Thanks Matthew, just came on to post the same!

Hi all.
I’m afraid I am unable to make the meeting today. I have one comment which I was reticent to make because it is unpleasant to rain on a parade. I do however have one thought on this project which has been nagging at me for a little while, and I raise it in good faith, and as an honest point for discussion. It relates to the concept of welfare economics and the work of the Copenhagen Consensus. To what extent should our choice of QI work be influenced by the potential “bang for our buck”?

If this project was as successful as we could possibly imagine, and as a result 100% of current asthma prescriptions in the UK were as carbon efficient as possible, what would be the measurable benefit? How many QALYs would our efforts have gained? Would there be a measurable or meaningful improvement in the UKs carbon output or world-wide temperature change? My instinct is that the answer is no, but I am willing to accept I might be wrong in this. I am no expert.

I’m also not suggesting that climate change is not important, or that we shouldn’t be mindful of the environmental impacts of health care. I’m only wondering if our efforts could potentially have a greater impact in other areas.

Could it be possible to combine the two? Perhaps rather than changing inhalers to more environmentally friendly ones we could do some work on overdiagnosis of asthma and overuse of inhalers. I wonder how many people are started on inhalers because of recurrent viral infections or functional cough, without evidence of reversible obstruction, especially with the move to telephone consultation. It is interesting looking back through the records to see if anyone has ever documented a wheeze. Could efforts to reduce unnecessary inhaler prescription be more impactful on patients, the NHS budget as well as the environment?

These are just some of my thoughts. I would be interested in others opinion.

Will.