England

Sustainable, Resilient, Healthy People & Places

Module: Healthy, sustainable and resilient communities

Sustainable | Resilient | Healthy People & Places2

Module: Healthy, sustainable and resilient communities

Every place will have a different set of geographical, social, economic and demographic set of circumstances which meansthat a local approach is needed to support communities to thrive, be more sustainable, resilient and healthy in changingtimes and climates.

NHS, public health and social care organisations play an important role in local communities, as employers, and as corepublic service providers. They are an integral part of communities and can help support community groups, local agenciesand local people to further build a sense of place and identity so people want to live, work and invest there. These elementscreate the conditions for improved health and wellbeing.

This module is divided into two parts that focus on:1. Developing local frameworks2. Building resilience to climate change and adverse events

Introduction

Vision: Communities create the right conditions forimprovements in physical health, mental healthand general wellbeing by being connected,sustainable and resilient to changing times andclimates

The measures of success by 2020 are:

Public services and communities work together within a high level framework for sustainabledevelopment for instance through Health and Wellbeing Boards

Current and future risks to health and wellbeing from changing times and climates are understoodand minimised

Communities, services and infrastructures are prepared and resilient to weather events and othercrises

Health and wellbeing is protected and improved by building on social assets, reducing environmentalharm and enhancing the natural environment.

Healthy, sustainable and resilient communities 3

The Climate Change Act20081

The Climate Change Act (2008) was introduced to ensurethe UK cuts its carbon dioxide equivalent emissions by80% by 2050 against a 1990 baseline and to ensure thatthe Government’s programme for adaptation enables theUK to prepare effectively for the potential impacts ofclimate change.

Adaptation – The Act requires the government to assessclimate change risks and develop plans to increaseresilience and preparedness in response to the risksidentified.

The first Climate Change Risk Assessment2 for the UK waspublished in January 2012 and set out the main prioritiesfor adaptation in the UK, including a specific health andwellbeing theme. The National Adaptation Programme3

(NAP) was published in July 2013. The Healthy andResilient Communities section of the NAP proposesspecific actions across the system to improve resilienceand preparedness in a changing climate.

Under the Adaptation Reporting Power requirement setout in the Act, the health sector has been identified as apriority for the next round of reporting on adaptation4.

Sustainable | Resilient | Healthy People & Places4

The need for an integrated, aligned and whole system responseto sustainable development was a significant theme emergingfrom the consultation. Improving the health and wellbeing oflocal communities can be achieved most effectively when publicservices act locally together within a high level framework.

Health and Wellbeing Boards are very well placed to take aleadership role in developing a strong and inspiring local visionfor sustainability and resilience. They have local accountability,membership from across the health and care system, the abilityto align and reinforce activity and a responsibility to act in theinterests of local people to improve health and wellbeing. Theyare able to integrate sustainable development issues into healthand wellbeing strategies. As Health and Wellbeing Boards areled by local authorities, they are also well-placed to ensure analigned approach with departments responsible for the widerdeterminants of health such as housing and transport.

In support of this approach, the Joint Strategic NeedsAssessment (JSNA) can helpfully reflect the needs and assets of

1. Developing local frameworks

"Adapting to a changing climate is not adistant issue, but in many cases requiresconcerted action now. Focussing efforts onlow-regret measures to increase resilienceto extreme weather and highertemperatures will have immediate benefits,and should complement other aims such asreducing emissions. I support the inclusionof building resilience as a strategic aim, andlook forward to working alongside theSustainable Development Unit in measuringthe impact of this strategy”

Lord John Krebs - ChairAdaptation sub-committee of the Committee on Climate Change

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Civil Contingencies Act 20045

The Civil Contingencies Act (2004), and accompanyingnon-legislative measures6, delivers a single frameworkfor public protection in the UK. Key organisations cometogether to form ‘Local Resilience Forums’ (LRFs) whichhelp ensure multi-agency coordination and cooperationbetween responders to emergencies and extremeevents at the local level.

The health and care system is an important part of thisplanning and response requirement. Local HealthResilience Partnerships (LHRPs) have been establishedto deliver national Emergency Preparedness, Resilienceand Response (EPRR) plans and to understand andaddress local risks to health and wellbeing.

Severe weather events such as heat-waves, floodingand cold weather can disrupt the operation of thehealth and care system and have direct and indirectimpacts on health. Such events are included in localresilience forum-led community risk registers and plansalongside major incident situations.

