1. Embedding sustainability into programmes and policies at every level
Embedding sustainability into programmes and policies at every level
David Pencheon Sustainable Development Unit
NHS England / Public Health England
(whole) Systems
Leadership
Embedding / normalising
South of England Sustainability Conference
SRSHN Autumn Conference,
16th November, 2016

2. a principle of action proposed or a specific approach expected / required, by an organization (or individual).
a principle of action proposed
a specific approach expected / required

3. Making the worthy normal and formal
From “nice to do” to “must do”
How do you take an issue which to most people is indisputably a good thing and embed it in policy?
How do we make this a normal part of:
“…the Governance agenda”
“…the Quality agenda”
“…the Improvement agenda”
“…our duty of care”

4. Understand the issue you are trying to promote and embed it in policy
The core task; the core proposition…
e.g. “Protecting and improving health by preserving natural systems on which all life depends, access to nature, and biodiversity.”
The multiple framings of that core task
…that will engage those people who will help embed it in policy
“The health promoting effect of nature is too good an asset not to value properly”
“Why would we want to be the only organisation not to align the science, the law, and our duty to the public, with our intentions”
Policy making by stealth

5. Policy
Practice
…despite the policy
…because of the policy

6. 1. Start with the what is already in place
What does the law require you to do? Start with where the law is
Public Services (Social Value Act) 2012
What is your core job? Start with what the organisation does
Duty of care
Quality improvement
Safety
Workforce development
What is already happening in this area?
NHS England core mission / strapline
NHS Constitution

7. Public Services (Social Value) Act 2012
“…all public bodies in England and Wales are required to consider how the services they commission and procure might improve the economic, social and environmental well-being of the area.”

8. “High quality health care for all, now and for future generations”
…but what is quality?

10. 6. The NHS is committed to providing best value for taxpayers' money and the most effective, fair, and sustainable use of finite resources.

11. 2. Frame the case positively
How does sustainability align naturally with the organisational remit and / or the personal values of you and the workforce?

12. 3. Do it yourself Can I help? Write the policy yourself
Learning outcomes: Faculties and Royal Colleges
Embed in curricula
Help re-write the remit / mandate

13. Embedded…in training policy
FPH Learning Objective 5.7: Demonstrate leadership in environmental sustainability with a focus on the links to health and climate change
Public Health Specialty Training Curriculum 2015
GMC approval date: 23 July 2015
UKPHR approval date: 22 April 2015

14. 4. Make it stick Get your organisation scrutinised:
Invite senior colleagues to co-present
Parliamentary Select Committee
Climate Change Committee
Get it routinely reported on internally and publicly:
Sustainability reporting
Integrated reporting (Environmental, social, financial..)

15. 5. Who are the policy makers to work with?
Start at the top - go to the Board
Executive Directors
Find any evidence about HOW they take this issue seriously
Non-executives
Frame the case in terms of their wider, strategic, public and social responsibilities

16. Antimicrobial resistance Pandemic influenza Demographic changes
“NICE is committed to exploring methods for building sustainability into NICE guidance and to promoting sustainable growth in the life sciences industries. We warmly welcome this guidance. It represents an important extension of the scope and methods of carbon accounting. It’s also a very practical support to industry efforts to reduce the carbon footprint of the drugs and medical devices that are so important to NHS patients.”
Sir Andrew Dillon CBE
CEO of the UK National Institute for Health and Clinical Excellence
Strategic priorities for UK Department of Health Chief Medical Officer.
Antimicrobial resistance
Pandemic influenza
Demographic changes
Bioterrorism
Climate Change

17. Dr. Margaret Chan, DG of WHO:
“…climate change is the defining issue for the 21st century… The evidence is there, and it is compelling. Here is my strong view: climate change, and all of its dire consequences for health, should be at centre-stage, right now, whenever talk turns to the future of human civilizations. After all, that's what's at stake.”

