Delivering Transformational Change

Published on Tuesday, 21 December 2010 00:00
Written by David Pencheon OBE

David Pencheon, Director of the NHS Sustainable Development Unit places Sustainability at the core of quality care, delivering a more effective, efficient healthcare service


Since our establishment in 2008, we have continually raised awareness about the opportunities sustainability can provide for the health sector. These are not just opportunities in terms of resilience and environmental sustainability but more crucially about how taking sustainability as a core pillar of quality can contribute positively to many of the other challenges the NHS faces.
As an organisation, we have raised awareness through continuous research around the carbon footprint of the NHS and how much can be saved both financially and environmentally for the NHS and the wider health system. The goal of sustainable development is to meet the needs of today, without compromising the needs of tomorrow. This means that we can't continue using current levels of resources at the current rate and in the current way as this will not leave enough for future generations. Stabilising and reducing carbon emissions is key to living within environmental limits.  

The SDU believes operating within the right economic, social AND environmental boundaries will create a truly sustainable NHS, one that is fit for the future. In the NHS, sustainable development is often partnered with good corporate citizenship.  This means that the NHS can use its organisations' corporate powers and resources in ways that benefit rather than damage the economic, social and physical environment in which we live.

An essential part of delivering sustainable practice within the NHS is the embedding of the strategies or route-maps in terms of what is believed to be necessary if we are going to see the opportunities sustainability has to offer. There are still some people who view sustainability sceptically. Many people react to sustainable practices with caution. However, as time has gone on people have begun to realise that taking sustainability seriously is a positive part of their day job.
A sustainable approach can solve a lot of issues we all deal with daily, like dealing with illnesses, dealing with energy consumption and a much more congested transport system. These areas are where sustainability lends itself to the challenge.


There is always more we could all be doing to promote sustainable practice, but in some senses we should be congratulated for not losing focus on the future benefits it can hold. Recently, we have seen funding withdrawn from a few areas. This included the Sustainable Development Commission   where it was viewed that the Commission had done what it had set out to do and that was embed sustainability in Public Sector Services. The Coalition felt it had now gained enough knowledge to address sustainability through its own Departments.
It has to be said that this same practice has not been demonstrated by the Private sector, with many leading companies continuing with their funding on sustainability practices. Even the recent changes to the Carbon Reduction Commitment Energy Efficiency Scheme  have not deterred many private organisations who still see the positive benefits the scheme can bring.

It is unfortunate, however, that the Scheme is turning from a cost neutral incentive into more of a tax. It would be very short sighted for anyone to ignore the advantages of engaging with sustainability seriously e.g. the CRC. It is clearly obvious that you will save much more money through a systematic use of energy. The other issue is the possibility of separating the public and private sector tables which is currently being consulted upon. Again this throws up the argument of comparisons and incentives.  It is not clear why the public sector should be immune from comparisons with the private sector. We are all in this together after all. Having a scrutiny role from the public via a league table can incentivise Trusts and Hospitals to embed better sustainable practices.

 One area the NHS Sustainable Development Unit is promoting is that of staff engagement. The problem is not about gaining the attention of staff, it is more about creating a workplace where making sustainable choices becomes easier. It is not easy to get engaged about sustainability at work, if you are very busy as many Doctors, Nurses and Clinicians often are, it must become difficult to make sustainable choices. If staff cannot find the recycling bins or light switches then it will not happen. The NHS is not an un-sustainable organisation; however, its staff are sometime not aware of the benefits it can bring and in some cases not incentivised to be more sustainable.


Efficiency has always been a key driver for sustainability; it has probably never been more prominent. The recent Spending Review and cutbacks to the public sector have highlighted the need to embed sustainability even more in public service delivery.
Many leading managers or clinicians working within the NHS have expressed that the current economic climate makes it important to adapt sustainability. For example, if you look at a trust like University College London, which takes its sustainability responsibility very seriously, what senior managers have done there is generate their own evidence to show in multiple case studies that by doing things sustainably you can save substantial amounts of money. These case studies will help push sustainability on the agenda of Trust Boards throughout the country. But, sustainability can do more than just save money, it can enhance a Trust’s reputation and improve the health of those they care for.
The main issue surrounding efficiency is creating back office functions which can be shared between numerous Trusts.  Another equally important issue is for Trust managers and Boards to have the ability to manage the supply chain from which they procure. Trusts should be challenging themselves to become better skilled procurers. They need to be constantly asking their suppliers, are we getting the best deals as an organisation? As one of the biggest organisations in Europe, we have never really systematically excelled at procuring and I feel we should learn from the private sector more. We should be exploiting shared services more and driving a better deal.
We must move on from sustainability being simply an efficiency debate and ask how the health service can mange people living with a terminal condition more effectively. This is one area we have not done well in the past. Chronic disease management and palliative care are also areas which we must build to become more sustainable and patient focused. When we can empower people and engage with them effectively then we can achieve a more sustainable healthcare service.

Dr David Pencheon will give the Keynote Address at GovToday’s NHS Sustainable Development 2011: Delivering Transformational Change Conference and Exhibition on the 2nd February 2011 at Church House, Westminster.  

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