Campaigning for a revolutionary way of thinking: In plastic. In healthcare. In practice.
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Plastic use and disposal in hospitals is at an all-time high.
The vast majority of plastic waste in healthcare is not recycled.
This affects us all.
PLASTIC WASTE IN HEALTHCARE
Each year in the UK alone, an estimated 5 million tonnes of plastic waste is generated, with around 1.2 million tonnes of plastic film from packaging discarded. A third of this is from commercial, industrial and agricultural sources, including the healthcare industry.
Nearly 70% of all total plastic waste in the UK is packaging.
>1 million tonnes more of mixed plastic waste is discarded in addition to this, though exact figures from the NHS on plastic waste disposal this are lacking – why? Because plastic from the healthcare sector is not formally separated from other clinical waste.
There are no established nationwide in-hospital recycling schemes which serve to minimise the environmental impact of this waste, nor are effective measures being taken to seek alternatives to plastic consumption in healthcare. Current estimates are that just 7% of all healthcare plastic waste is recycled . The consulting group Axion have also estimated that around 2,250 tonnes of PVC could be recycled each year by collecting oxygen masks, oxygen tubing and anaesthetic masks alone .
This plastic consumption is also not just limited to toxic or hazardous healthcare waste – since 2013, organisations within NHS England have purchased more than half a billion disposable plastic cups  for hot drinks, cold drinks and dispensing medicines. Again, with no formal infrastructure in which these plastics can be recycled, almost all will end up in landfills or incinerators.
We want to change this.
Equally, much of the available information on waste disposal and recycling statistics is outdated by several years, with policies not routinely updated: The NHS Carbon Reduction Strategy was last revised in 2010, and the UK Government’s Safe Management of Healthcare Waste policy was last revised in 2012 . The last statistic available widely on the cost of healthcare waste disposal to the NHS is cited from 2013 as exceeding £86m , whereas the last estimate of waste quantity was reported (incompletely) as over 185,000 tonnes of waste from 69% of NHS Trusts in England for the period 2015/16. In the World Health Organization’s 2017 “Safe management of wastes from health‑care activities” policy document, recycling of healthcare waste is not even mentioned.
These methods and policies are outdated, and unsustainable.
We want to change the approach to plastic waste in UK healthcare for good.
Our 4-point strategy is to influence and promote the following:
1. PLASTIC RECYCLING SCHEMES IN HEALTHCARE SETTINGS
Introducing formal recycling plans for hospitals and community healthcare settings to ensure adequate recycling of non-toxic consumables
2. PROTOCOLS AND REGULATION
To identify and regulate the point at which a disposable healthcare product becomes “hazardous waste”, and how this waste can be minimised
3. HANDLING TIME
Through education on appropriate use, our aim is to increase the average time that a person is in contact with a disposable plastic unit from 0.4s to 0.6s: This will increase recycling rates of plastic by up to 20%
4. PRODUCT DESIGN
To compel organisations responsible for disposable healthcare produce and healthcare waste disposal to seek sustainable alternatives to plastic packaging and consumption
The purpose of this campaign is to:
Petition the government to implement formalised and stringent recycling schemes for healthcare-generated plastic waste
Raise awareness of this significant environmental issue
Put pressure on those organisations responsible for healthcare waste disposal, and to seek sustainable alternatives to plastic consumption
This issue is not one which exclusively affects NHS hospitals and clinics, however, but additionally affects small producers of healthcare and healthcare type waste including:
First Aid Rooms at schools and work environments
Alternative Practitioners – e.g. chiropractors, acupuncturists, non-NHS physiotherapists
Care Homes (with and without nursing care)
Companies dealing with drugs-related litter (not including local authorities)
Learning Disabilities Homes (residential, day care and respite)
O U R
We are on a mission to ensure that there are effective, safe and sustainable practices implemented nationwide across NHS Trusts for plastic waste recycling.
We are calling on the UK government and the healthcare manufacture industry to revise the way in which plastic medical waste is produced, handled, treated and reused.
Whilst we at Recycle Health Organisation® as medical professionals ourselves understand the need to minimise infectious disease transmission through single-use equipment and rigorous sterilisation as well as to ensure appropriate manufacturing standards of high quality and safety of devices in healthcare are met, we cannot ignore the increasing burden that plastic packaging has to play in harming our environment, and not least that from healthcare institutes.
We are campaigning to revolutionise the way in which healthcare waste is packaged, handled, disposed of and recycled.
It is a legal requirement for NHS trusts to consider the waste hierarchy and strive to move away from disposal and progress to energy recovery, recycling, reuse and ultimately reduction/ elimination . The current methods of landfill disposal and incineration are linked with numerous environmental and health problems, and are limited as such by the EU Waste Incineration Directive . Incinceration in particular generates pollutant emissions including carbon dioxide, nitrogen oxides and particulate matter, augmenting environmental damage.
