Reducing nitrous oxide emissions – how is the Shelford Group helping?

12 July 2023 · Shelford Group

As set out in our introductory sustainability blog earlier in the year, Shelford Group members are committed to achieving net zero ambitions for the benefit of our people, our NHS, and our planet. In this blog, Policy Fellow Emily Hughes sets out how members are reducing nitrous oxide usage and wastage – a medical gas with significant global warming potential.

Addressing anaesthetic emissions

Climate change poses a major threat to our health and wellbeing, with direct and immediate consequences that threaten to undermine years of health gains. The NHS accounts for 4% of the UK’s total carbon emissions; in recognition of the role it therefore needs to play to tackle climate change, on 1 July 2022, the NHS became the first health system in the world to embed net zero carbon into legislation, committing to doing so by 2045.

Anaesthetic and analgesic practices account for 2% of the NHS carbon footprint, making it crucial for the NHS to address the emissions associated with this specialty. Significant work is underway in this regard; NHS England, with the support of the Royal College of Anaesthetists and the Association of Anaesthetists, have committed to cease purchasing desflurane – a volatile anaesthetic used for surgery – from January 2024, with clinicians across the country opting to use clinically appropriate alternatives, with a significantly lower global warming potential.

Much work remains to be done, however, to achieve these ambitious net zero targets. Nitrous oxide – used to assist sedation in medical procedures, and in a diluted form to provide pain relief – accounts for more than 80% of the total anaesthetic gas footprint, and is almost 300 times more potent as a greenhouse gas than carbon dioxide. Nitrous oxide can readily escape into the atmosphere, either directly from patients exhaling, or from the piped networks providing the gas.

A data sharing process across Shelford members identified a large gap between volumes of nitrous oxide purchased and volumes used for clinical care, suggesting significant (often 90%+) wastage due to expired stock, overprovision, and leaks. Recognising the need to drive impact in this area, colleagues across Shelford agreed to come together to commit to collectively going further, faster.

Achieving the ambitious targets as described above will require all NHS employees to play their part in delivering a net zero NHS. Bringing together an interdisciplinary group of leaders across Shelford, as well as members of the Greener NHS team, we set out to:

• share learning, data, and best practice case studies around reducing nitrous oxide usage and wastage;

• engage colleagues across professional groups;

• challenge members to accelerate the current 7% year on year rate of reduction.

Case study: decommissioning nitrous oxide manifolds

In a major step to reducing their anaesthetic emissions

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