Health Industry Leaders Issue 02 by PelotonEvents

Sentai’s Story: A personal Tale of Innovation and Care

TECHNOLOGY

04 A Mixed-Methods Analysis of the Experience of Primary Care Networks

08 How Connecting Consultants Benefits Everyone

12 Using AI to Predict NHS No-Shows and Clear the Waiting List Backlog

SUSTAINABILITY

20 Navigating the Path to Sustainable Medicine Usage and Patient Care

24 Facilitating Net Zero Achievement in the NHS

28 About Us

Olivia Staveley Graphic Designer

Hannah Wintle Multi Media Journalist

Chelsea Bailey Multi Media Journalist

FOREWORD f.march@peloton-events.co.uk Hello and welcome to the second edition of the Housing Industry Leaders eMagazine. Over the coming issues, we will be delving into the role of technology in healthcare and how to improve sustainability in the sector, with a focus on net zero. It is the latest branch of technology and sustainability eMagazines that we publish, with our other issues focusing on Hydrogen and Housing. Over the space of 2024, we will be launching our podcast series, and webinar series and will be growing our online content so follow us on Linkedin and Twitter to keep up to date with our developments.

CONTENTS

Floyd March Editor

In this edition, we delve into the need to use AI to predict NHS noshows and clear the waiting list backlog, how connecting consultants benefits everyone, and a mixedmethods analysis of the experience of primary care networks.

TECHNOLOGY

A MIXED-METHODS ANALYSIS OF THE EXPERIENCE OF PRIMARY CARE NETWORKS

PCNs in the most deprived areas would collectively receive £18.6m more funding per year if all population-based PCN funding streams used in the available allocation formula that best accounts for deprivation. With the right long-term resources, stability and organisational support, PCNs could represent an important route for addressing local health inequalities. PCNs cannot be separated from their constituent practices. Policymakers must take steps to address the longstanding inverse care law in core general practice funding and staffing.

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A MIXED-METHODS ANALYSIS OF THE EXPERIENCE OF PRIMARY CARE NETWORKS

While the state of play amongst general practice is widely recognised as being under continued pressure, it is often more acute in deprived areas of the UK, adding further disparities to the primary care given. This can be due to fewer doctors, less funding and different health needs for different people in these areas. To tackle this, the primary care networks were introduced before the COVID pandemic, to bring together general practices into local groups to provide additional services. Backed by extra funding - reaching £2.4bn a year by 2023/24 - PCNs were expected to recruit new staff, deliver additional appointments and new services, and work to improve health and reduce inequalities. This report analyses whether PCN policies have widened the underlying gaps between general practices in more and less deprived areas. It explores the impact of national policies on PCNs in more deprived areas, using analysis of workforce and funding data, and interviews with PCN leaders about their experiences.

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A MIXED-METHODS ANALYSIS OF THE EXPERIENCE OF PRIMARY CARE NETWORKS

Looking over some of the key findings in the report by The Health Foundation explained: “When adjusted for the higher needs of local patients, PCNs in the 20% most deprived areas of England employ six fewer full-time equivalent staff per 100,000 patients than those in the 20% least deprived areas.”

PCNs in deprived areas would also benefit from more targeted support from local commissioning bodies to improve management capacity and capability to design better services. Recent restructuring from clinical commissioning groups to integrated care systems has been destabilising for some PCNs, who report finding it harder to access support, and the loss of commissioners with local experience and knowledge.

PCN leaders broadly welcome additional staffing and report that PCNs have enabled better collaboration between local general practices and links with other local services. “However, leaders also felt funding does not reflect the additional workload of caring for patients in deprived areas.” Despite this, the report also highlighted that: “With the right long-term resources, stability and organisational support, PCNs could represent an important route for addressing local health inequalities. Ensuring their success will also require greater contractual flexibility in the roles PCNs can recruit, more discretion over spending and reasonable adaptations of PCN service specifications.”

To tackle some of the issues regarding PCNs in areas of high deprivation, the report highlighted the requirement for funding that meets the greater needs of their populations. “In the short term, NHS England should base all PCN funding and workforce allocations on the PCN-adjusted population, which better accounts for need. “In the longer term, funding allocations for core general practice services, as well as staffing and resource allocations for PCNs, should be changed to better align with need.”

ANALYSING THE IMPACT OF CURRENT PCN FUNDING, INCENTIVES AND CONTRACTING While stating the issues facing PCNs in their current form, the report authors conducted a series of interviews to analyse the impact of current PCN funding, incentives and contracting.

