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What does it mean to be sustainable? For world leaders gathering in Glasgow over the next two weeks it means limiting global warming to 1.5–2 degrees Celsius by 2100, compared to pre-industrial levels. As Jennifer Dixon sets out in her blog for this month’s newsletter, what is good for the planet is good for health too. We also share some of the work the Foundation and its partners are doing to contribute.

For the NHS, what it is to be ‘sustainable’ is less precisely defined. In response to calls for pre-emptive action to reduce transmission of COVID-19, Sajid Javid, the Secretary of State for Health and Social Care, said last week that the government doesn’t ‘believe the pressures on the NHS are unsustainable’.

While interpretations of what it means to be sustainable vary, what is indisputable is that the NHS is experiencing exceptionally high demand for care. In September 2021, there were over 2 million visits to A&E departments in England, the highest number in that month since current records began. The number of people waiting for elective treatment reached a record high for the eleventh month in a row, with 5.7m people in England waiting.

Primary, community and mental health services are also severely stretched. And winter will bring further asks on the health and social care workforce; having entered the pandemic with significant shortages, staff have experienced sustained unrelenting pressure over recent times. As discussed on our elective care webinar with Sir Jim Mackey, Dr Jugdeep Dhesi and Richard Sloggett last week, developing ways of enabling recovery that aren’t based only on asking staff to work longer and harder will be one of critical factors in dictating the pace of recovery.

And into a fragile system under intense operational pressure comes a promise from Sajid Javid that 2022 will be a year of ‘renewal and reform’ for the English system. In addition to the introduction of integrated care systems and provider collaboratives, a Health and Care Bill is in train, as well as white papers on social care and health and social care integration, and a leadership and management review.

NHS leaders will have to navigate this complexity while ensuring management attention is focused on restoring and delivering the basics of service to the public and patients. These include enabling and encouraging people to come forward for treatment, organising and delivering safe, compassionate and efficient care, looking after staff, improving ways of working, reducing inequalities, and particularly paying attention to the vulnerable (our new analysis shows the impact of the pandemic on the more than 4 million people classed as clinically extremely vulnerable).

In the long run, the most sustainable improvements in care will be those discovered, developed and owned by clinicians and patients themselves. In my six years at the Foundation, our improvement work has supported over 130 fellowships, 250 grants to front-line teams, 350 coaches in improving flow and 4,500 Q members – all people and teams doing practical work on the ground to improve the quality and productivity of care.

Our recent long read brings together case studies and learning for practitioners and policymakers for increasing productivity, drawing on examples from changing skill mix, patient activation, improving flow, and new uses of technology. You can read a summary of five key things from this long read in a feature for this newsletter.   

Will Warburton (@willwarburtonHF) is Director of Improvement at the Health Foundation. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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