working across the nhs, public health and social care system creating a sustainable health and care...

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

Creating a Sustainable Health and Care SystemThe role of leadership and HWBsDavid PencheonSustainable Development UnitNHS England and Public Health England

May 2014.Peterborough


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


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.


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


Leaders

• work at every level, and have...• Vision• Courage• ..and can engage people well• ..and understand human behaviour

and what makes people change


1. Engagement:- a compelling narrative- entry points


Entry points1. To save money / conserve limited resources2. To comply with regulations and law / scrutiny / governance3. To manage risk and improve resilience4. To manage reputation / take exemplary action5. To reduce environmental impact harmful to health6. To take action consistent with the scientific evidence7. To innovate and improve/assure quality8. To support staff to align personal and professional behaviour, to

build community assets, to help all leaders leave a legacy9. To align actions with ethics / values of the health / care system10. To improve outcomes: improving health, community resilience,

and reducing health inequalities now, and in the future….


Example of an entry point:“governance framework”

1. Civil Contingencies Act 20042. Climate Change Act 20083. 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)


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


2. Vision and Strategy


Vision


Goals


Goal 1: A healthier environment

1a. valuing and enhancing ALL resources and capitals (natural, human, social, economic...)

1b. reducing pollution and carbon emissions


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


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


3. Measurementand

reporting


4. Multiple benefits of taking action


“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 healthBetter 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 systemMore 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:


- 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.

ImprovingHealth and Social

outcomes

Living within environmental boundaries

Operating within financial limits

Opportunities in the health/care sector Accounting for three bottom lines

http://cmsdata.iucn.org/downloads/iucn_future_of_sustanability.pdf


5. Leadershipand

Legacy


HWB areas for a sustainable future?1. Jobs/ local economy2. Housing3. Energy4. Procurement5. Food6. Waste7. Transport8. Planning, infrastructure, built and natural environment9. Social/health care10. Health and Wellbeing; Inequalities; prevention;11. Climate resilience, adaptation, Community development, social

capital/cohesion.12. Education


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?


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

working across the nhs, public health and social care system creating a sustainable health and care...

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