Tag: NHS Lothian

NHS Lothian offers new support to Scottish Prison Staff

NHS Lothian’s Lifelines Scotland project, a dedicated service to promote resilience and wellbeing for emergency responders, has today (25 September) expanded its reach. The service will now also be available to all Scottish Prison Service staff, recognising the challenges and particular stresses that these individuals face through their work.

The Lifelines Scotland project was established in 2016 by NHS Lothian’s specialist trauma service, the Rivers Centre, to provide support to voluntary emergency responders.

In 2020, the project was extended to Scotland’s blue light services and has been working with ambulance, fire and police to embed an understanding of responder resilience and wellbeing at the heart of these organisations.

Gill Moreton, Lifelines Scotland, Project Lead explained: “The NHS Lothian Rivers Centre team has a wealth of experience working with blue light colleagues and we are delighted that we can use this knowledge and expertise to help support other sectors where similarly challenging working environments are experienced.”

In doing their jobs, prison staff face uncertainty, risk, and challenge on a daily basis. Tensions can build in an instant, and it is their professionalism and dedication which is often the tempering factor. It is therefore vital that resources such as Lifelines are available, to help them care for their mental health.

Gill added: “Prison staff can face a range of challenges because of the environment they work in. Their roles can be physically, emotionally and psychologically demanding.

“Ensuring these individuals have the tools available to support their own wellbeing, as well as information should they become unwell is vital to boosting resilience amongst this workforce. I am delighted that Lifelines Scotland will now be available for Scottish Prison Service staff.”

Prison staff are welcomed to the project on national Hidden Heroes Day; an awareness day launched by the Butler Trust to recognise and thank prison, probation, and other Justice sector staff who deliver a critical public service.

The dedicated resource will provide additional support for all prison staff, who work in complex and demanding environments. They are responsible for the care of a largely vulnerable population, who are known to have high rates of trauma and mental ill-health.

Lifelines Scotland is unique in providing a single point of access for all of Scotland’s emergency responders, whether they’re employed, volunteer or have retired, and for their family, friends and other supporters. This access will now be expanded to all staff working within the Scottish Prison Service, with dedicated content available to them.

Adam Jobson, Director of Organisational Development for the Scottish Prison Service said, “We are delighted to be working alongside NHS Lothian to extend Lifelines Scotland resources to all our staff.

“Our staff go above and beyond every day, supporting and caring for some of the most vulnerable people in society, and doing their bit in keeping Scotland’s communities safe.

“We recognise the importance of providing wellbeing services appropriate to their specific needs. This resource will provide a valuable tool for supporting their self-care, resilience, and recovery, while also signposting to other wellbeing services that are available to them.”

The Lifelines Scotland project works upstream, taking a preventative, early intervention approach. It provides valuable information to ensure that people have access to support if they become unwell, but its principal focus is on helping people to stay well in the first place.

The Lifelines website is based on the Lifelines 10 Essentials, which recognise that emergency service staff, volunteers and prison service staff are at risk of psychological injury because of their roles, but that injury isn’t inevitable and that there are lots of things that can help to keep people well.

Angela Constance, Cabinet Secretary for Justice and Home Affairs, Scottish Government said, “The everyday stresses and strains of a job can have an impact on staff.

“Lifelines is exactly that – a lifeline providing resources and tools to help people manage their mental health and resilience when it comes to the physical, emotional and psychological demands of their job.

“I welcome this initiative being made available to all staff in the Scottish Prison Service. It is vital that we keep the people safe, who are keeping our communities safe.”

The Lifelines Scotland website can be accessed at https://www.lifelines.scot/

NHS Lothian: Students urged to ensure their vaccines are up to date before the new semester starts

Students across Lothian are encouraged to ensure their vaccinations are up to date before heading off to college or university this year.

Infectious diseases such as meningitis, septicaemia (blood poisoning) and measles can spread easily in universities and colleges. Vaccination offers the best protection against these diseases, which is why it’s important to check your vaccines are up to date.

Students are 11 times more likely to develop invasive meningococcal disease, which causes meningitis and septicaemia. The meningitis ACWY (MenACWY) vaccine helps to protect against these very serious diseases.  Students who have missed having the vaccine, can get it up to the age of 25 years.    

Parts of the UK and other countries in Europe have been seeing an increase in the number of people getting measles, and evidence suggests students are at higher risk. That’s why it’s important to check you’ve had two doses of the MMR vaccine, which protects against measles, mumps and rubella and has saved over 4,500 lives across the UK.

 Pat Wynne, Nurse Director for Primary and Community Care, NHS Lothian, said: “These diseases can be severe and, in some cases, life threatening.

“Students are at increased risk due to the large amounts of mixing with new people in enclosed spaces. Increasing cases of measles and meningococcal disease in particular were observed earlier this year.

“Vaccines are the best way to ensure you’re protected and these are offered for free on the NHS in Scotland. These vaccines are offered as part of the routine childhood immunisation schedule however if they’ve been missed, it’s not too late to catch up.

“Ideally, they should be given at least two weeks before the new semester starts.”

There is also still time to get the human papillomavirus (HPV) vaccine.  It helps protect against HPV-related cancers including head, neck and cervical cancer and also protects against over 90% of genital wart infections.  Most students will have had the HPV vaccine at school if eligible but if not, students may still be able to get it up until the age of 25. 

To find out about more information about these vaccines, please visit nhsinform.scot/vaccinesforstudents

If you are under 25 years and you’ve missed any vaccinations, call the Vaccination Enquiries Line on 0300 790 6296.  If you are 25 or over, call your GP practice.  They can check your records and arrange a referral if it is required.

International students may be able to get additional vaccines that were not available where they lived before.

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Eye Pavilion to close for six months for urgent plumbing repairs

MSP MILES BRIGGS REPEATS CALL FOR REPLACEMENT EYE HOSPITAL

Urgent repair work will have to be carried out at the Princess Alexandra Eye Pavilion at the end of October.

Extensive work is required on the plumbing system, meaning that all patient appointments which were scheduled to take place from October 28 will now be moved to other NHS Lothian facilities.

It is anticipated that the PAEP building will be vacated for around six months while contractors replace two waste pipes and remove asbestos material from a sealed cavity where the pipework is located.

The decision to move to other locations temporarily while the work takes place is designed to protect patients, staff and visitors.

Jim Crombie, Deputy Chief Executive, NHS Lothian, said: “We are very sorry for the inconvenience this will cause our patients and it is not a decision we have taken lightly. 

“Whilst patients and staff are not at risk, the work is essential and the advice we have received from our contractors is that this can be done more speedily and safely if the building is temporarily vacated.

“Patient and staff safety are always our chief consideration. Our teams are working hard to minimise disruption and to ensure patients continue to be seen and treated throughout this period.”

Teams are currently developing plans to ensure that inpatient and outpatient appointments continue throughout this period and it is expected that all appointments will be held in NHS Lothian facilities.

Patients do not need to do anything differently.

The vast majority of patients due to be seen at the PAEP between now and Friday October 26are unaffected. A very small number of appointments scheduled to take place before then may need to be rescheduled. These patients do not need to do anything as they will be contacted individually by their clinical teams at least two weeks in advance.

Those who already have appointments booked for dates from Monday October 28 will be contacted by letter, text or both in good time to arrange their new appointments, starting with patients who have appointments in the week beginning October 28. 

Mr Crombie added: “We are really grateful to all of our patients for their patience and understanding.

“I would like to reassure them they do not need to do anything. All affected patients will be being contacted with details of the new location of their appointment.

“Our staff and teams throughout PAEP are working really hard to make the move as smooth as possible at short notice and I can’t thank them enough.”

Lothian MSP urges residents to make their voices heard over unacceptable lack of a replacement Princess Alexandra Eye Pavilion

Lothian MSP, Miles Briggs, has called on Edinburgh and Lothian residents to send a clear message to SNP Ministers and the Scottish Government that the failure to deliver a replacement Princess Alexandra Eye Pavilion is unacceptable.

On Tuesday NHS Lothian announced that the eye hospital would be closing for six months due to urgent plumbing repairs (see above).

Previous FOIs to NHS Lothian showed a list of 125 outstanding items of maintenance work, totalling £2.3 million, that needed carried out at the hospital.

Since April 2022 the list of outstanding maintenance work has remained the same, with MSP Miles Briggs, calling the building “unfit for purpose”.

A scheduled visit to the hospital with Lothian MSPs and the Cabinet Secretary for Health is scheduled for next month to see the extent of work required at the hospital and the urgent need for a replacement Princess Alexandra Eye Pavilion.

Figures from Sight Scotland show that over the last ten years there has been a 230% increase in ongoing waits for ophthalmology outpatients in NHS Lothian. The number of people waiting over sixteen weeks has increased by 5600% and those waiting over 12 weeks has increased by 2752%.

This closure to the Princess Alexandra Eye Pavilion is only going to worsen ophthalmology waits in NHS Lothian.

Lothian MSP, Miles Briggs, said: “Residents in Edinburgh and the Lothian’s must let SNP Ministers know how angry they are with the lack of funding being delivered for a replacement Edinburgh Eye hospital

“Waits for Ophthalmology services in NHS Lothian have grown dramatically, especially over the last 3 to 5 years and people are having to wait excessive lengths of time for treatment.

“As with any medical treatment, the sooner that you are seen the better the expected outcome and this is especially the case for ophthalmology.

“People who want to make their voices heard can sign my petition online to restore funding for a new Princess Alexandra Eye Pavilion.”

If you would like to support Mr Brigg’s petition to reinstate funding for a replacement Princess Alexandra Eye Pavilion, you can find the petition here:

https://www.edinburghconservatives.org.uk/news/miles-briggs-msp-launches-petition-restore-funding-planned-new-princess-alexandra-eye-pavilion

Students are urged to ensure their vaccines are up to date

Students across Lothian are encouraged to ensure their vaccinations are up to date before heading off to college or university this year.

Infectious diseases such as meningitis, septicaemia (blood poisoning) and measles can spread easily in universities and colleges. Vaccination offers the best protection against these diseases, which is why it’s important to check your vaccines are up to date.

Students are 11 times more likely to develop invasive meningococcal disease, which causes meningitis and septicaemia. The meningitis ACWY (MenACWY) vaccine helps to protect against these very serious diseases.  Students who have missed having the vaccine, can get it up to the age of 25 years.    

Parts of the UK and other countries in Europe have been seeing an increase in the number of people getting measles, and evidence suggests students are at higher risk. That’s why it’s important to check you’ve had two doses of the MMR vaccine, which protects against measles, mumps and rubella and has saved over 4,500 lives across the UK.

 Pat Wynne, Nurse Director for Primary and Community Care, NHS Lothian, said: “These diseases can be severe and, in some cases, life threatening.

“Students are at increased risk due to the large amounts of mixing with new people in enclosed spaces. Increasing cases of measles and meningococcal disease in particular were observed earlier this year.

“Vaccines are the best way to ensure you’re protected and these are offered for free on the NHS in Scotland. These vaccines are offered as part of the routine childhood immunisation schedule however if they’ve been missed, it’s not too late to catch up.

“Ideally, they should be given at least two weeks before the new semester starts.”

There is also still time to get the human papillomavirus (HPV) vaccine.  It helps protect against HPV-related cancers including head, neck and cervical cancer and also protects against over 90% of genital wart infections.  Most students will have had the HPV vaccine at school if eligible but if not, students may still be able to get it up until the age of 25. 

To find out about more information about these vaccines, please visit nhsinform.scot/vaccinesforstudents

If you are under 25 years and you’ve missed any vaccinations, call the Vaccination Enquiries Line on 0300 790 6296.  If you are 25 or over, call your GP practice.  They can check your records and arrange a referral if it is required.

International students may be able to get additional vaccines that were not available where they lived before.

CAELUS: NHS laboratory specimens delivered by drone for first time

In a ground-breaking first for Scotland, laboratory specimens have been flown from one NHS board to another – by drone.

This step forward by the Project CAELUS initiative, led by AGS Airports in partnership with NHS Scotland, took place during a three-week flight trial between NHS Lothian and NHS Borders.

Live flying took place between the Edinburgh BioQuarter next to the Royal Infirmary of Edinburgh and Borders General Hospital in Melrose.

Invited guests were involved in a special event on Wednesday (21st August) showcasing the live flight trial with presentations around the work conducted by Project CAELUS.

Currently, laboratory samples which inform urgent clinical decision-making are transported by road and can take up to five hours between NHS Borders and NHS Lothian due to due to needing to make multiple pick-ups.

Innovation activity being conducted by Project CAELUS could see this delivery take 35 minutes, enhancing the transport provision, particularly for rural areas.

