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look, Romania, you sent a whole bunch of really nice questions right up at the top to try and prompt me to say something sensible. I'll read them out so people know that I'm not just making some nonsense up. How do you become the first chief sustainability? Something for the NHS. When did you realize there's something you want to do and do? Uh, what are some of the challenges you might have faced as you got there? What are the challenges? Your face, day after day. Um, reflections. Good, bad leadership. Um, what sort of competencies? Uh, do we think people might need try and answer some of those, um, in a way that only in a reverent reverend Australian can, um, I'm a doctor. I started in Australia. Uh, I went into medicine because I wanted to help, um, a bit of a cheesy thing to say, but I'm sure most people here probably felt something somewhere similar at some point in their lives. Probably still do. Um, so probably understand that impulse got their day three. Someone told me about the social determinants of health, and I was like, What? How come no one told me about that earlier. What the hell? I thought the healthcare. I thought medicine was responsible for the entirety of the health outcomes that, uh, our population were experiencing or not benefiting from what the hell. Day four. It got worse. They told me about the sustainable development goals. I was like, What? There are other countries outside of Perth, Western Australia. What the hell? Um, I love medicine. I love the interaction of sciences and art. I love the patient's I love the passionate, smart, intelligent, driven people yet to work with. Um, but I started to leave clinical medicine because I was interested in some of those bigger challenges in applying some of that nonsense to some of those bigger challenges. So I slowly started to leave. I didn't do it immediately, Slowly started to leave, I started different multiple toes and fingers and, you know, knees and limbs into water around public health around global health. Did it as a medical student did. As a junior doctor, um went and did a bit of training in a masters of something and something and something. Um, and over time, uh, came across climate change, and if I was surprised and annoyed that the world hadn't told me about the social determinants of health or the sustainable development goals or the Millennium Development Goals. Imagine how furious I was when I found out about climate change. Okay, raising global average surface temperature rises over the over the 15 years I've worked on climate change and health raising global average surface temperatures from what they were before at 0.51 degrees above the preindustrial average where they are this morning, 1.12 degrees. A huge astronomical shift. The public health implications of that documented counted year after year in the world famous Richard Horton tells me, world famous Lancet medical journal Um so I slowly started to leave, right As I started to get more and more interesting than blow in those broader considerations, um, worked in evidence generation worked with the Lancet in the, uh, something called The Lancet countdown. We were a collaboration of 40 something, uh, academic institutions, U N agencies scattered across the world. We were attempting, uh, in the words of Richard to replicate what I h m e does with the G D study. Um, but for climate change, it was good fun. Um, I worked in diplomacy a little bit as much as you can call. What the W h o. Does a bit of that, Um, on the link between health climate change in the U. N. F. Triple see the U. N. Framework Convention on Climate Change. Um, looking principally at adaptation resilience in lower middle income countries. Um, working on adaptation, finance mobilisation, and I worked in advocacy. Um, with a couple of those alliances, you mentioned it. Very, very. Start UK Health Alliance on Climate Change. Bunch of Royal medical and nursing colleges. Um, global Alliance on Health and climate change, Global climate and health Alliance. Something like that. Um, and then I got tricked. Um, I got tricked number one by our chief executive or our former chief executive, Simon's, uh, into saying okay, okay. You've done a really great job very well done of evidence generation, doing a great job with a bit of nonsense negotiation with the wh on a bit of advocacy. Time to take this seriously. Time to move into the realm of actual dick are been ization, right? Because if this really is a health crisis, climate change, it really is a health emergency. Then let's start acting like that. So I worked with the NHS for about a year developing this net zero strategy. Um uh, and I think we announced our intentions through this 20 January 2020 25th of January 2020. Uh, W h O declared a public health emergency of international concern, which was inconvenient. Um, I turned around to the board and I said, Listen, should we postponed some of this climate change nonsense because covid is going to be a big deal. And they shouted back at me, Absolutely not. If anyone has the ability to tackle both health crisis, both covid and climate change, it is the NHS and is the health profession Absolutely not. And I promise you one of the few things that were maintained at full pace the whole way through 2020 2021 well into 2022 with the work we're doing on climate change, In fact, it is accelerated over that period of time and really good fun. Really impressive to get to know how impressive the NHS can be on some of this. Um, that's what I got here, right? I'm here now today because I really love the idea of doing tangible stuff because I get scared off by the fact that if you talk about climate change for too long and you hang around into space for too long, it's really easy to be very intangible and very fluffy and talk about a world that we might want to live in sometime in 2050 something or 2040 something. Um, what I like about the work that we get to do in in the NHS at the moment is that we talk about nine. AM tomorrow morning. And unless you're talking about that and unless you're linking that, unless you're building those blocks up to 2040 for the emissions, we control directly 2045 for our full emissions profile uh, zero targets, then it doesn't matter. So that was that was that remaining you had some other questions. Challenges I might have overcome reflections of good, bad leadership. I can talk about that. That of interest. Nod. Shake your head. Yeah, Okay. Challenges. Look, I didn't overcome these, but one of the biggest challenges I think we face on a day by day basis is there is no roadmap. No one has designed, uh, Net zero healthcare system. No one has transformed medicine globally so that it aligns within, You know, the operational boundaries that that we find ourselves with on the planet. Um, and so we're making some of this up as we go. Um, it's pretty terrifying to be frank. Um, uh, We test things a lot. We get a lot of things wrong. Um, we do a lot of, uh, evidence synthesis, a lot of stakeholder engagement, a lot of consultation, and then we broadly go for it. Um, we stick by things, we evaluate them, we get them wrong fairly regularly, and then we pivot. Um, it's a pretty unique part of the NHS that is allowed and given the space and political freedom to do that. But