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Can you hear me? Amazing. So welcome, Teo. Medic 2022. Prescription for climate action. This's actually incredible to see or hear. Teo, welcome into the Wall Geographical society. If you're very lucky to be able to have this conference in this amazing venue, we've got about 102 150 people here in person today on we have over 300 people registered online. So it's everyone online. A massive welcome. Head to the chat on. Introduce yourselves, tell us away from on the right hand side of your screen. So that's that's quite a lot of people Here is about sort of 3, 400 people in total on it gives me a lot of hope. What we're going through the climate crisis at the moment, it's quite daunting. It could be quite scary sometimes and quite anxiety inducing. But seeing everyone gathered here today, everyone online from around the world from more than 10 different countries really gives me a sense of hope that actually when we come together that things will start to happen and will move in the right direction. So huge thank you to all of you have come here today to sport what we're trying to do with the co medics, Master, thank you to the committee, to our sponsors on Thio and, of course, to all of our speaker's today and the rest of the medics team. So before we get started, we've got some housekeeping eso terms of food and drinks. So there's no food and drink allowed in the lecture. The it apart from water on in terms off coffees, teas, lunch that will be served in the map room where hopefully you were just now. So it's out these doors and round to the right up the stairs Toilets We've got ladies toilets on disabled toilet straight out the door Just ahead of you on the gents is on the left as you got this door on the a d If we need it which hopefully we won't is by the first a drum straight out the door on the right is well in terms of accessing everything you need to know for the day. There is a hub which you conscon the q r k to find their cure codes scattered around the venue on. It's also linked on our bio and instagram. So also, if you want to take photos today? Take any for two Cheryl station media that be amazing intact at Ikea. Underscore medics and we will We will re share that on Deacon. Use the hashtag of your medics 2022. So, without further do you want to introduce place onlookers who will introduce off there? We go right by everyone. Yeah, it's wonderful to see some reading off. You just echoing what? Nathan? That said It's just fantastic that so many of you have got involved on a Sunday, no less. I respond that that's probably the worst day told a conference. And yet here you will last it. Thank you so much for coming. So to make sure that we keep to time and make sure that you get your coffee breaks on time and lunch breaks on time, important things I'm going to introduce our first fantastic speaker. We have doctor nicked what's with us, and it's an honor to have him here. He is the chief sustainability officer off the NHS. So he is responsible for its commitment to deliver a world class net zero emission health service and he leads the green or any chest team he may know we'll follow on Twitter in particular across the country, which focuses on improving the health of patients on the public through a robust and accelerated response to climate change. And also the any chest is broader sustainability agenda. Prior to the NHS, Nick Work is the executive director of The Lancet. Count down on the Lancet Commission on health and climate change. So he has a really expert in the area and very, very passionate about sustainability and health. He also found in both the global and UK Climate and Health Alliance on climate change. So, as I've said, is wonderful to have him here. And thank you for being off for speaking neck so around the poster neck. You know, I pad Nick, Is the chief sustainable? Okay. Good morning. Good morning, everyone. It's a Sunday. Thank you. I need to say thank you. Thank you for coming here on a Sunday. I can't think of anywhere I would rather be when the invite came through. Actually had quite a few meetings on for the rest of the day. I'm gonna have to run it some point. But immediately I thought the one thing I would love to go and do on a Sunday morning is hang out in the road Geographical society with some people that think, feel scream occasionally like I do people that are really quite really quite a energized by tackling the health crisis of climate change. So here we are. Thank you for the bio. Thank you for inviting me very long. We can ignore all of it. The one thing it missed which all of you have now realized is that Nick is also an Australian. I'm gonna be as quick as I can possibly be. And every time I say something that you go on, Nick, there was a weasel word there. You put a little parenthesis around that commitment or Nick, I'm not quite sure. I agree that you're actually moving as fast as you should be on that issue. I want you to write it down, and I want us to have some time for some controversial questions. Okay? No questions allowed that begin with Nick. How is it that you are so fantastic and look so much like you? Jackman? No, no, that I get enough of that every day. Okay. Talk about three things. Why what and how. Okay, First two, I'm gonna skip