Sustainable Healthcare - Q2 2021

Sustainable Healthcare A Mediaplanet campaign focused on

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“The saying ‘never waste a good crisis’ is more apt now than ever before.”

- All-Party Parliamentary Group on Health

Q2 2021 | A promotional supplement distributed on behalf of Mediaplanet, which takes sole responsibility for its content

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“Creating a sustainable health service requires not just additional investment, but a change in mindset, culture and practice.”

- Medical Technology Group

Read more at www.businessandindustry.co.uk

IN THIS ISSUE

Repurposing generic medicines in the fight against COVID-19

Embedding sustainability into health policy

Carol Blount NHS Partnerships Director, British Generic Manufacturers Association (BGMA)

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The saying “never waste a good crisis” is more apt now than ever before.

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ublic awareness of both public health and climate change has never been higher and the two are becoming increasingly linked in the mind of the public, as well as policymakers. Alongside this, the COVID-19 pandemic has led to a series of legislative and policy proposals regarding the organisation and delivery of services from public health to primary and secondary care.

Three ways digital technology can help the NHS deliver greener and better care Pritesh Mistry Fellow, Digital Technologies, The King’s Fund

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Embedding sustainability into healthcare Lottie McMahon Sustainability Lead, ABHI

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Identifying innovation The first step in ensuring that this crisis is not wasted is collecting examples of best practice. We need to see what’s already working to recover and reimagine a sustainable health service geared towards the needs of the population now and in the future.

Several steps that represent a shift towards sustainable healthcare and improved patient experiences have been accelerated during the pandemic, including, for example, the use of innovation to digitise aspects of the health service. The NHS has introduced several measures at pace during the pandemic including use of telehealth appointments and medication reminders, virtual neurorehabilitation and virtual wards. These innovations offer alternatives to hospital visits that manage time and resource effectively whilst responding timeously to patient need.

Embedding sustainability These examples can influence policy to ensure that sustainability is embedded into proposed changes to health care delivery. The NHS Health and Care Bill will be presented before Parliament in 2021. The Bill offers the opportunity to embed innovation; the focus on integrated care also promotes sustainability in other ways through data sharing, personalised care, treating patients in their preferred place of care and distributing resources according to the needs of the population.

Further organisational changes include the structure of public health including the formation of the UK Health Security Agency and the rest of public health being brought into the Department of Health and Social Care.

These reforms have the potential to aid a shift towards a preventative health service if applied effectively.

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To ensure a sustainable health service, fit for purpose now and in the future, policy makers must ensure that legislation reflects the needs of the population.

Effective policy making To ensure a sustainable health service, fit for purpose now and in the future, policy makers must ensure that legislation reflects the needs of the population.

The All-Party Parliamentary Group on Health is one forum for this. The group provides an opportunity to hear the voices of industry and innovators, health service leaders and patients. It brings together a cross-party group of parliamentarians and is committed to a collaborative approach, promoting better public policy.

To find out more visit policyconnect.org.uk/aphg

WRITTEN BY

Dr Lisa Cameron MP Chair of the All-Party Parliamentary Group on Health (APHG)

Contact information: uk.info@mediaplanet.com or +44 (0) 203 642 0737

WRITTEN BY

Becky Rice Health Policy Manager, Policy Connect

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A rise in remote consultation drives new momentum for change Restrictions on healthcare access as a result of COVID-19 have led to an unprecedented digital transformation within healthcare.

T INTERVIEW WITH Ranjan Singh CEO & Co-founder, HealthHero WRITTEN BY Mark Nicholls

he events of the past 18 months have created a historic tipping point for digital, with more of us turning to digital services than ever before. Healthcare is no exception: digital innovation that may normally have taken years to implement has been delivered for clinical application within weeks, days and in some cases, almost overnight.

HealthHero CEO and Co-Founder, Ranjan Singh, argues that as with other sectors, there can be no going back.

Fundamental issues The pandemic lent new urgency to challenges that surround patient access to healthcare, inconsistent patient outcomes and a lack of capacity.

Singh says: “For the majority, accessing healthcare is still a one-size-fits-all experience, whether you have flu, need a prescription for a chronic illness, or need support to manage your mental health. At the core of this has always been fundamental, structural issues underpinned by a need to resolve patient experience and outcomes on the one hand, and system inefficiency and capacity on the other.”

COVID-19 has been a powerful catalyst for change, with patients and doctors switching to virtual consultations because of social distancing and clinics closed, but according to Singh, it’s an acceleration of a transformation that was long overdue.

Patient experience Pre-COVID, digitisation of healthcare was slow, focused on appointment bookings and some video consultations. While this marginally improved the patient experience, it did little to alleviate pressure on the NHS. Later, end-to-end digitisation of the process filtered in, but as Singh remarks, “…that was just digitalising an inefficient, existing process.”

As CEO and Co-Founder of HealthHero, an NHS integrated urgent care provider offering remote access to experienced doctors and expert clinicians for patients, he believes that: “We are at an inflection point: the NHS and policy-makers have a unique opportunity to harness and accelerate further digital innovation in healthcare to radically increase efficiency and improve both the patient and staff experience.”

HealthHero uses artificial intelligence-led medical grade clinical triage tools to guide patients in the right direction. The service is always free at the point of use to the patient, accessed through the NHS 111 pathway, or for private users, via their health insurer and company portals.

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Increased efficiency Alongside phone or video consultation, HealthHero provides access to a clinician through a variety of channels. This enables physicians to respond in less time or direct the patient to a relevant specialist or treatment pathway.

A class one medical device approved by the MHRA (Medicine and Healthcare Regulatory Agency), HealthHero has also achieved two CQC (Care Quality Commission) outstanding ratings in a row as well as the ISO standard for telemedicine.

“By bringing these channels and tools together into the platform, we marry a better, faster experience for the patient with greater efficiency for the healthcare provider, and the system overall,” says Singh. “And what we’ve seen is that 30-40% of people who use our platform do not need to see a doctor.”

Holistic service HealthHero is not a replacement for the doctorpatient process. Instead, it’s a smarter step that saves time, increases efficiency and alleviates the burden on the NHS, reducing the need for patients to travel to a clinic.

“Telehealth provides care where people are most comfortable - in their homes,” Singh adds.

“Through connected devices, you can do remote monitoring, have constant data access and provide high-quality care.”

COVID created the conditions where this shift became not just desirable but a critical necessity, with, according to Singh, “years of progress made in a few months.” But he also knows how important it is that the transformative momentum of the past year is maintained: “The digital transformation of healthcare has a long journey ahead - our priority is to simplify healthcare for patients and staff, ultimately improving lives.”

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HealthHero is a pan-European digital healthcare provider, currently operating in the UK, France, Germany and the Republic of Ireland. Covering 23 million individual lives and 1,000 businesses, it expects to conduct three million consultations this year alone. healthhero.com

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Through the keyhole – a glimpse of a more sustainable health service Growing pressure from chronic conditions and the impact of COVID-19 means the NHS must look towards medical technology to create a more sustainable future.

A WRITTEN BY Barbara Harpham Chair, Medical Technology Group

round half of people aged 65 and over in England have at least two chronic conditions1 and, with the number of those 85 and older set to double by 2025, analysts predict a burgeoning older population with complex multi-comorbidities.2 The COVID-19 pandemic has intensified this challenge, presenting the problem of treating millions of patients waiting for non-urgent care because of delays. The crisis has accelerated the adoption of innovative medical technologies – from diagnostic devices to artificial intelligence systems for detecting cancer; that pioneering spirit now needs to be harnessed to stimulate the uptake of technology that improves patient outcomes and increases healthcare efficiency.

Minimal invasion – maximum benefit First pioneered by interventional radiologists, minimally invasive procedures and diagnostics such as endoscopy, microsurgery, keyhole surgery, robotics and medical imaging can now be used to treat a plethora of conditions, from heart and orthopaedic surgery to organ transplants.

These techniques offer a host of benefits. Unlike traditional surgery, they require small incisions, which heal quicker, and local - rather than general - anaesthetic. They are less painful for the patient, shorten recovery time and lower the risk of infection.

Minimally invasive procedures are also a more efficient way of treating patients, increasing accuracy, while reducing the risk of complications such as haemorrhaging. Meanwhile, robotics reduce variation in technique and improve clinical outcomes. By limiting overnight stays and reducing followup care, minimally invasive procedures also bring down costs.

Working towards a more efficient health service The Government recognises the need to invest in managing long-term healthcare demand and to address the COVID-19 backlog. However, compared to other Western European countries, the NHS lags in terms of efficiency. Spain, for example, has the healthiest population in the world3, yet spends half the UK budget per capita on healthcare; the UK by contrast ranks 19th in the healthiest population index.4 In its 2018 NHS spending review, the Government allocated just 5% of the additional budget to medical technology despite solutions, such as minimally invasive procedures, having the potential to treat more patients in less time and improve outcomes.

Creating a sustainable health service requires not just additional investment, but a change in mindset, culture and practice.

Repurposing generic medicines in the fight against COVID-19 While vaccines play a critical role in protecting society and getting us out of the grip of COVID-19, generic medicines are what have saved many thousands of lives.

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he vast majority of medicines used to treat hospitalised COVID-19 patients – including those requiring ventilation – are generic drugs. Four out of every five NHS prescriptions are generic medicines. Despite the enormous challenges caused by COVID-19, generic medicine supply has been a success, with no patients going without treatment.

The first medicine found to help treat patients suffering from COVID-19 was a genericised corticosteroid product called dexamethasone. Previously, the medicine was used to treat a wide range of health conditions, including severe skin conditions, anaphylaxis and autoimmune conditions, such as Lupus.

Repurposing generic medicines However, a clinical trial supported by the National Institute for Health Research (NIHR) found that dexamethasone could be repurposed.

This generic medicine significantly reduced the risk of dying from COVID-19 for patients requiring respiratory intervention. It was a breakthrough. Not only was it the first drug found to treat COVID-19 sufferers, but as a generic, it was widely available in large quantities and affordably priced. Use of dexamethasone for COVID-19 has so far saved 22,000 lives in the UK and an estimated one million worldwide.

Repurposing existing generic medicines is an untapped but vital way of discovering new treatments.

These treatments are inherently affordable because the drugs are off-patent. Generic manufacturers already have the requisite supply chains in place, well-established regulatory departments and pharmacovigilance systems to monitor safety.

Policy interventions are needed However, the NHS and patients will miss out on repurposed medicines without policy interventions. Generic manufacturers rarely conduct clinical research because they cannot afford it. It’s a low margin business. If one generic company is given a firstmover incentive to lead the way in licensing the new indication, the others in the market will quickly follow, with no change to generic prescribing and dispensing practices.

Finding an incentive for the first mover is essential. We believe solutions need to be transparent, simple to administer and avoid complexity. Recently, a NHS England repurposing report recommended creating a ‘catalyst’ fund solution for high-priority areas for the NHS. Over three years, NHS England needs just £10.5 million to support two to three repurposed medicines through the regulatory process.

Incentives for repurposing medicines NIHR’s work has put the UK in a world-leading position for medicines repurposing. But, it’s a position that will be lost to other countries unless the Government makes a significant investment in repurposing drugs.

If we can get the incentives right, the NHS, industry and patients will benefit from innovative yet affordable treatments. Innovation doesn’t always mean expensive. Re-examining our existing drugs can bring affordable and substantial patient benefits.

WRITTEN BY Carol Blount NHS Partnerships Director, British Generic Manufacturers Association (BGMA)

References 1. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model, Andrew Kingston, Louise Robinson, Heather Booth, Martin Knapp, Carol Jagger, for the MODEM project, May 2018, https://doi.org/10.1093/ageing/afx201 2.Ibid.

3. Bloomberg Healthiest Country Index 2019: https://www.bloomberg.com/news/articles/2019-02-24/ spain-tops-italy-as-world-s-healthiest-nation-while-u-s-slips 4. Peterson-Kaiser Health System Tracker: https://www.healthsystemtracker.org/chart-collection/ health-spending-u-s-compare-countries/#item-average-wealthy-countries-spend-half-much-perperson-health-u-s-spends

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Partnerships and innovation are key to improving healthcare The pandemic has put pharmaceutical companies into the spotlight, however their value is not just in supplying treatments but partnering with the system to support progress.

B WRITTEN BY Katie Noon Health Economics & Outcomes Research Lead, Bristol Myers Squibb

Katie Noon is part of the Health Economics and Outcomes Research team at Bristol Myers Squibb which generates evidence of the value of new drugs to enable decision-makers within the NHS determine the funding of new treatments. It also helps to build stronger connections with partners to better serve patients’ needs.

efore working at Bristol Myers Squibb, I’d assumed that the pharmaceutical industry wholly focussed on providing new treatments to patients. Of course, developing new treatments for patients that help them to manage their disease, stay well and live life to the full, in itself is an incredibly complex task.

But it’s appreciating the network of activity that goes on all around this core purpose that has been a huge learning experience for me. An experience that I believe the wider public and media are understanding more, particularly in the wake of the pandemic.

Pharmaceutical companies connect multiple stakeholders and engage in partnerships which have far-reaching and long-term impacts on the way that health systems operate, and how professionals provide medical assistance to those most in need.

The delivery of drugs is crucial, but so is everything else on the patient journey, from early diagnosis to providing emotional support throughout treatment.

From my perspective, that is what I believe is the true purpose of the pharmaceutical sector. It is an enabler as well as a provider, excelling in strategic and process-driven approaches that help both the pharmaceutical industry itself and others to function more effectively.

Collaborating for change Since I joined the company, what struck me was how quickly a conversation between a healthcare professional and industry can drive real changes to clinical practice. One recent example led to a pilot of annual pulse checks for diabetic patients to spot signs of non-valvular atrial fibrillation, which affects 200,000 people in the UK annually and raises the risk of stroke.1 This simple idea - spawned from an informal talk between a healthcare partnership manager at BMS and an NHS Cardiovascular Disease (CVD) Programme Lead - has the potential to prevent 340 strokes and save the NHS £7.9 million each year.2 Partnerships like this can bring simple innovative ideas into practice, helping to improve patients’ quality of life and reduce the burden on the health service.

We’ve also seen industry play an important role in response to the pandemic, from the work to

develop vaccines and treatments to supporting the NHS respond to the backlog of non-COVID healthcare needs.

With hospitals overwhelmed by COVID-19 patients, the NHS experienced interruptions to cancer services and treatment capacity issues due to the need for social distancing. To help the continuation of services, BMS partnered with a provider of Mobile Cancer Care Units, building two new units that will help bring treatment and services closer to patients’ homes.3

Working with industry brings commercial values of speed, expertise and relationship networks which complements and adds value to the NHS, to bring about better outcomes for patients.

– CVD Programme Lead, Academic Health Science Network for the North East and North Cumbria

Working towards sustainable change for patients Discovering how we within the industry can be accountable for sustainable changes to the healthcare system beyond the delivery of drugs, has inspired me to think of new ideas within my own role and I feel it is vital that everyone has the opportunity to explore these ideas.

Perhaps one of the most significant shifts from this past pandemic-scarred year is that a wider audience has been given more insight into the way we work.

It is not simply about medicines, but we are also in a unique position to innovate through collaborations for the greater good and to bring meaningful change to both our industry and the wider healthcare network.

References 1. Martinez C, Katholing A, Wallenhorst C et al. Increasing incidence of non-valvular atrial fibrillation in the UK from 2001 to 2013. Heart 2015;101:1748–1754.

2. BMS internal data 3. Bristol Myers Squibb: Delivering Care and Support to Communities Across the UK. Available from: https://standing-united.com/bristol-myers-squibb/ Last accessed: June 2021

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NO-GB-2100155 June 2021

Visit bms.com/gb to see how we’re discovering, developing and delivering innovations to support our communities. © 2021 Bristol-Myers Squibb Company. All rights reserved. NO-GB-2100155 June 2021

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WRITTEN BY Dr Pritesh Mistry Fellow, Digital Technologies, The King’s Fund

How can innovation support Three ways digital technology can help the the NHS net zero target?

NHS deliver greener and better care

We know digital will be an essential part of the future of the NHS, but it can also support the NHS to play a part in tackling climate change.

Innovation is instrumental to the NHS achieving its target of becoming carbon neutral by 2040.

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ver the past 10 years there have been multiple initiatives to increase how digital technologies are used for health care. The pace of change has been slow, but now the pandemic has accelerated the use of technology in the NHS. While much of the focus has been on how technology can make health care more efficient, how can the NHS use digital technology to reduce its significant greenhouse gas emissions?

Reducing the need for travel NHS emissions are equivalent to 4% of England’s total carbon footprint.

Cutting emissions isn’t just good for the environment, but good for our health as well: it reduces the use of fossil fuels that cause air pollution, a source of ill health.

