In the growth years of health much emphasis has been placed on equity in all it's guises. However as need rises and resource falls the challenge of sustainability grows.
Recognising that healthcare is a complex system, and further an ecosystem, offers the chance to use principles of ecological sustainability to guide changes required in delivery and philosophy.
Enrich Coiera in 2007 borrowed the work of Natural Step to suggest system principles. https://twitter.com/enricocoiera/status/244583214931378176 We can take these principles and clean them up, fit them closer to the NHS.
Principle Of Recycling.
Healthcare must use resources at a rate which equals or is less than the economic benefit it delivers.
Principle of Accumulation.
By products of a system should not accumulate. Waiting lists, outpatient attendances should become static or decline.
Principle of Wastage.
Resources must not be wasted. Staff trained in NHS should be retained, theatres should be "sweated" etc.
Principle of Evolution.
The system must change to fit the societal and economic drivers in the environment.
Although there are similarities with the QIPP agenda, I believe that national, regional and sub-regional systems will be better served by considering the sustainable nature of our system, rather than the QIPP focus, which has, to date, been organisationally driven rather than system led.
As CCGs take system reins the sustainability principles should be written on the back of the hand of every commissioner. System success depends on it.