CleanMedAs austerity measures begin to bite across the world, the cost of healthcare is becoming more of a concern to policy makers, healthcare professionals and patients alike. And it’s not just the financial cost that matters. Many decision-makers are starting to count the environmental and social sustainability as well, and to ask how we can change healthcare to make it more sustainable financially, environmentally and socially in the long term, without compromising on patient care.

Back in September, CleanMed Europe 2013 brought together healthcare professionals, administrators, patient representatives, healthcare infrastructure professionals, and experts in sustainability over three days. Day 1 of the conference focused on how the sustainability challenges are starting to be addressed across Europe. Day 2 looked at emerging models of care, and Day 3 suggested how healthcare might be radically transformed.

Addressing sustainability in healthcare

The first plenary session was about developing a shared framework. With Muir Gray, Chief Knowledge Officer of the NHS, in the chair, and a panel consisting of Rachel Stancliffe, Head of the Centre for Sustainable Healthcare, Jane Griffiths from Johnson & Johnson, Mahmood Bhutta, founder of the Medical Fair and Ethical Trade Group at the British Medical Association and Anja Leetz, director of Healthcare Without Harm, Europe, most of the key perspectives were at the table. Components of the shared framework included ‘wellness’, rather than illness, how to reduce carbon footprints, and ethical procurement.

Sessions followed on sustainable and ethical procurement, reducing waste, and ‘greening’ hospitals, using both specific examples and more general discussion. Towards the end of the day, a final plenary demanded of participants ‘How can we scale up the small-scale success that has been achieved so far?’, with contributions from sustainability experts and businesses who are already ‘walking the walk’ such as EnergyBank.

Models of care

Day 2 started by looking at models of care which have potential to improve sustainability. The plenary again involved both doctors and patients, ensuring that both perspectives were brought into play. Andy Williamson, a musician and kidney patient, pointed the session to online and mobile resources which helped him to manage his care, but reminded everyone that ‘sometimes we all need someone to help us’, be it friend, carer or health advocate. The parallel sessions looked at successful transformations, and then at how to transform, and some essential tools such as informatics, culture change and payment systems. A final plenary again considered how small-scale models could be scaled up. For example, Andrew Smith discussed how BUPA is redesigning care pathways to focus on prevention and wellness, care at home using new technology, treatment not overtreatment, and recovery acceleration. All these will both improve the patient experience and be financially better for BUPA. Sonia Roschik of the Sustainable Development Unit talked about moving towards healthcare as part of the community, personal care, and an integrated service that is able to monitor in real time. In particular, healthcare should become ‘everyone’s business’ and not ‘nobody’s business’, returning to the theme of everyone taking responsibility for their own health and wellness.

Radical transformation ideas

Day 3 looked at how the healthcare sector could be radically transformed; less of the ‘let a thousand flowers bloom’ approach of the day before, and more a whole-system approach. In particular, it considered how healthcare affects and is affected by the wider determinants of wellness, such as climate change, access to open space, and social attitudes to junk food. The World Health Organisation brought a global perspective by highlighting the different health challenges faced by low-, middle- and high-income countries, while stressing that all had to address the ‘triple bottom line’ of environmental, financial and social success. Again, a ‘successful’ system would be one where healthcare was everyone’s business.

But surely this costs money?

This may be your immediate reaction, but the take-home lesson from this conference is that it could be a lot more expensive not to do these things. We all know about social challenges like demographic pressures, and surely it would be better to address them ahead of time? As Ian Gilmore, one of the contributors, pointed out, hospitals are expensive to run, bad for the environment, and make patients ill. But how do we move care into the community, when so many people are so resistant to hospital closures? We need to harness doctors as advocates to help people improve their wellness, and avoid the need for hospitals. It is a huge challenge to move away from an established system, but it is starting to look like there is no other way.

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