Interim Insights: A conversation with Dr Simon Munk, Interim Implementation Director of Sustainability

We spoke to Dr Simon Munk, Interim Implementation Director of Sustainability on his career in sustainability and how he see roles within sustainability evolving in the future.

What made you want to pursue a role within sustainability given this has been a varied understanding of what it entails.

A deep concern about climate change, and particularly its impact on people led me into a career within sustainability. During my early career I spent time working in a rural medical clinic in Malawi, and later I was a member of leadership team for a youth conservation expedition to Bornean rainforest. During these times, I saw the early impact of climate change, reminding me, that not only is this work important here, but we must continue to think of the climate change impacts on communities elsewhere.

Being a doctor, I am always thinking about the health of my patients, as well as having a deep concern about biodiversity loss. It is important to recognise that health systems contribute significantly to this, with estimates suggesting that health systems globally account for about 5% of the worlds carbon footprint.

Whilst working clinically at the Royal Free Hospital in London I helped establish their original sustainability programme, and throughout my career I have provided strategic support to a number of campaigning organisations with regards to their sustainability strategies. However, it was over the last couple of years that I decided to pivot into applying all my health system strategy implementation experience into how we can decarbonise the health sector.  I see this as an implementation challenge; we know what we need to do, it is now about bringing the right people together and developing the right partnerships to make things happen.

What does a role in sustainability within the NHS encompass – there are strong drives to the estates and building infrastructure/decarbonisation but what more do you see?

There are several elements to building a strong and effective sustainability agenda – and whilst estates and building infrastructure is an important element of the NHS’s sustainability agenda, it is much broader than this alone.

To ensure success, there needs to be buy-in and support from the executive board, NED’s and the leadership teams. They need to see this a priority. Equally, frontline staff need to feel empowered to get involved, both in terms of changing the behaviour at work but also to leading initiatives. Where I have seen this work well in the NHS is where people have clear understanding on the data on what their carbon footprint is and what progress they are making towards decarbonisation.  

There are two other elements to consider when assessing healthcare decarbonisation, these being:

Transforming clinical pathways

• There is huge opportunity for decarbonising how healthcare systems deliver care to patients; whether via reducing unnecessary activity, reducing patient and staff travel, or thinking about waste reduction.  

Reviewing supply chains

• Similar to many organisations, over 70% of the NHS’s carbon footprint comes from its supply chain.

Helping the NHS to change its approach to working with its suppliers and ensuring that their suppliers are decarbonising that Supply Chain is a big challenge across medicines, medical devices and services. Bringing in academics and technical expertise to help this could help with developing solutions to lower carbon whilst maintaining clinical efficiency and cost effectiveness.

How do you get the board to prioritise sustainability and do they understand the actual impact this crucial area brings.

My recent experience of working with 20 plus NHS Trusts across London and Essex has highlighted that there is real varied level of maturity surround the NHS’s sustainability journey.  There are several actions that can help increase board and leadership support in this agenda.

Firstly, reminding NHS boards of growing regulatory requirements and accountability. NHS boards have already developed decarbonisation plans, but currently there is not much pressure for accountability to delivery on these. Though this is changing, and regulatory pressure is increasing on Ttrusts to act and deliver on their ESG agendas.

Secondly, reminding boards of the huge opportunities beyond carbon benefits, that decarbonisation brings. For the NHS, this also includes both clinical and financial benefits. Clinically, reducing carbon improves the health of the local community via better air quality and active transport, as well as the benefits of  lower carbon care often delivering better clinical outcomes to patients. Decarbonisation also has the potential for huge financial benefits; whether via switching to new energy contracts, retro-fitting estates and reducing energy demands, or from reviewing supply chains.

Other elements I discuss with boards is that there is both staff, and increasing patient pressure to deliver strong and effective sustainability agendas.  Employees across the NHS really care about this agenda and are pushing their boards to prioritise this. From a wider healthcare perspective, and especially in pharmaceutical or med-tech organisations, there is buyer pressure, with purchasers demanding decarbonisation and placing increasing pressure on suppliers to disclose what they are doing in this space.

Talk to me about your role as Interim Implementation Director for sustainability, UCLParters, what were the challenges you faced and how did you overcome these?

I have faced a number of challenges during my career, more recently encountering the varied level of sustainability agenda prioritisation across the NHS trusts. From increasing patient needs to reducing wait times post COVID, the NHS is under enormous pressure, which can prove challenging when building executive buy-in for the sustainability agenda. Deploying actions to help make like easier for executives and by focusing on the co-benefits of costs, clinical and carbon it can help with this.