there is almost no other way that you can do something like this without a without a map. That's the first barrier. I think the second is, um, second is probably that if you think that you are working on this and it's all good fun. And there isn't a considerable forces pushing against you for whatever reason, financial interest, political interest, maybe they just don't like you very much. Maybe they don't like Australians. That's fair enough. Um, you're dreaming. There are considerable forces marshaled against the NHS as attempts to D carbon. Is there a considerable forces marshaled against the United Kingdom against the world's attempts to tackle climate change? Um, they are underhanded. They are politically shrewd and capable. Um, they don't care if they lie and paint numbers of hundreds of millions of pounds over to the NHS per week If we vote for policy X or Y on the side of a bus, Um, that sort of stuff is really difficult to fight if you are tethered to reality and tethered to evidence. Um, and that's a big challenge, right? Um uh, fighting some of that because, quite frankly, the NHS to do big, impressive things, But we're not always the best at defending ourselves. Um, and sometimes we need some of the other organizations out there, uh, to rush to our aid. And I'm not quite sure the ecosystem is where it needs to be just now. Which means you're pretty politically exposed. Um, and occasionally I think I feel pretty politically exposed. Um, it's okay, I if I was to make another challenge. I think the other challenge is probably, um this stuff is hard because the world's on fire and we've sat on our hands for 30 years. Um, I talked about that global average surface temperature rise over the last couple of years that I've been working on this. That's because the amount of energy released into the atmosphere is roughly the equivalent of 4 to 4.5 atomic bombs worth of energy released into the atmosphere. Additional energy contained in the atmosphere every single second of every single minute hour day week is because the energy here is enormous, so you can never sprint hard enough. You could work from six AM until 10 PM, seven days a week. You could work from four AM till midnight, eight days a week. And if I quickly jump on teams, I will see 123456789 over 30 people in our team currently still working because they desperately care about this stuff, and I promise you they'll still be working when we finish. Um, it's hard to know when to stop and getting that balance right of Hey, this is a sprint, but it's also a bit of a marathon. Um, can be can be challenging countering that rather than talk about examples of at the leadership. How about I talk about some good examples of leadership that I think I've seen or some of the principles that I've maybe been attracted to out of this number one people matter. Um, and that's how you deal with the hard stuff, right? Uh, I'm sure a bunch of people on this call will will know who poor Farmer was and will have heard that he passed away recently. Um, he used to say when people said, How do you get through some of this stuff stuff he would say, Listen, Major, it's all about doing hard things with friends. Um And I think if I were to talk about the 30 people there that are up still work and they are my closest friends, um, and the people working on this across the broader eat system are some of the closest friends that I have out there. Um and that's one of the most important things that I have seen is the people that are most effective are the people that really value people that will do whatever they can to go out of their way to go and meet a person in person and understand their perspective. Take them out for a coffee, take them out for a drink. Um uh, and properly get through to the bottom of that because that's you know how you get through those difficult, difficult fights. Uh, I think I've seen people be bold. People take risks. People be okay with the fact they don't have all the answers. But we're gonna have to go with it anyway, because they're sprinting. Um, and that usually means that you come with some sort of risk. Um, you know, at its most extreme, someone turns around and says, Nick, what the hell are you doing? And they fire you? Um, that's probably not going to happen, right, But they are still taking risks. And when you see people taking those risks, it's really impressive. Um, you want to follow those people? I I think I've been impressed by leaders that are relentlessly, unwaveringly positive, unwaveringly certain of the direction of travel, that we are all heading and not put off by the fact that it's going to be tough to get there, but are convinced that we will get there because they're surrounded by some of the best people that they get to work with. Um uh, those are the kinds of people I usually want to gravitate towards and and work with. Um and I think I have been most impressed. Remain. And then I'm gonna stop if that's okay, unless you want to prompt you with something else. I have been most impressed by leaders who know that direction of travel. Know what that endpoint looks like? Know what the first five steps look like are okay with the fact that they don't know what steps six through 7000 are but are able to deploy almost every tool you can imagine in their arsenal to get there, whether it is hard angry financial levers and regulatory relievers, whether it is taking someone out for a drink and have an achy cash and understanding that perspective whether it is, uh, slip in a few comments to the H S J, which you might read about it at some point. Um, this evening, that sort of stuff, I think is always, um, is always pretty impressive When you see people go well outside of the bounds of the you know what you might consider normal structural. Did you do a project Management gan chart nonsense stuff? That's that's important, too. Uh, but thinking outside the box, I think more so. Remainder. Did I answer your questions? You did, Thank you very much. Can I ask one final one additional? You mentioned that it's really difficult, and it's and it's important to kind of stay positive and hopeful in this space. And I just wondered, what keeps you going and what keeps you able to do that? Um, good question. My answer is boring. It's the people that I get to work with. You should meet them. Um, we get shelved out a lot by people saying, You're not doing enough here. You're not doing enough there. You're not doing enough on X. Why? We agree. That's the problem. Everyone in the team agrees desperately, but they haven't yet found a way to create 1/9 day in the week. Because they are so angrily passionate, it is find exhilarating, energizing to be able to work with them. You know, some of the more furious nurses and GPS angrily by sort of Shia will changing their clinical practice and the practice of their colleagues. Um, we have some of the best analysts in the world who say, Listen, we don't know how to count Carbon, but we're going to figure it out. We're going to build it out. An entire infrastructure across the now National Health Service fit largest organization in the entire world, largest purchaser of faxes and pages in the world. And yet we are going to find a way. I assure you, of tracking carbon month by month across the entire system because of how impressive and