Feature

Time for the NHS to think bigger

The health service can make a major contribution to future health by starting to think – and act – sustainably, says Victoria Read

As Europe’s largest employer, occupying 83,161 acres of land (the equivalent of 132 Hyde Parks), spending more than £1,000 every second of every day, producing 600,000 tonnes of waste every year, and investing billions in capital development, the NHS has huge potential to make a major contribution to health determinants.

It is common knowledge that factors such as local employment and education levels, quality of the local environment, access to healthy food, advice about healthy eating and participation in community activities are important determinants of health.

The question is: how can the health service’s potential be maximised? How can the NHS use its resources in ways that promote sustainable development, enhance local communities and improve the health of local populations?

With the publication of the Wanless report earlier this year, Securing Our Future Health: Taking a Long-Term View, the focus is shifting from service delivery and waiting lists towards public health and the impact of the NHS on the wider determinants of health. Developing new healthcare standards provides an opportunity to encourage NHS trusts to bring sustainable development and public health into the mainstream of service delivery.

The forthcoming public health white paper and the Department for Environment, Food and Rural Affair’s current review of the UK sustainable development strategy are also opportunities to make the links between sustainable development and health. What can the NHS do to promote public health and sustainable communities — through its role as a good corporate citizen — and to show how sustainable development goes a long way in tackling health inequalities?

The Sustainable Development Commission’s Healthy Futures project is funded by the Department of Health to help make these links and support sustainable development in the NHS. The focus is on NHS food and its building programme – both major areas of spending, where a significant contribution to local regeneration and sustainable communities can be made.

One element of the project, called Progress in Practice, is gathering and disseminating examples of good practice. For example, the project team for Whipps Cross University Hospital NHS Trust redevelopment, in east London, is determined to put sustainable development, regeneration and the needs of the local community at the heart of the changes. Funded through the private finance initiative, it will include various resources for local people, such as a healthy living centre, sports facilities and a nature trail.

The trust is working with the local authority to ensure that local young people have the appropriate training to make the most of new job opportunities resulting from the building work, that local businesses are ready to meet the demand once the building work starts, and in improving public transport links to the hospital.

Food for thought

The contribution that procurement can make to local economies and environments is now widely recognised across the public sector. Spending decisions are starting to be based on whole-life costs and are taking the impact of these decisions on the wider determinants of health into account.

The positive contribution the NHS can make to local economies and communities through procurement has been recognised by the Rural Regeneration Unit in Cumbria. Sharron Rourke, at the RRU, has been working with West Cumberland Hospital to help it establish local food supply chains for milk, eggs and fresh meat.

She says there are benefits all round: ‘We’ve found that local food suppliers can often offer competitive prices. By buying locally, the NHS not only gets good quality fresh food, it also supports local farmers, many of whom have gone through extremely hard times over the past few years.’

Many primary care trusts are investing in new premises using the Local Improvement Finance Trust (LIFT) scheme and other funding mechanisms. These projects offer an opportunity to tie in the provision of health services with other facilities such as training centres, leisure centres and employment advice.

To achieve sustainability in new developments, the NHS Environmental Assessment Tool (NEAT) helps trusts identify ways to improve the energy efficiency and environmental performance of their buildings. NEAT can help trusts address important issues for staff and users, such as access from the site to public transport, the provision of storage for bicycles, or the opportunity to open up resources to local community groups.

Putting sustainable development principles at the heart of LIFT schemes will engage local people in schemes from the outset, so that the development is designed around what communities want and need.

More information about the Healthy Futures project is available at www.sd-commission.gov.uk/healthyfutures or from susannah.senior@sd-commission.gsi.gov.uk and victoria.read@sd-commission.gsi.gov.uk