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20th February 2025
Research exploring eco-directed sustainable prescribing has found that while awareness is increasing among healthcare professionals and the public, further education is required on the drivers, potential effects and possible interventions – of which the results highlighted several for consideration.
Medications contribute substantially to pharmaceutical pollution, impacting both ecological health and public safety. Growing environmental concerns about this issue highlight the need for more sustainable prescribing practices that minimise environmental harm while ensuring effective patient care.
This study examined public and prescriber perceptions of pharmaceutical pollution in Scotland’s water environment, with a focus on eco-directed sustainable prescribing as a strategy to mitigate this pollution.
Semi-structured qualitative interviews were conducted with nine members of the public and 17 prescribing healthcare professionals to explore perceptions, barriers and opportunities for implementing eco-directed sustainable prescribing practices.
Public participants recognised the environmental issues related to pharmaceutical pollution but stressed the need for further education on the topic. They suggested that pharmacy-specific interventions should include targeted messaging and informative displays at the point of care, clearer labelling on medications to highlight their environmental impact and better access to pharmacy return schemes for unwanted medicines.
Additionally, a more person-centred approach, with an emphasis on regular medication reviews and deprescribing, was seen as useful.
While participants were open to environmentally friendly alternatives, they emphasised that any change to prescriptions should not compromise their effectiveness. They preferred to make informed decisions based on clear, accessible information and discussions with prescribers.
Prescribers also agreed that pharmaceutical pollution should be incorporated into their training. They noted that similar conversations already occurred around changes such as inhaler switches and that eco-directed sustainable prescribing could align with these efforts.
They also emphasised the need for effective multidisciplinary communication and for accessible tools, such as environmental sections in formularies and integrated decision-support in prescribing systems. Key strategies for advancing sustainable prescribing included regular prescription reviews and shorter courses of treatments where possible.
The authors noted the need for healthcare to ‘undergo fundamental changes’ to create more sustainable medicines use practices, although they did acknowledge the difficulties in translating recommendations from prescribers and the public into policy.
Nevertheless, they highlighted ‘the need for accessible and robust knowledge support tools to enable [eco-directed sustainable prescribing], which should be underpinned by policy guidance and embedded into existing systems.’
And they championed cross-sector and transdisciplinary collaborative approaches to overcome the challenges for achieving this.
Further research will be needed to evaluate the long-term effects of eco-directed sustainable prescribing on both environmental health and patient outcomes, they concluded.
Reference
Niemi L, et al. Do you think medicines can be prescribed in a more eco-directed, greener way? A qualitative study based on public and prescriber focus groups on the impact of pharmaceuticals in Scotland’s water environment. BMJ Open. 2025 Jan 20;15(1):e088066. doi: 10.1136/bmjopen-2024-088066.
This article was originally published by our sister publication Hospital Pharmacy Europe.
14th February 2025
A new Green Paper published by the European Society of Intensive Care Medicine highlights the importance of addressing environmental sustainability in intensive care. Katherine Price speaks to Professor Jan De Waele, who led the work, to find out the context, conclusions and key takeaways of the Green Paper and how frontline intensivists can help to drive the sustainability agenda forwards while maintaining high quality patient care.
Intensive care units (ICUs) are among the most resource-intensive hospital departments, with high levels of energy consumption, waste, reliance on single-use devices, medicines and resource-intensive therapies.
One study found the greenhouse gas emissions per ICU bed per day were more than double that of an acute care bed. This creates a vicious cycle in which ICU emissions are contributing to climate change, which itself is producing more patients, increasingly complex conditions and even new diseases.
Against this backdrop, the European Society of Intensive Care Medicine (ESICM) sought to produce a white paper demonstrating how it is possible to maintain and even enhance patient care at a high standard while limiting the environmental impact of ICU activities.
Objectives included evaluating the impact of climate change on ICUs, the environmental impact of ICU activities, identifying key opportunities to reduce this impact, and developing a framework for initiatives including actionable strategies. The resulting Green Paper entitled ‘Environmental sustainability in intensive care: the path forward‘ was published in October 2024.
The ESICM Executive Committee appointed a task force of experts and committee representatives to develop the Green Paper. They worked to identify key areas and actions informed by personal experience, relevant literature and member feedback.
Lead author and task force chair, Professor Jan De Waele, is an intensivist in the surgical ICU at Ghent University Hospital in Belgium. President of the ESICM since October 2024, he was drawn to intensive care medicine by the dynamics of acute disease and multifaceted, fast-changing environment.
‘Intensive care medicine is becoming a speciality in its own right,’ he says. ‘It has become much more complex over the last 20-30 years compared to when I started my training.’
Interested in environmental sustainability, he noticed that while many intensive care professionals were taking steps to be more sustainable in their private lives, this wasn’t necessarily being applied to their practice in the hospital.
‘This Green Paper is not only a practical guide, it’s also a call to action. The fact that we prioritised this hopefully helps people understand that this is an important thing for them, and that it’s not just something that you can switch off when you enter the hospital,’ he explains.
‘It’s an overview of the little information we have right now and trying to give some direction and guidance for our members.’
While he says the intensive care community mirrors society at large in that there is a growing awareness of the importance of environmental sustainability, equally, there are those who turn a blind eye to the problem or resist change, presenting a challenge to the task force and the aims of the Green Paper.
‘There is, of course, always some resistance. Climate change is still something that is contested around the world and, based on recent trends in international politics, one may expect that we still have some work to do,’ Professor De Waele says.
As well as highlighting four main areas for strategies and solutions – clinical care; research and innovation; awareness and education; and ESICM leadership – the Green Paper categorises actions into three tiers.
Tier 1 actions require minimal resources and can quickly contribute to environmental sustainability, such as energy-saving measures, training and promoting reusables. Tier 2 actions require more investment and coordination but can result in significant benefits, for example digitising communications and recordkeeping, or investing in more energy-efficient equipment. Tier 3 includes highly impactful actions that may require considerable investment, long-term planning, like sourcing renewable energy and retrofitting buildings, and cultural change within an organisation.
Intensivists and other intensive care professionals are encouraged to contribute to a multidisciplinary ‘green team’ and evaluate systems and processes to identify low-value clinical practices that could be changed or removed to reduce costs and environmental burden but also improve patient care. Professor De Waele explains that this includes ‘unnecessary lab tests, examinations, having patients in the hospital for too long’, among others.
The paper also lists recommendations for the ESICM itself, such as developing sustainability educational pathways, embedding the topic into courses and organising an annual sustainability conference.