committed these analysts are. Uh, probably not the best example, but my, um, our chief of staff um, Vienna. You will know a goddamn. He is such a lovely guy. Um, I was talking to him about what the last two or three years with the team has been, Um, and he was reflecting on a few of the people in the team and how much fun it was. And I said, Why is it so much fun? And he said, Because this team break rules, he said, I can't believe the number of barriers we have broken as a team. There's a normal way of doing things that slow is bureaucratic and he sees our team veer off to the left, smashed through seven fences via back on to the right and get there in 1/10 of the time and that stuff is just good fun. I think honestly, that is the stuff that keeps me going. It is the people you get to work with and it is feeling like even though you haven't yet solved climate change for the entire world, you have done at least one small thing day after day after day. Brilliant, thank you. And we've got another question in the chat and then I'll introduce our wider panel as well. And so when NHS staff, already really overworked, have low morale, how do you make them interested in climate change and make them think about making changes? I don't have to. It's a good question, but I don't have to. Every year we go out and ask any chest up. Hey, what do you care about every year? They shout back angrily. I care about climate change. I want to work for an organization that lives and breathes my values that is, tackling the environmental crisis. Um, nine out of 10 91% of your colleagues feel that way. 91% of them want to personally do something in their personal and professional lives to tackle climate change. As it turns out, most people are already with us. As it turns out, almost everything you want to do to respond to climate change is good. It is good either because it is about 7 billion lbs. We are going to invest in our estate to Dick are benign, is it? And how much is that if we already mobilized so far? About 600 million. So hold us to account. We've got 10 years, 600 million lbs already invested into Dick Arborize in the NHS state. Why is that good? It's good because that money pays itself back in three years. Almost nothing in the NHS has an r O I of three years. Almost nothing. Um, it is good because often low carbon medicine is just good common sense medicine. It avoids polypharmacy. It tackles overprescribing. It provides care closer to home. It makes use of all of the tools that your disposal, digital social prescribing all sorts of different things to make sure you're providing care for your patient in a way that maximizes their health. Um, so we don't actually see that dichotomy. Very, very rarely do I see the dichotomy or the tension of I could either be a good clinician or I could practice low carbon health care. If you do say the attention, be a good clinician, very simple, and then go and find the other 72 ways that you can find those energies. Brilliant, thank you. And just one more question I think you might be able to answer, and I will open to the panel. It's just in terms of a lot of people. There's a question about lots of people in organizations seem to do a lot of sustainability work in their in their spare time. And whether you think there's scope to have more kind of paid roles in organizations at all. Oh yeah, absolutely. We've got to We've got to value this work. Um, let's tell a little bit of a story year and a half ago, two years ago, um, at least within A and I there were five paid jobs on health and climate change. When I started working on this, uh, you could fit globally the total number of people employed on health and climate change around one table. And we met somewhere in Bali at cop 13. Um, that is not the case anymore. There are now 100 and 50 jobs within a an eye out there for people wanting to work on this. There are being a clinical fellowship programs for people that want to take a year out and say, Hey, I'm going to dip my toe in the water and learn what it means to be a leader in this space. Um, there are so many more more jobs out there for people to have a crack at this other enough. Absolutely not do anymore. Do we need to better value this? Absolutely. Will we? Yeah. This is a transition, right? And we're on the upward curve of something, uh, something exponential, incremental or exponential. Um, so, yes, I do think there's gonna be a lot of there is also still going to be a lot of clinicians doing this in their spare time. Uh, what you're probably going to find is that uh, it gets built into quality improvement. It gets built into just what does it mean to be a good clinician? Um, and so it's built into the day to day brilliant. Thank you. I'm gonna introduce others in our panel and direct some questions that everybody might be able to answer as well. So we've got I'm going to introduce Dr Veena Algal, who's a GP trainee. And she, as Nick mentioned, is one of the first cohort of the chief sustainability opposite clinical fellow. So she might be able to have some experiences to share from that. You know, if you want to just give away, that would be great. Um, And then we've also got Doctor Donnie Groom, who's an anesthetic registrar, and he co founded the Green or Anesthesia and Sustainability Project. And they actually won the Environmental Sustainability and Climate Action team of the Year at the BMJ Awards. So be really interesting to hear some of his or his thoughts about that, and we've also got Ms Cleo Kennington, who's a consultant in emergency general surgery and major trauma at Saint George's Hospital. And she's the lead the sustainability at the Association of Surgeons in Great Britain, Ireland and represents them at the UK Health Alliance for Climate Change. So I I wanted to do is just There's a question in the chat that kind of explores how we can empower, and it just starts to just start to engage in the sustainability agenda. And I wanted to just put that out to any any of the panel members who feel that something they feel they can answer at all any notes from anyone. Yeah, I'm happy to come in on this. Thanks so much for Mina. Thanks, Nick. I just want to build on what Nick was saying about how good clinical care is low carbon care because this is actually something. I'm working at the moment, and I wanted to give the example about the respiratory work that I'm doing so in respiratory. We know that we have some of the poorest asthma outcomes in Europe in this country, and we know that we have overuse of salbutamol inhalers we have under use of steroid inhalers which are preventer inhalers. They reduce the inflammation and address the underlying disease, and that we also use metered dose inhalers a lot more than the rest of our counterparts in Europe who have, um, sort of lower rates of hospitalizations and deaths in asthma. So actually, a lot of these things need to be addressed, and they are part of our sustainability strategy. They are the core of our sustainability strategy. So, actually, if we know that if we can empower clinicians to make the right decisions for clinical care, they're also the greener decisions. So actually making sure that people know that what they can be doing is simultaneously solving two problems that is improving our outcomes and also reducing our carbon