CSH's Joint Letter To Nice: Act More Urgently On Climate Change.
The Centre For Sustainable Healthcare has been working alongside NICE, the National Institute For Health and Care Excellence for almost 10 years to ensure that sustainability becomes a core element of their mission to provide best practice guidance to the NHS and wider health care system, but NICE are falling far behind in those efforts and now the message is changing. Along with a significant number of other healthcare organisations, CSH is now asking NICE to take much more urgent action on climate change.
The National Institute for Health and Care Excellence (NICE) is a hugely important and well-respected part of the health system both across the UK and internationally. NICE provide evidence-based clinical guidance, technology appraisals and quality standards on treatments and care. They make recommendations on how to best identify, refer, diagnose, treat and manage patients based on the best evidence available. Given this influence, as a critical organisation in assessing the quality of healthcare, NICE has a pivotal role to play in introducing consideration of environmental impact of care into the health system in a transparent and standardised way.
The problem is that after almost a decade, they have been far too slow to take action.
The Centre for Sustainable Healthcare (CSH) first approached NICE in 2015 and worked diligently with them on ways to incorporate more sustainability into best practice guidance and incorporate measurement of carbon into their work. However, despite starting some internal work and employing someone to lead on sustainability, 9 years later we have not seen any real progress to embed environmental sustainability into guidance.
In the absence of standardised guidance and agreed best practice on sustainable healthcare, the health industry, who provide the medication, equipment and devices used during patient care, have largely started to take it upon themselves to create their own criteria for environmental impact and incorporate environmental criteria for how they operate. The problem is there are no agreed standards. This is creating confusion for those in NHS organisations trying to procure more sustainably as they have no standard criteria for making decisions. The same is true for healthcare professionals who rely on best practice guidelines to deliver care. They are being told that they should be incorporating more sustainable practices into their daily work, but have no crieria on how to do so.
This is something that NICE can rectify.
What can NICE do?
NICE is internationally recognised for its scientific robustness and the quality and accuracy of its recommendations. Whilst some steps have been taken over the years much more can be done to use that reputation and authority to make changes for the better. We at CSH urge NICE to provide leadership in introducing environmental impact into consideration of the guidance it provides and have such have joined forces with other powerful voices coordinating work in the climate and health interface to send a joint letter to NICE, urging it to take more decisive action sooner rather than later.
The letter in full:
Dear Sharmila Nebhrajani and Sam Roberts,
As WHO says, climate change and the destruction of nature are the major threats to global health. Global warming is accelerating and each of the last 10 months have been the hottest on record. We know that NICE is committed to environmental sustainability, but we call on you to urgently increase the emphasis you place on environmental issues, particularly in providing guidance to the NHS on environmental issues and assessing technologies available in the NHS.
You write on your website: “We’re conducting an options appraisal to understand the feasibility, benefits and risks associated with different ways that we might request and use product-level environmental sustainability data.”
It seems to us that you have been conducting this appraisal for a long time, and we recognise that there are methodological difficulties. We urge you, however, to introduce a “good enough” method and revise it as necessary rather than continue a search for perfect methods.
The NHS is committed to reaching net zero on all it directly controls by 2040 (with an 80% reduction by 2028-2032) and all it consumes by 2045 (with an 80% reduction by 2036-39). The first of those targets is only four years away and will require energetic input by NICE to reach those targets.
About a fifth of the carbon footprint of the NHS is medicines and chemicals and another 10% is medical devices. There is lots of scope, to improve prescribing and the use of equipment and reduce cost and carbon. NICE should be leading on this.
Inhalers and anaesthetic gases account for 5% of the NHS footprint, and we welcome the guidance you have produced on inhalers.
Anaesthetic gases, however, provide a good example of how NICE could have prevented environmental damage. Desflurane is now being phased out, but NICE could have stopped it from being used in the NHS in the first place, reducing greenhouse gas emissions from the NHS. Desflurane has minimal if any advantages over existing anaesthetic gases and yet a global warming potential 2500 times greater than carbon dioxide. Rudimentary environmental assessment could have stopped it from being used.
We urge you to make increasing your contribution to helping the NHS reach its targets for net-zero a priority.
We would welcome the opportunity to meet with you to discuss this further and to provide any support we can offer.
Yours faithfully
Dr Richard Smith CBE, FMedSci, Chair, UK Health Alliance on Climate Change
Dr Fiona Adshead, Chair, Sustainable Healthcare Coalition
Rachel Stancliffe, Chief Executive, Centre for Sustainable Healthcare
Dr Mark Hayden, Ride for their lives
Dr Fiona Brennan, Green Health Wales
Maria Carvalho, Climate Campaign Medact
Judith Anderson, Climate Psychology Alliance
Samantha Holmes, Clinical Fellow, BMJ
At CSH, we strongly urge NICE to take swifter and more decisive action in making healthcare more sustainable. Your support is crucial in amplifying this message and ensuring it reaches a wider audience. We kindly ask you to help us spread the word by sharing this letter with your networks and encouraging others to join us in advocating for the change needed in our healthcare system. Together, we can make a significant impact.