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Can we afford sustainable health and social care in a time of austerity?

Chris Naylor, Fellow in Health Policy at the King’s Fund, argues that improving the environmental sustainability of health and social care can go hand-in-hand with promoting efficiency and quality of care – but only if we are prepared to fundamentally rethink the way services are delivered.

SD Scene publishes news and comment on sustainable development from across government, business and civil society. The views expressed in this article do not necessarily reflect government policy.

Health and social care provides an interesting test-bed for the sustainability movement. It is a sector dedicated to improving human lives, and dominated in the UK by a single provider – the NHS – which is under public control. It might be hoped that these characteristics would provide fertile conditions for developing sustainable practices.

It is also, however, a sector where the nature of the work involved – which can be literally a matter of life and death – often keeps people firmly fixated on the short-term. Add to this the enormity of the financial challenge facing health and social care organisations, and the demands of implementing the government’s reform programme, and it is unsurprising that sustainability can sometimes appear to be a marginal concern.

But despite these challenges, momentum is building behind the idea that health and social care need to be provided in a way that is both financially and environmentally sustainable. Earlier in the year, SD Scene reported on the results of a survey which indicated that both the public and senior NHS leaders strongly support the principle that health services should be delivered in a more sustainable way.

Since then, the NHS has held its first ‘day of action’ on sustainability, in which over 100 organisations within the NHS and beyond joined forces to raise awareness and highlight the importance of delivering services in a way that allows both current and future generations to enjoy the benefits of high-quality health care.

And in social care, the sustainable social care programme funded by SCIE has extended sustainability thinking into a sector with very different structural characteristics from the NHS, but with closely related goals.

Given the current economic conditions, a key question remains whether health and social care organisations can align sustainability with the need to become more efficient. In this context, a new report published by the King’s Fund explores what service changes might be needed to develop approaches which are sustainable in terms of the use of both financial and natural resources.

A key message of our report is that although many of the quick wins involve operational changes such as adopting energy efficiency measures in health and social care facilities, improving efficiency at this level is unlikely to be sufficient. A more fundamental transformation in service models will be needed.

For example, a key part of this transformation will involve putting greater emphasis on preventative measures to help people to remain healthy. The critical importance of improved public health to the long-term financial affordability of the NHS has been stressed in the Wanless review and elsewhere. By the same logic, the most environmentally sustainable approach to health and social care is likely to be one that minimises the system’s use of natural resources by promoting good health in the population and preventing those who become unwell from going on to need highly resource-intensive care.

The transformation will also involve organising services in new ways so that different components of care are integrated more closely.  If services are provided in such a way that patients experience an efficient journey through the system, obtain maximum value from every contact with professionals, and receive well-coordinated support for their multiple needs, this should be more sustainable from both an environmental and a financial perspective.

The use of pharmaceuticals is another important area where improvements could be made from a cost, quality and environmental perspective. Pharmaceuticals account for 22% of the overall NHS carbon footprint. Large volumes of medicines are wasted due to inadequate stock management or inappropriate prescribing, and a high proportion of drugs are not taken as intended. Improved medicines management and prescribing practices could reduce this waste, with shared decision-making tools being used to support patients to make informed choices about the medication they take.

These examples illustrate that to some extent, the changes needed to improve the environmental sustainability of health and social care are the same as those needed to improve quality and efficiency. There is still much that needs to be done to make sustainability a core organising principle for health and social care services, but if the right approach is taken it should be possible to do so while also building a system which delivers better value and improved quality of care for patients.

The full report, Sustainable Health and Social Care: Connecting financial and environmental performance can be read on the King’s Fund website.

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