Examination of Witnesses (Question Number
CBE, AND RICHARD
20 OCTOBER 2010
I thank both of you for coming along. Our session is very curtailed
this morning, so I hope you will bear with us. We are hoping to
have a full half hour. That gives you some indication of where
we are. I think we wanted to invite you along because the Department
of Health seems to have been cited as a good practitioner in terms
of sustainable development. To start off with, what we would like
you to do is perhaps just introduce yourselves and then my first
question will be: from your perspective, has the Sustainable Development
Commission been good value for money and what arises out of that?
Thank you very much, and thank you for inviting us today. I'm
Flora Goldhill. I am acting Director General and Chief Operating
Officer at the Department of Health. My colleague, Richard Mundon,
is Director of Operations at the Department of Health and he leads
for us on sustainable development.
Our view of the Sustainable Development Commission
is that they have been very good partners. They've really helped
us understand the agenda. I think I would say by way of introduction,
though, that health and well-being is at the heart of what we
in the DH, the NHS and public health do and believe in. I think
we have been very open to what they could offer us. I think they
particularly helped us interpret what we do in the language of
sustainability. As the SDC have just said, you often don't realise
that you are talking about sustainability when you're talking
about particular things, but we have found them an extremely valuable
partner and we've learned a huge amount from them. We believe
we are on the way to embedding what we've learned. We've particularly
valued the fact that they've embedded in the department one of
their team, who has really worked with departmental colleagues,
to help them understand the sustainability agenda and present
it in a way that's helpful to broader understanding.
That all sounds very well and good, but, if I was going to convey
to one of my constituents about how that's made a difference in
the Department of Health, I'm not sure that they'd know where
the detail of the policy is. Can you give us an example of something
that's realsomething that's actually delivered resultsand
how you've changed your policy, how you've done things in a different
way and how that's led to money savings and environmental well-being?
Richard will have many examples, but if I could just start with
one example that the SDC helped us with, they helped us develop
a sustainable development tool that supports the NHS in understanding
sustainability. Some 80% of organisations in the NHS use that
tool to help them make decisions about sustainability, which deliver
better quality and value for money.
Can I just ask you there whether you are talking about the NHS
estate or whether you are talking about hospitals and those, if
you like, who are technically outside the NHS estate?
The tool that Flora is referring to is a good corporate citizen
model, which looks at buildings as part of its remit, but also
looks at many other aspects of sustainability. One of the things
that Andrew was talking about a little earlier is that Government
departments are very often focused on operational estate. The
Department of Health has a very small operational estate and most
of our opportunities for delivering sustainability are around
how we influence people and how we deliver policy, so we were
very keen to develop a tool that was broader than just operational
estate and looked at other aspects as well.
Can I just press you on this a little bit? I think you were here
for the earlier evidence session. It talked about, I think it
was, designing obesity out of the equation. So how is it possible
for a new hospital to be designed within the NHS which didn't
have a kitchen at the heart of it, where local food could be produced
in terms of promoting high, good nutritional standards for people
in that hospital? How do you make sure that all the different
tickboxes are ticked when it comes to sustainable development?
How has working with the Sustainable Development Commission assisted
with that agenda, or not got to where it should be on that agenda?
The role of the department, obviously, can't be to get into all
local decisions. Local decisions are for local people. What we
do is create an environment, create a framework, create the strategy
and policy and the levers by which we encourage sustainability,
but we can't do it for individual providers on the ground. That
is something where they have to be accountable for themselves.
But we do want them to take those things into account. For example,
the way that contracts are constructed requires providers to produce
a Sustainable Development Action Plan themselves so that in the
NHS those who commission services can understand how sustainability
is going to be delivered through provision; but how individual
providers do that is something they have to be held accountable
Q29 Zac Goldsmith:
Can I ask you, just on that point, am I right in thinking that
the department's latest Sustainable Development Action Plan doesn't
make any reference at all to sustainable food procurement? That
is my understanding of it, in which case I think that would provide
something of an answer to your question, but that also to me seems
quite shocking given that it is a Sustainable Development Action
Plan. Is that correct?
