Making Healthcare Sustainable – A Holistic Approach

Gemserv Health discusses the necessity of making healthcare sustainable and how the industry can play a key role in tackling climate change.

In an early autumn doomed by news of rising gas prices, there is certainly a lesson to be learned about the domino effect one issue can have on many others.

The global squeeze on gas and energy supplies has indeed led to the closure of two of the UK’s largest fertiliser plants, which has in turn caused a shortage of carbon dioxide usually produced as a by-product. This ripple effect is not uncommon.

Climate change is already exacerbating issues across all areas of global economies – including our healthcare services.

With a polluted environment directly contributing to public health issues like respiratory diseases, exposing people to asthma and pneumonia, we can expect a heightened demand for care as global temperatures continue to climb. There is also a risk that supply will be reduced at the same time, particularly as staff become unwell.

Hospitals could also be faced with having to operate in higher temperatures whilst having to reduce their carbon footprints in line with commitments for a ‘greener NHS’ – which currently accounts for 5% of the UK’s total carbon emissions.

The challenge at hand shouldn’t be underestimated.

What steps should be taken to ensure the healthcare system is sustainable and fit for the future?

Innovators, clinicians, operational teams, and consulting firms have been investing time, money, and skills to answer this question – or at least taking steps towards doing so.

The answer revolves around the hottest subject of the 21st century: ‘sustainability’. The notion of sustainability has transitioned over time, shifting from its earliest definition – “never harvesting more than the forest can generate1– to becoming a more inclusive concept built on economic, social, and environmental pillars.

In recent decades, the accelerated call for sustainability has seen many industries and companies around the world adapt to new and sustainable ways of doing business. We have seen fundamental changes to how people bank and shop, for example, with the rise of online capabilities leading to the disappearance of shops and banks from our high streets and the reduction in travel to city centres by car.

We have also seen a commitment from the UK government to achieve net zero carbon emissions by 2050.

Is the Healthcare sector keeping up with the transition?

October 2020 saw the NHS publish a plan for “Delivering a ‘Net Zero’ National Health Service”’ – outlining a comprehensive plan for meeting a ‘world first’ target. The plan is comprehensive – providing a detailed account of modelling and analytics, interventions required, and trajectories to net zero, all coupled with the direction, scale, and pace of change.

Two clear targets have emerged from the net zero commitment and have been classified according to NHS’ control of emissions:

Direct control – emissions that are directly emitted and controlled by NHS facilities. This includes fossil fuels, NHS facilities, anaesthetics, and NHS Fleet and Leased vehicles. Target: Net zero by 2040, ambition to reach an 80% reduction by 2028 to 2032.

Indirect control – emissions the NHS can influence but not directly emitted within NHS facilities. This includes electricity, energy, metered dose inhalers, business/staff travel, waste, water, medicines, medical devices, food and catering, construction, manufacturing, freight transport, business services, ICT, and commissioned health services. Target: Net zero by 2045, ambition to reach an 80% reduction by 2036 to 2039. 

The Net Zero Strategy – one small piece of the pie

However, current challenges faced by the NHS raise questions about how well the sustainability concept has been applied in the health sector.

The Net Zero Strategy places great emphasis on the supply chain, for example, but misses the opportunity to make service delivery centre of the debate. Applying the Net Zero Strategy in isolation means we will have an impact on the carbon footprint of the NHS but at the cost of missing a critical opportunity to address the whole sustainability ecosystem. Simply put, implementing the Net Zero Strategy is only one small piece of the pie.

The Gemserv team is currently engaging with pharmaceutical trade associations and supporting them to understand exactly this. One observation is that there is an ability for the pharmaceutical industry to contribute to the bigger challenge – as helpful as it is to reduce direct emissions from the supply chain, it is also vital to understand the direct impact of this on service delivery and the healthcare ecosystem as a whole. This is true in several other areas, including regulators and those assuring quality of care.

Finding a solution

So how should the transformation of the healthcare system be done?

From our experience in major transformation across all systems, we know that a holistic approach is the way forward – regardless of the change required.

Until we look at the sustainability ecosystem holistically and understand the impact of every Net Zero Strategy on service delivery and patients, the system will continue to fail. This approach must consist of pillars of equal strength; if one is weaker than the rest, the entire system will topple over.

