Challenge 4 | Health & Delivering the Net Zero Transition
Speakers: Chris Baker, Director, Studio Zao | Sarah McInnes, Head of Sustainability, NHS South West London | Michelle McCann, Chief Sustainability and Innovation Officer, NHS London Procurement Partnership (NHS LPP) | Gosbert Chagula, Head of Programmes, Startup Discovery School | Professor Issa Chaer, Associate Dean, Built Environment and Architecture, London South Bank University
Chris Baker, Director, Studio Zao
Welcome. My name is Chris Baker. I’m a Director at Studio Zao. We’re an innovation consultancy and we help people do new things. We help people do things better. That expands across a lot of different industries, different sectors, different sizes of organisations. We work with small businesses, corporate organisations and the NHS. We’ve done Net Zero projects, so a bit of everything. We’re not specialists on those topics but we hopefully add to that conversation. We do quite a lot of work in South London. We’ve been working with South London Partnership for over two years and know the ecosystem pretty well.
Just for context, why are we talking about health and net zero, and what’s the scope of this conversation? The carbon footprint of healthcare and obviously healthcare within the NHS in the UK, according to a British Medical Association write up, is that the NHS itself is responsible for about 4% to 5% of the UK’s total carbon emissions. 62% of that is within the supply chain. Everything in terms of the development of medicines, the prescription of those, transporting them. And then there’s still quite a big chunk on things like real estate, 10% of energy from the building real estate, you’ve got patient travel, staff travel, different scopes of emissions that all lead into different things, even things like the size of the fleet and the fact that 83% of NHS vehicles are still petrol and diesel-powered. I think we tend to think of hospitals as big, and they use a lot of energy, but there are quite a lot of different nuances to decarbonisation and the carbon footprint of healthcare more broadly in this country.
This might be a little niche, but I read somewhere that every time you go to your GP, just for an appointment, that’s 6 kilograms of CO2 emissions, which rises to 18 kilograms if you’re prescribed medicine. So obviously, that suggests perhaps disease prevention and stopping people from getting ill will also help decarbonise. And there might be some conversations and questions we might have about the public benefits of decarbonisation to public health. I’m going to ask some questions and let our panel talk. Perhaps each of our panellists could introduce yourself and tell us a little about what you do in this space in relation to the topic.
Sarah McInnes, Head of Sustainability, NHS South West London
I’m Sarah McInnes, Head of Sustainability at South West London ICB, part of the NHS. The NHS is a big old beast. The part of the NHS that I sit in is the part that’s responsible for coordinating and planning services in South West London. My role is around coordinating the delivery of the green plan. I work with acute trusts, mental health trusts, community trusts and primary care on our activities to deliver our green plan in South West London. Glad to be here.
Michelle McCann, Chief Sustainability and Innovation Officer, NHS London Procurement Partnership (NHS LPP)
I am the Chief Sustainability and Innovation Officer at an organisation called NHS London Procurement Partnership. We’re a member organisation, owned by the 35 trusts in London, including South West London trusts. While historically, we were set up to provide frameworks and routes to market for our members to call off services quickly, since the introduction of the integrated care systems, we’ve been looking at more sustainable solutions across London. Where it makes sense to do it once rather than doing it 35 times, and the sustainability and social value work streams were born out of that desire to collaborate and do something once across London, and I lead that team.
For the last two years, we’ve done a lot around introducing a social value toolkit to ensure that social value is being treated in the same way, across all of the NHS tenders in London, being evaluated in the same way, so that there’s a standard approach, but also working alongside the London anchor institution and the ICBS and the NHS green team, to look at ways of decarbonising the NHS, and we can do that through the social value mandate, but we also need to do that by looking at our estates. If you look at the NHS estate, it’s a collection of pre and post war buildings, right up to modern new hospitals. And trying to find a strategy that covers that huge breadth of estate is no mean feat.
