The first question to ask when endeavouring to make improvements in the management and analysis of healthcare data is what is the objective? Why bother making amendments if there is already an adequate process in place?
From a clinical perspective, the primary purpose of constantly interrogating healthcare data is to make sure patients get the best treatment possible.[1] Effectively utilising data can inform long-term and personalised prediction models regarding prognosis and health status thus reducing the time and resources spent on getting to a diagnosis. The right data can also be used to streamline care provision such as improving the waiting time to be discharged with better social care put in place and improved primary care to reduce the demand on A&E. These types of efficiency methods will contribute to a low carbon health care system. Breakthroughs in research and innovation that will power new medical treatments provide motivation to improve the way data is collected and analysed. [2]
If patients get the right treatment the first time, long term there will be less strain on the system and the Scope 3 emissions associated with patient and staff travel will lower. In Delivering a Net Zero NHS, it was estimated 3.5% (9.5 billion) of all road travel in England relates to patients, visitors, staff, and suppliers to the NHS, which contributes to around 14% of the organisation’s total emissions.[3] There is immense potential to lower the NHS’ carbon footprint if evidence-based targets and good data are used to unpin a commitment to better public health and wellness that causes less stress on the system.
As well as improving the quality of care, the right data can improve the population's health through the proactive targeting of services. Taking a comprehensive approach, if we build a healthier community, we will improve the health of the people as well as create a nicer environment to live in. A fitting example of this is the “Bristol One City Approach” whereby a range of public, private, voluntary, and third-party sector partners come together with Bristol Council and the local NHS trusts to make the shared vision of Bristol being a fairer, healthier, and more sustainable place to live a reality.[4] This community lead approach can be tangibly linked to the 17 United Nations Sustainable Development Goals and using these global goals as a framework guarantees a holistic approach can be maintained.
The ‘One City’ document covers six themes (Economy and Skills, Children and Young People, Transport, Homes and Communities, Environment and Health and Wellbeing). [5]The plan to tackle these six areas has been strategically thought out, with year-by-year goals being put in place until 2050. With improved data analytics continually measuring progress, it provides the NHS with a consistent awareness of how they are performing on key sustainability topics as well as the opportunity to celebrate success and focus on areas that are underperforming and why.
Better scrutiny of data can also ensure greater success when planning and attempting to improve current services, including sustainability initiatives like procuring materials from the supply chain that have greener credentials. Understanding supply chain data is vital in inspiring greener procurement choices. It can provide transparency and allows the NHS to confidently make decisions that balance safe and sterile treatment needs with their environmental impact.[6] By mapping their supply chain and collecting data from their 80,000 suppliers on their sustainability credentials the NHS can analyse the benchmark for commonly procured items and calculate the environmental impact of each product across its lifecycle.
This will help identify heavy-emitting suppliers and create transparency in baselines and targets. Interrogation like this requires data sources that break down lifecycles and allow for like-for-like comparisons on different materials/equipment with the same functionality. Looking at suppliers with already low carbon footprints or novel technologies will help the organisation meet its sustainability goals by 2045. From here, procurement options can be chosen where there is a less carbon intensive extraction of materials, lower transportation emissions, a greater ability for reuse or refurbishment and less end-of-life waste.
The NHS has approved a roadmap to help suppliers align with their net zero ambition between now and 2030. From April 2022, all NHS procurements will include a minimum 10% net zero and social value weighting. From April 2023, for all contracts above £5 million per annum, the NHS will require suppliers to publish a Carbon Reduction Plan for their UK Scope 1 and 2 emissions and a subset of Scope three emissions as a minimum. By incorporating environmental standards into purchasing agreements it will boost the demand for more sustainable textiles and related services and thus stimulate greener innovations across the healthcare supply chain.[7]
This is a terrific opportunity to create a more resilient supply chain more equipped for a sustainable future and minor changes can make a stark difference. It is estimated if the NHS had an uptake of 30% of a lower carbon inhaler, it would reduce emissions by 374ktCO2 per year. [8] Straightforward things like upgrading inventory management systems ensure sustainable practices with data are embedded into day-to-day operations. It ensures the products that are due to expire first are used and staff can get a better gauge of demand to prevent over ordering in the future.