Professor De Waele hopes the main takeaway for intensivists is ‘that what we do in the ICU does significantly impact the environment’ and that to mitigate this goes beyond switching the lights off.
‘Part of the resistance to environmental sustainability is often rooted in the fact that people think, “people are taking things away from me”. But it’s more than that, it’s added value,’ he explains, noting that there’s much more to do. For example, integrating sustainability into research, such as including the environmental impact of a new drug or intervention in the outcome measures.
The Green Paper also stresses the ‘critical’ need to develop flexible sustainability strategies that can be adapted to local needs, resources and conditions. Initiatives that have been seen across Europe include the UK Intensive Care Society’s Gloves Off in Critical Care campaign or efforts in the Netherlands to reduce the amount of paracetamol delivered intravenously in ICUs.
‘There is no uniform solution for every unit and country. You need to look at the low-hanging fruit, and the best to see that are those working at the bedside – the nurses and clinicians,’ explains Professor De Waele.
Green teams, he says, need to be multidisciplinary to ensure initiatives are rooted in clinical practice, are context specific and work for all members of the team – and the best place for teams to start is by focusing on actions that reduce environmental impact but also save time, money and maintain quality of care.
Priorities for the ESICM for 2025 include updating the Surviving Sepsis Campaign guidelines, which are expected to be published within the next 12 months, as well as addressing the Green Paper’s recommendations – towards which the environmental sustainability task force will evolve into a formal multidisciplinary environmental sustainability committee.
The ESICM plans to provide research grants and set up infrastructure to support knowledge exchange on sustainable ICU practice, such as hosting an annual online sustainability conference. There is also work to be done on making ESICM operations more sustainable and engaging with patient and community groups to ensure people understand why changes are being made and that they will not compromise patient care.
‘Now we need to bring this to the bedside, to our members,’ says Professor De Waele. ‘We’ve laid out a number of ideas and solutions, but now it’s up to us – and all of us, not only the ESICM – to solve it and take it seriously and take action.’
13th February 2025
Hospital Healthcare Europe is delighted to announce the launch of its new sustainability content zone and accompanying newsletter.
With pressure on the NHS to reduce its carbon footprint and progress towards net zero targets, sustainable healthcare is becoming an increasingly important consideration for clinicians and their teams in terms of greener prescribing, reusing and recycling medical devices, reducing waste and more.
Aligning with these aims, the new sustainability zone has been launched as part of the brand‘s commitment to support best practice and patient outcomes in secondary care.
Via the new sustainability zone, Hospital Healthcare Europe will curate innovative case studies highlighting pioneering initiatives at UK hospitals; overviews of novel research into sustainable practices of the future; and analyses of newly published guidelines, toolkits and reports to encourage clinicians and their teams to embrace positive change and support them in achieving individual, organisational and national goals.
All content is underpinned by first-hand insights from a dedicated and ever-expanding group of expert clinical contributors who have their finger on the pulse of the latest trends and innovations.
Recent examples include an exemplar case study on sustainable infection prevention and control at Great Western Hospital in Swindon, an overview of a new study addressing the environmental impact of inhalers, and the latest views on remanufacturing single-use medical devices, with insights from hospitals in England and France.
Alongside the zone, a new quarterly sustainability newsletter will be launched, delivering all the latest sustainability content into subscribers‘ inboxes in a convenient round-up to keep them abreast of the latest developments that can support and inspire their practice.
The inaugural sustainability newsletter will be circulated on Thursday, 20 February 2025, so sign up now to receive this as well as future newsletter bulletins and clinical round-ups.
As the healthcare sustainability agenda is intertwined with the evolution and adoption of technology within the healthcare landscape, and Hospital Healthcare Europe has also launched a health technology content zone.
This zone showcases examples of how technological advances can offer solutions to the challenges faced in day-to-day practice, allowing clinicians and their teams to improve efficiencies, respond to unmet patient need and optimise patient care and outcomes in their own hospitals and beyond.
10th February 2025
Rising drug costs are putting increasing pressure on healthcare systems, highlighting the need for rational and responsible medicines use, according to a new study looking at cost-effective and sustainable drug use in hospitals.
Conducted at Erasmus University Medical Centre in Rotterdam, Netherlands, this research developed a systematic framework known as the 8-Step Efficiency Model to identify and implement medicines cost-saving strategies while maintaining high standards of patient care.
The Model was developed through collaboration between clinical pharmacists, physicians and business analysts.
Some 39 high-cost drugs, which accounted for 57% of national drug expenditure in 2021, were assessed using the Model, with strategies explored for implementing cost-effectiveness. Evidence-based practices guided the development of this framework, with input from a broad range of stakeholders.
From the initial analysis, cost-saving initiatives focused on 27 agents. For instance, switching anti-tumour necrosis factor therapies to biosimilars resulted in savings of 7–7.5% per patient annually, totalling €320,000. A further €10,000 was saved by dose-rounding to the nearest full vial of infliximab.
Additionally, the authors developed a strategy for intravenous immunoglobulin (IVIg) weight-based dosing. This database analysis comparing IVIg plasma concentrations across various body mass index groups will potentially reduce costs by €670,000 annually.
‘The model presented in this study can guide clinicians in identifying, developing, and implementing novel strategies for cost-effective drug use at the hospital level,’ the researchers said.
They also highlighted how the Model could help reduce the environmental footprint by promoting more sustainable drug use practices.
Hospital pharmacists can apply the 8-Step Efficiency Model at their own institutions to identify cost-optimisation opportunities, reduce drug waste and ultimately enhance sustainability in clinical practice.
A three-stage implementation framework, developed in parallel to the Model, was crucial for helping hospital pharmacists and other stakeholders integrate the Model effectively.
The authors recommended that future research should focus on interventional pharmacoeconomic trials which evaluate the impact of initiatives like this Model. They also call for increased collaboration between healthcare providers, insurers and pharmaceutical companies to accelerate the adoption of cost-effective drug use strategies across healthcare systems.
Reference
Zietse M, et al. Cost-Effective and Sustainable Drug Use in Hospitals: A Systematic and Practice-Based Approach. Appl Health Econ Health Policy. 2024 Dec 19. doi: 10.1007/s40258-024-00937-6.
With Great Western Hospitals NHS Foundation Trust recently receiving recognition from NHS England as an exemplar site for sustainability in infection prevention and control, Katherine Price finds out what initiatives they implemented, how clinical staff got involved and how other hospitals and Trusts can take inspiration to achieve their own sustainability goals.
From floods in Spain to wildfires in Los Angeles, healthcare professionals globally are continuing to see the devastating impacts of climate change first hand, and the UK is no exception.
