The future of health, wellbeing and sustainability

Any take on sustainability that doesn’t have health and social care close to its heart probably isn’t worth taking seriously.

Any take on sustainability that doesn’t have health and social care close to its heart probably isn’t worth worrying about any further. But you’d be astonished at how many people just don’t get that.

A bit of history. Labour set up the Sustainable Development Commission back in 2000. It took a while to persuade the Cabinet Office that we should operate across the whole of government but, by 2004, we’d already started to work closely with the Department of Health on a whole range of different initiatives within the NHS. The redoubtable Anna Coote joined the Commission, and we quickly developed a fantastic health team within the Secretariat.

It was a fruitful period. Synergies began to flow around public health issues (e.g. food and nutrition), health inequalities (e.g. food poverty), transport (cycling, walking, air pollution etc.), planning and housing, greening the NHS itself, and, of course, climate change. There was extensive engagement with Strategic Health Authorities (long gone), Primary Care Trusts (duly re-engineered), and Directors of Public Health through Regional Assemblies (again, long gone).

During that time, the Department of Health got more and more involved, as did key people within the NHS. A Sustainable Development Unit in the NHS was created in April 2008, and the Department launched its own Carbon Management Strategy in January 2009. Of all the relationships the SDC had across government at that time – advising, supporting, monitoring, challenging – this was one of the best.

Which mattered not a jot to the incoming quango-crushing Coalition Government. It wasn’t just the Sustainable Development Commission itself which was unceremoniously brushed aside. Bit by bit, with clear intent, not by accident, almost every element in the "SD infrastructure" of the outgoing government, built up over a decade (Departmental Action Plans, procurement, audited performance reports, improved policy-making and so on) was rooted out or simply allowed to die.

But not completely, thank heavens, in the Department of Health – despite yet another mega-restructuring. And the best possible proof-point for this was the launch last week of a seriously impressive Sustainable Development Strategy not just for the NHS itself, but for Public Health England (which now falls under the remit of local government) and social care (which has never been part of this agenda before).

I know that all sounds remarkably geeky – yet another strategy, clunky, departmental integration, boring old support units, and so on. But dismiss all that at your peril. When it comes to actually delivering more sustainable outcomes on the ground, institutional strength and continuity matter at least as much as smart policy-making.

By and large, institutions work because of the people in them. Right from its inception, the NHS Sustainable Development Unit has been run by two extraordinary individuals: David Pencheon and Sonia Roschnik, with huge encouragement and vision from Sir Neil McKay. It’s a formidable team, which has somehow managed to navigate its way through the chaos of the last few years – and to bring together a quite extraordinary coalition of organisations across the wider health system which are all now committed to playing a much bigger role in putting sustainability at the heart of that system.

I acknowledge I may be making a bit too much of this – the Sustainable Development Unit’s budget, for instance, is laughably inadequate. But right now, if you scan across the whole of Whitehall, sustainable development is mostly invisible. Michael Gove killed it in the Department of Education; BIS meddles a bit with various aspects of the "green economy", but has no strategic overview; DEFRA’s a basket case; DCLG has gone backwards on sustainability issues from the first moment that Eric Pickles crossed its threshold; the treasury is a pit of very smart, ideologically hostile vipers; the Foreign Office and DFID do good stuff, but are desperate to ensure that the Daily Mail never hears of it. It’s a grim picture.

So against that backdrop, what the Department of Health is doing is really quite special – and the new strategy is very special, too.

David Cameron on a hospital visit in 2013. Photograph: Getty Images.
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Donald Trump's healthcare failure could be to his advantage

The appearance of weakness is less electorally damaging than actually removing healthcare from millions of people.

Good morning. Is it all over for Donald Trump? His approval ratings have cratered to below 40%. Now his attempt to dismantle Barack Obama's healthcare reforms have hit serious resistance from within the Republican Party, adding to the failures and retreats of his early days in office.

The problem for the GOP is that their opposition to Obamacare had more to do with the word "Obama" than the word "care". The previous President opted for a right-wing solution to the problem of the uninsured in a doomed attempt to secure bipartisan support for his healthcare reform. The politician with the biggest impact on the structures of the Affordable Care Act is Mitt Romney.

But now that the Republicans control all three branches of government they are left in a situation where they have no alternative to Obamacare that wouldn't either a) shred conservative orthodoxies on healthcare or b) create numerous and angry losers in their constituencies. The difficulties for Trump's proposal is that it does a bit of both.

Now the man who ran on his ability to cut a deal has been forced to make a take it or leave plea to Republicans in the House of Representatives: vote for this plan or say goodbye to any chance of repealing Obamacare.

But that's probably good news for Trump. The appearance of weakness and failure is less electorally damaging than actually succeeding in removing healthcare from millions of people, including people who voted for Trump.

Trump won his first term because his own negatives as a candidate weren't quite enough to drag him down on a night when he underperformed Republican candidates across the country. The historical trends all make it hard for a first-term incumbent to lose. So far, Trump's administration is largely being frustrated by the Republican establishment though he is succeeding in leveraging the Presidency for the benefit of his business empire.

But it may be that in the failure to get anything done he succeeds in once again riding Republican coattails to victory in 2020.

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.