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I'm delighted to be chairing this webinar today along with my colleague Amy Booth, uh, who is also from the University of Oxford.

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My name is Sara Shaw, and I am professor of health policy and practice here at the University of Oxford.

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Um, so I'd like to formally introduce our speaker today, professor Nick Watts.

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And to take, uh, a bit of time to give a background to the talk before doing that.

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Can I just ask that everyone, please take time to introduce yourselves in the chat.

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Maybe just post your name, your role, your organisation, just so we can get a bit of a sense who's in the room today.

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And then I'm very happy to introduce Nick.

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Uh, professor Nick Watts, who's director of the centre for Sustainable Medicine at the National University of Singapore, uh,

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where he leads the centre's mission of shaping the growing field of sustainable medicine, both locally and internationally.

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Uh, Nick has a background in medicine and public policy, and many of you will, I'm sure,

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know him from his work as executive director of The Lancet Commission and later The Lancet countdown on health and climate change,

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but also from his previous role as chief sustainability officer of the NHS,

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where he led the way in taking the NHS towards becoming the first net-zero health system in the world.

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Now, as you be aware, the driver net zero is not a smooth path,

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which I think is probably why many of us are here today, and it's fraught with all sorts of politics and change.

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Um, and we've just been talking about some of the headlines in the papers.

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Uh, so we might come on to that. Um, so there've been significant achievements, which I hope you'll touch into.

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Nick. Um, but I'm sure they've been and continue to be significant challenges along the way.

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And it's for this reason that Amy and I were really keen and just delighted to hear from the horse's mouth where,

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uh, what net zero means in the context of health care and the influence of national and transnational politics,

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industry, other stakeholder interests, uh, and the media in advancing towards net zero across different settings and unpack

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really what works and perhaps what doesn't work and where we need to focus attention.

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Um, so Nick's talk today is open to all, but it also forms one part of a new course here at Oxford Focus, specifically on sustainable healthcare.

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Students, many of whom are in the room today, had a really intense week last week on that course.

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Um, looking across global north and south, considering issues of implementation and unimplemented.

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Uh, global supply chains, the role of the pharmaceutical industry, opportunities and impacts of technology and much more.

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And I think it's really good timing, Nick, to then have you here today to add to this.

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And we talked a lot about politics actually, and innovation. So um, to hear you talk about politics, innovation and change and the path to net zero.

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I know you're planning to talk without any slides. Um, just to talk for 30 or 40 minutes.

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And we're then going to open to the floor for wider discussion. Everyone in the room.

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Please do also use the chat function in the interim. Post any questions that you have there as we go.

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And Amy and I will moderate that chat. Uh, once we've finished and open up for some live discussion as well.

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Enough from me. Nick, welcome over to you. Hello, everybody.

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Thank you for having me. Um. And thank you, Amy.

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Thank you Sarah. Thank you, Robin, for for everything you've done to put this thing together.

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Um. Uh, in the first three seconds.

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You've probably got a sense. Uh, I'll try and be as informal as possible.

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And frankly, if people have questions I want to throw into the chat, if people want to try and interrupt me.

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Um, but I'm very happy with that. If you want to, uh, instead, Sarah, Amy, uh, save all those things up, we can talk about them at the end.

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But the discussion is often more important than any kind of prepared remarks.

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Um, talk a little bit about, uh, about decarbonising health care, what that looks like in the context of the NHS.

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Um, taking a look at the people that are introducing themselves.

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I mean, the chat is full of people who have a really, really great sense of what that means on the ground and what some of those challenges look like.

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So, so we can skip over. I'll move very quickly through.

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I think the first two parts of what you might want to, you know, look at when you ask this question,

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which is why why would you want to go and care about this stuff?

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The next thing is, well, once you've decided you want to care, what are you running at? What's your target call that that the what?

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Um, the far, far more difficult question.

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And frankly, I think the the question. We don't spend enough time thinking about all this space.