emissions, which then therefore also improves human health. Thanks so much for dinner, Johnny, Did you want to come in? Yeah, I just wanted to say I think I think it's important that we we don't stop at clinicians. I think we need to use a huge pool of enthusiasm and in fact, knowledge that this medical students as well they really lack empowerment when it comes to actually getting on with Q. I work within hospitals, but they really they have they. They are such a valuable at that when it comes to getting them involved because they have different time frames to us, they have become. A lot of them come with a much fresher knowledge set. When it comes to this sort of area and more and more now, as it's being embedded within the G. M C syllabus, we're going to start seeing people come through really clued up and wanted to get to work. So I think we need to really work to empower them, too. That's great, Johnny. And clear, I wondered in the kind of surgical sphere is it? How do you overcome some of that that kind of environment? Is it something that you're finding colleagues are receptive to or the challenges around that? Um, yes. So I I have had some challenges, but I think the way that I've dealt with it is is talking about it. The important thing is to talk about, um, uh, issues and and make make sure people know that you're concerned about it. So what? What I did was arranged teaching sessions, so I would go to I went to the theater teams, um, and the anesthetics teaching sessions and also the hospital, ground rounds, and, uh, and each of them I did sort of vaguely similar talks, and it meant that everyone in the hospital I knew that it was something that I was really passionate about. And people keep coming to me, asking what they can do, what, what what changes. And it's just really important that people know about it and also then and that the talks that you do, It's all simple things that people can change. And like you said, is, um is that it's better medicine? But if people think that it's not just improving the medicine that they're doing, but they're also doing a bit a good thing for the environment, then then they'll start thinking about these things. So just making sure that the that we're all talking about these things Thanks, Cleo, and just come into another question in the chat. I might go to Johnny for this one, just in terms of how you co founded and organization. Really, that's obviously done a lot of good work. How do you keep your focus to get things done? Because there's obviously lots of distractions and we're all very busy people. Yeah, we came about by mistake. Let's just put it Frankly, it was it was a necessity. We got recalled really involved in an early waste related projects and then as trainees. We rotate quite frequently, really wanted to keep this project going. And so I thought, we need to create a group realized quite quickly that that group needed to be very multidisciplinary and span quite a lot of areas. So we grew into our group what we are today. And now there's 80 of us worldwide working in four domains and within within our little organization. How do we keep focused? I think the one of the great difficulties that a lot of us have is something that's been touched already. And that's time and trying to persuade a group of 80 monitors throughout the world to give their time towards our mission statement. And towards the end, you know, shared Net zero ambition, um, is a challenge is difficult. What's even more difficult is trying to put those volunteers towards maintaining and keeping an organization sustainable. So that's where it starts to become quite difficult from a leadership and management perspective. Um, so actually one of our biggest challenges recently. But one thing that is not lacking within our organization and throughout the MHS as Nick is touched. Touched upon is ambition and enthusiasm, and people are incredibly generous with their time. They're incredibly focused and just want to help an awful lot and many people obviously wanting to do things for their C V and now looking towards the sustainability to I related projects in order to to do those things. It's becoming the interesting thing to have on your back page. Thanks so much, Johnny. And there's a question in the chat about medical students as well. And if any other clinical staff, medical students, doctors want to do some quick projects on climate change, where can they find examples or help and how to do that? I don't know who to go to with that. If anyone feels they can answer that one, come on. He's coming on this, Uh um, on the future NHS page with those of case studies and also on the Center for Sustainable Healthcare. I think they've got a page with lots of case studies as well, and they're really good examples of what people can do. Um, really inspiring. And then, um, I would say through the networks as well I'm talking to people and finding out what they've done either in their local area or even in other parts of the country. Um, for example, I'm in, um, green and practice, and I'm sort of co chairing the South London group. Um, and actually, it's a really good network because people can say, Oh, I'm thinking of doing a project on, you know, active travel. And I don't know how to start as anybody done this. And then everybody can share ideas with each other. Um, but it depends on the person and what kind of route they like, where they're like looking at case studies or finding out sort of local, local things. But there are lots of opportunities to to network and and here from other people of what they've done. Thanks so much. Gina. I had a question myself. Actually, it's not actually, Daddy, can I go to you? Cause I think you're going to add something to that. No, I was just gonna say where and where possible. A physical introduction. Go and meet that person in the flesh. Take them to someone within that trust that is leading the way in this domain. And that will just get things going straight away. Um, it's difficult. Especially when people are students. Potentially don't feel like empowered. Um, it's difficult for them to make those initial inroads, but we can really facilitate that. And I I had a discussion yesterday, and I was actually really surprised to hear that. Like a lot of medical schools, planetary health isn't even really considered particularly important as a curriculum item. I was actually shocked. I had no idea that it wasn't kind of high on the radar. And I wonder from any of you. Really, What do we do? How do we What can we do to make sure it's on the radar of all the future clinicians, where this is their future as well? And they need to be taught in understanding how they can shape this. Um, uh, I might go to Nick on that. Do you have any thoughts? I do, but I'm looking at clear who was a muted Sorry. Go for it. Clear. I can't remember his name, but I So, uh, we've got some great medical students at, uh affiliated university who are coming together and forming a society and echo society. Um, and they're having regular talks, so I've gone and talked to them about, um, some of the things that I think are important. But also what they've done is, um, there's an international of medical schools that are they? They've they they're forming. It's like an audit process where they're each medical school is ranked