There is a great burden placed on the NHS to collect data on their services and how well they are caring for their service users. Yet this collection process can be done to a point of excess, if the data is collected with a purpose in mind, it will remove unnecessary bureaucracy and this time can be put back into the direct care of patients. To realise our vision of a truly sustainable healthcare sector and decarbonise our clinical pathways, data and data driven innovations must be at the heart of every level of decision making.
Without widespread access or dedicated analysis of timely and accurate data the NHS cannot maximise the opportunities to improve care for all patients nor can the effect of the healthcare system on our physical environment be mitigated. From speeding up diagnosis to planning local services, researching new treatments, and hitting sustainability aspirations; good data has the potential to save lives, costs, and emissions.
Eliminating speculatory hypotheses and existing biases with the right data regarding executing sustainability plans and interventions on issues like overconsumption and poor waste management as well as encouraging greater collaborative, circular economy thinking within procurement can ensure services and activities are streamlined.[9] Thus, wasteful costs and carbon activities can be eliminated from the system and free up resources to put back into patient care. There is also potential for revealing new targets for an improved, sustainable healthcare service delivery with data driven innovations.
There is a huge amount of NHS data sitting in patient and supply chain databases designed to improve care delivery, support aetiological research, and inform policy development. NHS Digital collect and curate around 200 data collections from health and social care organisations in England.[10] To give an insight into the sheer volume of data at the fingertips of NHS professionals, Open SAFELY, a secure analytics platform for electronic health records has over 70 BILLION lines of data entry.[11] Data alone cannot provide insights, the concern within the NHS is the quality of analytic work…
This forms the first part of a 5 blog series on Data in Healthcare. Next week we will look at the current issues surrounding NHS data.
[1] Keith, J., Grimm, F. and Steventon, A. (2022). How better use of data can help address key challenges facing the NHS - The Health Foundation. [online] www.health.org.uk. Available at: https://www.health.org.uk/publications/long-reads/how-better-use-of-data-can-help-address-key-challenges-facing-the-nhs.
[2] Shah, A. (2019). Using data for improvement. BMJ, [online] 364(189), p.l189. Doi: HTTPs://doi.org/10.1136/bmj.l189.
[3] NHS England (2022). Delivering a ‘Net Zero’ National Health Service. [online] Available at: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf.
[4] bdesign_@boc_editor (2019). The One City Approach - Bristol One City. [online] Bristol One City. Available at: https://www.bristolonecity.com/.
[5] The One City Approach - Bristol One City, https://www.bristolonecity.com/.
[6] Supply Management. (n.d.). 10 steps to greener public procurement. [online] Available at: https://www.cips.org/supply-management/news/2022/january/10-steps-to-greener-public-procurement/.
[7] One Planet network. (2018). Green Procurement of Textiles in the Healthcare Sector. [online] Available at: https://www.oneplanetnetwork.org/knowledge-centre/resources/green-procurement-textiles-healthcare-sector [Accessed 14 Jul. 2023].
[8] NHS England (2022). Delivering a ‘Net Zero’ National Health Service. [online] Available at: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf.
[9] Hopcroft L, Massey J, Curtis H, Mackenna B, Croker R, Brown A, O'Dwyer T, Macdonald O, Evans D, Inglesby P, Bacon S, Goldacre B, Walker A Data-Driven Identification of Unusual Prescribing Behavior: Analysis and Use of an Interactive Data Tool Using 6 Months of Primary Care Data From 6500 Practices in England, doi; 10.2196/44237.
[10] NHS Digital (2019). Home - NHS Digital. [online] NHS Digital. Available at: https://digital.nhs.uk/.
[11] www.phc.ox.ac.uk. (n.d.). Ben Goldacre. [online] Available at: https://www.phc.ox.ac.uk/team/ben-goldacre.
Written By Charlie Dawson