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Doesn't spend enough time thinking about is the how. I sort of call it the 9 a.m. tomorrow morning question.

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And what I think I mean by that is, for the last 2 or 3 decades, the sort of health and climate change space it has existed in the realm of really,

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really important, uh, either sort of NGO based, civil society based advocacy,

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um, uh, often led by a whole range of different health professionals for,

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uh, for our space in, in, in particular, um, or at the sort of public health epidemiology, uh, level and then, uh, things like the Lancet countdown,

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go and ask, uh, questions about what a country's economy looks like, what a region's economy looks like over the course of 20, 30, 40 years.

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And those are really important questions. But but only if you're trying to convince yourself that this is a good idea.

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Once you've convinced yourself that this is a good idea, you no longer need to really.

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I mean, other than matters of high strategy and policy.

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You no longer need to spend too much time fixated on 2049 or 2044.

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You need to spend almost all of your time fixated on what you're going to do tomorrow morning.

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And you and you find that the questions and some of the answers that this space had for us, uh, aren't quite fit for purpose.

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So the why? It's simple. Um, if you are the NHS, you exist to deliver high quality care for all now and for future generations.

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It's been written on the letterhead. It's been written up on the top of a couple of the buildings at least.

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Um, when you when you head into work, you simply can't do that unless you respond to climate change,

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the National Health Service, and every health care system across the world.

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They were designed with a core assumption that the environment was stable.

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Turned out, that was a pretty bad assumption. Um, things have started to move far, far quicker.

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In the United Kingdom.

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You see a doubling of the number of NHS facilities, actually up to about 2.4 times, uh, the number of NHS facilities on high risk floodplains,

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um, as a result of, uh, as a result of climate change, you see that by 2030, 2030 is half a second away.

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You see a tripling of the, uh, standard deviation of the duration, um, duration for heatwave is what is what tends to matter in this country.

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At least we see a tripling of that, um, out heatwaves becoming far, far more fatal, far more dangerous by 2035.

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That's the first reason why you might want to respond to that.

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It turns out you can't. You can't run a high quality health care system unless you are directly tackling climate change.

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The second reason, frankly, is the NHS has had a little bit of experience running at this.

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Since 2008, the Climate Change Act, the NHS has started to have a proper institutional.

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Almost everywhere you look, almost everything the NHS has done, it turns out it saves a bit of money.

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It turns out it's better for patient care. It turns out people love it.

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And that's the third reason. When you go out and you ask health care professionals across the country, hey, what do you care about?

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And the health profession is tired in this country and frankly, the whole way around the world, when you ask them, hey, what do you care about?

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Paradoxically, you might expect them to say, listen, I'm really tired.

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I'd quite like a break.

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But if you say, hey, are you interested in working for a health care system that is low a carbon that lives up to our own values?

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If you say, hey, would you like to be a part of driving that?

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The response is thunderous. Nine out of ten, 91% of health care professionals across the United Kingdom want to live up,

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uh, want to work for the health care system that is that is responding to net zero.

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89% want to take an active personal role in that, in their professional and their personal lives.

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You kind of get 90% of healthcare professionals to agree on anything.

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You can't get 90% of people to agree on anything. There is remarkable consensus here.

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I think sometimes we forget about that. I think sometimes we let ourselves get a little too caught up in some of the guys out there in the media,

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sometimes on social media, sometimes just in our heads. It turns out when you look left, look right, look down, look up.

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Sitting in an auditorium, pretty much everyone around you. Nine out of ten of those people are on your side and asking, well, what do I do now?

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So the what's important as well. I just wanna spend three seconds digging into what is behind the NHS net zero strategy.

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Um, two targets 2040 and 2045.

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2040 is for the emissions the NHS controls directly.

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This is stuff that happens on campus in the sort of four walls of a hospital.

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It's stuff that we directly own. So whenever we own a vehicle, we take direct responsibility for that.

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2045 is, frankly, for the majority of our emissions profile.

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And then that is about the stuff that we don't directly control.