on their, uh, sustainable kind of, uh, policies of what they do, but also of the teaching. And then they're compared to all the other medical students is an international thing comes from America, but so there are lots of American countries that have it, but it's coming around the world as well. I try to remember what it's called. Sorry. I know exactly the thing you're talking about, but I don't know what it's cool. Um uh, I thought it came from Canada's, But how about we say Americans, if it was Canada's that will annoy the Canadians? Um, yeah. Look, uh, you know, you're right. Remain are probably not a focus of, you know, a whole bunch of med schools, But, like, who's surprised? Man? When I was in med school, we're still focusing about how you know kids didn't learn enough anatomy get lost. Um, of course I'm I'm sure that I've learned enough anatomy, and I certainly didn't. But But that doesn't surprise me. What I would say is, I'd shout about, um, I would go and say, For God sake, why aren't we doing this? Why isn't there a course on this way? Isn't there a lecture on this way? Isn't there a entire module on this? Why isn't this woven into the very fabric of every single thing I ever get taught ever? Full stop. Um, And if you don't get a response, I would shout louder. If you don't get a response, I'd shout even louder. Um, and if you don't get a response after that, I go and create your own course. Um, I've seen some pretty great, uh, short courses created by medical students on these sorts of topics. Um uh, and you're exactly right. Clear right? People should gain a bit encouraged from the fact that there are medical schools out there. Um, nursing schools out there that do this stuff Well, um, and if there are people that do it, well, then why the hell isn't my medical school really? Well, um uh, there was a great, uh, story. I heard the other day about an anesthetist who had been offered two jobs. One somewhere in the middle of the country. And I'll, uh, keep them. Keep them anonymous and one over to towards the west in Bristol. Um, uh, one in the middle of the country. The job in the middle of the country Paid a little more. Um, but they ended up taking the job over in the West, and the chief executive called them up and said, What the hell? We thought you were really interested. He said, Yeah, yeah, I am. But I wanted to work for a trust that really lived and breathed my values. God, have you seen what Bristol has been doing on low carbon anesthesia? I love that. That is going to become the kind of thing you will see in medical school as well. Um, the schools that don't get their act together, we'll just fall behind. Thank you both for answering that one. I can see a handout to a D. Do you want to come in? Thank you. Um, thank you for for this session. It's really it's really interesting. And I'm just thinking from a policy setting and strategy perspective within public health, there's often a kind of a mixed approach as to whether or not you engage with commercial industry. So within tobacco, you don't engage with the tobacco industry within, uh, food. You know, one of the strategies has been around working with food industry to encourage self regulation and reformulation of food. What's the approach within sustainability? Um, regarding engagement with industry? Are there certain industries that you don't go near because they're so underhanded or what? What is the approach? Does anyone feel they can answer that one? I mean, I can, but someone else might have a more interesting answer. Dana, clear. You guys are both on muted. Uh, the only industry I know is, uh, surgical devices. And I've I've definitely found that that that there is the one biggest one is is quite underhand and come up with a lot of excuses. But finding this the industries that are doing good things and really supporting them and and and talking about them to your colleagues, that's what what I've been doing is the the companies that produce more more of the reusable kit and really making sure that that gets out there. I'm not sure how much that answers your question. Yeah, I think, Um, embedding yourself within them as much as possible, trying to find out exactly what they're doing. Go to the belly of the beast. If you see some greenwashing question it, go and ask them why. What what? What's there? What's their end goal? What's their story? It's easy to turn around and say No, no, that's nonsense. But try and look one step further. If someone comes to you with the recycling solution, ask yourself why they're doing that. Most of the time, you'll find they're making a single use product, and that's their only lifeline left within an industry that's trying to move back to re usable. But as I'm sure Nick will tell you, the NHS has created some pretty in credible targets when it comes to procurement, which are having significant downstream effects. Um, I do some extra work on the side, working for a supplier for the NHS, um, within the within the sort of they healthcare charity, and they've set up very quickly, and that's why they've asked me to come and give them some help with what they're doing because they know that if they do not change very quickly, the stick is going to get quite big for them from a financial perspective and people all throughout that sort of area really starting to get quite concerned now. So I think a lot of the stuff that Nick, Nick, Nick and Esteem have been doing is really starting to have some impact. Now, I might I might, uh the start of your question, you know, began with tobacco. Should we be working in tobacco companies know, you know? Of course not. We ask that question in the nineties or, you know, 300 years before then or something. And the answer is still no back then should we? Working with food companies. Interesting. More complex. Um uh, problem with carbon is it's everywhere, right? You can't say I won't work with any company that has carbon attached to that product because that is literally everything effect. You probably need to stop working with yourself and your colleagues. Um, so you have to engage with with companies on this on this topic, there are some you should be pretty damn skeptical about. Those are people who have stranded assets either intellectual property or physical assets that mean that they have a commercial incentive in things actively going slower and, you know, shell BP. I'm low looking at you, but I'm also looking at pharmaceutical companies. And you're exactly right, mate. You know, companies who have a bit of i P. That means that they want to hold on to that to the very last minute, no matter what. If they have to push you towards recycling rather than you know something else, uh, they'll do that because it is in their commercial interest. Fair enough. They're black. That's that's the rule we set up. And people are just playing by that game. Um, I think I would say the approach has to be engagement, an attempt to unleash the innovative capacity of the private sector on a lot of these issues. And angry, unwavering skepticism. Um uh and so that is sort of the approach we have attempted to take right? We've set an end point within the decade. The NHS will no longer purchase from anyone that does not meet or exceed our commitments. What do we mean by that? Go read the thing. We've set dates. One minute past midnight. April 1st, 22 23. 