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The Wasteland

The Wasteland

Growing consumer concern over single-use plastics combined with Chinese reluctance to continue handling our contaminated waste, means the NHS must do more to recycle waste, writes Jane Renton.


It was only a matter of time before the media turned the full glare of the publicity spotlight on the NHS in England over its use of plastics or rather plastic cups for coffee and tea.  According to an investigation by the Press Association, the organisation has got through more than half a billion of them over the past five years, with a current usage of 334,000 cups per day. That isn’t counting the thousands of paper cups – often with a plastic lining – that are also used to serve hot drinks.


Add to that growing Chinese reluctance to keep handling our contaminated waste and Theresa May’s statement that “avoidable" plastic waste in the UK must end by 2042, along with gut-wrenching TV images of polluted seas and wildlife from David Attenborough’s Blue Planet series, and it is small wonder that this troubling issue is rising rapidly up the political agenda.


According to England’s Chief Medical Adviser, the NHS is “a significant polluter” and must do more than it is already doing to reduce its carbon footprint.  As Dame Sally Davies states in her annual report published last month [April], the health service generates 590,000 tonnes of waste, more than the entire municipal waste from European countries such as Cyprus or Luxembourg.


The problem, as Davies acknowledges, boils down to the sheer size of the organisation – it is the world’s fifth largest employer with more than one million staff. The NHS accounts for one in every 20 vehicles on the road. A major buyer of goods and services, it is invariably one of the biggest – if not the biggest - single employer, whatever the region of England.


That means every person, every organisation within the NHS has an obligation to mitigate the effects of climate change, which is arguably the biggest health threat facing the planet this century. The NHS must do more than it is currently doing to become a beacon of sustainable development and good practice in Britain. 


The tip of the iceberg


Single-use cups, however, are just one aspect of a growing problem. The NHS spent some £87m on waste disposal in 2014/15 and the cost appears to be rising, not just in monetary terms. Most domestic waste generated by hospitals – quantities of uneaten food, newspapers, flowers, bottles and plastic coffee cups - is relatively easy to deal with. Such municipal waste makes up almost 60% of total NHS Trust waste. It is harder and more costly to deal with the 33% of waste that is classified as infectious, with the balance made up of bagged waste that is not assessed as infectious, but classified as ‘offensive’ and includes items such as stoma or catheter bags, incontinence pads, hygiene waste, gloves, aprons, maternity waste as well as blood contaminated items from screened community. This type of waste can be sent to landfill, treated, recycled or sent for energy-from-waste conversion. 


According to a survey conducted last year by the Royal College of Nursing a total of 185,233 tonnes of waste were reported for the period 2015/16 by the 69% of Trusts who responded to the RCN’s Freedom of Information Requests. 


Yellow-bagged infectious waste is the most costly to deal with: it involves materials contaminated with bodily fluids, laboratory specimens or chemically contaminated items, assessed as having the potential to cause infection and which must be sent for incineration at an authorised facility. 


All categories of waste appear to be showing increases in price per tonne, but particularly infectious waste, largely it seems as a result of rising incineration prices, which the RCN survey states can cost in extremis as much as £22,000 per tonne to deal with. Municipal waste, by contrast, ranges from anything from £2,356 to as low as under £100 per tonne to deal with.


In a healthcare climate where every penny counts, there is every incentive to reduce the costs involved in waste management, something also acknowledged by the RCN survey:  improved classification of bagged waste would be a good start, it states. A 20% reduction in bagged infectious waste would mean a saving to the NHS of close on £5m a year, the report highlights. A 50% reduction in waste, currently wrongly classified as infectious, instead of offensive would represent a potential year-on-year saving of close on £3m. 


Making a difference


The correct separation of these two types of waste has enabled Guy’s & St Thomas’s NHS Foundation Trust, which treats 2.4m patients a year in London, to cut its waste bill substantially by diverting more of its clinical waste away from expensive incineration.        


“Five years ago the vast majority of our clinical waste was incinerated,” explained Trust Waste Manager Alan Armstrong in a recent in interview with Resource Magazine. Now a very much lower percentage of clinical waste is sent for incineration.


Guy’s & St Thomas’s, which was paying £900 a tonne for incineration four or five years ago, has also managed to reduce that cost to just over £500 by bringing in a new contractor, Bywaters, to manage the process. The previous contractor was a clinical waste specialist who had little incentive to segregate out the different varieties of waste.


Despite those endeavours, the costs of waste management are rising - Guy’s & St Thomas’s spent £1.13m on waste in 2013/14  - as more clinical areas open within the Trust. All this makes it essential that employees are fully aware of their own responsibilities and obligations regarding waste. As a result a huge, ongoing communications campaign has been underway to fully instil these into hospital staff, no easy task where employee churn rates are inevitably high. 


As Resource magazine explains clinical and housekeeping staff are responsible for moving waste from bins to disposal hold, where the large clinical waste wheelie bins are all colour coded for specific types of waste. Everyone has to go through an induction programme on joining the Trust and training sessions are held with housekeeping staff, food service assistants and infection control link nurses. Departments are also monitored and audited on waste generation. 


However, as the Trust’s waste manager, stresses it is an ongoing battle: despite the rigour with which the new waste protocols are enforced, human behaviour continues to frustrate best endeavours on this front. On one occasion, 70% of items found in a sample infectious waste bag were fully recyclable. 


But more can be done


The actions by Trusts, such as Guy’s & St Thomas’s, begs the question whether good practice is being shared widely enough across the NHS. Where waste is concerned there seems to be a long way to go, particularly in regard to coming up with reliable ERIC (Estates Return Information Collection) figures. They clearly need reviewing. NHS Improvement should collect, compare and publish data on NHS Trusts’ waste management systems, concludes the RCN. This data should also be aligned with Sustainable Management Plans (SDMP) to allow for local improvements. It also needs to build on the work of Lord Carter’s report, Operational productivity and performance in English NHS acute hospitals: Unwarranted variation.


“NHSi needs to do more to investigate apparent variations in waste types generated by all Trusts and support improvements to reduce variations in assessment of waste and associated costs,” the report states.


All NHS England commissioning should ensure that suitably qualified waste managers are provided to help nursing teams and departments create sustainable waste streams.


Other recommendations in the RCN report suggest potential opportunities to manage waste on a locality or STP (sustainability and transformation partnership) basis; introducing procurement criteria that emphasise ability of disposal of items, not just quality and safety. It also suggests that NHS England publishes an annual report on the impact of procurement decisions.


Longer term, technology may also come up with some of the answers. Just as concern over disposable plastic cups in the NHS or otherwise reached crisis levels, news broke about a possible breakthrough in recycling technology as a result of an engineered enzyme that eats plastic. British researchers at Portsmouth University created the plastic-digesting protein accidentally while investigating its natural equivalent. Tests showed that the lab-made mutant had a supercharged ability to break down polyethylene terephthalate (PET), one of the most popular forms of plastic deployed by the food and drinks industry.


As for the NHS, sometimes low-tech is the best and quickest way to deal with things. When it comes to coffee cups, several sites have gone back to old fashioned china crockery. As a gesture it might not be that meaningful in the grander scheme of things, but then again the British public loves a symbolic gesture. However, it’s high-time we got real about waste.