There is often varied level of capacity and capability across the NHS teams, with sustainability teams ranging from 1-2 people, to having whole teams.  To support the NHS to accelerate its decarbonisation agenda, with limited capacity to do so can be challenging. We have been working on building capability via helping Trusts to measure and understand their baseline for their carbon footprint, as well as how to measure the impact of different actions, and enable them to prioritise their limited resources. We have also helped Trusts to develop their capabilities in the energy and retrofitting and procurement spaces, which in turn helps staff better deliver across the decarbonisation space.

Another challenge faced is siloed working. Typically, NHS trusts have seen sustainability as an estate’s agenda, and whilst estates and facilities are an important element, to be effective and long-standing, the sustainability agenda must also engage with clinicians, executives, innovation, and procurement leads. Linking different teams allows trusts to also build capacity.

Lastly, supply chain is important. The NHS is at an early stage of thinking of decarbonising its supply chains.

There is a framework in place for how it will increase the expectations on suppliers, but from my experience, NHS Trusts are really struggling to know how to start. Utilising data to prioritise their top suppliers has been helpful. Many organisation may have 100s of suppliers, though often we find that most of our carbon footprint is within the top 30-50 suppliers. If Trusts begin to engage more with their suppliers, setting out their expectations and providing ideas on how supply chains can develop  low carbon solutions right across the life cycle, we could see real innovation.

Do you have any advice on how clients can best utilise their data to prioritise action?

Data is crucial.

Firstly, we need to support the NHS to interpret the data and build an understanding and measurement of their carbon footprint, before using this knowledge to identify what they need to prioritise.

Secondly, helping executives understand the data to see the co-benefits of decarbonisation actions, reiterating that it is not just carbon data, but that it includes finance and clinical activity data. By prioritising carbon reduction, you will also save money and/or improve clinical outcomes.

It is also important to not just show the baseline data, but to also use this to measure progress against decarbonisation plans, identify the challenge points and highlight the quick wins.

Data can also help with understanding supply chains. Though, currently there are data limitations here, due to supply chain data often focusing on financial and activity data, as opposed to proper life cycle analysis. It is important to speak with suppliers about their supply chain decarbonisation actions, and increasingly promote the need for  transparency between suppliers and healthcare systems.

What do you think are the wider challenges faced by the NHS in their journey for decarbonisation, and what do they need to consider when setting up their ESG Strategy?

The NHS ESG agenda needs to be broader than just estates and facilities retro-fit by also including procurement and clinical teams.

I think one of the challenges the NHS is facing is how to learn from other sectors. They need to start seeing ESG as not just seeing this as an NHS challenge, but recognising that other sectors are often well ahead in their decarbonisation journeys, and have elements that could be implemented into the NHS. This could include retrofitting estates, reviewing energy solutions and approaches to supply chain engagement.

Another important aspect that is relevant to the healthcare systems is the need to focus on adaption and health system resilience. From an ESG perspective, there is a need to consider how to decarbonise activities as well as health systems needing to prepare for the impacts of climate change on patients. The NHS is already seeing an increase in prevalence of heat related and infectious diseases, and it will continue to do so. They need support in planning for this and as well as ensuring that their estates are resilient to extreme weather events.

Lastly, as healthcare organisations think about the ESG agenda, there is a need to think beyond the environmental factors and start to think of the social role and how this impacts the local community. This can cause trade-offs between what will work in the interest of your local community and what will have the most impact on decarbonisation, for example, do you purchase from your local supplier as opposed to the suppliers that have the best carbon record?

What would you say are your career highlights / where have you been able to have the biggest impact?

One of my real career highlights has been the recent work I have undertaken across London. Despite all the other pressures the NHS is experiencing, I have been able to build momentum and secure executive buy-in across about 15 NHS trusts in London. I have assisted in getting these NHS trusts to explore power purchase agreements, examine solutions to better retrofit their estates, as well as introducing academic collaboration.

How do you see roles within sustainability evolving in the future?

From a healthcare specific focus, the changes I have seen since my early career working at The Royal Free Hospital have been vast. Back then, the issues were more around the “why”; why was it important, why were we campaigning for this and why should it be a priority. Now, the focus is more on the “how”; and it is more an implementation challenge. We know we need to implement change but can struggle with how we do this effectively.

A further reflection is how I see the role of the sustainability consultant evolving across the sustainability sector. Often to date, sustainability roles have been held by those with estates or energy backgrounds, and whilst these skills and knowledge is essential, there is a growing need for other skillsets. Strong leadership, implementation and strategic stakeholder engagement skills will help to bring teams together, gather board buy-in and bring together the technical expertise of colleagues.