20 for one minute past midnight. April 1st 2027. If you are a company that doesn't have a board approved plan demonstrating that you are not only moving in the same direction as we are, but you're moving the year after year, we're not doing business with you anymore. Qualifying criteria for all tenders. Um, outside of that and you can see what we're doing There is We're setting the direction, the pace and the scope and scale of change outside of that all power to you and go forth and unlock. You know, uh, the solutions in the future. Um, And yet I need to constantly remind myself that just when I think I found a friend in a pharmaceutical company or a med tech company who just wants to help, um uh, that's probably not the case, and they probably want to help insofar as it suits them. No offense, Jackson and I think we've got another question from someone on the talk about. I think this is true for a lot of leadership works on us. But how do we reduce fragmented, repeated uncoordinated work, local and regional level. I think there's often a lot of reinventing the wheel and repeating things with rather than collaborating and uniting. And I wondered if anyone has any reflections on how to answer that one. Uh, go on clear. I don't think it's necessarily bad. Repeating work is that if you see something that works well in one hospital, repeat it. That's brilliant and see if it works in your hospital. And if it does publish it, share the information, go to a conference, say what you've done, where your challenges were, how you overcome them, and then hopefully somebody else will copy that as well. So I think that there isn't harm with that. But but then, But I'm sure others have more, more kind of centered ideas of, of working, completely agree. Cleo. I think sharing of ideas is the best way to to make sure that people can learn from each other and then speed up that process by learning what didn't didn't work. I also wanted to mention that there's regional greener NHS teams being set up as well, but some of them are very set up, and some of them are more at the beginning, of that process. But I think that will really help as well, because that kind of gives a coordination role so they can help to link people up with each other. And they can help kind of disseminate ideas through a coordinated way, and that will help get things out from national to slightly more local level as well. And something a combination of, like, local networks, people on the ground showing ideas with each other and that sort of slightly more top down kind of coordination. Both need to be there in order to, uh, to make sure that that the work is coordinated. Can I say yes to that? But let's have a bit of chaos. This is gonna be chaotic. We're not talking about an organized, centralized approach to, you know, one piece at a time, changing every single part of medicine. We are going to compete. We're gonna fight. We're going to fight with the Scottish. I hope when they get their act together and really start to take this stuff seriously, they're probably gonna blow us out of the water. It's gonna be great. And a bit of that chaos and competition is going to have to be quite important. So I'm Yes. You wanna align people? Yes. You want to try to share a bit of best practice? Yes. You want to do a bit of good cross pollination. But I'm also OK with a bit of duplication. Also Okay, with a better, you know, people relearning the same thing because often the benefit gained from learning how to implement some new quality improvement program probably isn't actually the carbon reduction itself. It's probably the journey of learning that person went through. Certainly, that's my experience. The times I got things wrong again and again and again and again. And then finally I got it right. The important part was that process that I had to go through, and it had to take me a year and a half to go through that. That's great. Thank you. And, Gina, can I just ask you to, as I mentioned you, the kind of first cohort of the chief sustainability officer fellows and I know the recruitment rounds for that. I just closed. But I just wondered if you would share some of your reflections on what that experience has been like for others on the call in case it's something they want to do in the future. Yeah, absolutely more than happy to. So I just finished my GPS t one year when I came into here. Um, and I've not done a sort of formal, full time kind of policy role before. So made me clinical jobs. Um, it's been really exciting. It's been amazing to see how I can make that switch from just doing a little project here and there on my own or, um, in my practice, too, actually changing national policy. And it's been amazing to see how these things happen on national level, working with some brilliant people from both clinical and non clinical backgrounds, and I get the really exciting opportunity to work in two teams. So I get to work in the green or NHS team and also in the primary care team. So I get to see, um, sort of multiple different angles and different bits of policy being being developed and then kind of trying to link those together, um, to get the knowledge that I'm gaining from both teams and the and the contacts and the skills. Um, and it's really exciting. So the main project I'm working at the moment is about inhalers I mentioned already, which I've become really passionate about having not really done that much in respiratory before. Um, because this is such an exciting opportunity. Um, I think to both improve health and also reduce carbon at the same time. And I think actually, it's something that we can really get momentum on. And so I'm doing a big stakeholder project at the moment on. Clinician comes in education to support the policy incentive scheme, which was developed before I joined. Um, so I get the really good opportunity to work with lots of different people, from royal colleges, to commercial educational providers to really senior leaders and get to meet lots of really people. Um, and as Nick said earlier, it's all about building relationships. And I'm learning so much about how to how to kind of meat and develop relationships with different different stakeholders both in the team and externally. So, yeah, it's been a great opportunity, and I'm happy to answer any more specific questions people have about fellowships. Love. Thanks so much, Leena. Um, and just for Johnny as well. I was wondering in terms of obviously. And you said you're the organization that you've kind of co founded. It will come about by accident. You've obviously done some really substantial good work in the in the climate change space. Um, and I just wondered, Obviously, things have progressed. You've got bigger as an organization. Is there anything you've learned over that time? Things you might have done differently if that will come back again now if it was also going back to the beginning again now, anything you would do differently. Oh, yes, many things. But that was all part of the journey. Really, I think when I mean, there's there's organizational things I would have done very differently. I think I would have. I mean, we've basically grown in a way that people have joined an increasing number as time has gone on. Um, I think earlier on, I would have