Project CALEUS is working with 16 consortium partners to deliver what will be the first national drone network that can transport essential medicines, bloods and other medical supplies throughout Scotland including to remote communities.

Fiona Smith, Project Director for Project CAELUS said: “Our consortium has been working extremely hard to get to this stage and we are delighted we have been able to test this important use case for the NHS.

“Transporting laboratory specimens by drone could speed up the clinical decision making allowing for same day diagnosis and treatment.

“It is also one of the first times in the UK that there has been a demonstration of beyond the visual line of sight medical drone operations transiting between controlled and uncontrolled airspace.

“This is an important milestone for our project and we now look forward to testing more potential use cases by drone across Scotland in the coming months.”

Hazel Dempsey is the CAELUS NHS Scotland programme lead: “Our aim, from an NHS perspective, is to explore opportunities where drone technology could benefit patients and NHS services in urban, remote, rural and island landscapes. 

“The NHS is reliant on van logistics that have provided valuable service for decades, however these can take time, travelling hundreds of road miles each day.  In some parts of Scotland, patients who live in remote and rural locations are dependent on ferry or airline availability. 

“This project will enable the NHS to consider if drone technology is viable and able to contribute to improving the health and wellbeing of our population. This project will position the United Kingdom and NHS Scotland as a leader in healthcare and aviation industries.”

CAELUS (Care & Equity – Healthcare Logistics UAS Scotland), is part funded by the UK Research and Innovation (UKRI) Future Flight Challenge.

It brings together 16 partners including the University of Strathclyde, Skyports Drone Services, NATS and NHS Scotland.

In the latest live flight trials, tests were also carried out on how NHS staff in future would engage with the drone both physically and digitally.

Dr Tracey Gillies, Medical Director and Executive Lead for Innovation, NHS Lothian said, “Across NHS Lothian, we are continually exploring ways to innovate and enhance our patient experience.

“Lothian and the surrounding areas are very diverse, from city to country and coastal living. Drones could play an important role in helping to transport samples for testing or speed up the delivery of critical medical supplies.

“These exciting trial flights have been a collaborative effort between our clinical leads, South East Innovation Hub and partner organisations and I look forward to seeing further developments with this project.”

Laura Jones, Director of Quality & Improvement at NHS Borders said: “We are proud to be involved in Project Caelus, exploring how drone technology could provide an additional logistics service to enhance access to essential medical supplies particularly in rural parts of Scotland like the Scottish Borders.

“Our involvement in this project is part of our commitment to providing high quality person-centred care by modernising services so that they are fit for the future using the technologies that are available to us going forward.”

Since January 2020, the CAELUS consortium has designed drone landing stations for NHS sites across Scotland and developed a virtual model (digital twin) of the proposed delivery network which connects hospitals, pathology laboratories, distribution centres and GP surgeries across Scotland.

In October 2023, in a hugely successful trial, flying took place between Glasgow Airport and NHS Golden Jubilee in Clydebank. This initiative was showcasing the integration of drones with modern airspace.

Live flight trials were operated by CAELUS consortium member Skyports Drone Services. The UK-based operator is an experienced provider of drone delivery, survey and monitoring services. The company has a long history of operating medical drone deliveries, including the first drone deliveries with the NHS.

The Scottish Ambulance Service also carried out a simulation study in August to better understand the feasibility of delivering an Automated External Defibrillators (AEDs) via drone technology.

Paul Gowens, Associate Director, Research and Innovation with the Scottish Ambulance Service, said: “We are delighted to be a key partner in Project CAELUS.

“Our recent study carried out in Edinburgh was a great success as we learned more about the feasibility of delivering an Automated External Defibrillators (AEDs) via drone technology. We look forward to working alongside AGS and our partners on Project CAELUS on future milestones.”

Richard Ellis, NATS New Airspace Users Director, said: “This is a major step forward for the project and its fantastic to see many of the operational concepts we’ve helped developed be put into use.

“We are now a step closer to realising a truly integrated airspace where drones fly safely and seamlessly alongside conventional aircraft.”

The University of Strathclyde’s principal investigator for the project, Dr Marco Fossati, said: “The latest live flight trials mark an important milestone in the journey to developing a national  medical transport drone network.”

Mike McNicholas, managing director for Infrastructure at AtkinsRéalis said: “It is a fantastic step forward for the project to make its first drone delivery and to see the ground infrastructure in use as part of the test flight.

