1. Developing a sustainable health and care system: the role of NICE
Gemma Partridge Clinical Fellow, NICE

2. A sustainable health and care system
SOCIAL
ENVIRONMENTAL
ECONOMIC
Health and care sector carbon footprint was estimated to be 26.6 million tonnes of carbon dioxide equivalent (MtCO2e) in 2015
39%
of public sector emissions
To achieve a truly sustainable health and care system we need to consider, social, economic and environmental sustainability
We are going to use this session to explore the role of NICE in the development of an environmentally sustainable health and care system
The health and care sector was estimated to be responsible for 39% of public sector emissions in 2015, so it is imperative that sustainable development does not just focus on financial sustainability but also on the environmental and social aspects.
References:
SDU: Carbon update for the health and care sector in England 2015

3. Improving health and social care through evidence-based guidance
NICE
Improving health and social care through evidence-based guidance
NICE’s role is to promote improvement through evidence based guidance across health, public health and social care.

4. What does NICE offer?
NICE has a suite of public health guidance with 4 guidelines in development which will provide evidence-based recommendations on air pollution, housing and physical activity and the environment.

5. Could NICE do more? Sir Andrew Dillon CBE
CEO of the National Institute for Health and Care Excellence
Could NICE do more?
The NICE sustainability steering group is chaired by Sir Andrew Dillon and is exploring what NICE could usefully contribute to promote the environmentally sustainable development of the health and care system beyond the development of guidance.

6. Quantifying the environmental impact of NICE guidance on a care pathway
Aim: To contribute towards the development of methodology that NICE could use to quantify the environmental impact of its guidance by delivering a proof-of-concept project outlining the feasibility of applying the pathways guidance from the Coalition for Sustainable Pharmaceutical and Medical Devices (CSPM) to NICE processes.
The NICE environmental sustainability steering group strategy includes a focus on methodological development that could allow NICE to incorporate environmental factors into both guidance development and the cost impact analysis of guidance that has already been developed.
A feasibility study was completed in partnership with the University of Nottingham and the NHS Sustainable development unit to assess the application of guidance from the CSPM to NICE guidance in order to provide an estimate of environmental resource impact of NICE’s recommendations

7. Current NICE resource impact assessment
Treatments and adverse effects
People (per 100,000)
Unit Costs (£)
Cost (£)
Current treatments
Warfarin
549
283
155,000
Aspirin
360 32
12,000
Dabigatran etexilate 76
802
61,000
Rivaroxaban
767
58,000
Apixaban
No treatment
464
Strokes 59
12,228
719,000
Major bleeds 12
1,173
14,000
TOTAL COST
1,080,000
Future treatments
748
212,000 40
1,000
186
150,000
143,000
253 41
495,000 15
18,000
1,168,000
NET COST/SAVING
88,000
NICE produces a resource impact assessment for all of its guidance. This currently accounts only for financial resource impact.
Example – atrial fibrillation

8. Future NICE resource impact assessment?+ + +
Could a future NICE resource impact assessment take into consideration greenhouse gas emissions, water usage and waste consumption alongside financial impact?

9. Coalition for Sustainable Pharmaceuticals and Medical Devices GuidanceGP
CONSULTATION
PATIENT
TRAVEL
EMERGENCY
DEPARTMENT
VISIT
INPATIENT
BED-DAY
SURGICAL PROCEDURE
CONDITION SELF-MANAGEMENT
The pathways guidance from the Coalition for Sustainable Pharmaceuticals and Medical Devices (CSPM) is a method for assessment the environmental cost impact of a care pathway.
It breaks down care into six modules…
Each module has an associated average value for greenhouse gas emissions, fresh water consumption and waste production. A care pathway is assessed as to the number of each of the modules that an average patient would encounter and then these are simply added together to give totals of greenhouse gas emissions, water and waste per care pathway.
= kg CO2e
= kg CO2e
= kg CO2e
= kg CO2e
= kg CO2e
= kg CO2e
= m3
= m3
= m3
= m3
= m3
= 0 m3
= kg
= kg
= kg
= kg
= kg
= kg

10. Care Pathway: CG180 Atrial FibrillationGP
CONSULTATION
PATIENT
TRAVEL
EMERGENCY
DEPARTMENT
VISIT
INPATIENT
BED-DAY
SURGICAL PROCEDURE
CONDITION SELF-MANAGEMENT + + + + + x1 x2 x1 x3 x1 x1
= Care Pathway

11. CONDITION SELF-MANAGEMENT CONDITION SELF-MANAGEMENT
Current Treatment GP
CONSULTATION
PATIENT
TRAVEL
EMERGENCY
DEPARTMENT
VISIT
INPATIENT
BED-DAY
SURGICAL PROCEDURE
CONDITION SELF-MANAGEMENT + + + + + x1 x2 x1 x3 x1 x1
Recommended Treatment GP
CONSULTATION
PATIENT
TRAVEL
EMERGENCY
DEPARTMENT
VISIT
INPATIENT
BED-DAY
SURGICAL PROCEDURE
CONDITION SELF-MANAGEMENT + + + + + x1 x1 x0 x0 x0 x3

12. A potential final product
Resource Impact Analysis CG 180
+ 88,000
- 102 kg CO2e
What we may end up with is a resource impact statement which gives
+ 23 m3
- 50 kg

13. Reflections Is it feasible? What are the limitations? Is it useful?
This work demonstrates that it is feasible to apply an environmental impact assessment to NICE guidance.
However, there are limitations that will need addressing before a wider work programme is developed.
The CSPM guidance is limited in terms of the number of modules available. Using this method provides us with an estimate of the environmental impact and the method will need further testing and refining in order for NICE to be assured of the rigour before publishing such assessments.

14. Plans
Further proof of concept study to apply environmental impact assessment to other types of NICE guidance
Assessing the significance and value of environmental impact assessment to the system
Consideration of sensitising NICE’s appraisal process to environmental impact and the implications this may have in terms of NICE recommendations

15. Acknowledgements