2. Medicines waste

Resolution submitted by the RCN Welsh Board

That RCN Congress asks Council to investigate and promote ways to reduce the cost of prescribed medication and unnecessary wastage

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Progress report

Submitted by: Welsh Board
Council lead and committee assigned: Jane Bovey (until October 2011) and Tim Coupland (from October 2011), Nursing Practice and Policy Committee
Committee decision: Existing work addresses this issue
Members involved: Christine Thomas, Swansea Branch and Council member from October 2011

Final summary update at May 2012

This agenda item focused on promoting ways to reduce unnecessary waste and the associated costs of prescribed medication.

It was decided that this issue was already covered through existing work, with the RCN heavily involved in the project: Making care safer, which is led by the National Care Forum and involves organisations, including Royal Colleges, from across the health sector. The project looks at waste related to medicines, in particular the dispensing of unnecessary medicines and the frequency and effectiveness of medication reviews.

As there is already guidance on preventing medicinal wastage across all four countries, a working group, including RCN Council members Tim Coupland and Christine Thomas and RCN staff members, looked at how this information could best be communicated to RCN members.

The working group also used data from the RCN’s Frontline First campaign to source examples where nursing staff have successfully tackled medicine waste issues. These were highlighted in RCN forum newsletters as well as an article in RCN Bulletin in September 2011 titled “A dose of common sense”, which went to all RCN members.

The working group is continuing to collect examples of medicine waste and best practice, with plans to profile these in future issues of RCN Bulletin throughout 2012.

Update at November 2011

Tanis Hand, RCN Health Care Assistant Adviser is a member of the integrated working group of the Joint Colleges’ Project “An integrated approach to medication safety in care homes: Working together to develop practical solutions” which is exploring ways of improving the management and administration of medication in care homes, from prescribing through to administration. The work includes looking at medicines waste, in particular the dispensing of unnecessary medicines and the frequency and effectiveness of medication reviews.

Tanis met with the Proposer and telephoned the Council Lead in November to update them on progress and discuss further actions.

Christine Thomas (submitting entity) will join the group looking at this work. Ian Hullett, Mental Health Adviser and Ruth Burey, Learning and Development Facilitator have also agreed to be involved in this item.

Proposed plan:

There is already guidance on preventing medicines waste across all four countries as outlined in background information. It would therefore be useful to consider how information can be disseminated to the membership in a meaningful way, making use of the information that we have available through Frontline First.

  1. Seek information from Frontline First about examples of innovations where nursing staff have tackled medicines waste issues and successfully addressed them.
  2. Profile these members in RCN Bulletin and reference the guidance documents so that this information is highlighted for all members to see and read.
  3. Consider running a fringe event at Congress 2012 inviting members to meet those who have addressed medicines waste issues.

Tanis Hand is seeking information from the Frontline First team on suitable issues and innovations in order to seek members for profiling.

A team including members from RCN Communications, Nursing Department and Learning & Development has been established and a meeting was held on 2 November 2011.

Contact has been made with the DH steering group on waste to establish what joint work could be done, and we are currently awaiting response.

The issue has been highlighted in forum newsletters calling for examples of best practice and a case was presented in RCN Bulletin on 7 September in “A dose of common sense”, and waste examples submitted via the Frontline First website will be used to identify suitable case studies to highlight the issue.

An email will be sent out in early 2012 to all those who contributed initially to the ‘waste’ strand and to ask for both further examples of medicines waste and examples of best practice in reducing this waste.

To identify issues and discuss possible solutions some members of the Communications team have arranged to shadow nurse prescribers.

The next meeting/teleconference is planned for early January 2012.

Debate report

Christine Thomas  from the Welsh Board asked Congress to urge Council to investigate and promote ways to reduce the cost of prescribed medication and un-necessary wastage. The cost to the NHS was financial and environmental  she said, and asked why unused medicines could not be given to other patients to prevent stockpiling and waste.

Christine said there was a widespread belief that if you did not order repeat prescriptions, they would be stopped. This has led to annual waste costs of £300 million in England, £52 million in Scotland, £50 million in Wales and £2.5 million in Northern Ireland. “We can and must find solutions,” she said.

The resolution was seconded by Yvonne Thomas from the Ceredigion branch who highlighted a system  which meant that patients receiving chemotherapy were automatically given repeat prescriptions without anyone first checking if they had used their previous prescriptions.

“This resolution has the potential to save the NHS millions of pounds,” said John Hill, speaking in support of the resolution. He gave an example of a patient stockpiling four carrier bags of unused medicines containing more than 250 sealed boxes of medication.

