1. Creating a Sustainable Health and Care System
The role of leadership and HWBs
David Pencheon NHS Sustainable Development Unit
15th Jan 2013
Theme of making it part of core business, and a requirement for NHS organisations to know and understand the contents of the CRS
Peterborough

2. 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
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. Sustainable healthcare?
“Healthcare that meets the needs of the present…
…without compromising the ability of others, in future or elsewhere now, to meet their own needs”
- Adapted from the Brundtland Commission
How does SD link into climate change? Give the audience a glimpse of the breadth of SD 3

4. To behave within environmental limits – not prejudicing
the future
To improve health and deliver high quality health care to the public and patients
Maintain financial viability
- Barbier, E.,1987. The Concept of Sustainable Economic Development. Environmental Conservation, 14(2):
- 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.

5. Why / how does change happen and what is the role of leadership?
Burning platform
Curiosity > Opportunities > Competitiveness
Organised efforts of society / laws / policies
Technological advances
Social/cultural tipping points
Reaction to sudden events?
King’s Cross Fire, 9/11

6. Published online 2003 December 4. doi: 10.1186/cc2404.
The time is now
At least 30,000 people died prematurely as a result of Europe’s heat wave in 2003 in France1
1. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments
Jean-François Dhainaut, Yann - Erick Claessens, Christine Ginsburg, and Bruno Riou.
Crit Care. 2004; 8(1): 1–2.
Published online 2003 December 4. doi: /cc2404.
and Bhattacharya, S. (October 2003), ‘European heat wave caused 35,000 deaths’, The New Scientist.
Climate change is probably the most serious threat to life, to our health and well-being.
Unless we take effective action now, millions of people around the world will suffer from flooding, drought, hunger and the spread of disease, threatening to contribute to conflict and global migration.
In 2000, climate change caused 150,000 deaths
In 2003 heatwave, 35,000 people died prematurely
IPPC predicts that by 2080, billion people would be experiencing water scarcity, million hunger and 2-7 million a year coastal flooding.
The United Nations predicts that there will be millions of 'environmental' migrants by 2020 with climate change as one of the major drivers of this phenomenon." "Europe must expect substantially increased migratory pressure."
In the Middle East, water systems are already under huge stress with significant reductions in crop yields predicted. Climate change could also have a dramatic impact in South Asia, with serious consequences in Europe because of trading and financial links. Higher sea levels could threaten almost two billion people because 4 out of 10 people in Asia live within 60 kilometres, or 38 miles, of a coast. 6

8. Current drivers in health/care
Demographic – growing / ageing
Long term, mutiple conditions
Technology
Growing / changing expectations of public, patients and staff
Triple bottom line health care
Economic: more value for investment
More health and social outcomes
Within environmental limits

9. NHS England CO2e footprint 1990 – 2020 with Climate Change Act targets

10. Breakdown of NHS England 2010 emissions?

11. Procurement Breakdown

12. Who produces the greenhouse gases?
The world map reflecting production related to climate change. “Climate Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697  pp , May ).

13. Who bears the burden?
The world map reflecting mortality related to climate change. “Climate Change presents the biggest threat to health in the 21st Century” The Lancet (373;9697  pp , May ).

14. Health co-benefits: For the public’s health For the healthcare system
“What is good for adaptation to, and mitigation of, climate change......is ALSO good for health and healthcare”
For the public’s health
More physical activity, better diet, improved mental health, less road trauma, less air pollution, less obesity/ heart disease/cancer, more social inclusion/cohesion...
For the healthcare system
More prevention, care closer to home, more empowered / self care, better use of drugs, better use of information and IT, fewer unnecessary admissions, better models of care…
For global health inequalities / social justice
Contraction and convergence, technology leapfrogging

16. Why do healthcare organisations take sustainable development and climate change seriously?
Save money
Comply with regulation
Improve resilience
Enhance reputation
Improve health