Gosbert Chagula, Head of Programmes, Startup Discovery School
I’m Gosbert Chagula, Head of Programmes at Startup Discovery School. We run innovation and support programmes for businesses and new and emerging technology. I come at this from having worked on projects with the NHS, which looks at issues of decarbonisation. One of the first projects we worked on was in Exeter, working with the Royal Devon & Exeter Hospital Trust, looking at issues around missed appointments, but with the lens of traffic. Exeter gridlocks quite easily, which has a knock-on effect in terms of missed appointments. And for that, we create a programme almost purposely because missed appointments are something everyone connects to, as opposed to the issue of decarbonisation, which sometimes feels so distant.
What does that mean to my life? We really created a series of programmes like that. A lot of our work has been working with emerging technology and businesses, looking at bigger issues and connecting them to pilot opportunities. We’ve recently completed a big programme around housing and inequality, listening to the council, looking at some of the most vulnerable residents, tenants, looking at the conditions they live in, and how we can connect emerging technology to tackle some of those big challenges. Often sitting in the middle of big organisations such as the NHS, but also innovators with interesting ideas and investors.
Professor Issa Chaer, Associate Dean, Built Environment and Architecture, London South Bank University
I’m a Professor of Thermal Energy Systems, and also the Associate Dean at London South Bank for the School of Development and Architecture. My involvement over the National Health trusts across London has been through my students working in the sector and bringing in projects for final year dissertations and some of these were really impactful in terms of analysis, but also in terms of results. We looked at aspects of energy consumption in the health sector in the estates; as Michelle has highlighted, we looked at ways to support the decision-making in the carbonisation of these estates. And we looked at the technologies that can be embedded into the estates. We also looked at the infrastructure. Where should they start? We then transitioned into what technologies could be implemented at a lower capital investment.
I’m also currently working as part of the London South Bank first centre, where we’re looking at linking public health with planning. We’re evaluating how local authorities can embed public health experts in planning departments of local authorities in order to guide on the planning of new properties and also Health Trust, but also supporting the highways and policy departments in developing sustainable but also net zero and healthy policies.
Chris Baker, Director, Studio Zao
Brilliant. Thank you all for that introduction, very relevant to our topic today. Perhaps, Sarah, I could start with you. I threw out some statistics, but statistics don’t really tell you what’s going on behind them. What I didn’t talk about was all the things that have been going on in NHS healthcare, all the different kinds of subsidies that are starting, things that will be happening in the future. I’d love it if you could contextualise, from your side, what the net zero transition means for you and your organisation, particularly with regard to South London, and what you’re starting to focus on.
Sarah McInnes, Head of Sustainability, NHS South West London
The first thing to say is that really the climate crisis is a health crisis. So that’s how we position and contextualise some of our work in the NHS because -of the adverse impacts of a warming planet, be it on heat-related deaths or depression and anxiety caused by flooding, the increased risk of disease, etc. That’s all relevant to us in the health service.
One of our lines of work is thinking about how we can change our services to meet the inevitable rise in demand that these events will bring. As you’ve mentioned, we’re looking to engage with public health colleagues. I think that’s a brilliant initiative and looking at redesigning our services to better meet those needs, which is a really important thing. Looking at models of care that we have already around integrated neighbourhood teams, looking at the messaging and the prevention messaging that they’re giving to their patient population. Looking at the automation of some of that around triggers and alerts, etc, is really important. It’s absolutely a bread-and-butter space for us to be operating in. It’s models of care, but it’s also estates and the adaptation of technology in estates.
One of the projects we did in South West London, in St George’s, and I think they’re on the agenda, was a smart theatres programme which looked at adopting technology into theatres. Theatres are incredibly resource intensive in terms of carbon, and sensors and technology were able to keep the theatre at a safe operating level. The theatres have to be a very stable environment. It meant we could maintain improved productivity, because of less downtime, improved patient care. And actually, the projected savings are £570k annually from savings and energy efficiency. A win, win, win.
