HEFMA has been talking to waste management specialist, Anenta for an update on clinical waste. Last summer, Anenta published a market review on the UK clinical waste incineration capacity and challenges faced by the sector. The review analyses the available data around capacity, pricing, the potential for monopolistic behaviour and misuse of RPS 222 and the impact of new regulatory guidance.
The report was issued as a working document and was designed to encourage further discussion and submissions from industry colleagues on the issues which it raises.
The report’s call for action posed significant questions around improvement of the current clinical waste system:
•Should clinical waste treatment for the NHS be treated as a national strategic issue and overseen by a regulatory body such as Ofcom?
•Should decisions be made without full market consideration – eg RPS 222?
•Should government make some assets public again in order protect available treatment capacity for the NHS?
•How will EPR 5.07 be achieved?
•How do we rectify a dysfunctional system to create a best-in-class industry?
•It is well known that the incineration assets are ageing – and not well – but what is being done to address this situation?
What has changed
Since the review Anenta reports there has been very little progress on these calls to action from industry leaders and nor has there been very much investment in existing infrastructure, although there is some ongoing investment in new incineration facilities.
The Coronavirus pandemic has led to one significant change, confirmed by new Guidance set out in the Covid-19 Regulatory Position Statement (RPS) C4, published on April 15. Following concerns raised by the NHS about the volume of orange clinical waste bags expected to be generated through treating patients with Covid-19 – as many as 15 million a month – which would outstrip existing capacity for clinical bagged waste, RPS C4 allows operators of permitted municipal waste incinerators used for residual waste to energy to accept and incinerate Covid-19 infectious waste.
There are a series of conditions (13 in total), all of which must be met for the Covid-19 RPS to apply. In essence, Anenta advises, it is designed as a route of last resort, designed to cope with extraordinary circumstances. The waste producer and the municipal waste incinerator provider need to be able to demonstrate that the producer has used all other permitted options available for the treatment or incineration of the waste before turning to this municipal waste to energy route. Read the guidance and the 13 conditions here.
Different rules apply to healthcare workers in the community.
Incineration waste capacity
Anenta’s review of general capacity for incineration of clinical waste across the UK highlights discrepancies between the view of the Environment Agency (EA) that the UK does not have an issue with incineration capacity, and the data, which, it states, tells a different story. One of the biggest issues is that permitted capacity values do not reflect the true disposal capacity for healthcare waste at each facility.
The data is in itself flawed, often out-of-date, contradictory in its nature and inconsistent in its collection and measurement. For example, analysing the data available from the two sources on medical waste - the Environment Agency and ERIC returns - the report identifies a “wide gap in the numbers.”
There is also discrepancy between the EA data and Defra data for Healthcare Waste Incineration, however, EA data includes double-counting as it has to monitor movements of waste which may be between multiple facilities. Whilst ERIC data does not include Primary Care or pharmacy waste, so it cannot be effectively compared to the EA or Defra data.
The rising cost of disposing of healthcare waste is also a concern. For instance, the report notes that if ERIC data is to be considered as accurate, the NHS spent an additional £1.9m in 2017/18 disposing of less waste than it did in 2016/17.
Various reasons are suggested for the dramatic increase in incineration costs – some of which are influenced by the demise of a major player recently. These include lean pricing driving competition, capacity being held back to support NHS contingency plans and operators spreading the risk of service failure across contract portfolios. Whilst it should be apparent to the waste operator and producer that what is needed is a “balanced relationship”, there are unfortunately many cases where this fails, “resulting in higher costs for the producer.”
Planning for contingency contract arrangements may also be influencing the market adversely, at the tax payer’s cost, amounting to “profiteering from an NHS contract,
brought about to overcome a short-term emergency requirement.”
Challenges to come
Whilst the changes to EPR 5.07 Clinical Waste (January 2011) that the Environment Agency is consulting on are aimed at improving the way the healthcare waste sector operates, they are likely to also add some challenges to the system.
For instance, the review highlights the significant emphasis being placed by the waste disposal industry on waste tracking. This must be implemented as a computerised system by the permit holder and must include a pre-booking feature to ensure there is sufficient storage and process capacity at the designated facility. Data management and other systems will be necessary to achieve this and operators will also need to invest in training.
“The EPR change and the disposal capacity issue will inevitably continue to impact the price of disposal for the customer. Although they are separate issues, the fact that waste ‘collection’ and ‘disposal’ operators will need to invest in coming years will see the costs passed on to the customer.”
Anenta’s review called for a new market supply and demand report to be completed as a priority, requiring all parties to simultaneously provide transparent and accurate data to enable the true market position to be fully understood. It also wants to see more collaboration between invested parties so the UK waste industry can overcome the issues it faces around clinical waste incineration capacities.
Read Anenta’s full review here.
