I'm delighted to be chairing this webinar today along with my colleague Amy Booth, uh, who is also from the University of Oxford.
My name is Sara Shaw, and I am professor of health policy and practice here at the University of Oxford.
Um, so I'd like to formally introduce our speaker today, professor Nick Watts.
And to take, uh, a bit of time to give a background to the talk before doing that.
Can I just ask that everyone, please take time to introduce yourselves in the chat.
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.
And then I'm very happy to introduce Nick.
Uh, professor Nick Watts, who's director of the centre for Sustainable Medicine at the National University of Singapore, uh,
where he leads the centre's mission of shaping the growing field of sustainable medicine, both locally and internationally.
Uh, Nick has a background in medicine and public policy, and many of you will, I'm sure,
know him from his work as executive director of The Lancet Commission and later The Lancet countdown on health and climate change,
but also from his previous role as chief sustainability officer of the NHS,
where he led the way in taking the NHS towards becoming the first net-zero health system in the world.
Now, as you be aware, the driver net zero is not a smooth path,
which I think is probably why many of us are here today, and it's fraught with all sorts of politics and change.
Um, and we've just been talking about some of the headlines in the papers.
Uh, so we might come on to that. Um, so there've been significant achievements, which I hope you'll touch into.
Nick. Um, but I'm sure they've been and continue to be significant challenges along the way.
And it's for this reason that Amy and I were really keen and just delighted to hear from the horse's mouth where,
uh, what net zero means in the context of health care and the influence of national and transnational politics,
industry, other stakeholder interests, uh, and the media in advancing towards net zero across different settings and unpack
really what works and perhaps what doesn't work and where we need to focus attention.
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.
Students, many of whom are in the room today, had a really intense week last week on that course.
Um, looking across global north and south, considering issues of implementation and unimplemented.
Uh, global supply chains, the role of the pharmaceutical industry, opportunities and impacts of technology and much more.
And I think it's really good timing, Nick, to then have you here today to add to this.
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.
I know you're planning to talk without any slides. Um, just to talk for 30 or 40 minutes.
And we're then going to open to the floor for wider discussion. Everyone in the room.
Please do also use the chat function in the interim. Post any questions that you have there as we go.
And Amy and I will moderate that chat. Uh, once we've finished and open up for some live discussion as well.
Enough from me. Nick, welcome over to you. Hello, everybody.
Thank you for having me. Um. And thank you, Amy.
Thank you Sarah. Thank you, Robin, for for everything you've done to put this thing together.
Um. Uh, in the first three seconds.
You've probably got a sense. Uh, I'll try and be as informal as possible.
And frankly, if people have questions I want to throw into the chat, if people want to try and interrupt me.
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.
But the discussion is often more important than any kind of prepared remarks.
Um, talk a little bit about, uh, about decarbonising health care, what that looks like in the context of the NHS.
Um, taking a look at the people that are introducing themselves.
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.
So, so we can skip over. I'll move very quickly through.
I think the first two parts of what you might want to, you know, look at when you ask this question,
which is why why would you want to go and care about this stuff?
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?
Um, the far, far more difficult question.
And frankly, I think the the question. We don't spend enough time thinking about all this space.
Doesn't spend enough time thinking about is the how. I sort of call it the 9 a.m. tomorrow morning question.
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,
really important, uh, either sort of NGO based, civil society based advocacy,
um, uh, often led by a whole range of different health professionals for,
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,
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.
And those are really important questions. But but only if you're trying to convince yourself that this is a good idea.
Once you've convinced yourself that this is a good idea, you no longer need to really.
I mean, other than matters of high strategy and policy.
You no longer need to spend too much time fixated on 2049 or 2044.
You need to spend almost all of your time fixated on what you're going to do tomorrow morning.
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.
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.
It's been written on the letterhead. It's been written up on the top of a couple of the buildings at least.
Um, when you when you head into work, you simply can't do that unless you respond to climate change,
the National Health Service, and every health care system across the world.
They were designed with a core assumption that the environment was stable.
Turned out, that was a pretty bad assumption. Um, things have started to move far, far quicker.
In the United Kingdom.
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,
um, as a result of, uh, as a result of climate change, you see that by 2030, 2030 is half a second away.
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.
At least we see a tripling of that, um, out heatwaves becoming far, far more fatal, far more dangerous by 2035.
That's the first reason why you might want to respond to that.
It turns out you can't. You can't run a high quality health care system unless you are directly tackling climate change.
The second reason, frankly, is the NHS has had a little bit of experience running at this.
Since 2008, the Climate Change Act, the NHS has started to have a proper institutional.
Almost everywhere you look, almost everything the NHS has done, it turns out it saves a bit of money.
It turns out it's better for patient care. It turns out people love it.
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?
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?
Paradoxically, you might expect them to say, listen, I'm really tired.
I'd quite like a break.
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?
If you say, hey, would you like to be a part of driving that?
The response is thunderous. Nine out of ten, 91% of health care professionals across the United Kingdom want to live up,
uh, want to work for the health care system that is that is responding to net zero.
89% want to take an active personal role in that, in their professional and their personal lives.
You kind of get 90% of healthcare professionals to agree on anything.
You can't get 90% of people to agree on anything. There is remarkable consensus here.
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,
sometimes on social media, sometimes just in our heads. It turns out when you look left, look right, look down, look up.
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?
So the what's important as well. I just wanna spend three seconds digging into what is behind the NHS net zero strategy.
Um, two targets 2040 and 2045.
2040 is for the emissions the NHS controls directly.
This is stuff that happens on campus in the sort of four walls of a hospital.
It's stuff that we directly own. So whenever we own a vehicle, we take direct responsibility for that.
2045 is, frankly, for the majority of our emissions profile.
And then that is about the stuff that we don't directly control.
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,
uh, into our catering system and into into patients or staff.
We don't control the emissions of a factory somewhere else in the world for some of our pharmaceuticals or surgical devices,
but we do exert one [INAUDIBLE] of an influence. We are a price setter.
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,
we're going to take responsibility for that decarbonisation process as well, because we know that if we don't, no one else will.
And in fact, we know that when you look around the world, more and more health care systems are saying, yeah, me too.
That's the distinction between those two targets.
One of them is what we feel damn confident we directly control, and the other one is what we're saying.
We know we don't directly control this, but we're going after it anyway.
And we're going to make that commitment ourselves. We think the NHS is big enough, important enough not just for the United Kingdom,
not just to Europe, but frankly, to the world to be able to take that kind of commitment on.
And we'll talk a little bit about some of the international dimensions of that a bit later.
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.
Number one, there's a word out there that you should never really use in this discussion.
Offsetting negative emissions inherent in.
The phrase net zero. There are positive and negative emissions.
You can't get away from that. What you can do is stop talking about them in 2024 and 2025 and 2026 and 2027.
The approach the NHS takes is that you mitigate as far as you absolutely, possibly can.
You do everything. You look at all of the different carbon sources the whole way across the system.
You tackle every single bucket of emissions you can find.
You go as far as you can and then you stop and you take a break.
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.
Then you start to talk about the kinds of new things.
You hadn't even dreamed up, the innovation potential of the NHS.
And you mitigate a little bit further. And then out the other side of that.
Only then and only, frankly, in the 2040s.
Are you allowed to even begin to think about talking about things like offsetting.
There's a few reasons for that. Partly it's a distraction.
And partly, frankly, it isn't a particularly effective way of reducing the emissions for something like the NHS.
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.
And we said, what if we maximised the tree planting potential everywhere?
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.
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.
So if the NHS is direct emissions, 6% is what we have left in that little offset basket, 8% for our total footprint.
It's important that people are transparent about that.
And anytime someone says when you ask, hey, how much you offsetting attached to your targets, they go, oh, it's quite complex.
You have to think of boundaries and I don't know the line.
People know the answers to these questions, they have buried them somewhere in their report.
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?
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.
We've got over 90% of the way down to reducing our emissions.
We feel pretty good about that, that last bit. It's not the part we intend to offset.
In fact, it's the part that we say, hey, we're not really sure how are we going to deal with this,
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.
And out the other side, at the very, very end, we will then start to turn our attention to offsetting.
The final thing I would say about those targets is they've actually got two components to them.
They have an 80% reduction. If you look at the emissions trajectory of the NHS, it's not a linear decline.
It goes like this. And then it scrapes along the bottom. That last mile problem is really, really quite challenging.
There are just some really tough parts of the healthcare system to decarbonise.
We are carbon intensive because we are activity energy economically intensive.
That shouldn't stop us from running up the very front, because cumulative emissions matter and because momentum matters as well.
The very, very last thing.
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.
Is that good enough? Is that fast enough? Are we going fast enough yet?
The answer invariably, invariably, is no.
Invariably, the answer is we have to go faster. So how do you actually set that target?
Is it based purely on science? No, it's frankly not.
The question you have to ask yourself from a scientific perspective, from a climate perspective, is how fast can you go?
Because you needed to have got there yesterday.
And so the question for the NHS is footprint and its and its reduction strategy is actually one of feasibility.
It's about trying to balance that urgency with making sure that it's credible,
because unless it's credible, you are sure as [INAUDIBLE] not going to be able to mobilise the industry,
the health care system, the health workforce and international partners across the across the world to be able to run at this.
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.
The second we start to feel as though, hey, we're getting on top of this,
we feel pretty good about this and we are starting to feel better about our 80% interim reduction target.
You move that forward. You don't go, okay, I feel good about this.
You say, okay, we ain't fast enough. No. Not yet. The why is simple.
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,
like this topic, the what in some ways has a whole bunch of complexity around it, right?
Your your direct and indirect emissions profile, your sort of territorial versus international profile,
what you control, what you directly or indirectly control, your offset capacity, all that stuff is complex.
I would encourage people not to. Spend too much time worrying about that.
I would encourage people to say, is the target difficult?
If the target is difficult, then cool. Then let's just get on with doing stuff at 9 a.m. tomorrow morning.
If it's not quite, if we want it to be a little more ambitious. Fine.
But how about we do this stuff today? How about we demonstrate that this stuff is possible?
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.
You can cut that how? Up into a million different ways you can cut it up into buckets of carbon.
Sort of how the NHS tends to do it. That's something we probably need to apologise to the world for.
We count our carbon, frankly, based on how, uh, the GHG protocols that are divides up emissions flows.
You see us talking about fixed assets, mobile assets.
You see us talking about medical and non-medical supply chain. You see us talking about scope one, two and three.
It's a pretty useless way of counting carbon, and it's a pretty useless way of running, uh, a delivery program,
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.
No one understand that health care system to be structured in terms of fixed and mobile assets?
Um, you know, no doctor working inside a hospital really has any idea about what goes on behind the scenes.
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.
We could cut it out by clinical speciality based on how, uh, how a patient might experience, um, a health care system, primary care.
Um, whether they show up in an ambulance, in an emergency department,
whether they are up in an operating theatre or then up into intensive care for the purposes of the.
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,
more as a organisational challenge.
The NHS, at the end of the day, is the fifth largest organisation in the world,
the largest in Europe, £180 billion of spend and 1.4 million health care professionals.
It's big and that comes with an enormous, enormous strength.
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.
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.
Health spreading. Best practice from one ward to another in the same hospital can be pretty tough.
Um. I think of this mostly as a large scale change management program.
Three things matter if you're going to take some of the literature seriously, which I guess I take medium seriously.
Um, autonomy matters. People need to feel as though they have been given the permission to run at this.
Not just 1 or 2 people, but everyone. Capability and capacity matter.
They need to not just have been given the permission, but they have to have the tools to be able to run at this.
They have to have the time to be able to run at some of this.
And then finally, I think the political science literature would tell you something about interconnectedness.
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.
If we are running around like the fun police telling people to recycle into this stripy bin rather than this purple bin,
and telling people that that light actually isn't sustainable as they thought it was.
And whatever I, I promise you, we're going to lose.
I promise you we are going to go too slow. This has to be something that is open to everyone.
It has to be something that is accessible. It has to be something that we can genuinely unlock.
The innovative capacity at 1.4 million. Health professionals.
So taking that in turn, and this is a little bit of how the NHS thinks about this.
We think about autonomy what matters. Well but right to the top.
The Health and Care Act of 2022,
with the support of all sorts of pretty impressive individuals in the House of Lords and the whole way through the Commons,
now says that if you want to be an NHS trust, if you want to be an integrated care system,
if you want to be part of a high quality health care system, you have your own net zero strategy.
You respond to climate change, you take it seriously. You have a board level lead.
It's pretty boring stuff, right? It results in the generation of a lot of plans.
Those plans, if you go and read them, frankly, actually, quite a few of them are pretty impressive.