The other area we do a lot of work in is on medicines, and that’s probably unique to the health setting, because some of our medicines have outsized carbon impact, things like nitrous oxide, which have been in the media, recently, but that’s, 300 times more warming than carbon, but it’s actually an essential part of how we deliver healthcare and pain relief, especially if you think of maternity services and use of gas and air. We’ve done a load of work to reduce emissions from nitrous oxide where we can control it. We’ve reduced by about 21%, fixing things like leaks, etc.
But one of the new spaces we’re moving into is, what to do in maternity units? Because obviously it’s not about, not providing the pain relief women need, but we’re using technology in those settings and using nitrous oxide cracking units to recover the gas, storing it for safe disposal. There are so many strands to this area of work and healthcare and so much happening across South West London.
Chris Baker, Director, Studio Zao
I’m really glad you came to innovation and what you’re doing. There’s obviously a lot going on in the background around strategising and how we put these commitments together. Perhaps Gos, I can come to you? Seeing it from outside the NHS, and some of the startups you know, and the organisations you’ve worked with, these skills and use cases and needs from the sector. How is that being engaged with by the startup space and what are you seeing in that realm, in terms of people starting to work with some of the hospitals and trusts?
Gosbert Chagula, Head of Programmes, Startup Discovery School
I think there’s a tension. A capital tension. When we think about start-ups, where do they come from? The reality is there’s a whole ecosystem of different actors, private investors, angel investors, people in universities and research labs, all these people working together and out pops a business. And some of those businesses have no commercial use whatsoever. They’re just interesting pieces of technology which, strangely and conversely, in the NHS context, could be useful. And I’d say NHS has great parallels with the oil and gas industry. It’s everywhere but nowhere. Everyone knows it. Hospitals are the obvious thing. This whole ecosystem in which hospitals exist is shrouded in mystery. So, there is a tension between private capital and how it’s used and funds businesses.
Private capital needs returns now, even sooner than now, and also the usefulness and use cases for NHS and the problems that it solves. No one, in their right mind, is going to argue against theatres needing to be operationally steady. However, there’s often a tension with private capital. I think there is an interesting thing with barriers and pathways.
A lot of our programmes are geared at providing a pathway to sectors. For example, we run a programme for the council on some of their housing issues around the retrofit, attacking things like mould, the inefficiency of electricity, that sector to most early businesses, unless you’re in it and you’ve come from it, where do you start? And what isn’t going to create a great pathway is to engage with them.
Often in engagement, it could be a series of facilitated conversations, learning opportunities are more valuable than the deployment of actual cash. I see a curiosity and interest in looking at NHS and the size of the problem, but perhaps not necessarily knowing a way in. And the good I have seen can come from funding.
There is a fund which isn’t an NHS fund, but they work in partnership with NHS over in Paddington. It was an interesting use of private capital. Opening up opportunities to pilot with the NHS. It was a great way of showing pathways in. Definitely, from our perspective, we see the tension of private capital, which needs results now, but also the challenges which institutions under the NHS face, which isn’t necessarily in line with that, but the use and impact is huge.
Chris Baker, Director, Studio Zao
Issa, from the academic side, you mentioned some of the projects that you have been working on in student engagement. How do you find that engagement?
Professor Issa Chaer, Associate Dean, Built Environment and Architecture, London South Bank University
I think one of the biggest obstacles is that the health sector has lots of challenges. One is the infrastructure, but also the investment which comes in to support the modernisation of the infrastructure, the technologies, but also embedding energy managers in the trusts. As a result of a collaboration between the students, the university and the trust, the trust offered the students placements as their energy managers and that was successful.
In terms of what Gos has said, there is a lot of procurement. Every little bit of kit has to be checked and rechecked and rechecked before it goes in. Contractors have to be vetted. And those on the suppliers list to support the transition or the implementation of new technologies as well. As a university, we graduate approximately 50% of the building services engineers in the sector here in London, so it was easy for us to transition into some of these establishments. However, I think there are barriers also because everybody who needs to work with the health sector needs to be checked.
