Today, Earth Day 2022, is a good moment to reflect whether we are all doing what we can in the race to achieving net zero. The challenge is huge, particularly in healthcare, and the activities to reduce carbon footprint are wide ranging. But one particular area where healthcare providers can make a real difference in reducing their emissions is around the use of medicines, notably anaesthetic gases and inhalers.

Medicines make up a large chunk of the emissions within healthcare, with the NHS estimating they account for 5% of their total emission levels. But when you dig a little deeper, there are a small number of medicines that account for a particularly large proportion of the emissions, including anaesthetic gases which make up 2% of total NHS emissions, and inhalers at 3% of total NHS emissions.

Independent healthcare providers are already working together to reduce carbon emissions. Last autumn, IHPN were proud to launch a voluntary industry wide net zero commitment which has already been signed up by almost 50 independent healthcare providers who deliver care in over 1,500 locations. This was the culmination of a work programme led by IHPN which focussed on sharing of best practice around net zero strategies – whether that be support and advice over baselining and measuring current carbon footprint, all the way to carbon reduction strategies that really work. The ambition was always to agree an industry wide voluntary net zero target that created the impetus for change – that was challenging yet achievable for the vast majority of providers, regardless of size and provision.  Following industry-wide engagement, providers agreed to achieve net zero for scope 1 and 2 emissions by 2035 (both direct and indirect emissions) and for scope 3 (supply chain emissions) by 2045, and for many providers their own organisational commitments are even more ambitious.

As part of this, it’s therefore important that independent healthcare providers, like the NHS, find ways to reduce emissions wherever they can, including from both inhalers and anaesthetic gases. But what does this mean in practice for those working in the sector?

Inhalers are used in a variety of respiratory conditions, ranging from asthma to chronic obstructive pulmonary disease. The majority of the emissions come from the propellant in metered-dose inhalers (MDIs) used to deliver the medicine, rather than the medicine itself. Achieving the required reduction in emissions from inhalers should be possible through three main ways: increasing the use of dry powder inhalers (DPIs); increasing the frequency of the greener disposal of used inhalers; and supporting the innovation in, and use of, lower carbon propellants and alternatives.

Increasing the use of dry powder inhalers (DPIs) is widely seen as the most effective measure in reducing emissions. For many patients, DPIs may be clinically equivalent and come with significantly lower carbon emissions – a 30% uptake would result in a reduction of 374 ktCO2e per year. Scandinavia are leading the way – their high use of DPI appears to be compatible with good respiratory outcomes for patients. But progress in the UK is much slower likely due to a lack of awareness among health professionals and patients. Indeed, patient engagement will be key to the success of their effective roll out and providers should make use of the wide range of resources available for specialists, prescribers and patients to support decision-making. This includes the National Institute for Health and Care Excellence’s (NICE’s) Asthma Patient Decision Aid to support shared decision-making and a shift to low carbon inhalers.

Looking at anaesthetic gases, those used in surgery, such as desflurane, have a particularly high carbon footprint, with the emissions from one bottle equivalent to those from burning 440kg of coal. Reducing emissions requires a shift from desflurane to lower carbon alternatives such as sevoflurane, and/or, exploring the use of regional anaesthesia.  Indeed, data from a US study in 2019 suggests that the vast majority of hip and knee replacements (over 90%) could be performed successfully using regional anaesthesia. This may seem ambitious but there are undoubtedly carbon reduction benefits that can be achieved through moving to regional anaesthesia.

Added to this, the capture and destruction of nitrous oxide could cut over one-third of UK health anaesthetic emissions – technology which has been deployed in Sweden for over 16 years. Significant carbon savings are also available by decreasing nitrous oxide wastage, with the College of Paramedics estimating that 30% of nitrous oxide is left in canisters after use. Recycling or reusing this is technically difficult, with new methods required to address the residual nitrous oxide

In using any alternatives to traditional inhalers and anaesthetic gases, it of course must be ensured that there are clear clinical benefits to the patient, that they provide value for money for providers along with economic benefits in the wider supply chain (for example, in the reduction of non-recyclable/non-biodegradable waste there is no increase in hidden carbon emissions from the manufacture of alternative practices). If healthcare providers and individual clinicians can get this right, then effective reduction of emissions will happen with engaged patients being brought along on this carbon reduction journey. And that is definitely something to think about not only today on Earth Day 2022 but in the months and years ahead as we work towards net zero.

Danielle Henry, Head of Primary and Community Care Policy, IHPN

Kelly Marsh, Policy and Regulatory Executive, IHPN