While many individuals are identifying ways to reduce the environmental impact of their clinical practice and driving change, the NHS in England recognised the need for formal, integrated processes to meet its net zero by 2045 target.
Following discussions with NHS England, Great Western Hospitals (GWH) NHS Foundation Trust in Swindon became the pilot site for an exemplar sustainability project. It received around £2,000 towards a four-month programme of initiatives and to create a replicable model, including governance and reporting structures, for sustainability quality improvement.
A clinical sustainability group – chaired by Graham Pike, associate director of nursing and infection prevention and control and clinical sustainability lead – was established in January 2024 to oversee progress. The group included representatives from infection prevention and control (IPC), sustainability, quality improvement, facilities management, pharmacy and procurement.
Following the successful pilot, GWH became the first organisation recognised by NHS England as an exemplar site for sustainability in IPC practices.
As IPC touches all areas of practice, it is ‘crucial to optimise sustainable practice’ in this area, says Rachel McLean, sustainable quality improvement programme lead at the Centre for Sustainable Healthcare.
Many practices in hospitals are driven by fear or risk of infection, and Graham says this includes ‘the products we use, the procedures we do, the way we do them and how we dispose of things’. And while sometimes those risks are real, if the rationale and evidence are lacking, there may be opportunities to identify and adopt more sustainable practices without compromising patient care.
As part of its efforts in the pilot project, GWH implemented a series of 11 initiatives that other hospitals around the UK and beyond can take inspiration from to make strides towards their own sustainability goals, of which three had a particularly big impact.
Many UK hospitals change patient bedsheets daily. Although regular linen changes are important for IPC, evidence supporting the daily changing of unsoiled sheets is lacking. ‘This is a really good example of “we do it this way because we’ve always done it this way”, and how we need to review everything we do – can we do it less, can we do it differently?’ says Graham.
A proposal to move to twice-weekly linen changes – excepting specified circumstances – was approved by the Trust’s infection control group, received positive feedback from the public and now is being trialled.
Reducing glove use was a priority, which saw GWH adopt the Intensive Care Society’s Gloves Off in Critical Care campaign.
‘There’s plenty of evidence out there that the unnecessary use of gloves, as well as being a waste and costing money, increases the risk of infection,’ says Graham. Posters showing when and when not to wear gloves were displayed by patient bedspaces and emails, articles and a webinar on glove use were shared among to team members.
Subsequently, the percentage of staff observed performing a procedure where inappropriate use of gloves risked cross-contamination fell from 63% to 20%. Hand washing observed before glove application improved from 15% to 70% of cases, and hand washing after glove removal increased from 20% to 90%.
Procurement data showed a 22% reduction in glove use over three months that, if sustained, would lead to a £1,382 annual saving for the hospital and prevent 1.6 tonnes of CO2e emissions.
GWH’s emergency department (ED) also set about working towards the Royal College of Emergency Medicine’s GreenED sustainability accreditation. ‘There were challenges on that – how do you release the staff to do the project and how do you fund [it]?’ says Graham. Pilot funding helped pay for the registration fee and staff time – and GWH became one of the first five GreenED accredited sites in the UK, and one of just two to achieve silver.
This scheme specifically encourages reduced cannulation and, after developing and displaying clear cannulation criteria, GWH saw a 29% reduction over three months. Since the pilot, this has continued to a 40% reduction – approximately the same amount of CO2e as nine flights between London and New York.
There can be a perceived conflict between IPC and sustainability, and Graham says existing case studies were a valuable resource to allay anxiety, for example when shifting to use reusable theatre caps.
‘Data demonstrating the potential or actual impact of improvement is important,’ explains Rachel. ‘If you don’t fully understand the problem beforehand and have baseline data, you won’t be able to show you have improved care later. Utilising existing case studies which demonstrate tangible benefits – for example, carbon and cost savings – can build trust that similar initiatives will be successful in another setting.’
She also suggests tailored messaging highlighting the range of benefits, including time savings, and, of course, improvement in patient outcomes.
Generally, it was straightforward to achieve buy-in for the project from colleagues across all departments and seniority, Graham recalls, partly because there is increasing concern about the effects of climate change.
‘There are a lot of staff out there who are worried,’ he says. ‘They see the waste that’s generated by healthcare every day and people are increasingly aware of climate change.’
Graham recommends working with managers to identify team members keen to drive sustainability projects within their departments. Two intensive care nurses at GWH led the Gloves Off project, for example. Already frustrated by glove waste in their unit, the project empowered them to implement and drive change, and Graham says they ‘did a cracking job of engaging the rest of the team’.
Rachel adds that collaboration ensures staff ‘feel ownership over an improvement and that changes are made in a way that best embeds them into the existing workflow and everyday systems’.
Following completion of the pilot at GWH, trials continue, initiatives are being rolled out, more sustainability groups have been established across the hospital. Sights are also set on GreenED gold accreditation.
Every project created a ripple of discussion and action, says Graham, and funding staff time to focus on sustainability identified significant cost savings as well as opportunities to reduce environmental impact, highlighting an important return on investment.
Formalising the relationship between IPC and sustainability also ensured projects progressed more quickly and consistently, resulting in an exemplar site project report that can be adapted to service, resource and patient need.
27th January 2025
A Spanish study aiming to address the environmental impact of inhalers has highlighted the importance of aligning clinical need and sustainability criteria into prescribing practices.
Focusing on reducing the high carbon footprint of pressurised metered-dose inhalers (pMDIs), the researchers developed a framework promoting the use of eco-friendly alternatives like dry powder inhalers (DPIs) and soft mist inhalers.
pMDIs contribute notably to the carbon footprint of medicines and healthcare, with two puffs of a hydrofluoroalkane (HFA) propelled pMDI being equivalent to driving 2km by car. Therefore, the study’s aim was to create a framework to reduce this environmental burden by implementing greener prescription practices without compromising patients’ health.
The mixed methods research first involved the formation of a multidisciplinary working group, including hospital pharmacists, pulmonologists and academics. A comprehensive database was then developed, incorporating the carbon footprint and other environmental data of inhalers marketed in Spain.
A key element to this was creating a decision-making algorithm integrating both clinical and environmental criteria, allowing healthcare professionals to consider sustainable alternative inhaler types.
The study revealed ‘significant variability in inhaler carbon footprint, with pMDIs showing the highest emissions due to HFA propellants’, the researchers said.
Scenario projections showed that a 10% shift from pMDIs to DPIs could reduce CO2 emissions by up to 40,000 tonnes annually. A 50% shift could save as much as 200,000 tonnes.