Going back to the technologies and the infrastructure itself, as Michelle highlighted, there is a very old structure, and there’s some new structure. When we first looked at, how can we help the trust? We had to go back and find out, where is the energy intensity areas within the trust, where is the use? And we found, it was not just looking at the estate itself, it was the heating and domestic hot water. These are two elements, and then we have the lighting and ventilation air conditioning.
To mitigate the emission from heating, the first thing to do was look at the infrastructure, because you make that infrastructure tight and thermally insulated, you could mitigate the losses through the infrastructure. But some of this infrastructure is quite old. It’s difficult to replace. Some of the windows are single-glazing in positions that are awkward to get to, and some of the windows, in summertime, bring in lots of solar radiation. So, we needed to take a methodical approach. How do we implement these technologies in the health sector?
Next, we looked at smart metering. But that needed investment, and it’s a massive estate. One of the obstacles with the estate, is that although the health sector or trusts own part of the estate, there are different residents in the buildings, or buildings are leased, or occupied by different departments. And it’s awkward to distinguish between what’s under the trust remit and what’s not. And where do you place the meters? How do you get investment? How do you keep monitoring these systems? Because that also needed an energy manager to keep on being employed and look at it. And sometimes, it costs something like £90,000 to analyse this data on an annual basis in a house first. Something we needed to overcome.
However, there were opportunities for quick wins. A quick win was the lighting. Changing the lighting into LEDs was one of the quick wins that could be implemented and done very, very quickly. Infrastructure was very difficult, moving from the steam boilers, which the Health Trust had bought lots of steam boilers, or old boilers that needed to be replaced, in their hope of moving away from gas. They’ve implemented CHPs (Combined Heat & Power) in some, but also they needed somebody to keep maintaining and looking at the gas prices. The opportunities are in networks, thermal energy networks, where all of these estates and the surrounding areas can come together, and they can have a thermal network. They can work together on sharing energy, because energy cannot be created or destroyed, or they can convert it from one source to another. If you have a building that’s rejecting heat and a building that requires heat, if you recover that heat and give it to the other building asset, that’s viability.
Health Trust’s have lots of zones that fall into that category. And they could create a thermal network. One of my colleagues, Graeme Maidment, has been working on a scheme in Islington called Green SCIES, where they are building thermal energy networks and reclaiming heat from the London Underground in order to heat up the houses in the Islington area.
In terms of the policies, just working with the local authorities opened our eyes to the importance of public health and how you prevent illnesses before they occur and embedding public health in planning departments has highlighted the importance of tackling the issues before they happen. Milton Keynes and Oxfordshire are implementing these practices of embedding public health planning departments. Looking at the mobility, parks and air quality, all of these elements are important for the health and wellbeing of the public.
Chris Baker, Director, Studio Zao
I’m glad you went into that as well. Every time we talk about things like retrofitting, for example, partnership on that and the public health benefits, not just in terms of staying warmer and energy efficiency and saving people money, but houses not being damp, which means people aren’t getting cold, not having to go and have those GP appointments, driving that down as well.
These are all super important public health issues. Michelle, we talked a little bit about procurement and working with people and how we can create that environment for successful collaboration. I listened to the conversations we had this morning that were procurement-focused, and some of the things that are coming in, hopefully that may make that easier, at a broader level.
From the procurement angle, from the supply chain piece, the 62% coming to the supply chain etc. What do you think needs to be done? What is being done that can start to ensure net zero is achieved by working more holistically and creating these partnerships? We have a very fragmented healthcare system, with individual trusts all doing their own thing. How can A) procurement bring that together and B) they work with the supply chain to start to drive that through?
Michelle McCann, Chief Sustainability and Innovation Officer, NHS London Procurement Partnership (NHS LPP)
I think there’s a lot of work already underway. If we look at the area of waste and physical waste, we have seven different categories, from domestic to clinical. In a typical hospital, you’ll see banks and banks and banks of different coloured bags for waste to go in.
