1. The world’s leading sustainability consultancy GHG Accounting Approaches for Healthcare Products & Pathways The world’s leading sustainability consultancy 17 th February 2015 Tom Penny (tom.penny@erm.com)tom.penny@erm.com

2. The world’s leading sustainability consultancy Coalition for Sustainable Pharmaceuticals and Medical Devices 2 Aim ■To enable the transition to more sustainable healthcare products and services internationally through promoting best practise and developing sustainability tools and guidelines related to pharmaceuticals and medical devices. Objectives ■Acting as the convenor of expertise related to sustainable pharmaceuticals and medicals devices and disseminate best practise throughout the healthcare system globally. ■Developing tools and guidelines to support global healthcare in achieving more sustainable healthcare products and services through a holistic life cycle sustainability approach. ■Monitoring and updating existing tools and guidelines developed by the coalition to ensure their applicability (eg carbon footprint guidance). Administration ■SDU acts as secretariat ■Meetings every six months ■www.sduhealth.org.uk/cspmwww.sduhealth.org.uk/cspm

3. The world’s leading sustainability consultancy GHG Accounting of Healthcare Products 3 GHG guidance document ■Drafted GHG sector guidance for pharmaceuticals and medical devices to allow for more simple and consistent quantification of carbon footprint of healthcare products. ■Modular approach to product life cycle (eg chapters for appraising API manufacture, packaging, distribution, etc). ■Reviewed by WRI and ‘Built on GHG Protocol’ approved. ■Freely available on GHG Protocol and SDU website. Top prescription items ■Identify likely highest GHG intensity prescription items to NHS carbon footprint. ■Contact suppliers to provide GHG information to update NHS footprint. ■Aim to reduce footprint of NHS over time.

4. The world’s leading sustainability consultancy GHG Accounting of Healthcare Pathways 4 Sustainable Care Pathways Project ■Develop freely available guidance allowing interested parties to investigate and understand the sustainability aspects of healthcare pathways globally; and ■Enable sustainability considerations to be more easily taken into account in a transforming global healthcare system. Guidance Document ■General information on how to appraise care pathways ■Care pathways broken into modules (expandable over time) ■Detailed guidance on modules and provide information for combining modules into care pathway ■Each module includes definitions, activities, flow diagram, reference unit, example data and calculations ■Example calculations to appraise sustainability metrics (more to be added over time) ■Example case study to be included (diabetes with more added over time) GP Consultation Patient Travel Emergency Department Visit Inpatient / Bed Day Surgical Procedure Condition Self Management WasteWaterGHGs

5. The world’s leading sustainability consultancy Example Module: GP Consultation 5 Description: A GP consultation is a patient attending a face to face consultation by a General Practitioner, delivered in a General Practice. Unit of Analysis: A patient of defined age group, with a specific condition, attending a GP consultation at a general practice in a geographical area. Calculation steps: How to calculate impacts for specific scenario. Activity Data: Generic data collected from Trusts. Emission Factors: Sourced from GHG Protocol, ecoinvent, ELCD, US LCI, Defra/DECC, ICE, etc. Metrics: estimates of GHG, water & waste for a generic GP consultation. Priority Areas: Identifying hotspots & activities to improve sustainability.

6. The world’s leading sustainability consultancy Sustainable Care Pathways Project 6 Mapping a Care Pathway ■Develop flow diagram and identify modules that make up the pathway. ■Collect and model data for significant modules using guidance. ■Use module sustainability estimates for non-significant modules and for screening. ■Important to note document is dynamic – further modules, metrics and case studies to be added over time. Progress ■CSPM initiated project in December 2014 ■Workshops held with technical experts to define and scope modules ■Completing first draft of guidance ■Data collection to start imminently ■Project completion aim for May 2015 Important to note first version and many gaps (modules, metrics, etc) developed over time but CSPM as good first step GP visit x1 In patient x1 Surgery x1 Hospital bed day x3 Out patient x1 Care pathway