Author(s)

Laura Morgan

Why was it done?

Inhalers are the largest single contributor among medicines to the NHS carbon footprint, accounting for 3% of total NHS emissions. In 2020, the NHS became the first health system globally to commit to Net Zero, later formalised through the Health and Care Act 2022 and the Delivering a Net Zero National Health Service report, which provides statutory guidance to ICBs. This project responds to that call-to-action and aligns with South East London’s Green Plan, which pledges to reduce emissions within its footprint. It also serves as a proof-of-concept to inform NHS England’s assessment of the viability of nationwide, routine inhaler recycling.

What was done?

Developed as an innovative sustainable project in response to NHS Net Zero ambitions and SEL Integrated Care System’s (SEL ICS) Green Plan, SEL ICS launched the first fully NHS-funded, ICS-wide inhaler recycling pilot in England. The scheme is fully integrated across primary and secondary care and enables the public to recycle used inhalers at any participating site. The inhalers are then transported to a recycling facility (Grundon Waste Management) for up to 99.9% recovery of propellants, plastics, and aluminium. This pilot serves as a proof-of-concept to assess the feasibility of business-as-usual inhaler recycling in the NHS.

How was it done?

An inhaler recycling pilot is being delivered across 20 community pharmacies and five acute/mental health trusts in SEL. A project working group (PWG) and formal memorandum of understanding was established between South East London Integrated Care Board, NHSE, King’s College Hospital (KCH), SEL Pharmacy Alliance, Guy’s and St Thomas’ (Essentia), and other stakeholders to ensure structured, cross-sector collaboration. The project leveraged existing NHS clinical waste infrastructure to recycle pressurised metered dose inhalers (pMDIs), ensuring operational efficiency with minimal disruption. The PWG collaborated with behavioural science colleagues and patient engagement groups to develop public-facing communications that encouraged appropriate inhaler disposal. All activities were embedded into routine workflows without additional staffing. Monthly data submissions from participating sites enabled continuous monitoring and will inform a fully commissioned evaluation.

What has been achieved?

Over 16,000 inhalers have been collected so far, with more than 11,000 returned through community pharmacies. The current recoupment rate at community pharmacies is approximately 15%, i.e., the number of pMDIs reported returned is around 15% of the high-carbon pMDIs dispensed by that pharmacy in the same month. This figure will undergo further scrutiny in the final evaluation, after corroboration by Grundon data following the project’s last recycling cycle. The project has also seen strong patient and public involvement. A live public-facing survey on the SEL website has received more than 100 responses to date. Themes identified include low awareness of proper disposal routes, strong interest in inhaler recycling, and improved understanding and willingness to return inhalers after campaign exposure. These results demonstrate meaningful public input and are informing ongoing communication strategies. In terms of reach and influence, the pilot has attracted national and international interest with over 25 NHS providers across the country having contacted the SEL team for support with replication, and a Canadian research group has requested to learn best practice from the model. The project demonstrated high operational feasibility, environmental impact potential, and strong appetite for scale-up. Complete evaluation is ongoing.

What next?

This innovative project shows inhaler recycling can be embedded in existing NHS systems. It presents a replicable and scalable national model, supporting medicines optimisation, waste reduction, and sustainability; it stands apart by being completely publicly owned, leveraging existing NHS contracts and infrastructure, without the need to rely on external sponsorships. This pilot offers a practical blueprint for embedding environmental sustainability into medicines optimisation across the NHS and the outcomes will inform future commissioning and advance the NHS’s Net Zero goals.
An evaluation of the pilot is currently being developed with the last inhaler collection at all sites due January 2026; the evaluation is due to be published in the Spring of 2026.

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Author(s)

Lone Møller Deleuran, Bitten Abildtrup, Sofie Pedersen, Ulrik Wøldike, Nina Winther Müller

Why was it done?