through very quickly, because if you are here on a Sunday, you know why the NHS needs to respond to climate change. You know that as of this morning, global average surface temperature rise with 1.18 degrees above preindustrial levels. You know that when I started working on it, probably when you got started working on this, the temperature was down a 0.57 degrees above pre industrial average. It is rising and rising quickly. Why really simple. We're releasing energy into the atmosphere. Morgan. We should more than we used to. How much? Roughly the equivalent off. Six atomic bombs of additional and energy up into the atmosphere. Every single second of every single hour. Every single day of every single week, month, year, decade for a century. That's how you raise the temperature of an entire planet by 1.1818 degrees. So why is simple the energy? It exists to deliver high quality care for a while now and for future generations been on the foot up for almost a century. Doctors, clinicians, medics. We signed a north right, but we're talking over. We did some version of that. At least we do down in Australia. Primum non not your first. Do no harm Can't do your job as a doctor. You can't do your job is an NHS professional and left. We are tackling climate and you cannot. We cannot. The NHS cannot provide high quality care for all now and for future generations unless we tackle climate change. The doubling off the number of facilities in high risk flood zones expected by 2030 which is very soon would get in the way of that Tripling of the standard deviation of the duration or fatal he weighs in this country would get in the way of that high quality care phe Back when PAG was PAG finding an endemic eighties, Ms Skipped eighties Agip time A schedule down in southern England that would get in the way. That's the one right first reason. The second reason is just a simple gun use Russia's latest deadly. The second reason is just a simple Every quarter we go out, we ask your colleagues we ask NHS professionals a 1.4 million of us. Hey, what do you want to do? it. What do you really care about? What really gets you up in the morning? Every single quarter, nine out of 10 of them Shout back. I want to work for a NHS that is living up to my values. 91% of your colleagues agree, believe desperately, feel that we have to tackle the climate crisis. 91%. We don't agree on much. The fact that we agree on that is remarkable. Those are the two reasons that's the Y. Do your core job. You have to be able to tackle climate change. So if it is a climate crisis, it is a health crisis. You do with that pretty damn aggressively. In fact, you do with it as aggressively as quickly as you possibly can. We sat down with a big national consultation. We got some clever people in from other parts of the world and all that sort of nonsense and even an Australian. And we looked at how quickly we thought the NHS could get to net zero. For us, that means 2040 for the emissions we control directly. But we're good health care professionals. And so, unlike the Climate Change Act of this country unlike any other healthcare system. Unlike to be honest, almost any off the Net zero commitments you will hear about, we are also taking responsibility for our full global footprint. All 80,000 suppliers that the NHS purchase from the matter where they are in the world. Net zero by 2045 2040 fives a long way away. So when someone asks you when someone tells you Sorry about their Net zero commitments, ask a few very skeptical questions. Number one 2040 fives a long way away. How do I know that you're gonna be honest? The NHS has two answers to that. We have an 80% reduction target by 2028. So our trajectory goes like this and then we have the last 10 20% which is quite hard to mitigate. And we have a little bit of time to figure that the last part of that out, But we reduce our missions missions as quickly as we can. Number two. We report on our reductions annually. The second we stopped doing that, get angry, get upset because it probably made someone's trying to hide something. If anyone is committing to net zero by 2040 something and not telling you the annualized reduction that they have achieved. Perhaps a note on track. You must also asked, how big is the size of that net? Hey, I don't like the size of that. That makes me anxious. Let me be very clear. All the emissions we control directly. 6% for our total global footprint. It is 8% to put that into contact of our emissions today, 26.5 megatons roughly the size of the entire country off Denmark or Croatia. Current plan by 2045 is to reduce that from 26.5 all the way down to 1.6 megatons. Why the 1.6 world? Because there are parts off this agenda that science hasn't yet. So it's not actually an intention to offset. You won't catch us doing that ever until we get to 2044 sometime in December. What you will instead find us doing is investing in innovation, investing in our clinicians, trying to find ways to tackle that last bit that last mile problem and in the mean time, focusing angrily on in your reduction. Why want the far, far, far more interesting question is always how the far, far more interesting part of that question is. Not the how for What are you going to do for me in 2030? Not for What are you gonna do for me? In 2035 2040? Not