To coincide with COP26 in Glasgow, the Highland Marketing advisory board discussed the NHS’ strategy for net zero and how this will impact on health tech. Members agreed with presenter David Newell from Gemserv that the industry urgently needs to find and speak with one voice on how digital can contribute to the big picture on carbon reduction and on the procurement regulations that will force companies to act.
Over the past two years, there has been a significant renewal of interest in the NHS’ impact on climate change and what health and care services can do to address it. One of the catalysts was Newcastle upon Tyne Hospitals NHS Foundation Trust’s decision to declare a climate emergency in June 2019.
This promoted other trusts to follow suite, including the big acutes in Manchester, Gloucestershire and Bristol, and Great Ormond Street Hospital for Sick Children and University College London Hospital in London. It also led to a lively and well-attended debate at the Health and Care Innovation Expo in 2019 and follow-up action from NHS England.
In October 2020, the commissioning board’s chief executive, Sir Simon (now Lord) Stevens unveiled an ambitious strategy to make the NHS “the world’s first carbon net zero national health system” by 2040 (for the emissions it controls directly) or 2045 (for the emissions it influences).
Six months later, he launched a For a Greener NHS Campaign, arguing that the health system, which is responsible for 4-7% of the country’s carbon footprint, had a moral duty to act, given the huge toll that air pollution and heat make on public health.
Six months later again, health and social care secretary Sajid Javid announced that the health services in Northern Ireland, Scotland and Wales would follow suit, as part of an initiative backed by 50 countries attending at the United Nations Climate Change Conference in Glasgow.
Scoping the scale of the challenge
Northern Ireland, Scotland and Wales are yet to release their strategies for delivering their COP26 commitments. But But England is taking an approach that is familiar from other industries, David Newell, a former NHS manager and consultant at Germserv, told the Highland Marketing advisory board.
“The strategy is recognised as one of the most comprehensive and robust health service documents in this space,” he said. “And it takes a familiar view of the world, looking at scope one, scope two, and scope three emissions.”
Scope one covers the greenhouse gas emissions that the NHS is responsible for directly (such as switching on the lights in its operating theatres). Scope two covers the greenhouse gas emissions that are generated to support its activities (the emissions made by the power company that provides the electricity, or the bottling company that provides the oxygen).
While scope three covers all the emissions for which it is indirectly associated, up and down its supply chain (the extraction of the materials that the power company burns, the carbon impact of the packaging around the gas cylinders and other consumables).
Most emissions lie in scope three, which the NHS England strategy estimates is responsible for more than 60% of the NHS carbon footprint plus. Newell acknowledged that this approach and these calculations throw up some oddities.
First, and most seriously, the approach runs the danger of missing the big picture. “There is a danger of focusing on measuring different kinds of carbon impact when the biggest and most impactful way to reduce the carbon footprint of the NHS would be to make sure that people don’t get ill and need it in the first place.”
Secondly the scope three calculations, which are based on spend rather than hard data, may overstate its impact and so push too much of the responsibility for reducing the NHS’ carbon impact onto its suppliers. Although Newell argued “this might not matter” in practice, “because suppliers are going to have to measure and reduce their footprint, whatever.”
Procurements will be looking for action on climate heating, soon:
That’s because the government is taking a procurement approach to getting suppliers on board with the climate agenda. Newell took the advisory board through an NHS England slide that says that from next April 10% of contract value will be allocated to what companies are doing on climate change: “although the feedback we are getting is that this is happening already.”
From April 2023, every procurement over £5 million will require suppliers to have measured their carbon footprint and drawn up a plan to reduce it: just to take part. More recently, NHS England has been talking about creating three tiers of suppliers: influencers, mature, and early adopters: and it is assumed that being an influencer will offer a significant competitive advantage.
“If there is one message to get across to the health tech community it is that this is very, very significant,” Newell said. “And my concern is that taking an organisation from measuring its carbon footprint, to drawing up a plan, to reaching the first year of net-zero is really complex.
“Gemserv has been carbon neutral for five-years, but initially a lot of what we did was offsetting. That’s a less and less credible approach, so now we’re getting into emissions reduction, and that’s hard. Yet the timescales that NHS England are talking about are very tight.”
There is some advice for health tech companies that want to get started. The Government Digital Service has drawn up a Technology Code of Practice that includes action on climate change, and NHS Digital has set up a sustainable healthcare technology programme with some practical challenges and tips.
However, most of these are very basic. And Newell argued that individual health tech vendors will not be able to do this alone. They’re going to need a strong, industry voice to negotiate with the NHS about their role in the bigger prevention piece and about what they will be expected to address within their own operations.
The good news, he added, is that “NHS England is clearly in listening mode. It has set out the vision, but it is willing to be challenged on it. It is saying they don’t have all the answers and we need to work on them together.”
Engage or be regulated
James Norman, a former NHS IM&T director, who until recently worked at Dell, agreed with the need for an industry voice. “Dell has been at the forefront of renewables,” he said. “We have made all our packaging recyclable. You could eat the packaging in our boxes, as it is made from mushroom and bamboo-based material, rather than Styrofoam – although I wouldn’t recommend it!
“Our energy will be 100% renewable by 2040. But we haven’t aligned with the scope one, scope two, scope three approach that the NHS is using, and it would probably be a significant challenge for us to do that.” Newell noted that another challenge that big, international companies like Dell face is that they don’t just need to align with NHS or even UK initiatives.
“[Companies may have production lines in] the UK, and India, and China, and other places so they will be facing multiple regulatory environments, each with their own complex regulations. Our take is that there will need to be a lot of work done on regulatory equivalence, and that will have to be done by industry groups. It’s almost impossible to do it as an individual company.”
Entrepreneur Ravi Kumar pointed out that it’s not just big companies that face regulatory hurdles. “I am part of three start-ups, but I don’t have an office,” he said. “We can be net-zero from the outset. But HMRC wants my office address for tax purposes. The NHS wants my office address so it can assess me if I am involved in a procurement. We need these organisations to adapt their thinking.”
Putting digital into the big picture
Meanwhile, advisory board chair Jeremy Nettle agreed there was a need to keep an eye on the big picture. “From the point of view of the NHS, you can see that the supply chain is the easy thing to go for,” he said. “But the bigger impact is going to come from pathway redesign.
“And, on the positive side, a lot of innovators and SMEs are light of foot. They come with a low footprint, they use hyperscale cloud, they can develop and plug-in a lightweight solution, using an API. All of that should help to massively reduce the climate impact of NHS processes.”
Nicola Haywood-Alexander, the system chief information officer for NHS Lincolnshire, said her area was certainly trying to think this way, given its geographical challenges, and the long distances that some people had to travel for treatment.
However, she pointed out that remote management and monitoring doesn’t solve all challenges. Digital solutions can increase electricity consumption and e-waste. Even if care is being delivered remotely, someone may have to deliver kit or drugs to patients and dispose of their packaging.
“We are trying to take a holistic view of our pathways, because if we don’t, we don’t get the whole picture,” she said. “We’re trying to approach it from the point of view of closing the loop on the patient journey, and not from any one organisational point of view.”
Newell said this was exactly why he thought the health tech industry needed to find a collective voice. Individual hospitals and GP practices are not going to be able to negotiate with dozens of companies. And they are not the only players. Commissioners and regulators will have a big say in what acceptable and safe practice looks like.
An urgent need for health tech to find and speak with one voice
Unfortunately, the advisory board was hard-pressed to think of a health tech organisation that could take on the role of, for example, the Association of the British Pharmaceutical Industry or the Food and Drink Federation, in negotiating in its interests.
TechUK is probably the most likely body, but for the moment its health and social care council is not active in this area. Indeed, Susan Venables, co-founder and client services director at Highland Marketing, suggested that health tech suppliers are, generally, not well-prepared to engage with the NHS on climate change. “We talk to a lot of vendors, and as a rule they do not seem to understand the urgency,” she said.
Newell said he thought awareness would grow. “The strategy was published a year ago, the NHS has only just started to engage with the supply chain, and it has started with pharma and food,” he said. “As the NHS starts to engage more widely, health tech will get drawn in.”
If it didn’t, he agreed, there are big risks: to individual companies “because if you don’t engage with this, somebody else will, and that will give them a big competitive advantage”; to the NHS, which could miss the opportunity to tackle climate change at a public health level; and to society. “This is real,” he said, “and it’s real because it is a crisis.”