In July 2022, the NHS became the world’s first health system to embed net zero into legislation, as part of the Health and Care Act 2022. This followed on from the NHS announcing in October 2020 its commitment to being the world’s first health service to reach carbon net zero.

The importance of reaching net zero – and its impact on the wider sustainability goals of addressing climate change for future generations – is widely accepted. We are also committed to this goal, with our own sustainability strategy having a keen focus on environmental protection.

But what are the NHS targets, how do they affect suppliers and how realistic and achievable are the ambitions? In this blog, we take a closer look.

The world’s first net zero national health service 

The ambition is certainly a commendable one and comes after the NHS established a net zero expert panel to review almost 600 pieces of evidence and conduct comprehensive analysis and modelling to understand when and how the NHS can realistically reach this target.

As the NHS itself acknowledges, identifying a route to net zero emissions for such a large, labyrinthine system brings with it several challenges. Despite this, it describes its targets as being ‘as ambitious as possible’ while also remaining realistic. It says these ambitions are backed by immediate action and ‘a commitment to continuous monitoring, evaluation and innovation’.

The institution has set two targets:

• to reach net zero by 2040 for the emissions it can control directly (otherwise known as the NHS Carbon Footprint), with an ambition to reach an 80% reduction by 2028 to 2032;
• and to reach net zero by 2045 for the emissions it can influence (the NHS Carbon Footprint Plus), with an ambition to reach an 80% reduction by 2036 to 2039.

This is part of the UK’s wider plans to reach net zero by 2050, by reducing its greenhouse gas emissions by 100% from 1990 levels.

What about suppliers?

It’s well known the NHS relies on a wide source of suppliers and it’s therefore no surprise they will have a major role to play to help the organisation meet its net zero targets.

A roadmap was approved by the NHS England Public Board in September 2021 to help suppliers align with the NHS’s net zero ambition between now and 2030. As a result, it’s already the case that all NHS procurements include a minimum 10% net zero and social value weighting, while for all contracts above £5 million per year, suppliers are required to publish a Carbon Reduction Plan for their UK Scope 1 and 2 emissions and a subset of scope 3 emissions as a minimum.

From April 2024, the NHS will extend the requirement for a Carbon Reduction Plan to cover all procurements, while from April 2027 all suppliers will be required to publicly report targets, emissions, and publish a Carbon Reduction Plan for global emissions aligned to the NHS net zero target, for all of their Scope 1, 2 and 3 emissions.

Further to this, from April 2028, there will be new requirements introduced overseeing the provision of carbon foot printing for individual products supplied to the NHS. And lastly, from 2030, suppliers will only be able to qualify for NHS contracts if they can demonstrate ‘their progress through published progress reports and continued carbon emissions reporting through the Evergreen sustainable supplier assessment’.

While the NHS strongly encourages all suppliers to prepare for the above milestones, it also recognises that not all suppliers are the same and that some will face more barriers than others in meeting the requirements.

It says support will be available for Small & Medium Enterprises (SMEs) and Voluntary, Community & Social Enterprises (VCSEs) at each stage of the roadmap, while a two-year grace period will be available for SMEs and VCSEs on key future milestones and requirements.

It’s fair to say that many suppliers are already on a journey towards sustainability – and if they aren’t already, the net zero plans will surely prompt a wave of suppliers to take stock of their emissions and their sustainability goals. At the same time, the above is a lot for suppliers – especially SMEs – to achieve, which is why it’s promising that support is available.

Where are we now?

At the beginning of the year, the BMA said more support was needed from UK governments to help the NHS reach its net zero targets.

While it acknowledged some good progress had been made in the NHS being less carbon-intensive and more sustainable, it also said this progress was in danger of stalling and called on governments across the UK to up their support for NHS organisations – who are one of the main contributors to public sector emissions – to help them ‘achieve sustainability goals’ and ‘keep up momentum in reducing their carbon footprint’.

At the same time, National Health Executive and E.ON Energy came together to hold a webinar offering a practical guide to achieving net zero, while others have talked of the need to fully electrify the NHS’s fleet of vehicles to lead the charge towards a greener future.

Meanwhile, a recent study found that single-use surgical items make up two-thirds of the carbon footprint of the five most common NHS operations, with researchers suggesting that better waste management and using reusable items where possible could aid in slashing emissions.

The research, which observed operations across three sites at University Hospitals Sussex NHS Foundation Trust, found that 68% of the carbon contributions came from single use, in particular plastic items such as gowns and drapes for patients and instrument tables.

Although exact data on how well the NHS is doing in meeting its net-zero targets is hard to come by, there are plenty of examples of net zero in action, and a cursory search on social media shows how many individuals and groups are dedicated to achieving it.

What’s more, as the largest employer in Britain and Europe, the NHS can set a great example for other major employers and industries and be a leader in the public sector. All action, however small, by employees, organisations and suppliers working in the NHS, can make a considerable difference to achieving the goal of net zero. Do you know how your organisation is working towards reducing its carbon emissions?

In this blog, our Principal Consultant, Philip Purdy, looks at why community-based mental health services need more assistance with meeting the proposed new waiting time standard.

Despite having gone under the radar compared to other new initiatives, a new waiting time standard for certain areas of mental health is set to be gradually phased in over the course of this year – although data recording and implementation issues means the new standards have not yet been introduced, with only an indicative timeline for their implementation. 

The 4-week (28 days) standard will mean that all mental health service groups – adults, older adults and children and young people – presenting to community-based mental health services should begin to receive care within four weeks from when they were first referred.  

But issues with the capture and recording of data makes it challenging, at present, to provide an accurate picture of the number of people who currently receive help within four weeks. This is why, to support systems in improving data quality and improve the flow of data relevant to the community waiting time standard, a phased approach to implementing the waiting time standard has been created, allowing more time for organisations to get used to the new systems. 

With the new approach, the clock starts when the first request for mental health services is received and stops when the person is in receipt of a clinical assessment, either a clinical or social intervention and a completed co-produced personalised care plan. 

Surprisingly, despite its obvious importance, the new waiting time standard wasn’t included in the NHS’s 2023/2024 priorities and operational planning guidance, suggesting that the challenges faced in recording and monitoring may be significant enough to prevent mandating this as a ‘must-do’ this year.  

Recent data featuring in the HSJ shows the extent of the challenge, with data assembled by NHS Benchmarking unveiling the first national picture of the number of patients currently being treated in four weeks. Its aggregated figures for 2021-22 revealed that 72% of adults and 67% of children waited more than four weeks for treatment. Importantly, this must be viewed alongside the caveat that metrics may be measured across providers with differing definitions. 

What’s the problem? 

Access waiting times are still a new concept for community-based mental health services. While it’s true that consultant-led mental health services have (technically) been subject to the 18 weeks RTT standard for a number of years, it’s also the case that this has not been widely integrated into how mental health organisations run their services. 

Consequently, and unsurprisingly, the infrastructure to collect and report on waiting times data, and utilise the intelligence provided by it, simply isn’t there at present. This means, in turn, that organisations are now involved in a game of catch-up to meet the conditions of the 4-week standard.  

What are the solutions? 

To allow mental health providers to monitor their performance against this new standard – and see how close or far away they are from making it a reality – a patient tracking list becomes worth its weight in gold. 

Here at Acumentice, we have been working closely with two mental health organisations to design and build a patient tracking list that enables these organisations to see in transparent detail how long their waiting times currently are. 

It’s important to note that this isn’t an easy process. It involves getting to grips with some complex pathways, interwoven between different teams and services. It also involves coming to terms with different sets of processes that have evolved in a way that don’t necessarily lend themselves well to easy oversight. 

During our work in this area, we have quickly concluded that these types of projects are as much about culture change as they are process change – developing capability in the process of management and oversight is as important as that in the technical field.  

A lesson from the past 

If we cast our minds back to the first decade of this millennium and the last time the NHS was introducing waiting time standards into new territory – namely cancer waits and RTT – we will remember the sea change in practice that was needed to make a success of those standards. 

This isn’t something that happens overnight, and this isn’t something that happens without the necessary support and assistance.  

It wouldn’t be a stretch to say that the NHS developed an entire industry to support the effective recording, management and reporting of waiting times with these previous initiatives. The new waiting time standard isn’t something that can easily be absorbed by organisations who are experiencing unprecedented demand for their services. 

This focus is going to become more high-profile as the year progresses, and we already know it’s going to be a difficult process and adjustment, but there are ways in which you can ready and prepare yourselves for it when it does come into play.  

It’s important to have the right systems and processes in place to enable you to meet the standard, and that’s something we can help with to ensure waiting times for mental health patients are adequately tackled and improved. Find out more here. 

As a company, we are always eager to help our team grow, develop and enhance their existing skillset. And ongoing learning is a key part of that.

So, with this in mind, we are delighted to announce that two of the Acumentice team will be carrying out apprenticeships with the Multiverse platform in partnership with Goldman Sachs’ 10,000 Small Businesses (10KSB) scheme.

Abigail Smith, a business analyst who joined us in March 2022 while still carrying out her university degree, is doing a course in data fellowship, which aims to develop her analytical skills with coding software and Excel/Power BI. The apprenticeship is set to end in early 2024.

Abigail said the course has already helped her to improve her time management skills, with the course coaches giving good advice and helping to adjust things when needed.

“The content makes the working day feel more active as you are continuously thinking about the learning, while the group events/seminars are really useful to build a sense of community and to get to know others on the course,” she added.

Meanwhile, Fizza Hassan – who joined us as a product manager in August 2022 after more than five years’ experience in a fast-paced scale-up – is undertaking a 13-month apprenticeship in Business Transformation.

The course is focused on developing business transformation skills, with a particular spotlight on digital transformation – something that is becoming ever-more important in all industries, none more so than healthcare.

“Multiverse uses innovative methods on its online platform to engage its students, but also provides a good balance of engagement with real people, giving you an overall great blended learning experience. The business transformation course looks at building data-driven cases to deliver strategic initiatives with an agile mindset and drive change in an evolving digital workplace,” she explained.

The apprenticeships are part of the inaugural Goldman Sachs 10,000 Small Businesses & Multiverse Accelerator partnership, which was formally launched on Tuesday 31 January at Goldman Sachs’ London HQ.

“In launching this partnership, it has been a privilege to spend time not only with 10KSB alumni, but also with the extraordinary individuals that make up their teams. It could not be clearer that a spirit of ambition, innovation and growth exists at every level, and we have the highest confidence that this fully-funded apprenticeship offering will prove immensely beneficial to your growth journeys, both as individuals and as businesses,” Goldman Sachs and Multiverse jointly stated.

Abigail, Fizza and our managing director, Karina Malhotra – herself an alumni of the Goldman Sachs 10KSB programme, which she graduated from at the end of last year – all attended the event, which included distinguished speakers from Goldman Sachs and Multiverse followed by a brilliant networking reception, where we were able to make a number of inspiring connections.

One of the speakers was Euan Blair, son of former PM Tony and founder of Multiverse, who talked passionately and articulately about his impressive vision for the platform and how it is trying to disrupt the traditional education market. To do this, he is aiming to give much better access to ongoing career education for those who may otherwise be marginalised.

Following this, Karina took part in a Q&A panel discussion with Charlotte Keenan (from Goldman Sachs) and Caspar Rose (CEO of Fresh Fitness Food and another former 10KSB alumni) on the importance of upskilling employees.

Karina said: “We are growing at a rapid pace and are so grateful that Goldman Sachs and the 10KSB programme continue to enable this, even post the programme! By giving us access to this excellent initiative with Multiverse, we are now able to offer amazing professional development programmes for our key people. Multiverse’s programmes are truly curated for the current world of work and the community they have created is impressive.”

She added: “I am really excited to see Abigail & Fizza grow as individuals and professionals in their field as well as help lay strong foundations for the future of Acumentice.”

What is Multiverse?

Euan Blair first founded the tech start-up in 2016 and, in 2021, it broke the record for the UK’s largest ever EdTech venture round. Multiverse’s main mission is to create a diverse group of future leaders, which it aims to achieve by offering high-quality apprenticeship programmes ‘that combine work, training and community’.

Since it was established, Multiverse has trained more than 5,000 apprentices in partnership with over 200 of the world’s best employers, with programmes ranging from business operations to data science to equip people with the skills needed for the future. It expanded globally in 2021 by launching in the US.

If you’ve visited A&E, tried to see a doctor over the past few months, or are on an elective waiting list for treatment at a hospital, you will likely have noticed drastic changes in waiting times and availability. 

Recent data shows that only 33% of people can get appointments on the same day with their GPs, with a staggering 21% having to wait at least a week or more to see a doctor. This could be one reason behind the total number of A&E attendances in December 2022 increasing by 21.8% on December 2021 with more patients presenting to A&E departments with minor conditions.