17. Priority areas for more sustainable clinical practice?
Helping people eat better and move better
Enabling women to have control over their fertility
Targeting prescribing on those most likely to benefit
Promoting a greater sense of belonging
Helping people manage care before / without / after specialist hospital care
Helping people manage a better death
Five areas emerged, neatly summarised by Peter Cawston, a GP from Glasgow:
Ref:
Helping people eat better and move better (where some of the most significant co-benefits for health can be made. Over eating red processed meat is not good for immediate health or for longer term environmental survival and the use of fossil fuel to travel is good neither for our own health nor our children’s – as well as being dangerously carbon intensive).
Enabling women to have control over their fertility (especially pertinent as we welcome the 7 billionth citizen to the planet).
Targeting prescribing on those most likely to benefit (in particular moving from target driven medication lists to therapy tailored to the individual, with consequent improvements in safety and effectiveness as well as reductions in financial and environmental costs arising from the manufacture and use of drugs).
Promoting a greater sense of belonging (helping people to connect more and consume less, building on the personal trusting relationships at the core of general practice).
Helping people manage a better death (where the avoidance of death and promotion of longevity as signs of success need to be recalibrated to what is a much more humane and dignified approach to helping people manage their end of life, and end of life care). 17

19. Reading the pledge and these three key publications will give many actions that can be taken now.
Just SOME of the actions that can be taken:
At an individual level
Measure your carbon footprint
Understand exactly where you use energy and how you can reduce it.
Think tonnes or kgs of Carbon dioxide rather than just KWH
Understand what low carbon and active travel really is and live it – walk, bike, public transport
Think about the carbon and climate consequences of the way we/you eat, everything from food miles, to waste, to supporting local producers an retailers to the carbon consequences ad health consequences of high meat and dairy diets
At an organisational level
Ensure your workplace really provides low carbon transport options, buses, liftshare, cycle paths, racks, showers, lockers...
Is there a sustainable development or climate change staff group that tackles things from the ground up?
Has there been a organisational carbon footprinting or auditing process done?
Ensure the head of your unit / line manager / Chief Executive, knows that MANY health professionals are seriously concerned. Numbers matter.
Set an example to other staff, patients and visitors
Is climate change on the risk register of your organisation?
Is your organisation part of the carbon Reduction Commitment from April 2010?
Is sustainability built into the measurement of performance of your organisation?
How much renewable energy does your organisation buy, and could it buy more?
Is your organisation explicit about what it’s climate impact is and what it is doing about it?
Is there a procurement policy in your organisation that reduces the climate/carbon impact?
Is the leadership team in your organisation aware of the many immediate health co-benefits that can be gained from immediate action – health, lives, money and reputation...?
At a political level
Write to your MP and get you family friends and colleagues to do the same.
Contact them well before the next round of international agreements are made in Copenhagen, Nov 2009 and ask tem where they stand.
The journey so far... 19

22. Results of Public Opinion Survey:
Source:
Ipsos MORI

23. Views and Values of NHS Leaders
Almost nine out of every ten leaders surveyed in the NHS actively engage with sustainability and believe it is important
60% believing it is essential to the running of their organisation
Easy things:
Promoting energy efficiency
Engaging with staff on sustainability
Implementing travel initiatives
More challenging:
Improving infrastructure
Ensuring sustainable pathways and models of care
Working with other groups and organisations to achieve more sustainable results
Source: RAND survey

24. Five lessons in leading change in this area...
This is a journey: Therefore engagement and a call for action is crucial: Leaders need to ask, listen, understand and re- articulate the win-wins, and take exemplary action
Don’t focus too much on the environment / climate change – focus on finances, governance, reputation, resilience, ethics and health. Don’t start where you are, start whey THEY are…
Focus on positive, win-wins, and align change/incentives with what is driving large scale societal change
Measure, compare, track progress, report, reward/award to help embed SD within evolving system-wide governance
Work on efficiency and transformational change simultaneously

26. Regional meetings East – 14th Feb West Mids – 26th Feb
The Environment Agency, the NHS SDU, and Climate UK are hosting a national programme of local workshops during February and March 2013 to Health & Wellbeing Boards to realise their objectives in a changing climate.
East – 14th Feb
West Mids – 26th Feb
South West – 27th Feb
East Mids – 1st March
Manchester – 4th March
York – 5th March
South East – 6th March
London – 7th March