Challenge 10.9

Why does this Challenge need to be solved?

NHS Scotland has a target to reach net zero by 2040 for operational aspects of its activities and by 2045 for its supply chain which includes the products and services the NHS procures.

The ‘NHS Scotland Policy on the Global Climate Emergency and Sustainable Development’: DL(2021)38 sets out a clearly defined aim to:

“Establish NHS Scotland as part of the circular economy through designing out waste and pollution, keeping products and materials in use and contributing to the regeneration of natural systems”

NHS Scotland aims to reduce its demand for resources and avoid the production of waste. Carbon footprint data from NHS Scotland and across the UK identifies that the products and services procured by the NHS account for over 60% of the total carbon footprint of the NHS, with some estimates suggesting an even higher impact of >80%.

NHS Scotland is a significant part of the public portfolio in Scotland and combined with social care, the NHS is responsible for circa 40% of Scottish Government spending. NHS Scotland has a key role to play in supporting National, UK and Global targets for reduction in carbon emissions. In simple terms NHS Scotland has a key role and responsibility to support Scotland’s net zero ambition. Without clear action from NHS Scotland and it’s supply chain, Scotland will not meet its net zero targets. Working towards circular supply chains is the single most effective way of reducing carbon emissions and the NHS Scotland Carbon Footprint.

By working with their supply chain partners, NHS Scotland can better manage the almost £4b worth of products and services procured annually. Change will be required. In planning and preparing for that change NHS Scotland and our supply chain partners need a solution which enables each party to model and evaluate options and scenarios for supply and management, develop a shared understanding of these and share data in a secure manner which ensures that all commercially sensitivity and confidentiality is maintained. This must enable us to ask questions and generate answers based on data from across the supply chain, without compromising confidentiality.

If we consider something as simple as scissors, we know that a large percentage of scissors used in NHS Scotland are single use. If we look at options to change, consideration needs to be given to viable alternatives to the linear ‘purchase-use-dispose’ model which is currently in place. This may include re-use, remanufacture and metal recovery.

Spatial data is likely to be a key component and the nature, use and location of items is likely to be a key factor to modelling alterative supply methods. Information from the manufacturing and supply chain will also be key.

This Challenge offers the opportunity to focus on a selected number of items and work with NHS and our supply chain partners and support future planning.

Solving this Challenge is critical to NHS Scotland moving towards net zero and in turn will make a major contribution to Scotland achieving its wider net zero goal.

How will we know the Challenge has been solved?

Meeting the longer term net-zero goals will take time and we can’t wait until 2045 to measure our success. Therefore net zero metrics although fundamental to the long term goal are not the most appropriate metric of success for the Challenge.

We can’t define an end point for ‘solved’ without pre-empting the solution and we are open minded and keen to the CivTech process to help us identify solutions. Therefore to answer the question of how we know when the Challenge has been solved, we need to reflect on what would a good outcome  look like. We feel that the desired outcomes would include:

• Drawing on a small number of items, developing a core data model capable of supporting our needs

• Liaison with supply chain partners and demonstration of approaches to maintain commercial confidentiality;

• Identification of a series of metrics which can be used for measuring ongoing success, such as items re-used, remanufactured, material recycled and carbon impact. A key component of this will be how that information can be shared between stakeholders.

• A proto-type or example of a developed system for one or more items.

Who are the end users likely to be?

• Healthcare Supply Chain

• Scottish Government Health and Capital Investment Team

• NHS National Services Scotland - National Procurement (responsible for national procurement activities)

• NHS Health Boards and their procurement teams

• NHS Health Board Sustainability and Waste Leads

• NHS Health Board staff

• Scottish Enterprise and Highlands & Islands Enterprise

Has the Challenge Sponsor attempted to solve this problem before?

No.

There are a number of published papers focusing on changing supply models or practices based on the findings of individual life cycle assessments. These studies focus on single products and/or patient pathways. NHS Scotland is not aware of any initiatives at Scotland or UK level (or elsewhere) that have focused on challenging the asymmetry in information between key stakeholders that could support circular economy activities and allow the investment to be made to return and processing systems.

Are there any interdependencies or blockers?

The healthcare supply chain is global and with this in mind CivTech project stakeholders include the NHS from across the UK. There is an interdependency in UK supply chain and a need to ensure that systems put in place in Scotland can equally apply to the rest of the UK.

NHS Scotland is a member of the international healthcare NGO: Healthcare Without Harm as is in a position to share findings and expertise as required.

There are no known conflicts. However, the commercial confidentiality of supply chain organisations should be a key consideration and a core element of the Challenge is to support information sharing to support the development and investment in circular systems whilst ensuring commercially confidentiality is retained.

Will a solution need to integrate with any existing systems / equipment?

• PCS tender system

• PECOS system used for product orders

• NSS Warehouse Management Tool

Additional integration with systems used by NHS England will be required.

Is this part of an existing service?

The Challenge directly links to the published NHS Scotland Climate Emergency and Sustainability Strategy and the published net zero targets.

Any technologies or features the Challenge Sponsor wishes to explore or avoid?

CivTech is tech agnostic. As long as the proposed solution offers the opportunity to solve the Challenge in question, we will consider it.

That said, any proposed solution must be capable of integrating with existing systems as required by the specific Challenge and its Challenge Sponsor, and if appropriate be compatible with current and developing Scottish Government infrastructure.

Much is currently being made of the potential of advanced AI. In truth, just about all the products CivTech has developed over the past few years have AI as part of the tech stack but there is no obligation on your part to go down this route – either with componentry such as machine learning and pattern recognition, or indeed LLMs.

We are not aware of any technologies we would wish to avoid but it is important that any solution(s) are compatible with existing NHS Scotland systems and also link to those of NHS England as required.

Change is required in the way products and services are supplied, used and collected. Public and private sector investment will be required, a key feature will be collating and using the information to allow multiple stakeholders to make informed decisions and plan for future services whilst maintaining commercial confidentiality.

What is the commercial opportunity beyond a CivTech contract?

This solution could be of use in other Health Services around the globe as well as other industries who purchase goods and services. It is also beneficial for Scotland’s economy and wider industry as this Challenge encourages innovation for new and existing business.

Working with NHS Scotland gives Challenge participants access to robust national data sets from which systems can be developed which can be applied to other sectors.

Who are the stakeholders?

• NHS Scotland National Procurement

• NHS Scotland Assure

• Scottish Government Health Infrastructure and Sustainability

• Greener NHS

• NHS Supply Chain (England)

• SSN

• Sustainable Healthcare Coalition

• ABHI – Association of British Healthcare (Med Tech) Industry

• Zero Waste Scotland

Named individuals for each organisation have been identified and will act as representatives of their wider organisation. All of the above stakeholders actively participated in the workshops pre-submission of this document and are now known to the CivTech team.

Who’s in the Challenge Sponsor team?

National Procurement:

• Climate change and circular economy lead

• Head of Governance: Strategic Sourcing 

Scottish Government:

• Head of NHS Circular Economy Programme & wider team as required

NHS Scotland Assure:

• Sustainability Manager – Waste and Resource

• Communications Manager for Sustainability Team

NHS Scotland Boards (x 14)

• Waste management Officers

• Heads of Procurement

Others (as required):

• IT/Technology Services Manager/Ehealth

Industry

• Sustainable Healthcare Coalition (SHC)

• Association of British Med Tech Industry (ABHI)

NHS from across the UK

• Greener NHS Team

• NHS Supply Chain

• Links with the Design for Life Programme from the Department of Health and Social Care (Westminster)

This Challenge is co-lead with two Challenge Sponsors who will work together to ensure full support. The Sponsors are the Scottish Government, Directorate for Health and Social Care Finance and Governance, with the key contact being the Head of NHS Scotland Circular Economy Programme and NHS Scotland, National Services Scotland with the key contact being the NSS Chief Data Officer. The Challenge Sponsors will be the primary point of contact and will liaise with the other stakeholders and facilitate the process as required.

Wider NSS teams (NHS Assure and National Procurement) are able to support data requests and hold national information regarding procurement and related systems and existing monitoring systems such as the national waste data tool. Where appropriate the team will work with colleagues from other parts of the UK to ensure mutually compatible systems are developed and access data as required.

The industry (supply chain) involvement will be key and will allow the Challenge team to work with a large cross-section of the healthcare supply sector, supporting discussions and dialogue. It is envisaged that this dialogue will be key to address commercial confidentiality concerns and to ensure that the results / products of the Challenge are accepted and usable by industry.

All member of the Sponsor team including the wider stakeholders that have engaged to date are aware of the time commitments required and the need to support the process in a timely manner.

What is the policy background to the Challenge?

NHS Scotland is aiming to become a net-zero health service by 2040, we are part of an international coalition of over 50 countries to date who have committed to developing low-carbon health systems.

The Scottish Government has established a NHS Scotland Circular Economy Programme to support the transition to more circular supply systems. Circular systems will play a pivotal role in enabling NHS Scotland to reach net zero. We need to review and change how we procure goods and services, ensure ancillary and support systems are in place to enable greater re-use and reprocessing and work with the supply chain to help suppliers evolve and change their business models.

NHS Scotland purchases almost £4b billion worth of goods and services each year from around 8,000 suppliers and much of the NHS's carbon footprint is created by the manufacture and supply of medicines, chemicals, equipment and other materials. To become an environmentally and socially sustainable health service we need to embrace a circular economy, using our purchasing power to encourage our suppliers to cut their greenhouse gas emissions to net-zero and limit the negative environmental and social impacts of our supply chain.