even 2020 2025. That's too far away. Narrow people on answering these questions. If you're not able to want to the questions the itself in the time scales of 24 hours, what do I need to do tomorrow morning at 9 a.m. Or in the time scales of either six months back or six months forward? Then we're probably not moving fast enough. So gonna talk about some stuff that the NHS is done. But I am going to talk about things that the NHS is done only looking at a six months back or six months forward. Okay, Anything other than that to be frank doesn't really count. I don't really have time for casting that far back all that far forward. How How does the health care system transform medicine? How does the healthcare system change what it means to be a clinician what it means to deliver high quality care for a while now for future generations. Well, number one, you have to get your governance right. Well, they're boring stuff on pieces of paper, etcetera, etcetera. So when we started, there were 24 trust in the country that had their own strategies for how they were going to deal with this problem. 24. Give me when's comfort. Give me four weeks. We are dangerously close. 98 percent of trust in this country. 98% of integrated care systems currently now finally have their own at zero strategy, 98% 50 of them would blow you away would be damn proud. You would be excited. You see some ideas there and you go. Wow. I haven't even thought about that. About 150 of them are reckoned this room would go. Yeah, okay. Sure. Decent strategy. 50 of them. I reckon this room would look at it. Go. Okay. You've taken your first step. You've clearly started thinking about this just in the last couple of months. Let's take the next step together. They are good plans. What's more important is that they all have a lead dedicated to tackling that plan. And that lead sits on the board off that trust. There is an individual who is accountable to deliver delivering against that that you can and should. We all should go and yell at. But we should also be saying, Hey, how can I help? What else do you need within your trust? What else can I do to help out? So you get your governance right? Put it there. You put it in the planning guidance of the NHS boring sort of concepts of standard contract that the NHS signs with A with the providers out there in capital planning guides. We've done all of that. Every single document you could imagine. The terms and conditions of the standard contract. The NHS signs now net zero. Is that the heart of it? Once you've got that part right, you move on pretty damn quickly, right? You've got to get your estate in order getting at your hospitals clinics in order. So the NHS, in the last 12 months or so has invested half a billion pounds in two D, carbonized in the estate in about three weeks. We're going to announce another 240 million lbs. Every time we've done this, we have discovered our patients love it. We have discovered our clinician love it. And if gas prices and electricity price to shoot through the roof like they have that are oh, I that we already had that return on investment we already had off 3.5 years has shrunk down to two. This is one of the best investments, the NHS 10, and he's making. So you invest in that you set new angry standards called the Net zero Hospital standard. Any build in the country over 15 million lbs has to adhere to the standard. If someone doesn't want to have an angry Australian that they can go and talk to about that. Fixed assets is what we call them hospitals, clinics, then your mobile assets. We are the second largest fleet in the country, behind only those stupid red vans. Royal Mail eating, coming close up your to electrify it right. Some of this stuff is going to be relatively easy, and we have started to extend the duration of our contract started to preferentially higher for electric vehicles instead off old, outdated, polluting vehicles that more tick over. I have every confidence. What is a little trickier is our specialist vehicles. We have ambulances. We have rapid response vehicles. Those things are tough. Ellen Mask is not focusing on them. God forbid so for those vehicles, we've had to innovate. 12 months ago, we didn't have anywhere in the world and zero emission ambulance. Three months ago, the NHS had to fully electric currently carrying patients in Birmingham. At the moment it is quiet. It tackles air pollution. Patients actually love it. Paramedic love it. It's a great place to go to work. Then a second one on electric hydrogen hydron hydron. That hydrogen range extender gives you this much news going on gives you an extra 252 160 miles. You can carry patient anywhere in the country on this thing. So first they were to what we need next it another three. Bring us up to five. Then we've got some serious competition. Then we can force a bit of that competition, drive some of that price down between the five suppliers we're working with. And then the NHS will just start purchasing these and we will turn over our ambulance fleet. Tackle your states. You tackle your governance. Check your transport. Tackle your medicines. Run in this room. Heard of debts, Lauren? Of course. I was out in Manchester just a few days ago talking to the Royal College of in a City. If I was talking to them about some killer things they have done about five years ago, the world realized that this was quite a bad as desflurane was quite a bad, as people have been saying. One bottle of it. It's an anesthetic gas, volatile anesthetic gas, one bottle of it roughly the equivalent of burning 354 kg off coal. Modern medicine doesn't need it anymore. There are of our better volatile gas is. In fact, modern anesthesia is moving away from volatile gas is all together to TV to total intravenous therapy doesn't need it anymore. We set a target for the college of in a city. We said we want to hit a reduction. Such the desk for it is only 10% off the total of the total volume the NHS purchases. We want to hit that by the end of the financial year. the college responded. Nick, you know, being ambitious enough. They blew that target out of the water down to 6% and I was up there saying What our next target should be 5%. And again they responded. Nick, you know being ambitious enough. The NHS doesn't need this drug anymore. In fact, we want you to decommission it all together while you're at it. Get rid of pipe. Nitrous is well, we don't need that either. It's a complex question around maternity and emergency services, and we can tackle that. But the pipe side of this come on, medicines moved on, and they're exactly right. So we're gonna stop doing that as well. The emissions reductions that those that anesthetist have already achieved roughly the equivalent of taking the entire flight route of London to Edinburgh off the map. 890,000 seats flights going back and forth from London to Edinburgh, amount of emissions that they have managed to reduce in just three years is the equivalent of taking that off every single year. It is damage. Press it. So you tackle some of that you tackle. I don't know. What else have we been doing you tackle innovation. Been pretty clear. The NHS doesn't have a lot of the answers, right? And I want to continuously admit that because to be frank, when we look around the world and say, which are the health care systems are running at this quite as angrily. The answer is No. One. The answer is the NHS is genuinely world leading here. That's something we should be proud off. Something we should be cautiously optimistic off. Pretty damn cool. But we have to innovate. We have to invest heavily into that innovation into our clinicians into collectively learning what Net zero means for us. You know, clinical practice, right? So for our part with our friends at the NIH are on the MRC. We have invested 21 million lbs Internet zero healthcare research calls We invest another 6 million lbs into clinical pathway research calls for low carbon healthcare with welcome trust. Invested another 4 million lbs into research looking at heat adaptation across the healthcare system. This is serious amount of cash dying to flow out into the system. I almost refused to let someone tell me, Nick, I would do mawr, but there just isn't enough money anymore. That's no longer the environment. We are in huge amount of impressive innovation. What kind of stuff does it Does it look like out the other side? Well, it looks like that zero emission ambulance that did not exist before that came from one of those programs. It looks like some really cool drones down in the aisle of White. They're about to shift the way that we moved cancer medications across to the trust in the aisle of what? We're gonna shift them there, but using drones charged up electrically, we're not going to need the trucks. And we're not going to need the boats in the harbor craft to get the stuff there anymore. We're gonna be able to fly out there the first flight coming out in three weeks. Damn cool. It looks like new materials for the ppd. We use it look like new clever ways to think about wife. One of the things I really loved if anyone saying it is down in Royal Horrible. There one from Royal Coma. They've got this really cool thing. I'm not actually precisely sure I understand the full today energy balance of what's going on and I kind of want to look at it before we think seriously about rolling it out. But they take the paper a waste. I find a cool way to desegregate, uh, disinfect it. Then I melt the thing down, turn it into plastic, and they use that plastic for all sorts of things across the across the hospital. Really, really cool innovation. I'd want to make sure that it was actually reducing emissions as much as we want it to. But if it is, what a cool idea. That's the kind of stuff that you're going to start to say. I think pervading out upper confit where we're going to talk about those 100% about 100% of trust with there, it's zero strategies. You will also hear of talk about a new innovation fund out for clinicians out into the system. So some of what I've been talking about there is for small businesses for researchers, but we also need smaller parts of funding five K 2025 k 10-K. 4 Clinicians, you say, Hey, I just got a cool idea. I reckon I could do something slightly differently on my ward and I want to try it out. Calm. Promise It's going to work. I can't promise it's going to tackle all of climate change. But I can promise I'm going to engage with my colleagues that can promise that I'm gonna learn something and I can promise I'm going to take it further from that point on. And so we're gonna