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We don't control 100% of the emissions profile of, uh, an apple that goes somewhere from a farm the whole way through truck into,

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uh, into our catering system and into into patients or staff.

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We don't control the emissions of a factory somewhere else in the world for some of our pharmaceuticals or surgical devices,

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but we do exert one [INAUDIBLE] of an influence. We are a price setter.

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We, uh, large enough to be able to say, well, we're going to stand up a little bit and we're going to say,

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we're going to take responsibility for that decarbonisation process as well, because we know that if we don't, no one else will.

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And in fact, we know that when you look around the world, more and more health care systems are saying, yeah, me too.

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That's the distinction between those two targets.

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One of them is what we feel damn confident we directly control, and the other one is what we're saying.

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We know we don't directly control this, but we're going after it anyway.

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And we're going to make that commitment ourselves. We think the NHS is big enough, important enough not just for the United Kingdom,

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not just to Europe, but frankly, to the world to be able to take that kind of commitment on.

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And we'll talk a little bit about some of the international dimensions of that a bit later.

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A few other things that are kept quiet. 68 page report that net zero strategy, a few other things that have kept quiet behind those targets.

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Number one, there's a word out there that you should never really use in this discussion.

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Offsetting negative emissions inherent in.

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The phrase net zero. There are positive and negative emissions.

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You can't get away from that. What you can do is stop talking about them in 2024 and 2025 and 2026 and 2027.

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The approach the NHS takes is that you mitigate as far as you absolutely, possibly can.

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You do everything. You look at all of the different carbon sources the whole way across the system.

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You tackle every single bucket of emissions you can find.

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You go as far as you can and then you stop and you take a break.

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It's probably Friday. You go off for a weekend and you come back on Monday, and you keep going a little bit further and a little bit further.

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Then you start to talk about the kinds of new things.

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You hadn't even dreamed up, the innovation potential of the NHS.

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And you mitigate a little bit further. And then out the other side of that.

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Only then and only, frankly, in the 2040s.

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Are you allowed to even begin to think about talking about things like offsetting.

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There's a few reasons for that. Partly it's a distraction.

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And partly, frankly, it isn't a particularly effective way of reducing the emissions for something like the NHS.

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We did some modelling where we looked at all of the available car parking space, all the Browns land, all the green space that the NHS has available.

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And we said, what if we maximised the tree planting potential everywhere?

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What if we just just for the fun of it really went wild? You can offset 0.6% of the NSA's annual emissions by doing that.

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The NHS doesn't have that many offset, uh, categories available to it, and the ones that it does have, they don't get anywhere close.

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So if the NHS is direct emissions, 6% is what we have left in that little offset basket, 8% for our total footprint.

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It's important that people are transparent about that.

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And anytime someone says when you ask, hey, how much you offsetting attached to your targets, they go, oh, it's quite complex.

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You have to think of boundaries and I don't know the line.

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People know the answers to these questions, they have buried them somewhere in their report.

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It's actually not that complex, to be honest. What is complex is what are you going to do with that little pocket at the end?

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And frankly, it's a little black box that the NHS says, well, we think we have got most of the way there against old 1990s baseline.

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We've got over 90% of the way down to reducing our emissions.

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We feel pretty good about that, that last bit. It's not the part we intend to offset.

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In fact, it's the part that we say, hey, we're not really sure how are we going to deal with this,

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but we're going to hope and we're going to work towards developing some of those innovations and technology to help us do some of that.

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And out the other side, at the very, very end, we will then start to turn our attention to offsetting.

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The final thing I would say about those targets is they've actually got two components to them.

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They have an 80% reduction. If you look at the emissions trajectory of the NHS, it's not a linear decline.

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It goes like this. And then it scrapes along the bottom. That last mile problem is really, really quite challenging.

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There are just some really tough parts of the healthcare system to decarbonise.

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We are carbon intensive because we are activity energy economically intensive.

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That shouldn't stop us from running up the very front, because cumulative emissions matter and because momentum matters as well.

