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What do we need to change to make the NHS sustainable?



The NHS has to change. Everyone says so but no one says from what to what or how. Health secretary Jeremy Hunt says the NHS must change and GPs must do more. How, what and where? He doesn’t say. NHS chair Malcolm Grant, the man who is too posh to be a patient in the NHS, says the GPs are all on the golf course, but doesn’t say how he’s going to entice them back into the surgery.

Services must be reconfigured, working practices must change, doctors must change, nurses must change, managers must change, out of hours service must change, the patients must change and the weather must change. Everything must change.

Isn’t the core issue sustainability? Is the NHS sustainable? Changing everything at once is stupid and undermines sustainability. The approach to change is the key to sustainable change. We need to change how we ‘do’ change, using the techniques of ‘sustainable change’.

Killer facts

To do serious change, impacting a lot of people with different perspectives and vested interests you need facts, evidence and proof. Wading into ‘failing’ hospitals on the basis of Hospital Standardised Mortality Ratios (HSMRs), only to have the man doing the wading to pronounce HSMRs are not a good enough indicator of ‘failure’, is an embarrassment.

To condemn an entire Trust because a curtain in A&E, insufficiently closed, allowing an inspector a glimpse of a patient, however discourteous, is not proof of anything but a momentary oversight that can be fixed, there and then. To single out Trusts with frail balance sheets as ‘failing’ is to recognise the failure of allocations and high-lights their heroic attempts to survive. The charge of the Change Brigade must be armed with killer facts.

Change must resonate in the real world

To enjoin change demands providing practical alternatives: recognisable, real-time, oven-ready, different and better ways of doing things. Calls for innovation, integration and leadership are pointless. Asking people to support theory is asking for trouble.

The NHS is practical and hands on. Hypothetical solutions are of no interest. Examples of ‘nurses at St Someplace Foundation Trust find this works’, delivers imitation, buy-in and results. The NHS is a ‘me too’ environment working in the real world.

Leaders, show up

Leaders are visible, have a vision and share it often. Visiting to look and learn and leave with a smile is one thing. To change, leaders visit, share their vision, get buy-in and leave behind disciples, believers and acolytes.

Better than what?

Change implies; to what? Cheaper, faster or better? Or all of the above? How will we know when we get there? How far away are we? Simple key indicators, never more than three, become the flagpole the whole service can rally around. Disaggregated targets mean disaggregated effort. NHS staff are harassed and confused, over-managed and distracted by politicians. To march in step they all need to hear a simple tune.


The NHS is a whole system. Fiddle with one bit and some place you never knew existed will have a bit that drops-off! Please one group and hack off another. Expect rows and argy-bargy.

NHS people have been changed, modernised and liberated to death. They have been reported on, inspected and regulated to the point where the frontline has become the ragged-edge. Is it any wonder people push back? The trick is to provide a realistic achievable, describable, doable, attractive vision that is so enticing they will volunteer to change.


You can’t change anything based on a lie. A sustainable NHS?  We spend -8% of GDP on the NHS. The Netherlands spends 12% and Germany 11%.  Austria, Denmark, France and Luxembourg manage more than us per head. As do Switzerland, Norway and Iceland (more very good OECD comparisons here).We are a long way from ‘unsustainable’.

So, now what?  Does anyone have any real, workable ideas? A vision for the future? An explanation for Jeremy Hunt’s panic?

I think, “Despite our financial and economic anxieties, we are still able to do the most civilised thing in the world – put the welfare of the sick in front of every other consideration.”

Not my words; Aneurin Bevan, 1948.

So tell me: what, exactly, do you want to change?

Roy Lilley is a healthcare writer, broadcaster, commentator and conference speaker, and editor of This article originally appeared as an e-newsletter, which you can subscribe to for free here.

Further reading:

On this day in 1948: the National Health Service is born

UK population grows to 63.7m but growth should be ‘managed’

On this day in 1957: cancer and smoking linked

Investing sustainably in an ageing population


How Going Green Can Save A Company Money



going green can save company money
Shutterstock Licensed Photot - By GOLFX

What is going green?

Going green means to live life in a way that is environmentally friendly for an entire population. It is the conservation of energy, water, and air. Going green means using products and resources that will not contaminate or pollute the air. It means being educated and well informed about the surroundings, and how to best protect them. It means recycling products that may not be biodegradable. Companies, as well as people, that adhere to going green can help to ensure a safer life for humanity.

The first step in going green

There are actually no step by step instructions for going green. The only requirement needed is making the decision to become environmentally conscious. It takes a caring attitude, and a willingness to make the change. It has been found that companies have improved their profit margins by going green. They have saved money on many of the frivolous things they they thought were a necessity. Besides saving money, companies are operating more efficiently than before going green. Companies have become aware of their ecological responsibility by pursuing the knowledge needed to make decisions that would change lifestyles and help sustain the earth’s natural resources for present and future generations.

Making needed changes within the company

After making the decision to go green, there are several things that can be changed in the workplace. A good place to start would be conserving energy used by electrical appliances. First, turning off the computer will save over the long run. Just letting it sleep still uses energy overnight. Turn off all other appliances like coffee maker, or anything that plugs in. Pull the socket from the outlet to stop unnecessary energy loss. Appliances continue to use electricity although they are switched off, and not unplugged. Get in the habit of turning off the lights whenever you leave a room. Change to fluorescent light bulbs, and lighting throughout the building. Have any leaks sealed on the premises to avoid the escape of heat or air.

