Addressing climate change in health and social care reforms

As the Health and Social Care Bill progresses through Parliament there has been little debate on the impact it will have on local efforts to put health and social care systems firmly within a framework of responding to climate change.

The government’s public health white paper – Healthy Lives, Healthy People, published last year – reinforces Sir Michael Marmot’s finding that ‘climate change is one of the biggest public health threats of the 21st century, with the potential to increase health inequalities’. So it really matters how the bill will affect local efforts to incorporate climate change.

Against this backdrop, in late July LG Improvement and Development and the Social Care Institute for Excellence (SCIE) invited a group of health, social care and sustainability practitioners, policy makers and researchers to discuss how best to corral climate change into both the health and social care policy reforms and practical restructures that are underway already.

The discussion had two pretty clear conclusions: if climate change is to be taken seriously within the context of health and social care then local authorities need to be reminded of their major responsibility, as set out in the health white paper, to ‘improve the health and life-chances of the local populations they serve… these functions will be conferred on local authorities as a whole.’

Second, health and wellbeing boards (HWBs) – new forums of local commissioners, elected representatives and representatives of HealthWatch, proposed in the current bill – need to be encouraged to see the role that a whole range of disciplines have to influence health and social care. Improving health outcomes is about attending to regeneration policy as well as to renal care.

There are good reasons for doing this. Incorporating climate change into health and social care reforms can help local authorities and HWBs to more effectively fulfil strategic responsibilities such as:

• Assessing need and tackling health inequalities;
• Leading communities;
• Managing risk;
• Improving community resilience.

LG Improvement and Development and SCIE recently published Changing Climate, Changing Conversations, a document written a result of this discussion and sketching out these links in more detail.

Debates about the detail of structures and budgets are understandably top of the agenda for local authorities and HWBs. But there is a case for doing some strategic thinking now too. A relatively small investment in this now could make a big difference to the effectiveness of local actions. The new LGID/SCIE document includes many practical examples of local authorities and fledgling HWBs that are looking at how to incorporate climate change into the work they do and will be doing.

For example, Birmingham’s Green Infrastructure and Adaptation Partnership – a subgroup of the local strategic partnership called Be Birmingham – is focusing its work on the needs of the city’s most vulnerable communities as they are more likely to be affected by the extreme weather that is a likely consequence of climate change.

Wiltshire Mental Health Partnership NHS Trust (AWP), with support from Bristol City Council, has set up Go Low, an innovative programme to reduce the amount of petrol that community health teams use. They are purchasing low-emission cars and electric bikes and encouraging team members to use them instead of their private vehicles to make home visits.

And Coventry’s proposal to establish a HWB suggests that the board includes identified leads on the six themes set out in the Marmot Review, including ‘creating and developing healthy and sustainable places and communities’.

The LGID/SCIE document concludes that:

‘The decisions local authorities, health and wellbeing boards and commissioning groups make about how to incorporate climate change into health and social care reforms will influence health inequalities and health improvement in a local area.’

We hope that local areas will have the space to do this effectively when the health and social care bill becomes law.