Guided by our experience delivering transformational changes across a range of industry sectors – including both the energy and healthcare markets – we have developed a clear set of principles to ensure success:

  • Stakeholder Engagement – change starts at the leadership level but requires full stake holder engagement
  • Shared vision of what the future state looks like – building Excitement around the end game
  • Establish a clear vision for the impact areas of the programme – what will good look like!
  • Identify the barriers to success and Enable the programme to incrementality remove these barriers
  • Establish new governance structures, performance measures and behavioural norms based upon the future state
  • Identify a continual stream of quick wins – ensure that programme Execution demonstrate their delivery building momentum further
  • Measure Effectiveness of programme, support evolution of thinking and build on stakeholder learning
  • Embed these principles so the system continues to transform and no longer sees the transformation as unusual – it becomes business as usual

Our e4 Framework

Whilst the principles above can be applied to any programme of change, even greater impact can be achieved if they are structured to meet the specific challenges of an industry sector. This has driven us to establish a specific healthcare model where the areas of impact are clearly articulated at the outset: our e4 framework.

Efficiency– increasing access of care for the population without compromising on quality of care. Eliminating operational inefficiencies in all pathways and sectors with focus on the health and wellbeing of our health and social care workforce to foster productivity, maintain mental health and reduce retention.

Effectiveness – personalising solutions and bring care closer to the patient’s home to maximise clinical outcomes, improve patient experience and alleviate the pressure from front door health services.

Economic – maximising the access and quality of care received for every pound spent by the taxpayer. To bridge the demand-supply gap, not increasing resources or funding but maximising efficiency and effectiveness of existing resources and pathways.

Environment – not relying on short-lived solutions. Actively minimising the negative impact on the environment and leveraging every opportunity to restore and improve it, to the benefit of the health and well-being of current and future generations. Achieving this while maintaining or improving the quality of care received by patients.

An underlying pillar – buy-in

But there is an enabling pillar that must be combined with experience and methodologies: buy-in. Our experience of successfully delivering change underlines this point – we cannot impose change on people and must heavily invest in shifting mindsets and cultures by creating visible short-term benefits in addition to the wider sustainable contribution to achieve buy-in and sustain change. History has shown us all that no matter the quality of your methodology, if the people do not stand behind and believe in your concept, your strategy becomes as useful as a glass hammer.

This has been one of NHS’ biggest challenges in the past and present. Director of Policy & Strategy at NHSX and Chair of the Health and Care Information Governance Panel, Simon Madden, confirmed in a recent webinar that closely following architectural challenges, achieving buy-in of users remains a pressing challenge in reshaping health and social care.

So how do we ensure success?

The answer involves two clear elements:

  • Have a clear understanding of the transformation journey
  • Establish and implement a framework.

With these two elements in place, we can establish a common vision. As an organisation that stands for profit with purpose, it has been proven to us at Gemserv that successful transformation stems from alignment to a common vision. This ideology has enabled us to deliver change where other major players in the field have failed.

About the authors:

Fereshta Qayumi
Senior Health Care Consultant at Gemserv

Fereshta Qayumi

Fereshta is a senior healthcare consultant whose background involves over five years of experience in the healthcare sector, both as a front-line healthcare professional in Oncology as well as a change management consultant delivering service redesign and operational transformation across the health care sector. She amalgamates her clinical experience and problem-solving skills to identify root causes of inefficiencies in demand and supply of health care. She is not afraid to roll up her sleeves to invigorate and mobilise clinical and operational teams with both “on the ground” strategies and “top-down” PMO structures. She holds a clinical degree from City University London and an MSc in International Health Management from Imperial College London.

David Newell
Director of Health at Gemserv

David Newell

David joined Gemserv in September 2018 as part of the acquisition of ASE Consulting where he led the Healthcare Consulting practice and is now Director of Health for the combined organisation. David has a highly successful commercial career spanning some 30 years. His career started in the NHS where he held NHS Trust Board responsibility for Information Technology, Clinical Audit and Medical Records. Since then, his career then focused upon delivering technology enabled transformation across both health and life sciences sectors. He has worked for a range the leading consulting, software, and IT services companies in the UK.


  1. A Brief History of Sustainability – The World Energy Foundation

Special Report Contact Details
Author: Fereshta Qayumi & David Newell
Organisation: Gemserv Health
Telephone: +44 (0)207 090 1000
Website: Visit Website

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