And what what I guess is behind that is not just one national conversation about what this look like at the national level,
but ideally 212 conversations in every trust, 30, 40, 50 across different intimate integrated care systems and regions.
You start to see that this becomes localised and personalised.
You start to see trusts engaging with their local community, engaging with their patients,
engaging with their staff, saying, hey, what does this mean to you? No one gets it perfect.
No one comprehensively tackled all of this stuff and that is what I love about it.
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.
I think we should encourage that diversity.
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.
Now I'm going to be really, really great at the same thing, but for PPE.
I'm really excited about providing more nutritious, better tasting food to my patients.
I reckon I can do it in a lower carbon way that might actually invest in my local economy,
local farmers, different trusts taken up, that kind of stuff.
I think we should encourage as much as as much as possible.
What we do need to do, though, is as well as provide some of those high level signals.
So you see it in health and care, actually see it in the NHS England planning guidance.
You see it out in the standard contract that goes out to every single part of the system.
You also need to provide just a little bit of guidance, some guardrails on the sides.
I don't want to go too wild. Maybe an example of what this looks like.
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,
but it is a thing that sort of management types in NHS England understand.
There's a net zero supply chain roadmap published a couple of years ago.
It was very long. It was a little bit boring. It had some nice pictures.
Page 3 or 4 though there was one deeply important sentence.
Within the decade, the NHS will no longer purchase from anyone that does not meet or exceed our commitments on net zero.
Initially that was met with a little bit of outrage, frankly, from industry.
They said, what are you talking about? You can't be serious. You guys are only 2.4% of the global pharmaceutical market.
You can't expect us to change just because of you. Then I looked around and they said, oh, really?
Interesting.
Germany said they were quite interested in following and and the United States and that actually they thought this was not a terrible idea.
Even the Kiwis thought it might be. It might be an interesting idea.
What that sort of policy is aiming to do is set something off into the decade, we clarified.
Half a second later. One minute past midnight, April 1st, 2027 is that deadline point.
And then a sequence of milestones going back every year to present day.
Those milestones are just saying, hey, start with a 10% weighting, but you figure out how to do that.
And then they go on to say, well, stop.
We next step build in carbon reduction strategy requirements as a gateway into all tendering for contracts over £5 million,
not for small medium enterprises, for large, large parts of the health industry then starting to slowly expand out.
But that sort of guidance, if you go and read it, it's actually pretty broad brush.
What it's intending to do is say to the 12,000 procurement offices across the country, this is for you to implement.
This is for you to figure out what this looks like in a community nephrology centre.
This is for you to figure out what this looks like in a mental health trust.
We're going to provide the broad parameters of this, but you have the autonomy to go and figure this stuff out for yourself.
And we've got some time to figure it out together. Capability and capacity matter as well.
It's a bit of a myth out there that net zero health kit costs too much money.
Don't ever let let anyone tell you that it is the world's most boring.
Uh, PPE answer to what's the barrier to change?
Someone says bureaucracy. Someone else says money. I, for God's sake.
The NHS thinks it can act on the vast majority of its emissions profile.
We think we can act on 87% of our total emissions profile with no additional capital pressure.
This is principally about the decisions we make and how we deliver care,
and where we get the goods that we deliver that care from about delivering high value care.
There is a capital pressure out the other side and you do need to tackle that.
The good news is that the return on investment attached to that, because broadly we are talking about more efficient health care.
We're talking about delivering health care in more efficient settings.
It has a return on investment of about 3.6 years.
On average, it pays for itself like almost nothing else, but nonetheless, I don't want to brush over it entirely.
So we've had to invest. We've invested over £780 million into low carbon healthcare.
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,
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.
You have to make sure that people have some of the training and some of that and a bit of time attached to this.
We see right across the country, uh, Truss starting to say, hey,
why don't we have that emergency department nurse who is really passionate about this?
It's been .2.2 of that time on a Friday or Monday.
Thinking about what this looks like for their emergency department,
thinking about how they can improve the care they're delivering to their patient and staff at their patients,
and starting to run at this, whilst also delivering the high quality clinical care for the rest of the town.
We've had to roll out new training program staff available to, frankly, anyone that's interested.
I know I would say this, but honestly,
maybe the only online two hour training course like fully automated course that I've ever seen that I actually enjoyed.
I like when the team was developing it, I was frankly a little bit sceptical.