A MIXED-METHODS ANALYSIS OF THE EXPERIENCE OF PRIMARY CARE NETWORKS

Better weighting, targeting and uplifts were thought to be needed to account for the effects of deprivation. A number of interviewees welcomed the move away from the Carr-Hillweighted population (used in core GP funding) towards the PCN-adjusted population for some PCN payment streams. This was considered to better account for deprivation. But the continued use of Carr-Hill for other PCN payment streams and in core general practice payments was reported to be a problem. Several interviewees also felt that the PCN-adjusted population approach still did not go far enough.

“We’re pleased to see that some of [the PCN funding] is starting to use the [PCN-adjusted population] calculation, which hopefully will reflect deprivation a little better. But effectively, all PCNs are accessing similar amounts of funding. It’s not really truly reflective of what the need and the workload is.” Primary Care Lead Interviewees held mixed views about the way the PCN contract as a whole directs how funding is to be used. Some valued the structure it offers to guide PCN investment and organisational development. Others felt strongly that there was not enough flexibility in how to spend PCN funding and spoke about how they were prevented from doing innovative work to address patients’ social and economic barriers to better health.

BUILDING A PCN WORKFORCE FOR AN AREA OF HIGH DEPRIVATION There was strong consensus among interviewees that ARRS roles can add real value for PCNs in areas of deprivation. Some interviewees emphasised the contribution of clinical roles, such as pharmacists or physician associates, in helping tackle high primary care workloads. One PCN leader explained: “There’s a tension between what the practices see as valuable and what is possibly valuable in wider terms and that does come to deprivation and health inequality […] the practice’s initial focus would be, what can help me get through the day as a practice and hence an emphasis on clinical skills, clinical pharmacists, physiotherapists.” Clinical Director

LEADING AND MANAGING A PCN IN AN AREA OF HIGH DEPRIVATION Some interviewees reported that the role of clinical director offers a chance to engage more systematically with communities and use designated funding to do innovative work aimed at reducing health inequalities. Developing leadership and other skills was also seen by several as a positive aspect of being in the role. However, many spoke about how difficult or unsustainable the role was given the pressures of trying to lead a PCN, with a small number planning to step back from the role in the future. These pressures were seen as potentially accentuated in areas of high deprivation by the additional challenges faced in setting up services and addressing complex local needs. Some interviewees reported tensions, or even conflict, where other voices in the PCN had called for a

firm focus on the ‘day job’ of trying to meet high general practice demand rather than investing scarce time and resource in establishing new roles and services. A few clinical directors described a balancing act between progressing the PCN agenda and the need to keep other colleagues on board. “It’s that balancing act, isn’t it? Because you’ve got to keep your practices on side. I think you can’t just go on a tangent and leave your practices behind because that’s when everything will fall apart. […] [PCN members say] “Why do you need to go to all these meetings [with voluntary sector, faith and council groups]?” But if you don’t have that network in place, if you don’t have those relationships, how are you supposed to address all these health inequalities?’ Clinical Director Recommendations 1. PCNs in areas of high deprivation need additional funding to meet the greater needs of their populations. 2. PCNs could benefit from greater flexibility within the national contract to better tailor new services to local needs. 3. NHS England and ICBs should ensure that their commissioning approach is suitable for PCNs in different contexts, and can account for and respond to the additional challenges faced by PCNs in areas of high deprivation. 4. Policy and planning for PCNs must take better account of the needs of PCNs in more deprived areas. 5. PCNs cannot be separated from their constituent practices. Policymakers must take steps to address the longstanding inverse care law in core general practice funding and staffing.

TECHNOLOGY

ISSUE 2

GPs can quickly access specialist advice for their patients through Consultant Connect Addressing concerns at primary care levels leads to better patient outcomes and decreased pressure on hospitals Better utilising existing technology within the NHS can achieve great results In order to offer the best care possible, it is important that the vital services offered by the NHS aren’t overwhelmed, and by enabling the provision of comprehensive care in the first instance, unnecessary hospital appointments could be avoided.

How Connecting Consultants Benefits Everyone Each year, over 300 million general practice appointments are delivered, and according to NHS, the service forms the ‘bedrock’ of their care offerings. Getting things right at such a foundational level helps to ensure the smooth running of the entire service, and providing patients with appropriate care at this level has a knock-on effect when it comes to delivering hospital services. 8

The challenge facing GPs, therefore, is to address patients’ concerns at a primary care level to the fullest extent possible before referring them for secondary care, and in instances where this is necessary, referring them appropriately. Co-founder and CEO of Consultant Connect, the UK’s largest telemedicine provider, Jonathan Patrick, said: “GPs by their nature don’t know absolutely everything, and yet they have to decide what to do with you, a patient, if something falls out of their area of expertise. “If they’re worried about you, they will naturally want to send you to hospital. The problem is, as we already know, that even a few years ago, sending somebody to hospital, particularly in some specialties, was committing them to being on a waiting list, an often a very long waiting list. And one thing we know about waiting lists is people tend not to get better, they tend to get worse.” To serve the best interests of both patients and the NHS’s services, supporting GPs is essential, and in many cases, technology is already assisting in this ongoing endeavour.

BRIDGING THE GAP BETWEEN PRIMARY AND SECONDARY CARE Streamlining communication between NHS services can have a drastic impact on how patients receive the care they need, and it is this that forms the basis of Consultant Connect.

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BY HANNAH WINTLE

Founded in 2015, the service works by connecting primary care clinicians with specialists, via phone or app, to best assist with a patient’s specific needs. Rather than phoning through to a switchboard and risking calls being missed or unanswered, the average time of reply through Consultant Connect is 33 seconds.

“It wasn’t uncommon for people to call a hospital, ask for a specialist or a specialty, be on the phone for 10 minutes, and it not be picked up. This is just the way the world has always been.” Jonathan said: “Initially, we made it so that if you dialled a number from your landline or your mobile, it would find consultants who were available on a rota. And if they were not available, the call would loop through to two other clinicians until one of them answered. And that’s how we made it reliable. “We took an initial answer rate of under 20% and, in the first iteration, got it up to around 75-80%. Then with various tweaks to it, what we’ve now done is, again, just using the same old phone technology, the answer rate for a specialist consultant is as high as the highninety-percents.”

HOW CONNECTING CONSULTANTS BENEFITS EVERYONE

Being able to reliably access a wide range of clinicians in specialisms, such as cardiology and diabetes, in such a short window of time, means that in many cases, doctors can get the appropriate advice while their patient is still in the room.

The technology also expands to cover dermatology concerns, with photo sharing capabilities enabling GPs to take photos of a patients lesions for review, as well in urgent care scenarios where paramedics can ascertain whether a patient needs to come into hospital, and if so, which department. Jonathan highlighted that the technology, especially in an urgent care setting, not only reduces strain on NHS services, but also the mental strain on the professionals delivering care who may often wonder whether they had made the right choice.

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Our challenge with Consultant Connect was not so much new technology, not so much getting people to use new technology, but getting them to use existing technology in a more clever way. He said: “A paramedic is forced to make decisions all the time about which patients to convey. If you have a child or older person fall over and bang their head, and you don’t send them to hospital, you’ve got that nagging ‘what if’ feeling. ‘What if this has caused them more damage?’ “So the other main part of our business is now providing advice in urgent care scenarios, and that is paramedics speaking to specialists. That’s the peace of mind benefit. But then there’s also the learning benefits for junior paramedics as well.”

DELIVERING TIMELY CARE ALSO REDUCES STRAIN ON HOSPITALS Importantly, Consultant Connect seeks to enable GPs to deliver appropriate care to their patients at the earliest opportunity. Previously, in instances of uncertainty, patients would have been referred to a hospital waiting list or even the wrong specialist, delaying the time taken to receive the care they needed. Timing remains an important factor in healthcare – treating patients too late could result in, in extreme cases, life and death scenarios. Ultimately, the sooner a patient receives treatment, the better the outcome, highlighting the importance of enabling appropriate care provision at a primary care level. “Avoiding going on a waiting list is unbelievably important. But then also, if you are going to

go on a waiting list, if you can get started with a medication that you are likely to be prescribed, if a consultant says, ‘I want to see this patient, but you can get them started on this drug in the meantime and I can see how it’s going with them’, then it means that everything moves along faster,” Jonathan explained. Reducing hospital visits not only benefits patients, but alleviates pressure on the hospitals themselves, as they are able to treat those most in need without being overwhelmed with referrals that otherwise could have been avoided. Additionally, referring patients to the right department in the first instance prevents specialist consultants time being consumed redirecting patients rather than treating those in genuine need. To date, Consultant Connect covers more than 40 million patients throughout the UK. It is through better utilising existing technology that the company hope to streamline services and enable more patients to get the care they need, reduce waiting lists, and alleviate some of the pressure experienced by busy hospitals. As Jonathan summarised: “It’s better for the GPs. It’s better for the patients. It’s better for the consultants in hospitals. And it’s better for the NHS that pays less money for people coming to hospital who didn’t need to.”

