The Centre For Sustainable Healthcare's Response To The NHS Constitution 10 Year Review Consultation

As strong advocates for sustainable healthcare, we at the Centre for Sustainable Healthcare are deeply invested in the future of the National Health Service. The NHS Constitution 10-year review presents a pivotal opportunity to reshape healthcare in England and put a significant focus on a more sustainable, more equitable and healthier future for the whole industry. 

Climate change is a major threat to health and increases health inequalities, including within the UK. Climate impacts on health include increased deaths in heat waves; loss of homes, livelihoods, and mental health from flooding; rising costs of food and energy due to crop failure and conflict over natural resources. This is why it is essential that the NHS must play its part in meeting UK climate commitments, and this consultation on the NHS Constitution can help prepare it to do just that.

Understanding The NHS Constitution

The NHS Constitution is a vital document that outlines the core principles and values of the NHS in England. It is not legally enforceable, but it does set out the rights and responsibilities of the public and of staff, and the level of care that all patients should expect to recieve. As such it is designed to safeguard the enduring principles of the NHS and ensures that it operates fairly, equitably, transparently and consistently across the country. 

The NHS Constitution 10 Year Review - Why It Matters 

First created in 2009, the law requires that the NHS Constitution is reviewed at least every 10 years to ensure that the NHS remains relevant and effective.. That review process is taking place now, and NHS England have recently been consulting on the changes they propose making. This 10 year review is crucial for several reasons:

• Adapting To New Challenges: The healthcare landscape is very different to what it was even just 10 years ago and is constantly changing, with new best practices, technologies, treatments and challenges emerging all the time.
• Sustainability: With increasing legislation and pressure to adapt Net Zero strategies and become carbon neutral, there is a growing need to adapt and address the environmental impact of healthcare services.
• Efficiency: With budgets decreasing and costs rising, there is added pressure to find ways to reduce costs and deliver a more cost effective industry.
• Equity And Accessability: There has always been a need to ensure that healthcare services are accessible to all corners and levels of society, but with an ever changing social landscape these challenges remain as relevant as ever. 
• Quality And Safety: Maintaining the absolute highest level of care to all patients must always be the highest priority, but pressures on budgets and resources make this a significant challenge.

CSH's Response To The Consultation:

This consultation process is vital to ensure that any changes that are made to the constitution prepares the NHS for its sustainability obligations in the future.

As part of these changes, the government is proposing to introduce a new NHS value called 'environmental responsibilities'. This value encompasses achieving legislative commitments and enhancing our resilience and efficiency, a concept that we at CSH fully support in principle. The problem with this, however, is that it does not go far enough and that the wording in the current draft plays into a misleading narrative that care for the environment is in conflict with care for patients.

"The NHS is a major contributor to the UK’s carbon footprint, being responsible for over 30% of public sector emissions. The government has already placed legal duties on NHS bodies through the Health and Care Act 2022 that compel action on environmental issues. As the hosts of the United Nations Climate Change Conference of the Parties (COP26) in 2021, the government further committed to updating the NHS Constitution to reflect its environmental responsibilities, while guaranteeing transparency for patients and the public on how this work aligns with the NHS’s core principles and the government’s overall environmental strategy. We are therefore proposing to add a new NHS value of ‘Environmental responsibilities’: We play our part in achieving legislative commitments on the environment. We do this by improving our resilience and efficiency, while always prioritising value for money. We will never compromise standards of care or the needs of patients in pursuit of these targets." NHS Constitution Consultation.

This language again implies that there is a trade-off between quality and sustainability, something that we at CSH have proven is not the case time and time again. This is a fundamental problem in the core principle of the constitution that needs to be addressed if the NHS is to make true, long lasting changes for the better. 

Evidence shows that addressing the environmental impact of NHS care can improve patient outcomes and standards of care while also reducing financial costs. This is why the constitution should make it explicitly clear that sustainability and care are not mutually exclusive and that striving for excellence in one will not impact negatively on the other; quite the opposite is true, in fact. By meeting our environmental responsibilities, we can improve care for patients while supporting staff wellbeing and reducing financial costs at the same time.

CSH's Recommendations For The NHS Constitution 10 Year Review

As an organisation that has worked alongside the NHS to make healthcare more sustainable since 2008, we have seen significant strides forward and magnificent changes in all that time, but we still know there is a long way to go. As such, we have several recommendations for the NHS constitution consultation to ensure that the NHS continues to address its current and future obligations to sustainable healthcare.

• Integrate Sustainability Goals: We absolutely welcome the inclusion of sustainability criteria into the constitution; however, this must come with an absolute paradigm and language change to ensure that it is not mere greenwashing. Sustainability must be embedded into the core principles of the NHS and of clinical practice, and should be seen as something everyone can do alongside current practice, not instead of or on top of, and also something that is a net benefit all round, not something that is in direct competition with clinical care.  
• Promote Preventative Healthcare: Emphasising the importance of preventative care and health and wellness will significantly reduce the burden on the NHS. Early detection and improved disease management, personalising care, and supporting patients to be active partners in managing their conditions —all of these can improve health and reduce the need for care.
• Promote Care In The Community: Community care is essential for the future of a sustainable NHS.
• Tackle Climate Emissions At The Source: In care delivery, tackling climate emissions can uncover and address avoidable waste —whether in the use of medical equipment, the supply of medical gases, duplicated tests, or even unwanted procedures. In some cases, alternative treatments and technologies are already available that are clinically effective and have a lower environmental impact; these can be prioritised within service improvement programmes.
• Invest In Green Spaces: Improving the biodiversity of NHS green spaces and encouraging their use has also been shown to benefit the health and wellbeing of patients, relatives, staff, and local communities.
• Embed A Commitment To Equitable Access To Care: Strengthen measures to ensure that healthcare measures are accessible to all, regardless of socio - economic status, ethnicity, or geographic location.

The NHS Constitution 10 Year Review is a critical moment for the future direction of sustainable healthcare. At CSH, we remain committed to supporting a healthcare industry that prioritises the health and wellbeing of people and the planet at the same time, and by integrating these recommendations into the NHS Constitution, we can ensure the NHS is a leader in that field and provide equitable, high quality and sustainable care for generations to come.