Greener Black Country

According to Asthma+Lung UK, the UK has the worst death rate for lung conditions, such as asthma and chronic obstructive pulmonary disease (COPD), in Western Europe. The same data show that the UK’s mortality rate for asthma is twice as high as that of the next worst country in Europe, which is unacceptable given that the National Review of Asthma Deaths (NRAD) reports that two-thirds of these deaths are preventable.

So, why is this the case?

Delays in diagnosis, poor housing, high pollution levels, overuse of short-acting beta-agonists (SABA) and underuse of personalised action plans are some of the reasons given. But — surprisingly — the NRAD’s primary finding was complacency among both healthcare professionals and patients.

Asthma is just not taken seriously enough.

Poor respiratory health has been closely related to deprivation and the Black Country has some of the most deprived neighbourhoods in the UK. Respiratory indicators, such as patients taking six or more SABA inhalers, are higher than the national average in the Black Country ranking 40^th/42, providing motivation for action.

In the Black Country, our medicines optimisation team continue to promote the change to low carbon footprint inhalers appropriately. We are working towards targets to reduce prescribing of six or more SABA inhalers and reduce prescribing of high carbon preventer inhalers have been incorporated into the GP prescribing incentive scheme for 2024/2025 for all places across BCICB.

In 2023/2024, a target of 10% reduction in both six or more SABA prescribing and Flutiform (very high carbon impact) inhalers was locally agreed with NHSE. BCICB met both targets- achieving a 22% reduction in items and cost of Flutiform prescribing and a 10.13% reduction in six or more SABA inhaler prescribing.

This year we are working on projects that help educate primary care clinicians on greener inhalers, campaign to tackle SABA overuse, educate patients on the greener inhaler options and increase the return of used, expired and unwanted inhalers to community pharmacies for safe and responsible disposal/recycling.

Find out more about Asthma:

Asthma + Lung UK (asthmaandlung.org.uk)

Share our patient leaflet:  SABA Overuse

We have been working with TfWM and NX Bus to offer staff and patients bus discounts and free trials to help encourage a shift to reduce emissions and improve local air quality. In the Black Country over 1,500 staff members claimed one-month free bus travel in 2023/2024, saving them a total of £134,000.

We continued this amazing project with TfWM and expandedthe offer to one-month free travel and two months with 25% off. We hoped this increased offer would encourage long-term behaviour change for staff and patients across the Black Country. 

Across the West Midlands, the Bus Improvement Scheme has supported over 2,900 NHS staff members saving 774 tonnes of CO2e and 106,194 bus journeys between July and November 2024.  

The Cycle to Work scheme is an excellent initiative designed to promote healthier and more sustainable commuting options for employees. By participating in the scheme, employees can enjoy the numerous health benefits of cycling, such as improved cardiovascular fitness, increased muscle strength, and enhanced mental well-being.

Starting your day with a bike ride can leave you feeling invigorated and ready to tackle your workday with more energy and focus. Additionally, cycling is an environmentally friendly mode of transportation, contributing to reduced traffic congestion and lower pollution levels in urban areas, making it a responsible choice for both personal health and the environment.

For employers, the Cycle to Work scheme is a fantastic way to demonstrate a commitment to the well-being of their workforce and the environment. Encouraging employees to cycle to work can lead to a healthier and more productive workforce, with fewer sick days and higher levels of engagement and job satisfaction. 

If you don’t own a bike, they are available to hire across the West Midlands as part of the cycle hire scheme, for further details please click https://www.wmcyclehire.co.uk/ or see your local council website.

The climate emergency is a health crisis that affects all of us.  

On high pollution days, we will see more patients admitted to our sites with asthma attacks and strokes. We regularly see flooding of our roads, impacting our ability to get to work, for ambulances to get to emergency calls, and for our community staff to reach their patients. We can expect greater demands on our services unless we play our part in reducing greenhouse gas emissions and moving towards net zero.

Clare Nash, Head of Clinical Products Management, is empowering teams across Sandwell and West Birmingham NHS Trust (SWB) and the wider NHS to make more sustainable and informed choices with an innovative tool she has developed to reduce the environmental impact clinical products have on the planet. Clare explained: “Approximately 62 percent of the carbon footprint comes from the products we use to care for patients, so by choosing greener solutions, including reducing use or moving to reusables, we can all contribute to the SWB green plan of reducing emissions. “There are 788,638 nurses, midwives, and nursing associates registered on the permanent register of the Nursing and Midwifery Council. As the most trusted profession, we can significantly influence the products we use and how we deliver care. Many colleagues have yet to recognise the correlation between the declining health of our planet and our population. I aspire to raise awareness about this issue and create a sense of urgency to modify behaviours at work and home. It is worth noting that approximately five per cent of emissions in the UK come from delivering healthcare “I recently shared my work on a national webinar focused on the tool I have developed. An example of the change I discussed is a reusable tourniquet we implemented, saving around £42,000, reducing waste generated, and reducing the carbon footprint by about four-fifths. I take advantage of all opportunities to speak with people about innovative solutions like this and share how we can all work together to achieve even more green and sustainable outcomes.”

There are exciting new initiatives to improve patient care. Earth Day on 22 April 2024 will be the launch of the second Greener AHP week which showcases some of these changes in care delivery. 

