Green with envy

We all know that our amazing planet is on borrowed time. Our actions today will make a massive difference our shared tomorrow. Green. Carbon Neutral. Sustainability. Offsets. Footprints. Net-Zero. Efficiencies. Greenhouse gas emissions. We're all being hammered with these terms, and in the NHS, we know that we have a massive role to play as to whether the UK will achieve its Green Plan ambitions and?a greener NHS .?

I've seen many Integrated Care Boards (ICBs) and many NHS Trusts formulate Green Plans, all declaring variants on how they will aim to support the national targets of Net Zero.?

Within Midlands Partnership NHS University Foundation Trust, the target is Net Zero by 2040 for the emissions directly within our control,?and for those emissions we can only influence, Net Zero by 2045.?The MPFT Green Plan is published online. ?

This blog post isn't going to be a commentary on whether these targets are significant enough or a polemic on whether they're all too ambitious, I'm just using these to frame the context from which we're operating within today in my local digital team. This post is about money. A green plan is an investment into the future of our planet, and our future generations. But it's a challenge because it's exactly that. A financial investment. In addition to our 2040 Net Zero targets there's also something else that's being mandated within health and care, something more immediate...savings targets.?And guess which is being discussed more often? And guess which we "need to achieve the soonest"?

How to make Green IT affordable

So this post is all about how we can afford a sustainable, Green IT approach to support our Net Zero plans over the next 15 years or so, when seemingly we cannot afford to do anything much at all with the savings targets that are staring us in the face right this second.

The reality is that if we're not successful, if we don't meet Net Zero and reduce carbon, there won't be much of anything left at all to try and save money for. We're doomed. And even Net Zero might not be enough. So why isn't this getting more air time? Why aren't we dedicating more local resources??

When the Greener NHS agenda was first launched there was an immediate flurry of activity across Health and Care to get that box ticked, produce that plan and show that we're there ready to stem the flow of melting ice caps and do our bit. But when it comes to daily activity? Well the discussion is rightly on patient backlogs, urgent care, efficiencies, productivity gains and money saving activities. If these plans also happen to support our carbon neutral plan at the same time, great! ("Can someone write that down and send it over to the Green Team please? Was it 1,000 pieces of paper a week? Great, I'll email them now...")

In my opinion, this is not cool. We can and will prioritise there here and now and our sustainable, greener future concurrently, we will build sustainability into our way of thinking on a day-to-day basis, into our transformation prioritisation processes and our supplier selection processes. The only significant issue I'm facing at the current moment in time is...being Green is very expensive!?

Green needs green (if you live in America.)

If you live in the UK, this is far less punchy, green needs cash/money/dosh/budget/revenue.

And did I mention that budgets were tight? In a daily?climate?of consistently reviewing budgets with a fine-tooth comb and assessing where our efficiency gains might be, how can we justify spending more to achieve practically the same result? This is what many of our current background discussions for sustainability approaches entail...

• If we move this system hosting from here to here instead it'll be more carbon efficient and help with our Net Zero
• If we stop doing this and do this with a digital system instead, we'll be able to save time and use less paper
• If we make our clinicians, professionals and patients do more stuff virtually, we can reduce our mileage claims and carbon footprint
• If we join up all of our Building Management Systems with an upgraded digital system we'll be able to reduce travel by our Estates team AND reduce emissions

The list goes on. But there's a common theme. These initiatives (and many more) are all about investing in new ways of achieving the same thing, typically resulting in a greater local cost within the digital budget.

So if the blinkers are on and we're focussing on digital budgets in a financially distressed environment, we're in trouble...?if we're going to be greener, our digital budget needs to grow.?To save the planet, at least?initially, we need to spend more. How do we make this work in an NHS where every penny counts???

Look for quick wins

There are genuinely lots of things we can do, with relative ease and pace, and at minimal extra cost, to get us well on our way with our Net Zero journey.

