HSJ’s expert briefing on NHS finances, savings and efforts to get the health service back in the black. This week, correspondent Nick Carding looks at what the NHS should learn from the clinical waste scandal.
Contingency plans are being put into action at around 50 NHS trusts after a clinical waste management company was found to be stockpiling potentially dangerous waste across its sites.
Fifteen trusts have terminated their contracts with Healthcare Environment Services following the revelations.
The issue was considered so serious that Matt Hancock even convened a COBRA meeting, a rare event for a health secretary.
While the government and HES are locked in a bitter dispute over how much incineration capacity exists in England, there are certain things the NHS should ponder.
Low on the agenda
Given the potentially lethal consequences to public health if hospital waste is not disposed off properly, one might think clinical waste management is a regular topic in trust boardrooms across the country.
However, research has shown only 9 per cent of trust boards receive monthly reports on waste management.
The majority (60 per cent) report waste management performance just once a year.
Twelve per cent discussed the issue quarterly, while 15 per cent said waste management reports never reached board level discussion.
The research was carried out by Rose Gallagher at the Royal College of Nursing, who wrote a report on waste management in the NHS earlier this year.
Her research also found dramatic variation in trusts’ costs per tonne of waste disposal, ranging from a few hundred pounds to more than £2,000.
She told HSJ she has called for “improved processes” around the management of healthcare waste for more than five years – having written a similar report in 2012.
Corporate memory loss
There are two conclusions to be drawn from Ms Gallagher’s report, both of which should trouble anyone with an interest in NHS efficiency.
First, that there is a potential for the NHS to record savings by ironing out the blatant price differences that currently exist, and by standardising how trusts classify their waste.
Second, the NHS’s ability to performance manage its waste management providers is, at best, highly dubious.
While it is the responsibility of a trust’s estates and facilities management team (or the outsourced equivalent) to monitor their provider’s performance, there is less incentive to do so if the executive board is not interested in the issue.
The latter is particularly troubling given the fact that trusts’ responsibility for waste is only relinquished once the waste has been disposed off, for example through incineration, sterilisation, or landfill.
This is set out in the Health Technical Memorandum 07-01: safe management of healthcare waste – a government document which offers guidance to NHS trusts.
But several people in the waste management sector said the NHS has “lost its corporate memory” during the last decade, in terms of understanding the importance of quality – rather than just price – when procuring waste management services.
Echoes of the past
In the wake of the troubles reported at HES sites, industry experts have highlighted the case of Eurocare in 2003 as an example of the NHS failing to contract manage waste companies.
The company collapsed after it was fined by the Environment Agency for leaving human tissue, including placentas, to rot in trailers all over the country. It also poured thousands of litres of clinical fluids, including blood, into a leaky septic tank which polluted the River Dee in North Wales.
It’s important to note that HES maintains it has safely stored its waste at all times, and is only guilty of breaching the levels of waste allowed by the Environment Agency.
So, how can trusts be more efficient at managing their waste provider’s performance?
Ms Gallagher said NHS managers could undertake site visits and talk to the company’s staff to assure themselves that their contract is being complied with.
The fall out from HES’s problems should, therefore, be a stern reminder to trusts over the dangers of not paying attention to what happens with their waste.
The financial impact is already apparent; the government has had to commit £1m to fund its contingency plans and health minister Stephen Barclay admitted some costs are likely to be borne locally, while the 15 trusts may have to spend money in a legal battle against HES should the company challenge the contract terminations in court.