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The Green gauntlet

Pharma will run up against another challenge as the NHS considers its carbon footprint

Green Giant I very seldom do shopping. I should explain. I like buying things. That's computers, gizmos, clothes, cars, holidays and stuff like that. Shopping, however, is for bog rolls, jars of coffee, washing-up liquid and stuff like that. For me, there is a clear difference. So, I don't do shopping. Well, I didn't, but for the past couple of weeks I have had to make a bit of an effort. My mother, usually a redoubtable, indestructible eighty-something year old has been poorly with a cough that sounds like the milkman's horse, and a back strain. So, I've been doing the shopping.

I found myself in Sainsbury's. I unloaded a trolley full of stuff on to the conveyor belt and a distracted soul, in a trance, called Kylie, with a fake tan, fake nails and fake eyelashes, mechanically beeped her way through the soap, tins of beans and cough mixture. When the beeping was done, she looked at the mountain of stuff and said, "D'ya wanna a bag?"

I got off on the wrong foot. I said, "Of course I want a bag. Do you think I'm going to put this lot into my pockets?" That was a bad move. Kylie reached under the conveyor belt, pushed a hidden button and next I had to contend with Brenda, the supervisor. I was lectured on politeness to staff, people only doing their job should come to work and expect 'compliance' (whatever that is) and Sainsbury's views on how we would save the planet if we all had a shopping basket.

My next bad move was to say that I would buy a shopping basket if the Chinese stopped building a coal-fired power station every week, if India stopped building a coal-fired power station every day and if America would sign the Kyoto Accords.

By now a crowd had developed. A mixture of pensioners with bags on wheels, young mums with bags on pushchairs and a security bloke. I shut up, bought a bag made from the recycled nose hair of a Tibetan Yak and skunked-off.

I hate green, recycling and mending. I think in these difficult times we should all be buying new stuff. What's the point in having £30 grand in the building society earning 2 per cent interest when you can buy a brand new 4x4 Range Rover at 30 per cent off. Go buy stuff – it's your civic duty!

The NHS buys more stuff than any other organisation in Europe. With the exception of guns, bullets and tanks, it buys more stuff than the MoD.

The NHS has just published its Green Guidance. Carbon management and associated policies are not going away. It is an imperative for policy across Whitehall, and indeed Europe.

Big steps
The NHS has the largest carbon footprint in Europe and emits approximately 18 million tonnes of carbon each year. Its annual energy bill is approximately £400m.

Government has committed itself to taking action and the Department of Health has a mandatory target to reduce carbon emissions by at least 60 per cent by 2050, with a minimum reduction of 26 per cent by 2020.

Although I can't quite believe it, 5 per cent of all the UK's emissions from road transport are attributable to NHS-related journeys. Staff, patients and visitors travelled almost 25 billion passenger kilometres for NHS-related purposes in 2001, of which 83 per cent were by car or van.

One in every 100 tonnes of domestic waste generated in the UK comes from the NHS, with the vast majority going to landfill.

All this kerfuffle came to light recently when the NHS' carbon management Tsar, the Jolly Green Giant himself, Dr David Pencheon, announced patients would have to make do with less meat on the hospital menu because most of it comes from Argentina and by the time it arrives here it has the carbon footprint of an elephant.

If NHS trusts meet their target to cut primary energy consumption by 15 per cent by 2010, the NHS will save £50m per year on its energy bills – equivalent to 7,000 heart bypass operations

The Jolly Green Giant says that if 166 acute hospital trusts in England turned off idle computers they would eliminate an estimated 90 kilo-tonnes of CO² a year – the equivalent of flying over 26,000 people from London to New York and back – now you're talking!

I hate all this green stuff but I am warming to the theme. If domestic and clinical waste were correctly segregated and just 40 per cent recycled, additional emissions savings would be similar to those produced by driving an average-sized car around the equator more than 550 times. Now that is something I would like to do.

What's the point of all this? Well I have learned it is not just how stuff is made that is important. It is just as important to find out where it comes from.

So, just as the NHS is going to have to get to grips with tele-consultations, web conferencing, restricting hospital visitors, dumping its army of district nurses and bringing bus loads of grannies to the surgery to get their leg ulcers fixed, so pharma has a problem too.

The NHS likes to keep a handle on the drugs bill. So, generic products are the flavour of the month. The £3bn plus UK generics market is one of the world's largest in terms of size and generic penetration. In 2005 over 59 per cent of prescriptions were dispensed as generics, accounting for 26 per cent of the market value. Today the figure is well over 70 per cent. Fierce competition and price pressure are turning up the heat. To deal with competition pharma is manufacturing product overseas. India, China, and Ireland are just few of the places that have modern factories and low labour costs and are churning out pills by the tonne.

The problem is their delivered carbon footprint is the size of a pair of shoes for an Indricotherium and it just won't fit the NHS anymore.

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster
To comment on this article, email pm@pmlive.com.

26th March 2009

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