Reducing the common paper waste

paper waste

Shutterstock Licensed Photo – By Yury Zap

Modern technologies and state of the art equipment, and tools have almost eliminated the use of paper in the office. Instead of sending out newsletters, brochures, written memos and reminders, you can now do all of these and more by technology while saving on the use of paper. Send out digital documents and emails to communicate with staff and other employees. By using this virtual bookkeeping technique, you will save a bundle on paper. When it is necessary to use paper for printing purposes or other services, choose the already recycled paper. It is smartly labeled and easy to find in any office supply store. It is called the Post Consumer Waste paper, or PCW paper. This will show that your company is dedicated to the preservation of natural resources. By using PCW paper, everyone helps to save the trees which provides and emits many important nutrients into the atmosphere.

Make money by spreading the word

Companies realize that consumers like to buy, or invest in whatever the latest trend may be. They also cater to companies that are doing great things for the quality of life of all people. People want to know that the companies that they cater to are doing their part for the environment and ecology. By going green, you can tell consumers of your experiences with helping them and communities be eco-friendly. This is a sound public relations technique to bring revenue to your brand. Boost the impact that your company makes on the environment. Go green, save and make money while essentially preserving what is normally taken for granted. The benefits of having a green company are enormous for consumers as well as the companies that engage in the process.

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5 Easy Things You Can Do to Make Your Home More Sustainable




sustainable homes
Shutterstock Licensed Photot - By Diyana Dimitrova

Increasing your home’s energy efficiency is one of the smartest moves you can make as a homeowner. It will lower your bills, increase the resale value of your property, and help minimize our planet’s fast-approaching climate crisis. While major home retrofits can seem daunting, there are plenty of quick and cost-effective ways to start reducing your carbon footprint today. Here are five easy projects to make your home more sustainable.

1. Weather stripping

If you’re looking to make your home more energy efficient, an energy audit is a highly recommended first step. This will reveal where your home is lacking in regards to sustainability suggests the best plan of attack.

Some form of weather stripping is nearly always advised because it is so easy and inexpensive yet can yield such transformative results. The audit will provide information about air leaks which you can couple with your own knowledge of your home’s ventilation needs to develop a strategic plan.

Make sure you choose the appropriate type of weather stripping for each location in your home. Areas that receive a lot of wear and tear, like popular doorways, are best served by slightly more expensive vinyl or metal options. Immobile cracks or infrequently opened windows can be treated with inexpensive foams or caulking. Depending on the age and quality of your home, the resulting energy savings can be as much as 20 percent.

2. Programmable thermostats

Programmable thermostats

Shutterstock Licensed Photo – By Olivier Le Moal

Programmable thermostats have tremendous potential to save money and minimize unnecessary energy usage. About 45 percent of a home’s energy is earmarked for heating and cooling needs with a large fraction of that wasted on unoccupied spaces. Programmable thermostats can automatically lower the heat overnight or shut off the air conditioning when you go to work.

Every degree Fahrenheit you lower the thermostat equates to 1 percent less energy use, which amounts to considerable savings over the course of a year. When used correctly, programmable thermostats reduce heating and cooling bills by 10 to 30 percent. Of course, the same result can be achieved by manually adjusting your thermostats to coincide with your activities, just make sure you remember to do it!

3. Low-flow water hardware

With the current focus on carbon emissions and climate change, we typically equate environmental stability to lower energy use, but fresh water shortage is an equal threat. Installing low-flow hardware for toilets and showers, particularly in drought prone areas, is an inexpensive and easy way to cut water consumption by 50 percent and save as much as $145 per year.

Older toilets use up to 6 gallons of water per flush, the equivalent of an astounding 20.1 gallons per person each day. This makes them the biggest consumer of indoor water. New low-flow toilets are standardized at 1.6 gallons per flush and can save more than 20,000 gallons a year in a 4-member household.

Similarly, low-flow shower heads can decrease water consumption by 40 percent or more while also lowering water heating bills and reducing CO2 emissions. Unlike early versions, new low-flow models are equipped with excellent pressure technology so your shower will be no less satisfying.

4. Energy efficient light bulbs

An average household dedicates about 5 percent of its energy use to lighting, but this value is dropping thanks to new lighting technology. Incandescent bulbs are quickly becoming a thing of the past. These inefficient light sources give off 90 percent of their energy as heat which is not only impractical from a lighting standpoint, but also raises energy bills even further during hot weather.

New LED and compact fluorescent options are far more efficient and longer lasting. Though the upfront costs are higher, the long term environmental and financial benefits are well worth it. Energy efficient light bulbs use as much as 80 percent less energy than traditional incandescent and last 3 to 25 times longer producing savings of about $6 per year per bulb.

5. Installing solar panels

Adding solar panels may not be the easiest, or least expensive, sustainability upgrade for your home, but it will certainly have the greatest impact on both your energy bills and your environmental footprint. Installing solar panels can run about $15,000 – $20,000 upfront, though a number of government incentives are bringing these numbers down. Alternatively, panels can also be leased for a much lower initial investment.

Once operational, a solar system saves about $600 per year over the course of its 25 to 30-year lifespan, and this figure will grow as energy prices rise. Solar installations require little to no maintenance and increase the value of your home.

From an environmental standpoint, the average five-kilowatt residential system can reduce household CO2 emissions by 15,000 pounds every year. Using your solar system to power an electric vehicle is the ultimate sustainable solution serving to reduce total CO2 emissions by as much as 70%!

These days, being environmentally responsible is the hallmark of a good global citizen and it need not require major sacrifices in regards to your lifestyle or your wallet. In fact, increasing your home’s sustainability is apt to make your residence more livable and save you money in the long run. The five projects listed here are just a few of the easy ways to reduce both your environmental footprint and your energy bills. So, give one or more of them a try; with a small budget and a little know-how, there is no reason you can’t start today.

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