“…We should not perpetuate a culture of single use inappropriately and universally. From a health and pollution perspective, the adoption of every single use item should be considered, not the default. The overuse of disposable equipment has a downside, being disproportionately polluting”.
- Professor Dame Sally Davies, Chief Medical Officer for England
We at Recycle Health Organisation® want to ensure that all healthcare plastics are safely effectively recycled nationwide, and to promote the implementation of viable, safe, and cost-effective recycling solutions for these products.
Our goal is to increase the 4% waste in sharps bins that actually classifies as “true sharps” to 40% by campaigning for more sustainable workplace practices, packaging, disposal units and education.
We also want to see the changes better implemented from the Chief Medical Officer's 2017 Report recommending improvements to healthcare infrastructure and waste management:
Waste reduction, notably through efficient procurement, must be at the centre of all efforts to reduce pollution and harm caused by healthcare.
NHS bodies should use incentives to comply with the waste hierarchy, such as built into waste-management/ recycling contracts.
Healthcare waste-management operations at local, regional and national levels should be well organised and well planned
ARE YOU WITH US?
TAKE ACTION AND SIGN OUR PETITION
An average wound dressing uses 4 pieces of single-use disposable plastic
An average cannulation procedure uses 10
An average day-case surgical procedure can use more than 50
We believe there must be a better way.
The NHS in England spent £87 million on waste in 2014/15 , and waste in the NHS is estimated to account for 20% of total health expenditure. Last estimates from 2009 are that around 5.5kg of waste is produced per patient per day ; more than quadruple that seen in French and German healthcare infrastructure.
The following model developed by the WHO illustrates a “waste hierarchy” which argues that prevention is better than cure, and that reduction is better than recycling. The hierarchy is largely underpinned by the 3 “R”s – reduce, reuse and recycle. Best practice waste management aims to avoid or recover as much of the waste as possible in or around a healthcare facility, rather than through disposal. This is described as tackling waste “at source”, rather than adopting “end of pipe” solutions.
One NHS Trust in England in 2009 identified that around 40% of all waste was potentially recyclable paper, card, plastic, and glass, and just 4% by weight of sharps bin contents was actually “true” sharp waste – the rest being classified as either non-hazardous or non-sharps hazardous waste which was inappropriately discarded .
Whilst the focus of our campaign is plastics waste, in order to appreciate the scale of the problem as currently plastics are not separated from other waste in NHS healthcare, we have illustrated the means by which of this waste is handled, treated and disposed of in the UK .
HOW IS WASTE MANAGED IN UK HEALTHCARE?
Healthcare waste in the UK is split into four categories – infectious, sharp, anatomical and medical. Sharp waste – those items capable of causing cuts or puncture wounds, including needles, broken glass medicine containers, broken ampoules, scalpel and other blades, and the sharp part of infusion sets - can only legally be disposed of into plastic containers, which are locked and secured once filled to capacity.
Anatomical waste, such as body parts, organs and surgical waste, is also placed into separate plastic containers.
Redundant medicine is separated further into two categories: Hazardous, containing cytotoxic and cytostatic drugs; and non-hazardous, which does not contain these chemicals but contains other medicines and medicinal chemicals.
The following image illustrates exactly how this segregation is organised according to a colour-coded bin-bag system (also, unironically, made of plastic):
All of this waste has to legally be segregated, stored and transported by classification, without mixing so as to avoid the risk of cross-contamination. Hazardous waste is not strictly deemed safe for handling unless appropriate personal protective equipment is worn, though non-hazardous waste is generally not considered problematic if you come into contact with it.
However, poor stock control can also lead to increasing amounts of waste being dumped in landfills, or worse, incinerated - generating harmful toxic gases including carbon dioxide and nitrogen oxides which contribute to atmospheric pollution.
It is a legal requirement in the UK for NHS Trusts to consider and be held accountable for their waste hierarchy, and to strive to move away from simple disposal to seek alternative methods of energy recovery, recycling, reuse and reduction.
The WHO has estimated that around 85% of all waste from healthcare facilities, however, is non-hazardous, and usually similar in characteristics to municipal solid waste. More than half of all non-hazardous waste from hospitals is paper, cardboard and plastics, while the rest comprises discarded food, metal, glass, textiles, plastics and wood.
"Dealing with waste in a less polluting way is important (for example replacing landfill with mixed dry recycling, energy to waste recovery), but absolute reduction in waste (starting with procurement) and circular approaches to resource management should be the priority".
- Professor Dame Sally Davies, Chief Medical Officer for England
HOW IS THIS WASTE DISPOSED OF?
