Ian Thurgood, our Environmental Services Manager at NTH Solutions recently sat down with Operations Lead Trainer, Daniel Sullivan, to discuss sustainability and the challenges of Waste Management.
Hi Ian, thank you for taking the time to come speak to us today.
No problem, always happy to talk sustainability.
So, as waste management lead for NTH Solutions, what would you say is the biggest culprit when it comes to needless waste in a large healthcare organisation?
Single-use plastics, without a doubt. Theatres create a lot of waste. Bottles of saline solution, for instance. Ours comes in palettes stacked with 500ml plastic bottles. You may need a few of them for each operation, then the bottles have to be disposed of.
Why produce it in Switzerland? I thought saline was an easy solution to mix.
Possibly due to the sterile requirements, possibly just the contractor sourcing them from wherever a ready supply of quality resources can be found. But I’m not sure it needs to be in such small bottles. Also, the theatre equipment we receive comes in sterile packs – it’s like a bundle of things you’ll need for each operation. Well, each bundle contains a green plastic cup. This is meant to be storage for any used instruments during surgery, but our staff don’t use them because they have reusable dishes they use instead. Now, each cup is 40g of plastic that is wasted. The NHS carries out 10 million operations a year – that’s 2000kg of plastic waste created just because the cup is included in the pack!
That’s incredible when you scale it like that. Are there any other quick wins you could point to, that other Trusts might look at?
Invest in a baler for your cardboard. At the moment, our waste cardboard is thrown into a skip. This skip gets collected when full and driven away to be emptied by a contractor. This trip has to be taken 104 times per year, and the Trust receives £30 per tonne of cardboard we dispose of. We’re getting a cardboard baler installed – this makes the waste more compact and saves anyone to need to sort through it at the disposal end. In one stroke, those 104 trips get cut down to 12 trips a year. And the Trust gets £70 per tonne of waste, so we’re more than doubling the revenue we get back. Within one year, the baler will have paid for itself, and the lifespan is at least twelve years.
But you don’t even have to buy new equipment – sometimes you just need to think about what you are doing. Say you have an office desk that gets thrown into a general waste skip. It has a wooden top and a metal frame. That has to be destroyed, incinerated or whatever. If you break it up, the wood goes off to be recycled and the metal goes off to be recycled. When you go to throw something away, see if you can separate it out into different materials. Also, as a Trust you can go further with this. A lot of places will have one contractor collecting all of their waste – the card, the plastic, the metal and so on. That contractor is charging you to separate this waste out and hand it over to a range of specialist disposal services. They are middle-men essentially. Now, it’s more paperwork, more invoices to sign off etc, but if you set up each waste stream separately, you save a lot of money because you get the waste to the disposal specialist more efficiently.
Well it sounds like there’s a lot that waste management teams can be doing, but what about the wider team across the Trust? What can clinical, admin and other services do to support waste reduction?
You’ve already said it, Dan! Reduction. The Waste Hierarchy was published by the government in 2011 and it sets out the 5 priorities for waste management and sustainability. First is Reduce. Second is Reuse. Third is Recycling. Well, the order of those is really important, but for whatever reason, Recycling has better PR than the other two. What we find therefore is that a lot of people try really hard to recycle, and that’s great, but they skip the first two options, which are more efficient and better for the environment than recycling. It makes sense as soon as you think about it – the more you reduce, the more you reuse, the less there is to recycle in the first place! Go back to my example of the desk from the office. Fine, the guys have put it in the skip so it can be recycled. But could it have been reused? Is there anything even wrong with it, or does it just not have a place after an office got rearranged? Sometimes things get thrown out that are just unloved, or in need of a slight repair. We want to recycle whatever makes it to our skips, but it should only be coming to the skip as a last resort. You have to remember, Trusts measure waste by tonnage. Now, included in that is contractor waste. Think about domestic waste left in bin bags, or plastics and cable drums etc. left behind after a refurbishment. Contractors should be asked to remove their waste when they are done. Yes, it’s easier for them to just leave it in a cage or a corridor for the Trust to dispose of, but then you are literally adding tonnes of waste to our total for that year.
Sounds frustrating.
Don’t get me wrong, we’re doing brilliantly at North Tees and Hartlepool. The target for waste generation laid out in the NHS Green Plan was to be below 40%. Well, we’re currently sitting at 8% and we’re really proud of that. We’re always looking to get that number down even further though.
Of course. I looked at a recent meta-analysis of the carbon footprint of the NHS overall and I was surprised to see the biggest contributor was medicines and chemicals. Why is that?
Well, often in clinical settings like wards, a patient is discharged and the medication they’ve been taking is disposed of. But in a lot of cases, they might only have had 8 pills out of a pack of 40, and the other 32 get thrown away just because the box has been opened. Then you have the issue of stock going out of date if it isn’t rotated properly. Also, there’s the risk of a mechanical fault with the fridges and freezers that some medication has to be stored in. A single fridge going offline can result in up to £80,000 worth of medication being destroyed. There’s so much packaging included in medication that 1 tonne of medication creates 100 tonnes of waste. We’re tackling that too, of course. The wards now have green bins that you can throw unopened blisters of pills into. These then get repackaged – as I said before, Reuse and Reduce before you think about Recycling.
How did Covid impact waste generation?
Usually when a patient is discharged, the items they have come into contact with can be sterilised and reused, or if they are disposed of, they go into different waste streams for recycling etc. During the pandemic the government advice has been that all items exposed to a Covid patient have to be classed as hazardous waste. This meant that a patient with Covid creates 10kg of waste as opposed to a non-Covid patient generating 1.5kg. The increased waste put strain on our manpower, with 90 cart collections per day across the Trust rising to 225 per day, including full weekend shifts. We have a fantastic team though; it was tough but we managed.
Ian, thanks again for your time, that was really interesting and I’m sure a lot of people will find some of these tips very useful.
No problem at all, happy to help.