Neighbourhood Health Watchin Devon

In the same way that Neighbourhood Watch tackles localcrime, Neighbourhood Health Watch groups aresupported to engage in activities which are useful to boththem and their communities. Volunteers supportneighbours with activities like lifts to the hospital, helpingwith simple DIY tasks, caring for pets, picking upprescriptions or shopping. This network helps increasecommunity resilience and reduce isolation and loneliness. Italso reduces the strain on resources of agencies like thepolice, local GPs and hospitals. This multi-agency initiativeinvolves Devon Partnership NHS Trust, Devon CountyCouncil, Devon and Cornwall Police, Devon ClinicalCommissioning Group and others7.

communities and provide the foundation for a strong sustainabledevelopment component of a local framework. The JSNA canhighlight local risks in relation to climate change, opportunitiesto work together at a system level and also highlight how thesystem can create conditions that support health andcommunities to live more sustainable lifestyles.

Public health directors, sustainability managers and leaders ingeographical patches can take a place based approach tosustainable development. By working with local communities,elected members and other key stakeholders they can helpdefine local priorities, expectations and monitoring criteria forlocal health and care organisations to actively help theircommunity to be a better place to work in, to live in and investin.

Mainstreaming environmentalsustainability in social care

Bristol City Council is leading the way in mainstreamingenvironmental sustainability in social care. Supported bythe Social Care Institute for Excellence and working withother public bodies through the Local StrategicPartnership, the council has set ambitious targets forimproving environmental performance. This includes a 40%reduction in carbon emissions by 2020 from a 2005baseline. Up to 60% of Bristol’s total expenditure relates toresidential homes so the council has focused its sustainablesocial care policies on reducing the expenditure of theHealth and Social Care directorate. Informed by the JointStrategic Needs Assessment this has led to a number ofcorporate measures including environmental assessmentsof new proposals and strategies, regular audits of servicesand the development of a procurement and commissioningframework. Strong clear leadership and a clear vision haveunderpinned these actions8

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Creating healthy homes forindependent living

Leeds Care & Repair enables healthy, independent living athome for vulnerable people primarily through practicalhousing help. This includes home adaptations, repairs,hospital discharge support, housing options advice, fallsprevention and the Warm Homes service. The WarmHomes service helps provide improved heating forhouseholds suffering from cold related illness. For thewinter of 2012/13, 727 vulnerable households receivedheating improvements through the scheme. A partnershipbetween Care & Repair Leeds, Leeds Adult Social Careand Public Health Leeds led to the establishment andtraining of ‘Energy Champions’ who identify vulnerablepeople with long-term cold related health conditions livingin cold, damp homes and refer them to the Warm Homesservice9.

The climate in the UK is changing. The NHS, public health,social care services and their communities need to understandthe health and wellbeing implications of current andprojected changes and adapt services accordingly. Animportant component of this is ensuring the health and caresystem infrastructure (buildings, emergency services, vehiclesand the supply chain for fuel, food and key products) isprepared for, and resilient to, severe weather events andother disruptions. Additionally, as many care services and anincreasing number of health services are delivered in people'sown homes, there is a growing need to ensure that domesticas well as institutional settings are adapted, resilient andaccessible.

Equally important is ensuring that people, families andcommunities have a suitable level of mental and physicalhealth, wellbeing and connectedness to be resilient to suddenand disruptive events. Individuals and communities can beequipped with the skills and tools to help them to helpthemselves and others, particularly the most vulnerablepeople in the community. This could be developed through arange of routes (including neighbourhood support, healthand social care and locality development) and provided by arange of organisations including local government, primarycare and the voluntary sector.

Heat10 and cold wave11 plans are already in place to supportthe health and care system response. The system will need tocontinue to prepare for further effects of adverse weatherevents and climate change such as longer and more frequentheat waves, increased flooding, droughts and the continuedoccurrence of cold snaps. Extreme weather can represent athreat to the effective delivery of health, public health andsocial care services. A rapid increase of service users duringsuch events increases pressure on staff dealing with increasedworkloads and potential staff shortages.

Building resilience and adaption to severe weather events andclimate change is not the responsibility of one singleorganisation. It requires a system-wide approach across theentire health and care system: integrated planning anddelivery from colleagues from the NHS, public health, localauthorities, Health and Wellbeing Boards, Department ofHealth, Clinical Commissioning Groups, Defra, theEnvironment Agency and others. Many simple interventionsare good for health, reducing carbon and improving climateresilience. For instance sound spatial planning can alleviaterisks and support people to lead healthier lives byencouraging active travel which in turn can reduce theenvironmental impact.

2. Building resilience to climate change and adverse events

West Sussex County Council

The Council used the “Built Infrastructure for OlderPeople’s Care in Conditions of Climate Change”(BIOPICCC) tool to understand the risks to older peopleof climate change focussing on the Horsham District inWest Sussex. The information allowed the Council toidentify priorities and implement local action. As well asaddressing flood risk there was also funding for localcommunities to help themselves combat extreme weatherby preparing local community flood plans or by buyingequipment the community can share in an emergency. Thecouncil is taking a leading role in working with others tobetter prepare for extreme weather events, improving theresilience of both local communities and the services thatsupport them12.