start to put some cash out into the system there as well half a million pounds to begin with. And then we're gonna start to grow that once it's demonstrates its own success, Do you do the estates do transport you to governance. You do your medicines, innovation, that leadership final thing. And then I'll shut up if you'll put me the final thing. I talked about the NHS's full carbon footprint. We purchase from 80,000 supplies. We are big 1.4 million healthcare professionals 121 130 billion lbs of spend every single year. We have been clear. Within the decade, the NHS will no longer purchase from anyone that does not meet or exceed our commitment on net zero. I say that is regularly as I can. It's not just me anymore. that says that as regularly as I can in Chief commercial officer Jackie Rockets chief executive Amanda Pretty good director procurement prayer Bailey within the decade sounds like a phrase that was designed to maybe obscura precise date. It actually was designed to do exactly that. So we followed it up with something far more precise. One minute past midnight April 1st 2027. New qualifying criteria for every single supply. Every single thing that we purchased 2020 sevens a long way away. So I got a couple of girly milestones. We're gonna start firing warning shots over the bow. In fact, we've already started as a to start of this financial year. There's a 10% waiting into every single tender for everything. That the NHS purchases for net zero 10% isn't gonna shift the entirety of our procurement spend. It's only 10%. What it is going to do is force a conversation between our suppliers and, uh, procurement office is going effectively act as a mechanism to increase the carbon literacy off both out supplies and all that staff start those conversations about what might it mean to slowly decarboxylase and then rapidly decarboxylase the emissions off product X y maybe say it's the first step. Then you start to introduce new qualifying criteria. So we do that. April 1st 2023. Those qualifying criteria. You can't even get into the door to have a conversation initially for 5 million lbs and higher contracts and then for every contract, but at a lower carbon scoping. So just go one and scope to just the United Kingdom. What you can see where doing here is we are ramping up. We're sending fair warning out to our suppliers so that everyone is ready for the cliff edge that faces thumb. We also then invest heavily in innovation, and we engage heavily with small and medium sized companies because, to be frank, the regulations, when it comes to AstraZeneca or GSK or Johnson and Johnson, they can meet that. I'm not worried about that. When it comes to our partners. We want to make sure that we are creating a thriving life sciences industry for British healthcare. How it's simple. Okay, yet the governance get your estates, you get the big capital, spend a half a billion pounds. I'm talking about your innovation in place. You get your mobile assets. Your fleet second largest fleet in the country. Electrifying. We think we may even have our contribution to air pollution in the next five years. Damn, that would be cool. Get your procurement. You send some of those long term signals. You invest heavily in clinical leadership. We started up a new clinical fellowship program for our brightest pharmacist physiotherapist nurses, doctors across the country. It works so well. We doubled the number of places available for this year. Coming. Do a lot of that stuff. And what I think you should be hearing from me is that your colleagues, our colleagues, my colleagues are on side. 91% off us want to tackle the climate crisis. We want to do it in our personal lives. 91% passion isn't a problem. Give me four weeks in 100% NHS trusts and in integrated care boards will have net zero strategies and they will have board level leads accountable for delivering against them. The governance is not a problem. This is on the face. Our duties are on the faith off the health and care bill going through parliament right now committing the NHS to tackling this like it never has before. That stuff in there. The finance. Half a billion pounds invested Internet zero healthcare. It's actually a little closer to 600 million. That's in place to what I'm trying to get at is the question is no longer will the NHS de carbonized. The question is no longer will we hit net zero healthcare no longer. This would be fun. This would be possible. This would be positive. This is now the inevitable direction of travel for health care in the United Kingdom and globally. The question is how quickly we're going to get there. And what can each of us do at 9 a.m. Tomorrow morning to help change the face of medicine? Thank you. Yeah. How long with that? But what's the times? 