JSNA and JHWS development lead
People, Communities and Local Government,
Department of Health
Wellington House
133-155 Waterloo Road
London
SE1 8UG
29th August 2012
Dear Sir/Madam,
Re: NHS Sustainable Development Unit’s response to the Department of Health’s consultation on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies.
The NHS Sustainable Development Unit (SDU) welcomes the opportunity to respond to the consultation on the Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. This response is in letter form to better convey the overarching principles that the Sustainable Development Unit (SDU) would like to make.
The NHS SDU provides leadership, expert support, and technical guidance across the health and care system in relation to sustainable development. Financially, socially and environmentally sustainable healthcare meets the health and social needs of today without compromising the needs of tomorrow. Sustainable development is an integral dimension of quality in health care; it is a fundamental principle for the delivery of an affordable, future proof healthcare service, for improving population wellbeing, and reducing health inequalities.
The NHS SDU fully supports the broad principles of the guidance. We believe that if health is to be improved, need must be carefully assessed and responded to with evidence based strategies. We also strongly endorse an integrated, cross-sector approach to improving wellbeing as the only way to tackle health problems today. However, currently despite the good evidence that in the long-term wellbeing and health inequalities can only be reduced within a sustainable framework, the guidance does not refer at all to sustainable development within the needs assessment.
The principles of sustainable development are fundamental to improving wellbeing and are entirely aligned with the desire of the draft document to ensure that the needs of the entire community are met, that inequalities are reduced, that wider determinants of health (including the environment) are improved, and that local communities are empowered and facilitated to access appropriate social and health care information. In addition, one of the most effective ways to reduce the financial and environmental cost of the health is to prevent illness by primary prevention and improved early access to services when appropriate, thus reducing the need for costly health services and reducing carbon emissions. Therefore we are entirely supportive of guidance that will help to deliver well designed JSNAs and Wellbeing strategies.
Improving wellbeing and reducing health inequalities are aligned and completely linked to sustainability:
· Social sustainable development describes how we can maintain and improve the health and quality of life for people and communities, now and in the future, and thus is inherent to ensuring that we have a society in which enduring wellbeing is achieved. This is also enshrined in the Social Value (Public Services) Act 2012 – legislation that will need to be considered as public authorities commission and procure services.
· Improvements in wellbeing and reductions in health inequalities can only be maintained if they are delivered in a financially sustainable way that considers long-term outcomes over short-term financial gain. In addition sustainable development will not only yield long term financial saving, but will also identify immediate savings; the UK Government’s own estimates show sustainable development measures already save the government £60-70 million every year.
· Environmental sustainable development delivers co-benefits to health with immediate, and long lasting benefits (for example active transport, reduced meat consumption and reduced air pollution).
· It is impossible to consider improving the health outcomes and reducing health inequalities without considering climate change. Climate change is a significant threat to health[i] and it is likely that climate change will disproportionately affect the poorest in society.[ii]
· The way we deliver services today should not be at the expense of out ability to improve tomorrow’s health and wellbeing, thus the JSNA has a responsibility to ensure that we are not increasing intergenerational health inequalities.
It will be impossible to make long term improvements in wellbeing without considering sustainability, and thus the principles of sustainable development should be integral to any wellbeing strategy.
In addition the NHS Constitution’s declared aim is for the NHS to commit to the “fair and sustainable use of finite resources”, and the Climate Change Act 2008 sets a legal requirement to achieve carbon reductions of 34% by 2020 and 80% by 2050. Work carried out by the NHS Sustainable Development Unit (SDU) for England indicates that the NHS needs to achieve a 10% reduction on 2007 levels by 2015 in order to be on an appropriate trajectory to meet the legal requirements. Thus any JSNA and resulting strategy should ensure that these NHS commitments can be met. The public health outcomes framework also includes the presence of a board approved sustainable development plan and the clinical commissioning groups are required to commit to promoting environmental and social sustainability as part of their authorisation process, and wellbeing strategies should ensure that they are consistent with other NHS partners sustainability commitments.
The case for sustainable development in healthcare and public health policy is clear. There is sound evidence that many components of sustainable development achieve both cost reductions, and immediate (and long term) health and wellbeing gains. Sustainable development ensures the development of a more sustainable health system which reduces inappropriate demand, reduces waste and incentivises a more effective use of services and products.
The NHS is based on values of fairness, accessibility, resilience, and social responsibility. The NHS is the largest employer in the UK, and therefore has an important responsibility to prepare and respond to changing requirements and to look forward to ensure it considers its duty of care for the future. This will mean embedding a culture of economic, social and environmentally sustainable behaviour across the whole sector.
A high quality sustainable health and social care system will meet the needs of today without compromising our ability to meet the needs of tomorrow. Indeed the NHS in England is already considered on the international platform as a leader in the development of sustainable services and is well placed to continue this trend if the principles of sustainable development continue to be embedded in important processes such as JSNAs and wellbeing strategies.
Please do not hesitate to contact the unit for any further clarifications or questions in relation to this response.
Thank you for the opportunity to respond to this consultation.
Yours faithfully,
Dr. Emma Waters.
Public Health Registrar, the NHS SDU.
[i] A. Costello, M. Abbas, A. Allen, S. Ball, S. Bell, R. Bellamy, S. Friel, N. Groce, A. Johnson, M. Kett, M. Lee, C. Levy, M. Maslin, D. McCoy, B. McGuire, H. Montgomery, D. Napier, C. Pagel, J. Patel, J. A. de Oliveira, N. Redclift, H. Rees, D. Rogger, J. Scott, J. Stephenson, J. Twigg, J. Wolff, and C. Patterson. Managing the health effects of climate change. Lancet 373 (9676):1693-1733, 2009
[ii] M Marmot. Marmot Review - Fair Society, Healthy Lives. Strategic Review of Health Inequalities in England Post-2010. 2012. http://www.marmotreview.org