HTN was joined by James Driver, digital innovation manager at Buckinghamshire, Oxfordshire and Berkshire West (BOB) ICB, to talk about some of the work going on around “going green”, and the role of digital in supporting the sustainability agenda across health and care.
James shared with us a little about his role at BOB, including his main focus on primary care, and his involvement in horizon scanning, business analysis, business intelligence, and more. It also involves “cascading and communicating the development of primary care models, and particularly primary care networks,” he said, “as well as engaging with best practice and collaboration around that”.
In his role as digital lead for the ICB’s Net Zero board, James talked about some of the challenges that accompany delivering the net zero and sustainability agenda at system level. “In terms of the health system, they can relate to a number of things, such as medical waste management and hazardous materials, energy use around things like MRIs and scanners, old estates, infrastructure backlogs, transport and logistics, and more.”
With digital specifically, James highlighted “the management, regulation, and lifecycle of hardware, laptops, scanners, etc., that have come to the end of their life”. Recycling those efficiently, and ensuring sustainability in procurement “comes back to the compliance and governance element of this conversation,” he went on, “which is managing how we can embed procurement and manage end of lifecycle recycling in terms of regulatory compliance, new initiatives, policies, and best practice”.
Embracing Net Zero at BOB ICB
When it comes to the net zero agenda at BOB ICB, James shared that one of the main focuses is on virtual wards and out of hospital care. “We’re looking at how to deliver a virtual ward model within the net zero and sustainability agenda,” he said, “and that’s coming back to the principal that many patients are better cared for at home, and that home has better outcomes for their recovery after an initial hospital admission. If you can link the pathway model and nursing model with telemedicine and remote monitoring, that’s a win-win scenario in that you’re improving outcomes for patients whilst offering a more sustainable out of hospital model.”
For virtual wards and virtual consultations, the main benefits are around timesaving and the potential for “greater degrees of monitoring” supported by technology, James said, “but the issue with digital design is that you’re managing the digital twin, or the digital replica of the patient; seeing the patient through a digital prism, and not the face-to-face person in front of you. Whenever you’re doing digital design it’s always important that that patient can get that face-to-face time if that is needed.”
A challenge however, is funding “in terms of actually being able to buy the technology that supports that model and properly embedding that, so there is a gap there, and then it’s looking to ensure that that pathway design can be supported”.
Other initiatives at BOB come back to infrastructure and hospital estates, he mentioned, “and BOB has a number of trusts who have had support from NHS England and the public sector to swap out some of their boiler rooms, and some of our sites have changed over to heat pumps – those are the sorts of areas we’re hoping to get the biggest wins from”.
Strategies and approaches to achieving sustainability and short-term objectives
When it comes to strategies and approaches to achieving sustainability, “it’s important to group the workstreams”, James told us, “maintaining focus on the objectives and keeping clear-sighted on organisational strategy, as well as that organisational commitment to net zero policy and green infrastructure”.
James also mentioned digital skills training and ensuring that remote care infrastructure works well, including having secure systems in place to support remote working. It’s important to establish and embed a culture which “prioritises green”, he said. “I think most ICB boards have established the delivery of their strategy, at least around workstreams, travel and transport, recruitment, and digital; so there’s a means of cascading that through staff networks.”
One way of doing that is to have “green champions”, James noted, “who are people who might want to take a lead on that, and you can build a group or network of champions who can then distribute these messages through their wider team”.
Whilst it’s not necessarily about making this the focus of people’s roles, he continued, “it’s for them to be at least aware of the objectives we’re trying to deliver. They might see where that’s relevant in their day-to-day practice and help to deliver that.”
Looking at strategic changes and digital procurement, where those types of things have started to become embedded into the structure of the system and change ways of working, “it’s important to give staff an awareness of how those things do work and the changes that they might make to their practice”, James acknowledged.
The role of procurement and device management in sustainable care
Following on from a comment coming in from the live audience on findings from the Darzi report around an imbalance of staffing between in-hospital and out-of-hospital care, James told us how the balance between acute care and efficiency, and the wider move toward preventative care and staying well, “is always a moving piece”, but that getting back to the tech, a lot of the issues come back in some way to procurement.
“It’s about efficient procurement, efficient contracts – not getting locked into long contracts which aren’t beneficial to health organisations, and that comes back to squaring some of this stuff with policy and movements in sustainable care. If well designed out-of-hospital care can be matched with efficient contracts and effective management, and can be to the advantage of the NHS rather than those selling the products, then things can work better, but it can be difficult to achieve that in practice.”
Talking about an initiative at BOB involving the refurbishment and donation of laptops “that had served their purpose in a healthcare environment” to charitable organisations, James also said that it’s important to consider how devices are disposed of at the end of their lifecycle in a sustainable way.
The wider NHS Net Zero agenda
On the wider NHS Net Zero agenda, James observed that “it’s a mixed picture. There is funding from various sources, and mandated targets so that organisations are aware of what they’re working towards, and what needs to happen. But the funding is not across the board, you have to bid for it, and there’s a need for increased funding to enable that pace we’re supposed to be working at toward this.”
The technology aspect of net zero could be delivered a lot more quickly with increased funding, James considered, “and in other ways it moves as fast as the net zero environment does outside of healthcare. So it takes a while for awareness of new technologies and how they can be implemented into strategies to filter back into healthcare environments.”
In terms of calculators being used to calculate efficiencies and savings, “there have been some NHS approved or sponsored works; but very often this can be abstract. So if you’re changing your pathways, you’ve got fewer journeys. and how that translates into carbon reductions, but that becomes very statistical or abstract. We’ve used some of the numbers from that, and we looked at the carbon footprint of one day of emergency admission, the impact of earlier discharge, but it’s very difficult.”
The future for sustainability at BOB ICB
Bringing the discussion to a close, James talked about where he would like to see BOB ICB in five years’ time with regard to the green agenda and sustainability. “For five years I think it would be a more embedded digital model,” he said, “with a well-designed out-of-hospital pathway with sustainable procurement, good contract management to provide value for money, and with improved health outcomes.”
In hospitals there is a lot of opportunity with AI, he went on, “which is getting very good at reading images and diagnosing things like tumours from images, which enables a lot of productivity as well. That’s one of the clearest ways in which some care can be digitised.”
James also spoke of hopes that funding will be available to help modernise the hospital estate, using more sustainable sources of power and making upgrades to offer “better hospitals for patients, and better working environments for our staff”.
Many thanks to James for taking the time to join us.
