HSJ’s expert briefing on NHS finances, savings and efforts to get the health service back in the black. This week by correspondent Nick Carding.
Filling the clinical waste void
One would be forgiven for thinking that the fate of Healthcare Environmental Services – which ceased operating over Christmas – marked the beginning of the end to the clinical waste problems faced by sections of the NHS.
However, the consequences of HES’s fall from grace will be felt throughout 2019.
The sector must now fill the void left by the Scotland-based company, which was responsible for the disposal of around 25-30 per cent of NHS waste.
Imagine the NHS having to treat the same number of patients but with 25 per cent fewer providers, and the scenario feels more frightening.
And while HES workers go to foodbanks following their abrupt redundancy, the financial impact on the NHS will also be felt.
The contingency plans alone, which involve drafting in more than a dozen waste management consultants (mostly from Mott MacDonald) and using temporary containers as waste repositories is fast draining the £1m allocated by the Department of Health and Social Care in October 2018.
It was also inevitable that HES’s immediate replacement Mitie would charge more for the same service to trusts.
However, HES’s rivals argue the company lowered the market’s prices to an artificial and unsustainable level, which has led to the present situation.
Concern for small providers
The NHS is now at the mercy of the remaining contractors in the market, whose prices have and will continue to rise when demand is at a premium.
For NHS trusts, the best scenario is that the financial impact amounts to a few unimportant alterations on the balance sheet, which could be offset elsewhere.
However, there is concern among sector sources HSJ has spoken to about the knock-on effect the price increase will have on other care providers, such as pharmacies, dentists, and care homes.
These industries walk on a far narrower financial ledge than secondary care providers, and an unexpected increase in waste disposal costs could have serious consequences.
More data needed
Where does the NHS go from here to avoid a similar disaster in the future?
A priority must be to collect much more data on trusts’ waste generation and disposal.
Up to now, the only publicly available data on this is compiled annually through the Estates Return Information Collection (ERIC), of which the level of accuracy is considered – at best – a mixed bag.
Currently, the ERIC data records the cost and amount of trusts’ waste that is incinerated, and the cost and amount of waste being recycled or sent to landfill.
However, there is no recording of how much is spent disposing of different categories of waste – for example, offensive (non-hazardous) and infectious (hazardous). This matters because disposal costs vary per category, yet the Royal College of Nursing believes the NHS is miscategorising a significant proportion of its waste.
The capacity question
There is also a question mark over the government’s ability to get the full picture of incineration capacity across the country, despite its insistence there is enough to treat NHS waste.
Most incinerators are run by private companies, and while they are given permits dictating the amount of waste they can process, there is no official record of how much waste is processed annually or how much actual capacity an incinerator has per year.
When one factors in the unplanned closures of incinerators due to maintenance issues, the capacity question becomes even harder to answer.
So far, the government has said it is reviewing the way clinical waste contracts are awarded in the NHS, but no other specific measures have been announced yet.
Unsurprisingly, the NHS long-term plan made no reference to the future treatment of clinical waste, but – given the problems caused in the last four months – that could be an expensive omission in the long term.