13th August 2024
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