• Digital Mail and NHS App integration: the NHS sends a significant amount of letters to service users, and lets face it, often multiple letters for the same appointment for no apparent reason. Digital mail approaches can reduce costs AND reduce our carbon footprint if we can integrate it with the NHS App so that - if it's suitable for the patient - we don't even need to send a letter at all.
• eConsent, questionnaires, medical forms and feedback forms:?similar to the above. But with local development skills and a cheaper small Azure cloud hosted approach, we can significantly reduce postage, printing and travel to undertake digital 2-way correspondence with patients. If we're lucky, we'll also be able to reduce our paper use and printer estate and reduce our local energy consumption too with less local printers in use or on standby.
• Virtual Consultations and Remote Care:?I won't be giving guidance for sucking eggs here, BUT, we do need to make sure our approaches are robust, easy to use, secure, sustainably hosted and as cheap as possible. And yes, we'll reduce travel for everyone if we get these things right.?
• Cloud Hosting:?So this one is interesting. It is often very expensive to explore like for like hosting arrangements (more on that later). Making the shift from local data centre design to cloud through Azure, AWS or Google can leave you with the same functionality and performance, at a much higher cost, with no immediate benefits to end users.?
• However, there are some quick wins to be gained. Our local data centres aren't the greenest at the current moment in time, and the less systems we host locally, the less our local need for data centre hosting and all the carbon emitting kit that goes with them will be.?
• So whilst we're waiting for the magical day when we can shut off a local data centre, our approach so far has to been to review each system, each app and assess each for suitability to be cloud hosted. So far, we have found that by far and away the most cost effective approach to improving performance, high availability AND our carbon footprint position is to look for private cloud hosting where it is appropriate.?
• Many of the key health and care systems providers are offering private cloud options which have a proven green plan and sustainable hosting platforms and with only a marginal cost increase from our current spend on our local data centres. These are our cloud hosting quick wins, cherry picking the right system with the right private cloud hosting approach at the right cost.
• Electronic Prescribing Services (EPS) and Electronic Prescribing and Medicines Administration (EPMA):?this may seem like a bit of a cheat to list this as a quick win. BUT, with NHSE support and supplier maturity improving, the deployment of EPS and EPMA are resulting in some very real and very quick wins for us, with deployment pace increasing across the organisation. The wider we deploy these systems into the community and onto our wards the less green FP10 paper prescriptions and drug charts we need to procure, print on and post and the less travel we need to do in the community to hand deliver these to patients. Through digitisation we also enable better quality, data rich reporting which empowers our medicines administration to be optimised, reducing waste.
• Building Management Systems (BMS):?energy costs, cost of living crisis, carbon emissions. Why aren't we focussing more on making sure our buildings are energy efficient and ran effectively through BMS? By connecting our estates team and finance teams to the data available for gas and electricity utilisation across each of our buildings through digital, we have a very simple way of prioritising our least efficient/most costly buildings. At the very least, BMS control can help us set outside air temperature set points and boiler behaviour. During heatwaves we'll be able to centrally switch off our heating across multiple premises without leaving our chair if we need to, reducing both carbon and financial waste.
• Devices:?we are working on ensuring that all devices are used as long as practicable, performant and compliant. When they meet the end of their usable life within the NHS, they are to be securely wiped and donated to service users, carers and local education/voluntary sector where they will continue to serve and support our localities.

If we're clever about it, we can achieve many of these quick wins by using the staff we already have, the licences we already own and the systems suppliers we already use to continue our Net Zero journey. There is still so much more to go at in terms of reducing our carbon footprint, and with a concerted effort and a continued focus on evaluation, data capture and benefits realisation for our sustainability plans, we'll be able to make a difference without needing to damage our Cost Improvement Plans (CIP) or overly inflate our existing digital budgets.

There's yet more we can do too, but these will take more time, more cash and more risk.

Longer term approaches...

These approaches aren't so easy. They'll take time. And many of these, if we're not careful, will also present as an immediate cost pressure to the organisation before benefits can be realised.?

Following a longer term Green Plan approach is a little bit like healthy eating. It seems so much more affordable to buy ready made meals and sweets and chocolate, but if you want to eat healthier, it'll cost you more in raw ingredients and take more of your time to create that healthy menu choice.?

If we're getting our Green Plan right, it'll be slightly more complicated, it'll cost a bit more initially, but we're hopefully going to live a lot longer as a result!

To be greener, to do "healthy IT", we need to build sustainability into:

Our business cases.?

We will justify where greater financial expense may lead to far more carbon neutral or negative carbon results, and we know that this will take time and be pretty difficult too given the financial austerity we're facing. Here's how a typical conversation goes when we're building in the green agenda into a business case options appraisal for a preferred option:

Finance: "But that option costs us more"

Us: "But it's the right choice for our green plan and far more sustainable and higher quality."

Finance: "But we can't afford it. We don't have that kind of money. That option doesn't have enough robust cashable savings."