The authors concluded that incorporating environmental criteria into inhaler prescribing decisions could substantially reduce the healthcare sector’s carbon footprint and that ‘the decision-making algorithm developed in this study offers a practical tool’ for achieving this.
The study’s findings also highlighted the importance of involving patients in the decision-making process, empowering them to consider the environmental implications of their treatment choices.
Moving forward, the researchers suggested further work was needed to refine the decision-making algorithm and explore its application in other healthcare settings and countries. Additional studies are also required to evaluate the long-term effects of greener inhaler prescribing practices on both patient health and environmental outcomes.
Policymakers should consider incorporating these findings into national healthcare guidelines to promote sustainable prescribing on a broader scale, the researchers added.
Reference
Garin N, Zarate-Tamames B, Lertxundi U, et al. The environmental impact of inhalers: a framework for sustainable prescription practices in Spain. European Journal of Hospital Pharmacy, January 2025. doi: 10.1136/ejhpharm-2024-004402.
13th November 2024
The remanufacturing of single-use medical devices has the potential to significantly reduce greenhouse gas emissions from health systems, and while there are impressive examples of best practice, there is still a long way to go across much of Europe. Here, Bob Unwin and Josselin Duchateau share an overview of remanufacturing and describe how the practice works at Stepping Hill Hospital, part of Stockport NHS Foundation Trust, UK, and efforts to get programmes started in France.
A growing body of evidence finds that when it comes to harmful greenhouse gas emissions, hospitals are part of the problem.
Health systems generate nearly 5% of all global greenhouse gas emissions and a staggering 71% of these emissions come from the supply chain. In a study looking at emissions from the UK’s NHS, single-use medical devices were found to have an outsized impact on the NHS carbon footprint.
A regulatory framework for commercial remanufacturing of medical devices labelled for ‘single use’, also known as SUDS, began in the United States in 1998, and Germany followed in 2002. Commercial remanufacturers – meaning the work is done by private industry outside of the clinical setting – are regulated under the EU Medical Device Regulation (MDR) 2017/245 in force since May 2021. Today, over 11,900 hospitals and surgical centres use reprocessed devices globally.
Remanufactured SUDs must be compliant with the MDR under Article 17. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) guideline regulated the remanufacturing of SUDs from 2016. CE marked remanufactured devices must obtain the same levels of cleanliness, sterility and functionality as required of a virgin device.
Remanufactured SUDs cost at least 30-50% less than the virgin devices, according to the Association of Medical Device Reprocessors (AMDR). They also reduce waste, greenhouse gas emissions, and reliance on the international supply chain that hospitals found to be vulnerable during the Covid-19 pandemic.
Commercial remanufacturers collect devices, decontaminate, function test, clean, repackage, sterilise and return the SUDs for reuse by hospitals and clinics. Thus, remanufacturing creates a circular economy.
Peer-reviewed life cycle assessments are a well-established resource for comparing environmental impact across numerous categories to examine the cradle-to-grave impact on air, water and land for choices between two or more products.
A research team from Fraunhofer – the prestigious German research society – confirmed through a well-designed life cycle assessment that a remanufactured electrophysiology catheter resulted in a 50% reduction in greenhouse gas emissions compared to its virgin alternative when shipped from the UK to Germany where the devices were remanufactured and returned to the UK. Numerous additional peer reviewed life cycle assessments confirm substantial CO2 reductions at an average of 41% from the use of remanufactured SUDs.
In 2022, Stockport NHS Foundation Trust staff initiated a Green Plan, which included targets such as reducing greenhouse emissions by 85% by 2032, a 75% cut in business travel emissions by 2030, and achieving a ‘net zero’ carbon footprint by 2040 in line with wider NHS ambitions.
Supply chain leadership had become aware that an inordinate amount of greenhouse gas emissions from hospitals resulted from the supply chain. They sought to implement initiatives proven to reduce greenhouse gas emissions.
The leadership team’s research included review of NHS support for SUD remanufacturing including NHS-funded research and the NHS ‘Device Remanufacture “How to” Guide’ for the use of commercially remanufactured devices that documented substantial savings and emissions benefits at other hospitals.
The remanufacturing programme launched at Stockport NHS Foundation Trust in July 2022 significantly reduced Stepping Hill Hospital’s waste stream and greenhouse gas emissions. The Trust generated savings of approximately £33,000 during the fiscal year 2022/23 and received an additional £350 through a collections agreement with their remanufacturing partner.
While switching products can be difficult, as surgeons always have preferred medical devices, they had no difficulties using the remanufactured products because they were using the same product make and model. In the fiscal year 2023/24, the programme saved £40,763.52. By replacing 183 virgin surgical Harmonic Scissors (devices) with their reprocessed counterparts, Stepping Hill eliminated the use of the equivalent of 209 kg of CO2.
The Stockport programme underscores the UK’s leadership in circular innovation in healthcare, standing out as a key example.
Taking this further, in October 2024, the UK’s Department of Health announced ‘a major crackdown on waste’ in an effort to save millions of pounds a year, helping to divert more resources to frontline NHS care. The ‘Design for Life roadmap’ strategy is a full-throttle approach to driving a circular economy. A commitment to use remanufactured SUDs plays a leading role, with plans to radically cut the number of SUDs in the health service and reduce its reliance on foreign imports.
Many European nations, such as Belgium, Germany, and Spain, have also embraced remanufactured devices. However, in the EU, the MDR only allows remanufacturing when permitted by national law within individual Member States, with the requirement to notify the European Commission of their regulations.
This ‘opt-in’ model does not incentivise countries to adopt the practice and adds extra regulatory hurdles before they may do so. As a result, in some European countries, concerned healthcare providers and other industry stakeholders must often raise their voices to advocate change in linear, outdated, or stagnant national policies. An illustrative example of this is France.
Outside of the hospital, France has long been a leader in the promotion of a circular economy – a 2023 policy saw the French Government pay people to repair old clothes rather than throw them away, for example. But French hospitals are given no such treatment, and the use of remanufactured devices has been banned in France.
This ban has been a thorn in the side of environmentally minded French clinicians and healthcare staff. In December 2022, a position paper published in Le Monde signed by representatives of different medical and pharmaceutical scientific societies called for a lift of this ban.
At the April 2023 European Heart Rhythm Association Congress in Barcelona, Spain, numerous French clinicians and researchers spoke forcefully in favour of the use of remanufactured devices. Then, in March 2024, a group of more than 20 doctors from the French Society of Cardiology published a position paper that similarly endorsed remanufacturing and advocated wider regulatory and professional acceptance of remanufactured devices across the continent.