AtkinsRéalis has been working closely with the AGS Airports-led consortium on the development of large, portable landing pads that can be folded up and stored when not in use, or moved to another location to receive another drone landing.

“Using a combination of digital twin technology and live test flights, Project CAELUS is able to trial various prototypes, taking learnings from each iteration to hone designs and land on something that can demonstrate the viability, scalability and efficiency of a drone network for medical deliveries across Scotland.”

Anne-Lisa Scaillierez, partner at The Drone Office: “Public feedback from our engagement activities has shown overwhelming support for using drones in medical logistics across Scotland.

“We’re thrilled by the significant progress achieved as part of Project CAELUS.”

David Hiller, Associate Director of Arup, said: “Arup has been enormously privileged to contribute to such a pivotal study, helping to better understand the human impacts of noise in relation to health and wellbeing.

“The study facilitated by CAELUS is one of the first of its kind and will support broader innovation globally. Cross-sector collaboration is both exciting and crucial as the capabilities of advanced air mobility technology evolve.”

Connected Places Catapult’s Ecosystem Director for Air Mobility & Airports, Andrew Chadwick said: “It is tremendous to see drones being used as part of Project CAELUS to transport essential medical supplies from one site to another, particularly as this is the first time a drone flight has operated in Scotland between two different NHS health boards.

“Connected Places Catapult has been working with NHS Scotland to develop the business and economic cases for these types of services alongside consortium members, and we look forward to exploring future opportunities for drone operations.”

The CAELUS consortium comprises:

  • AGS Airports               
  • ANRA Technologies UK
  • Arup
  • AtkinsRéalis              
  • Boldyn Networks UK
  • Commonplace Digital
  • Connected Places Catapult                                                                                        
  • DGP Intelsius 
  • Dronamics
  • NATS
  • NHS Scotland
  • Plane Finder
  • Skyports Drone Services
  • The Drone Office                                                                                                                         
  • Trax International
  • University of Strathclyde

Improving cancer care

Funding for projects to benefit patients and clinical staff

A total of £1.5 million funding in 2024-25 is supporting 12 projects to continue providing direct and personalised support to patients with cancer.

The Single Point of Contact (SPoC) pilots provide patients with ongoing contact to support them, putting them at the heart of all decisions and actions involving them throughout their care journey.

The NHS Lothian SPoC uses a centralised digital hub delivering telephone communication and support to patients with a range of cancer types.

Around 40% of calls are diverted away from Clinical Nurse Specialist workload, which has led to improvements in the quality of their telephone contacts. Patient engagement work carried out by NHS Lothian and Healthcare Improvement Scotland has indicated high satisfaction with the service.

Confirming the funding, which is included in the 2024-25 Budget, as he met nurses at Edinburgh Cancer Centre with experience of the service, First Minister John Swinney said: “We are fully focused on improving cancer survival, and delivering excellent and accessible care is at the core of how we do that.

“The Single Point of Contact Service meets requirements identified by Boards to deliver improvements in communication and support for patients with navigating cancer care.

“By taking in the region of 2,000 calls per month and providing person-centred support to those patients throughout their care journey, the Edinburgh Single Point of Contact project provides consistent access for patients to have conversations about their care, freeing up capacity for specialist staff to focus on the most complex cases.”

Katie Gibson, Neuroendocrine Tumour Clinical Nurse Specialist at the Edinburgh Cancer Centre, said: “I’ve seen first-hand how the SPoC service has transformed our ability to care for cancer patients.

“The centralised system streamlines communication and allows us to spend more quality time with those who need it most.

“As a result, patients are aware of who to contact for the support and advice they require from diagnosis , treatment and beyond.”

Over £1.5 million will support 12 pilot projects across Scotland to deliver a single point of contact to people diagnosed with cancer.

