Question

Provide an example of how healthcare can be linked to each of the three pillars of sustainability (economy, society, and environment). Please explain (150+ words).

Answer 1

True sustainability recognises that the three 'pillars' – the environment; society; and the economy – are reliant on each other and interconnected. ... “A sustainable health and care system works within the available environmental and social resources, protecting and improving health now and for future generations.

Financial
To operate sustainable healthcare services, both now and long into the future, we must learn to do more
with less. If the NHS is to achieve the required £22bn efficiency savings target1
, whilst not affecting front
line services and simultaneously meeting the demands of our ever growing and ageing population, then we
need to implement a significant transformation of our services. Utility costs, in the form of energy and
water bills, have almost trebled in the space of a decade and this upward trend is not likely to stop. The
NHS’s forecasted energy bill, for 2020, stands at £1.2bn. Market forces alone dictate the need for more
efficient use of our natural resources.
Statutory requirements, outlined in the following section, bring additional financial pressures. The cost of
emitting carbon increases each year, with the Carbon Reduction Commitment and the European Union’s
Emissions Trading Scheme leading the way. The cost of energy and carbon will continue to be a priority
when planning how we deliver our healthcare activities in a changing climate. The benefit of operating a
more sustainable organisation means that significant financial gains can be made from efficiency savings
through environmental and socially focused projects.

Environmental Legislation
With the Climate Change Act 2008, the UK government set out the world’s first carbon budget,
demonstrating a clear commitment for organisations to drive iterative and continual carbon emission
reductions. All organisations must reduce their carbon emissions by 34% by 2020, 50% by 2025 and 80% by
2050 (based on 1990 baseline emissions). As accurate 1990 baseline data is not available for NHS
organisations, a commitment was made to use 2007 baseline data for the NHS (or a revised 2020 target of
a 28% reduction from a 2013 baseline). In addition to the Climate Change Act, the UK government has
implemented other statutory instruments with a focus on sustainable development:
The Civil Contingencies Act 2004 requires certain public bodies, including the NHS, to prepare for adverse
events/incidents. Our changing climate, resulting in heat-waves, flooding and extreme cold weather can
disrupt the operation of the health and care system and have direct impacts on public health. These
situations are recognised as relevant to the Act, alongside major incident situations.
The Public Services (Social Value) Act 2012 places a requirement on commissioners to consider economic,
social and environmental benefits, taking a value for money approach – not lowest cost – to assessing
contracts, when buying goods and services.
The Carbon Reduction Commitment (CRC) Energy Efficiency Scheme is a mandatory energy efficiency
scheme. There are penalties if the participation requirements are not met. For every tonne of carbon
emitted from building energy use we are taxed by central government. This doubly incentivises energy
efficiency measures, given the financial savings from reduced energy bills and the CRC tax savings this also
brings.
Legislation, and national guidance in response to this, is continuously changing to ensure UK organisations
are improving performance to both mitigate, and adapt to, the effects of climate change.
Societal Expectations
Delivering our healthcare services in a more sustainable manner is now expected by our patients, staff,
visitors and members of our wider community. Awareness of climate change, its impact on human health
and development, and what mankind needs to do to mitigate these changes has never been higher. In
2015 the Sustainable Development Unit (SDU) commissioned Ipsos MORI to conduct a detailed public
opinion survey of over 1000 people to shape understanding around the public’s view of the NHS’s role in
leading on sustainability. The results showed that 92% of the public think it is important for the NHS to
work in a more sustainable way, with 43% saying they should do this even if it costs money and 25% who
thought it should be a top priority. These figures have either stayed at this level or have increased since the
first Ipsos MORI poll was conducted in 2011, and repeated in 2013.
Our own staff have been consulted on their views with regards to sustainability, in annual Staff
Sustainability Surveys for the last four years. Matching the SDU’s Ipsos MORI questions, we know that:
 8% of our staff think that it is very important for our Trust to work in a more sustainable way
 86% of our staff answered with a rating of 7 or higher, when asked to what extent should the Trust
make sustainability a part of the way we work (on a scale of 1-10, where 10 means top priority and 1
means no priority at all).
 When asked about the cost of sustainability, the majority of our staff aligned themselves with the
statement: ‘The Trust should act in a more sustainable way even where this would cost a small amount’.