Unsurprisingly, the NHS is still recovering from the impact of COVID-19 and faces enormous challenges, including record waits in A&E across the country, patients waiting longer than a year for elective treatment at hospitals following increased demand, scaled-down healthcare services during the pandemic and long-term workforce shortages.

In the recent budget announcement, Chancellor Jeremy Hunt promised a further £3.3 billion in NHS funding for each of the next two years. Although this rise may give some hope of seeing significant changes in the NHS, the rising energy prices and inflation will likely consume the majority of the increased budget, leaving little to improve services.

Digging deeper, we analysed data and challenges from 2022 and explored approaches the NHS can take to move towards recovery.

Elective Care Waiting Times

Elective care is one of many areas still experiencing long waits. The number of secondary care hospital referrals taking over 52 weeks has increased drastically since Covid. What used to be a waiting list of around four million people pre-Covid has nearly doubled, and where patients would typically wait no longer than a year for treatment is now closer to two in many cases. It’s also important to note that these extensive waiting list figures do not include mental health treatment and only focus on physical care within hospitals. Mental health figures remain woolly and not as easily measurable, but it’s well known those services are just as challenged.

Not only are patients waiting for treatment, but they are also waiting on vital supporting equipment, such as wheelchairs or walking aids, with many having been forced to purchase these items with their own money where they are able to afford them due to extensive waiting times. Over a third (35%) of respondents admitted they did not have enough support from local services to manage their condition.

Addressing challenges at a granular level 

The cause of these issues is more than just staff numbers and the speed at which they can see patients. However, the workforce crisis and persistent understaffing are becoming ever-growing problems for the NHS. Recent research suggests the NHS in England alone is short of 12,000 hospital doctors and over 50,000 nurses.

Having said that, other factors are impacting these waits. Each region faces different challenges, suggesting the need for bespoke solutions to help improve the use of data, internal systems and processes, as well as collaboration and interaction across all aspects of the NHS; Primary, Secondary and Community care.

Our founder, Karina Malhotra, states: “Creating new systems and processes without a quick solution to poor performance is not going to support NHS recovery in the long term when they are not thought through. We must gather in-depth data to thoroughly evaluate a patient’s journey and identify the points where issues are created in each region at a granular level. No two journeys are the same, so you can’t apply a single size fits all method across each organisation. We must consider all dependencies within a complex system to create an effective solution.”

This can include but is not limited to understanding the demographic and population needs a practice or hospital serves. For example, if a trust is situated in an area where the population is primarily over 50, the health issues it will need to manage are very different to that of an area highly populated with children and the younger generation.

Prioritising local population needs can make the NHS equipped to deal with changes in requirements. This prioritising should not be based on age or population size but should also consider the areas that are more affected and susceptible to health inequalities.

New solutions to old problems

Changes are being made to the NHS to improve the efficiency of resources. One example is elective orthopaedic centres being set up to take ‘easy cases’ from hospitals with emergency departments. . These optimised centres can improve productivity with doctors performing treatments without the impact of emergencies using GIRFT principles.

Karina adds: “Whilst these new centres help significantly reduce the pressure on hospitals, not enough is being done to use these systems to the best of their capabilities.

“For example, many surgeons are hesitant to share lists and patients with other hospitals, which is only further adding to the long waiting times and other issues. More incentives, such as more funding for areas with increased activity, could help to see a change in collaborative working and improve these problems.”

But other than collaboration and incentives, how else can the NHS get closer to recovery? The answer isn’t as simple as creating more hospitals or a larger workforce. We also need to focus more on getting the most out of existing resources.

Whilst many new, innovative technologies are being brought into the NHS to improve productivity and efficiency, they need to be better integrated into existing solutions and be viewed as part of a bigger picture instead of an isolated system. There also needs to be more cooperation between technologies, and the collected data needs to be used more effectively to help make fundamental changes in the NHS.

One step closer to recovery – but by when?

Karina explains: “No one can give an accurate estimate of when the NHS will be fully recovered. National recovery targets are currently focused on eliminating 18-month waits by April 2023 and waits of longer than a year by March 2025 for elective care. This is an ambitious target already, and therefore recovering to waiting times closer to 18 weeks seem fairly distant at the moment. We also have to consider the current cost of living crisis and strikes and how these issues could create changes to funding or priorities.