Us: "But we might have that kind of money in years 2 and 3 and 4 when this?might?happen, and these things?might?take place, and hosting costs?might?reduce as technology further improves. We just can't quantify the cashable value yet. And when it comes to the planet, can we afford?not?to?"

Finance: "Yeah as I was saying, we don't have the money. Go with fossil fuel Option A please."?

So obviously I'm exaggerating, but when it comes to building better, more sustainability focussed business case, quantifying the immediate benefits of a green approach and making that seem financially viable without definitive and firm cashable data in play is pretty daunting and fairly difficult, nay impossible.?

I'm personally hopeful that through progression of our low cost, quick win efforts described above, we can build the trust and confidence into digitisation with proven, locally driven data sets that can potentially help us make decisions on some of the longer term financial releasing cases which may not look immediately affordable. Lots of hope and potential in that paragraph but that's where we are!??

Our procurement exercises.?

We will ensure that any newly commissioned system or hardware solution contributes to our sustainability targets. This may mean ensuring all private cloud hosted systems have green data centres, or any new hardware such as printers have energy efficient standby modes, or desktop PCs with Integrated Lights Out which allows the ability for them to be fully shutdown, but powered on in the evening temporarily to perform updates. We will look for suppliers and partners we work with to have the ISO 14001 certification to ensure we have assurance on their management of sustainable approaches. Furthermore, sustainability impact assessments will be key. Our local sustainability impact assessment will be shared with each prospective supplier, ensuring that they can meet the needs upfront and articulate how their product, their service, their hosting can meet our sustainability objectives and our carbon?

Our Estates plan

Our Trust is a community Trust and we currently have over 80 priority managed IT buildings. With estates rationalisation becoming more feasible as our approaches to hybrid working and remote consultation mature, this gives us the foundation to reinvest existing budgets into our long-term premises. Every closed building is a reduction in our carbon footprint, and a reduced IT support overhead for network, wireless, telephony, printers, devices, door access systems etc.

At present, the sheer number of buildings means our budgets are spread thinner and our capital backlog is larger. By reducing the estate, we literally have less lights to keep on.?

A reduced estate will improve our sustainability status and it will increase the flexibility within the digital budget to invest more into our Green Plan. We can reinvest those support costs into further digital transformation and into improving our building standards, enabling our buildings against the BREEAM standards for sustainably built environments.?

There's also those local data centres of ours, if cloud isn't the answer to everything, we need to stop being so siloed with our data centres, and we rapidly need to look to securely co-locate our systems into shared data centres wherever possible with our ICB buddies. When it comes to data centres, less is definitely more.

And the not so quick wins in cloud...

For those systems that don't have a nice, sustainable and off the shelf cloud hosting offer, we need to design and scope very carefully what they look need to look like in an Azure cloud setting. If our budget won't allow for these to be cloud hosted right now with their current design, what does local hosting look like? How can we make it more efficient? By the time we've progressed on many of our other schemes such as One Drive and private cloud migrations, there will be very little left to host locally. Hopefully by that point our Estates Strategy and data centre strategy will be such that we can re-invest the released budget from local IT support in our closed premises into those more costly, cloud hosted environments for those systems that we cannot afford to move to green hosting at the current moment in time.?

Furthermore, our suppliers will be pressured into re-designing the apps to be cloud ready. A huge chunk of this cost is because our NHS suppliers just aren't ready with low cost, low storage, low compute cloud ready Platform as a Service (PaaS) applications. The historic design of some of our systems is a key reason why it costs so much to "do the right thing" and move them to Microsoft carbon neutral data centres to?"reduce our carbon footprint by up to 98%" .

Summary

So all in all, I am green with envy of those organisations that have the budget available or the risk appetite to back the Green Plan in earnest. What I can say is that our local ambitions are the right ones, and we have a really great team across the Trust (including our Sustainability Champions network) that are passionate about making our Green Plan a reality and hitting our 2040 targets.?

We're in this together, we just need to make sure that we keep doing the right things, capturing them, measuring them, and reporting them. For the planet's sake, I hope it's more than just the money that talks.

To read more about our approach to sustainability through digital transformation, you can?read our MPFT Digital Strategy here .?

You can watch a short video on our approach at MPFT Digital:

https://youtu.be/PJCfFdUKVl0

Follow me on Twitter:?@martyngwperry ?

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