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The very, very last thing.

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I think when we think about these targets and every now and then people say, hey, Nick, in 2045 versus 2050 versus 2040 versus December 15th, 2044.

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Is that good enough? Is that fast enough? Are we going fast enough yet?

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The answer invariably, invariably, is no.

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Invariably, the answer is we have to go faster. So how do you actually set that target?

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Is it based purely on science? No, it's frankly not.

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The question you have to ask yourself from a scientific perspective, from a climate perspective, is how fast can you go?

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Because you needed to have got there yesterday.

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And so the question for the NHS is footprint and its and its reduction strategy is actually one of feasibility.

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It's about trying to balance that urgency with making sure that it's credible,

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because unless it's credible, you are sure as [INAUDIBLE] not going to be able to mobilise the industry,

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the health care system, the health workforce and international partners across the across the world to be able to run at this.

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That's what the 2045 and 2040 targets are. They are set right at the 50%, 50, 50 margin of what we think is achievable.

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The second we start to feel as though, hey, we're getting on top of this,

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we feel pretty good about this and we are starting to feel better about our 80% interim reduction target.

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You move that forward. You don't go, okay, I feel good about this.

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You say, okay, we ain't fast enough. No. Not yet. The why is simple.

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The impacts, the savings, the fact that nothing motivates the health workforce at a time when we could really use a little bit of extra motivation,

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like this topic, the what in some ways has a whole bunch of complexity around it, right?

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Your your direct and indirect emissions profile, your sort of territorial versus international profile,

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what you control, what you directly or indirectly control, your offset capacity, all that stuff is complex.

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I would encourage people not to. Spend too much time worrying about that.

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I would encourage people to say, is the target difficult?

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If the target is difficult, then cool. Then let's just get on with doing stuff at 9 a.m. tomorrow morning.

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If it's not quite, if we want it to be a little more ambitious. Fine.

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But how about we do this stuff today? How about we demonstrate that this stuff is possible?

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Positive. Fun. And then go from there. By far the more interesting, more important side of this discussion, I think, is, is the how, um.

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You can cut that how? Up into a million different ways you can cut it up into buckets of carbon.

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Sort of how the NHS tends to do it. That's something we probably need to apologise to the world for.

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We count our carbon, frankly, based on how, uh, the GHG protocols that are divides up emissions flows.

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You see us talking about fixed assets, mobile assets.

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You see us talking about medical and non-medical supply chain. You see us talking about scope one, two and three.

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It's a pretty useless way of counting carbon, and it's a pretty useless way of running, uh, a delivery program,

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because no one other than someone that spends way too much of their time looking at this stuff really knows what the [INAUDIBLE] that is.

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No one understand that health care system to be structured in terms of fixed and mobile assets?

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Um, you know, no doctor working inside a hospital really has any idea about what goes on behind the scenes.

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You could cut it up based on the levers you have control of, either at the National, the, uh, trust, or down at the individual clinical level.

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We could cut it out by clinical speciality based on how, uh, how a patient might experience, um, a health care system, primary care.

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Um, whether they show up in an ambulance, in an emergency department,

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whether they are up in an operating theatre or then up into intensive care for the purposes of the.

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Today, I was going to suggest we we think of this perhaps less as a health care system problem and more as a political challenge,

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more as a organisational challenge.

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The NHS, at the end of the day, is the fifth largest organisation in the world,

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the largest in Europe, £180 billion of spend and 1.4 million health care professionals.

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It's big and that comes with an enormous, enormous strength.

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Like I said, we're a price that, um, when the NHS starts to run out of things, the rest of the world goes, oh, wow.

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It also brings challenges. It means that spreading best practice from one trust to another, even if they're right next door to each other.

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Health spreading. Best practice from one ward to another in the same hospital can be pretty tough.

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Um. I think of this mostly as a large scale change management program.

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Three things matter if you're going to take some of the literature seriously, which I guess I take medium seriously.

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Um, autonomy matters. People need to feel as though they have been given the permission to run at this.

