England

Sustainable, Resilient, Healthy People & Places

Module: Sustainable clinical and care models

IntroductionAll services aim to deliver the best quality of care within the resources available. This has always been a challenge and willbecome increasingly so as costs escalate, scarce resources diminish and weather patterns become more unpredictable. To beprepared for changing times, climates and events it is increasingly important to consider the environmental and socialimpact of how services are delivered.

Preserving the values that underpin a universal health service, free at the point of use, will mean fundamental changes tohow we deliver and use health and care services. The principles of sustainability are aligned with the policy direction in thehealth and care sector: more integrated health and social care service provision, integrated connections between serviceproviders, empowered patients, improved use of information and communications technology (ICT), supported self-care andmanagement of long term conditions. These will transform the way we deliver care and provide an opportunity to thinkabout services differently. These issues need to be discussed with people and their communities so that they are at the heartof the design and delivery of care. NHS England through its “Call to Action”1 is developing an in depth approach to ensurethat services are sustained and affordable in the future.

Sustainable | Resilient | Healthy People & Places2

Module: Sustainable clinical and care models

Vision: Quality services and systems includesustainability as a fundamental principle. Thismeans minimising environmental impacts,enhancing health and building resilience withindividuals and their communities

The measures of success by 2020 are:

Professionals are encouraged to consider sustainability principles when deciding what is right forpatients and clients

Service transformations deliver improved health outcomes coupled with social and environmentalbenefits

Sustainability is a core and measurable dimension that underpins quality

Funding solutions and contracts that incentivise more sustainable models of care and enable the re-configuration of services away from acute settings are jointly developed by commissioners, regulatorsand providers.

Transforming the way care is delivered provides an opportunity to take a whole systems approach. Taking account of theenvironmental and social impacts of service models can support the development and delivery of more integrated andsustainable models of care in the future.

This module is divided into two parts that focus on: 1. Sustainability as a factor underpinning high quality care 2. Transformational care

Sustainable clinical and care models 3

Sheffield Right First Timeprogramme

The Right First Time programme focusses on developing aprimary and community model of care that supports thephysical, mental health and social care needs of those mostat risk. One element of the programme is to target 16,500people in the city with a high risk of admission to hospitalwith a joined up care plan. This helps these morevulnerable people remain as independent as possible. Earlyresults suggest the approach is better for patients, betterfor staff and appears to be delivering value for money.There are the financial and environmental benefits of bothreducing emergency hospital admissions and reducingdelays to hospital discharge. The programme is acollaboration between Sheffield’s hospitals, mental healthservices, NHS commissioners of services, GPs, communityhealthcare professionals and the City Council2.

Sustainable | Resilient | Healthy People & Places

Every organisation considers high quality of care as a keyresponsibility. The Health and Social Care Act (2012)3 defineshigh quality care as safe and effective with a positive patientexperience. These are clearly fundamental to any service.

Three additional elements can underpin this definition todevelop a system-wide approach to quality services. Theserelate to functions that include a wider societal impact to thedelivery of services and include fairness, best value andsustainability.

The diagram below highlights these system pillars thatunderpin individual quality care.

Every service, organisation, professional and carer can takethe opportunity to consider how these concepts apply to theirservice planning, delivery and monitoring.

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1. Sustainability as a factor underpinning high quality care

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The elements can be described as follows:

Effective care: The right evidenced based intervention and sound care that is delivered at the right time in the right placePositive experience: People are treated with compassion, respect and dignity and care is tailored to their needs Safe care: People are protected from physical, psychological or emotional harm.

Supported by: Best value: Based on sound evidence of value for money for outcomes achievedFair: Ensures equity in the distribution of resources and delivery of servicesSustainable: Delivered within environmental limits and building on social value.

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Integrated care for an ageingpopulation

Severe floods in 2009 in Cockermouth, Cumbria, acted asa catalyst to integrating health and social care services. Anew hub for healthcare in the community was establishedcalled Centre for the Third Age. The centre allows the co-location of GP surgeries and community services withreferral services geared to meet patient needs. The centreoffers a range of support services in one place includingadvice on benefits, supported discharge from hospital,friendship groups and help at home. The result has beenimproved cooperation between health services, the thirdsector and the community. By supporting independenceand improving overall health and wellbeing for the elderly,hospital admissions and associated costs have beenreduced4.

"Any quality aims that cannot bemaintained with the resourcesavailable to us are set up to fail. It isimportant to realise that working toimprove sustainability will seldom be inconflict with the other dimensions ofquality. In particular, low carbon,environmentally sustainable healthcareis likely to improve cost efficiency andpatient empowerment.”

Professor Donal O'Donoghue - NephrologistSalford Royal NHS Foundation Trust and Board Member Liverpool CCG

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LIVING WELL

ENABLEMENT AND SUPPORT

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PREVENTION & EARLY INTERVENTION

By working in different ways service providers can deliver moresustainable health and care. This is likely to involve designingservices with patients and users, a focus on prevention andhealth improvement, and rewarding health and social carestaff to enhance wellness and enable independence. The model below highlights the different levels of support that

a person may need at different times of their life in a moresustainable system. Evidence has shown that the need foracute and specialist interventions can be minimised whenthere is a system-wide focus on living well and supportingpeople to manage their lives in a positive way.