As health professionals and care organisations we have a duty to deliver health care now and to ensure that the care we are giving is not playing a part in damaging our patient’s health. AHPs are well placed to play a role to play in getting to net zero while ensuring high quality care for all.  

We’re asking AHP teams to get involved with Greener AHP week in any way they would like. Visit the Greener Allied Health Professional hub for inspiration.

Rhea Conn, a critical care senior sister at Sandwell and West Birmingham NHS Trust (SWB) introduced a range of cost-saving carbon net zero initiatives at the organisation and will go on to share her learnings nationally so that other organisations can follow suit. She joins the Greener NHS programme in a year-long secondment. It aims to reduce the impact on public health and the environment, save money and reach carbon net zero. Rhea said: “I’m thrilled to be taking part in the Chief Sustainability Officer’s Clinical Fellow Scheme and I’m most looking forward to developing my leadership skills, understanding NHS operations from a national level and seeing another side of nursing.” Rhea will be working at the centre of teams who are working to embed carbon net zero principles into the delivery of care. The role sees healthcare professionals stepping out of their roles for 12 months to lead on key projects that will fundamentally change the way that care is designed, developed, and delivered across the system. She added: “I will be working in London with NHSE in the Chief Nursing Office twice a week and presenting at the professional forum to share my learnings. It will give me the opportunity to meet regularly with senior members of the Greener NHS team, wider NHSE policy teams and stakeholders. I am hoping through this role, we can give more power to clinicians to make sustainability changes.”

Sandwell and West Birmingham NHS Trust nurses Rhea Conn, Clare Nash and Janice Nelson were highlighted at a regional Greener NHS meeting for their work on reusable torniquets and pioneering the hybrid nurse role. The Daisy Grip has been trialled with success and great feedback from patients and staff using the product. Not only that, but it demonstrates financial and carbon savings.

In the first scheme of its kind in the Black Country as part of as part of the Greener NHS agenda, 19 community pharmacies have joined The Royal Wolverhampton NHS Trust (RWT) in a commitment to reduce carbon emissions, improve public health and protect the environment. The scheme supports NHS England’s ‘greener NHS’ mission aimed at achieving net zero emissions by 2040. Simon Evans, Chief Strategy Officer for RWT, said: “Our Green Plan sets out how we can continue to provide high-quality care for patients, while at the same time protecting our local environment and visitors. The Trust has already made significant achievements in several areas including the physical estate, clinical services, waste recycling, catering and medicines – with this inhaler recycling scheme from pharmacy being the latest string to our bow.” Inhalers contain a propellant called hydrofluoroalkane (HFA) – a potent greenhouse gas – and not disposing of them correctly risks HFAs leaking into the ground/atmosphere. With more than 60 million inhalers prescribed in the UK each year, inhaler recycling offers an opportunity to prevent further harm to our planet.  Thanks to collaborative working across the Black Country Integrated Care System, and with support from AstraZeneca UK Ltd, the Trust received special collection bins for the hospital and community pharmacy sites, with supporting guidance that explains what can and cannot be recycled. Robin Jassal, Pharmacy Manager and Dispenser and Summan Ahsin, Dispenser at Ettingshall Pharmacy  Robin Jassal, who is based at Ettingshall Pharmacy in Wolverhampton, received his bin this week. The pharmacy manager said: “We all have a role to play in the decarbonisation of our health service and I’m happy that we’re able to take part in the scheme.” The inhalers will be recycled and transformed into new products such as coat hangers and waste bins. RWT is the pilot site before the project rolls out across the wider Black Country later this year. People can return old or used inhalers to New Cross and Cannock Chase Hospitals or a participating pharmacy in Wolverhampton – please ask your local pharmacist for more information.

Health and care colleagues from across the Black Country ICS attended a Greener NHS Sustainability Networking Day in May, to share their views on how healthcare can be delivered more sustainably in the Black Country.

Since 2010, efforts across the health service have resulted in NHS emissions being cut by 30%. This is already improving care, as well as the health and wellbeing of our patients. Decisions have been made to invest in greener medicines, greener transport, greener buildings, and greener energy consumption. In 2020, the NHS announced its ambitions to become the world’s first ‘net-zero’ health service by 2040.

More than 75 people - including clinicians, health and care leaders and suppliers - attended the event, which was hosted at Bescot Stadium in Walsall, to discuss the Black Country’s NHS Greener ambitions, why we need to reuse, recycle and reduce, and the work that has been done across the system to date.

Attendees heard from the NHS England regional team about the targets that are collectively being worked on across the Midlands, as well as updates from Greener NHS workstreams that are currently in place in the Black Country.

A series of workshops were also hosted, enabling attendees to share best practice, explore ideas for the future and about how they can apply some of the work that is already happening in the Black Country in their workplace too.

Tom Jackson, Greener NHS Executive Lead for the Black Country ICS, said: “The event was an opportunity for clinicians, healthcare leaders and suppliers from across the Black Country to come together and network, share experiences and look at a variety of different solutions that can help us meet our Greener NHS targets. By working with our system partners, we will deliver Greener NHS’s national vision of a Net Zero health service by delivering change where we have direct control, and influencing what we can indirectly control, so that we are responding to climate change, improving health and creating healthier places, people and futures in the Black Country.”