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Not just 1 or 2 people, but everyone. Capability and capacity matter.

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They need to not just have been given the permission, but they have to have the tools to be able to run at this.

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They have to have the time to be able to run at some of this.

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And then finally, I think the political science literature would tell you something about interconnectedness.

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It's a big word and I'm a relatively simple guy. So, so fun is my is my sort of final piece that I think matters here.

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If we are running around like the fun police telling people to recycle into this stripy bin rather than this purple bin,

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and telling people that that light actually isn't sustainable as they thought it was.

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And whatever I, I promise you, we're going to lose.

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I promise you we are going to go too slow. This has to be something that is open to everyone.

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It has to be something that is accessible. It has to be something that we can genuinely unlock.

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The innovative capacity at 1.4 million. Health professionals.

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So taking that in turn, and this is a little bit of how the NHS thinks about this.

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We think about autonomy what matters. Well but right to the top.

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The Health and Care Act of 2022,

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with the support of all sorts of pretty impressive individuals in the House of Lords and the whole way through the Commons,

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now says that if you want to be an NHS trust, if you want to be an integrated care system,

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if you want to be part of a high quality health care system, you have your own net zero strategy.

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You respond to climate change, you take it seriously. You have a board level lead.

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It's pretty boring stuff, right? It results in the generation of a lot of plans.

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Those plans, if you go and read them, frankly, actually, quite a few of them are pretty impressive.

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And what what I guess is behind that is not just one national conversation about what this look like at the national level,

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but ideally 212 conversations in every trust, 30, 40, 50 across different intimate integrated care systems and regions.

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You start to see that this becomes localised and personalised.

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You start to see trusts engaging with their local community, engaging with their patients,

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engaging with their staff, saying, hey, what does this mean to you? No one gets it perfect.

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No one comprehensively tackled all of this stuff and that is what I love about it.

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Each trust gets to take on its own unique personality, its own unique idea of what net zero and low carbon healthcare means to it.

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I think we should encourage that diversity.

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I think we should be okay with people saying, hey, I'm going to be really, really great at the circular economy within my operating theatre.

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Now I'm going to be really, really great at the same thing, but for PPE.

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I'm really excited about providing more nutritious, better tasting food to my patients.

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I reckon I can do it in a lower carbon way that might actually invest in my local economy,

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local farmers, different trusts taken up, that kind of stuff.

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I think we should encourage as much as as much as possible.

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What we do need to do, though, is as well as provide some of those high level signals.

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So you see it in health and care, actually see it in the NHS England planning guidance.

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You see it out in the standard contract that goes out to every single part of the system.

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You also need to provide just a little bit of guidance, some guardrails on the sides.

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I don't want to go too wild. Maybe an example of what this looks like.

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And again, you'll hear me refer back to things like procurement. I'm sorry, procurement isn't really a thing that a health care system understands,

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but it is a thing that sort of management types in NHS England understand.

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There's a net zero supply chain roadmap published a couple of years ago.

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It was very long. It was a little bit boring. It had some nice pictures.

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Page 3 or 4 though there was one deeply important sentence.

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Within the decade, the NHS will no longer purchase from anyone that does not meet or exceed our commitments on net zero.

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Initially that was met with a little bit of outrage, frankly, from industry.

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They said, what are you talking about? You can't be serious. You guys are only 2.4% of the global pharmaceutical market.

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You can't expect us to change just because of you. Then I looked around and they said, oh, really?

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Interesting.

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Germany said they were quite interested in following and and the United States and that actually they thought this was not a terrible idea.

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Even the Kiwis thought it might be. It might be an interesting idea.

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What that sort of policy is aiming to do is set something off into the decade, we clarified.

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Half a second later. One minute past midnight, April 1st, 2027 is that deadline point.

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And then a sequence of milestones going back every year to present day.

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Those milestones are just saying, hey, start with a 10% weighting, but you figure out how to do that.

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And then they go on to say, well, stop.