Digital can help patients by making it easier for those who live or work far from their GP or hospital to be able to access care at the touch of a button – avoiding journeys and the associated emissions while still receiving highquality care.

Reducing the need for healthcare As well as treating illness, the NHS is now charged with improving the health and wellbeing of local communities. Technology in the home, simple and sophisticated, can support the NHS in this aim, by informing both staff and patients themselves of how they are managing an ongoing illness, without having to be in the hospital.

Devices like wearables, data from our phones and information on the internet (e.g. NHS.net), all have a part to play in helping people understand

how their lifestyle impacts their health and the positive ways to manage their wellbeing.

If successful, in the longer term they will moderate the demand growth through fewer hospital visits and treatments, decreasing the number of patient journeys, reducing use of hospital facilities and fewer surgical interventions with lower release of anaesthetic gases into the atmosphere (one hours use can be equivalent to a 200 mile car journey)

Digital can help patients by making it easier for those who live or work far from their GP or hospital to be able to access care at the touch of a button.

The NHS as a greener consumer Digital devices and connectivity are an essential part of digital transformation but require mined materials and power for manufacture and use. All which contribute to climate change and ecological damage. The NHS can play a part in incentivising digital health companies to be transparent on their green credentials and instigate improvements to be greener.

Using tech to improve care by having more care closer to home, better management of health and wellbeing and being more selective when buying tech means better care and becoming a greener health care system.

WRITTEN BY Kathy Scott Director of Operations and Deputy CEO of Yorkshire & Humber AHSN and Lead of the AHSN Network Sustainability Community of Interest Group

lobally, greenhouse gas emissions from healthcare are equal to the airline industry. The NHS contributes the equivalent of 4% of England’s total carbon footprint. Recognising climate change’s threat to health, the NHS has become the world’s first healthcare system to commit to reaching carbon net zero by 2040.

Although healthcare delivery is complex, there are many direct measures that can help tackle climate change, such as providers switching to renewable energy and reducing waste.

However, there are also innovative indirect measures that can have an impact by reducing the need for patients to attend services.

Reducing waste Remote patient monitoring (RPM) not only supports social distancing by reducing face-to-face appointments, but also reduces unnecessary journeys for patients and staff.

During the first wave of the pandemic, the AHSN Network - the innovation arm of the NHS and collective voice of England’s 15 Academic Health Science Networks (AHSNs) supported local healthcare services to accelerate roll-out and uptake of online patient triage by GP practices and remote consultations.

During the second wave, we built on this knowledge to further support frontline services with spread and adoption of RPM. AHSNs supported the roll-out of in-home oximetry devices with the ‘COVID Oximetry at Home’ initiative.

Often there is a way where we can improve patient outcomes, and reduce NHS costs and environmental harm at the same time.

Preventing illness Procurement links to 62% of the NHS carbon footprint. From February to July 2020, the NHS consumed 3 million items of PPE – almost all single use. During the pandemic, AHSNs collaborated with partners to investigate reusable solutions.

However, to really address the challenges, we must get better at preventing serious illness through the development of new pathways, products and practices. Often there is a way where we can improve patient outcomes, and reduce NHS costs and environmental harm at the same time.

For example, last year over 40,000 pregnant women benefited from innovative tests for pre-eclampsia. AHSNs supported the roll-out of Placental Growth Factor (PlGF) tests, which speed up diagnosis and treatment for women at risk of developing severe complications. We estimate that in 2020/21 PlGF saved approximately 1,149 tonnes of CO2e, equivalent to 3,043,660 miles driven.

Embracing change COVID-19 has encouraged us all to embrace change. RPM is likely to become a healthcare mainstay in the wake of the pandemic. Not only does it support the delivery of highquality care to a growing and ageing population, but it can also help reduce carbon emissions, contributing to the NHS net zero target.

References https://www.ahsnnetwork.com/more-than-40000-pregnant-women-have-benefitedfrom-pre-eclampsia-test-following-national-ahsn-rollout

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Embedding sustainability into healthcare Sustainability is impacting all our lives, and with the NHS setting out clear sustainability targets, healthtech has a critical role to play.

S WRITTEN BY Lottie McMahon Sustainability Lead, ABHI

ustainability is increasingly significant to all our lives. Last year, the NHS set out a bold ambition to become the world’s first carbon net zero national health system by 2045. As a key part of the global supply chain, and its subsequent footprint, the healthtech industry has an important role to play.

