David Pencheon: We face a SSTEEEP learning curve

David PencheonIf the health service takes environmental, social and economic sustainability seriously, it is amazing how many co-benefits there are – for the health of individuals, for the health of the population, and for the cost and quality of the health care system – genuine win-wins – win now, win later. You might think therefore that health systems like the NHS (and the managers, clinicians, and other staff who work within it) would grasp sustainability as a real opportunity to promote quality and contain cost. Well, although there are some outstanding (and even inspiring) examples of action by individuals and organisations in the NHS, we can’t quite say we have a consistent, or systematic or ambitious approach to reaping all the many benefits of making the NHS much more sustainable.

Why is this? Let me suggest at three reasons why we dangerously waste this opportunity. First, we have a halo effect in the NHS – all health services do – we’re the good people: we already save lives – you want us to save the planet too? Secondly, health service professionals are crisis junkies. I think that one of the reasons I chose medicine as a career is because I liked the idea of identifying problems and fixing them (and the more sirens, blue lights and drama the better…) And thirdly, we don’t do change, despite being world experts at talking about and sometimes even researching it. System-wide change where the evidence is good or the need is compelling is rare. The NHS is too fragmented, too tribal, and too busy, to have enough energy and leadership left to ensure we remain a world beating quality health service that does more long term good than harm.

We should count ourselves blessed that most of the systematic changes that increase the quality and contain the cost of health care are largely those that would be environmentally, socially and economically sustainable. (In the next blog, I will outline some of the practical and specific examples of what that quality health service looks like – nearly all of them entirely congruent with long standing health care policy in developing countries.)

So can we afford to take sustainability seriously? The answer is: we can’t afford not too. So let’s get sustainability as a core part of a quality health service, alongside being safe, timely, effective, efficient, equitable, and patient-centred [STEEEP] (Crossing the Quality Chasm: A New Health System for the 21st Century” Institute of Medicine’s 2001)

SSTEEEP – Now, that really would be amazing wouldn’t it? No, that would just be common sense, good management, and a duty of care…