Whilst the talk often seems to be of financial sustainability of the NHS, we hear little, and talk even less of the environmental sustainability of the health service. Perhaps that’s because we, as clinicians, think that the improvement of health (or strictly speaking the management of ill-health) is too important to let environmental issues get in the way. “I am too busy saving patients to save the planet” I hear the clinical side of my brain say. But the real point, if I have the time and space to consider it, is that all health depends on our physical environment. Moreover, by considering the environmental aspects of health (access to good diet, good housing, good education and employment, friends and family and safe communities…) we can relieve the NHS of much of the preventable illness that blights our patients’ lives and stops us as clinicians addressing the more intractable illnesses we face. Thirdly, many of the actions that help deliver immediate health improvement (improving food systems, helping develop more sustainable transport systems…) we can help improve health both now and long term for our children and grandchildren.
Although it is not clear exactly the way we should bequeath a health system and a society fit for the future to our children, some of the issues are clear now. For instance, we need to radically re-orientate many of our models of clinical care so we only do in hospitals what needs to be done there. Technology such as hand held diagnostics for clinicians or mobile apps for patients can revolutionise health care in the same way as they have transformed the retail sector, the banking sector and the airline industry. However, we can be a conservative bunch and we, as doctors are sometimes the resistors not the drivers of change. Most of the unsustainability of the health service is not just in heating or lighting or travel (although those are obvious and important place to start). It is in the more clinical areas such as sensible prescribing (or even non pharmaceutical and social prescribing) and developing better models of prevention and care centred on people’s lives and homes.
There is currently an NHS and Public Health England consultation on how some aspects of this could develop. In particular, there are three modules being consulted on presently (Innovation, Social Value, and Metrics) where clinical engagement from HCSA members and others would help this future develop. We really do need clinician involvement in creating a sustainable health service.
So if you’re in any way interested in helping shape a sustainable health service that can deliver consistency high quality patient care for future generations, please do get in touch and PLEASE consider a few minutes of your time to contribute to the simple consultation (details below). We need the clinician’s voice to achieve a healthier population, supportive, resilient communities and a natural environment that enhances physical and mental health. Just like clinicians taking positions on smoking, obesity, and other major risk factors, we should have a clear stand on scientifically proven health risk. The Lancet has made it clear that climate change (one part of the sustainable development agenda) is the biggest global health threat of the 21st century.
This happening on our watch and will be our legacy. If not us, then who? If not now, then when?
If you would like to contribute thoughts and case studies on:
- An integrated metrics approach
- Innovation, technology and R&D
- Creating social value
…please respond to the consultation visit the NHS/PHE SDU website.
 Costello, M. Abbas, A. Allen, et al. Managing the health effects of climate change. Lancet373 (9676):1693-1733, 2009.