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We next step build in carbon reduction strategy requirements as a gateway into all tendering for contracts over £5 million,

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not for small medium enterprises, for large, large parts of the health industry then starting to slowly expand out.

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But that sort of guidance, if you go and read it, it's actually pretty broad brush.

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What it's intending to do is say to the 12,000 procurement offices across the country, this is for you to implement.

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This is for you to figure out what this looks like in a community nephrology centre.

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This is for you to figure out what this looks like in a mental health trust.

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We're going to provide the broad parameters of this, but you have the autonomy to go and figure this stuff out for yourself.

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And we've got some time to figure it out together. Capability and capacity matter as well.

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It's a bit of a myth out there that net zero health kit costs too much money.

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Don't ever let let anyone tell you that it is the world's most boring.

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Uh, PPE answer to what's the barrier to change?

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Someone says bureaucracy. Someone else says money. I, for God's sake.

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The NHS thinks it can act on the vast majority of its emissions profile.

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We think we can act on 87% of our total emissions profile with no additional capital pressure.

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This is principally about the decisions we make and how we deliver care,

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and where we get the goods that we deliver that care from about delivering high value care.

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There is a capital pressure out the other side and you do need to tackle that.

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The good news is that the return on investment attached to that, because broadly we are talking about more efficient health care.

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We're talking about delivering health care in more efficient settings.

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It has a return on investment of about 3.6 years.

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On average, it pays for itself like almost nothing else, but nonetheless, I don't want to brush over it entirely.

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So we've had to invest. We've invested over £780 million into low carbon healthcare.

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It started to pay for itself. You can see it in the trust that has some pretty significant savings as energy prices spiked a couple of years ago,

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but the NHS as a whole, they tripled. They would have gone up by 3.8 fold if we hadn't already started investing their.

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You have to make sure that people have some of the training and some of that and a bit of time attached to this.

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We see right across the country, uh, Truss starting to say, hey,

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why don't we have that emergency department nurse who is really passionate about this?

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It's been .2.2 of that time on a Friday or Monday.

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Thinking about what this looks like for their emergency department,

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thinking about how they can improve the care they're delivering to their patient and staff at their patients,

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and starting to run at this, whilst also delivering the high quality clinical care for the rest of the town.

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We've had to roll out new training program staff available to, frankly, anyone that's interested.

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I know I would say this, but honestly,

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maybe the only online two hour training course like fully automated course that I've ever seen that I actually enjoyed.

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I like when the team was developing it, I was frankly a little bit sceptical.

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We all kind of hate those e-learning module things. I went and looked at it and I had to go and find it.

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I was like, this is amazing. And they sort of were like, yeah, what do you. I mean, you know, you you knew we were working on this.

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Yeah. I just didn't expect it to be very good. It's actually worth taking a look at.

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A day long in-person and hybrid workshop. If you want to take that next step, you want to try to localise that down to some of your personal contexts.

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And then for people that are really ready to go forward, there are courses popping up all over the place,

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including the one that we're talking about right now here.

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Um, starting to say, hey. It's not that complex,

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but we're going to have to figure some of this stuff out together with a little bit of shared learning and a bit of community training for the NHS.

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We do a six month executive level, board level, uh training programs as well, to try to really put an infusion of energy into this stuff.

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The capability and the capacity matters as well as the autonomy.

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By far though, and I cannot stress this enough.

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If we have to become the guys that run around every single year, when emissions reporting time comes up,

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when the annual report comes up and chastise different parts of the system,

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different hospitals, different clinicians say, oh God, you haven't done enough.

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You didn't recycle enough, you didn't turn your lights off and off. You didn't. Uh.

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So boring. And I promise you, everyone is going to turn the other way and go and do something else.

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This stuff has got to be. It's got to be fun. I talk sometimes about, uh, a micro grant scheme the NHS ran.

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It's called the Healthier Futures Action Fund. I'm not sure who names these things.