made more of a management framework and structure within early on and brought people along on the management and leadership journey, as opposed to getting people within their own, doing their own sort of projects and supporting and nurturing that because it's created a bit of a monster in that regard. So we're having to have a big rethink this year, Um, and create that structure on the back foot. Really? So that I think I would have started that much earlier on brought people along on that side of things much earlier on it would have made, um, would have probably given me a lot less to do at this point in time. And, um, I probably would've had more of a life for the last five years to 19. Thanks, Johnny. And for clear as well. I just wanted to ask you, in your kind of your leadership journey in this area as well. Is there any kind of big take homes for you? About what you think colleagues can learn from in terms of how you've got to where you are now in terms of representing kind of surgical specialties in this area. Um so So for me, it was that I was one of the first people to put my hand up and say that this is an important area and something needs to be done, and so I kind of went into it with no knowledge and but just because no one else was doing it, I they people were turning to me for answers. So I think I I found it difficult because I've I've as I've learned more, I've suddenly realized that maybe what I was saying before and people were listening to me wasn't the right thing. Um, but I don't think I could change that in any way. Sort of, Even if I had my time again is that I've had to just keep doing this. The important thing is to be the person who stands up and and to just to try and make change. And and as soon as you know something, then then you know, the more you learn that, the more you can keep, uh, kind of spreading the word and making the changes. So I don't think I could could or would change anything, But but But that has been The difficulties I faced is not having enough knowledge myself and through my journey, Um, that's great. Thank you just to build on that. It just wondered if there's any particular things that anyone, anything anyone thinks that's helpful for people to build their knowledge a bit better in this area at all. I know there's a couple of things that have been mentioned in the in the chat. But anything in particular that people feel is helpful for colleagues to read up on or listen to that would help them feel more educated in this. So I think there's there's, there's 20 you want to look at. There's knowledge based learning which you can do. There's many in credible resources. My Royal College or College of Anesthetists has a great free learning platform you can learn about. The basics are websites got odds and sods on it, centers. Stomal Healthcare has got some really good stuff about how to go out and do some projects. But I think if you really want to learn about implementation, to talk to as many people as you can hear their stories here about their journey, because that's how you're really going to understand. I mean, for me. Over the last five years, it's been a journey about how to negotiate with Senior Leadership team to get buy in from stakeholders that I would never even consider talking to, like healthcare estates one whatever have to deal with them before, so just going in, actually talking to people and showing an interest. What you'll find is people will bring you along on their educative journey, and you'll probably learn a lot more than just opening a textbook. Can I tell a story about a friend of mine who said, Nick, I'm desperately concerned about this climate nonsense. And I said, you should be, um, as a supportive friend would, Um, What can I do? And I said, go talk to someone. Um, they're a physio in there. Trust. They went and spoke to someone. Um they spoke to the line manager. My line manager. They go talk to someone else. Um, so they stood up at, uh, you know, a weekly meeting of all of the Allied health professionals for the orthopedic service there, Um, and said, Hey, I'm concerned about this, and it turned out six or seven of them were. So they all met up and they devised two or three things that they could do together, and they shifted some of their allocation services. Um, uh, digital that a better job with some of their outreach, And they have a new recycling scheme for their mobility aids in the hospital. Um, and then six months later, once they've done that. Uh, they started talking to the nurses, and it turned out they were concerned as well. Um, and so the group changed from just therapist to therapists and nurses. And then, in fact, they went and, God forbid, spoke to the doctor's, um who said get lost. No, the doctor said, God, it turns out we've been really concerned as well. Anyway, this person now has left physiotherapy. They now work full time as a clinical sustainability lead in there. Trust, um, leading an enormous program of work in a really, really impressive, exciting way. Um, I promise you, they don't have a masters of sustainable healthcare. Um, I promise you, they read a few books, but really, they learned most of this stuff because they want to ask the person and they tried it out, and then they kept trying it out. That's I genuinely believe that that's almost the only way to learn this stuff because say it again. We're making this stuff up as we go. There's not a huge amount of places you can go to actually go and read about this. I completely agree with Nick that you don't have to have learned everything. Um, I certainly didn't. You know, I don't know everything about climate change of climate science at all, but, um, when I started learning about this, um, I was probably really quite new to it a couple of years ago. And the first, the first thing I think I did was watch the R S M series on climate change, which is now on YouTube. I really recommend that there's about maybe 10 episodes and they're really in interesting. And they have so many aspects to it. I hadn't thought of. I think I knew about air pollution and lung disease, but I didn't know about, you know, rates of miscarriage and climate change, for example being linked. And there were so many aspects to it, they were new to me. So I found I found that really insightful, actually. So I really recommend watching that if if you haven't already, and I found the Center for Simple Healthcare course is really good. So it's probably the first time I've ever enjoyed the learning, because normally I just click through and I'm really bored, but they have half a day of the learning and half a day of in one in person, zoom person in person, uh, teaching. And, um, I found that Elon really interesting because it was a bit of theory and a lot of case studies about the kind of really amazing things people are doing both in the UK and around the world. So I really recommend them going on those courses. Often you can get them from a study, leave or study budget. Um uh, for example, um, so they were the two things I would say really kind of got me inspired to start doing more on this in a clinical setting. Yeah, thanks, Gina. And I think we've answered a lot of the questions in the chat. Really? And if anyone else has anyone's to add, um if not, then what I was going to do is just go around each of the