“There is some hope around the corner, though, as the government is starting to focus on the waiting times crises. It has recently launched an Elective Recovery Taskforce which has been asked to advise the government on where the NHS can utilise extra capacity in the independent sector to treat more patients. This is welcomed by all of us as this should support in the short term in reducing the backlog of waits. 

“However, long-term solutions are still needed for the workforce and capital investment challenges that will need to be addressed for genuine recovery. The A&E crisis, which has come to a head during the winter months, needs urgent action but one which is comprehensive and sustainable, including a focus on gaining efficiencies wherever possible and finding areas to reduce waste, whether this is wasted time, staff or equipment.”

At Acumentice, we are stalwart supporters of the NHS and do not doubt that with the right funding and interventions, such a genuine recovery is completely possible. The workforce of the NHS is capable of amazing things – they now just need the support to do so.

Find out more about our recent work here, or stay up to date with our latest news on our blog.

It’s that time of year again. As we slowly get to those stubborn tasks that remain low down on the priority list, with a promise to commence 2023 afresh and make our new year resolutions, we took some time to take stock of what we have achieved. To ask questions of ourselves, like how have we grown, and how have we met our aim of making a healthier NHS.

It was not an easy year for many and especially the NHS – the ongoing post-pandemic recovery, the impact of the well documented strikes and increasing waiting times across all services, not to mention answering to multiple Health Secretaries! Through all these challenges, we have continued to stand by the NHS as a trusted partner, to deliver the innovative support that is needed now more than ever.

So what did we achieve in 2022?

As we delivered our expert support across multiple NHS organisations, 2022 has seen us grow more than ever before…

• We expanded the team threefold, with three additional roles coming up in January 2023
• New service offers were added to our wheelhouse under Data and Analytics
• We stepped up to solve new challenges in mental health and primary care
• Karina, our MD, successfully completed the Goldman Sachs 10ksb programme for high-growth businesses (you may have seen a post or two from her about this already!)
• Launched two product development streams (watch out for them in Summer 2023!)
• Last but not the least, our revenue grew by over 50%!

And next year, we plan to continue to build on this and achieve so much more!

How did we do it?

Our teams work endlessly with one ultimate objective in mind – how do we create and sustain a healthier NHS. In 2022, we did more of this than ever before by supporting both NHS staff and patient outcomes. As our expertise expands, we are taking on new challenges in primary care, secondary care, mental health and several Integrated care systems as well. We learnt that the devil is in the detail. One size never fits all and therefore, our granular data and evidence-led approaches are the most reliable way forward in designing the best solutions for our NHS partners.

We also never shy away from offering our passionate opinions on matters that impact the NHS, such as the Fuller Report, Community Diagnostics Hubs, the challenges in pursuing novel methods of prioritising Elective Waiting Lists, the Future of Healthcare through data and the recently commissioned Future Health Report on the pressures newly established ICSs face.

But who are we really?

As we grow, we have really taken some time to reflect on our values as a team in 2022. Sure, we all want to do a great job for our clients but who are we really and what do we stand for in this world? As usual, we had healthy debates for days till we settled on what we all agreed reflected us and our work both. We can sum this up in these 4 key values:

• In it together
• Brave
• Visionary
• Dynamic

If you have met any of us, we are confident you can see how these fit. We work hard to ensure we live and breathe these values and we will be talking a lot more about these in 2023 and why they are important to us.

With great growth comes great responsibility

Growth also means more responsibility. Therefore, this year we started integrating sustainability as one of the central objectives for the company. We are a small business but we don’t let that influence how big an impact we believe we can have on our environment – both socially and on the climate. Watch this space as we will have a lot more to say about what we are doing about this in 2023!

Stepping Into 2023

We are living in interesting times – tough in many ways but equally ripe for finding unique solutions for the different challenges we are all facing. And that is the motto we take into 2023 – “The obstacle is the way” – Marcus Aurelius, Roman Emperor, 180 AD.

This is the timeless art of turning trials and tribulations into triumphs.  As a strong values-led organisation with sustainability at its core, we know that we have so much value to add to our NHS partners and towards wider society and we are raring to go. We look forward to transforming all obstacles into our way forward. Bring on 2023!

Our brave, visionary, dynamic and in it together Acumentice Team wish you all a very happy Christmas and New Year!