Reducing Intervention Impacts Part I – Olympus Medical

A Value-Based Procurement (VBP) project focused on Endoscopy, conducted by NHS Supply Chain, Olympus Medical, and an NHS trust, highlighted measurable improvements in patient experience, clinical outcomes, and demand/capacity management.

Published as a VBP case study last year, it also pointed towards meaningful sustainability benefits that are now being explored in greater depth.

Endoscopy plays a vital role in diagnosing and treating gastrointestinal conditions, from acute bleeding to cancer. Traditional gastroscopy involves inserting an endoscope through the mouth, often requiring patient sedation. This can lead to prolonged recovery time, the need for post-procedural support, and in some cases, general anaesthetic for patients unable to tolerate sedation.

TNE offers a less invasive alternative. The endoscope is inserted through the nose, making sedation unnecessary for most patients. That means faster procedures, no need for a recovery unit, and reduced staffing – enabling the procedure to take place in outpatient clinics rather than dedicated endoscopy suites.

When the VBP case study was initially undertaken, financial benefits, including the avoided cost of consumables, were identified. However, at the time, the environmental savings couldn’t be quantified. No data connected the reduction in materials or procedure time to carbon impact.

Still, the case study acknowledged clear sustainability advantages.  

TNE also has some clear advantages over standard transoral approaches in reducing the need for single use plastic devices such as cannulas, tubing, mouthguards, and syringes for sedation as well as the pharmaceuticals themselves. At present although the financial benefit/cost reduction of this has been quantified in this case study, data is lacking to enable a carbon benefit of the streamlined endoscopy procedure. It is anticipated that TNE has reduced the carbon footprint of endoscopy, but more data and research is required to confirm this reduced impact. 

Other sustainability co-benefits have been referenced such as patient wellbeing through improved patient experience, tolerability and satisfaction and the benefit to patients being discharged directly, able to drive home or use public transport without the need for a chaperone.

At the time of the case study’s publication, robust data on the carbon footprint of endoscopy procedures was limited – a gap acknowledged by BMJ Journals in January 2023:

“A high-quality evidence base of the actual carbon footprint of clinical activity and various elements of endoscopic procedures is presently lacking, more research needs to be done to generate this evidence, there is recognition that steps need to be taken now to protect our planet.”

With improving data availability and growing understanding of procedural emissions, we aim to build on the foundation laid by the case study, developing metrics to better capture environmental impact.

The VBP study drew up a process map comparing conventional gastroscopy and TNE pathways. Key differences included reduced operating time, outpatient setting advantages, and decreased consumables and waste. These variations in activity and resource use can now be mapped against emissions data to estimate environmental benefit – a process we aim to undertake with support from the Category team and Olympus.

Refining these methodologies is a key priority for our Sustainability team. Quantifying the environmental benefit of emerging care models is essential on the journey to net zero, especially as services become more efficient and decarbonised.

One of the NHS’ strategic goals is shifting care from hospital settings into communities. TNE exemplifies this shift with lower space, staffing, and sedation requirements making it suitable for outpatient clinics, community hospitals, and even mobile units. These alternatives can further reduce environmental impact while enhancing access.

This theme is also central to ongoing work by our Category Manager for Endoscopy and Ultrasound, Sian Listers. Sian is exploring a new VBP pilot with Olympus: an Outpatient Head and Neck Biopsy Service using local anaesthetic and single-channelled Video Laryngoscopes. This could involve diagnostic biopsies during endoscopy or dedicated outpatient clinics.

The proposed pathway promises transformative benefits:

• Faster diagnosis
• Freed-up theatre capacity
• Fewer staff and equipment resources
• No general anaesthetic or recovery beds
• Lower risk and enhanced patient experience.

Its sustainability advantages – reduced resource consumption and emissions – are expected to be significant.

Olympus is a key partner in our Supplier Management programme, and we’re excited to collaborate on future VBP pathways that prioritise environmental savings alongside clinical value. Our goal is to define and deliver ‘total value’ in every sense – clinical, financial, and environmental.

To contact the Endoscopy team, email: