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And we are live. Good morning, everybody. It's an absolute pleasure to see so many of you here on this Thursday morning. Um My name is Fran. Oh, I'm going to get rid of that. Sorry. Something is just popped up on my page. Um My name is Fran and we've got Mister s Open, who's with us today. Um We're delighted, see you at the Botha and Oruk Sustainability in orthopedics Conference. Um I'd like to hand over to Mr ASAP A to be able to welcome us to the conference today. Yeah, good morning, everyone. Welcome to the Boat and Oruk Sustainability in orthopedic surgery conference. 2023. I'm VIP in a soap, a consultant orthopaedic surgeon based at Southwest London Elective orthopedic Center. And I'm accompanied by my colleague, Serum Afzal as part of the team for today. So the NHS as you know, has set its sights on being the world's first net zero National Health Service and aims to achieve this by 2022 story 2045. It's planned to do this by a number of different methods. So it wants to target, for example, medicines, equipments and supply chains. Wants to reduce the carbon footprint and actually reduce personal travel. A lot, a lot of these things can contribute to um unsustainable practice. And the processes that are involved are either through direct interventions within estates and facilities, for example, and or enabling people to work more efficiently and better. Now, sustainability can be considered as having three facets. There's a social facet, there's an asset and environmental facet tea achieving sustainable practice involves considering all of these factors in the projects that people two are undertaking, but not only facets, we need to think about quality improvement and the challenges to change that is required to achieve sustainable practices, conizations and people need to be willing to change. But there are challenges is to achieve that change include ia's emotion, the Sociology, people's cultures and behaviors and beliefs and human actions. People need to be having their psychological needs met before they consider their safety needs. They need to feel that they're part of a group or being loved. There's a feeling of belonging and then they need to have their self esteem needs met before they actually reached the point where they would actually care about undertaking sustainable practice or change. This is called Maslow's hierarchy of needs. And it's an important consideration when developing projects. This means that for example, it's difficult to engage teams to change practice when there are a lot of other issues when people are unhappy to work with each other, for example, so as part of quality improvement methodology at Southwest London Elective orthopedic center with ear a muscle. And the team, we made sustainability the eighth pillar of clinical governance. And that meant that we had monthly reporting at our clinical governance meeting and this gave it importance. Sustainability meetings were held every two weeks and we found that was useful to try and improve sustainable practice. And we ensured that we had people from different teams present, for example, therapies, nursing, radiography, and outpatients. And we created a series of projects that were clearly defined, had a smart aim and baseline evaluation was possible. We then created an Axion and carried out evaluation to assess barriers of change. At the same time, we used a tool that I want to introduce to you called the combi model of behavior change. And this helps people to consider how to bring about quality improvement. So it assesses the capability opportunity and motivation of the staff. And that allows you then to consider physical, physical, psychological, social and automatic slash reflective practice that improves behavior. We use this process to work on environmental sustainability projects, social sustainability projects and economic projects. So we've switched to reusable tourniquets through this process. We've um tried to switch to reusable gowns in theaters. We've recycled walking aids, we've saved water, we've changed our anaesthetic use. We've tried to cut readmission rates. We have developed a sustainable culture and we've cut costs. So we've targeted the various pillars but each of those has various facets. So um for example, procurement involves environmental factors, so making sure that we can still get things cheaper, bit of reasonable quality. Um And that is still easy for people to use. This table seems crowd id but the green highlights that although all sustainable projects have challenges, most of them can lead to success or part success, any changes, a positive change and that needs to be considered when organizing sustainable projects. So most sustainable projects, we can conclude our successful making them part of the culture is important and understanding behavior changes important. Whilst that is the current theme at the moment, we need to think about the future of sustainability. So we think about trying to achieve net zero. That's our goal, but that shouldn't be the only goal we need to think about it in a broader perspective. This figure illustrates the thought process is that we have think about the world as having a degenerative side and a regenerative side. Think about our practice is our country are people. We want to, we have been aiming for net zero. But actually we should be changing the goalposts and moving to regenerative thought process. We want to have integrated development. We want to increase the vitality of our practice. We want resilience and we want productive capacity in the NHS in ourselves, in our families, in the things we do. We don't want to have a reductionist approach. We don't want to be burning lots of oil. For example, we don't want to be damaging the environment. We're decreasing resilience, productive capacity and having a net negative effect. Instead, we need to think about the people, the processes, technology and research to push us forward so that we're at the cutting edge. So today, I'd like to introduce our agenda on the themes of people, technology and processes. We've got Professor mcnally talking about ways of improving preoperative planning. We've got ethical considerations, we've got environmental considerations and we've got being carbon neutral as concepts today. Now, Oruk, I'm very grateful are sponsoring this and they doctor A Rash Anga Gee is going to talk about NJR sustainability fellow posts. There's also the Dragon's Den, which is going to be providing seed funding for a sustainability project and we've got the abstract competition. So just remember that you are the future of orthopedic surgery. And I'd like to thank Mr Oliver Adebayo Francesca, Salary, Professor Eastward Ruth Thread Gold and Doctor Anga Gee for their support in this project. Thank you. Thank you very much. I'd like to invite ear um to be able to have a couple of moments with us. I think she wanted to say a few words, didn't she? Mr A sopa? Yup. Perfect ear. Um If you want to come and say a few words, I think it was a really fantastic introduction to the day and really sets out our stall for what sustainability means within orthopedics and within the NHS. Hello, good morning. Um I just wanted to thank everyone for, for the invite, but I just wanted to just highlight some of the stuff that Mr Super had already said um in terms of our, our sustainability processes that we have, we have at Swell Yolk. Um and one of the, one of the things that we're doing, we introduced eight, ours to our, our sustainability. So I just have a quick slide just to just to share, share on that, if that's okay. Oh Can you see my sides? So, so like Mr Super said, sustainability was environmental, economical and social. But what can we do? So at Swell. Yeah, we've introduced eight hours and we think this will be a good thing for people to introduce within their centers. So it's to rethink reduce reuse repair, revamp research, refuse and recycle. And so the future of this would be to if you can embed sustainability in the in the governance structure of your trust, just like we had swelling, got to adhere to greener initiatives to become advocates of greener purchasing by switching to energy, more efficient recyclable reusable products um to guide and educate and empower healthcare staff about sustainability and to advocate for research and sustainability. So, everything that Mr A sopa has said would just be reiterated by becoming advocates of the cyst sustainability by educating guy riding and empowering healthcare staff, your colleagues, your coworkers um in order to become the future. So to work collaboratively to meet the NHS NHS goal, the NHS is the world's first national health system to commit to uh to Net Zero. So that's just a few words that I just wanted to say. So. Thank you. Last stop showering. That's fantastic. Thank you so much. It's great to hear from swell. You can to, to have your continued involvement because I know that last year you guys were heavily involved in our first ever sustainability conference. Um I think.