It mentions sustainable procurement
Zac Goldsmith: Food procurement.
and the NHS supply chain that is responsible for most of
the procurement in the NHS has a specific role around food, so
through their actions between 64% and 65% of food in the NHS is
locally reared or sourced, so there is a specific output as a
result of that. The Sustainable Development Action Plan is not
specifically about food but it does refer to procurement.
Q30 Caroline Lucas:
I want to explore a little bit more about what the loss of the
SDC will mean to you in more concrete terms. For example, in some
of the reporting that's been shown, although you have been doing
very well on sustainability, just recently on some indicators
your performance has gone downfor example, on water use.
In your note you say that the department hopes to work with the
SDC to address performance slippages. In the absence of the SDC,
where will you go to get that kind of advice?
Just to go back to one of the points that the SDC made about leadership,
we are already engaged with our Ministers, and our Ministers are
engaged with DEFRA Ministers and have clearly demonstrated commitment
to this agenda, so we have got that leadership right at the top.
We have a new Permanent Secretary who takes up post in November,
and I am absolutely confident she will be committed to this agenda.
We have a very good network of championsI think that's
in the papers we submitted to youand there is a lot of
enthusiasm in the Department of Health for this agenda because
they believe in it. It is part of the core of what they do.
What we will be doing is really exploring all
opportunities to learn good practice. That's the way we want to
do this. We are confident that we've learnt the benefits of working
with the SDC and we want to go on working with the best people
who can advise us on this. That will be our way forward in this,
so we'll be making as many connections as we can in the hope that
we don't miss anything in the way of good practice.
Q31 Caroline Lucas:
Apologies, but that does sound a little bit vague. It is one thing
to have leadership in championsthat is absolutely essentialbut
it is also essential to have expertise and the best quality advice.
In the absence of the SDC, are you confident that you will easily
be able to access the quality of expertise and advice that you
have traditionally been able to access via SDC?
There are a number of routes into this, and I will ask Richard
to pick up in a moment, but we have a very big research and development
budget in the Department of Health. We can use it in many ways.
We will be looking at sustainable development as part of the way
that we think about our research programme. That will clearly
be built in. We will be looking for expertise wherever it exists.
I am sorry I sound vague, and am not able to say exactly what
exists where.Richard can help us with that.
The real benefit that the SDC has brought to the department around
things like water, which was one thing you mentioned, is transparency.
It's given us a great deal of transparency, and transparency brings
a need to act. By bringing these things to our attention in a
much more transparent way, we've acted on them in a way that perhaps
we wouldn't otherwise have done. They have offered some expertise
around those areas where there are particular issues, but they
aren't at the moment the only source of expertise on that.
There are lots of different places. We would look
at other organisations. We've got the NHS, for a start, who have
many properties, who have developed a degree of expertise in how
we might improve sustainability in their organisations. We go
to the centre of excellence on sustainable procurement in the
Cabinet Office, who also have expertise. And we have colleagues
in other Government departments who are both wrestling with the
same issues and have developed some expertise around thisfor
instance, in DEFRA and in DECC. So there are sources of expertise
around this that we already use or will use more as the SDC isn't
on the scene.
Q32 Caroline Lucas:
I have just a quick follow-up on that. In your experience, how
useful have you found the Sustainable Operations on Government
Estatesthe SOGE targets? How useful have they been in
terms of incentivising sustainability?
Very useful. It is transparent. It shows you absolutely where
you are in terms of comparators with other Government departments.
That acts as an incentive to try to improve performance. We in
the Department of Health have generally been very good on those
indicators. You mentioned the occasional blip, which everyone
has. The SDC have brought that to our attention and helped us
where there are issues. They haven't, frankly, spent an awful
lot of time with us because we haven't had massive issues around
that. Things like carbon from transport has been one of the things
that's been a perennial issue with the Department of Health, and
we have worked with the SDC on that. But we've reached a stage
now where we've learnt a lot from that relationship and started
to act and put plans in place which address those concerns. So
they have been helpful, but we still feel confident that we can
build on that and move on.
Q33 Dr Whitehead:
What about the arm's length bodies? How do you manage the sort
of processes you've described in terms of arm's length bodies
within the Department of Health, and what sort of targets and
arrangements exist for employees in those bodiesassuming
they're still there?