TECHNOLOGY

ISSUE 2

Using AI to Predict NHS No-Shows and Clear the Waiting List Backlog Roughly, 8% of patients missed their appointments in the UK and about 4% did so on short notice.

30% HBA1C increase with every missed diabetic appointment and beyond.

Missed appointments across the NHS cost over £1bn and have massive impacts on the health and well-being of citizens across the UK. With the increasing use of AI in healthcare, how can we better bridge the gap of missed appointments and find the root causes of the problem? The impacts of missed appointments have been widely researched and reach all aspects of diagnosis and treatment in the NHS. In asthmatics populations who miss their GP appointments, admissions to hospital are significantly more prevalent with studies showing as many as 217 more admissions in these groups compared to 0 admissions in populations who do attend.

A missed primary care appointment correlates with a subsequent emergency department visit among children with asthma.

These facts, coupled with the increasing waiting times for patients waiting to receive a consultative, assessment, diagnosis, care or treatment activity due to pressures such as the pandemic recovery have been exacerbating the situation.

FROM NHS FRONTLINE TO HEADING UP AI INNOVATION IN HEALTHCARE Meet Dr Benyamin Deldar, Co-founder and Co-CEO of Deep Medical and former NHS Doctor, looking to tackle this challenge head-on after witnessing these issues first-hand while working in the NHS.

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BY FLOYD MARCH

“We can better redirect those resources to addressing the fundamental inequalities that are in place.” Explaining the thought processes behind launching the web-based booking platform that predicts non-attendance, provides priority scheduling option to patients who are most at risk of no-shows, and recognises differing needs to tackle inequality directly, Ben explained: “When I looked at co-founding the company, my business partner was working on a piece of research which was looking at predicting whether we can use AI to actually identify which patients are likely to miss their appointments in radiology. “Since then we’ve been busy working on how we not only predict that, but predict it across all of the outpatient settings, day surgery, and also likely patients to cancel their appointments on short notice.”

AI CAN BE USED TO HIGHLIGHT HEALTH INEQUALITY AND REDUCE MISSED APPOINTMENTS This specific technology is aimed at increasing clinic capacity and reducing wait times across the NHS but a second prong is using the data gathered this way to drive more equitable access to care across the country based on gender, race and geographic barriers etc. “So, the core principle is to use AI to find out how patients behave when it comes to their patient journey. Are they likely to miss the appointment if it’s a new appointment, a follow-up appointment, or are they likely to cancel on short notice?” Adding a further layer of depth to this, Deep Medical can then study data further to understand the factors that take place and that can result in a patient missing an appointment.

THE FACTORS OF MISSING AN APPOINTMENT CAN BE GROUPED INTO THREE POCKETS Ben explained: “I group these factors into two or three pockets. The first is based on ‘me’ as a patient. These concerns can be things such as what’s my access to public transport at that time, what’s the weather like, what level of deprivation do I live in, and how have I behaved previously. “All of these things are freely available, and there are great datasets that we can gather and augment when we take information from the hospital. The second part is more about the base of the hospital itself in an operational sense, how they handle the appointments and the data, and how their processes evolve over time. He moved on to explain: “The final aspects of the data are more focused on the relationship that the patient and doctor have and how this compares to other doctors and processes in that speciality. “All of these factors interplay with each other in a nonlinear manner and we are all about figuring out how all of these factors come into play which can result in someone not turning up or canceling on a short notice.” On the ethics involved in using AI in healthcare, Deep Medical focuses on both ethical design and ethical use, ensuring the models don’t collect any special category data, health records or any personally identifiable information. 13

DATA COLLECTION IS NOT USEFUL WITHOUT ACTIONABLE OUTCOMES Collecting this data has obvious benefits, but turning the information into actionable results opens up a whole new myriad of challenges and obstacles. Roughly, 8% of patients missed their appointments in the UK and about 4% did so on short notice. When you compare that to America, it’s about 24% that miss appointments each year. So despite the fact the UK has some of the best attendance rates records in the world for appointments, there are still nuanced difficulties to overcome. Digging into this data has further nuances but doing so really allows Deep Medical to highlight what these barriers are, especially when the attendance rates are not consistent, so standard modelling is difficult to conduct. Ben expanded on this: “What we’re able to do is get people to think about how they can follow that natural flow, which is based on the individual.

