For the past three years, it has been standard practice within sustainability teams across the NHS to look at how resource efficiency, new models of care and staff wellbeing can contribute to better patient outcomes.
More recently, the sustainability agenda has been given a significant push for action. Sustainable Transformation Plans (STPs) were announced in December 2015, followed closely by Lord Carter’s report on productivity in NHS hospitals. These plans have the potential to change fundamentally the way the health and social care system works.
Carter revealed potential annual savings of £5bn for the NHS from 2016-2021. His report suggested three key areas in which savings could be made:
- Working together to share knowledge
- Collaborating on procurement
- Making sound investments
Alongside this, STPs outline a vision for health that goes beyond current organisational boundaries. Instead, they focus on ‘places’ (a classy word for communities) and aim to:
- Improve quality and develop new models of care
- Improve health and wellbeing
- Improve efficiency of services
This outline resonates closely with the strategic vision for health and social care set out by the Sustainable Development Unit in January 2014: ‘A sustainable health and care system works within the available environmental and social resources protecting and improving health now and for future generations.’
STPs force leaders first to consider what it means to be in good health and then to deliver a system to complement that, rather than react to it
If we’re going to make the best of STPs and the Carter Report’s findings, we need to define clearly what we’re talking about when we say sustainable.
Through STPs, we have the opportunity to work together to approach sustainability in its holistic form: the triple bottom line of finance, health and environment. If we consider any combination of the three in isolation, we abandon a true commitment to longevity and a truly sustainable healthcare system.
STPs force leaders first to consider what it means to be in good health and then to deliver a system to complement that, rather than react to it. If successful, people will be understood in the wider context of their place in a community – where and how they live, their access to healthy space, food and lifestyle, their education and whether or not they have job.
Realising this new vision for healthcare will take time, resource and significant amounts of goodwill between existing organisations (who may or may not currently see eye to eye). Those of us working within healthcare must do our bit to begin living this vision – we must look at how to drive everyday efficiencies, improve our communities and provide opportunities for employment.
A critical area of opportunity is addressing energy, water and waste inefficiencies. Trusts spent £762m on utilities in 2015/16, a year in which utility prices were unusually low. A 10% saving on energy alone would yield £57m – well over three times the average NHS deficit in the same year (reference – King’s Fund and ERIC data 2015/16).
Resilience can be built, costs vastly reduced and savings can be reinvested, but only if there is a long-term view.
A critical area of opportunity is addressing energy, water and waste inefficiencies
A pioneering few are already taking action and reducing the long-term impacts of their estates. They are also reaping the benefits; several organisations save more than £1m each year (10-15%) through investing sensibly in their estate with paybacks of five to seven years.
Northern Devon Healthcare NHS Trust, for example, has installed a range of technologies on its sites that deliver a guaranteed annual saving of £730,000 – more than 35% of the annual energy spend. The sites are now generating their own electricity, and new lighting has improved patient environments.
So, with this in mind, what is stopping other organisations from benefiting too? Government provides zero per cent interest loans for efficiencies that can be delivered within five years through the Salix programme, and NHS estates with their long operating hours and high energy demands are ideally suited for quick paybacks on energy efficiency.
Our experience is that many of the financial decisions that are made in healthcare are focused on day-to-day delivery and firefighting problems to meet targets. Often opportunities for proven technology, such as LED lighting and combined heat and power (CHP) engines are shelved in favour of immediately pressing problems.
A highly energy efficient building can vastly improve the environment for staff and patients
Organisations that will succeed in the new vision for healthcare will be those that take a step back and acknowledge that a bigger prize is out there for those who look beyond the immediate; that’s what a sustainable approach to healthcare will force us all to do.
The NHS needs to think about long-term estate planning and strategies and, within that, how buildings perform. Importantly, leaders also need to consider how people perform within those buildings. A highly energy efficient building can vastly improve the environment for staff and patients, but we should also strive to build in wellness. This can include:
- Providing access to natural daylight and ventilation
- Views over and easy access to greenery and natural spaces
- Ensuring stairs are visible and easily accessed
- Abundant bicycle parking to promote active travel, alongside walking
The NHS needs to think about long-term estate planning and strategies and, within that, how buildings perform
Part of the solution is around how we procure services. Could we simplify routes to procurement and be more creative so that Trusts can see the benefits from the outset? Are there ways of improving collaborative procurement between organisations?
For STPs to be a success, we need to consider how we make decisions across the NHS and who helps us make them. NHS leaders need to work with local government, schools and social care providers to align work and visions, rather than compete.
It will not be easy or simple and delivery will suffer some setbacks along the way. There is no additional resource to deliver STPs and the NHS has not traditionally been great at working alongside other community decision-makers. But, if we can crack this and tackle sustainability in its truest sense, we may finally have a health system (and in time, a population) that is fit for the future.