The clinical waste scene in the UK was in shock this time last year after all HCE staff were made redundant ahead of its liquidation at the end of April 2019.
To an extent, it still is.
The Lanarkshire-based company had multi-million pound contracts with 17 trusts in England and with NHS Scotland.
Since the initial disruption to clinical waste disposal was first identified more than a year ago, there has been a great deal of activity to resolve the backlog of waste between NHS England. A new company called Cliniwaste was issued a three-month license to clear waste from specific former HCE locations in conjunction with MITIE. Cliniwaste has bought all HCE premises.
Regarding this waste backlog at former HCE sites, I can report that Anenta has been advised through trade associations that waste which can be traced back to the producer will be exported using Transfrontier Shipment (TFS) routes. Meanwhile, waste which cannot be traced back to the producer will need to be treated in the UK. All anatomical waste must be treated or disposed of in the UK via the appropriate route.
Cost
There is, inevitably, a cost implication. We must be mindful that the incineration tax levied in Sweden and the Netherlands is likely to become commonplace across the EU, and that Brexit will bring further increases to the price of disposal. Costs will also increase due to transport regulations requiring the use of closed transport units such as enclosed containers and rigid sided trailers. These types of vehicles for this specific use are not as commonplace as curtain sided vehicles.
NHS England is still in the process of developing their waste strategy which, as we understand it, seeks to redefine the utilisation and standard perceptions of the current clinical waste market to create opportunities for new entrants and SMEs.
Investment
It has taken some time to gain traction on resolving the disposal capacity issues as reported in Anenta’s Waste market report*. However, innovative solutions are coming to the fore along with investment into the old infrastructure such as at Hillingdon Hospital’s NHS Foundation Trusts, where a bid notice states that the incinerator has recently been refurbished. Also, we see that refurbishment work conducted at the WasteCare East Kent incinerator will result in a capacity increase of 4,000 tonnes per year.
Taking a helicopter view, the market has responded well to calls for assistance to improve disposal capacity across the country, albeit with some logistical challenges, and some genuinely better systems have already emerged. Most noticeably, NHS England has initiated a greater core focus on waste management in areas such as national infrastructure and supplier resilience whilst also focusing on procurement strategies. This is a good start, but we’re not there yet.
Much local attention is still focused on a range of key areas where improvements and adjustments are well overdue.
Perhaps top of the ‘to-do’ list is having competent waste managers or managing agents in place who are qualified and responsible for clinical waste.
Segregation
It is still not yet embedded in the minds of all the people who really need to know that waste must be segregated into core streams for compliance and effective, efficient management, as stated in The Safe Management of Healthcare Waste guidance (HTM 07-01)
“We mustn’t neglect the environmental imperative that a more robust push is required to ensure no NHS waste is sent to landfill.”
At the time of writing, with concern about the scale of coronavirus in the UK mounting considerably, the Government has just updated its COVID-19 interim guidance for primary care to: ‘If entry to the room or contact with the patient is unavoidable in an emergency, wear personal protective equipment (PPE) in line with standard infection control precautions, such as gloves, apron and fluid resistant surgical mask (FRSM) and keep exposure to a minimum. All PPE in full should be disposed of as clinical waste’.
Government advice requires that all clinical waste generated where suspected or confirmed cases are identified must be packaged and disposed of as Category B infectious waste, isolated from all other clinical waste and sent for testing. This requirement puts additional pressure on already overstretched resources.
While we are dealing with all this, we mustn’t neglect the environmental imperative that a more robust push is required to ensure no NHS waste is sent to landfill and that plastics are removed from high temperature incineration paths. This means better understanding of product life 
cycles is needed.
Finally, work is needed to increase competency in auditing and compliance management and also in data and record keeping to assist with analysis for future procurement options.
Should further advice be needed on the management of COVID-19 please seek assistance from your designated Infection Control Practitioner or visit gov.uk.
* Anenta, waste market report, UK clinical waste incineration capacity
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