2. Transforming care

Description of different elements:

Living well – Being healthy throughout our life is an aim for every one of us. At different stages we are likely to come into contact withvarious forms of health and care support to help us lead a life we can value.

Prevention and early intervention - Throughout our life there are ways in which our health can be enhanced and ill health prevented.

For example through vaccination programmes, healthy food, active travel, warm homes or fall prevention programmes. Many of these can

improve health and sustainability simultaneously. For instance, addressing the causes of ill health by switching from motorised travel to

walking or cycling or by reducing the levels of consumption of animal fats.

Enablement and support - Some periods of ill health will mean that we need support through enablement approaches such as talkingtherapies, assistive technology or volunteering schemes which ensure that we are supported to be more effective in our daily roles.

Self-management - Many of us will want to learn more about how to manage our own conditions, such as depression, diabetes or

vascular disease, by self-monitoring and taking action to support a healthier life. This might include regular and easy access to specialist

support.

Acute and specialist rehabilitation - At times we may need acute and specialist help following an emergency or an episode of significant

ill health. Secondary and tertiary care will be crucial to assist us through the most acute phases with the emphasis being on early intervention

and providing only the right care at the right time in the right place rather than a series of poorly coordinated interventions. Acute and

specialist rehabilitation can support this process, minimise any hospital stay and equip us for a world of self-management and living well.

Dying well - Every individual may have a different idea about what would, for them, constitute ‘a good death’. Changing attitudes andbehaviours in society towards dying, death and bereavement is an important issue and needs to be considered with the dignity of those

involved.

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Independent Living Programme

West Lindsey District Council implemented a moresustainable approach to reducing demand for residentialcare, hospital care and social care as part of a preventativestrategy to enable greater care in a person’s home.Integrating social care and health processes allowed bettercoordination and a streamlined pathway, placing lesspressure on acute hospitals. Integration of services wasnot considered in isolation. Equal focus was given to:• Addressing housing quality, including policies for futureproofing housing - this was done in collaboration withthe housing association and other housing professionals.

• Citizen self-help and community action - promotingschemes for befriending, rural transportation and othercommunity activity that supports independent living.

As well as reducing demand on acute hospitals thesemeasures also reduced travel and improved energyefficiency in people’s homes5.

“We will only be doing our best for patientsof today and tomorrow by understandingthe overlap between socially, financially andenvironmentally sustainable health systems.This is crucial to the role of clinicalcommissioners placing the right level ofemphasis on high quality, prevention, care,cure and rehabilitation.”

Michael Dixon - ChairNHS Alliance and President NHS Clinical Commissioners

This document is one of a number of modules supporting the “Sustainable, resilient, healthy people and places – asustainable development strategy” (www.sduhealth.org.uk/sds). For further information, guidance notes, tools and goodpractice to support the delivery of this module visit www.sduhealth.org.uk/focus

The Sustainable Development UnitVictoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB

T: 0113 8253220 E: england.sdu@nhs.netW: www.sduhealth.org.ukFollow us on Twitter - @sduhealth This publication is printed on 100% recycled paper and is printed using vegetable-based inks and a water-based sealant.

Designed and produced by: MJWebb Associates Ltd

Published January 2014

References

1. NHS England, 2013. The NHS belongs to the people: a call to action [Online] Available at: www.england.nhs.uk/wp-content/uploads/2013/07/nhs_belongs.pdf [Accessed 06 January 2014]

2. Right First Time, 2014. Right First Time Home [Online] Available at: www.rightfirsttimesheffield.co.uk [Accessed 06 January 2014]

3. HMSO, 2012. Health and Social Care Act 2012 (c.7) [Online] Available at: www.legislation.gov.uk/ukpga/2012/7/contents [Accessed 06 January 2014]

4. Cockermouth Centre for the Third Age, 2013. Cockermouth Centre for the Third Age [Online] Available at: www.cockermouth.org.uk/C3A/ [Accessed 06 January 2014]

5. West Lindsey District Council, 2012. Living Independently and Staying in your Home [Online] Available at: www.west-lindsey.gov.uk/residents/housing/living-independently-and-staying-in-your-home/ [Accessed 06 January 2014]

Document produced by the Sustainable Development Unit (SDU) which is funded by, and accountable to, NHS England and Public Health England towork across the NHS, public health and social care system. The SDU supports the NHS, Public Health and Social Care system to be sustainableenvironmentally and socially. This is done by engaging across the system to identify the frameworks, networks and mechanisms that will encourage ahealthier environment, better health and enable communities and services to be resilient to adverse weather events and climate change.

Responsibility for the content of this document lies with the Sustainable Development Unit.