Thankfully, French authorities appear to have seen the writing on the wall: in the Social Security Financing Bill for 2024, the Government included an article finally authorising the use of remanufactured devices as part of a two-year experiment.
In a recent report detailing how the experiment could work, the General Inspectorate of Social Affairs (IGAS) and the General Inspectorate of the Environment and Sustainable Development (IGEDD) situated the potential adoption of device remanufacturing as part of France’s broader efforts to reduce its healthcare sector’s environmental footprint.
According to the report, the experiment will examine commercial remanufacturing of SUDs for four French healthcare establishments. As France lacks any existing infrastructure for a medical device remanufacturing industry, the report further encourages working with an experienced commercial remanufacturing partner.
In its own report commenting on the experiment, the French National Academies of Medicine, Pharmacy and Surgery highlighted that stakeholders across the board support the idea, provided that safety, technical and regulatory standards are maintained.
It would seem, at last, that the regulatory and medical communities in France are on the same page about this critical issue. The success of this experiment could pave the way for more sustainable practices, aligning with France’s aspirations to be a leader in the sustainable transition of healthcare. All eyes will be on this two-year trial as it explores the safety, cost-effectiveness and sustainability of remanufacturing medical devices in one of Europe’s largest healthcare sectors.
While a firm date for the commencement of the programme has not been set, the Directorate General of Health has stated that the decrees implementing the experiment should be finalised by the end of 2024. The current working draft proposes to evaluate both CE and CS remanufacturing routes, therefore allowing the experiment to cover a wide number of devices.
The experimentation phase should last two years, and the evaluation of the experiment will result in either a prolongation of the ban, or a modification of the law legalising remanufacturing of SUDs in France.
In addition to the UK successes and the French experiment, remanufacturing of SUDs is currently permitted in Belgium, Croatia, Germany, Ireland, the Netherlands, Spain, Portugal, Sweden and Israel. Globally, commercial, regulated remanufacturing of SUDs also takes place in the US, Canada, Japan, Israel and Australia.
The AMDR – the nonprofit trade association representing the remanufacturers – hopes to remove the ‘opt-in’ language in the EU MDR in a move that will make it easier for more countries in Europe to benefit from this sustainable option and reduce greenhouse gas emissions within their health systems.
Authors
Bob Unwin, registered nurse, directorate manager, theatre and critical care at Stepping Hill Hospital, Stockport NHS Foundation Trust, UK
Josselin Duchateau, clinical electrophysiologist, University Hospital of Bordeaux, France
12th November 2024
The effect of climate change on public health is becoming increasingly evident, and the need to act is perhaps more urgent than ever. But it’s not just global governments at the COP summits who can influence sustainable change. As the Royal College of Emergency Medicine’s GreenED initiative highlights, all hospital staff can play their part. Katherine Price investigates.
Emergency healthcare systems are already having to manage the consequences of climate change, with associated air pollution and extreme weather events on the rise and increasing pressure on services. The recent catastrophic floods in southeastern Spain and heatwave in the UK in 2022 are just two examples.
While the impact and repercussions of the floods are still being assessed, the UK heatwave caused an estimated 2,985 excess deaths in England alone and also led to IT failures at one of London’s largest NHS hospital trusts, demonstrating a significant logistical and human cost.
Focus groups at the recent European Emergency Medicine Congress rated the severity of the impact of climate change on health systems, and specifically on emergency care, both now and in the future, at an average of seven on a scale of zero to nine. This highlights widespread concern and the need for the emergency medicine community to mobilise around the climate agenda.
‘There’s broad recognition in the health community that climate change is the biggest threat to public health,’ says Dr Zoe Steley, emergency medicine registrar, co-founder of the Royal College of Emergency Medicine’s (RCEM) Environmental Special Interest Group and clinical co-lead of its GreenED initiative. ‘That’s a big part of why GreenED is a priority, because it’s connected to the broader care crisis.’
Launched in September 2023, GreenED aims to measure and reduce the environmental impact of emergency departments (EDs) in the UK, thus driving environmentally sustainable practices within the specialty of emergency medicine and contributing to NHS England’s ambition of achieving net zero by 2040.
Its open-source framework has been designed to hit a ‘triple bottom line’ within secondary care: quantifiable sustainable changes that also reduce costs, improve efficiency and maintain or improve patient care outcomes.
‘Climate change is a health emergency, and the NHS has a pivotal role in tackling this issue for the benefit of our patients,’ says Chris Gormley, acting chief sustainability officer for the NHS. ‘With the dedication of our clinical staff and the collaborative efforts of the RCEM, we are making significant strides towards safely and sensibly decarbonising the care we provide, and we are proud to support this work.
‘Our goal is to ensure that NHS EDs can deliver not only high-quality, efficient and cost-effective care but also environmentally sustainable solutions. We are committed to enhancing patient outcomes while improving health now, and for future generations.’
As part of these efforts, in September 2024, the RCEM awarded five EDs in the UK GreenED accreditation for environmental sustainability. The first accreditations of their kind, these align with the three levels of the GreenED sustainability framework – bronze, silver and gold.
Providing evidence of achieving or sufficiently addressing specific actions across the three levels leads to respective accreditation for 12 months, with an annual £2,000 fee per site to take part in the support and accreditation scheme. According to Dr Steley, accredited sites have, on average, saved around £10,000 per year by implementing the changes.
For Dr Daisy Stevens, a specialty doctor in emergency medicine and GreenED lead at the newly bronze-accredited Derriford Hospital in Plymouth, keeping the patient front and centre of all sustainability efforts is imperative. ‘[It’s] making sure that everything that we do request for a patient is appropriately indicated, getting rid of any excess or duplication that isn’t going to change patient management or isn’t in their best interests.’
And she advises starting small. ‘Evidence the victories and use this to gain momentum to target some of the bigger actions,’ Dr Stevens says.
Kate Whittaker, a junior sister in the ED at Great Western Hospital in Swindon, which received both bronze and silver accreditation, agrees. ‘It’s just looking at where you can make those small changes first that can make quite a big impact… and then you can start building on it from there,’ she says.
At this Trust, in conjunction with Royal United Hospitals Bath NHS Foundation Trust and Salisbury NHS Foundation Trust, all employees can sign up to ACT – an interactive programme aimed at supporting action on climate change. Staff earn ‘green points’ for registering positive environmental actions on the ACT app, with top scorers receiving rewards such as vouchers, which helps keep motivation high.