panel and just ask top tips that you would recommend to colleagues as a kind of like final remark of what what they could do to stay start in this space or things that you would suggest that people interested could do or learn from, or read, or whatever it is that you think would be a top tip even to to maintain resilience, whatever it is, um, I will go to I'm gonna see I'll go to Johnny first, if that's okay. Jesus, it is. I mean, collaboration is key, and you need to get outside of the silo. That is your own department that you're working in if you're really going to start making waves from in your hospital, Um, it's none of these. Things are easy to do on your own, but you'll find there are many, many allies within your working environments. You've just got to find them and you'll end up meeting some awesome people along the way. Thanks, Tony. Cleo, do you have any thoughts on that? Um, I mean, I think I've mentioned them all already, but it's not just speaking out looking to see where there's a, uh what? There's something that you don't feel is right. That, and and and just doing something about it and and but, like Johnny says, is finding your allies is that maybe within your department, certainly within my general so department, there's a lot of people who aren't interested but actually more senior to them there. There's plenty of people who are interested and so I found other people who will support me. Um, and I think that's the way to do. It is fine to the people who will support you, um and and and and and and work with them great. Thank you. Vina completely agree about finding other people to do things with. And I would say, When you do find a team, it's really important to spend a bit of time thinking and planning as to what what it is you want to do because you can't do everything straight away, but actually thinking about your interests and also the interest of your team. So if you've got someone in your film GP practice, you really like cycling. They might be more interested in doing a project on active travel. And then if you've got someone else who's interested in, say, um, packaging and recycling, they might want to do that. And then someone else might be interested inhalers. So thinking about kind of what makes you unique or members of your team unique in terms of their skills and also the interests, and then you can kind of work together and bounce ideas off each other as to what's going to be best place to start with, but definitely agree that having a team and definitely don't do it alone. It's so good just to bounce ideas of other people and do it together. Thanks, Fiona. I think that's probably true for a lot of things as well. And I'll end with Nick, if that's okay. Any kind of top tips from yourself. Final remarks that you would say to interested colleagues that want to get more involved. Christ, nothing insightful. Um, Vienna. I think you said something really special there. I'm going to come back to in a second. Um, three things. Find a friend, talk to them, grab him, take him to the pub, taken by him a coffee, Talk to him as regularly as you can, and use them as yeah, you know, support mechanism the whole way through this because this stuff is hard. It's a bit lonely. Uh, number two. And here's a serious mechanism people can hook into it. It's the second of March 14th of January. Every single trust and the entire goddamn country should have had a net zero strategy. A green plan of its own, I can tell you that 78% of them had that at that moment, we're up to 90 something at the moment. Um, it's going to kick over to 100% sometime, very, very soon. Come the 31st of March. Every single integrated care system in the goddamn country needs to have a net zero strategy as well. So if we belong to a trust and ambulance, trust the mental health trust and your credit care system, Go send an email for the chief executive. It'll just be something like See I CEO at whatever. Do we have a green plan? Send it every day until they respond to you. God damn it. If they say yes, move to the next step, they say no shout. Why the bloody hell not okay. If they say yes, then take Vienna up on her advice. Go take a look at it and think. What is it that makes me unique? What is it that makes me and my profession? What piece of carbon do I hold? That uniquely no one else can hold? What change can I make uniquely that no one else can make? And you don't have to solve all of climate change all that once. Please don't try to do that. It's quite difficult. You just have to hold one thing that no one else can do. And you have to do it well and you have to do it day after day nine AM after nine AM Christ, even eight AM after eight AM or six AM after 6 a.m. If you're clear when you're a surgeon, um, uh, maybe take a break on Sundays If you're feeling a bit tired, uh, do it incredibly well and talk about it. Find that friend again and talk about the successes and the things that you have done, uh, incredibly well, but you can go find that damn marine plan Shout if you don't have one, shout loud and angrily. Don't take over. I've been busy as an excuse. Trust were told 24 months ago that they needed to have this in place. They have the resource. They've had the guidance. Send them my way. If they tell you to get lost, we'll have a fight with them together, um, and then figure out how you can help implement it, because I promise you invented This is like one of the biggest learnings. I think I've had learnings. It's not a word. Learnings is not a word. One of the biggest lessons I have learned from the N. H s over the last couple of months is the only thing that changes. Something is when a passionate clinician who owns something that no one else can picks it up and runs with it. That's why the anesthetists are doing so in incredibly well because they uniquely can act on desperate. That's why GPS are so impressive with the work they're doing in the primary care of state you the work they're doing with inhalers because they uniquely can act on that right. If you find your version of that promise, you will quickly become world leading. People will quickly start turning to you saying, Hey, how did you achieve such incredible success? How can I learn from you? That's great, thank you. Some really helpful and inspirational work there. Thank you so much, Nic Um, and from everyone else in the panel and Johnny, Bina and Cleo, it's been really lovely hearing all of your reflections as well. I think there's been lots of questions in the chat and lots of resources shared really lucky to have some other chief sustainability officer clinic as well as on the call as well to to answer some of those questions as well. Um, I think we've had really rich and helpful discussion's and hopefully inspired colleagues to take their first or next steps. Um, in leadership in the climate change space. Um, And I think I'll draw this evening to to a close now and thank you all for coming and being enthusiastic about sustainability and climate change and the massive thank you to all the speakers and Panelists as well. Um, we hope to run more events, and there's been a couple of events listed in into the chat as well. Um, and we'll hopefully run a follow up climate change one in due course. So thank you all very much. Thank you. Thanks so much. That was great. Thank you.