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A pile of stone with the word 'hope' written on one of them

The NHS has continued to evolve and reform over its 75 years of existence. But perhaps now more than ever questions are being raised about its future sustainability. The organisational climate of the NHS – often defined as the shared perceptions of a working environment – is under the spotlight. The ecosystem surrounding the NHS is similarly taking on even greater significance. Our changing climate has led many to declare these current times as a defining period in planetary history. Could the same be said for the NHS?

Navigating a cold climate and atmospheric pressure

The NHS resides within a challenging landscape that is often attributed to the cold climate of austerity and financial challenge it has experienced since 2010. Our recent contribution to the excellent edited collection on the NHS at 75 by Health Services Management Centre (HSMC) colleagues charts the history of quality in the NHS. It reflects on the long-time conundrum facing the ‘scaling up’ of quality and safety innovations where successes often find it difficult to translate into system wide improvement. It is a situation explained by under investment and a lack of capacity, but also lack of a coherent strategy in addressing the problems faced and the surrounding cultures. A policy approach rooted in short term fixes rather than long term solutions reinforces and restrains local and regional possibilities.

The NHS is an increasingly pressurised environment with rising demand, staff shortages, and unprecedented strike action. Burnout and low morale in the face of meeting care demands with limited resources is widespread. The workforce recruitment and retention gap lays bare the challenges that face the NHS Long Term Workforce Plan.

Preparing for environmental change and novel events

Alongside a challenging organisational climate, the NHS is now at the frontline of changes in the ecological climate. It is seeing the impact of extreme weather events alongside the well-established annual winter pressures.

The impact of the Covid-19 pandemic and its ongoing effects have raised questions about NHS emergency preparedness and how it will respond to novel events in the future. Its aftermath has brought long-held challenges into greater focus. We are experiencing the widening of health inequalities as well as alarming rates in mental health and long-term sickness. The NHS is being required to engage with the accelerated adoption of technology within resource constraints and limited scope for learning and development.

Engaging with these challenges will be crucial for the NHS if it is to sustain itself. Yet it is not alone in this regard. NHS challenges are also global health challenges. HSMC’s newly established Online MBA Clinical Leadership is supporting the development of business and management skills needed for smarter and sustainable healthcare systems. Our proposed MSc in Global Health System Leadership being developed at the University of Birmingham Dubai campus will include a module focused on emergency planning, preparedness, and resilience.

A way forward: extending the ecosystem

A sustainable NHS will ultimately rely on its ability to work in partnership with the health and social care ecosystem. HSMC will continue to support the NHS in achieving this goal with practical evidence and support for improving the integration of social care, primary care, and public health. Our recent report reviewing how to increase collaboration across the NHS provides solutions for building the trust, faith, and confidence necessary for high quality and sustainable partnership working.

Faced with the climate challenges ahead, learning from other ecosystem perspectives can also support the NHS. The work being done to better understand the NHS as an anchor institution holds promise for recognising social, economic, and environmental impact it can achieve within local areas. The promotion of population health management provides the NHS with other solutions for sustainability as do perspectives such as One Health that emphasise the integral links between human, animal, and environmental health. While at one level, such thinking might feel far removed from the sharp end of NHS healthcare, at other levels these collaborations can support and sustain its surrounding environment.

History shows the NHS to be remarkably resilient in withstanding crises, shocks, and shortage. The impressive work the NHS is doing to reduce carbon emissions and deliver net zero represents a notable example of its innovation in response to the pressing global health challenges we are facing. On that basis there is optimism, but like our climate, is the damage from human impact now irreversible? As long as there is a willingness to sustain the NHS we must remain optimistic. Our longstanding relationship with the NHS, as illustrated by the HSMC 50th anniversary celebrations, is testament to that. But given the changing climate we find ourselves in, how we approach its future will require sustainable solutions in order to protect and nurture one of our nation’s most precious ecosystems.