We all kind of hate those e-learning module things. I went and looked at it and I had to go and find it.
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.
Yeah. I just didn't expect it to be very good. It's actually worth taking a look at.
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.
And then for people that are really ready to go forward, there are courses popping up all over the place,
including the one that we're talking about right now here.
Um, starting to say, hey. It's not that complex,
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.
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.
The capability and the capacity matters as well as the autonomy.
By far though, and I cannot stress this enough.
If we have to become the guys that run around every single year, when emissions reporting time comes up,
when the annual report comes up and chastise different parts of the system,
different hospitals, different clinicians say, oh God, you haven't done enough.
You didn't recycle enough, you didn't turn your lights off and off. You didn't. Uh.
So boring. And I promise you, everyone is going to turn the other way and go and do something else.
This stuff has got to be. It's got to be fun. I talk sometimes about, uh, a micro grant scheme the NHS ran.
It's called the Healthier Futures Action Fund. I'm not sure who names these things.
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,
I don't know if the world has to be this way, I reckon I've got a cool way of making the service.
We provide our patients more efficient. I reckon I could do better for them,
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.
I might be able to save the trust quite a bit of money. We had a small amount of money for you.
£5,000. £10,000. Out. We had to close the applications for that process.
I think within 48 hours. We open the thing on Friday by Monday afternoon.
We had expected 50 or 60 applications we'd expected. We put it out for a couple of months.
Um, the health care system has been busy.
We had forgotten that 91% of the NHS want to work for a health care system that is living up to their own values.
We've forgotten how good doctors and nurses and pharmacists are at grabbing with
two hands an opportunity to define the future of their of their clinical practice.
We had 7000 applications come through.
Completely overwhelmed. This great story.
Um, one of the, uh, deputy chief financial officers came to us and said, Nick, I normally hate these sorts of micro grant schemes.
I'm not really sure they add up to much.
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.
Their eyes light up so bright, so excited,
dreaming about the different things they could do for their practice and for their patients and for their communities.
They have so many ideas that coming back to our house tomorrow night to keep, keep plodding.
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?
This has to be about fun. The criteria for that was exclusively you got to do something good for your patients.
You got to do something good for the bottom line, the carbon in the cost of the NHS.
But you have to learn something and you have to have fun. That was all.
You run that sort of stuff, you run the £30 million worth of innovation funding that has started to flood this space from Ukri,
from the MRC, from Nigel, from the NHS, from CBRE, from Alphabet Soup.
You start to get some pretty impressive, pretty exciting ideas.
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.
That's where some of the different discovery processes that lead out to more reusable PPE, um, circular, uh, endoscopy, uh, drones getting,
getting chemotherapy medication out to the Isle of Wight faster, cheaper and lower carbon than the alternative,
which I think was a truck, a truck, a car, a hovercraft and truck.
Um. Unless we turn this into something that is fun, unless we turn this into something people want to run at.
I'm not going to get anywhere. Three things matter.
I think autonomy matters. When you have a challenge. This big capability and capacity matter.
Fun matters. I know I say that now. I know when I say fun, I say it with a very severe and grumpy face.
I'm actually quite a fun guy. The fourth and final thing, though, that I think matters.
I reckon we are five seconds away from being there is a sense of inevitability matters.
When the NHS says it's going to get to net zero by 2040, by 2045.
When it says within the decade we will no longer purchase from anyone that does not meet or exceed our commitments on net zero.
When it starts to invest hundreds of millions of pounds into higher quality care,
when it starts to innovate with drones and with zero emission ambulances.
And when you start to see health care systems all around the world Germany, France, Australia,
Vietnam, Singapore, Canada, the United States all start to say, hey, yeah, me too.
That's when this stuff stops becoming just fun and it starts becoming the inevitable future direction of health care.
That's when we start to say, let's figure out the how.
Not that should we? So thank you very much.
I hope that was, uh. All right. I'm sorry I didn't have slides. And I apologise for my Australian accent.
Thank you Nick. The Australian accent is very welcome. Um, and very engaging.
You covered so much ground. Really helpful overview.
And I just love it. That is plain talking. How it is.
Um, cutting through some of the crap that's out there and it's very, very welcome.
So thank you from everyone on the call, particularly our students and tutors.
Thank you. Thanks, guys. Thanks anyway.
Thanks, Sarah. That's really, really cool so much.