30 minutes is all along. I'm so sorry. Oh, thank you, everyone. We've got some questions coming in on the online chat with Force. Feel free to ask questions now as well. So the first one, I'm just gonna read them in order for people watching online. A zit was submitted, so we have a question from calf Brown says Danic estates in primary care is a complex issue with varying age of buildings and ship, it cetera. What is being done to Actis is in reducing carbon footprint off their states. The primary care estate is complex, as I suspect. Cath brown nose. Hence the question. Why is it complex? Well, it's easier to tackle and target 800 large hospitals across the country because I can count the 800 over them. It is harder to manage primary care because they're your unit of analysis is larger, right? It is harder to manage primary care because, quite frankly, the NHS owns a secondary carrier state. We don't own about primary care of state. That's a complex slit throughout the system. And look, if we want to talk about that split, we should have that conversation. But we can have that conversation another day. Um, the sorts of things that we have done to start to engage with that split and start to engage with primary care focus, I think, principally on the innovation side of this. So a new innovation call coming out in the next month or so to a month or so. Looking at primary care, low carbon innovation, it has looked like new contracts, new training programs with the Royal College of GPS. We have started a program with them investing in 100. I think they're looking for trainers and experts that could be sent out to individual practices to have a conversation about the kinds of grants available to that practice, about the kinds of things that practice might want to do to reduce its emissions. And then, thirdly, on incentives game for asthma nurses and for our primary care physicians, 26 million lbs out to shift away from a particularly high sweet of medicines. Some of the particularly high carbon inhalers. Well, no. The name of the broil We don't know Ventolin. Ventolin is very high, high carbon, um, salbutamol itself slightly less. And it's principally more about the delivery mechanism, the major dose inhaler that highest carbon 1 22 kg off top and damn unit of thing. You're delivering the average for every inhaler, 1.7 kg and the average for the low carbon variance 0.8. And so we are investing 26 million lbs in a new incentive scheme to swap away from that, but also to encourage to fund Mawr. After conversations about good, sensible management between patients and their nurses and doctors, I talked about innovation there. I talked about sending people out with our see GP, and I talked about incentivizing incentivizing switches in medicines. I did not answer the question. I did not talk about the primary care of state and what money we're putting into that. Quite frankly, I don't have anything to say that that is something that we have struggled to invest with in terms of the actual capital going out there because we don't own that estate or we don't own almost more Aleve, that estate. And so we can't actually transfer the funding there. It's a work in the system, but that's my honest answer. The next question next question online we have is from Sorry, I'm sorry. Can you hear me now that cover it, I'll just have to speak up. So our next question is from Skull and McNally. Dainik, why haven't you talked about cycling? 1.5 million and a chest are forced to drive because there is no safe cycling, parking and cycle lanes, 1.5 million and a chest. Uh, so literally everyone. So just finishing the question from Scarlett. There are huge Kobe. If it's for health, less particular pollution, pollution, etcetera, Please. Can you demand cycle parking slash lanes at all Any chest premises and subsidies covering electric cycles Now, Thank you from Professor Skull. It finally, orthopedic surgeon. It's college. It's been a while. We haven't seen each other for a while. We should, um, meet up. It's called here or is she on line? She don't like. All right, fine. Um, she's entirely right. So when we talk about a pollution we care deeply about if you're in the NHS effectively, three point sources road travel how we are producing power heat. So are boil boilers, gas boilers and were phasing those out right? And our waste. Those are the three point sources of emissions. I've talked principally about transport, and I've talked principally about electrifying out transport, fleeting about reducing journey numbers. What I haven't talked about it, what skull it's getting at, which is motile shift. You really need a car to take that journey, either as a patient, as a clinician, moving too informal between hospitals or someone delivering medication out into the community in the answer Morris than not, it's probably not. Actually, um, the solution to that sort of problem is complex. So as I know, it's garlic nose. And I'm sure many people here no, because the barriers to active travel the barriers to that motile shift very wildly, depending on which trust you are in very wildly, depending on which geography you are in. If you tried to sort of sort of things you might want to do down in Perth, western Australia, where I am from a completely different in every single way toe what you might do if your imperial college. So the strategy we've been taking to address that is a few phone number one. We started to identify capital investment that trust have been spending into net zero emissions, and then we've been trying to increase the PI, increase the size of that the size of that capital prioritization and direct them towards three or four low cost high carbon impact interventions and cycle infrastructure for staff is absolutely one of thumb number two. We started to be pretty damn serious. We don't want just five or six trust to have cycles. Work leads. We don't want just five or six Trust to have places toe store, their store, blacksmith, good showers and good facility to start. In fact, we want everyone to have it. And so we started doing exactly what's called it's asking for. We started saying Listen, take this damn seriously. Appoint someone within your trust to be responsible for figuring out what the local response to that is. The number as off today or least the number as of about three weeks ago when our last collection came in is 117. Trust. 