But we also buy lots of consumables, and they come wrapped in single-use plastic a lot of the time, and that is waste. They might come in a cardboard box so we can write into specifications that we don’t want that level of packaging coming into our site, or if it is coming in, you need to take it away with you because why are we paying to throw that into our waste cycles, when sometimes it’s not necessary? Then we can look at things that need to be wrapped in plastic because they need to be sterile, and we can say, does that plastic need to be traditional plastic, or are there alternatives?
Somebody was talking earlier about plastic being manufactured in London from seaweed. We can, through procurement, put the challenge out there to say we don’t want virgin plastic; we want something better on our products. And we also don’t want so many disposable products. There’s a concerted effort to look at reusable, and a number of trusts are looking at reusable gowns and reusable caps.
There’s a really good campaign in a Trust where they said, we’re not going to use gloves for these types of procedures. They managed to save a couple of £100,000 a year by simply saying, wash your hands instead of using gloves for these non-clinical type procedures.
And we need to work in partnership. Yes, there’s LED lighting, and lots of funding available for LED lighting. But in some trusts, the wards are like villages. They’re in occupation 24 hours a day. So, when is a team coming in to do all that work to change those systems? We have to work in partnership, and we have to understand that in order to do some of this work, we need to invest, to save. If we want to do things at scale, maybe there’s a mobile decant space that we can move around London to allow some of this. And if you’re going to do the lighting as well, do the windows and coordinate things so they’re not as costly in the first place.
And we need to move away from looking at cost in isolation when we are procuring as an awarding criterion. We need to look at the whole life cost of the product. It might cost 10p more to procure something that is more sustainable, but actually, in the same lifetime as the cheap product, you might only use two of the sustainable products, but you might use 10 of the unsustainable ones. We need to look at that whole life cost, including the cost of disposal, to make sure that when we are evaluating things on a like-for-like basis.
Chris Baker, Director, Studio Zao
I’m glad you said invest, because it’s come up across the whole panel. What does investment look like? There’s been a lot of conversation around the recent budget and where some of that money might be going. That wasn’t necessarily net zero related, but to create a more sustainable long-term environment that isn’t just a stop-gap or treating the problems, what would be on your wish list? If you were to get investment, would it be for something specific? What would it look like? Is it in people? What would you need?
Sarah McInnes, Head of Sustainability, NHS South West London
It’s the really big issue, estates. I think it’s about £800 million we have to invest in our estate across South London. These figures are astronomical, and that is a big part of how we will drive decarbonisation down in our supply chain.
We are exploring models of private-sector investment. It is difficult, even because of the way we would do our accounting; that’s a whole separate discipline. NHS accounting. It is difficult sometimes for us to access private sector investment, but we have to explore that option. Because the reality is there isn’t the magic grant funding available that we would need to support our transition.
The main grant funding is something called the PSDS fund, the Public Sector Decarbonisation Fund. But the NHS is bidding along with the rest of the public sector. Somebody likened it to the Hunger Games in terms of an exercise. It’s incredibly competitive to secure that funding, and a huge amount of investment and time goes into getting it, and then you’re not sure if you’re going to land the money in the end. So, that would be our wish list. Some kind of magic money tree.
Chris Baker, Director, Studio Zao
But green financing is an emerging space. There’s a lot more being written about it. Lots of these public, private pieces. It’s a maturing field and Gos, you mentioned the tension. It’s difficult to get proper funding. It’s a hugely political topic. Taxes and the impact that has. How much of a role can private finance play there? How practical is it in the space?
Gosbert Chagula, Head of Programmes, Startup Discovery School
I think there’s a strange paradox between the challenges NHS faces and the fear that strikes private investors. It’s a bit of a cliche about investors and hardware. As soon as you start talking hardware, they get nervous. Hardware is about building things and that sounds expensive. When do we get our money back? Going to the bottom line, when do we get our investment back?
Typically, if you look at the spectrum of investors, with the same venture capital being one of the most aggressive risk and strangely, one of the risk takers, any mention of large institutions, such as the NHS, can strike a bit of fear into those investors about their own returns. I think there’s a bit of a blended approach that could possibly be taken. Just hearing Sarah and Michelle speak, they have insights which are undervalued.