‘Persistence is key, especially getting off the ground,’ adds Dr James Walton, consultant in emergency medicine at Northumbria Specialist Emergency Care Hospital, which also achieved both bronze and silver accreditation. ‘Once there’s momentum, it’s been really easy to run with it… Our initial plan was just bronze and then we actually looked and we were 90% of the way to silver.’
The GreenED framework lists 13 bronze, 13 silver and 14 gold actions that EDs can use as starting points on their sustainability journey, which include things as simple as switching off equipment and lighting when not in use and using reusable medical devices where possible.
One bronze action is to set up a multidisciplinary working group. RCEM recommends including a mix of junior and senior, as well as clinical and non-clinical roles. This encourages shared responsibility and accountability, the inclusion of different ideas and perspectives, and creates a space for feedback.
‘If you are making things harder for someone else to do their job, then that’s not a sustainable change,’ points out Dr Stevens. ‘We need to make sure that we’re not doing any harm by the changes that we’re doing.’
For example, ensuring that any sustainable alternatives are suitable for all patient cohorts involves cross-departmental input.
Another bronze action is to make dry powder inhalers (DPIs) available within the ED. Inhalers contribute to 3% of the total NHS carbon footprint, and DPIs have a carbon footprint 20 to 30 times smaller than metered-dose inhalers. Since introducing DPIs into the ED formulary at Northumbria, approximately a third of dispensed inhalers are now DPIs – a projected saving of 665kg CO2 equivalent (CO2e) per year.
It’s the kind of project that often also has huge potential outside the ED, Dr Steley points out. ‘If you know that not only your successes but the challenges you encounter are going to be informative to unblocking yourself, but also others, that mindset is incredibly motivating,’ she says.
Anaesthetic gases can be a carbon hot spot, but methoxyflurane (brand name Penthrox) has a climate change impact of 117.7 times less CO2e than Entonox. Making methoxyflurane available in the ED and reducing Entonox use by 30% fall under silver actions, while gold involves reducing Entonox use by 60%.
Northumbria has introduced methoxyflurane as its first-line trauma analgesic and turned off nitrous manifolds in the ED, saving 7,200kg CO2e while maintaining excellent patient outcomes. Previously, 38% of patients with shoulder dislocations were discharged within four hours, which has since increased to 75%, and while nearly half of these patients were being sedated, this is now less than 10%.
‘That hits the triple bottom line fully because it’s a shorter length of stay, which is better for the patient; there’s less sedation, which is better for the patient; it’s cheaper; and it’s less environmentally harmful,’ emphasises Dr Walton.
The hospital pharmacy team also reviewed discharge medication to eliminate any unnecessary dispensing – and found very little needed to be changed to maintain sustainable practices.
Despite GreenED involvement being encouraged across all staffing levels, and a statement of support from a clinical lead being a silver action point, the 2022 GreenED pilot report highlighted limited or no senior support as a challenge, particularly sites that did not have consultant involvement.
‘Sites that have senior buy-in from the outset are able to get a lot more done more effectively,’ says Dr Steley. A senior clinician doesn’t have to lead the work, but their support is essential.
A lack of protected time for carrying out the actions was also flagged as problematic, particularly when trying to juggle clinical and other pressures, and the University Hospital of North Tees polit site therefore called for effective resourcing to enable the initiative to progress effectively.
Another key challenge is waste. Having recycling bins throughout Derriford ED saw items ending up in the wrong bins, so instead, a single recycling station has been set up. Northumbria, meanwhile, is conducting bin placement audits.
Also at Northumbria, achieving the bronze action of eliminating single-use plastic cups and cutlery was not as straightforward as hoped. ‘It was really much more complex for patients,’ says Dr Walton. ‘We weren’t able to fully eradicate disposables, but we’ve made a significant improvement.’
There was, however, unexpected success when it came to the logistics of recycling crutches, which had been a concern. Input from the physiotherapy team led to a simple sustainable solution which is expected to become standard operating procedure before the end of the year – ticking off the silver action of creating pathways to return loaned equipment.
More than 35 hospitals across the UK have registered for GreenED accreditation – including all EDs in Wales – since it was launched in 2023, and now the first international pilots have also been set up in Australia. ‘The framework itself doesn’t need structural changing really to accommodate different national contexts,’ explains Dr Steley, which means progress in the UK has the potential to be replicated across the world.
Accreditation has been a great motivator, says Dr Walton, with the changes projected to save an estimated 37,500kg of CO2e a year. ‘There’s been a real culture shift and now everybody’s aware of it and knows who to speak to and that it’s everybody’s responsibility to try and make things better. And I think there’s a sense of pride in the whole team,’ he says.
Dr Stevens has a similar sentiment: ‘As a healthcare provider, we have got the ability to deliver this message as a respected member of society. It’s not just altruistically doing it for the environment and for future generations, it’s actually empowering people to see the benefits in their own health care right now.’
8th November 2024
Moving medical supplies via drone was once a farfetched idea, but there are now multiple projects working to make it a reality. Kathy Oxtoby considers five case studies from the UK and the Netherlands to determine the benefits for clinicians, patients and healthcare systems, as well as the remaining challenges and future potential of drone transportation within the healthcare landscape.
With rising waiting lists, ongoing staff shortages and mounting pressure on hospital teams, it is increasingly vital that care is delivered faster and more efficiently to patients. Greener, more sustainable care is also a priority, with the drive to achieve a net zero NHS by 2040.
One approach that has the benefits of both faster delivery and sustainability is the use of drones – also known as unmanned arial vehicles or UAVS. Drones are already transporting medicines to remote areas in such countries as Rwanda, the United States, Australia and India.
In recent years, the NHS has been trialling the use of drones for a variety of purposes, including delivering medical supplies of blood packs and chemotherapy, transporting lab specimens, and more.
For Professor Claire Anderson, Royal Pharmaceutical Society president, the Covid-19 pandemic and recent advancements in technology have made the drone transportation of medical supplies eminently possible, and the benefits are clear.
‘Drones offer timely access to medicines, especially in remote areas, and the pandemic highlighted their potential for safe, contactless delivery of essential supplies,’ she says.
‘It can reduce costs and travel time, improve access to healthcare for patients in rural or hard to reach areas, and free up staff time for direct patient care. Drones are also more environmentally sustainable, emitting less carbon dioxide than cars or trucks.’
For patients with chronic conditions, using drones to deliver critical medicines can ‘help reduce waiting times and ensure more consistent access to healthcare’ and ‘alleviate some of the pressures caused by long waiting lists’, she adds.