117 out of 221 Trust have cycle toe work leads who have their own strategy for how they're going to deal with that. Now that's 50% or so. It's no good enough, but it is a damn sight better than where we were when we started 18 months ago. It's got to go a lot further. That's where we are today. One thing I would love to see a lot more off. I'm going to talk about Manchester a bit because it's front of mind when I was out there. MFK has this great cycle hub. Has anyone here from Manchester or Mm, they got. And if he has this great cycle hum out there, they've got HEB the space. Your bike got some really lovely showers. In fact, I might even just consider going there if I worked there. You know, other than my shower at home on Dave got, you know, someone that shows up and runs a bike repair station at the place three days a week. They got all sorts of really cool incentives for this. That kind of stuff is that kind of stuff. I think we should start to be seeing more of across the country. Do they really? Um, and this So our next online questions from Matthew Lee question any chest whales advertises itself is having a target for net zero by 2030. However, the finer detail states that it is net zero for the public sector and the actual real term reduction in emissions for the NHS is hoping for a reduction of 34% by 2030 much of which will happen naturally with the D carbon ization of the national grid. How much greenwashing is also happening with the guards toe any chest England on What can we use clinicians do to fight this misleading narrative. I love it. I That question takes me out, but not not gonna talk about whales. But that question keeps me up at night. The NHS was the first healthcare system in the world to make a commitment like this. It was the first healthcare system to take it seriously enough to publish it. Plan to publish it's annualized reduction strategy to do a lot of the things I've just talked about in the last 18 months to hire 150 professionals to take this on within the corporate center. Damn impressive. Nine months later, there were 15. Healthcare System's up in Glasgow a cop 26 the U N Climate Change conference 15 Healthcare system's not going to name them that said yes. Uh, stew, we're also going to commit to this when you go in, look it. What they've committed to you will see something that either has a well, it's 2040 but it's sort of complex. Don't work, or you will see someone that refuses to specify how much they are offsetting. Well, you will see some one that says we will have a strategy, but we'll get there. I don't have it yet. Go away. That keeps me up at night because if one of us is making a commitment like this and we are damned serious about it and there's a whole bunch of other people that say, Oh, yes, that's too But they're not quite that serious about it. You run into what I'm sure everyone familiar with in in this space common problem, right? You have a problem with the tragedy of the comments where that first movie, the person that damn serious, pays for the transition. So all of a sudden, this thing I learned about it and in one of my philosophy class is that sounded very interesting, actually, really scares me because all of the sudden, the NHS, when we are demanding some of these transitions to are 80,000 suppliers, are supplies go well. The others say that they're you know, they care about the environment as well, but they're not asking for anything, anywhere near a stringent as you are, and that is worrying because people will attempt to price hike. It also means that the innovation burden lives on only one actor, and that is enormously problematic. of medicine is enormously complex, not just in this country but everywhere in the world. The only way the NHS and I should be honest about this. The only way the NHS can get to net zero is if a lot of our colleagues in Germany in Francois, God forbid in New Zealand, also tackling the climate crisis with the same anger as we are. Because that's how the cost days of saying that's how you drive down that cost. And that's how you accelerate that innovation curve. So I'm really worried about that exact problem. What can we do? We can be angrily skeptical. Someone could go and look at the countries that committed to being Net zero in Glasgow. Someone could go and ask them. Do you have a plan to have a tame? What was your annualized emissions reduction? Cop 27 is coming up very soon. Can you publish that? Can you tell us how much have you actually achieved in 12 month period? And if they can't tell you that you can respond with listen, that commitment's know avoid because the price to entry now is no longer just Can you stand up on stage and say ex it is Can you deliver? So we've got time for just one more question Will