A lot of investors can learn a lot from their experience day to day, working within the NHS as an institution. There may be insights which are hidden away. Especially those who are working with emerging technologies, are blinded. I did a project years ago with Devon and Cornwall police, looking at procuring solutions around reducing road traffic accidents. That was a whole crash course in the police. You see the police officers walking around, you don’t understand the institution they come from and how difficult procurement is for outsiders. And I find it quite intimidating, if I’m honest, to sit around the table with police, senior police officers, to understand the world in which they operate, which, again, I work with start-ups every day and investors, and if I’m distant, I don’t understand, I can only imagine what someone who gets a pitch deck is looking at.
I think maybe there’s a chance for a blended approach, and I can only draw parallels with another field. Looking at investors, or engaging investors who typically aren’t driven by the same kind of returns and motives others are. I found a whole class of investors recently anchored by religious institutions, who typically have impact funds and what they’re looking at is societal change. And I always say, why aren’t they investing in more projects related to health care? Because if you want societal change, is there any better vehicle than the NHS? I think maybe there’s a bridging together of the two different worlds. A more blended approach.
Chris Baker, Director, Studio Zao
That’s a really good point. I think finding the right investor for the right space. That’s why you bring it back to health, net zero and the social impact element, and longer-term returns.
Sarah McInnes, Head of Sustainability, NHS South West London
There are some other models I’ve seen around the country where people are doing things like energy cooperatives, leveraging our buying power on a footprint. This place, Taunton, the PCN, has buddied up with everyone in the local community, and they can leverage more effective buying power as a consultant and have that energy cooperative. I think it is about thinking outside the box and not necessarily doing the same things we’ve always done.
Chris Baker, Director, Studio Zao
Brilliant, thank you. Does anyone have any questions?
From the audience: I just want to ask you, Sarah, about who does what and referring to the previous session about health technologies. Under the integrated care system, if you are a patient in a virtual ward, receiving your care at home so in more comfortable circumstances, but your home is cold and mouldy, and you’re considering retrofit. Who would you refer that patient to for advice and guidance about the issue? Is it to go back to the GP? Is that social prescribing?
Sarah McInnes, Head of Sustainability, NHS South West London
I think that’s probably a silo, isn’t it, in that there is probably social care, and that’s what Martin was saying this morning as well. There are social care teams who would have involvement with that patient, and there are health patients. And then there’s a separate team with the council who do retrofit, and I think we are notoriously poor at joining those connections. This idea has been around for a long time, joining up across places, joining up our agencies better, I think that can be hugely enabled by data as well. And that idea of proactive care. We are making those connections. That is one of the challenges we face about joining us all up for the patient at the end of the day. That would be hugely beneficial.
From the audience: I work at Merton Council as a Programme Manager for business and we work within the region and economy team. I work alongside climate action colleagues. Each local authority has a net zero plan we’re working towards, but we need to be building relationships with all of you. We work really closely with the planners and strategic planners, and it feels like we need to have a platform to not just talk about finances, but actually learn best practice from each other and understand. We’re doing lots of things around our estate through our facilities management. We’re looking at social value through procurement. But we need to be collaborating a lot more on this. I need to reach out to all of you and link you with different people across the local authority. Maybe that’s something more from a sub-regional level that South London Partnership can perhaps take away and talk about. Definitely, there’s lots of things we can be talking about that reaches our residents and supports residents. It seems to be a focus on housing and residential properties and not on commercial and you are a huge employer and a huge part of the local authority and the sub region, as are we, and we don’t seem to be doing much together in terms of estates.
Sarah McInnes, Head of Sustainability, NHS South West London
I couldn’t agree more with you about joining things up. In the absence of money, we have to work together. It’s the only way we’re going to do this, and we have to make those connections.
