Sustainability in the NHS Long Term Plan

CSH welcomes the first NHS Long-term Plan, published in January 2019. Some of the key ideas underpinning sustainability: greater emphasis on prevention; patient-centred care; and integration across current silos, are central to the 10 year plan. Alongside changing models of care there are also some specific carbon reduction and efficiency targets. All these elements echo CSH's 4 principles for sustainable healthcare: prevention, person centred care, lean pathways and lower carbon interventions.

On prevention, there are specific targets in the plan for earlier detection of illness. There are also sections on smoking and alcohol with a commitment to making smoking cessation services much more universally available and specialist Alcohol Care Teams (ACTs) to be supported.

Person-centred care is emphasised under personalised care in section 1.4 on page 25. This includes dedicated support for social prescribing which includes green prescribing and other forms of intervention which are less medical and can be an important sustainable alternative or adjunct to drugs and other carbon-intensive therapies, and also build resiliance and positive health, and therefore contribute to prevention.

Specifically, "link workers within primary care networks will work with people to develop tailored plans and connect them to local groups and support services. Over 1,000 trained social prescribing link workers will be in place by the end of 2020/21 rising further by 2023/24, with the aim that over 900,000 people are able to be referred to social prescribing schemes by then."

An increasing share of NHS resources in England will be directed to GP and community health services. Local schemes which have successfully joined up health and social care provision will be shared across England.

The plan also includes some specific commitments towards environmental sustainability in section 17 on page 120.  The NHS has restated its commitment to the carbon targets in the UK government Climate Change Act (2008), reducing carbon emissions (on a 1990 baseline) by 34% by 2020, and 51% by 2025.  A shift to lower carbon inhalers will deliver a reduction of 4%, with a further 2% delivered through transforming anaesthetic practices.

The NHS commits to improving air quality by: cutting business mileage by 20% by 2023/24; ensuring that at least 90% of the NHS fleet uses low-emissions engines (including 25% ultra-low emissions) by 2028, and phasing out primary heating from coal and oil fuel in NHS sites.

The NHS will also ensure that all trusts adhere to best practice efficiency standards and adoption of new innovations to reduce waste, water and carbon, in addition to reducing single-use plastics. 

We support the ambitious plan and recognise that in order to deliver the targets, the NHS will need an increase in the supply of doctors and other healthcare professionals. This could be partly funded by significant efficiency savings. CSH has shown how the NHS can save £2bn by reducing waste. We urge the NHS to rapidly invest in sustainability and efficiency measures which can give them the savings they need for sufficient staff.

As a national charity with a huge amount of expertise and experience, we invite NHS organisations wanting to integrate sustainability and realise efficiency savings to work with us over the next 10 years.