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We're going to run straight now into the uh expert panel. Um So I'd like to um invite um Professor uh uh Shelton and um associate Professor Chantelle uh to kindly join us on the stage. Now, if you're able to turn your cameras on, um I'll just give you a moment to do that. Um So I can see uh Chantelle. Um I might not be able to, can I see a cliff? You want to say hello if you're there? Yeah, I'm here. Hello? Yeah, brilliant. Um I just couldn't see you for some reason, but that's absolutely fine. Um So thank you very much. Um Everyone for, for joining us. Um I would just like to start if I may in asking. Obviously, we've just heard from funny and I'd like to ask um Chantelle and Cliff if you kind of able to introduce yourselves. Hi there. It's lovely to see everybody. My a to, I'm an associate professor of Sustainable Health Care. I am on from Brighton and Sussex Medical School and it's lovely to be here. I attended, I think this is probably the fifth or sixth. Um I'm uh currently based at the center for sustainable Medicine uh at the National University of Singapore. I'm a medical doctor by background. Um My journey into sustainability was actually looking at lean management systems and essentially finding that when we have these re resource efficient systems that we have not only finance savings and better patient outcomes, but also then uh noticed these environmental benefits. So I went on to undertake a phd where I was looking at ways to reduce the environmental impact of the operating theater. Um And uh did, did work at various levels at national international level, try to actually um uh engage the clinical community um focusing mainly on, on the surgical groups with things like the green surgery report. Um And we set up a one group with the um uh with the Royal College of Surgeons of England. Um So it's a pleasure to be with you here today and look forward to the conversation that we have to come. Great. And uh I'm Cliff, I'm an anesthetist. And when I'm not doing that, I work at Lancaster Medical School. I'm a clinical academic. Um And uh it's really nice to join you. I think the reason I've been invited to be part of this is that one of my jobs at Lancaster University is that I'm the strategic lead for sustainability um in the NIH R. So the National Institute for Health and Care Research Research support service hub, which is hosted by Lancaster University and partners and and what that is is it's a um we're based in and around Lancaster, but we're a national service. And if you're in the process of developing or delivering research, which is funded by um national peer reviewed um open funding, uh you can come along and get some help from us, for example, in developing your um grant application or putting together a really good team to do your research. So I've been very busy recently because we've got some uh a couple of um national funding calls which are explicitly directed at making healthcare greener or adapting healthcare delivery to a changing climate. Um And so really uh excellent opportunity to come here and talk to everybody at this conference. Thank you so much. Um So the way that this panel is going to run is I will ask questions, some of them will be directed at all members of the panel and some might be specific to specific panel members. As I said, anyone is welcome to put some suggested questions in the chat and we'll certainly select from them. Um But I also hope to generate some stimulating conversation amongst the panelists. Um I'm quite happy if I end up sitting here for quite a while not saying anything and, and you're discussing amongst yourselves, that would be really fantastic. Um So I think I'll kick off with a, a first question. Um We're obviously in this period of time where we are trying to make change as quickly as we can. Um And the theme of this conference is around strengthening the evidence base towards net zero. So, um I wonder if the panelists could speak to you. Um And from their experience, what they found the ways to make the research towards sustainable healthcare at the most impactful if anybody would like to start off on that. I'm, I'm happy to take off if you, oh, we, we waited for exactly the same amount of time Chantelle and then started speaking you, I'll um I'll, I'll wait. Sure. So I II think it's always about beginning with the end in mind and actually designing research in a way that it will actually directly um er be structured in terms of the research questions that you're asking in a way that will help to drive change in clinical practice and policy. Um And I think that when I came to this field, there was a fair amount. Uh So this is kind of back in 2017, 2018. Um A lot of the research was about the quantification of greenhouse gasses um with, with that as essentially the end um go and I think that really um it's been about using carbon footprinting and life cycle assessment as a tool to provide us those insights that can help us to understand um where our greatest source of greatest sources of emissions are. And actually um to understand how we can um uh use that analysis to inform our mitigation strategies. Um And I think that we always need to be thinking about end to end systems and really trying to understand the systems that we're trying to influence. And one of the big challenges that we have um is the, the great number of actors that you have to consider when we're thinking about sustainability. And when we, when we think about the um the things that we use to provide healthcare and their environmental impact, um Often we're looking at very complex, undistributed um global supply chains. Um And so we need to understand the end to end systems um in terms of the, the, the products and the services that we use. Uh But we, we also need to understand um who the decision makers are. Um And so spending time um as as an academic uh engaging with policy makers and um with really understanding who are the, the key decision makers uh that can then be helpful to actually um shape the, the sorts of research that we develop. Um And certainly, um when I look to uh to publishing any of my work, I have to make a decision in terms of who is the key audience that I'm um seeking to influence here. Um And that will influence uh the, the framing and the language that we use. Um Because at, at its heart of it, reading a life cycle assessment is, is fairly dull. Um But for for many people. And so it's about how do we make this engaging um and relevant so that people can actually a a apply those findings uh to their day to day practice and I might just pick up on a couple of those points and, and ex expand them a little bit. Um So, so one thing that I think is really important is thinking about if it's gonna be research to support a health system, getting to net zero, you have to be mindful of what the purpose of that health system is in the first place. So, you know, uh one really simple way of making the NHS net zero is just to stop doing health care. Uh shut the whole thing down and go home and then it wouldn't have any activity. So it wouldn't have a carbon footprint, but that's clearly not adequate. So what you need to do is think about balancing up the primary purpose of a health healthcare system, which is to look after patients with the constraints that it works within. So for example, you know, we're resource constrained in terms of money and in terms of staffing. So a solution that makes something unfeasible, expensive probably isn't helpful. Um But then, you know, also looking at the um environmental um advances that you can make and ideally finding ways that you can get co benefit. So if you can manage to make care better and cheaper and greener all at the same time, that's got a really good value proposition. If you can make it greener, but it either becomes worse or more expensive, then you might have a bit of a debate on your hands. And so I think thinking about it in terms of integrating your end product into a healthcare system that works with certain responsibilities and certain boundaries is really important. And, and the other thing I'd just kind of add on in terms of, you know, how do you make sure that something is valuable? And this is I'm gonna, you know, um hon self citation klaxon at this point um is to think about research prioritization and what have other organizations or representatives said is important to do. So, one of the things I'll pop in the chat in a bit we did a couple of years ago was a James Lind Alliance research priority setting partnership uh focused in the perioperative setting. I'm afraid you've got two of us between me and um Chantelle working in that space on the panel just now. Um But looking at things that patients and professional organizations have said, yeah, we think this is a good thing to research. This is an unanswered question um is likely to have better impacts than something that maybe doesn't have that validation of the, of the starting point of the questions. Yeah. And, and, and I think, I think just finding the sort of real challenge that, that, you know, researchers are trying to address is, is really key. Um And I think just picking up on, on Chantal's Point, um you know, the engagement with Polyak, I think is, is really critical. Um because we've got to think about the end point. Um But we've got to also bring the sort of people that deliver on the data.