However, for an industry with regulation at its core, and many other facets that determine the adoption and spread of technologies, such as NHS procurement, health policy and funding, a holistic approach needs to be taken on how this is implemented.

The regulatory balancing act Sustainability is not straightforward for the healthtech industry, there is a complex interplay between clinical risk and environmental impact. The surge in demand for single-use PPE to combat COVID-19 has demonstrated this on a global scale.

Regulation, however, can be a useful tool for driving new sustainable practices. But, for an industry that is made-up predominantly of small and medium sized enterprises (SMEs), we must be mindful that any changes to regulation reflect this balancing act and do not create undue burden.

Sustainability in purchasing Procurement is another important way for the NHS to achieve their targets, however, as with regulation, it needs to be well thought through in collaboration with industry. The healthtech sector is heavily engaged with the sustainability agenda and there is a desire to make sure

that this does not become a tick box exercise, designed with good intentions, but with ineffective results.

A set of sustainable procurement principles, designed in collaboration with the NHS and industry could ensure NHS organisations are all engaging with sustainable suppliers, with a consistent level of effective criteria that embeds sustainability into purchasing decisions. At the ABHI, our dedicated Environmental Sustainability Group will be heavily engaged with the NHS and the wider healthcare community to realise such aims.

A set of sustainable procurement principles, designed in collaboration with the NHS and industry could ensure NHS organisations are all engaging with sustainable suppliers.

A future with sustainability at its core The pandemic has demonstrated, like never before, the value of close collaboration between the healthtech industry and the NHS. Lord Bethell, remarked at ABHI’s recent regulatory conference that it was the healthtech sector that “stood up first at the onset of COVID-19, and it is the healthtech sector that the NHS will depend upon as it looks to restore its services to pre-pandemic levels.” If the NHS net zero targets are to be achieved, we must maintain this level of collaboration and engagement well into the future, with sustainability at its core.

Digital move leads to better outcomes

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Sustainability, says: “That means a fundamental shift away from care happening to a patient, to seeing and treating the patient as a care collaborator. “That will enable a patient to truly understand their condition and give them the tools to support the ongoing self-management of it. If the patient’s condition gets worse, they know ahead of time where they can get help.”

Great use of digital tools and virtual consultations within the NHS will lead to better patient outcomes and make significant inroads into reducing the carbon footprint of health and care services in the UK.

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mpowering patients to take control of their health via digital tools can have environmental benefits and lead to a more sustainable healthcare system.

Experts say that by giving patients access to their electronic health records and enabling them to play a bigger part in the management of their care will also result in better outcomes as well as support NHS England’s target of being net zero for carbon emissions by 2040.

Find out more at patientsknow best.com/green

Net zero Former BMJ editor Dr Richard Smith says the UK’s health and social care system is not financially, socially and environmentally sustainable and currently produces about 5% of Britain’s carbon emissions.

Dr Smith, who is Chairman of the Patients Know Best (PKB) social enterprise organisation, suggests that achieving net zero emissions will require huge change in the way the health system works, with virtual consultations as an element of that.

He adds that a growing number of patients who have long-term chronic conditions will benefit from using digital means to play an increased role in their care.

Fundamental shift PKB aims to put patients in control of their medical records, supported by educational materials and available in 22 different languages, patients can better understand their condition and use the platform to interact with care services differently.

Tom Gausden, PKB’s Lead for

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Empowering patients Patients having virtual consultations and not attending clinics reduces the carbon footprint, but PKB suggest it is much more than that.

“The actual benefits come from empowering patients to know more about their condition, to better manage it themselves and interact with health and care professionals earlier in terms of any exacerbation,” says Gausden.

Examples include a gastroenterology service in Luton where patients were asked to track symptoms over time and send a message if they noticed their condition started to deteriorate.

“That led to savings being made and emergency admissions/ surgeries, which are carbon heavy and unnecessary outpatient appointments being avoided,” he says.

INTERVIEW WITH Tom Gausden Senior Business Manager and Lead for Life Sciences and Sustainability, Patients Know Best

INTERVIEW WITH Richard Smith Chairman, Patients Know Best, member of the NHS Sustainable Development Unit’s Advisory Group, and former Editor of the BMJ WRITTEN BY Mark Nicholls

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