USING AI TO PREDICT NHS NO-SHOWS AND CLEAR THE WAITING LIST BACKLOG

“That really brought us to the next part of what we’re doing, which is figuring out why a patient might be struggling to access care and how can the NHS ensure that they start delivering services and reduce those health inequalities in our society.

“When we spoke to over 1900 patients that were at risk [of missing an appointment] we found that when you call people, they’re more likely to turn up and tell you what they’re struggling with.” On an individual basis, this is extremely difficult to formulate and enact, which is why the use of AI technology can help speed these processes up. Ben told Health Industry Leaders: “To help aid the way we communicate with patients, we’ve built a way to create enhanced and personalised

communication based on how likely someone is to miss their appointment.” “So actually, this blended approach of targeted outreach and capacity management really allows us to get those patients waiting into those appointment slots that are going idle. “The data is a solution, but it’s about how we use actionable data, which is what we should be pushing towards.” When talking about data, technology and AI it is easy to become detached from the fact that digital innovations impact the real lives of many people across the country. Reducing the alarming statistics mentioned surrounding missed appointments and worsening symptoms is at the forefront of innovations such as this. Encapsulating all of these points on a human level, Cheryl Tackie explains her experience with her breast cancer diagnosis during the COVID pandemic and how digital solutions could have improved her experience in the video below.

AI AI AI AI AI

ISSUE 2

Sentai’s Story: A Personal Tale of Innovation and Care

In the heart of the adult health and social care sector's struggles, I found inspiration to create something meaningful – something that would redefine the narrative of ageing and independence. My name is Philip Marshman, and this is the story of how my personal journey caring for my father and seeking to help him maintain his independence and autonomy led to the creation of Sentai.

THE CATALYST: MY FATHER’S LOSS OF INDEPENDENCE Until the age of 87 my father was a fiercely independent man acting as the primary caregiver to his wife of 65 years, but this changed after she passed away. Around this time he began to experience a sudden decline in his independence, something that is common after a loss of a longterm partner. Those in the grieving process can often find that visiting places and people that historically were considered joint activities to be difficult. This seemingly overnight shift led him to cut existing social ties, stay indoors more and change his lifestyle completely, a change which was only worsened from the start of the Covid 19 pandemic with my father opting to self-isolate from February 2020, ahead of the government guidance to do so. It was as if he had lost his drive to go on and had given up. The knowledge that someone isn’t coping when they are physically ok can feel frustrating and overwhelming for carers as it can be hard to access traditional care resources without a physical ailment. It can be challenging when 16

loved ones do not want to answer the phone when you call to check-in, stop taking their medication, or fail to eat regular meals all whilst not wanting to visit or speak to family or friends. Seeing my own father struggle with this I realised that I couldn’t be the only one and that this must be a widespread issue affecting families around the world. This realisation of a vastly unseen epidemic of loneliness in our elderly population and the need for better support for them and their families is what sparked the idea that would eventually become Sentai. Due to the diversity of situations within the social care sector, it was immediately apparent that this could not be a one size fits all solution and that to make progress we would have to utilise a personalised approach to the care experience. Whatever we sought to create would also have to be accessible to a range of individuals within the circle of care from professional carers, to family members and most importantly the cared for individual. It became apparent that addressing the complex issues would need a multi-faceted approach, blending funding, workforce development, health service integration, and technological innovation.

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CREATING SENTAI: A GUARDIAN IN THE HOME When creating Sentai I teamed up with the man who would become the CTO of Sentai, Gowniyan Sivakumar. Together we set out to create a solution that would blend seamlessly into the lives of seniors. The inspiration for the name ‘Sentai’ came from merging the Japanese word meaning ‘guardian’ with ‘AI,’ perfectly encapsulating the product’s purpose. The initial vision for Sentai was simple but powerful – to be a companion that not only prompted day-to-day tasks for seniors but also acted as a reassuring voice in their homes. Crucially with our intended audience being the older population who are not always computer literate, Sentai needed to be “dad proof,”. It had to be a solution which catered to technophobes and offered a user-friendly experience.

