Inhalers and NHS Long Term Plan

The NHS Long Term Plan, published earlier this month, makes two references to inhaler climate change impact: 

Pg 120: The carbon footprint of health and social care has reduced by 19% since 2007, despite a 27% increase in activity. This leaves a significant challenge to deliver the Climate Change Act target of 34% by 2020 and 51% by 2025. A shift to lower carbon inhalers will deliver a reduction of 4%, with a further 2% delivered through transforming anaesthetic practices.
 
Pg 67: Pharmacists in primary care networks will undertake a range of medicine reviews, including educating patients on the correct use of inhalers and contributing to multidisciplinary working. As part of this work, they can also support patients to reduce the use of short acting bronchodilator inhalers and switch to dry powder inhalers where clinically appropriate, which use significantly less fluorinated gases than traditional metered dose inhalers. Pharmacists can also support uptake of new smart inhalers, as clinically indicated.

The Sustainable Development Unit has clarified that the "reduction of 4%" in the LTP  relates to the gap between current carbon emissions and the 2030 NHS carbon reduction target:

• The total 2017 carbon footprint of the NHS in England is 21.54 Million Tonnes CO2e
• The 2017 England MDI (inhalers) footprint is 0.85 Million tonnes CO2e
• The carbon saving required to hit the 2030 57% NHS target is 10.36 Million tonnes CO2e
• A 50% cut in the carbon footprint of inhalers would save 0.425Mt CO2e - which is 4% of the total carbon saving needed

The Expert Working Group on reducing climate change impact of inhalers is developing a shared action plan to ensure that this target is met. Strategies under consideration include:

• Where clinically appropriate- offering patients lower carbon options  eg DPI
• Offering patients MDIs with a lower volume of propellant 
• Offering patients MDIs with fewer actuations or puffs per dose 
• Better training on inhaler use, with regular review
• Prescribing inhalers with visible dose meters (to reduce waste)
• Increasing recovery and recycling rates for used inhalers 
• Reducing over prescribing 
• Development of propellants with less impact on climate change