Some of them will be, yes. The existing Sustainable Operations
on the Government Estate targets don't extend to arm's length
bodies, so we have a relationship with each of them based upon
a planning framework. That planning framework requires them to
take account of sustainability in the same way that the core department
does. They are an extension of our family, really. We expect the
same levels of performance from them as we would from our own
estate. Generally speaking, they are very good at that. Some of
them are exceptionally good. Organisations like the Health Protection
Agency and NHS Business Services Authority are very good and have
sustainable plans of their own that would stand up to close scrutiny.
We have regular meetings with the arm's length bodies to ensure
that their plans are on track and that they are performing in
the way that we would expect them to.
Q34 Dr Whitehead:
So are those linked by means of key performance indicators that
are in the contracts with the arm's length bodies, or are they
just a matter of custom and guidance as far as their relationship
with you is concerned?
There aren't contracts as such with arm's length bodies. There
are agreements around their performance and performance indicators.
Some of those take the form of KPIs; some of them are not quite
so precise. It varies from organisation to organisation, depending
on how big it is. Some arm's length bodies have much less capacity
to be dealing with sustainable development issues than others,
and therefore you need a tailored approach to how we deal with
them. There is a variety of different indicators and measures
that we use.
Q35 Dr Whitehead:
If you decided within the department that this was all a waste
of time for the futuredifferent circumstances, problems
in the health service what sanction would there be on you
if you decided to do that?
I can't envisage that we would decide to do that. Going back to
what I said at the beginning, health and well-being is absolutely
core to what we do. Public health colleagues have argued sustainable
development for as long as I can remember. If the decision were
taken that this were not a priority, I can't see it not being
part of how we do business in health and social care.
Q36 Dr Whitehead:
I think the thrust of the question, among other things, is to
whom might you be accountable for what you do in this area? If
it were, for example, a Cabinet Committee, how might that impact
on what you do, or do you see for the future this being very much
something that, as you have suggested, is internally generated
by your own wishes as a department to run yourself in the best
possible way according to what you consider your mission is?
I think in the department we welcome scrutiny of what we do. We
have absolutely no difficulty about scrutiny. I think audit is
helpful. Audit, and sustainable development could be open to audit.
I think the critical thing for us in scrutinising what we do is
that the measures are clear and that we can do them readily; that
we can collect data readily; that we don't create burdens on those
that are providing services; that we can compare data easily.
These are the kind of things that we would ask for. We would be
very happy to be accountable to a Cabinet Committee. There would
absolutely be no difficulty in having scrutiny. In fact, I think
scrutiny always does raise your game.
I just have a few very quick, short questions, just to get some
idea of how things are moving. Looking toward the Liberating
the NHS White Paper, I am just interested in how you feel
sustainable development will be embedded into the new architecture
that will come out from that?
I think the critical piece of architecture is the NHS Commissioning
Board, which will be responsible for health outcomes. It says
in the White Paper that it will be responsible for designing the
model contracts, and the contracts that the NHS use at the moment
for commissioning, as I said earlier, require providers to produce
a Sustainable Development Action Plan. We envisage that that would
continue in the way that the NHS Commissioning Board design contracts.
But the specific question is, should it have sustainable development
in the health care system, actually as part of its remit, because
if it doesn't have it, how can that direct the general direction
of policy making on sustainable development lines?
The functions that are envisaged in the new health care system
are set out in the White Paper and will be in the Health Bill,
which is about to go into Parliament. I think the opportunity
will be available to people to argue whether sustainable development
should be a core function of any of the bodies that are being
But as it is set out at the moment, do you believe that sustainable
development will be at the core and at the heart of that?
At the moment I don't see it as stated in that way.
So it's not there?
I think I go back to my earlier pointthat in order to deliver
good health outcomes you need to take account of sustainable development,
and therefore it's integral to that whole principle of delivering
better outcomes for people.
But my point is that our line of inquiry with our previous witnesses
and with yourselves is, when we're looking at new legislation
which is coming in, who is responsible for ensuring that that
function of sustainable development is one of the key policy drivers?
It would be helpful if you could say whether or not you think
that it is there. But if it is not there, presumably some further
work would need to be done to make sure that it is stated?
