[00:00:00] This Podcast is brought to you by the GOSH Learning Academy.
[00:00:04] SA: Welcome to the third season of GOSHpods Goes Green. In this season, we're going to be focusing on medicine sustainability. In 2021, Great Ormond Street Hospital was the first UK children's hospital to declare a climate and health emergency. The NHS as an employer is responsible for 4 percent of the UK's total carbon emissions.
[00:00:24] And medicines are responsible for 25 percent of that. We're going to explore this topic further, taking a journey through the life cycle of a medicine, covering everything from production and procurement, use of medicines in hospitals and homes, all the way through to medicines disposal, to properly explore how we can change the impact that medicines have on the environment.
[00:00:45] In this introductory episode, I'll be talking to Stephen Tomlin, Pharmacist at GOSH, who's going to be giving us an introduction to the series and telling us why medicine sustainability is such an important conversation to be had. Stephen, thank you so much for talking with us today.
[00:01:00] ST: Thanks very much. I'll tell you, it's really good to be here. A topic very close to my heart. Obviously sustainability carbon footprints, whatever words you want to throw in, an important topic, but being a pharmacist it's the medicines and where they fit into it all that really interests me.
[00:01:19] And hopefully I can get some of that one facts across and two passion across that we need to do something with it.
[00:01:25] SA: Yes, absolutely. I think the passion is evident already. I'm so excited, not just for this conversation, but for this whole series. I think we're going to have some really exciting and important conversations. Before we talk a little bit about this series, can you give us a brief introduction to yourself?
[00:01:43] ST: Yes, of course, it's, how can I put it, I've been around a long time consultant paediatric pharmacist by trade, so I'm a clinical pharmacist, and the last 30 years, that's where I've been sort of putting my time and my efforts. More recently, I've taken over as the director of the Children's Medicines Research and Innovation Centre.
[00:02:06] Great Ormond Street and part of that sustainability came along with me. I can't remember if I pulled this or pushed, but I was more than happy to take that on within that role and. Because of that, I'm sort of leading on the medicine sustainability within Great Ormond Street, but also then I've managed to get pulled or pushed into looking at medicine sustainability on behalf of the ICB so North Central London and also I'm the professional lead of the neonatal and paediatric pharmacist group, sort of the national group looking for paediatric pharmacists, and The same topic is on my shoulders for that group as well.
[00:02:44] So it's a, you can tell I probably pulled it, but it's a topic that I'm very interested in and that's sort of where it's come from. And that's who I am.
[00:02:52] SA: Whether you pulled it or it was pushed upon you, yeah, you sound like the perfect person to be having this conversation with.
[00:02:59] ST: I'm not sure there is a perfect person. It's one of those topics that everybody thinks we should be doing something about it. It's high on the agenda for a lot of institutions, but of course, because it's not The mainstay of what a lot of institutions are actually delivering. It often falls onto the back burners for actual delivery.
[00:03:19] And therefore, there's something about that having a passion for something to try and ensure that it stays higher on the agenda. It's very easy in particularly in a health service where you're primarily dealing with patients and sick patients that topics like this. Do drift down the agenda, and therefore it is it needs some passion.
[00:03:42] It needs some champions. otherwise it doesn't happen. And I don't think that's a fault of any institution in terms of not keeping it bubbling along as their top priority. But It does need to stay up there as a high priority and therefore. I'm just one of a number of people who are sort of trying to lobby and champion and keep the enthusiasm going so that it does move forward.
[00:04:08] SA: Yeah. Sustainability in its own way needs its own passion to sustain it.
[00:04:13] ST: Exactly.
[00:04:14] SA: So this whole series is about specifically medicine sustainability within the NHS. Can you tell us a little bit about how medicines contribute to the sustainability and the carbon emissions within the NHS? Mm
[00:04:30] ST: Yes. I mean, I suppose the broad topics that are often discussed is that the NHS is about 4 percent of the UK's carbon footprint. Which in its own right is a huge amount, but the NHS is a huge institution.
[00:04:44] But 25 percent of that is to do with medicines. Now I use that in its broadest terms, but 25 percent of An NHS contribution is phenomenal.
[00:04:55] So we shouldn't, as an NHS, be talking about sustainability without thinking of medicines. Obviously, a lot of that is not directly in our capability of handling. Medicines are made across the world. They are a huge industry in their own right. And therefore that carbon footprint comes from The manufacturer, the distribution as well as the use.
[00:05:21] And it's important that's understood. Doesn't matter how much we do individually. We will never get rid of that 25 percent unless we stop using drugs altogether. But there are many things that we can do to support decreasing that carbon footprint. And it's not just The carbon footprint with medicines, it's that, they, I'm gonna say mess up the environment in many other ways.
[00:05:47] they end up in the water supplies. There's a lot of materials that sit around medicines, which also you know, plastics. And a lot of those plastics are not recyclable and all these, and we can touch on some of that maybe, but I think it's important to understand that there's a carbon footprint, but there's also an environmental impact of medicines, depending on where they go and what people do with them.
[00:06:14] SA: Yeah, I think that point is so important because a lot of the push has been about getting the NHS to net zero, which is obviously about carbon emissions. But as you said, we can't just concentrate on that with medicines. Because yes, part of it is a supply chain, but like you said, it's the forms in which they come thinking about some of the statistics, just the amount of plastics, thinking of all the blister packs that people throw away. It's so much more, isn't it, than just net zero?
[00:06:43] ST: It is and again, you know, it's not your local pharmacy who puts them in those little
[00:06:49] SA: No, of course that is where it sort of industry comes in. And so, obviously, there's two things that we can do we can't suddenly get rid of blister packs blister packs came around for a particular reason.
[00:07:01] ST: They are. when I first started career, we were still tipping lots of tablets out of big bottles and counting them on trays and different bits and pieces. And now most of them, most tablets do come in blister packs. And it's a really good way of presenting them. In terms of child resistance it's a better way of doing it in terms of sterility and keeping a longer shelf life and all these sorts of things.
[00:07:28] So there's really good reasons for that packaging. Obviously, we are reliant on industry to make improvements, and hopefully everyone will be pleased to hear that industry is making big improvements and with a bit of push from the NHS, so we are sort of laying down some gauntlets that you know, we are looking more favourably at companies that produce this.
[00:07:52] More sustainable medicines. And so, so there is a push and industry is really picking that gauntlet up, which, which is really good to hear, but we will never get rid of some of those problems. And therefore, how do we recycle? How do we get rid of those packages and how do we use medicines, which are more sustainable than those that are less or big topics that we need to be talking about.
[00:08:19] SA: And big topics that we're going to be focusing on over the next couple of weeks.
[00:08:23] ST: We are indeed. And I think I certainly don't want to steal anybody's thunder. I want to, you know, hopefully whet people's appetite some of the topics which are coming up. But it's of the topics are topics that can be talked about for hours on end because they are in depth, they are complex.
[00:08:40] It's very easy to think that we should just change things overnight. Very hard to do, but it's really important that we pick up the different topics and try and ensure that we do the best. What's mad, in some ways, is the best thing to do with medicines, obviously, is not use them.
[00:08:58] SA: Yes.
[00:08:59] ST: And because then we wouldn't need them.
[00:09:01] That's not. Logical.
[00:09:03] We can't do that. We need to treat patients. Medicines are the biggest intervention for health care. And therefore, we need medicines. So it's a case of working together. But within the use of medicines, We have a lot of overprescribing. We have a lot of medicines that are thrown away and therefore the best thing we can do without thinking about anything that we do with things that have been left, and all these things is only use medicines when they're really needed.
[00:09:34] Only supply them in the amounts that they're needed.
[00:09:36] Make sure that people use them as best they can, so that they get the best effect from them. Often people are put on a medicine, doesn't seem to work, but we know that compliance can be very bad, they get swapped on to another medicine. The first medicine is still at home, so that gets thrown in the bin.