Michelle McCann, Chief Sustainability and Innovation Officer, NHS London Procurement Partnership (NHS LPP)
We managed to do it during the pandemic. London came together as a system. They asked how much of the PPE coming into the country we can have. 20%. So, give London 20% and then we’ll distribute it ourselves. So, we can do it. And just to your point, David, some of the reason there are people still in hospital beds is because their homes aren’t suitable for them to go back to. They’re well, but we can’t discharge them because we can’t send them back to a space that’s not fit for purpose. In Guys, they use some of their resources from their in-house maintenance team to go out and just make small adaptations to patients’ houses. Because that was cheaper than the cost of keeping them in a bed. So, there are trusts and organisations looking at ways of doing it, but you’re right, it has to be a collaborative approach to make sure that the right agency is doing the right thing.
Sarah McInnes, Head of Sustainability, NHS South West London
Absolutely. Sustainability needs to be woven into everybody’s thinking. There’s not a separate team over here that are going to do it, it’s every single initiative, even when you’re thinking about pathway discharging that could potentially have an impact on climate and sustainability. I just think that’s another one of our missions collectively across South West London to try and get the message out there and raise awareness in every single team so that we’re all greener by design at the get-go.
Chris Baker, Director, Studio Zao
I really like the tangible focus of this, because I’m not having to ask you that question. We’re already talking about it, which is great. What does it really look like for a patient, a client or a person? A real person who is engaging with the health service, their council authority, and their place of work, engaging all these sorts of things here, from that user/customer journey. They don’t care. They’re just trying to get through that piece and the various different instruments that then deliver bits of it that they don’t see.
I think that conversation, that collaboration, that forum for it. You’re almost having that engine, a task force, making sure people have the right conversations in the right places. That is not necessarily something that, by the sounds of it, will exist, but also is something that could potentially smooth things out, so nothing’s missed. There’s ultimately a useful reason to do something slightly different from our process and reuse things. People are able to innovate. They’re able to be slightly different, even if it’s quite practical and tactical like that. But are they then getting the opportunity to scale that out, share knowledge? Do they have contacts with the right people at the right time? That would be the ecosystem element.
Gosbert Chagula, Head of Programmes, Startup Discovery School
It’s a question of political language too. Sensitivity. Someone talks about going greener, tax rises, especially now. We have riots in the street. We have to brand things in a certain way.
Is everyone familiar with Innovate UK? It’s the UK’s innovation funding agency. It basically means writing cheques to businesses, and a lot of them have no commercial value, but we decide that it’s worth giving them money. And you know, about 2017, I worked for an investor in the Southwest. I saw so many opportunities for companies that were building the first generation of electric vehicle charging infrastructure, which is everywhere now.
Still, back then, there were hundreds of hundreds of millions of pounds pumped into this sector, the government effectively underwrote the construction of the industry. More than half of those companies went to the wall. But it was worth doing. Like there was a decision made, and it was branded out, and it was separated from normal activity, and it was like, this is the future. We’re willing to take losses. I think sometimes the NHS doesn’t have that attitude, so I’m going do this creative thing. It may or may not work, but it’s worth trying, and we’ll learn something.
Whereas Innovate UK, and it’s not an attack, but I just think I become aware of my engagements or the sensitivity of our sectors and our spaces. It may work, it may not work. If it does work, it’s going to be great. If it doesn’t, we’ll move on. Whereas I understand some of my colleagues – people on the panel today, they don’t have that space. So, how can we create that space? The journey is worth it, regardless of the tangible.
Professor Issa Chaer, Associate Dean, Built Environment and Architecture, London South Bank University
On that element as well, in terms of the innovations, you might walk into a health trust and find innovative technologies there, but the actual infrastructure itself it doesn’t help, it doesn’t assist those innovations. If you look at the IT infrastructure, the centralised systems, infrastructure is very, very difficult, and the health sectors are under a lot of pressure. Sometimes, when I go to visit my students in the Health Trust, I feel sorry for them because the cuts are happening in the people who are supposed to strategise, but all they’re doing is firefighting. And that’s the element where, in order to innovate, you need to map power, and you need to be able to strategise when you’re too busy firefighting. That’s what’s happening, and that’s what’s preventing it.
