1. Professor Gillian Leng CBE Deputy Chief Executive, NICE
National update
Professor Gillian Leng CBE
Deputy Chief Executive, NICE
© NICE All rights reserved.
Subject to Notice of rights

2. The UK health system NHS: sees one million patients every 36 hours
5th largest employer worldwide
39% of public sector emissions
9.1% of GDP (2014)
NHS: sees one million patients every 36 hours
Top health care system: Commonwealth fund, 2017
Patient contacts -
NHS – 1.3 million people
Adult social care – 1.34 million people
GDP

3. Wider impact – determinants of health
NHS has biggest impact of any organisation
Staff
Local communities
Local employment opportunities
Environment - air, water, green space
Due to its scale of staff, infrastructure, travel and expenditure in local economies, the NHS also has more impact through the way it works, travels and spends its money on the wider determinants of health than any other single organisation in England.

4. What do people think - public and staff
Parliamentary survey - public
18-40 years old: climate change and health
18-24 years old: climate change
SDU NHS staff survey
98%: important for H&SC to support the environment
71%: own organisation actively supports environmental sustainability
6200 staff responded
Top two issues
Full report to be launched later but supports the demand and expectations that our staff have about corporate behavior and the willing to support orgs to address the challenges we face in reducing carbon emissions, plastics waste and air pollution
Local ambassadors, keen to support local progress in their area
Top issue

5. Overall goal – NHS, public health, social care
Reduce carbon dioxide equivalent emissions by 34% by 2020
NHS, public health and social care system: reduce carbon dioxide equivalent emissions across building energy use, travel and procurement of goods and services by 34% by 2020.
SDU strategy 2014 – document here

6. How is this being achieved
ALBs + DHSC joint statement:
secure the environmental, social, and economic sustainability of the health and care system, for the health of the population
Commitments from national organisations
£90m saved
Waste, water and energy costs
And environmental benefits…

7. What is NICE doing?

8. NICE’s role
The national point of reference for advice on safe, effective and cost effective practice in health and social care, providing guidance, advice and standards aligned to the needs of its users and the demands of a resource constrained system.
Evidence
Guidance
Quality standards
Improved outcomes

9. Relevant guidelines Guidelines on environmental issues: 2 published
2 in development
Can register as a stakeholder

10. 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.
Sir Andrew Dillon CBE
CEO of the National Institute for Health and Care Excellence

11. Current NICE resource impact assessment
CG180 Atrial fibrillation: management
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

12. 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?

13. 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 assessing 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

14. A potential final product ?
Medicines optimisation guideline
Potential savings of:
0.5% of the annual carbon footprint of the health and social care system in England
179,133 million litres of fresh water
4.4% of the NHS annual waste
Feedback:
Local resource calculator time intensive
Resource Impact Analysis CG 180
+ 88,000
- 102 kg CO2e
What we may end up with is a resource impact statement which gives the above
Refined methodology and repeated for medicines optimisation guideline. Feedback from end-users was that local resource calculator was time intensive to use.
+ 23 m3
- 50 kg

15. Next steps
Preference sensitive decision points
Shared decision making
Inhaler use in asthma
Providing environmental impact information at key decision points “The negative impact on the environment is 10 times worse from inhalers that use a propellant”.