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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How Theresa May laid a trap for herself on the immigration target

When Home Secretary, she insisted on keeping foreign students in the figures – causing a headache for herself today.

When Home Secretary, Theresa May insisted that foreign students should continue to be counted in the overall immigration figures. Some cabinet colleagues, including then Business Secretary Vince Cable and Chancellor George Osborne wanted to reverse this. It was economically illiterate. Current ministers, like the Foreign Secretary Boris Johnson, Chancellor Philip Hammond and Home Secretary Amber Rudd, also want foreign students exempted from the total.

David Cameron’s government aimed to cut immigration figures – including overseas students in that aim meant trying to limit one of the UK’s crucial financial resources. They are worth £25bn to the UK economy, and their fees make up 14 per cent of total university income. And the impact is not just financial – welcoming foreign students is diplomatically and culturally key to Britain’s reputation and its relationship with the rest of the world too. Even more important now Brexit is on its way.

But they stayed in the figures – a situation that, along with counterproductive visa restrictions also introduced by May’s old department, put a lot of foreign students off studying here. For example, there has been a 44 per cent decrease in the number of Indian students coming to Britain to study in the last five years.

Now May’s stubbornness on the migration figures appears to have caught up with her. The Times has revealed that the Prime Minister is ready to “soften her longstanding opposition to taking foreign students out of immigration totals”. It reports that she will offer to change the way the numbers are calculated.

Why the u-turn? No 10 says the concession is to ensure the Higher and Research Bill, key university legislation, can pass due to a Lords amendment urging the government not to count students as “long-term migrants” for “public policy purposes”.

But it will also be a factor in May’s manifesto pledge (and continuation of Cameron’s promise) to cut immigration to the “tens of thousands”. Until today, ministers had been unclear about whether this would be in the manifesto.

Now her u-turn on student figures is being seized upon by opposition parties as “massaging” the migration figures to meet her target. An accusation for which May only has herself, and her steadfast politicising of immigration, to blame.

Anoosh Chakelian is senior writer at the New Statesman.

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