Research Project: How can Innovation in Medicines Optimisation support achieving Net Zero?

Care Quality Commission
4 min readNov 16, 2023

Sarah Billington is Deputy Director Medicines Optimisation and IR(ME)R[1] at CQC. Here, she talks about the environmental impact of medicine use in health and social care and invites you to support CQC’s new funded research into sustainable medicines optimisation.

Decarbonisation and the wider green agenda are high priorities for everyone. Climate change is happening all around us. We’ve seen the impact again this year. Heatwaves, flooding, and other extreme weather events are happening more often.

Achieving net zero requires innovation, collaboration and action across the whole health and care system. On 1 July 2022, the NHS became the first health system in the world to embed net zero into legislation. The Health and Care Act 2022 places a duty on NHS England, trusts, foundation trusts, and integrated care boards to contribute towards environmental targets.

The least sustainable medicine is the one that is prescribed but never used. This makes medicine optimisation key to medicines sustainability for prescribers across all sectors.

In general practice the Royal College of General Practitioners Green Impact for Heath Toolkit includes guidance on optimising the use of inhalers to improve asthma control and consider the carbon impact of different types of inhalers. The National Institute for Health and Care Excellence (NICE) decision aid, Asthma inhalers and climate change, supports an informed, patient-centred approach to optimising treatment to manage asthma.

An extract from the NICE decision aid on asthma inhalers which illustrates the relative CO2 footprint of different types of device. Full text:
An extract from the NICE decision aid on asthma inhalers which illustrates the relative CO2 footprint of different types of device. Full text: 2

Although there are no statutory requirements for medicines sustainability in social care, there is recognition and response to wider environmental concerns and the impact of climate change on people’s health and wellbeing. Focussing on medicines, we know that structured medicines reviews in care homes improve outcomes for people. It optimises their use of medicines whilst also reducing medicines waste.

Successful exploration of opportunities for innovation in medicines sustainability from procurement, prescribing, point of use and disposal of waste requires a whole system view.

Medicines sustainability

Medicines sustainability is about reducing environmental harms from medicines. Health and care services produce around 5% of the United Kingdom’s total CO2. The largest proportion of this comes from medicines and equipment. Medicines account for 25% of NHS’s total carbon emissions[3]. Medicines are the largest contributing factor towards the carbon footprint of NHS general practice[4].

NICE estimates that implementation of recommendations in their Medicines Optimisation guideline may reduce avoidable medicines-related hospital admissions, potentially saving 202 tonnes of greenhouse gas emissions and 24 tonnes of waste per 100,000 population[5]. Innovation in sustainable medicines optimisation will not only improve the safe person-centred use of medicines. It will support delivery of ‘net zero’ and wider environmental ambitions.

The project

We know that many health and care providers are developing innovative ways to support delivery of the NHS Net Zero. However, progress on medicines sustainability is not always consistent, and can be patchy across sectors, localities and specialities. Given that health and care providers and systems are under pressure, the need to innovate and spread best practice is crucial. Our research will deliver a new evidence base to support providers, businesses, and innovators in this arena.

Medicine optimisation is a person-centred approach to ensuring people get the most benefit from the medicines they take. Our research aims to improve outcomes for people though supporting innovation in the safe and sustainable use of medicines.

This research will also provide a unique opportunity for CQC to support more consistent and effective implementation of innovative solutions to sustainable medicines use, through its regulatory activity.

In his recent blog, CQC’s Director of Engagement, Chris Day, spoke about the importance and value of involving a wide range of voices in our work to help providers “drive improvement in [their] organisation and in the local system”. Your contributions will help us do this.

Join our research

Medicines use extends across the whole of health and social care, and we are calling on all organisations; innovators, industry, and providers, to support our research to identify innovation and importantly support collaboration in evolving and sharing best practice.

We aim to develop a collaborative network and invite you to share case studies directly with us. Please contact the team via to learn more about this initiative.

#medicines sustainability #net zero #innovation # research

[1] Ionising Radiation (Medical Exposure) Regulations

[2] © NICE 2022 Asthma inhalers and climate change. Available from NG80 Patient decision aid on asthma inhalers and climate change ( All rights reserved. Subject to Notice of rights

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.’

[3] Greener NHS » Areas of focus (

[4] bma-sustainable-and-environmentally-friendly-general-practice-report-june-2020.pdf

[5] NICE Environmental impact report: Medicines optimisation



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