Can we afford to waste medicines? - update on possible national strategies Bhulesh Vadher Clinical Director of Pharmacy and Medicines Management, Oxford University Hospitals

South Central Experience Many thanks for Leadership and support from: Clare Howard QIPP Medicines use and Procurement Lead Linda Trait Programme Manager Medicines use and Procurement Liz Bere NHS Southampton Clinical Commissioning Group South Central Chief Pharmacists and Medicines Management Leads

Old South Central Geography

Recognising a National Issue From defining in 2010 …… To planning in 2012

The NHS South Central Project: Regional Collaboration Hospital Waste Audits Zero tolerance policy to medicines waste now in place in a number of Trusts

Medicines Waste Self Assessment Policy - Return Drug Policy to manage risk and return all reusable medicines Resources - Cost effective staffing mode Process - Ensure a Zero tolerance approach is taken. Process - Ensure part pack reuse systems are in place Training - In place for returning all appropriate medicines Monitoring - Monitor month on month financials Audit - Annual sample of a 1 week to 1 months returns Senior staff - Visual inspection to identify potential benefits

Collaborative working: Key: Shared self assessments Heat Map Waste Audit (1 week) Total Returns ( Annually 2009 to date) Returning all available medicines (Self Assessment) Outcomes Achieved –100% savings returned to pharmacy budget –Year on year reduction in waste –Raised Board awareness

An Action Plan Trust Board level reporting of medicines waste Invest to save: install resource to facilitate waste reduction and recycling Conduct annual waste audits

The NHS South Central Project: POD Green Bags Regional Collaboration Hospital Waste Audits Second annual utilisation and £ savings audit complete Zero tolerance policy to medicines waste now in place in a number of Trusts

An Action Plan Conduct annual POD volume Plan to increase volume and improve management of patient’s own drugs Remove barriers to patient’s routine arrival with PODs Review discharge process Support patients beyond discharge

Use of Green Bags and POD’s

The NHS South Central Project: POD Green Bags Regional Collaboration Regional awareness campaign Hospital Waste Audits Incorporating secondary care for the first time Second annual utilisation and £ savings audit complete Zero tolerance policy to medicines waste now in place in a number of Trusts

Awareness campaign Population of 4 million 694 Community Pharmacy's 494 GP surgeries 11 hospital trusts 4000 pre and post evaluation patient questionnaires 510 patient surveys 260 professional surveys.

Key Message using Dynamic Advertising Group Think before you order –Only order what you need Unused Medicines can not be recycled –Wasted Medicines cost NHS South Central £20million per year Look after your medicines –Picture of standard pharmacy Green bag –The Green Medicines bag helps keep your medicines with you when you move wards and go home from or come into hospital.

Observations of the campaign are: A social marketing campaign is hard work:- diligent planning resource intensive early engagement of health professionals (clinicians vs patients) A medicines waste social marketing campaign is about long term cultural change

The main findings of the evaluation are as follows: Need to sustained over a longer period Regular and repeated evaluation Materials and messages should be reinvented Market segmentation Multi-faceted or multi-modal. Effective utilisation of media channels Alignment to practical interventions Targeting by disease type Good recall but no significant variations in behaviour

Synthesis of Food Waste Compositional Data 2010 Comparison of national food waste arising estimates for England (kg per household per year) Ref: WRAP( Waste Resource Action Program)

UK Supermarket Retailers Voluntary Carrier Bag Agreement 2011 Carrier Bag Use WRAP July 2012

The NHS South Central Project: POD Green Bags Meds Rec database Four innovation pilot projects Regional Collaboration Regional awareness campaign Hospital Waste Audits Inhaler Technique From a regional initiative to a national database Showing demonstrable reductions in emergency admissions The first pilot project delivering £10K per annum with potential for £1.6m region-wide! Incorporating secondary care for the first time Second annual utilisation and £ savings audit complete Zero tolerance policy to medicines waste now in place in a number of Trusts

The NHS South Central Project: POD Green Bags Meds Rec database Four innovation pilot projects Regional Collaboration Regional awareness campaign Hospital Waste Audits Inhaler Technique From a regional initiative to a national database Showing demonstrable reductions in emergency admissions The first pilot project delivering £10K per annum with potential for £1.6m region-wide! Incorporating secondary care for the first time Second annual utilisation and £ savings audit complete Zero tolerance policy to medicines waste now in place in a number of Trusts

Improving Quality, Safety and Cost Project Avoided Costs / Real Cost Savings 2011/12 Delivered 2012/13 Forecast 2013/14 Forecast Patient's Own Drugs Green Bags Real cost savings40%50%75% Medicines Reconciliation Avoided costs 500,000 admissions £2.5million 800,000 admissions £4million 1,100,000 admissions £5.5million Inhaler TechniqueAvoided costs5000 reviews 1000 reviews (but now a national scheme) Zero tolerance to waste in secondary care Real cost savings£200K£500K£800K Social marketing campaign Enabler (raising awareness) n/a Four innovation competitions Real cost savings £10K

The team won an NHS Innovation Challenge for its collaborative approach to tackling medicines waste. Our three challenges now … To prove the value of the collaborative concept To go further, faster and make a real difference to patient care For the project to sustain itself in the new NHS structures

The NHS South (TV and Wessex) Project 2013 POD Green Bags Meds Rec database Four innovation pilot projects Regional Collaboration Regional awareness campaign Waste Audits Inhaler Technique Learn from pilot and scope Assess opportunities for wider role out and implement a second round of pilot projects Develop a campaign to empower the patient: ‘collect what you need’ Process review to maximise POD Utilisation Report levels of waste to Trust Boards MDS boxes Care Homes and carers Engage and evaluate scale of waste Patient pathways & adherence Map links between systems and improve patient supports