However, in their current form, there are some inevitable drawbacks. Drones can only carry light items – typically around two to four kilograms – which limits their use for transporting a wide range of items. Additionally, they have limited range and battery life, which affects the numbers of deliveries that can be made on one flight.
In addition, some medicines need to be stored in specific conditions, such as controlled temperatures and multilayer packaging, which must also be taken into consideration. ‘Regulations require these conditions to be met throughout transport to ensure the product is safe to use,’ says Professor Anderson.
As the need and momentum for the use of drones in healthcare builds, the list of projects assessing the benefits, challenges and future potential of drone transportation is growing.
So what projects are currently underway, and what insights are they giving into this innovative movement of medical supplies?
The weather and geography of Cornwall, southwest England, present unique challenges when it comes to the collection and delivery of pathology samples and time-critical medicines, particularly on the Isles of Scilly – 28 miles off the coast.
Poor weather conditions mean flights to and from the islands can be grounded for two to three days, delaying transit of crucial items.
The Open Skies Cornwall project is a consortium of technology providers and end users. It includes exploring conceptual use cases involving the transport of pathology samples and blood products, point of care equipment and consumables, and Royal Cornwall Hospital Pharmacy service provision via drones.
‘We wanted to level up the provision of care and build a reliable and robust service for the island community,’ says Jo Walsh, pathology optimisation project lead at Royal Cornwall Hospitals NHS Trust.
Samples can be adversely affected by the time it takes to transport them, and often repeat testing is required as a result. ‘We’re looking to prevent any repeated testing and provide timely and accurate results for clinicians, that are not adversely affected by transport delays,’ says Ms Walsh.
‘We also want to enable patients to receive treatment at home, rather than having to travel to the main hospital – a journey that is especially problematic for those living off the mainland, as they have to travel by plane.’
As well as focusing on island healthcare connectivity, the Open Skies Cornwall project also involves working with Falmouth Harbour to integrate autonomous drone solutions and enable infrastructure for ship-to-shore delivery, remote healthcare, telemedicine and flying defibrillator applications to support residents and maritime visitors.
Lisa Vipond, pathology services manager at the Trust says that the team sees ‘this project as a complimentary element to our courier system, assisting their challenges.’
A key part of the project is looking at maintaining the validity of samples, and the impact of environmental factors, such as heat, cold, pressure and vibrations on samples transported by drone.
There are plans to do testing flights at the end of this year, but ‘we need to ensure the regulatory and legislative requirements are all in place ahead of this’, says Ms Vipond.
Ms Walsh believes many other areas of the NHS could benefit from drones, including emergency care.
‘Working in the NHS, patient care is at the centre of what you do,’ says Ms Walsh. ‘When you see a solution to gaps in service provision due to elements beyond your control – such as geographical and weather limitations – you want to push that solution forward.
‘We can’t just use this project as a “proof of concept”. We need to embed drone transport within our infrastructure long-term.’
Project CAELUS (Care & Equity – Healthcare Logistics UAS Scotland), aims to develop and trial the UK’s first national distribution network using drones to transport essential medicines, blood, organs and other medical supplies throughout Scotland to eliminate land transport issues.
Led by AGS Airports, it brings together 16 partners, including NHS Scotland and is funded by the UK Research and Innovation Future Flight Challenge and other partners. The consortium has developed a virtual model, or digital twin, of the proposed delivery network, which connects hospitals, pathology laboratories, distribution centres and GP surgeries across the country.
A number of live flight trials are taking place across the country as part of the project. For example, this August, laboratory specimens were flown between NHS Lothian and NHS Borders by drone.
In October, drone technology was used to connect the island community of Arran with the mainland. Further trials are planned in the NHS Highland and NHS Grampian areas of Scotland later in the year.
And the Scottish Ambulance Service has also researched whether a drone could transport defibrillators to the location of a cardiac arrest faster than an ambulance.
Dr Jamie Hogg, clinical lead for Project CALEUS for the north of Scotland and a retired GP, says the team hopes that the use of drones to transport medicines, blood samples and equipment will enable patients living in more rural areas to be ‘treated closer to home and more quickly’.
Requesting quick deliveries of medicines for patients via a drone network would have significant benefit, he says, however, a change in regulations to allow the move from the currently segregated to integrated airspace will be key.
The project ends in December, and then there will be ‘a period of reflection to take in everything that’s been done and decide on next steps’, Dr Hogg explains.
Blood packs have been successfully flown by drone in a series of ‘beyond visual line of sight’ flights, for the first time in the UK.
In a research study to check the viability of flying blood via drone, run jointly by NHS Blood and Transplant (NHSBT) and the medical logistics company Apian, 10 units of packed blood cells were transported on a 68km journey across Northumbria’s skies, while an identical 10 packs were transported concurrently by road.
After assessment, results showed both sets remained viable, with no significant difference in the biochemical or haematological profiles of the blood, which determine if it has maintained quality and can be used for clinical purposes.
‘We’re proud to drive innovation that could improve patient outcomes, and this trial could do exactly that,’ says Mike Wiltshire, component development laboratory manager at NHS Blood and Transplant.
‘Drone travel would be especially useful in transporting items – whether blood packs, blood samples or other – to more remote locations, or via routes that normally suffer from traffic congestion, meaning the products are available for patients faster than they would be by road and ensuring patients are treated as quickly as possible.’
If drones are able to deliver blood products faster, then ‘more patients will be able to be treated or receive results the same day’ than at present, which ‘may reduce patients having to return to the hospital at a different time, should the medicine or test results not be available same day’, Mr Wiltshire adds.
The UK has clear guidelines on the transport of blood components and maintenance of product temperature. ‘We needed to source a suitably sized and specified transport container, along with cool packs, to ensure the temperature of the blood was maintained as required,’ explains Mr Wiltshire.
The number of items and weight that can be transported at any one time is limited by the drone load capacity. Drone operators are therefore exploring different types of drone to determine the best one for the transportation of blood, which may in turn be dependent on the specific requirements of the transport route.
The flying of drones like those used in this study is currently ‘very tightly regulated’ meaning that drones cannot simply fly directly between any given two points – permission must be granted, which may not be guaranteed, depending on the locations in question. ‘Drone operators are looking to overcome this significant challenge for the use of drones for this and many other uses,’ he says.
NHSBT is currently in discussions around a similar trial for platelets, to understand how platelets for transfusion will react to drone transportation and whether their use will be viable in the NHS for this purpose.
The Welsh Blood Service (WBS) is interested in exploring what role drones might play in enabling efficient, sustainable transport of blood products between north and south Wales as well as faster, on-demand delivery of blood products and other medical supplies in rural Wales.
