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Environmental sustainability: supporting a Net Zero NHS 

We recognise that climate change poses a significant threat to human health. Carbon emissions are a critical driver of this, and in the UK the healthcare sector is responsible for roughly 4% of the UK’s greenhouse gas emissions.

As the innovation arm of North West London Integrated Care Board (ICB), ICHP has a critical role in supporting the ICB’s Green Plan to deliver a Net Zero Health Service, working with and supporting innovators who can help us to address and mitigate healthcare-driven climate impacts. 

We are keen to work with innovators* who can help us work towards our NW London ICB green priorities: 

  • Decarbonising the supply chain and embedding sustainability in procurement 
  • Increasing the use of low-carbon travel and transport options by staff and patients, and where possible reducing the need or distance required to travel 
  • Reducing energy consumption, costs and carbon emissions in all NHS sites and facilities

While these are our priority areas, we still welcome any innovators working on green/ low carbon solutions in other areas to get in touch as well. Email innovators@imperialcollegehealthpartners.com. 

Why support Net Zero?

  • North West London ICS’s baseline year total Carbon Footprint was 1,076,470 tonnes of Carbon Dioxide equivalent (tCO2e). That’s about the same as the emissions of 1 million people flying from Paris to New York and back. Or in terms of volume, is enough Carbon Dioxide to fill 200,000 Olympic size swimming pools.
  • The Carbon Dioxide equivalent of an outpatient GP appointment is an estimated 9.9kg compared to a telephone consultation which costs an estimated 0.05kg Carbon Dioxide Equivalent.
  • Research indicates that poor air quality (a consequence of carbon emissions) was responsible for 1,000 hospital admissions for asthma and serious lung conditions per year in London between 2014-16.
  • Metred Dose Inhalers account for 2.5% of NW London ICS’s greenhouse gas emissions – that’s over 27,000 tonnes of Carbon Dioxide equivalent.

Case Studies: Supporting Sustainability

London Asthma Decision Support (LADS) Tool 

The use of asthma inhalers is a significant contributor to greenhouse gas emissions. SABA (Short-acting beta-agonists) inhalers account for 70% of the total carbon footprint of inhaler devices in the UK, totalling >250,000 tonnes of carbon dioxide emissions. Poor inhaler usage also results in an estimated 29% of inhalers being disposed of while containing left over medication, which has a risk of leaking out into the air and contaminating water sources. As such, reducing the carbon footprint of inhalers is an important component of achieving a Net-Zero NHS. 

The London Asthma Decision Support (LADS) Tool was a project funded by the One London Pathfinder programme. It was developed by clinicians and technical teams from North West (NW) London and South East (SE) London Integrated Care Boards, with support from ICHP. 

The primary ambition of the London Asthma Decision Support (LADS) Tool is to provide a population health management tool that uses data-driven insights to improve asthma care in line with the NHS Long Term Plan across North West and South East London. As such, it brings together data on air pollution and the local asthma population. This includes detail of clinical prescribing, providing a view of inhaler prescribing, and inhaler technique – helping us to understand the associated carbon impact.  

Data pulled from the LADS tool has been used to inform ongoing asthma care improvement led by the NW London clinical resource group (CRG). 

Actions are taken as a result of insights gathered. For example: 

  • providing training to improve correct inhaler usage, 
  • improving and increasing use of corticosteroid inhalers compared to SABA,  
  • For appropriate patients, considering increasing the use of Dry Powder Inhalers (DPIs) versus Metered Dose Inhalers (MDIs), as DPIs have a lower carbon footprint.  

These actionable insights play a valuable role in reducing the carbon impact of inhalers, and supporting sustainable, improved care for asthma patients. 

As of January 2024, LADS information is already showing a reduction in SABA inhaler use and prescription. 

Learn More

Asthma / COPD dashboard

ICHP undertook a project in early 2022 to develop a dataset to support the diagnosis and care management of asthma and COPD patients.  

This would support wider system actions to respond to the effects of carbon emissions (London having some of the lowest air quality in the UK), and initiatives to reduce the carbon impact of inhalers used in asthma/ COPD treatment.  

The Pan-London Respiratory Dashboard was developed by ICHP with support from NW London ICS, Telstra Health UK, and clinical colleagues from London CRG and local Primary Care Networks (PCNs) 

The dashboard brought together Quality Outcome Framework (QOF), Hospital Episode Statistics (HES), and ePACT2 prescribing data together for the first time, with the goal of enabling healthcare professionals and commissioners to track, monitor and compare key metrics. 

The dashboard included three key metrics focusing on carbon impact: 

  • MDI vs DPI prescribing 
  • Prescribing rate of high carbon ICS/LABA inhalers 
  • Prescribing rate of high carbon SABA inhalers. 

By visualising the carbon impact of inhalers alongside other metrics, the aim was to reinforce the link between good clinical care and good carbon care. It would also make it easier to factor carbon impact into clinical decision –making. 

Monitoring clinicians’ ongoing use of the dashboard has proved challenging, not least where it is not possible to measure to what extent the data is impacting changes in clinical prescribing or patient behaviour. Learnings from this project are being used to inform future initiatives on using data sets to improve clinical care.  

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* Innovators include anyone who is developing or has developed a new product, way of working, technological solution, etc. This is not limited to commercial organisations, but also not-for-profit organisations, healthcare workers, patients and the public.