Embedding sustainable development across Government, after the Secretary of State’s announcement on the future of the Sustainable Development Commission

Supplementary written evidence submitted by

the Department of Health (21a)

Q How is senior and middle management in the Department of Health made responsible for achieving sustainable performance improvements? Do their objectives include references to sustainable development targets?

We have robust governance arrangements in place for ensuring that the strategic outcomes set out in our DH SD Strategy are realised through monitoring delivery of the SDAP. Using the DH project management approach, delivery of the SDAP has been coordinated as a programme of work. Our SD Programme Board has been established under direction from the SD High Level Group and is chaired by our SD Programme Director and Senior Responsible Officer. We have appointed lead senior managers as owners of each of the nine areas within our sustainable Development Action Plan. As members of the SD Programme Board, they are responsible for reporting on and delivering agreed actions within their area.

In addition, we have put in place a network of Green Champions to help with the improvement of sustainability in DH’s operations. This is a voluntary role, and Green Champions work locally with their colleagues to support staff to live and work more sustainably. We have grown the network to around 60 members.

Sustainable development is not currently part of the Department’s performance management framework. As such, performance objectives do not routinely refer to sustainable development targets, unless they are of particular relevance to a job or team.

The Department’s Sustainable Development Action Plan includes an action to include sustainability within the performance framework for Senior Civil Servants, but it is in competition with other objectives around staff management, volunteering, equality and diversity, financial management and leadership. The performance framework for SCS is largely set by the Cabinet Office.

Q In July the Department of Health issued details of four tests that should be passed before service reconfigurations go ahead – clear clinical evidence, patient choice and so on. [1] It might be argued that there is a more fundamental requirement that changes are coherent in sustainable development terms and that society’s longer term interests are properly taken into consideration. Did officials consider adding a reconfiguration ‘test’ that any changes should represent sustainable development? If not why not? [Or - if this was considered why was it not included?]

This Government is committed to devolving power to local communities – to the people, patients, GPs and councils who are best placed to determine the nature of their local NHS services. The objective of the four reconfiguration tests was therefore to ensure patients, local GPs and clinicians, and local councils have a much greater role in how services are shaped, and to ensure that these changes will lead to the best outcomes for patients. However, the tests were not intended to be a complete list of the only issues NHS bodies should take into account when planning and redesigning services. NHS bodies will continue to need to have due regard for their wider legal and public obligations in relation to the planning, operation and delivery of services.

DH addresses sustainable development and climate change requirements for the NHS through its policy and strategy as identified in:

· DH SD Strategy 'Taking the Long Term View: the Department of Health's strategy for delivering sustainable development 2008-2011"

· DH SD Action Plan 2009-2011;

· DH Climate Change Plan 2010-2012;

Operationally, these policies are delivered to the NHS via DH's "the operating framework for the NHS in England 2010/11" and by standards and best practice guidance, such as:

· Sustainable Development in the NHS

· Total waste management – best practice advice

· Carbon/energy management in healthcare – best practice advice

Also an Environment and Sustainability suite of guidance:

· HTM 07-01 Safe management of healthcare waste

· HTM 07-02 EnC0 2 de – making energy work in healthcare

· HTM 07-03 Transport management and car parking

· HTM 07-04 Water management and water efficiency

· HTM 07-05 Waste Electrical and Electronic Equipment

· HTM 07-06 Community pharmacy waste guide

· HTM 07-07 Constructing Sustainable Healthcare Buildings

The Sustainability agenda is supported by:

· BREEAM Healthcare (Building Research Establishment's Environmental Assessment Method specially adapted for healthcare)

· Good Corporate Citizen Model

There is no legislative requirement within the planning process to consider the environmental impact, but the BREEAM tool was initially developed to provide this requirement. However, it was never formally adopted by the building control and planning bodies although many authorities have taken up the requirement.

It is DH policy within the capital procurement process to require an environmental impact assessment to support a business case. BREEAM Healthcare was specifically developed to meet the need to ensure a sustainably constructed, energy efficient healthcare estate and to allow the particular aspects of healthcare to be embraced in an assessment.

DH also supported setting up the NHS Sustainable Development Unit to support, empower and galvanise the NHS to meet their obligations as a leading public sector body. A key document for the NHS is the NHS SDU’s

"Saving carbon, improving health: NHS Carbon Reduction Strategy for England " 2009, updated 2010.

Q The Initial Equality Impact Assessment, published alongside the Liberating the NHS White Paper, notes that the new "Health & Wellbeing Boards will allow local authorities to take a strategic approach and promote integration across health and adult social care, children’s services including safeguarding, and the wider local authority agenda". Will this wider agenda, include ‘wellbeing’ programmes, in the sustainable development sense of the term? [2]

· With the demise of the Audit Commission, how are you going to be able to assess how well local authorities deliver on their enhanced health and wellbeing obligations?

Directors of Public Health in local authorities will have use of a public health ring-fenced budget. The ring-fence will predominantly be for health improvement. Local authorities are best placed to make decisions about the services needed locally, within the framework of a set of national outcomes for public health. They will be able to use the ring-fenced budget widely to improve public health in the local area, including jointly with other Local Authority budgets such as those for children’s service, schools, housing, transport and environmental health.

Progress in improved health and well-being in local communities will be assessed through a new public health outcomes framework and local areas will be rewarded for improvements in agreed health outcomes.

Q The Care Quality Commission was heavily criticised in a report by the Sustainable Development Commission in August 2009. The SDC report said the Care Quality Commission "has yet to confirm that it accepts that sustainable development falls within its remit, has failed to pursue a sustainable development agenda, and has done little to inspire confidence that action will be taken in the future" . What have you done to improve the sustainable development credentials of the Care Quality Commission before it takes on its bigger responsibilities?

The Care Quality Commission (CQC) is the independent regulator of providers of regulated health and adult social care activities. Its statutory role is to provide assurance that the care delivered by providers meets essential levels of safety and quality.

Providers of regulated activities must be registered with CQC, and meet requirements set in regulations covering these essential levels of safety and quality. CQC can take independent enforcement action (including potentially closing a provider down) where a provider is not meeting the registration requirements. The enforcement powers available to CQC, set out in primary and secondary legislation, apply where patients and people who use services are being exposed to unacceptable risks or poor-quality care. CQC’s role has been confirmed recently in the White Paper, Equity and excellence: Liberating the NHS .

The content of the registration requirements was widely consulted on, and then debated in both Houses as part of the affirmative procedure for making regulations. The registration requirements do not cover sustainable development because that would not relate to the essential levels safety or quality of care that patients or people who use services are entitled to expect.

Further we would not expect CQC to use its enforcement powers in relation to registration to take action against a care provider based on its sustainable development record, unless this compromised the safety and quality of the care it delivers to patients and people who use services.

While CQC does not have an agenda that directly addresses sustainable development, many of its areas of interest will result in improving the efficient use of resources.

As an executive non-departmental public body, DH expects CQC to follow all appropriate guidance, including guidance on sustainable development, relating to how it carries on its business.

3 November 2010

[1] http : //www.dh . gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/ d h_118085.pdf

[2] htt p ://www.defra.gov.uk/sustainable/government/progress/national/68.htm