I think I would go back to the proposals made by the Sustainable
Development Commission that Dr Whitehead was referring to, which
is a Cabinet Committee of some kind looking at the work that we,
as a department, do. I think in terms of the NHS, as a core function
I think it has to be integrated, it has to be mainstreamed, into
what we do.
Right, but is it there now? Sorry, is it in what you envisage
as coming forward in the new legislation, or does further work
need to be done on that to ensure that it is?
I am sorry, perhaps I don't understand the question clearly. If
your question is, "Will there be a function to deliver, for
example, sustainable development?", at the moment that's
It's not envisaged in that way.
It's not envisaged? That was my question, thank you, that's helpful.
Does the Care Quality Commission have the remit for
sustainable development as well, as currently envisaged?
It doesn't have that in its remit at the moment, and there are
no plans to change it so that it specifically states that it should
have that as a function.
If there were plans to change it, where would those plans come
from? Would they come from the Cabinet Office or from yourselves?
How do you see the whole issue of sustainable development being
Clearly a cross-Government approach is very powerful, and that
gives us an impetus to doing things. I think the Cabinet Office
is a good place to co-ordinate that. All departments pay good
attention to what Cabinet Office requirements are, and we do everything
we can to meet those requirements.
Q46 Zac Goldsmith:
Can I just add to that? In the absence of the SDC, assuming it
ceases to exist as from today, and in the absence of anything
being put in its place, where would a reluctant department feel
the pressure to pursue the sustainability agenda? Assuming you
were a reluctant department, where would you feel that pressure,
We would feel it here, obviously.
Q47 Zac Goldsmith:
Where is "here"?
Here, in front of your Committee, the Environmental Audit Committee.
We would feel it here, certainly. We would feel it through any
audits that were put in the public domain. If there were targets
we would obviously want to do our best to meet them. So anything
that was in the public domain where we were being measured and
scrutinised would incentivise us to want to perform well.
Q48 Zac Goldsmith:
But if we are honest about itand this is not a reflection
on your commitmentif the department is reluctant to take
this issue, this agenda, seriously, the answer you've given suggests
that there isn't really any pressure at all. If you look at the
Department for Education, it will be judged on whether or not
it delivers enough school places and whether or not they are good
quality. If there isn't someone there with an absolute commitment
also to ensuring that the wider agenda is taken into account,
it seems to me that without the SDC there isn't that pressure.
Is that unfair?
I think the question you are exploring, as I understand it, is
what could you put in its place?
Q49 Zac Goldsmith:
It could be something done through financial penalties imposed
by the Treasury. It could be clearly something from Cabinet Office
on the cross-cutting agenda and targets that they set. We certainly
paid close attention to the Prime Minister's requirement for a
10% reduction in carbon consumption. So all of these things do
make us act, but where we would be held to account if we were
reluctantit would be somewhere like this, I think.
Zac Goldsmith: Thank you.
We are coming to the end of our session now, I say to colleagues.
On that last question, just a different way of asking
it: would it make any difference if delivering on sustainable
development were a part of the specification for whoever the chief
officer were in the departmentseither in your department
or in any other departmentif that was a requirement of
the job description that that chief officer had to deliver on?
Is that one way of doing it?
It is a way of doing it. I think the question would be how powerful
that would be, because I think if you hold people to account for
their objectives it would have to come from the top. It would
have to be something that Government expected its civil servants
to do. I think it was said before that there have been targets
and some departments have not done anything about it and there
has been no sanction, even with the SDC. I think the question
is, if the SDC were not to exist, what would actually change in
terms of sanctions? I'm not clear that anything would change.
It is about what's put in the public domain and what is scrutinised.
I think that is the critical part.
Okay. I have one absolutely final question. With regard to the
new Director of Public Health role and the new arrangements that
there are to link up the Department of Health with local authoritiesdo
you see that new role as being a trigger for bringing in sustainable
development policies and principles into local policies and services
from local authorities?
Most certainly it will be an important trigger, and the Directors
of Public Health, I think, will have this as a very key component
of their job roles. They will want to work with all partners at
local level, so I think they are very key to delivering sustainable
development on the ground.
Chair: Right, I think
that brings us to the end. We do have the comprehensive spending
review and Members are very anxious to get down to that. Thank
you for your time. Thank you very much for coming along.