BY PHILIP MARSHMAN

age gracefully at home. With Sentai ultimately being designed to be a constant companion for the elderly, providing reminders for daily tasks such as eating meals and taking medication as well as acting as a reassuring presence.

FINDING PEACE OF MIND: SENTAI’S IMPACT ON MY CARE JOURNEY After the creation of Sentai, I discovered that even in its earliest iterations it had a profound impact on my overall caregiving experience. Thanks to the real-time insights that Sentai was able to provide into my father’s daily activities, these updates offered a sense of peace and assurance. The technology allowed me to see that my dad was active, I could track his daily routine, and receive notifications if anything seemed amiss – this was a game-changer in the realm of remote care.

Usability was the most important thing for us when designing Sentai as we had one primary objective: bridging the gap between independence and support for those wishing to 17

PHILIP MARSHMAN

THE VALUE OF THE WORK THAT WE ARE DOING TO HELP REVOLUTIONISE THE HEALTH AND SOCIAL CARE SPACE IS EVIDENT

The personal impact of Sentai on my life was profound. It not only provided practical assistance but also offered me peace of mind. I no longer had to worry if my father didn’t answer the phone – Sentai’s insights provided me with the visibility I needed to ensure my father was well and independent. Allowing me to keep a watchful eye over his care needs from afar and maintain his independence at home.

A GOVERNMENT-BACKED SOLUTION: RECOGNISING THE NEED FOR CHANGE In late 2020 our work with Sentai received an important boost in financial support garnered from Innovate UK, the UK government’s Sustainable Innovation Fund. This was in part due to the increased threat to the elderly that had been brought on by the Covid-19 pandemic. Sentai’s AI-driven approach to companionship and assistance provided an important element to the care puzzle and helped to improve the wellbeing of the elderly in this difficult time.

This support was a recognition of the urgency of Sentai’s mission in addressing the challenges within the adult social care sector. As people live longer, and there are fewer people to care for them Sentai aims to connect individuals at the right time, coordinating services and systems for effective care.

TRANSFORMING HEALTHCARE: HELPING LOCAL COUNCILS TO ADOPT A HYBRID APPROACH Recently my work with Sentai has extended beyond individual households with exciting projects with local councils. One of the most recent of these projects is the work that we are currently conducting with Essex County Council. Sentai is currently taking part in a groundbreaking pilot with Essex County Council’s reablement program, looking to help reduce hospital readmissions and provide more effective follow up care to elderly patients.

These collaborations with local councils are highlighting the next steps for us at Sentai as we look to expand our offerings and to transform care delivery on a broader scale. By integrating Sentai into reablement programs, we aim to provide not just assistance but also companionship and emotional support to individuals undergoing rehabilitation processes, freeing up hospital beds and allowing people to go home sooner.

THE LEGACY OF SENTAI: REDEFINING CARING CONNECTIONS The legacy of Sentai is still unfolding, but the value of the work that we are doing to help revolutionise the health and social care space is evident. I am beyond proud of the work that we have undertaken to make something that started as a personal journey to help provide better care for my father into a nationwide movement towards improving hybrid care approaches. 19

SUSTAINABILITY

NAVIGATING THE PATH TO SUSTAINABLE MEDICINE USAGE AND PATIENT CARE Anaesthetic gases, along with analgesic gases, are responsible for around 5% of all NHS emissions. It is important to decarbonise respiratory care by using inhalers correctly and disposing them efficiently. Timely data can be used to support the healthcare sector to make key sustainability decisions.

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BY CHELSEA BAILEY

According to the British Medical Association, the healthcare sector contributes to around 4-5% of the total UK carbon emissions, and the NHS in England alone is responsible for 40% of the public sector’s emissions. As the healthcare sector navigates the path to net zero, industry leaders, innovators, and professionals must recognise their collective responsibility in ensuring the medicine it uses is more sustainable.

