Dr. Frances Mortimer, Medical Director Centre for Sustainable Healthcare National Workshop - Carbon...

Dr. Frances Mortimer, Medical DirectorCentre for Sustainable Healthcare

National Workshop - Carbon Modelling within Dentistry17th February 2015

Measuring carbon in healthcare

CENTRE forSUSTAINABLEHEALTHCARE

Measuring carbon in healthcare

1. Why measure carbon?2. How do we do it? 3. Carbon measurement examples:• The whole NHS• Dorset renal service – a clinical service• Antipsychotic depot injection – an intervention• Respiratory inhalers – a product

4. Overview


Why measure carbon – how does it help?

Carbon will be as important as money – you can’t commission if you can’t cost…

1.Policy development: setting targets, tracking progress2.Service redesign: identifying carbon hotspots, evaluating innovations3.Comparing higher and lower carbon interventions and products4.Engaging public, staff, suppliers /providers

carbon cost per QALY


Carbon footprint - The sum of greenhouse gas emissions released in relation to an organisation, product or service, expressed as carbon dioxide equivalents (CO2e).

Carbon footprint: what is included?(operational boundaries)

Can be expressed in carbon dioxide equivalents (CO2e)


Steps involved

1. Define the goal and scope of the study2. Identify the resources used

(set boundaries, create inventory)3. Measure the resource utilisation

(collect data)4. Attribute a carbon cost or footprint to

the resources used (x carbon intensity)

Bottom-up versus top-down

SDU. (2013). Goods and services carbon hotspots


Example 1

Carbon footprint of NHS England

Motive: policy development, engagement

Method: Scope 3 (consumption-based), mixed top-down / bottom up


NHS England activity data

Category Data source

Direct energy use of coal, oil, gas and renewables

ERIC returns

Direct release of anaesthetic gases & nitrous oxide

Suppliers’ figures

Electricity use ERIC returns

Procurement spend National accounts expenditure for government expenditure on health, HM Treasury PESA, NHS Shared Business Services (Trust level data)

Staff, patient and visitor travel National Travel Survey

SDU. (2013) Carbon footprint update for NHS in England 2012

CENTRE forSUSTAINABLEHEALTHCARESDU. (2013). Goods and services

carbon hotspots,

Climate Change Act 2008 targets

SDU. (2013). Goods and services carbon hotspots


Example 2

Carbon footprint of Dorset Renal Service

Motive: identify carbon hotspots, policy development/ engaging staff and others

Method: Scope 3 (consumption-based), mostly bottom-up


Steps involved

1. Define the goal and scope of the study2. Identify the resources used

(set boundaries, create inventory)3. Measure the resource utilisation

(collect data)4. Attribute a carbon cost or footprint to

the resources used (x carbon intensity)

Renal procurement data not available at national level


Dorset renal service

• Six service components: inpatient, outpatient, haemodialysis, peritoneal dialysis, transplantation, administration

• (Slices of) five sites

The Carbon Footprint of a Renal Service in the United Kingdom. Connor A. et al. QJM (2010) 103 965 – 975

Detailed knowledge needed for bottom-up study


Dorset renal service activity dataCategory Data source

Buildings energy use Calculated from ERIC returns for each site, based on the proportion of the floor space occupied by the Dorset renal service

Staff and patient travel Travel surveys

Visitor travel Estimated from National Travel Survey 2006

Procurement data Expenditure data for pharmaceuticals, medical equipment, paper, food, sanitation products and IT were collected from relevant departments

Numbers of radiological and laboratory investigations were taken from IT records

Water consumption taken from meter readings

Linen usage determined per patient

Waste amounts and disposal route were estimated from published reports



Discussion

• Total GHG emissions from Dorset renal service = 3007 tonnes CO2e per year

• Supply chain emissions contribute 72% (pharmaceuticals 35%, medical equipment 25%, waste 10%)

• Carbon footprint of dialysis = 7.1 tonnes CO2e per patient per year



Example 3

Carbon footprint of antipsychotic depot injection

Motive: service redesign: carbon modelling a service change

Method: Scope 3 (consumption-based), mixed bottom-up / top-down


Best Practice

• There is no clinical improvement from doses of Flupentixol Decanoate higher than 50mg every 4 weeksThe average dose prescribed in the UK is 60mg every 2 weeks


Activity data / emissions factors


Goods and services carbon hotspots, NHS Sustainable Development Unit (2013)

= building blocks for carbon modelling


Top down methods of carbon footprinting clinical activity

• Method 1. Total NHS carbon emissions per pound total expenditure apportioned on the basis of unit costs of each activity

• Method 2. Total NHS carbon emissions for secondary care (based on share of secondary care spend out of total spend) apportioned on the basis of shares of total activity for each service area

• Method 3. Total NHS carbon use for inpatient and outpatient care (based on share of inpatient and outpatient spend out of total spend) apportioned on the basis of shares of total activity

• Method 4. NHS Building energy use carbon emissions apportioned on the basis of inpatient activity (not applicable for outpatients)


Discussion

Currently, being on depot causes a significant increase in a person’s total carbon footprint of 6% per year, from 7.9 tonnes CO2 to 8.4 tons per year. This could be reduced by over 50%

Maughan, D., Lillywhite, R., Cooke, M. The economic cost and carbon burden of long acting injections. (submitted for publication)


Example 4

Carbon footprint of inhalers

Motive: internal product appraisal; public reporting on carbon impact of alternative devices

Method: product life-cycle, bottom up

Source: GHG Protocol Product Life Cycle Accounting Reporting Standard

The relationship between the Corporate, Scope 3, and Product Standards for a company manufacturing product A

Setting boundaries

• Per actuation, MDI emissions are 11x DPI emissions• The propellant HFA134a contributes >99% of the carbon footprint

of the Evohaler (MDI)• For a 200 dose Ventolin Evohaler, 88% GHG are released on

inhaler use, the rest in manufacture

Ventolin (200mcg) 60 Dose Accuhaler 0.8kg CO2e per pack

13g CO2e per actuation

Discussion

Ventolin (100mcg) 200 dose Evohaler 29kg CO2e per pack

144g CO2e per actuation

Source: GSK, by personal communication

Inhalers contribute 5% of NHS carbon footprint


Overview

• Carbon footprinting is easy: just multiply activity data x carbon intensity factors…

• Understand the goals of the study when setting scope & method – will you want to compare findings or monitor impact of changes?

• Data quality / access may limiting• Methodology is increasingly standardised• Be transparent about (look carefully at)

boundaries and assumptions

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Dr. Frances Mortimer, Medical Director Centre for Sustainable Healthcare National Workshop - Carbon...

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