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"We all know that people want tomaximise their independence and tobe active members of their localcommunities. Helping them to do thisinvolves promoting healthy, sustainableand resilient communities that are ableto offer social support and care. Itinvolves embracing the wider principlesof sustainability, helping communities tobecome more self-sufficient andbuilding on the assets and strengths ofour local places.”

Tony Hunter - Chair of Health and Social Care Network Society of Local Authority Chief Executives (SOLACE)

"There are clear relations betweenlocal environmental quality, globalclimate issues, extreme weatherevents and the health and wellbeingof communities that need to beaddressed. There are also significantenvironmental impacts associatedwith health service provisions thatneed to be assessed and managed.We look forward to continuing toengage with partners on theseimportant areas of work”

Paul Leinster - Chief Executive Environment Agency

References

1 HMSO, 2008. Climate Change Act 2008 (c.27) [Online] Available at: www.legislation.gov.uk/ukpga/2008/27/pdfs/ukpga_20080027_en.pdf [Accessed 06 January 2014]

2 Department of Environment, Food, and Rural Affairs, 2012. UK Climate Change Risk Assessment: Government Report [Online] Available at www.gov.uk/government/publications/uk-climate-change-risk-assessment-government-report [Accessed 06 January 2014]

3 Department of Environment, Food, and Rural Affairs, 2013. Adapting to climate change: national adaptation programme [Online] Available at: www.gov.uk/government/publications/adapting-to-climate-change-national-adaptation-programme [Accessed 06 January 2014]

4 Department of Environment, Food, and Rural Affairs, 2013. Adapting to Climate Change: Ensuring Progress in Key Sectors. 2013 Strategy for Exercising theAdaptation Reporting Power and list of priority reporting authorities [Online] Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/209875/pb13945-arp-climate-change-20130701.pdf [Accessed 06January 2014]

5 HMSO, 2004. Civil Contingencies Act 2004 (c.36) [Online] Available at: www.legislation.gov.uk/ukpga/2004/36/contents [Accessed 06 January 2014]

6 Cabinet Office, 2013. Preparation and planning for emergencies: responsibilities of responder agencies and others [Online] Available at: www.gov.uk/preparation-and-planning-for-emergencies-responsibilities-of-responder-agencies-and-others#the-civil-contingencies-act[Accessed 06 January 2014]

7 Neighbourhood Health Watch, 2014. Neighbourhood Health Watch Home [Online] Available at: www.neighbourhoodhealthwatch.org.uk/ [Accessed 06 January 2014]

8 Social Care Institute for Excellence, 2014. Sustainable social care programme [Online] Available at: www.scie.org.uk/adults/sustainablesocialcare/bristol.asp [Accessed 06 January 2014]

9 Leeds City Council, 2012. Report Template on the Leeds Warm Homes Healthy People Fund [Online] Available at: http://democracy.leeds.gov.uk/documents/s86969/leeds [Accessed 06 January 2014]

10 Public Health England, 2013. Heatwave plan for England 2013 [Online] Available at: www.gov.uk/government/publications/heatwave-plan-for-england-2013 [Accessed 06 January 2014]

11 Public Health England, 2013. Cold weather plan for England 2013 [Online] Available at: www.gov.uk/government/publications/cold-weather-plan-for-england-2013 [Accessed 06 January 2014]

12 West Sussex County Council, 2013. Climate changes and older people quick reference guide[Online] Available at: www.westsussex.gov.uk/your_council/strategies_policies_and_publi/policies/social_care_-_adults_services.aspx#GeneralCareSupport [Accessed06 January 2014]

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The Sustainable Development UnitVictoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB

T: 0113 8253220 E: england.sdu@nhs.netW: www.sduhealth.org.ukFollow us on Twitter - @sduhealth This publication is printed on 100% recycled paper and is printed using vegetable-based inks and a water-based sealant.

Designed and produced by: MJWebb Associates Ltd

Published January 2014

This document is one of a number of modules supporting the “Sustainable, resilient, healthy people and places – asustainable development strategy” (www.sduhealth.org.uk/sds). For further information, guidance notes, tools and goodpractice to support the delivery of this module visit www.sduhealth.org.uk/focus

Document produced by the Sustainable Development Unit (SDU) which is funded by, and accountable to, NHS England and Public Health England towork across the NHS, public health and social care system. The SDU supports the NHS, Public Health and Social Care system to be sustainableenvironmentally and socially. This is done by engaging across the system to identify the frameworks, networks and mechanisms that will encourage ahealthier environment, better health and enable communities and services to be resilient to adverse weather events and climate change.

Responsibility for the content of this document lies with the Sustainable Development Unit.