Amgros is committed to make its mark on the sustainability agenda regarding medicine – both nationally and internationally. Thereby improving access to medicines for patients in a more sustainable way – this project serves as a first step in this direction.

What was done?

In 2021, the Danish procurement organisation Amgros I/S issued the first national pilot tender for hospital medicines in which environment was an important award criterion along with price. Amgros procures 99% of the pharmaceuticals used at public hospitals. The pilot project was conducted to gain knowledge and experience about planning and executing future tenders with environmental criteria. The pilot tender was limited to the hormonal therapeutic area.

How was it done?

The chosen environmental criteria were environmental management, packaging (plastics and paper/cardboard), transportation and social responsibility.
It was a long process, including external help from consultants (The Technical University of Denmark), legal consultation, market dialogue with feedback, developing and adjusting the criteria to comply with national procurement legislation. Hence assuring the evaluation of the offers could be conducted in a meaningful, simple, and structured manner during the subsequent evaluation phase.
As a part of the final tender, a questionnaire was attached consisting of multiple choice questions concerning the environmental criteria. In the evaluation, the price weighed 80%, whereas the environmental criteria weighed 20%.

What has been achieved?

Amgros received 85 offers from 19 suppliers of which 76 offers contained the questionnaire about environment. Sixteen (84%) of the bidding suppliers completed the questionnaire. Three suppliers won the tender solely due to their environmental capability.
The tender with environmental criteria did not seem to discourage suppliers from bidding nor resulted in increasing price levels.
The pilot tender has created a great deal of awareness among the suppliers about the importance of environment and sustainability in production, distribution, and sales of medicine.

What next?

The experience obtained from this pilot tender is paving the way for the future broader implementation of more sustainable medicines in all tenders. Furthermore, the results will be shared nationally and internationally. Hopefully, the results will encourage other countries to incorporate environmental criteria in future medicinal tendering processes.

Pdf

Author(s)

Helle Pasgaard Rommelhoff, Lise Grove, Dorthe Bartels, Trine Ann Behnk, Lars Ole Madsen

Why was it done?

To share learning from a pilot of procuring pharmaceuticals jointly across borders in three European countries as well as post-learning on planning and execution elements in order to have a successful joint procurement.

What was done?

Three European countries decided to implement a joint procurement pilot in order to seek solutions for some of the supply issues in the three markets. This was a consequence of being a small volume market with potentially limited attractivity for suppliers of older products. An initial evaluation of synergies and discrepancies among the involved countries supported the understanding of how to jointly procure medicines for the hospital sector.

How was it done?

The visualised model of a product lifecycle was applied to understand where a pilot of joint procurement would support the supply issues of the older products. This led to a shared understanding between the countries on where the supply issues may occur and potential solutions. An evaluation of building the joint procurement process, which took approximately 2 years, is now available as a best practice with “Do’s and Don’ts” for other countries with joint procurement interest. Criteria in the tenders announced were either price alone or in combination with. One of the tenders included a mandatory bid for all 3 markets, the rest of the tenders were mandatory for 2 of the markets with optional submission for the 3rd market. This was an outcome of hearings with suppliers. The feedback from the hearings was modifying the tender materials into a new proposal for suppliers. A political framework was signed between the countries to have a shared fundament to build on.

What has been achieved?

The final outcome of a joint procurement was evaluated. Evaluation of the submission and preparation part showed that the majority of joint tenders had an efficient competition on price with a representative amount of suppliers bidding. It also shown that it was vital to have collaboration and to listen to stakeholders in order to have a robust insight on what was possible for all involved parties. The thorough preparations supported the process and the final outcome. There was dual engagement between the stakeholders and transparency on the wish from countries to overcome barriers and conduct joint procurement to support supply issues.

What next?

Efficient and timely planning is crucial. Collaborations between the involved stakeholders are important. Mutual understanding of the interests and strategy is helpful in building a shared view on the problems and potential solutions. It is seen as essential, when planning joint procurement, to include logistic thinking already in the early tender planning phase.