In the UK, private contractors – overseen by the Environment Agency - collect segregated waste from individual healthcare facilities to either transport it directly to facilities that render it safe and either heat-treat or incincerate it; or they can transport the waste to transfer stations that act as a “middleman” before they are sent to facilities for destruction.
This waste is stored at that station for a set time before it is transferred to a facility that will destroy it. There are a number of contractors in the sector, some carrying out the entire collection and destruction process, others focusing on certain stages.
WHAT'S THE ALTERNATIVE?
Though recycling strategies in healthcare are complicated by the need for segregation of hazardous waste and concerns over sterilisation, cross-contamination and disease transmission, a number of viable methods to reduce and recycle plastics in healthcare industries have already been demonstrated.
Examples of excellent strategies currently implemented in UK recycling include:
Newport-based St Woolos Hospital (Wales, UK) have trialled and implemented a “surgical wrap” recycling programme in collaboration with waste management company Thermal Compaction Group and the Aneurin Bevan University Health Board (ABUHB). Sterilmelt® produces sanitised, solid briquettes from polypropylene used in surgical theatres separated from other plastic waste. The method effectively shrinks plastic waste by up to 90% of its initial volume. These briquettes in turn have been recycled and reused in manufacturing of domestic and industrial products, and reduced clinical waste by between 50-70% in the Trust theatres alone with over 2 tonnes of sterilisation wrap now diverted monthly to the programme.
The RecoMed® project overseen by the British Plastics Federation (BPF) in conjunction with Axion Consulting and funded by VinylPlus serves to recycle plastic waste produce from anaesthetic and surgical procedures, including IV solution bags, nasal cannulas, oxygen tubes, anaesthetic masks and oxygen masks, saving over 830kg of PVC medical waste per month from initial pilot trials and recycling into products for the horticultural industry, such as tree ties. The scheme was awarded the Sustainability category of the 2016 INOVYN Awards for its innovative approach to sustainable healthcare recycling.
CIRCMED® RECYCLING SCHEME
Launched in September 2015, CircMed® was an initial 6-month project co-funded by Innovate UK to explore how proposed circular economy business models for supplying refurbished equipment can work within the UK healthcare sector. The project focused on a range of medical imaging equipment, including MRI scanners, ultrasound equipment, CT scanners, interventional X-ray equipment and mobile surgery and promotes use of refurbished equipment in-hospital.
The Waste and Resources Action Programme (WRAP) are a leading UK-based organisation which aim to revolutionise the way we think about and use plastic here in the UK. In 2018, they outlined their UK Plastics Pact in order to transform the way that the UK makes, uses and disposes of plastic. Stemming from knowledge that nearly 70% of all plastic waste in the UK comes from packaging, their aim is to move away from a linear plastics economy towards a circular system where we capture the value of plastics material – keeping plastic in the economy and out of the oceans.
The UK Plastics Pact brings together governments, businesses, local authorities, citizens and NGOs behind a common vision and commitment to a set of ambitious targets. WRAP launched The UK Plastics Pact in April 2018, working in partnership with the Ellen MacArthur Foundation (EMF) to create the first national implementation of the vision for a New Plastics Economy.
Their targets as part of this Pact for 2025 are:
1. Eliminate problematic or unnecessary single-use packaging through redesign, innovation or alternative (reuse) delivery models
2. 100% of plastics packaging to be reusable, recyclable or compostable
3. 70% of plastics packaging effectively recycled or composted
4. 30% average recycled content across all plastic packaging
HOW CAN WE IMPLEMENT CHANGE IN HEALTHCARE TO REDUCE PLASTIC WASTE?
This is not an issue that simply affects healthcare staff and patients – it affects us all, and it affects our environment.
We strongly encourage you to sign our petition to the Chief Executive of NHS England, Simon Stevens, to negotiate a new nationwide healthcare recycling scheme with the Waste and Resources Action Programme (WRAP) subsection of the department of Trade and Industry to improve resource efficiency across the healthcare industry in the UK.
Read our campaign strategy and four-point plan here.
See our Recycle Health Organisation® mission here.
Sign our petition here.
Recycle Health Organisation® was founded in 2019 and is a UK-based, not-for-profit initiative and campaign which seeks to rethink and revolutionise the way we approach plastic consumption in the healthcare industry.
We want to influence and change the ways in which plastic is effectively and safely used, handled, recycled and disposed of in a way that benefits our environment and care providers alike.
We have first-hand exposure to the daily plastic waste and inappropriate disposal that takes place in NHS hospitals.
We want this campaign to be the much-needed starting point that instigates practical and permanent changes to recycling of plastic waste in NHS hospitals and related.
You can find out more about our campaign here.
We would love to hear from you. Please include your message below and contact details to get in touch.