[00:09:54] Therefore that whole, how do we use medicines best to treat patients, is probably the best topic. Which, in some ways we should be talking about. For healthcare anyway, and it's probably the most exciting thing about the medicine sustainability agenda is virtually every topic that we're talking about is actually best for the NHS. It's best for patients. It's best for the environment. It usually costs less money. And therefore, it's a win,
[00:10:25] SA: Yeah. When you think of it that way, it's a no brainer, isn't it?
[00:10:29] ST: Exactly.
[00:10:30] SA: I wanted to touch briefly as well, not just net zero is a concept we're going to take through this whole series. Another thing I think is worth talking about is health inequalities as well which is a thread that we wanted to take through all of this.
[00:10:45] ST: So, health inequality, I think is a really important part of all of this. going back to the topic that I just touched on actually where, how do we make the most of medicines and how do we create an environment where we don't need as many medicines. One of the best ways of doing that is keeping people well.
[00:11:01] SA: Yes,
[00:11:02] ST: And there is obviously still, certainly across the world, but even in the UK, quite a big variance in terms of health, related to wealth, related to ethnic groups, and therefore that part about keeping people well. is an enormous part of using less medicines and therefore creating an equitable society where there aren't people who are, I'm going to say, on or under the bread line, and that inequality that we still have, unfortunately, within the UK is part of the why do we use more medicines? And one thing goes with another in some ways, you know, poor housing tends to lead to worse health outcomes and all of these sorts of things. Air pollution is often worse in areas of poverty. less wealth. It all goes together and it's not fair and it's not equitable. And whilst people think, well, that's not a sustainability issue.
[00:12:11] It is because of the way we have to treat the way we have to and then utilise treatments to overcome the wrongs that have almost happened to people. And so it's hugely an equity issue and one that. It's probably not being tackled enough from a pharmacy point of view. It's not one that we've touched on in a big way.
[00:12:33] We are talking a lot about recycling and these sorts of things, but the whole topic of the best use of medicines and how to keep people well. Is probably the biggest topic that we can look at to ensure that we don't use as many medicines as we currently are.
[00:12:54] SA: Yeah, absolutely. And this is, we're not remaking the wheel when we say this, this is stuff that the NHS has been talking about for a long time. And if we're thinking about health inequalities, not just in terms of medicine sustainability, but from a larger kind of climate change sustainability point of view, one of the NHS reports, and I'll put the link in the description, spoke about how particularly minority ethnic groups are disproportionately affected by pollution levels.
[00:13:21] Air pollution disproportionately affects areas of deprivation. And as climate change worsens, energy demands will rise, prices will rise, poorer families will be hit hardest. And the college as well, the Royal College of Pediatrics and Child Health has a position statement on climate change and talks about the health inequalities.
[00:13:40] So these are Bigger conversations, and if we can touch on it as well, from a medicine sustainability point of view, hopefully we can add to those conversations.
[00:13:51] ST: Totally, and I would applaud the statement from the Royal College of Pediatrics and Child Health, because whilst it reflects a global position that they are talking about, they very much allude to the fact that The UK has the issue as much as anywhere else, maybe not to the same extremes as some other countries, but obviously it is the Royal College of Pediatrics and Child Health within the UK, but they are the UK.
[00:14:20] And so yeah, known as an institution across the world. And therefore, a lot of their statements are about the global position. But I think it was right that within that, within their statement, they specifically said, and this is in the UK still. It's very easy to think that some of these equity issues , and population issues are somewhere else.
[00:14:42] SA: Yeah.
[00:14:43] ST: And then, and they're not happening in the UK, and they really are, and there's a lot we can do.
[00:14:49] SA: An important thread that we'll be talking about in the coming weeks. Speaking of the coming weeks, could you give us a bit of an overview of what this series is going to offer people?