Susan Smith asked if there would be a difference in the way in which prescriptions were claimed, depending on whether a charge was made. She said that patients often claim medicines on prescription they would not use but could be given to their relatives.

BJ Waltho highlighted the indirect costs incurred when patients enter emergency departments. Patients are sometimes confused she said, and advised that nurses have a role in helping  patients understand their medicines.

Christine Thomas, in her right of reply, advised that a price should be put on medicines to highlight that they are not free to the NHS – even if they are free to the patient. She said that her proposals would take time and effort but “374.5 million a year is enough incentive”.  As well as saving money, the resolution could save lives she said; with fewer tablets laying around, there was less chance of an accidental suicide.

The resolution was passed with an overwhelming majority.

Results

For:         99.78% (445)
Against:   0.22% (1)
Abstain:    (1)

Background

Thanks to developments in therapeutics, the longevity of those receiving medication and the polypharmacy of many patients, expenditure on prescribed medicines in the NHS is vast.

Of particular concern is the element of wastage in this huge expenditure: medicines leaving the pharmacy cannot be recycled or used by anyone else – even if unused – and have to be destroyed, while repeat prescriptions encourage a ‘just in case’ approach by patients who over request medicine. Many patients are also prescribed common medicines (such as analgesia) which could be more cost-effectively purchased in a local shop. Furthermore, compliance rates with long term medication use are currently estimated to be around 50 per cent.

A recent study for the Department of Health (November 2010) (York Health Economics Consortium and University of London School of Pharmacy, 2010) revealed prescription drug wastage costs the NHS in England at at least £300 million a year - and that £150 million of this wastage is avoidable.

Researchers identified factors such as illness progression (leading to changing patient treatment regimes) contribute to wastage and help account for the £90 million of unused prescription medicines currently stored in people’s homes and the £50 million of NHS supplied medicines disposed of annually by care homes. The research concludes that the optimal use of prescribed medicines in just five therapeutic areas – asthma, diabetes, high blood pressure, vascular disease and schizophrenia – would generate up to £500 million of extra value.

A number of community pharmacy-based interventions have been shown to improve medicines adherence and reduce waste; most pharmacies in England and Wales now provide ‘medicines use’ reviews, where people sit down with their pharmacist for a free consultation on getting the most from their medicines.

In Wales more than 250 tons of out-of-date, surplus and redundant medicines are returned each year to pharmacies and dispensing GP surgeries representing an estimated annual cost of £50 million. In September 2010 the Welsh Assembly Government launched a major campaign to reduce medication wastage (Welsh Assembly Government, 2011) and also issued a toolkit for health professionals working in all sectors.

In Northern Ireland the cost of unused medication in the health and social care service is estimated at ₤2.5 million per year. Over the past five years some £90 million of efficiency savings in the prescribing budget have been secured, primarily through a 17 per cent increase in the use of generic medicines. The Department of Health, Social Services and Public Services (DHSSPS) has put also put in place a programme to improve medicines management, and the Health Minister recently stated the DHSSPS and the Health and Social Care Board are working to ensure that issues of overprescribing and cost are dealt with.

Taking the Pulse of NHS Scotland (2010) (Royal College of Nursing Scotland, 2010) revealed NHS boards in Scotland overspent on primary care prescribing by around £22 million in 2009-10, with many boards criticising the unintended consequences of a renegotiated Pharmaceutical Price Regulation Scheme.  The Scottish Productivity and Efficiency Strategic Oversight Group, on which RCN has a Scottish staffside seat, has a key aim to reduce prescribing waste and further work is about to begin to deliver on this aim.  The RCN in Scotland has included issues over prescribing waste in its key Scottish election campaign on improved efficiency.

References and further reading

Royal College of Nursing Scotland (2010) Taking the pulse of NHS Scotland: a report from the Royal College of Nursing on the finance and workforce pressures facing NHS Boards. Edinburgh: RCN Scotland Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0004/352741/Taking_the_Pulse_of_NHS_Scotland.pdf  (Accessed 02/02/11) (Web)

Welsh Assembly Government (2011) Wasting medicines wastes money, Cardiff: Welsh Assembly Government. Available at: http://wales.gov.uk/topics/health/ocmo/professionals/pharmaceutical/medicine/?lang=en  (Accessed 02/02/11) (Web)

York Health Economics Consortium and University of London School of Pharmacy (2010) Evaluation of the scale, causes and costs of waste medicines, York/London; YHEC/University of London. Available at: http://php.york.ac.uk/inst/yhec/web/news/documents/Evaluation_of_NHS_Medicines_Waste_Nov_2010.pdf   (Accessed 02/02/11) (Web)