Chris Baker, Director, Studio Zao
I think it’s such a really good point around the human element behind all of this. We focus on the innovations, talk about money, we’ve talked about bringing together the processes etc. But people coming up with this stuff, delivering it, having the skills, the time, the capacity to actually do something with that, the connections they need. There’s a really inherently human element behind all of this to make this a reacting way.
Sarah McInnes, Head of Sustainability, NHS South West London
There are so many discussions I’m involved with where people have great ideas and they want to do something new and different, and we’re like, great, and then it just can’t go anywhere because nobody has the time or the bandwidth. Particularly if you’re working with provider organisations where there’s just that urgency of demand, where they have to see patients, etc, so you cannot, you just can’t get it going forward. I don’t know how we create bandwidth because we have to, we’re not going to change anything if we don’t.
Question from the audience: I work for Enterprise Ireland, and my previous colleagues have worked really closely with Michelle. My role is to help Irish companies come into the UK market, and part of that is advising them and connecting the right people to advise them on how best to present themselves to the UK market. We’ve got some really great Irish companies who might deliver some amazing sustainability solutions across the NHS estate. What do you need to see from those companies? Something like this is how we can solve problems? These are the cost of savings? It would be interesting to get an understanding.
Sarah McInnes, Head of Sustainability, NHS South West London
Yeah, it’s a great question. I don’t know how we would do this, but I think there’s something about listening to the shop floor problems and working out how we then pitch and tailor the solutions. Because sometimes that is part of the challenge about implementing new changes into the NHS is that busyness, and it creates a kind of a fear of doing anything differently, or lack of bandwidth to do anything differently because you’re firefighting, basically.
I don’t know how we do that, but I think it’s really important to engage with the shop floor people who are actually going to be working around that technology. Some frontline medical staff who understand what their challenges are, and then, if you can, the only things that I have seen thrive in the NHS is where there’s good managerial and clinical partnerships. You need both. Sometimes, you have very enthusiastic clinicians. But that in itself won’t necessarily get it over the line.
You need a good partnership, a good person who knows how to navigate the business case, writing whatever it might be, in order to get it over the line. And somebody who can speak to the heart of the matter, the clinician who can advocate for the improvement. That’s where things succeed in the NHS, where you’ve got those good partnerships.
Chris Baker, Director, Studio Zao
I think it’s a really good point. Everyone does a day job, but the engaging with shop floor is really an important bit. How do you pull that out of people who are on the front line?
Very briefly, we ran a programme that was more on mammographers, to think about improving the patient experience of going and having the breast screening process, especially in underserved communities. And that was absolutely what we’re talking about there, which was getting frontline log for system radiographers, working with their superintendents, working with the managers, working with data teams, bringing in that external piece, intrapreneurial people coming up with ideas and actually pitching them and taking them forward.
It was those sorts of programmes, not necessarily programmatical thing, but more building that kind of capability and skill, whether it’s for net zero or something else. It’s got to do more with what you’ve already got and I think the government comes into that. I think the innovation piece around universities. I mean, there’s a massive ecosystem there. If we can get more people to work together, equip them to feel good about their ideas, and have conversations with the right people, then we could start to see some change.
Thank you for the engagement and discussion we’ve had here. Major thanks to our panel here, really appreciate you all coming and spending an hour with us and talking through this in such a welcome experience, perspectives on the ground stuff, people living in, people working outside of it and inside of it.
So certainly, from my perspective, that’s been a super valuable conversation, just to get everyone together and to talk about a few things. I love the fact that we had a tangible element to that, thinking about how we’re going to start to build some of those relationships, the skills piece, the investment piece, how what’s going on, that we can start to bring together.
So, I’d love this conversation to continue, not just in the next 15 minutes but beyond that as well, because I think there’s something really valuable here, and I’m glad that net zero was the right way to bring people together around this. These things will go hand in hand as an ecosystem, and it’s absolutely key that nothing is siloed.