[00:15:00] ST: Yes . What we've tried to come across is, some of the key topics that we are currently looking at. How do we use medicines properly and get the most out of them? And I think really exciting. topics being looked at, i. e. are liquids more sustainable or less sustainable than tablets? And therefore, If liquids are, have got a much higher carbon footprint for the same medicine than a tablet, well, how do we get everybody off of liquids onto tablets?
[00:15:27] SA: A big question, generally in paediatrics. Yes.
[00:15:29] ST: A huge question for paediatrics, but also a huge question in care of the elderly and, people often get left on things which they might not need to be left on. We need to be reviewing more. A lot of this is about how do we review patients to make sure they're on the best thing for them. But we know that IVs are very bad.
[00:15:48] So how do we get people off of IVs? Lots of work has been done in antibiotics over the years on that topic. How do we look at all other IVs And move that along. So how do we get the most out of medicines and the sorts of medicines they're on? How do we stop people being on lots of medicines?
[00:16:05] Polypharmacy. So that's the next topic that will be discussed. Inhalers has been one of the big topics because it is probably as a standalone item of medicines is probably the one of the worst out there in terms of carbon footprint. Things are changing in industry to change some of that, but there are lots of things that we can do in the uk.
[00:16:28] We've got a lot more people on meter dose inhalers with the the gases inside than they have in say, Finland where they've moved virtually everybody over to dry powder devices. Is that what we should be doing? How do we do it? And if we can't, because we won't be able to change everybody, how do we of those canisters, all that aluminium, all that gas, all that plastic?
[00:16:53] Should we just put them in the bin? Should we put them, return them to our pharmacies? Or is there actually a way of recycling? All of that can be touched on in that session, but hugely important because it is such a big contribution within the medicine world. And then the very last session is that disposal, which is on that topic of waste. I think is high on everybody's minds when you talk about sustainability and really important topic because it's one everybody can get involved with.
[00:17:25] What is the right place to throw things, I suppose, if you don't need them anymore? Because there will be times, and whether that's a part used thing or a new thing, so what's being looked at? what recycling schemes are there? What can be recycled? What can't be recycled? Where should we put things?
[00:17:44] Should we put things down the sink? Should we put them in the bin? Do we return them to pharmacy? And what are the best things that we can do? And what are we looking at? I, we haven't got answers to all of these things yet, but there are a lot of schemes coming through some of which will cost money.
[00:18:01] Some which will be free, and it's so our very last session is almost on that topic, which everybody can engage with and therefore really important for the public as well as healthcare professionals and everything else. So, a really exciting group of sessions that we've got with some very good speakers who have really embedded themselves within the topics.
[00:18:23] SA: Yes. A real journey, I think, and yes, as you said, you're going to be hearing from me and from Steven as well, but then other members of the pharmacy team, members of the gosh, sustainability team and clinicians and nurses as well, who are interested and really passionate about this topic.
[00:18:42] ST: It's really important that you picked up on the multidisciplinary team. Medicines are certainly not about pharmacy. They are not just about patients who are taking them. Everybody in the healthcare sector gets involved with medicines and therefore this is a topic for everybody.
[00:18:59] SA: Absolutely.
[00:19:00] So. This is episode one keep your ears because episodes two, three, four, five, and six will be releasing weekly. And you can find them wherever you get your podcasts. Stephen, thank you so much for talking to us today and giving us such a fantastic introduction to this season three of Gosh Pods Goes Green.
[00:19:21] ST: Thank you very much.
[00:19:22] SA: Thank you for listening to this episode of GOSH Pods Goes Green. We would love to get your feedback on the podcast and any ideas you may have for future episodes. You can find a link to the feedback page in the episode description or email us at
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[00:19:49] You can also visit our website at www. gosh. nhs. uk and search Learning Academy. We have lots of exciting new podcasts coming soon, so make sure you're subscribed wherever you get your podcasts. We hope you enjoy this episode and we'll see you next time. Goodbye.
