Richard Smith: Buggered about by the NHS Sustainable Development Unit: a story with a moral

Richard SmithI’m an enthusiastic follower of the NHS Sustainable Development Unit, its director, David Pencheon, and its important mission of reducing NHS carbon emissions by 80% by 2050, but like all organisations it needs to pay attention to small as well as big things to succeed. That’s why I tell this (not very) sad story.

I was invited a long time ago to the unit’s launch of its new strategy on Tuesday 29 January. I accepted and made a note in my diary. At some stage I had to register on Eventbrite, a website that an increasing number of organisations use to invite people to their meetings. It’s particularly useful if you have only a limited number of places.

About three weeks ago I was emailed a reminder to the meeting by Eventbrite, and soon afterwards I got another one. I was asked to print out my invitation, which I did. As I prepared for my week on Sunday I looked at the invitation to check the timing and the venue. I was pleased to see that the event lasted only for the morning, not the whole day, as I’d marked my diary. I cleared the afternoon and soon had another appointment.

The venue baffled me. It simply said Westminster Bridge Road, London SE1 7EH, United Kingdom. I wasn’t surprised that the venue was in the United Kingdom, but where, I wondered, was the building on Westminster Bridge Road? Why was there no number? I put the postcode into Streetmap, another website, and saw that it was just south of the line out of Waterloo Station. I surmised that the meeting must be in the unit itself.

On the day I cycled to the spot, but couldn’t see the unit. As I looked lost, two men smoking outside a building asked me if they could help. “I’m looking for the NHS Sustainable Development Unit. Is this it?”
“No, mate.”
“Do you know where it is?”
“I think it’s round the corner.”
I went round the corner, and there, sure enough, was a huge NHS Building. I went in, asked for the NHS Sustainability Unit, and the guard waved me to the receptionist. I asked her for the unit and the meeting. She looked blank, but asked me to fill out one of the security forms. “Could it be this public health meeting?” she asked.
“It might be,” I answered.
“Have you got a name?”
“David Pencheon.”
Meanwhile, two others have arrived and seem to present the same difficulties, although they were not looking for the NHS Sustainable Development Unit.
The receptionist can’t find the unit, the meeting, or David Pencheon. Eventually she says, “It’s not in this building.”
“Is there another NHS building?”
“Yes, go the end of the street and turn…”
“Which way?” I ask.
“Er, just turn….” She’s presumably one of those many people who have trouble distinguishing left from right.
I leave. Surely, I think, it can’t be to the right, that takes you into a tunnel almost immediately. But I remember the arrow on Streetmap and how close it was to the railway. So I try the right. There’s just a pub. Could the unit be above a pub? It seems unlikely.
So I walk to the left, looking for likely buildings. Almost every building seems to be a possibility. I think about telephoning, but I don’t have my mobile phone and there’s no number on the invitation. I’m beginning to think “Sod the meeting,” when I peer into a building that looks likely because I see the word “choice.” A man sees me looking and comes out to ask if he can help. (I’m impressed by how many people are being helpful.)
I ask if he knows the unit. He doesn’t?
“Are there any NHS buildings near here.”
“Well, there’s the hospital.”
A small bell rings in my head. “Wasn’t the meeting at St Thomas’s. I think it was.”
So I walk to St Thomas’s, where all three of my children were born and where I’m going to die if I’m not careful. I haven’t been in a while, and I note that the foyer now looks like Terminal Three at Heathrow, full of shops and restaurants.
I know where I’m going now, and just beyond the huge statue of Queen Victoria I spot David and a gaggle of sustainers. I immediately start berating David in a mildly crazy way. But soon it gets worse. I discover that the meeting starts at 10.15 not 9.30 as the invitation says. I could have used that 45 minutes productively. Then I discover that the main meeting is in the afternoon not the morning. So the electronic invitation has thoroughly misled me.
I stay for the morning, but can’t now for the afternoon. “When things start badly,” says David, “they tend to go on that way. It’s like that in medicine.” He has an ability to pull a homily from almost any event or phrase, but he’s right.
There is a moral: to save the world or to achieve anything you can’t neglect the small things. We will save the world not through grand strategies, but one small step at a time. And personally I don’t think that we’ll manage it.

Richard Smith was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.