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Ignore the name. It was a cool scheme. If you were in community, if you were in trust, and you had thought to yourself, man,

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I don't know if the world has to be this way, I reckon I've got a cool way of making the service.

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We provide our patients more efficient. I reckon I could do better for them,

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and I reckon at the same time I might be able to save a bit of resource and might be able to save a little bit of carbon.

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I might be able to save the trust quite a bit of money. We had a small amount of money for you.

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£5,000. £10,000. Out. We had to close the applications for that process.

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I think within 48 hours. We open the thing on Friday by Monday afternoon.

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We had expected 50 or 60 applications we'd expected. We put it out for a couple of months.

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Um, the health care system has been busy.

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We had forgotten that 91% of the NHS want to work for a health care system that is living up to their own values.

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We've forgotten how good doctors and nurses and pharmacists are at grabbing with

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two hands an opportunity to define the future of their of their clinical practice.

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We had 7000 applications come through.

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Completely overwhelmed. This great story.

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Um, one of the, uh, deputy chief financial officers came to us and said, Nick, I normally hate these sorts of micro grant schemes.

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I'm not really sure they add up to much.

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But man, my partner is a GP and they had the entire practice over the other night and I have never seen, not in three years.

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Their eyes light up so bright, so excited,

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dreaming about the different things they could do for their practice and for their patients and for their communities.

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They have so many ideas that coming back to our house tomorrow night to keep, keep plodding.

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I know the deadline is in a couple of days. They've asked me to say, could they apply for more than one grant because they reckon they've got more?

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This has to be about fun. The criteria for that was exclusively you got to do something good for your patients.

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You got to do something good for the bottom line, the carbon in the cost of the NHS.

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But you have to learn something and you have to have fun. That was all.

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You run that sort of stuff, you run the £30 million worth of innovation funding that has started to flood this space from Ukri,

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from the MRC, from Nigel, from the NHS, from CBRE, from Alphabet Soup.

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You start to get some pretty impressive, pretty exciting ideas.

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That's where the NHS is. Uh, zero emission ambulance came from the first in the world, and then three second later the second in the world.

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That's where some of the different discovery processes that lead out to more reusable PPE, um, circular, uh, endoscopy, uh, drones getting,

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getting chemotherapy medication out to the Isle of Wight faster, cheaper and lower carbon than the alternative,

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which I think was a truck, a truck, a car, a hovercraft and truck.

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Um. Unless we turn this into something that is fun, unless we turn this into something people want to run at.

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I'm not going to get anywhere. Three things matter.

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I think autonomy matters. When you have a challenge. This big capability and capacity matter.

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Fun matters. I know I say that now. I know when I say fun, I say it with a very severe and grumpy face.

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I'm actually quite a fun guy. The fourth and final thing, though, that I think matters.

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I reckon we are five seconds away from being there is a sense of inevitability matters.

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When the NHS says it's going to get to net zero by 2040, by 2045.

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When it says within the decade we will no longer purchase from anyone that does not meet or exceed our commitments on net zero.

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When it starts to invest hundreds of millions of pounds into higher quality care,

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when it starts to innovate with drones and with zero emission ambulances.

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And when you start to see health care systems all around the world Germany, France, Australia,

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Vietnam, Singapore, Canada, the United States all start to say, hey, yeah, me too.

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That's when this stuff stops becoming just fun and it starts becoming the inevitable future direction of health care.

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That's when we start to say, let's figure out the how.

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Not that should we? So thank you very much.

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I hope that was, uh. All right. I'm sorry I didn't have slides. And I apologise for my Australian accent.

359
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Thank you Nick. The Australian accent is very welcome. Um, and very engaging.

360
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You covered so much ground. Really helpful overview.

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And I just love it. That is plain talking. How it is.

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Um, cutting through some of the crap that's out there and it's very, very welcome.

363
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So thank you from everyone on the call, particularly our students and tutors.

364
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Thank you. Thanks, guys. Thanks anyway.

365
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Thanks, Sarah. That's really, really cool so much.