Funding has been delivered in response to needs identified by individual Boards and proposals submitted by them, pilots vary by cancer type and location:

  • NHS Lothian has received £ 343,740 to support the telephone-based SPoC service at Edinburgh Western General, serving boards within the South East Scotland Cancer Network
  • NHS Borders has received £82,000 for 3 cancer care co-ordinators, providing support across a variety of cancer sites
  • NHS Dumfries and Galloway has received £71,000 for 2 cancer co-ordinator posts, providing a telephone-based support service across a range of tumour sites  
  • NHS Fife has received £107,354 to staff a Single Point of Contact Hub, dealing with all urgent suspected cancer referrals.  
  • NHS Forth Valley has received £67,556 for 2 healthcare support workers (HCSW) providing a single point of contact for 7 tumour groups
  • NHS Ayrshire and Arran, NHS Forth Valley, NHS Greater Glasgow and Clyde, and NHS Lanarkshire have received total funding of £202,668to develop a regional approach to digital remote follow up of prostate cancer patients in the West of Scotland
  • NHS Greater Glasgow and Clyde has received £67,566 for 2 support workers to augment specialist gynaecological nursing support  and £141,324 for 4 SPoC roles across GGC sites to smooth and facilitate the patient journey, for people diagnosed with lung cancer
  • NHS Grampian has received £84,500 for 3 posts to provide a joint service with Macmillan Navigators, providing support following an Urgent Suspicion of Cancer (USC) referral
  • NHS Highland has received £270,680 for 7 Cancer Support Workers providing tailored support throughout diagnostic pathway and onto treatment
  • NHS Tayside has received £33,288 to provide support for people diagnosed with advanced Upper Gastrointestinal or Hepatopancreatobiliary tumours and lung, renal and prostate cancers
  • NHS Western Isles has received £68,000 for 2 HCSWs, as part of the Macmillan Team, to support people with all types of cancer

Health Improvement Scotland is currently carrying out a scalability assessment of all 12 projects in order to identify best practice and how best to scale and expand these pilots.

Reducing the environmental impact of respiratory care across NHS Lothian

NHS Lothian recently led a project to reduce waste and carbon emissions caused by incorrectly disposed inhalers.

Across Scotland, respiratory disease is common, however the treatment for this is a major carbon hotspot. Emissions caused by incorrectly disposed inhalers contribute to air pollution, potentially exacerbating respiratory conditions and affecting the overall health of our communities.

Jane Hopton, NHS Lothian Environmental Sustainability Lead said: “The carbon footprint of respiratory disease is largely due to the current propellant gases found in some inhalers. These gases have 1,430 or 3,220 times the global warming potential of CO2, depending on the brand of inhaler. 

“By disposing of used, unwanted, or expired inhalers properly, we can ensure the safe destruction of the residual propellant gases and in doing so, help to reduce their carbon footprint.”

This project, which was funded by NHS Lothian Charity as part of their Climate Challenge Grant initiative, asked participating community pharmacies to add stickers to dispensing bags containing inhalers. The stickers stated, “please return unwanted or expired inhalers to your pharmacy for environmentally safe disposal.” 

In total, five community pharmacies took part in the pilot project. After 10 weeks of adding the stickers to bags, the number of inhalers returned was four times more than prior, representing a 300% increase. 

Jane added: “This has been an important project, and one which demonstrates how small changes can make a valuable contribution to supporting our sustainability goals.

“Our thanks go to staff within the Community Pharmacies that were involved for their support in making this pilot such a success. I look forward to seeing this work develop, as collectively we explore all opportunities to reduce our carbon footprint.”

While dry powder inhalers do not contain propellants, they are currently not recyclable due to the multiple types of plastic and components in them. Patients, however, are encouraged to dispose of these items safely and can return them to a pharmacy to do this.

The second phase of this project aims to increase effective prescribing for respiratory conditions by improving access to information that supports clinical decision making and promotes good inhaler techniques.

This is in recognition of the new Scottish Government quality prescribing strategy for respiratory conditions which recognises that the most environmentally friendly inhaler is one that patients can, will and do use correctly.

Resources have been developed to support this, including posters for healthcare staff and educational posters to support patients with their inhaler technique. These have been distributed to staff in primary and secondary care by the Respiratory Managed Clinical Network. 

Katie Johnston, Respiratory Lead, Primary Care Pharmacist, NHS Lothian said: “Lots of people use inhalers and often do not think about the environmental impact these can have. 

“Community pharmacies are ideally positioned and essential to support improved respiratory care and to help reduce the environmental impact of all medicines.

“Feedback regarding the resources has been very positive and the Managed Clinical Network plans to continue to develop and share information to ensure inhaler waste continues to be reduced, the carbon footprint from inhalers is minimised and every patient is prescribed an inhaler device that is suitable for them.”