The organisations involved in the Welsh Health Drone Innovation Partnership are the WBS – part of Velindre University NHS Trust –the Welsh Ambulance Service University NHS Trust, Snowdonia Aerospace Centre and the technology company Slink-Tech.
Currently, the partnership is undertaking a foundation study for drone-based blood delivery service between WBS stock holding units at Talbot Green in the south and Wrexham in the north to establish its potential for supporting the Welsh NHS, including specific use cases for the WBS, and to test the basic premise with the Civil Aviation Authority.
‘Drone-based infrastructure has the benefit of not being tied to pre-existing infrastructure on land, which due to geographical constraints has often unintentionally left rural communities underserved,’ says a spokesperson for Velindre University NHS Trust.
‘Drone technology provides the opportunity to tackle inequalities by improving accessibility to communities and regions which may be left behind by traditional logistic infrastructure.’
The primary challenge is to establish ‘a robust business case for early deployment of drone technology to improve the quality and resilience of health and care services in Wales’, the spokesperson adds.
Alan Prosser, the director of the WBS, says: ‘Technology is advancing at pace in this area, and we acknowledge that drone capability still needs to mature in terms of carrying capacity and battery payload before this becomes a viable option for our service.’
The UK isn’t the only country trialling the use of drones to transport medical supplies. In the Netherlands, researchers have investigated the impact of medical drone transport on the stability of monoclonal antibodies (mAbs).
The study findings revealed ‘no significant differences between car and drone transport’, indicating that the stability of mAbs in both vials and infusion bags was adequately maintained during transportation regardless of the mode.
As such, medical drones are ‘a viable and reliable means for the inter-hospital transport of mAbs, paving the way for more efficient and predictable logistics in healthcare delivery’, the authors say.
In fact, the researchers concluded that the integration of drone technology into healthcare logistics ‘has the potential to significantly enhance’ the crucial transport of this treatment type.
With so many ongoing trials and success stories demonstrating the benefits of drone technology in healthcare, the future looks bright, and Professor Anderson says it really does have ‘the potential to ‘revolutionise the way we deliver medical supplies, especially in remote or hard-to-reach areas’.
She is keen to point out, however, that ‘as with any transport around medicines, safety and security must remain a priority’.
The use of drones will ‘undoubtedly increase over the next five to 10 years, for a variety of applications,’ according to Mr Wiltshire. ‘However, there are challenges to overcome – such as restrictions on airspace – before this use is widespread’.
In the meantime, Dr Hogg is encouraging healthcare professionals to ‘think about what they could do if they had drones available to them’ to support patients in accessing vital medical supplies.
‘We are getting to the point where drone transport for medical products could become a reality,’ he says. ‘In three- or four-years’ time, we could be saying to a [resident] doctor: “Can you “drone” this down to Aberdeen?”, and the answer will be: “Yes, sure.”’
22nd October 2024
The Government is launching a ‘major crackdown’ on waste in the NHS to save millions of pounds a year. Ministers say the savings will be ‘redirected to frontline services’, and the waste reduction and recycling programme will help the NHS become net zero by 2045.
The new ‘Design for Life Roadmap’ strategy lays out 30 actions such as scrapping the use of single-use medical devices and reducing reliance on foreign imports. It includes the Government incentivising UK-based MedTech companies to produce sustainable products and train NHS staff on how to use them.
The proposals will initiate the shift to circular methods of reuse, remanufacture and recycling, keeping resources close to where they are needed and generating economic opportunities within the UK, helping to ‘transform the country into a life sciences superpower’ and creating ‘thousands more UK jobs’.
Reliance on high-volume products imported from overseas can make patient care vulnerable to global supply shocks and these plans to support UK manufacturing will limit this impact.
What’s more, single-use devices substantially contribute to the 156,000 tonnes of clinical waste that the NHS produces every year in England. Reusing medical devices will reduce the UK’s carbon footprint and plastic pollution and preserve precious metals such as platinum and titanium, which are often used in medical devices and currently end up in landfill.
Devices like walking aids and surgical instruments are currently thrown away after just one use, but the Government hopes to encourage innovation to safely remanufacture a wider range of products.
The roadmap gave examples of where innovations are currently being made. These included harmonic shears – a surgical device that seal wounds using ultrasound waves – which are £500 per device but 90% of them are thrown away after one use. However, some companies are purchasing these devices and remanufacturing them at a lower price.
At Northampton General Hospital NHS Trust, an Ophthalmology department saved 1,000 pairs of disposable scissors and £12,000 in a year by switching to reusable pairs, while Leeds Teaching Hospitals Trust saved £76,610 purchasing 604 remanufactured electrophysiology catheters, and generated £22,923 by selling used devices for collection.
Health and social care secretary Wes Streeting said: ‘The NHS is broken. It is the mission of this Government to get it back on its feet, and we can’t afford a single penny going to waste.
‘Every year, millions of expensive medical devices are chucked in the bin after being used just once. We are going to work closely with our medical technology industry to eliminate waste and support homegrown MedTech and equipment.’
Professor Sir Stephen Powis, national medical director of NHS England, said: ‘While the NHS is treating record numbers of patients, we know there is much more to do to ensure taxpayers get value for money.
‘The NHS made a record £7.25bn worth of efficiency savings last year and is targeting a further £9bn of savings for 2024/25. But we are rightly still looking for ways to get our money’s worth for every penny we spend.’
More than 80 stakeholders from the UK MedTech industry, the health and care system and research organisations helped to create the Design for Life Roadmap.
The Royal College of Physicians (RCP) welcomed its publication, saying the current over-reliance on single-use med-tech products is ‘expensive, wasteful, not sustainable and leaves us vulnerable to supply chain issues’.
Dr Mark Harber, the RCP’s special adviser on healthcare sustainability and climate change, said: ‘The NHS, like most health services, generates a huge amount of waste related to day-to-day practice. Only a relatively small proportion of this waste is recycled with most of it either going to landfill or incineration, both of which have very major environmental impacts.
‘Shifting towards a circular system for medical devices that enables them to be reused, remanufactured, or recycled will have a significant effect on the environmental impact of the NHS without compromising patient care.’
In the summer, the RCP released its Green Physician Toolkit suggesting a range of everyday steps physicians can take to help the NHS reach its net zero goal and mitigate the risks of climate change.
This came after the International Hospital Federation’s Geneva Sustainability Centre launched a platform in October 2023 to digitally empower hospitals and healthcare leaders to drive sustainable, low-carbon, equitable and resilient healthcare.
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