take one from the audience here. So, does anyone have any burning questions? Perfect money in the blue shirt. Hey, nice to meet you. Um, so my name is prime under. I come from Chile. So my razor question is, how would you say it's the best way to tackle these kind of issues? Is for developing countries like my own that account for a large part of the world on we? Sometimes we don't have the same resources. Are you sure? Of course. Chili's and interesting. Interesting example, right? Rewriting its constitution at the moment. Rewriting. It's Constitution expressly framed as being written within the context of the climate crisis in my right, That is pretty damn cool to be frank. Um, and I'm not a constitutional lawyer, but I think it's cool. Um, Chile is I want to say, an upper middle income country, is that right? And it has a fair degree of inequality. Jeannie. Coefficient of below 0.5. What's the population? Okay, sorry. The reason for the context. Um, cause I run into this trouble. This problem a little bit. In fact, we, uh That's part of what the NHS is response to that to my concern over the last question, we're setting up a new unit jointly with the World Health Organization to take the expertise, the knowledge, what we have and try to share it out with the rest of the world. Um, partly because we want to share some of that part because we want to steal some damn good ideas and partly because we want to raise the bar for what constitutes acceptable progress. Standards matter a great deal to us. So we're investing in that, um we've had to think quite a great deal about what knowledge we have that would actually be useful and valuable in a country like chili, as opposed to what might be useful, invaluable in a country like Australia. I feel really confident that I could go back home and teach the Australian healthcare system 85 million things about how to take it. Decarboxylase could really help them tackle this stuff damn quickly. I feel quite confident about that. I feel far less confident that I could provide valuable information. Probably the further away a health care system gets from something that looks like the NHS, right? And so I have Bean a little cautious about engaging in some of that particularly, I think, less with the upper middle income country, healthcare systems and more with sort of the lower middle income, lower income healthcare systems. Because, quite frankly, when Malawi came to us and said, How can we learn from you? We sent absolutely everything we could, fully aware that almost none of it was relevant, fully aware that probably where uM, allowing needed to be focusing was on climate adaptation was on strengthening. It's healthcare system, building up resilience and our expertise principally lies in mitigation. I'm not quite answering your question. I suppose what I'm trying to get at is this transition is gonna be very different for very different healthcare systems. I would like us to focus principally on high income countries because that's where the burden of the emissions are, and that's where the burden of the responsibilities and so that's where I've been focusing on. What I would say, though, is there are some pretty damn cool groups in South America is one example that are taking some of this on that have, I think, placed it in contact. And indeed in the right language that I've been turning to for advice there. So healthcare without harm is one group that I turned to. They have a network off hospitals across South America starting to tackle this kind of stuff. Rarely do you see them investing the same level of capital into into a healthcare system to decompensate, but probably, nor should you. I don't think the prioritization arguments are different, eh? More complex, depending on the political context you have. Can I have you come back to that? Does that? Does that seem right? Wrong? Would you like to see us doing mortgage? I want to be really cautious that we thanks. Um, so I understand that like large investments like government, like, politics might be difficult, but what What about, like, indivisible actions? How we can tackle that as, like doctors? Sure, that's there. So? So what we could try to do with this new unit with the Whr is is have a political dialogue between some of these high income countries where we're talking about joint regulatory enforcement and joint procuring enforcement. But we could do the clinical level professional body level engagement far more widely, right? We could certainly look to make sure that we're trying to make our resources and the things that we're sharing in the conferences and workshops, and we'll run some fellowship exchange programs, etcetera. We could certainly expand that. We should. You write. Sorry, expand that beyond just Canada in the United Kingdom or whatever it might be. A. My mind always immediately goes to emissions profiles. It immediately goes to who is the largest emitter, because that's where the fight is. But it sometimes leaves me a little blinking toe. Other parts of the world kicked out. I see. I see that there is some of the hands in the audience. But if we can perhaps move that conversation to the coffee break because happy to stay around, just sit in the interest of time so that we can move on. But round of applause again for Dr Nick Walks