a social care system Partnership working, engagement, measurement and governance Profound leadership

3. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Sustainable development...meeting the needs of the present without compromising the ability of others, in future (or elsewhere now) to meet their own needs, to live a life of comparable quality and value.... the requirement that the next generation must be left with whatever it takes to achieve a standard of living at least as good as our own and to look after their next generation similarly. - Adapted from the Brundtland Commission, Amartya Sen, and Robert Solow.

4. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 1.supports the NHS, the Public Health, and Social Care system in England to become more sustainable (particularly environmentally…) 2.helps shape policies and practices, reporting, develop networks, organisations and staff/social movements; 3.provides guidance, tools, metrics, and evidence to support more sustainable models of care (including prevention); 4.helps organisations comply with the law, save money and other resources; 5.supports organisational and leadership development in sustainable health. Working across the NHS, Public Health and Social Care system

5. www.sduhealth.org.uk Leaders work at every level, and have... Vision Courage..and can engage people well..and understand human behaviour and what makes people change

6. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 1. Engagement: - a compelling narrative - entry points

7. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Entry points 1.To save money / conserve limited resources 2.To comply with regulations and law / scrutiny / governance 3.To manage risk and improve resilience 4.To manage reputation / take exemplary action 5.To reduce environmental impact harmful to health 6.To take action consistent with the scientific evidence 7.To innovate and improve/assure quality 8.To support staff to align personal and professional behaviour, to build community assets, to help all leaders leave a legacy 9.To align actions with ethics / values of the health / care system 10.To improve outcomes: improving health, community resilience, and reducing health inequalities now, and in the future….

8. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Example of an entry point: “governance framework” 1.Civil Contingencies Act 2004 2.Climate Change Act 2008 3.Public Services (Social Value Act) 2012 – (Chapter 3)...requires public authorities to have regard to economic, social and environmental well-being. The NHS Constitution... Public Health, NHS and Social Care Outcomes Framework NHS Standard Contract Expectation to formally report on progress (equivalent to financial reporting)

9. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Example of an entry point: “Quality” 1.Compassionate [being kind, caring, compassionate, dignified] 2.Effective [employing the very best techniques systems known to work] 3.Safe [doing no harm] 4.Efficient [using the least resource that helps deliver the best outcome] 5.Fair [supporting equitably, prioritising investment where social justice maximised] 6.Sustainable [ensuring addressing today’s needs and assets that doesn’t prejudice meeting tomorrow’s needs] S Atkinson, J Ingham, M Cheshire, and S Went. Defining quality and quality improvement. Clinical Medicine 10 (6):537-539, 2010

10. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 2. Vision and Strategy

11. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Vision

12. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Goals

13. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Goal 1: A healthier environment 1a. valuing and enhancing ALL resources and capitals (natural, human, social, economic...) 1b. reducing pollution and carbon emissions

14. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Goal 2: Communities and services are resilient to changing times and climates 2a: personal / family / community resilience 2b: protecting the most vulnerable 2c: multi-agency planning / delivery

15. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Goal 3: Every opportunity contributes to healthy lives, communities and environments 3a: Prevent ill health / reduce care needs 3b: Empower self management 3c: Integrate services, align incentives 3d: Exploit health co-benefits

16. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 3. Measurement and reporting

17. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk

18. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 4. Multiple benefits of taking action

19. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk “What is good for creating a sustainable world in the future....is ALSO good for public health system, and the care system NOW” 1.For the public’s health Better homes, more local employment, better transport systems, more physical activity, better diet >>> improved mental health, less road trauma, improved air quality, less obesity/heart disease/cancer, less preventable ill health, less inequality, stronger more cohesive, resilient, local communities... 2.For the health and care system More prevention, care closer to home, more empowered / self care, better use of drugs, better use of information and IT, fewer unnecessary admissions, fewer distant large buildings, less travel, better models of care… Health co-benefits:

20. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk - Barbier, E.,1987. The Concept of Sustainable Economic Development. Environmental Conservation, 14(2):101-110. - Adams, W.M. (2006). "The Future of Sustainability: Re-thinking Environment and Development in the Twenty-first Century."Report of the IUCN Renowned Thinkers Meeting, 29–31 January 2006."The Future of Sustainability: Re-thinking Environment and Development in the Twenty-first Century." Improving Health and Social outcomes Living within environmental boundaries Operating within financial limits Opportunities in the health/care sector Accounting for three bottom lines

21. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 5. Leadership and Legacy

22. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk HWB areas for a sustainable future? 1.Jobs/ local economy 2.Housing 3.Energy 4.Procurement 5.Food 6.Waste 7.Transport 8.Planning, infrastructure, built and natural environment 9.Social/health care 10.Health and Wellbeing; Inequalities; prevention; 11.Climate resilience, adaptation, Community development, social capital/cohesion. 12.Education

23. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk In any one of the 12 areas: 1.Metrics and Toolkits? 2.Legal guidance and other mechanisms and machinery for implementation? 3.Case Studies/examples? 4.Alignment with national policy? 5.Partner organisations?

24. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 200 years of health systems and health workers protecting and improving health 2. Cholera: Broad Street Pump, 1854 3. Smoking and tobacco, 1962 5. Sustainable development and climate change, 2014 1. Slavery Abolition Bill, 1833 4. Nuclear proliferation and health workers. 1995