MEDICINES CAN MAKE THEIR WAY INTO WATERWAYS Health Industry Leaders spoke to Anna Edwards, Innovation Project Manager at Health Innovation West Midlands about how the healthcare sector can make its medicines more sustainable. Anna began by highlighting that nearly everything that we use on a day-to-day basis will eventually make its way to the environment, with medicine being no different. She said that our bodies can only break down a portion of the medicine used and whatever doesn’t metabolise will leave our bodies and enter the sewage network: “We’ve seen instances of antimicrobials getting into our waterways, there are medicines that we use to fight infections, such as antibodies making their way into waterways, this is significant and concerning.” Although modern wastewater treatment facilities are effective at combatting environmentally sensitive materials in wastewater, they can’t completely remove pharmaceuticals. Continuing, Anna explained that it isn’t just medicine entering the waterways that is having a negative impact on the environment, but anaesthetic gases have a huge role. She expressed: “There are a couple of areas at the moment that are facing the biggest environmental impact of medicines. For example, in particular surgeries and theatres are high users of medicine and some of the medicines they use have a high impact on the environment. Some of the anaesthetic gases they use have considerable environmental

impacts but they also use a lot of energy and resources.” According to NHS England, anaesthetic gases which are commonly used as part of everyday surgeries, along with analgesic gases like nitrous oxide, are responsible for around 5% of all NHS emissions.

THE HEALTHCARE SECTOR NEEDS TO ENSURE THAT INHALERS ARE BEING USED CORRECTLY Another area of the healthcare sector which is currently harming the environment is respiratory care. On this, Anna highlighted: “Inhalers are one of the biggest sources of carbon emissions. For example, Salbutamol inhalers are normally the ones that a lot of people use. These inhalers are short-acting therapy that is used to help relieve breathlessness.” To help reduce its negative impact on the environment, the sector needs to look at how the inhalers are being used. Anna agreed: “We need to look at the patients using the inhalers to see whether they are being used correctly. If you’re not using your inhaler properly, you’re not getting the medicine where it needs to be used.”

SUSTAINABLE MATERIALS AND TECHNOLOGIES NEED TO BECOME MORE EASILY AVAILABLE Another way in which the healthcare sector can make medicine more sustainable is by making sure that it is being disposed of efficiently. Anna stated the importance of patients disposing their used medicine packaging: “Patients can take their medicines back to a pharmacy to get it appropriately disposed of. For example, they can get their medicine incinerated so that way it doesn’t end up being in our waterways.” She said that inhalers are one medicine where it must be disposed of efficiently: “Sometimes with inhalers there is a bit of liquid left in it, and that gets put straight in the bin, but from that emissions are going out into the environment.” 21

“Sustainable health care is what we should be doing for our patients anyway and it will protect patients now and in the future.”

NAVIGATING THE PATH TO SUSTAINABLE MEDICINE USAGE AND PATIENT CARE

Anna Edwards Innovation Project Manager Health Innovation West Midlands

Anna said that the sector is looking into how it could implement more sustainable materials: “There are initiatives underway that are looking at sustainable packaging such as biodegradable packaging that you could make inhaler castings out of so they are no longer made of plastic, so they can be decomposed.” Remote technologies could have an essential role to play in this, Anna added: “With remote technologies, you’re able to monitor patients and how well the patient is using the particular device, all remotely.” Timely data like this will support the healthcare sector to be able to make key decisions around sustainability. Through the data, healthcare professionals can efficiently track whether someone is deteriorating, or if they need to visit their GP. Widespread implementation of technology like this will help to reduce the risks of medicines to patients and healthcare professionals.

HEALTH PROFESSIONALS NEED TO BE EDUCATED ON SUSTAINABILITY AT SCHOOL LEVEL Healthcare professionals are educating themselves on solutions and options for sustainability. Anna explained that educating industry professionals comes down to making sustainable resources available and bringing them into the curriculum: “Education on sustainability is something that needs to be implemented right through medical schools and nursing schools. Some schools are starting to implement sustainable principles of sustainable education.” Healthcare professionals of the future must know and understand the importance of sustainability right from the start, rather than playing catch up.

SUSTAINABLE HEALTHCARE IS JUST GOOD HEALTH CARE Health Innovation West Midlands is one of 15 Heath Innovation Networks across England, and was established by NHS England to connect health and social care, academic organisations, local authorities, third sector, industry, and citizens to spread innovation at pace and scale.

Anna explained that it has been helping to educate professionals about sustainability: “We have been doing work around both anaesthetic and inhalers, and have pulled tools together to create toolkits to help summarise the resources available and provide them with the kind of projects that people can undertake in certain areas.” In addition to this, it has been working with local partners to help them provide education to the staff on the grounds, Anna said: “We have some comprehensive workshops on upskilling. Alongside that, we are working with innovators to help them, we have an innovative support package which supports them to work through some of the NHS guidelines and recommendations.” Anna explained that to make medicine more sustainable, the main focus should be on the sector realising its responsibility and potential: “It is important to highlight that sustainable medicine care and sustainable patient care is just good patient care.” The environmental impact of the healthcare sector is a critical concern, and to combat this the healthcare sector must address multiple issues, ranging from medication disposal and usage efficiency to exploring sustainable materials and technologies.

SUSTAINABILITY

FACILITATING NET ZERO ACHIEVEMENT IN THE NHS 24

ISSUE 2

NET Z ACHIEVEME IN THE

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BY HANNAH WINTLE

The NHS seek to be the world’s first net zero national health service Reducing emissions from NHS buildings is achievable through better facilities management The efficient operation of NHS buildings supports better patient outcomes

Two goals define the NHS’s decarbonisation strategy. The first is to reach net zero on emissions they directly control, known as the NHS Carbon Footprint which includes facilities, fleet vehicles, and electricity, by 2040. The second goal is to reach net zero on emissions they can influence, the NHS Carbon Footprint Plus which includes catering, manufacturing, and staff commuting, by 2045.

NET NET NET

ZERO ZERO ZERO

With an ambitious goal to be the world’s first net zero national health service, making the necessary changes to be able to deliver a sustainable NHS is increasingly becoming a priority.

Both goals necessitate fundamental changes in the way the NHS is operated, and companies like Avrenim, specialists in healthcare and renewable energy who offer consultancy and design, project delivery, and facilities management (FM) services, are taking an active role in the decarbonisation of the sector. CEO Simon Harris explained the challenges facing the NHS: “You’ve got a very ambitious agenda within the NHS to reach net zero by 2040, and approximately 40% of the net zero target is derived from buildings and building infrastructure, energy, etc., so it’s quite a challenge. “You’ve got an old estate that’s trying to do very new things that sometimes aren’t compatible, and the biggest challenge that we’ve found supporting NHS estate customers is that they actually don’t understand what their baseline performance is today in full. “There is a big data gap as well, so there’s a lot of analysis that needs to be done to enable a clearer understanding of baseline performance today, what different measures could achieve for you, costs associated with making that happen, and the net result.” 25

FACILITIES MANAGEMENT

FACILITIES MANAGEMENT HAS A ROLE TO PLAY IN PROGRESSING TOWARDS NET ZERO With buildings responsible for such a huge proportion of the NHS’s total carbon emissions, it becomes clear how essential their efficient and purposeful operation is, and how important FM is to achieving their decarbonisation. “If we take FM as an overall umbrella, we are there at the sharp end delivering the capability of that building,” Simon explained.

FACILITATING NET ZERO ACHIEVEMENT IN THE NHS

“So whatever the building is, whatever it’s been designed for, it’s FM’s responsibility and remit to make that building run as efficiently as it possibly can.

“Obviously, at times you are hamstrung by what you’re inheriting, and then you can then put forward innovative ideas, saying we either change the way the building operates, we change behaviours in the building, we do some external passive stuff or we do some internal technologically based stuff. Then we can get the building to perform even more efficiently.” Simon also pointed to the advancement in AI technologies, which can recognise patterns in a building’s use and make changes accordingly through predictive algorithms. For example, when an AI recognises that a certain room is scheduled to be more populated on a given day of the week, the energy expenditure can be altered accordingly to save energy for when it is needed most.

IMPROVING EFFICIENCY IMPACTS PATIENT OUTCOMES, TOO A challenge commonly faced by FM companies like Avrenim is persuading decision-makers to invest in the necessary changes needed to make their facilities run more efficiently, when the priority for spending is often on patient outcomes. While the NHS understandably seeks to care for its patients at its primary goal and function, Simon explained how allocating more money to FM for net zero purposes can also support patients, and that more understanding on the impact that the built environment can have on supporting patient outcomes is required. He said: “NHS estate teams have been decimated over the years, they have been the focus of cost cutting and so on because obviously patient outcomes are the priority of any NHS trust. That’s where the money goes.

P A T I E N T O U T C O M E S

“There’s an educational piece here in a bigger context that says, if you get your building set up and the infrastructure that goes with it designed appropriately, that supports patient outcome, it’s not a hindrance and a draw, it supports and facilitates those things, because nobody wants to be closing areas of a hospital to repurpose it for something else.” Managing estates to be in line with wider NHS decarbonisation goals is going to be fundamental for targets to be met on time. Ultimately, opting to invest in the expertise offered by FM companies like Avrenim may enable a smoother transition to a net zero healthcare service, while still delivering from a patient outcome point of view. 27

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