18. Dr. Eric S. Chivian is the founder and Director of the Center for Health and the Global Environment (CHGE) at Harvard Medical School,[1] where he is also an assistant clinical professor of psychiatry.
Life and career
Between 1980 and 2000, Chivian was a staff psychiatrist in the MIT Medical Department.[2] Dr. Chivian was the co-founder (with Professors Bernard Lown, Herbert Abrams and James E. Muller), treasurer, and member of the board of directors of the organization International Physicians for the Prevention of Nuclear War,[3] which won the Nobel Peace Prize in 1985 for its efforts to highlight the implications of nuclear conflict for global health.[4] In the mid 1980s, he directed the first scientific survey (under the auspices of the American Academy of Arts and Sciences and the MIT Center for International Studies) of American and Soviet teenagers’ attitudes about the prospect of nuclear war and their concerns for the future. He was the lead author of a seminal paper on this study in The New England Journal of Medicine [Chivian E. et al.. “American and Soviet Teenagers’ Concerns about Nuclear War and the Future.” The New England Journal of Medicine; (7): ].[5] He was the senior editor and author for the book Last Aid: The Medical Dimensions of Nuclear War, published by W.H. Freeman and Company in 1983.[6]

19. Conotoxins—the chains of amino acids found in the venom of a cone snail—are medical marvels. In 2003 psychiatrist and environmentalist Eric Chivian of Harvard University described these sea creatures as having “the largest and most clinically important pharmacopoeia of any genus in nature.”
Ziconotide (SNX-111; Prialt) is an atypical analgesic agent for the amelioration of severe and chronic pain. Derived from Conus magus (Cone Snail), it is the synthetic form of an ω-conotoxin peptide.[1]
In December 2004 the Food and Drug Administration approved ziconotide when delivered as an infusion into the cerebrospinal fluid using an intrathecal pump system.
Ziconotide is derived from the toxin of the cone snail species Conus magus. Scientists have been intrigued by the effects of the thousands of chemicals in marine snail toxins since the initial investigations in the late 1960s by Baldomero Olivera. Olivera, now a professor of biology in the University of Utah, was inspired by accounts of the deadly effects of these toxins from his childhood in the Philippines. Ziconotide was discovered in the early 1980s by University of Utah research scientist Michael McIntosh,[2] when he was barely out of high school and working with Baldomero Olivera.[3]
Ziconotide was developed into an artificially manufactured drug by Elan Corporation. It was approved for sale under the name Prialt by the U.S. Food and Drug Administration on December 28, 2004, and by the European Commission on February 22, Azur Pharma acquired worldwide rights (except Europe) to Prialt in 2010.
----
Every cone snail species has easily 1,000 peptides of medical interest, which means cone snails offer millions of research possibilities. Some cone snail toxins show promise as muscle relaxants during surgery and as fast-acting interventions after a stroke or heart attack.
In 2004 the pain reliever Prialt became the first fda-approved, commercially available product derived from cone snail toxin. Based on a peptide from a magician cone snail in Olivera's lab, this pain reliever is estimated to be 1,000 times stronger than morphine, without addictive side effects.
Researchers in Mari's lab have identified a cone snail compound that blocks sodium channels, which could help treat multiple sclerosis. But this is just the beginning.
Cone snails are a large group of predatory snails that mostly
live in tropical coral reefs. They defend themselves and paralyse
their prey for food—worms, small fish, and other molluscs—by
firing a poison coated harpoon at them. There are thought to be
around 700 cone snail species, and each species is believed to
make distinct peptide poisons to coat their harpoons,
representing an explosion in marine evolution, both in terms of
species numbers and in the variety of chemical compounds.
There may be as many as toxic peptides in all, and they
are among the most potent and highly selective membrane
receptor binding molecules in nature, acting as both facilitating
and inhibiting agents and targeting an enormous variety of sites,
including sodium, potassium, and calcium ion channels and
acetylcholine, dopamine, serotonin, norepinephrine
(noradrenaline), vasopressin, neurotensin, N-methyl-D-aspartate,
oxytocin, and vasopressin receptors.
Only about 1% of the 700 species and less than 0.1% of the
estimated number of peptides have been studied in any detail,
and already several important new compounds have been found.
Ziconotide, derived from a cone snail calcium channel blocker,
is used to treat severe chronic pain that is not responsive to
opiates. What is remarkable about ziconotide is that not only is
it 1000 times more potent than morphine, but it does not cause
addiction or tolerance.

21. Dr David Pencheon E: david. pencheon@nhs
Dr David Pencheon E: B: BMJ Blogs / carbon